CURRENT APPROACHES TO THE ECHOGRAPHIC MONITORING OF UTERINE INVOLUTION IN THE POSTPARTUM PERIOD: IMPACT ON MANAGEMENT TACTICS

Ultrasonography (USG) is one of the most accessible, informative, and non-invasive diagnostic techniques for postpartum complications as before. The correct and reliable interpretation of the data of postpartum uterus echography to predict postpartum complications is commonly a difficult task. Objective. To estimate the value of the ultrasound parameters of the postpartum uterus in predicting infectious and inflammatory complications. Subjects and methods. A prospective observational study was conducted in 211 patients who had delivered babies at 37-to-41 weeks’ gestation at the VI. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, in the period January 1, 2014 to January 1, 2015. Group 1 included 105 women, whose echographic measurements were beyond the normal range; Group 2 consisted of 106 women with normal USG values. Each group was divided into 2 subgroups: a) patients after cesarean section and b) those after vaginal delivery. The data were statistically analyzed using a package of SPSS 22 programs. Results. There was no significant impact of the number of previous pregnancies, labor duration, fetal weight, and myoma of uterus on the pattern of its postpartum involution. Day 3 echography showed dilatation of the uterine cavity, amounting to 2.1±0.89 and 0.58±0.28 cm in Groups la and 2a, respectively, and 2.39+0.42 and 0.95+0.41 cm in Groups 2a and 2b. USG was performed in all patients on day 3 and over time within 60 days postpartum. By the end of the second postpartum week, the anteroposterior dimension of the uterine cavity was normalized in the majority (85.8%) of cases. In Group 1, the postpartum period was not complicated by endometritis in all the patients. Conclusion. USG is a highly informative technique to detect placental tissue remnants. However, the presence of gas bubbles in the uterine cavity, its dilatation in the absence of the clinical presentation of pyoinflammatory complications cannot be viewed as prognostic criteria for the latter and be an indication for surgical evacuation of the contents of the uterine cavity and/or for antibacterial therapy but these require a follow-up of this category of patients.

postpartum period, endometritis, uterine involution, ultrasonography