{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T04:47:06Z","timestamp":1772340426134,"version":"3.50.1"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T00:00:00Z","timestamp":1621209600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T00:00:00Z","timestamp":1621209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study aims to evaluate the feasibility and clinical interest of shear wave elastography, by quantitatively estimating the baseline stiffness of the myometrium before and after placental expulsion. We conducted a prospective cohort study of women at term, without known risk factors for postpartum hemorrhage, who gave birth via spontaneous labor in our tertiary center. Myometrium tonicity was evaluated based on measurements of shear wave speed (SWS) in the anterior uterine corpus. All data points were collected by a single operator. Measurements were carried out at three different time points: after fetal delivery (T1), after placental delivery (T2) and 30 min after placental delivery (T3). Our primary objective was to assess the feasibility of this new imaging technique. Ten valid SWS measurements obtained at each of the three different time points were considered as a positive primary outcome. Our secondary objectives were to evaluate the difference in median myometrial shear wave velocity between each time point, as well as to determine the correlation between myometrial shear wave velocity and patients\u2019 characteristics. 38 women were recruited during the study period, of whom 34 met the study criteria. 1017 SWS measurements were obtained. The median time to perform measurements was 16 s for one value, and 2 min 56 s for ten. For 11 women (32%) it was not possible to achieve ten SWS at T1 as placental expulsion immediately followed the birth of the newborn. One patient experienced placental retention and only measurements at T1 were performed. For all other patients, we were successfully able to obtain all measures as intended. There was no difference in the mean shear wave speed between the three time points. After adjustments for confounders, we observed a significant correlation for total blood loss (correlation coefficient\u2009= \u2212 0.26, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, units of oxytocin (correlation coefficient\u2009=\u2009\u2212 0.34, <jats:italic>p<\/jats:italic>\u2009=\u20090.03), and newborn weight (correlation coefficient\u2009=\u2009\u2212 0.08, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). It is feasible to assess uterine tonicity by shear wave imaging, after placental expulsion. We did not observe a variance in uterine tonicity between the three time points. Women who had higher blood loss, received more units of oxytocin and\/or those with newborns of a higher weight exhibited lower shear wave speed measures.<\/jats:p>","DOI":"10.1038\/s41598-021-89756-6","type":"journal-article","created":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T10:04:53Z","timestamp":1621245893000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Using shear wave elastography to assess uterine tonicity after vaginal delivery"],"prefix":"10.1038","volume":"11","author":[{"given":"Joanna","family":"Sichitiu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Yves","family":"Meuwly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Baud","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Desseauve","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,5,17]]},"reference":[{"key":"89756_CR1","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1016\/S0140-6736(06)68397-9","volume":"367","author":"KS Khan","year":"2006","unstructured":"Khan, K. S., Wojdyla, D., Say, L., G\u00fclmezoglu, A. M. & Van Look, P. F. WHO analysis of causes of maternal death: A systematic review. Lancet 367, 1066\u20131074 (2006).","journal-title":"Lancet"},{"issue":"353","key":"89756_CR2","first-page":"e1","volume":"202","author":"WM Callaghan","year":"2010","unstructured":"Callaghan, W. M., Kuklina, E. V. & Berg, C. J. Trends in postpartum hemorrhage: United States, 1994\u20132006. Am. J. Obstet. Gynecol. 202(353), e1-6 (2010).","journal-title":"Am. J. Obstet. Gynecol."},{"key":"89756_CR3","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1080\/17474086.2016.1245135","volume":"9","author":"L Sentilhes","year":"2016","unstructured":"Sentilhes, L. et al. Postpartum haemorrhage: Prevention and treatment. Expert Rev. Hematol. 9, 1043\u20131061 (2016).","journal-title":"Expert Rev. Hematol."},{"key":"89756_CR4","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s12884-016-1217-0","volume":"17","author":"LT Nyfl\u00f8t","year":"2017","unstructured":"Nyfl\u00f8t, L. T. et al. Risk factors for severe postpartum hemorrhage: A case-control study. BMC Pregnancy Childbirth 17, 17 (2017).","journal-title":"BMC Pregnancy Childbirth"},{"key":"89756_CR5","doi-asserted-by":"publisher","first-page":"1368","DOI":"10.1213\/ANE.0b013e3181d74898","volume":"110","author":"BT Bateman","year":"2010","unstructured":"Bateman, B. T., Berman, M. F., Riley, L. E. & Leffert, L. R. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth. Analg. 110, 1368\u20131373 (2010).","journal-title":"Anesth. Analg."},{"issue":"51","key":"89756_CR6","first-page":"e1","volume":"209","author":"LA Wetta","year":"2013","unstructured":"Wetta, L. A. et al. Risk factors for uterine atony\/postpartum hemorrhage requiring treatment after vaginal delivery. Am. J. Obstet. Gynecol. 209(51), e1-6 (2013).","journal-title":"Am. J. Obstet. Gynecol."},{"issue":"229","key":"89756_CR7","first-page":"e1","volume":"210","author":"AS Oberg","year":"2014","unstructured":"Oberg, A. S., Hernandez-Diaz, S., Palmsten, K., Almqvist, C. & Bateman, B. T. Patterns of recurrence of postpartum hemorrhage in a large population-based cohort. Am. J. Obstet. Gynecol. 210(229), e1-8 (2014).","journal-title":"Am. J. Obstet. Gynecol."},{"key":"89756_CR8","first-page":"69","volume":"77","author":"CA Combs","year":"1991","unstructured":"Combs, C. A., Murphy, E. L. & Laros, R. K. Factors associated with postpartum hemorrhage with vaginal birth. Obstet. Gynecol. 77, 69\u201376 (1991).","journal-title":"Obstet. Gynecol."},{"key":"89756_CR9","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1186\/1471-2393-11-97","volume":"11","author":"N Prata","year":"2011","unstructured":"Prata, N. et al. Inability to predict postpartum hemorrhage: Insights from Egyptian intervention data. BMC Pregnancy Childbirth 11, 97 (2011).","journal-title":"BMC Pregnancy Childbirth"},{"key":"89756_CR10","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1080\/00016340802087660","volume":"87","author":"HA Mousa","year":"2008","unstructured":"Mousa, H. A., Cording, V. & Alfirevic, Z. Risk factors and interventions associated with major primary postpartum hemorrhage unresponsive to first-line conventional therapy. Acta Obstet. Gynecol. Scand. 87, 652\u2013661 (2008).","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"89756_CR11","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1159\/000010028","volume":"46","author":"WL Choo","year":"1998","unstructured":"Choo, W. L. et al. Correlation of change in uterine activity to blood loss in the third stage of labour. Gynecol. Obstet. Invest. 46, 178\u2013180 (1998).","journal-title":"Gynecol. Obstet. Invest."},{"key":"89756_CR12","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1159\/000291942","volume":"42","author":"S Chua","year":"1996","unstructured":"Chua, S. et al. Correlation of total uterine activity to blood loss in the third stage of labour. Gynecol. Obstet. Invest. 42, 171\u2013173 (1996).","journal-title":"Gynecol. Obstet. Invest."},{"key":"89756_CR13","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1111\/j.1542-2011.2011.00130.x","volume":"57","author":"MN Schorn","year":"2012","unstructured":"Schorn, M. N. Uterine activity during the third stage of labor. J. Midwifery Womens Health 57, 151\u2013155 (2012).","journal-title":"J. Midwifery Womens Health"},{"key":"89756_CR14","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/S0002-9378(96)70397-6","volume":"174","author":"PP Arrabal","year":"1996","unstructured":"Arrabal, P. P. & Nagey, D. A. Is manual palpation of uterine contractions accurate?. Am. J. Obstet. Gynecol. 174, 217\u2013219 (1996).","journal-title":"Am. J. Obstet. Gynecol."},{"key":"89756_CR15","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1136\/bmj.4.5732.404","volume":"4","author":"JM Beazley","year":"1970","unstructured":"Beazley, J. M. & Underhill, R. A. Fallacy of the fundal height. Br. Med. J. 4, 404\u2013406 (1970).","journal-title":"Br. Med. J."},{"key":"89756_CR16","doi-asserted-by":"publisher","first-page":"245","DOI":"10.2147\/IJWH.S106321","volume":"9","author":"M Swiatkowska-Freund","year":"2017","unstructured":"Swiatkowska-Freund, M. & Preis, K. Cervical elastography during pregnancy: Clinical perspectives. Int. J. Womens Health 9, 245\u2013254 (2017).","journal-title":"Int. J. Womens Health"},{"key":"89756_CR17","doi-asserted-by":"publisher","first-page":"1686","DOI":"10.1111\/jog.13110","volume":"42","author":"DH Yilmaz","year":"2016","unstructured":"Yilmaz, D. H. et al. Can myometrial elasticity, as determined by elastography at 18\u201322 weeks of gestation, predict preterm delivery?. J. Obstet. Gynaecol. Res. 42, 1686\u20131693 (2016).","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"89756_CR18","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.ultras.2014.07.013","volume":"56","author":"J-L Gennisson","year":"2015","unstructured":"Gennisson, J.-L. et al. Quantification of elasticity changes in the myometrium during labor using Supersonic Shear Imaging: A feasibility study. Ultrasonics 56, 183\u2013188 (2015).","journal-title":"Ultrasonics"},{"key":"89756_CR19","doi-asserted-by":"publisher","first-page":"151","DOI":"10.7863\/ultra.34.1.151","volume":"34","author":"C Cimsit","year":"2015","unstructured":"Cimsit, C., Yoldemir, T. & Akpinar, I. N. Shear wave elastography in placental dysfunction: Comparison of elasticity values in normal and preeclamptic pregnancies in the second trimester. J. Ultrasound Med. 34, 151\u2013159 (2015).","journal-title":"J. Ultrasound Med."},{"key":"89756_CR20","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1016\/j.placenta.2015.06.008","volume":"36","author":"T Ohmaru","year":"2015","unstructured":"Ohmaru, T. et al. Placental elasticity evaluation using virtual touch tissue quantification during pregnancy. Placenta 36, 915\u2013920 (2015).","journal-title":"Placenta"},{"key":"89756_CR21","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1055\/s-0033-1335205","volume":"34","author":"J Bamber","year":"2013","unstructured":"Bamber, J. et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med. 34, 169\u2013184 (2013).","journal-title":"Ultraschall Med."},{"key":"89756_CR22","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1002\/jum.15190","volume":"39","author":"RG Barr","year":"2019","unstructured":"Barr, R. G. Can accurate shear wave velocities be obtained in kidneys?. J. Ultrasound Med. 39, 1097\u20131105. https:\/\/doi.org\/10.1002\/jum.15190 (2019).","journal-title":"J. Ultrasound Med."},{"key":"89756_CR23","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.7150\/thno.18650","volume":"7","author":"RMS Sigrist","year":"2017","unstructured":"Sigrist, R. M. S., Liau, J., Kaffas, A. E., Chammas, M. C. & Willmann, J. K. Ultrasound elastography: review of techniques and clinical applications. Theranostics 7, 1303\u20131329 (2017).","journal-title":"Theranostics"},{"key":"89756_CR24","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1007\/s13534-017-0028-1","volume":"7","author":"M Bruce","year":"2017","unstructured":"Bruce, M., Kolokythas, O., Ferraioli, G., Filice, C. & O\u2019Donnell, M. Limitations and artifacts in shear-wave elastography of the liver. Biomed. Eng. Lett. 7, 81\u201389 (2017).","journal-title":"Biomed. Eng. Lett."},{"key":"89756_CR25","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1159\/000370001","volume":"80","author":"M Patwardhan","year":"2015","unstructured":"Patwardhan, M. et al. 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. Gynecol. Obstet. Invest. 80, 26\u201337 (2015).","journal-title":"Gynecol. Obstet. Invest."},{"key":"89756_CR26","unstructured":"Shear Wave Ultrasound Liver Assessment | Philips Ultrasound. Philips https:\/\/www.usa.philips.com\/healthcare\/resources\/feature-detail\/shear-wave-elastography."},{"key":"89756_CR27","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s10396-010-0292-5","volume":"38","author":"T Tanaka","year":"2011","unstructured":"Tanaka, T. et al. Attempt to quantify uterine involution using acoustic radiation force impulse before and after placental delivery. J. Med. Ultrason. 38, 21\u201325 (2011).","journal-title":"J. Med. Ultrason."},{"key":"89756_CR28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2021.100318","author":"MA Ucci","year":"2021","unstructured":"Ucci, M. A., Di Mascio, D., Bellussi, F. & Berghella, V. Ultrasound evaluation of the uterus in the uncomplicated postpartum period: A systematic review. Am. J. Obstet. Gynecol. MFM https:\/\/doi.org\/10.1016\/j.ajogmf.2021.100318 (2021).","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"89756_CR29","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1515\/jpm.2010.032","volume":"38","author":"S Frei","year":"2010","unstructured":"Frei, S., Kurmanavicius, J., Zimmermann, R. & von Mandach, U. Puerperal symphysis fundus distance: Normal values. J. Perinat. Med. 38, 173\u2013177 (2010).","journal-title":"J. Perinat. Med."},{"key":"89756_CR30","doi-asserted-by":"publisher","first-page":"085016","DOI":"10.1088\/1361-6560\/aab532","volume":"63","author":"IM Rosado-Mendez","year":"2018","unstructured":"Rosado-Mendez, I. M. et al. Quantitative assessment of cervical softening during pregnancy in the Rhesus macaque with shear wave elasticity imaging. Phys. Med. Biol. 63, 085016 (2018).","journal-title":"Phys. Med. Biol."},{"key":"89756_CR31","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1007\/s13244-016-0514-5","volume":"7","author":"C Bruno","year":"2016","unstructured":"Bruno, C., Minniti, S., Bucci, A. & Pozzi Mucelli, R. ARFI: From basic principles to clinical applications in diffuse chronic disease\u2014A review. Insights Imaging 7, 735\u2013746 (2016).","journal-title":"Insights Imaging"},{"key":"89756_CR32","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1109\/TMI.2012.2212450","volume":"31","author":"W-N Lee","year":"2012","unstructured":"Lee, W.-N. et al. Mapping myocardial fiber orientation using echocardiography-based shear wave imaging. IEEE Trans. Med. Imaging 31, 554\u2013562 (2012).","journal-title":"IEEE Trans. Med. Imaging"},{"key":"89756_CR33","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1002\/ar.a.20274","volume":"288A","author":"S Weiss","year":"2006","unstructured":"Weiss, S. et al. Three-dimensional fiber architecture of the nonpregnant human uterus determined ex vivo using magnetic resonance diffusion tensor imaging. Anat. Rec. A. Discov. Mol. Cell. Evol. Biol. 288A, 84\u201390 (2006).","journal-title":"Anat. Rec. A. Discov. Mol. Cell. Evol. Biol."},{"key":"89756_CR34","doi-asserted-by":"publisher","first-page":"e1009","DOI":"10.1259\/bjr\/76693739","volume":"85","author":"F Fiocchi","year":"2012","unstructured":"Fiocchi, F. et al. In vivo 3 T MR diffusion tensor imaging for detection of the fibre architecture of the human uterus: A feasibility and quantitative study. Br. J. Radiol. 85, e1009-1017 (2012).","journal-title":"Br. J. Radiol."},{"key":"89756_CR35","doi-asserted-by":"crossref","unstructured":"Gennisson, J.-L. et al. Shear wave elastography in obstetrics: Quantification of cervix elasticity and uterine contraction. In IEEE International Ultrasonics Symposium 2094\u20132097 (2011).","DOI":"10.1109\/ULTSYM.2011.0519"},{"key":"89756_CR36","doi-asserted-by":"publisher","first-page":"2446","DOI":"10.1080\/14767058.2016.1253057","volume":"30","author":"Y Masuzawa","year":"2017","unstructured":"Masuzawa, Y. & Yaeko, K. Uterine activity during the two hours after placental delivery among low-risk pregnancies: An observational study. J. Matern. Fetal Neonatal Med. 30, 2446\u20132451 (2017).","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"89756_CR37","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1016\/j.ultrasmedbio.2013.10.021","volume":"40","author":"C-Z Wang","year":"2014","unstructured":"Wang, C.-Z. et al. Influence of measurement depth on the stiffness assessment of healthy liver with real-time shear wave elastography. Ultrasound Med. Biol. 40, 461\u2013469 (2014).","journal-title":"Ultrasound Med. Biol."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-89756-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-89756-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-89756-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T08:27:14Z","timestamp":1670056034000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-89756-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,17]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["89756"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-89756-6","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,17]]},"assertion":[{"value":"29 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 April 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 May 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"10420"}}