Clinical application of grey scale and colour Doppler sonography during abnormal third stage of labour.
OBJECTIVE
The purpose of the study was to investigate whether colour Doppler sonography is helpful in the surveillance of abnormal third stage of labour.


METHODS
20 patients were enrolled in the prospective study. Inclusion criteria were third stage of labour > 15 min and/or clinical suspicion of retained placenta. By means of grey scale and colour Doppler sonography the length of distinct phases of third stage of labour and length of visualisation of blood flow between myometrium and placenta were measured. These data were compared with previously published normal values.


RESULTS
The patients were allocated into four groups: 1. Patients with prolonged third stage of labour, but normal vaginal delivery of the placenta (Group 1, 8 cases). 2. Patients with clinically suspected retained placental parts (Group 2, 4 cases). 3. Patients with manual removal of the placenta without confirmation of placenta accreta (Group 3, 4 cases). 4. Patients with manual removal of the placenta with confirmation of placenta accreta (Group 4, 4 cases). A significant longer latent phase was responsible for the prolonged third stage of labour in Group 1 (p < 0.05). Blood flow between myometrium and placenta was significantly longer visible in Group 4 than in the normal cohort (p < 0.0001).


CONCLUSIONS
Grey scale sonography can help to distinguish between uncomplicated and complicated prolonged third stage of labour. Colour Doppler sonography can detect persistent blood flow between myometrium and placenta during third stage of labour in cases of placenta accreta. In these instances, the patient may benefit from colour Doppler sonography-guided curettage.
Krapp
M
M
Division of Prenatal Medicine, Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Campus Lübeck. MKrapp@hotmail.com
Axt-Fliedner
R
R
Berg
C
C
Geipel
A
A
Germer
U
U
Gembruch
U
U
D000328:Adult; D001783:Blood Flow Velocity; D002585:Cesarean Section; D005260:Female; D005865:Gestational Age; D006801:Humans; D007749:Labor Stage, Third / Q000502:physiology*; D008423:Maternal Age; D009215:Myometrium / Q000098:blood supply; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging*; D010298:Parity; D010920:Placenta / Q000098:blood supply; D018457:Placenta, Retained / Q000000981:diagnostic imaging*; D011247:Pregnancy; D018615:Ultrasonography, Doppler, Color / Q000379:methods*