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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2017; 39(04): 149-154
DOI: 10.1055/s-0037-1601418
Original Article
Thieme-Revinter Publicações Ltda Rio de Janeiro, Brazil

Ultrasonographic Evaluation of Uterine Involution in the Early Puerperium

Avaliação ultrassonográfica da involução uterina no puerpério precoce
Juliana Hocevar Kristoschek
1   Medical Sciences Post Graduation, Universidade Federal Fluminense, Niterói, RJ, Brazil
,
Renato Augusto Moreira de Sá
1   Medical Sciences Post Graduation, Universidade Federal Fluminense, Niterói, RJ, Brazil
2   Clinical Research Unit, Instituto Fernandes Figueira, Fiocruz, Rio de Janeiro, RJ, Brazil
,
Fernanda Campos da Silva
3   Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
,
Guillermo Coca Vellarde
1   Medical Sciences Post Graduation, Universidade Federal Fluminense, Niterói, RJ, Brazil
› Author Affiliations
Further Information

Publication History

27 May 2016

12 January 2017

Publication Date:
03 April 2017 (online)

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Abstract

Purpose Our aim was to describe the changes observed by ultrasonography in uterine dimensions during the early puerperium among women who experienced an uncomplicated puerperium. Additionally, the influence of parity, mode of delivery, breastfeeding and birth weight on uterine involution was evaluated.

Methods Ninety-one patients underwent an ultrasound examination on days 1 (D1), 2 (D2) and 7 (D7) of the postpartum period. The longitudinal, anteroposterior and transverse uterine diameters were measured, and the uterine volume was calculated by the formula: longitudinal diameter (LD) X anteroposterior diameter (APD) X transverse diameter (TD) X 0.45. The thickness and length of the uterine cavity were also measured.

Results The uterine volume and the LD, APD and TD decreased by 44.8%, 20.9%, 11.8% and 20.0% respectively. The uterine cavity thickness was reduced by 23%, and the length of the cavity was reduced by 27.2% on D7. Uterine involution was correlated inversely with parity when the day of the postpartum period was not taken into account (p = 0.01). However, when the uterine involution was correlated to parity separately, with D1, D2 or D3, no correlations were found. A significant difference occurred at D2, when it was found that the uterus had a smaller volume following cesarean section compared with vaginal delivery (p = 0.04). The high birth weight and breastfeeding were significantly related to uterine involution (p ≤ 0.01 and p = 0.04).

Conclusion The sonographic evaluation of the uterus in the early puerperium should consider birth weight, breastfeeding and parity, as well as the delivery route on D2, to identify abnormalities related to uterine involution.

Resumo

Objetivo Descrever as alterações observadas pela ultrassonografia nas dimensões uterinas durante o puerpério precoce em mulheres com evolução puerperal não complicada, considerando a influência da paridade, tipo de parto, amamentação e peso ao nascer sobre a involução uterina.

Métodos Noventa e uma pacientes foram submetidas a exame ultrassonográfico nos dias 1 (D1), 2 (D2) e 7 (D7) do puerpério. Os diâmetros uterinos longitudinal, anteroposterior e transversal foram medidos, e o volume uterino foi calculado pela fórmula: diâmetro longitudinal (DL) X diâmetro anteroposterior (DAP) X diâmetro transverso (DT) X 0,45. A espessura e comprimento da cavidade uterina também foram medidos.

Resultados O volume uterino e o DL, DAP e DT diminuíram 44,8%, 20,9%, 11.8% e 20,0% respectivamente no D7. A espessura da cavidade uterina reduziu em 23%, e o comprimento da cavidade foi reduzido em 27,2% no D7. A involução uterina se correlacionou inversamente com a paridade quando o dia do puerpério não foi levado em conta (p = 0,01). Uma diferença significativa foi encontrada em D2, quando se verificou que o útero tinha um volume menor no grupo submetido a cesariana em comparação com o parto vaginal (p = 0,04). O peso ao nascer elevado e amamentação apresentaram relação estatisticamente significativa com a involução uterina (p ≤ 0,01 e p = 0,04).

Conclusão A avaliação ultrassonográfica do útero no puerpério precoce deve considerar o peso ao nascer, a amamentação e a paridade, assim como a via de parto no D2, para a identificação de anormalidades relacionadas à involução uterina.

Keywords

postpartum period - uterus - ultrasonography

Palavras-chave

período pós-parto - útero - ultrassonografia
 

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