Ultrasound studies of the uterine venous circulation

This thesis investigated the ultrasound assessment of the uterine venous circulation and the clinical relevance to its associated pathologies, namely pelvic varicosities and thrombosis. The interand intra-observer variability in the measurement of venous diameter and classification of blood flow was assessed and a good level of agreement was found. Factors influencing venous diameter were also studied in women with normal pelvic organs and those with pelvic pathology. In both studies, the uterine veins could be consistently identified and measured in all subjects. Women who were pre-menopausal and of a higher parity had larger venous diameters in both groups. Moreover, the presence of pelvic pathology led to increased venous diameters compared to normal pelvic organs. This formed the basis of developing a reference range for uterine vein diameters. Additionally, there was no difference in venous diameter between women with and without pain. Transvaginal ultrasound was also used to assess the prevalence and short-term outcomes of uterine venous plexus thrombosis (UVPT). The prevalence was estimated to be 3%, with parity, premenopausal status, recent surgery, varicose veins and a positive family history of venous thromboembolism all being significantly associated with UVPT. In addition, adenomyosis was the main ultrasound finding that was significantly related to the presence of UVPT. The resolution rate was 55% overall, with number of clots present being the significant factor to affect resolution. Receiving medical management for UVPT did not increase resolution.