title: Dynamic Changes in the Myometrium during the Third Stage of Labor, Evaluated Using Two-Dimensional Ultrasound, in Women with Normal and Abnormal Third Stage of Labor and in Women with Obstetric Complications.
abstract: OBJECTIVE
  To investigate dynamic changes in myometrial thickness during the third stage of labor.
  
  
  METHODS
  Myometrial thickness was measured using ultrasound at one-minute time intervals during the third stage of labor in the mid-region of the upper and lower uterine segments in 151 patients including: women with a long third stage of labor (n = 30), postpartum hemorrhage (n = 4), preterm delivery (n = 7) and clinical chorioamnionitis (n = 4). Differences between myometrial thickness of the uterine segments and as a function of time were evaluated.
  
  
  RESULTS
  There was a significant linear increase in the mean myometrial thickness of the upper uterine segments, as well as a significant linear decrease in the mean myometrial thickness of the lower uterine segments until the expulsion of the placenta (p < 0.001). The ratio of the measurements of the upper to the lower uterine segments increased significantly as a function of time (p < 0.0001). In women with postpartum hemorrhage, preterm delivery, and clinical chorioamnionitis, an uncoordinated pattern among the uterine segments was observed.
  
  
  CONCLUSIONS
  A well-coordinated activity between the upper and lower uterine segments is demonstrated in normal placental delivery. In some clinical conditions this pattern is not observed, increasing the time for placental delivery and the risk of postpartum hemorrhage.
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, Mich., USA.
authors: Manasi
authors: M
authors: Patwardhan
authors: Edgar
authors: E
authors: Hernandez-Andrade
authors: Hyunyoung
authors: H
authors: Ahn
authors: Steven J
authors: SJ
authors: Korzeniewski
authors: Alyse
authors: A
authors: Schwartz
authors: Sonia S
authors: SS
authors: Hassan
authors: Roberto
authors: R
authors: Romero
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007749:Labor Stage, Third / Q000502:physiology*; D009215:Myometrium / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging*; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography
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