150 ABSTRACT: Objectives: To explore normal uterine contractile function across the menstrual cycle using a novel quantitative ultrasound method. Materials and Methods: This multicentre prospective observational study took place in 3 European centres from 2014 - 2022. Uterine contraction frequency (contractions/minute), amplitude, direction (Cervix-to-fundus; C2F, Fundus-tocervix; F2C), velocity, and coordination were investigated. Features were extracted from transvaginal ultrasound recordings (TVUS) using speckle tracking. Women of ≥18 years of age, premenopausal with normal, natural menstrual cycles were included. A normal cycle was defined as: regular (duration 28 ± 2 days), no dysmenorrhea, no menometrorrhagia. 4-minute TVUS were performed during the menstrual phase (M), mid-follicular (MF), late follicular phase (LF), early luteal phase (EL) and/or late luteal phase (LL). Of the 96 recordings available from 64 women, 70 were suitable for inclusion in the analysis Results: Contraction frequency (for the anterior wall) and velocity (for the anterior uterine wall in the F2C direction) were highest in the LF phase and lowest in the M and LL phases (1.61 vs. 1.31 and 1.35 contractions/min, p<0.001 and 0.81 vs. 0.67 and 0.62mm/sec, p<0.001 respectively).. No significant difference was found for contraction amplitude. Contraction coordination (simultaneous contraction of the anterior and posterior walls in the same direction) was least coordinated in the MF phase (p=0.002). Conclusions: This is the first study that measures uterine contraction features in healthy women during the natural menstrual cycle on TVUS in an objective manner. Likewise, it introduces contraction coordination as a specific feature of uterine peristalsis. We confirm differences in uterine contractility across the menstrual cycle, with highest activity seen in the LF phase, and lowest in the LL phase. Keywords: Uterine Peristalsis, TVUS, Menstrual Cycle, Speckle Tracking, Uterine Contractile Function
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