Does bilateral uterine artery ligation have negative effects on ovarian reserve markers and ovarian artery blood flow in women with postpartum hemorrhage? / 대한생식의학회지

OBJECTIVE: Bilateral uterine artery ligation (UAL) is a fertility-preserving procedure used in women experiencing postpartum hemorrhage (PPH). However, the long-term effects of this procedure on ovarian function remain unclear. The aim of this study was to investigate whether bilateral UAL compromised ovarian reserve and ovarian blood supply. METHODS: This prospective study included 49 women aged between 21 and 36 years who had undergone a cesarean section for obstetric indications. Of these, 25 underwent uterine bilateral UAL to control intractable atonic PPH. The control group consisted of 24 women who had not undergone bilateral UAL. Standard clinical parameters, the results of color Doppler screening, and ovarian reserve markers were assessed in all participants at 6 months after surgery. The clinical parameters included age, parity, cycle history, body mass index, and previous medication and/or surgery. Color Doppler screening findings included the pulsatility index (PI) and resistance index (RI) for both the uterine and ovarian arteries. The ovarian reserve markers included day 3 follicle-stimulating hormone (FSH) levels, antral follicle count, and anti-Müllerian hormone (AMH) levels. RESULTS: There were no significant differences in the ovarian reserve markers of day 3 FSH levels, antral follicle count, and AMH levels between the study and control groups (p>0.05 for all). In addition, no significant differences were observed in the PI and RI indices of the uterine and ovarian arteries (p>0.05 for all). CONCLUSION: In this study, we showed that bilateral UAL had no negative effects on ovarian reserve or ovarian blood supply, so this treatment should be used as a fertility preservation technique to avoid hysterectomy in patients experiencing PPH.

Effects of induced endometritis on uterine blood flow in cows as evaluated by transrectal Doppler sonography

This study was conducted to evaluate the effects of induced endometritis on uterine blood flow in cows. Transrectal Doppler sonography was performed on uterine arteries of six cyclic cows before and for 4 days after inducing acute endometritis by intrauterine infusion of 720 mg of policresulen, and for 4 days of the following estrous cycle. Time-averaged maximum velocity (TAMV) increased (p 0.05) in the next 4 days of the same cycle. TAMV and PI values in the subsequent cycle did not differ (p > 0.05) from the values measured before infusion and showed no changes (p > 0.05) within the cycle. Blood flow parameters were not related (p > 0.05) to plasma concentrations of progesterone and estrogen. All cows showed an acute endometritis determined by histopathological findings of biopsy samples taken 1 day after infusion and fibrotic endometrial alterations detected in the subsequent cycle. No relationships were observed between fibrotic changes of the endometrium and uterine blood flow during either cycle. In conclusion, acute inflammation is accompanied by a rise in uterine blood flow, but fibrotic alterations do not seem to be related to Doppler sonographic findings.

Correlación de la velocidad media de la arteria uterina con la edad gestacional como indicador de perfusión vascular uterina

Objetivo: Determinar la correlación de la velocidad media de la arteria uterina con la edad gestacional como indicador de perfusión vascular uterina. Diseño: Estudio transversal, analítico. Institución: Hospital III Honorio Delgado de Arequipa, Perú. Participantes: Gestantes entre 14 a 41 semanas de gestación, que acudieron al hospital para evaluación ecográfica de rutina sin evidencia de patología. Métodos: A gestantes entre 14 a 41 semanas de gestación que acudieron al hospital para evaluación ecográfica de rutina sin evidencia de patología, entre Julio 2013 y abril 2014, se realizó ecografía Doppler de las arterias uterinas y se correlacionó la velocidad media (MnV) promedio de ambas arterias con la edad gestacional determinada por ecografía del primer trimestre. Se buscó la correlación de la MnV promedio en el segundo (14 a 28 semanas) y tercer (29 a 41 semanas) trimestres de gestación y se determinó el percentil S para dicha velocidad. Principales medidas de resultados: Cálculo de la MnV promedio de ambas arterias uterinas y correlación con la edad gestacional. Resultados: Se evaluó 138 gestantes con una edad materna promedio de 26,4 años y se encontró un coeficiente de correlación de la MnV promedio con la edad gestacional de r = 0,SS6 (r2 = 0,31). En el segundo y tercer trimestre de gestación el coeficiente de correlación fue r = 0,634 (r2 = 0,40) y r = 0,32 (r2 = 0,001), respectivamente. El percentil S de la MnV promedio en el tercer trimestre fue 67,SO cm/s. Conclusiones: Existió correlación de la MnV con la edad gestacional, cuyos valores menores al percentil S según la edad gestacional podrían ser utilizados como indicadores de hipoperfusión vascular uterina en gestantes del segundo y tercer trimestre.

Objectives: To determine correlation ofthe uterine artery mean velocity with gestational age as indicator of uterine vascular perfusion. Design: Cross-sectional study. Setting: Hospital III Honorio Delgado, Arequipa, Peru. Participants: Pregnant women. Interventions: To pregnant women between 14-41 weeks of gestation admitted to the hospital for routine ultra­ sound evaluation without evidence of pathology both uterine arteries average mean velocity (MnV) was calculated and correlated with gestational age. Correlation of average MnV in the second (14-28 weeks) and third (29-41 weeks) trimesters and MnV Sth percentile were determined. Main outcome measures: 80th uterine arteries mean velocity (MnV) and correlation with gestational age. Results: Average age of the 138 pregnant women was 26.4 years and MnV correlation coefficientto gestational age was r = 0.SS6 (r2 = 0.31). Correlation coefficients were r = 0.634 (r2 = 0.40) and r = 0.32 (r2 = 0.001) respectively in the second and third trimes­ terso MnV Sth percentile average in the third trimester (29-41 weeks) was 67.S0 cm/s. Conclusions: There was MnV correlation with gestational age. Values below the Sth percentile for gestational age could be used as indicators of uterine vascular hypoperfusion in pregnant women in the second and third trimesters.

Flujo sanguíneo uterino en el embarazo

Los cambios fisiológicos cardiovasculares en el embarazo a nivel sistémico y uterino son fundamentales para el incremento del flujo sanguíneo uterino, la microcirculación y circulación en el espacio intervelloso. Los cambios fisiopatológicos de la circulación uterina y placentaria tienen relación con la preeclampsia y la restricción del crecimiento intrauterino. En esta revisión se describirá la anatomía de la circulación sanguínea uterina, el flujo sanguíneo uterino en el embarazo y sus implicancias clínicas.

Both systemic and uterine cardiovascular physiological changes in pregnancy are fundamental for blood flow increase in the uterus, microcirculation and circulation in the intervillous space. Pathophysiological changes in uterine and placental circulation are associated to preeclampsia and intrauterine growth restriction. In this review the anatomy of the uterine blood flow, uterine blood flow during pregnancy and clinical implications are described.

Elevated natural killer cell levels and autoimmunity synergistically decrease uterine blood flow during early pregnancy

OBJECTIVE: To investigate whether natural killer (NK) cell and autoimmune antibody acts synergistically, by the action of autoantibodies to increase NK cell number and cytotoxicity, to decrease uterine blood flow during early pregnancy in pregnant women with a history of recurrent spontaneous abortion (RSA). METHODS: Seventy-five pregnant women (between 5 and 7 weeks gestation) with a history of unexplained RSA were included in the study group. Forty-one pregnant women without a history of RSA were included as controls. All women with a history of RSA were tested for autoantibodies and number of peripheral blood natural killer (pbNK) cell by flow cytometry. Study populations were stratified into four groups by existence of autoantibody and degree of increase of pbNK cells. The uterine radial artery resistance index (RI) was measured by color-pulsed Doppler transvaginal ultrasound. RESULTS: The mean RI of the autoimmune antibody-positive (AA+) group (0.63+/-0.09) was significantly higher than that of the normal control group (0.53+/-0.10, P=0.001). The mean RI of the AA+/only-NK elevated (eNK) group (0.63+/-0.09) was significantly higher than those of the only-AA+ group (0.55+/-0.07, P=0.019) and the only-eNK group (0.57+/-0.07, P=0.021). CONCLUSION: Concurrent elevation in NK cells and autoimmunity results in decreased uterine blood flow during early pregnancy. However, the majority of cases of RSA remain unexplained and larger scale studies are needed to confirm our conclusion and to develop diagnostic and therapeutic plans for women with a history of RSA.

Clinical studies of U8 similar bioelectricity stimulation therapy of infertility with gracile endometrium / 重庆医学

Objective Observe the effect of of U8 similar bioelectricity stimulant therapy of infertility with gracile endometrium on endometrium reception .Methods 80 cases of patients in 252 natrual period with infertility caused by poor endometrial develop-ment for unknown reasons were randomly divided into two groups .The treatment group was intervened by U8 similar bioelectricity stimulant other day from the eighth day of menstruation until the day to inject HCG .After ovulation ,patients were sustained by progestin with a dose of 20 mg per day .The control group was given estradiol valerate with a dose of 2mg per day from the eighth day of menstruation until the day to inject HCG .After ovulation ,patients were sustained by progestin with a dose of 20mg per day as well .To compare the generral conditions on HCG injection day of the two groups anterior-posterior :both groupsal thickness and types ,parameters of intramembrane and submucosal uterine blood flow ,biochemical pregnancy rates and clinical pregnancy rates . Results The endometrial thickness and types on HCG injection day in treatment group were improved significantly (P<0 .05) . The parameters of intramembrane and submucosal uterine blood flow were better than the control ,there was a significant difference ( P<0 .05) .And the clinical pregnancy rate of treatment group was higher than that of control group there was a significant differ-ence(P<0 .05) .Conclusion U8 similar bioelectricity stimulation can promote the grow th of endometrium ,improve the endometrial receptivity and the clinical pregnancy rate .