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PubMed1993

[Ultrasonic evaluation of the uterus during puerperium].

The aim of this study was to evaluate morphological and volumetric changes in the uterus during the first eight days postpartum in a sample of 229 patients using ultrasonography. Both pregnancies and postpartum were physiological in all the women examined. Fifty patients underwent cesarean section. A sectorial 3.5 MHz probe was used to measure the longitudinal, antero-posterior and latero-lateral diameter of the uterus and its volume. Involution was gradual both in relation to the diameters and uterine volume up until day 8 and was most evident during days 1-4. Longitudinal and antero-posterior diameter reduced more quickly in relation to the latero-lateral diameter. Uterine volume, calculated by considering the uterus as an ellipsoid, diminished 42% from 730 cc to 421 cc. No differences were observed between uterine diameters in primiparas and those in pluriparas, nor between patients undergoing cesarean section and those after normal childbirth. However, there was a clear difference between those patients who breastfed immediately after birth and those who resorted to artificial methods; uterine volume diminished more rapidly in the former, especially between days 1-4, confirming that early breastfeeding plays an important role in uterine involution in the very early days of postpartum. The physiological characteristics of the postpartum uterus were useful in formulating a medical or surgical treatment strategy in the few cases of postpartum metrorrhagia observed during the study.

Adult↗
PubMed1977

The use of ultrasonic echo technique in the diagnosis of developmental anomalies of the uterus.

In the course of the fusion of the Müllerian ducts various anomalies of the uterus may be observed depending on the length of the septum between them. These anomalies can be recognized by the "B-scan" ultrasonic echo technique. Anomalies in pregnancy and puerperium were diagnosed in five cases and all of them were confirmed by clinical examination. The ultrasonic echo technique was applied in cases where manual examination revealed a uterus differing in shape from normal, the patient had a breech presentation in her previous or present pregnancy; and the involution of the uterus was slow. All the patients were multiparas and had breech presentation in their previous pregnancies. In four of the present pregnancies breech presentation was established and in three cases pregnancy was terminated before the thirty-seventh week. The involution of the uterus in the puerperium was generally slow.

Breech Presentation↗
PubMed1996

Ultrastructural aspects of endometrium in infertile women with septate uterus.

OBJECTIVES: To evaluate the endometrial surface morphology in patients with septate uterus and primary infertility in an attempt to throw light on the question of whether endometrial anomalies are involved in the pathogenesis of infertility in women with mullerian malformations. DESIGN: Endometrial biopsies were performed in eight women with septate uterus and primary infertility during hysteroscopy scheduled in the preovulatory phase of the cycle (when a follicle > 17 mm was identified by ultrasonography and E2 levels were >200 pg/mL [conversion factor to SI unit, 3.671]). Two samples were obtained from each patient, one from endometrium covering the septum and the other from endometrium lining the lateral wall of the uterus. All specimens were examined by scanning electron microscopy. MAIN OUTCOME MEASURES: The number of glandular ostia, the ciliated:nonciliated cell ratio, and the number of cilia on ciliated cells were analyzed in endometrial specimen from both the covering of the septum and the corresponding uterine lateral wall. RESULTS: In five patients septal endometrium showed the following defective preovulatory changes with respect to endometrium of the lateral uterine wall: a reduced number of glandular ostia, irregular nonciliated cells with rare microvilli, incomplete ciliogenesis on ciliated cells, and decrease in the ciliated:nonciliated cell ratio (1:52 +/- 11 versus 1:21 +/- 8). CONCLUSIONS: Our results indicate a decrease in the sensitivity of endometrium covering the septa of malformed uteri to preovulatory hormonal changes. This could play a role in the pathogenesis of primary infertility in patients with septate uterus.

Adult↗
PubMed1996

Study of the electromechanical activity of the uterus. Experimental study.

The uterine electromechanical activity was studied in 12 mongrel bitches. The uterus was exposed under general anesthesia, and 2 electrodes were sutured to its serosa. The electric activity was recorded for 30 minutes/day for 10 days. Simultaneous electric and mechanical activity (registered by a 4 F catheter connected to a pressure transducer) was also studied without and with uterine distension by a balloon. The electric activity was further recorded after performing uterine annular myotomy proximal and distal to the electrodes and between them. Pacesetter potentials (PPs) were registered from the 2 electrodes, having identical frequency and regular rhythm by the 2 electrodes, and were consistent in the individual dog on all test days. Action potentials (APs) followed PPs randomly and were associated with increase in uterine pressure. Balloon distension of the uterus effected increased PP and AP frequency. Annular uterine myotomy led to PP and AP disappearance distally but not proximally to myotomy. In conclusion, the study demonstrates that the uterus possesses electric activity represented by PPs which spread caudally. APs seem to be contractile waves. Recording of the electromechanical activity of the uterus may be of diagnostic significance in uterine disorders.

Action Potentials↗
PubMed1996

[Pregnancy and extreme myomatous uterus--conservative management].

The management of a pregnancy complicated by uterus myomatosus remains being controversially discussed. Myomectomy early in pregnancy is opposed by exspectative management with myomectomy subsequent to the post partum period. Therapeutic abortion and exstirpation of the gravid uterus represent only hypothetical but not reasonable alternatives. Complications like ureteral obstruction, sepsis, and torsion of the uterus with subperimetrial bleeding as a cause of fever of unknown origin may occur. Rapid growth of a fibromatous uterus in pregnancy may call for a biopsy. Two cases are presented to demonstrate that with intensive pregnancy surveillance exspectative management is justified and may lead to successful confinement of the pregnancy.

Adult↗
PubMed1976

Effect of estradiol on rat uterus DNA-dependent RNA polymerases. Studies on solubilized enzymes.

DNA-dependent RNA polymerases of immature and castrated rat uteri were studied after estradiol administration. The enzymes were solubilized from either whole uterus homogenate or nuclei and their activities were measured on an exogenous DNA template. alpha-Amanitin was used to distinguish alpha-amanitin-resistant from alpha-amanitin-senitive forms of the enzyme. The number of alpha-amanitin-sensitive RNA polymerase molecules was measured by a binding assay using labeled amanitin. In the first series of experiments RNA polymerases were solubilized from whole uterus homogenate. alpha-Amanitin-sensitive and -resistant activities were constant during the first 6 hours after estradiol treatment, followed by a late and moderate increase in their activities (50% at 12 hours for the resistant form and 40% at 24 hours for the sensitive form). The number of sensitive polymerase molecules evolved in an identical manner to its activity (+40% at 24 hours), suggesting that the increase in activity is due to the synthesis of new enzyme molecules. For both forms, no diffusible stimulatory factor was detected in the uterus of hormone-treated animals. In the second series of experiments, disrupted nuclei were washed with 0.15 M (NH4)2SO4 in order to release only enzyme molecules which were not firmly bound to DNA in a transcription complex. The amount of the sensitive form of polymerase which remains firmly bound to chromatin, was constant for 6 hours after estradiol administration and was doubled by 24 hours. The firmly bound alpha-amanitin-resistant activity was solubilized and was measured in the presence of an exogenous template. There was a progressive increase in activity first detectable in 1 to 2 hours, amounting to 50% at 6 hours and 100% at 24 hours. The reported results show that during the first 6 hours of hormone treatment: (a) the total content of RNA polymerases remains unchanged in the uterus; (b) the number of alpha-amanitin resistant molecules tightly bound to DNA increases progressively while the alpha-amanitin sensitive remains constant. At a later time (24 hours), an increase is observed both for the total amount of enzymes and for their fraction engaged in a transcription complex.

Amanitins↗
PubMed1998

Diagnosis and treatment outcome of the septate uterus.

AIM: To compare the accuracy of transvaginal ultrasound, transvaginal color Doppler, hysterosonography, and three-dimensional ultrasound in the detection of septate uteri. To evaluate obstetrical prognosis of the septate uterus and to assess the reproductive outcome following operative hysteroscopy. PATIENTS AND METHODS: Four hundred and twenty infertile patients undergoing hysteroscopy were evaluated prospectively during a 4 year period. Transvaginal ultrasound and color Doppler were performed in all patients, whereas hysterosonography and three-dimensional ultrasound were used in 76 and 86 patients, respectively. RESULTS: The sensitivity of transvaginal ultrasound and transvaginal color Doppler in the identification of the septate uterus was 95.0% and 99.3%, respectively. Color and pulsed Doppler studies of the septal area revealed vascularity in 71.2%. The sensitivity of hysterosonography and three-dimensional ultrasound in the detection of the septate uterus were 100% and 93.6%, respectively. However, the latter method predicted the existence of a congenital uterine defect in all the patients with septate uterus, but was inaccurate in differentiating it from other fusion anomalies. The pregnancy rate in 116 patients following the operative hysteroscopy for an intrauterine septum in a prospective follow-up period of 24 months was 50.9%: 44 patients (74.6%) had term deliveries, 11 (18.6%) had first trimester abortion, and 4 (6.8%) had preterm delivery. CONCLUSIONS: Transvaginal color Doppler and hysterosonography are highly accurate diagnostic tools for preoperative evaluation of the uterine cavitary defects. Three-dimensional ultrasound increases the accuracy of conventional two-dimensional transvaginal scan, allowing precise reconstruction of the uterine cavity. Removing the intrauterine septum in patients suffering from infertility and recurrent pregnancy wastage is beneficial.

Adult↗
PubMed1998

[Effects of progesterone antagonists on the eosinophilic granulocytes in the rat uterus].

An effect of estrogen in the uterus of rats is the invasion of eosinophil granulocytes into the endometrium and the myometrium. Progesterone prevents the estrogen induced eosinophilia. In the uterus the eosinophils degranulate, probably mediated by steroid hormones. The extent of infiltration with eosinophils may allow estimation of the estrogen activity of drugs. The present study investigates the effects of a long-term treatment with the progesterone antagonists Onapristone and ZK 112.993 on the eosinophils in the uterus of intact mature rats. The visualization of the eosinophils was done immunohistochemically with an antiserum against the Major Basic Protein (MBP) localized in the secondary granules. The localization of this protein in the extracellular matrix immediately beneath the eosinophils in Carnoy-fixed uteri was taken as a marker for their degranulation (Duchesne and Badia 1992). Onapristone caused a strong infiltration by eosinophils which corresponds to those seen in ovariectomized rats treated with estrogen, while the effect of ZK 112.993 was clearly weaker. This is in agreement with the lower antiprogestational activity of ZK 112.993 also found with other endpoints. In uteri fixed in Bouin' solution the immunoreactivity of the eosinophils was strongest and restricted to these cells. However, after Carnoy' fixation the antibody reacted with the extracellular matrix beneath the eosinophils while the staining intensity of the cells was decreased. Our results do not support the idea of a substantial extracellular deposition of MBP in the uterus of rats but speak in favour of a permeabilization of the eosinophil membranes by alcohol containing fixatives allowing granule contents to leave the cell.

Animals↗
PubMed1977

The atrophic postmenopausal uterus.

The size of postmenopausal uterus varies, but after 65 years of age, it routinely appears atrophic. A pelvic mass in this age group should not be assumed to be within the uterus unless a careful search excludes an atrophic uterus. Single sweep longitudinal ultrasound sections are the best method of localizing a small uterus, but sometimes gain settings must be varied to demonstrate the organ.

Aged↗
PubMed2006

Velamentous cord insertion into the lower third of the uterus is associated with intrapartum fetal heart rate abnormalities.

OBJECTIVES: To evaluate the accuracy of sonographic identification of the site of umbilical cord insertion (CI) at 18-20 weeks of gestation, to compare the sensitivities for detection of a velamentous cord insertion (VCI) secondary to a CI into the anterior, posterior or fundal wall, and to compare the intrapartum complications secondary to VCI into the upper, middle or lower third of the uterus. METHODS: As part of the routine ultrasound scan at 18-20 weeks' gestation we evaluated abnormal CI (VCI and marginal CI) and the location of the CI in the uterus in 3446 pregnancies. In cases of abnormal CI, the location of the CI was further classified as being in the upper, middle or lower third of the uterus. After delivery, the placenta and the umbilical cord were examined and intrapartum complications were compared with the location of the CI. RESULTS: The values for antenatal detection of VCI were: sensitivity, 25 of 40 (62.5%); positive predictive value, 25 of 25 (100%); and negative predictive value, 3406 of 3421 (99.6%). The sensitivity for cases in which the CI was located on the anterior wall was 12 of 13 (92.3%); when it was located on the posterior wall, the sensitivity was 11 of 22 (50.0%); and when it was fundal the sensitivity was 2 of 5 (40.0%). Variable decelerations were frequently observed with a VCI. In lower VCI cases, non-reassuring fetal heart rate patterns and emergency Cesarean sections occurred with a higher frequency than in cases with upper or middle VCI (P < 0.01). After delivery, the length of the aberrant vessels in cases of VCI by pathologic examination was 3.9 +/- 3.3 cm in the upper third, 4.7 +/- 4.6 cm in the middle third, and 10.6 +/- 6.8 cm in the lower third; thus, the aberrant vessel length was significantly greater when the CI was in the lower third of the uterus (P = 0.024). CONCLUSION: We have demonstrated that VCI with a lower CI site and with longer aberrant vessels is associated with various intrapartum complications. This finding has the potential for improving perinatal outcome.

Female↗
PubMed2006

Cord insertion into the lower third of the uterus in the first trimester is associated with placental and umbilical cord abnormalities.

OBJECTIVES: To assess the feasibility of detecting the cord insertion site during the late first trimester, and to investigate the possible association between perinatal complications and a cord insertion in the lower third of the uterus in the first trimester. METHODS: This was a prospective cohort study in which the positional relationship between the uterus and the cord insertion site was examined using gray-scale transvaginal sonography at 9-11 weeks of gestation. The distance between the internal os and the fundus was divided equally into three parts. Cord insertions located in the upper or middle thirds were defined as normal (controls), and those located in the lower third were defined as cases, regardless of their relationship to the chorion villosum. Third-trimester sonography and pathological examination of the placenta and cord at delivery were performed to check for placental/cord abnormalities. The univariate association between the location of the cord insertion in the first trimester and placental and umbilical cord abnormalities and perinatal complications was assessed. RESULTS: The cord insertion site was identified in 318/340 (93.5%) cases at 9-11 weeks of gestation and it was in the lower third of the uterus in 35 (11.0%) cases. Of these 35, the cord insertion was found at delivery to be low in nine cases (26%) and the placenta was low-lying at delivery in eight (23%). None of the 283 cases with a normal cord insertion in the first trimester was found to have a low-lying placenta at delivery (P < 0.0001). Ten (29%) of the cases with a low cord insertion and four (1.4%) with a normal cord insertion in the first trimester had a velamentous or marginal cord insertion at delivery (P < 0.0001). At delivery, five (14%) of the low cord insertion cases and four (1.4%) of the normal cord insertion cases (P < 0.0001) had some form of placental malformation, including accessory placenta and infarction of the placenta. An emergency Cesarean section was performed in four (11%) and six (2.1%) of the low and normal cord insertion cases, respectively (P = 0.003). CONCLUSION: Developmental abnormalities of the placenta and umbilical cord occur frequently in cases in which the cord insertion is in the lower third of the uterus in the first trimester. We suggest that screening for the cord insertion site at 9-11 weeks of gestation may have clinical significance for predicting abnormalities of the cord and the placenta at delivery.

Adult↗
PubMed1996

The stereoisomers of 17alpha-[123I]iodovinyloestradiol and its 11beta-methoxy derivative evaluated for their oestrogen receptor binding in human MCF-7 cells and rat uterus, and their distribution in immature rats.

We studied the potential of both stereoisomers of 17alpha-[123I]iodovinyloestradiol (E- and Z-[123I]IVE) and of 11beta-methoxy-17alpha-[123I]iodovinyloestradiol (E- and Z-[123I]MIVE) as suitable radioligands for the imaging of oestrogen receptor(ER)-positive human breast tumours. The 17alpha-[123I]iodovinyloestradiols were prepared stereospecifically by oxidative radio-iododestannylation of the corresponding 17alpha-tri-n-butylstannylvinyloestradiol precursors. Competitive binding studies were performed in order to determine the relative binding affinity (RBA) of the unlabelled 17alpha-iodovinyloestradiols for the ER in both human MCF-7 breast tumour cells and rat uterine tissue, compared with that of diethylstilboestrol (DES). Target tissue uptake, retention and uptake selectivity of their 123I-labelled analogues were studied in immature female rats. All four 17alpha-iodovinyloestradiols showed high affinity for the ER in human MCF-7 cells, as well as rat uterus. Their RBA for the ER showed the following order of decreasing potency: RBA of DES >Z-IVE >Z-MIVE >E-MIVE > or =E-IVE. Neither of these 17alpha-iodovinyloestradiols showed any significant binding to the sex hormone binding globulin in human plasma. The biodistribution studies showed ER-mediated uptake in the uterus, ovaries and pituitary, that of E- and Z-[123I]MIVE being higher than that of E- and Z-[123I]IVE. High target-to-non-target tissue uptake ratios, especially at longer periods after injection (up to 24h), were exhibited by both isomers of [123I]MIVE. The uterus-to-blood uptake ratio was higher for E-[123I]MIVE. However, the uterus-to-fat uptake ratio appeared to be higher for the Z-isomer of [123I]MIVE, especially at 24h after injection. Metabolic properties and temperature effects, which play a more important role in vivo, probably cause the discrepancies seen between in vitro and in vivo binding results. On the basis of their in vitro binding properties and in vivo distribution characteristics we conclude that E- and Z-[123I]MIVE could be suitable radioligands for the diagnostic imaging of ER in human breast cancer. Therefore, further studies with these radioligands in mature normal and tumour-bearing rats are warranted.

Animals↗
PubMed1988

Malignant müllerian tumours of the uterus.

Thirty-two cases of malignant Müllerian tumours of the uterus of the mixed mesodermal type were investigated. Histological examinations were performed on tissue obtained during curettage or biopsy and/or surgical removal of the uterus; in 4 cases postmortem examination was also carried out. The biphasic tumours of the uterus were classified into four groups and comprised 44% of alle uterine sarcomas. In 10 of the 28 cases in which uterine curettage or cervical biopsy was carried out, the final diagnosis was clarified when the tumorous uterus was removed. The prognosis was poorer for heterologous than for homologous tumours. In the heterologous group, the prognosis was better for the form with chondrosarcomatous features (2 patients are still alive after more than 5 years) than for the form containing striated muscle tissue (all 5 patients died within 1 year). Attention is drawn to the fact that the adenosarcoma should be considered a separate type; its prognosis was relatively good (2 such patients are still alive after more than 5 years).

Adenocarcinoma↗
PubMed2003

Inversion of the uterus at caesarean section.

INTRODUCTION: Inversion of the uterus through the uterine incision during caesarean section is a rare event. Therapy is usually simple and maternal morbidity is low when re-inversion of the uterus can be accomplished immediately. In cases of prolonged uterine inversion thereof, haemodynamic instability and shock, often out of proportion to the degree of blood loss, have been reported as serious sequelae. CASE REPORT: We describe such a case with a prolonged inversion to re-inversion interval where the patient suffered an intraoperative cardiovascular arrest during unrepositioned uterine inversion. Reposition of the uterus led to an immediate return of the patient's vital signs and improvement of her haemodynamic status. DISCUSSION: The mechanisms of haemodynamic instability and the technical aspects of manual reduction of the inverted, heavily contracted uterus during caesarean section are discussed.

Adult↗
PubMed2005

Rupture of the pregnant uterus: a 9-year review.

OBJECTIVE: To investigate the frequency of ruptured uterus, possible etiologic factors and fetomaternal outcomes. STUDY DESIGN: A retrospective chart view of all patients with ruptured uterus over a 9-year period from 1995 to 2003 was carried out. Relevant data relating to the clinical features, characteristics of labour, operative procedures, and fetomaternal outcomes were assessed. RESULTS: During the study period there were 17 cases of ruptured uterus among a total of 117,095 deliveries, giving an incidence of 1 in 6,888 deliveries. Thirteen patients (76.5%) were multiparous and mean parity was 1.9. Uterine rupture occurred following vaginal delivery in ten patients. Caesarean delivery was performed in seven (41.2%) patients, of which five (29.4%) patients had a history of previous caesarean section. Abdominal hysterectomy was performed in 12 patients (70.6%), of which 9 (75.0%) were total and 3 (25.0%) were subtotal. The other five patients (29.4%) had suture repairs. In seven patients (41.2%), uterine rupture was associated with oxytocin use. There were one maternal and three perinatal (17.6%) deaths. CONCLUSION: Sudden fetal heart abnormalities in labouring patients should be taken as a potential sign of danger. Early diagnosis and immediate preoperative resuscitation are of great importance in cases of ruptured uterus. The fetomaternal outcomes can be improved with the experience and skill of the surgical team.

Adult↗
PubMed2000

Benign metastasizing leiomyoma of the uterus: documentation of clinical, immunohistochemical and lectin-histochemical data of ten cases.

The clinical histories of 10 women suffering from benign metastasizing leiomyoma (BML) after hysterectomy and information on lung lesions detected in these women are presented, together with corresponding data for 2 women with metastasizing leiomyosarcoma of the uterus for comparison: gross appearance, survival, and light microscopical, immunohistochemical and lectin-histochemical findings are reported. All patients with BML had undergone hysterectomy for uterus leiomyomatosus without any detection of sarcomatous lesions in the uterus wall. After a median period of 14.9 years intrapulmonary masses were detected by imaging techniques. On average, six nodules with a mean diameter of 1.8 cm were seen. Resection of the lesions was performed in all cases. The immunohistochemical and lectin-histochemical examination of the tumors included analysis of the proliferation-associated protein Ki-67, the p53 protein, estrogen and progesterone receptor, sarcolectin as an indicator of the presence of lymphokine macrophage migration inhibitory factor, antibodies and the labeled protein to assess galectin (galactoside-binding animal lectin)-dependent parameters, analysis of tumor vascularization (CD-34), and expression of bcl-2, vimentin, smooth muscle actin, desmin, and keratin. The lesions were characterized by low proliferation activity of 2.9% (measured with Ki-67), frequent hormone receptor expression (8 of the 10 cases presented hormone-specific receptors), low to moderate vascularization compared with metastases from the two uterine sarcomas, remarkable p53 overexpression and frequent expression of the lymphokine, the galectins and accessible binding sites. The median survival of the BML patients was 94 months after excision of the intrapulmonary lesions, and the maximum survival of the two sarcoma patients was 22 months. The results recorded in this patient sample with the methodology applied suggest that benign metastasizing leiomyomas are a slow-growing variant of leiomyosarcoma of the uterus, which becomes clinically apparent at a young age and progresses with low velocity.

Adult↗
PubMed1978

Effects of cholinesterase inhibitors on the spasmogenic action of acetate esters on rat uterus.

Acetate esters, such as phenyl acetate and aspirin, induced atropine-sensitive contractions of isolated uterus only when choline was present. These contractions were selectively and reversibly inhibited by carbamate-type cholinesterase inhibitors, such as neostigmine and eserine, and quaternary ammonium compounds, such as tetraethylammonium and decamethonium. After treatment with organophosphorus cholinesterase inhibitors, such as di-isopropyl fluorophosphate and tetraethyl pyrophosphate, the uterus failed to respond to the acetate esters, even when high concentrations of choline were present. The inhibition of the response of the uterus by organophosphates was effectively removed by pyridine-2-aldoxime methiodide. Pretreatment of the uterus with neostigmine or simultaneous addition of high concentrations of quaternary ammonium compounds prevented the inhibition by organophosphates. The inhibition produced by neostigmine was also reduced by simultaneous addition of quaternary ammonium compounds. These findings suggest that some esterase having an anionic site and an esteratic site, probably cholinesterase, may mediate in the uterine contractions induced by acetate esters in the presence of choline, and that inhibition by organophosphates, carbamates and quaternary ammonium compounds of cholinesterase activity in the preparation may impede the initiation of contractions by the acetate esters in the presence of choline.

Acetates↗
PubMed1983

Dantrolene sodium: stimulatory and depressant effects on the contractility of guinea-pig uterus in vitro.

The effects of dantrolene sodium on the spontaneous and oxytocin-induced contraction of guinea-pig uterus were studied in vitro. Dantrolene reversibly increased the spontaneous contraction frequency of guinea-pig uterus. The effect was not dose-related and was not antagonized by atropine, methysergide or indomethacin. Dantrolene dose dependently and reversibly reduced the contractile responses of guinea-pig uterus to oxytocin. The varying effects of dantrolene on the uterus probably involve inhibition of calcium movement at more than one site of the muscle.

Animals↗