Patwardhan Manasi, Hernandez-Andrade Edgar, Ahn Hyunyoung, Korzeniewski Steven J, Schwartz Alyse, Hassan Sonia S, Romero Roberto
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, Mich., USA.
Gynecol Obstet Invest. 2015;80(1):26-37. doi: 10.1159/000370001. Epub 2015 Jan 28.
To investigate dynamic changes in myometrial thickness during the third stage of labor.
Myometrial thickness was measured using ultrasound at one-minute time intervals during the third stage of labor in the mid-region of the upper and lower uterine segments in 151 patients including: women with a long third stage of labor (n = 30), postpartum hemorrhage (n = 4), preterm delivery (n = 7) and clinical chorioamnionitis (n = 4). Differences between myometrial thickness of the uterine segments and as a function of time were evaluated.
There was a significant linear increase in the mean myometrial thickness of the upper uterine segments, as well as a significant linear decrease in the mean myometrial thickness of the lower uterine segments until the expulsion of the placenta (p < 0.001). The ratio of the measurements of the upper to the lower uterine segments increased significantly as a function of time (p < 0.0001). In women with postpartum hemorrhage, preterm delivery, and clinical chorioamnionitis, an uncoordinated pattern among the uterine segments was observed.
A well-coordinated activity between the upper and lower uterine segments is demonstrated in normal placental delivery. In some clinical conditions this pattern is not observed, increasing the time for placental delivery and the risk of postpartum hemorrhage.
研究分娩第三产程中子宫肌层厚度的动态变化。
对151例患者在分娩第三产程期间，以上下子宫段中部为测量点，每隔1分钟用超声测量子宫肌层厚度，这些患者包括：第三产程延长的女性（n = 30）、产后出血患者（n = 4）、早产患者（n = 7）以及临床绒毛膜羊膜炎患者（n = 4）。评估子宫段肌层厚度之间以及作为时间函数的差异。
直到胎盘娩出，子宫上段平均肌层厚度有显著线性增加，子宫下段平均肌层厚度有显著线性减少（p < 0.001）。子宫上段与下段测量值的比值随时间显著增加（p < 0.0001）。在产后出血、早产和临床绒毛膜羊膜炎患者中，观察到子宫段之间不协调的模式。
正常胎盘娩出时，子宫上段和下段之间表现出良好的协调活动。在某些临床情况下，未观察到这种模式，从而增加了胎盘娩出时间和产后出血的风险。
