Miyometriyum kalınlığı ölçümü doğum sonrası kanama miktarını ve doğum şeklini öngörebilir mi?

Year 2023, , 246 - 251, 28.06.2023

Ahmet Demirci , Tayfur Çift , Süleyman Serkan Karaşin

https://doi.org/10.47582/jompac.1294035

Abstract

Giriş: Bu çalışmanın amacı, miyometrial kalınlığın doğum sonu kanama miktarına etkisini belirlemek ve doğum sonu kanamayı öngörmede yardımcı bir yöntem olarak rolünü araştırmaktı.
Gereç ve Yöntemler: Bu prospektif çalışmaya vajinal doğum ve sezaryen olmak üzere iki grup halinde 305 gebe dahil edildi. Fundal, orta anterior ve alt uterin segment myometrium kalınlıkları ölçüldü. Postpartum dönemde kanama miktarı ve doğum şekli kayıt edilerek miyometrial kalınlık ölçümleri arasındaki ilişki belirlendi.
Bulgular: Sezaryen olan hastalarda kanama miktarı vajinal doğum yapanlara göre daha fazlaydı (p<0.01). Sezaryen olan hastaların miyometriyumu normal doğum yapanlara göre daha kalındı (p<0,05).
Latent fazda ölçülen mid anterior myometrium kalınlığı için belirlenen cut-off değeri olan 6,1 mm'nin üzerindeki ölçümler %63 sensitivite ve %66 spesifite ile sezaryen ile ilişkilendirildi (p=0,011).
Sonuç: Aktif fazda ölçülen fundus miyometriyum kalınlığı ve 2. evrede ölçülen alt uterin segment miyometriyum kalınlığı vajinal doğum yapan hastalarda doğum sonu kanamayı öngörür. Gizli fazda ölçülen orta ön miyometriyum kalınlığı sezaryen doğum olasılığını tahmin edebilir.

Keywords

Myometrial Kalınlık, Doğum Sonrası Kanama, Sezaryen, Doğum

Can myometrial thickness measurement predict the amount of postpartum hemorrhage and delivery type?

Abstract

Aims: This study aims to determine the effect of the myometrial thickness on the amount of postpartum bleeding and to investigate its role as an auxiliary method in predicting postpartum hemorrhage.
Methods: This prospective study includes 305 pregnant women in two groups, vaginal delivery, and cesarean section patients. The fundal, mid anterior, and lower uterine segment myometrium thicknesses were measured. In the postpartum period, the amount of bleeding and the type of delivery was recorded, and the relationship between myometrial thickness measurements was determined.
Results: The amount of bleeding in the patients who had a cesarean section was higher than in those who had a vaginal delivery (p<0.01). The myometrium of the patients who had a cesarean section was thicker than those who had a vaginal delivery (p<0.05). Measurements above the cut-off value of 6.1 mm determined for the mid-anterior myometrium thickness measured in the latent phase were associated with a cesarean section with a sensitivity of 63% and a specificity of 66% (p=0.011).
Conclusion: Fundal myometrium thickness measured in the active phase and lower uterine segment myometrium thickness measured in the 2nd stage predict postpartum bleeding in patients with a vaginal delivery. Mid-anterior myometrium thickness measured in the latent phase can predict the probability of cesarean delivery.

Keywords

Myometrial thickness, postpartum hemorrhage, cesarean section, birth

References

• Organization WH. WHO labour care guide: user’s manual. 2020, Available online: https://www.who.int/publications/i/item/ 9789240017566
• Spiegel E, Weintraub AY, Aricha-Tamir B, Ben-Harush Y, Hershkovitz R. The use of sonographic myometrial thickness measurements for the prediction of time from induction of labor to delivery. Arch Gynecol Obstet. 2021;303(4):891-896. doi: 10.1007/s00404-020-05811-z
• Marconi AM. Recent advances in the induction of labor. F1000Res. 2019;8:F1000 Faculty Rev-1829. doi:10.12688/f1000 research.17587.1
• Pacagnella RC, Souza JP, Durocher J, et al. A systematic review of the relationship between blood loss and clinical signs. PLoS One. 2013;8(3):e57594. doi:10.1371/journal.pone.0057594
• Bienstock JL, Eke AC, Hueppchen NA. Postpartum hemorrhage. N Engl J Med. 2021;384(17):1635-1645. doi:10.1056/NEJMra1513247
• Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: postpartum hemorrhage. Obstet Gynecol. 2017;130(4):e168-e186. doi:10.1097/AOG.0000000000002351
• ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol. 2009;114(2Pt1):386-397. doi:10.1097/AOG.0b013e3181b48ef5
• Buhimschi CS, Buhimschi IA, Malinow AM, Weiner CP. Myometrial thickness during human labor and immediately post partum. Am J Obstet Gynecol. 2003;188(2):553-559. doi:10.1067/mob.2003.77
• Zuckerwise LC, Pettker CM, Illuzzi J, Raab CR, Lipkind HS. Use of a novel visual aid to improve estimation of obstetric blood loss. Obstet Gynecol. 2014;123(5):982-986. doi:10.1097/AOG.0000000000000233
• Erratum: Adverse birth outcome: a comparative analysis between cesarean section and vaginal delivery at Felegehiwot Referral Hospital, Northwest Ethiopia: a retrospective record review [Corrigendum]. Pediatric Health Med Ther. 2016;7:129. Published 2016 Oct 17. doi:10.2147/PHMT.S118618
• Durnwald CP, Mercer BM. Myometrial thickness according to uterine site, gestational age and prior cesarean delivery. J Matern Fetal Neonatal Med. 2008;21(4):247-250. doi:10.1080/ 14767050801926709
• Escobar MF, Nassar AH, Theron G, et al. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet. 2022;157 Suppl 1(Suppl 1):3-50. doi:10.1002/ijgo.14116
• Schwendemann WD, Watson WJ. Postpartum hemorrhage. In: Clinical Maternal-Fetal Medicine Online CRC Press; 2021. p. 10–1.
• Diaz V, Abalos E, Carroli G. Methods for blood loss estimation after vaginal birth. Cochrane Database Syst Rev. 2018;9(9):CD010980. doi:10.1002/14651858.CD010980.pub2
• Stafford I, Dildy GA, Clark SL, Belfort MA. Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol. 2008;199(5):519.e1-519.e5197. doi:10.1016/j.ajog. 2008.04.049
• Biguzzi E, Franchi F, Ambrogi F, et al. Risk factors for postpartum hemorrhage in a cohort of 6011 Italian women. Thromb Res. 2012;129(4):e1-e7. doi:10.1016/j.thromres.2011.09.010