Garagiola D M, Tarver R D, Gibson L, Rogers R E, Wass J L
Department of Radiology, Indiana University Medical Center, Wishard Memorial Hospital, Indianapolis 46202.
AJR Am J Roentgenol. 1989 Dec;153(6):1239-41. doi: 10.2214/ajr.153.6.1239.
We analyzed CT scans of the pelvis made within 24 hr of an uncomplicated term vaginal delivery in 14 women to document the anatomic changes that occur in the immediate postpartum period. Scans were interpreted by three radiologists, and the results were compared with those from pelvic CT scans made from normal, age-matched, nonpregnant women. In addition to soft-tissue windows, bone windows also were obtained to assess the pubic symphysis and sacroiliac joints in both the postpartum women and the control subjects. The mean uterine length, transverse width, and anteroposterior diameter in the postpartum women (14 +/- 1.4, 12 +/- 1.5, and 9 +/- 1.6 cm, respectively) were significantly larger than in the nonpregnant women (7 +/- 1.4, 5 +/- 0.8, and 4 +/- 0.9 cm) (p less than .0001). CT scans showed intrauterine blood in nine of the postpartum women (64%), and three (21%) had intrauterine gas. There was widening of the sacroiliac joint in one (7%) of the postpartum women compared with none of the control subjects. Widening of the pubic symphysis was present in six (42%) of the postpartum women and in none of the control subjects. Six (42%) of the postpartum women had gas in the sacroiliac joints, 33% of which occurred bilaterally; gas in the pubic symphysis was seen in four (28%) of the postpartum scans. In one patient, an asymptomatic muscle hematoma was discovered. We conclude that normal changes in the pelvis after uncomplicated term vaginal delivery include enlargement of the uterus, intrauterine blood, widening of the symphysis and sacroiliac joints, and gas in the sacroiliac joints.
我们分析了14名足月顺产且无并发症的女性在产后24小时内进行的骨盆CT扫描，以记录产后即刻发生的解剖学变化。扫描结果由三名放射科医生解读，并与年龄匹配的正常非孕女性的骨盆CT扫描结果进行比较。除软组织窗位外，还获取了骨窗位以评估产后女性和对照受试者的耻骨联合及骶髂关节。产后女性的子宫平均长度、横径和前后径（分别为14±1.4、12±1.5和9±1.6 cm）显著大于非孕女性（7±1.4、5±0.8和4±0.9 cm）（p<0.0001）。CT扫描显示，9名（64%）产后女性有宫腔积血，3名（21%）有宫腔积气。与对照组无一例出现骶髂关节增宽相比，1名（7%）产后女性出现了骶髂关节增宽。6名（42%）产后女性出现耻骨联合增宽，而对照组无一例出现。6名（42%）产后女性的骶髂关节有气体，其中33%为双侧；4名（28%）产后扫描显示耻骨联合有气体。在一名患者中发现了无症状的肌肉血肿。我们得出结论，足月顺产且无并发症后骨盆的正常变化包括子宫增大、宫腔积血、耻骨联合和骶髂关节增宽以及骶髂关节积气。
