Vascular and morphological changes in uteri exposed to diethylstilbestrol in utero

Transvaginal-ultrasound
This 1996 study is particularly helpful in understanding the mechanisms of repeated miscarriage in the DES exposed because it suggests that vascular participation may be responsible. Sagittal image of the uterus showing some of the different measurements taken (day 5 of the menstrual cycle) Measurement 1 = maximum uterine length; measurement 2 = maximum uterine thickness; measurement 3 = maximum uterine cavity length.

Abstract

Transvaginal ultrasound studies of vascular and morphological changes in uteri exposed to diethylstilbestrol in utero, Human reproduction (Oxford, recipe England), NCBI PubMed PMID: 8981149, 1996 Nov. Full text: Human Reproduction vol 11 no 11 pp 2531-2536, oxfordjournals, 1996.

The aim of this prospective study was to establish complementary data of uteri exposed to diethylstilbestrol (DES) in utero for transvaginal analysis and vascularity changes during the menstrual cycle.

A total of 28 women with DES-exposed uteri were compared with 60 non-exposed women. Transvaginal ultrasound and colour Doppler imaging were performed on days 5 and 22 of the menstrual cycle. Uteri were measured on sagittal and transverse scans. Uterine length, width, thickness and uterine cavity length and width were measured.

  • Uterine volume and uterine cavity area were calculated. DES-exposed uterine volume was equal to 31.84 +/- 3.37 cm3.
  • The cavity area of DES-exposed uterus was equal to 35.85 +/- 3.93 cm2.
  • Cervix length of DES-exposed uterus was significantly smaller than that of non-exposed uterus.
  • The uterine artery pulsatility index (PI) of DES-exposed uterus was significantly higher than that of normal uterus. Blood flow remained stable throughout the menstrual cycle.
  • The PI of DES-exposed uterus remained stable during the menstrual cycle, as in non-exposed uterus, and it decreased during the luteal phase. This lack of modification in vascularity of DES-exposed uterus may explain miscarriages and obstetric complications such as intrauterine growth retardation or pre-eclampsia.

The data may have implications for the assessment of reproductive status and the design of future studies on disorders of implantation in DES-exposed uterus. Based on these results, we now propose a study by Doppler transvaginal sonography and hysterography for all patients exposed in utero to DES Colour Doppler echography gives an appreciation of the implantation chances of DES patients. A high PI may in part explain repetitive miscarriages. We suggest low doses of aspirin for these patients from the beginning of pregnancy.

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