Intrapartum ultrasonographic assessment of foetal occiput position a comparison with transvaginal digital examination during the second stage of labor

To compare between digital vaginal examination [DVE], transabdominal sonography [TAS] and transvaginal sonography [TVS] as regards accuracy and time requirements for determination of foetal occiput position during the second stage of labor. Prospective randomized blinded study. 120 laboring patients in the second stage of labor. An informed consent was obtained. A detailed sterile digital vaginal examination was performed immediately before transabdominal and transvaginal examinations. Each sonographer was blinded to the finding of the other as well as to the DVE finding. The findings of digital and ultrasonic examinations were compared with the actual position of the vertex, as determined by direct visualization at vaginal delivery after spontaneous restitution of the foetal head or at cesarean delivery. The foetal head position was assessed by determining the foetal occiput as "the time on a 12-hour clock" into eight categories. The findings of DVE and TAS were considered to be correct if the foetal occiput position was within +/- 45° of TVS finding. The time required by the three methods was recorded. Sensitivity, specificity and diagnostic accuracy of DVE, TAS, combined DVE and TAS and TVS [gold standard] in the determination of the foetal head positions in the second stage of labor were calculated. TVS diagnosed correctly the foetal head position in all cases [100% accuracy] when compared with the actual foetal head position at delivery and thus was considered as the gold standard. The accuracy of DVE in determining foetal head position in the second stage of labor was 72%, being higher for occiput anterior positions. DVE was inaccurate in 26.7% of cases, the majority of which were in occiput posterior positions and was unable to determine 5% of cases. The accuracy of TAS in diagnosing the foetal head position was 80.5%. TAS was inaccurate in 9.16% of cases, the majority of which were in the occiput anterior positions and was unable to determine 4.16% of cases. The accuracy of TVS was significantly higher than DVE and TAS [P= 0.001]. However, combining DVE and TAS increased the sensitivity and diagnostic accuracy than using either alone. The time required for determining foetal head position was significantly shortest for TVS in comparison to TAS or DVE [8.17 +/- 2.15 vs 29.4 +/- 2.81 or 22.27 +/- 3.59 seconds, P= 0.0001]. Transvaginal sonography is the preferred imaging method for the determination of foetal head position in the second stage of labor. However, combining DVE and TAS was more accurate in the assessment of the foetal head position than using either alone and can be used as an alternative to TVS

Helicobacter pylori infection and hyperemesis gravidarum is there a relationship?

To investigate any possible association between Helicobacter pylori infection [H. pylori] and hyperemesis gravidarum [HG] by using both H. pylori Stool Antigen [HpSA] test and H. pylori IgG Antibody [HpIgG Ab] serologic test. Prospective randomized study. One hundred thirty pregnant women in the first 16 weeks of pregnancy divided into two groups: 65 patients with HG [HG group] and 65 randomly selected asymptomatic pregnant women matched for age, parity, gravidity and gestational age with patients in HG group and formed the control group. Serum samples collected from cases were examined for HpIgG Ab by Chemiilluminescence on Immulite and feces samples were examined for HpSA by Helicobacter Antigen Quick test. Chi square [x[2]] test was used accordingly for statistical analysis. Positive HpSA test was detected in 47.7% of patients with HG and in 13.9% of asymptomatic cases, the difference was statistically significant [x[2] = 7.25, P=0.001]. Positive HpIgG Ab was found in 81.5% of patients with HG and in 69.2% of control women. The difference was not statistically significant [x[2]= 3.23, P= 0.07]. This study suggests an association between H. pylori infection and HG. HpSA test provides a more accurate tool for detection of active H. pylori infection than IgG Ab serologic test that recommends its routine use in patients with HG as well as in women who desire to become pregnant in the near future

Saline infusion sonography versus 3d ultrasound in evaluation of endometrial cavity

To compare the diagnostic accuracy of 3D ultrasonography with 2D saline infusion sonohysterography [SIS] in evaluation of intracavitary lesions with reference to hysteroscopy as the gold standard. Prospective cross sectional comparative study. 64 women [20 patients with infertility, 16 patients with recurrent pregnancy loss and 28 patients with abnormal uterine bleeding] with abnormal uterine cavity provisionally diagnosed by transvaginal ultrasound were included in the study. An informed consent was obtained from all patients. Patients were examined by 3D ultrasound followed by 2D SIS. Diagnostic office mini-hysteroscopy was done one or two days later. Sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and diagnostic accuracy were calculated for 3D ultrasound and 2D SIS as compared with the findings of hysteroscopy. The hysteroscopic findings were 7 septate uterus, 7 intrauterine adhesions [IUAs], 23 endometrial polyps and 27 submucus myomas. Both SIS and 3D ultrasound were equally accurate in diagnosing septate uterus [100% sensitivity and diagnostic accuracy]. 3D ultrasound was more accurate than SIS in the diagnosis of acquired intracavitary lesions as a whole [sensitivity 92.9% vs 89.4%, diagnostic accuracy 93.75% vs 90.6% for 3D ultrasound and SIS respectively]. SIS was more sensitive than 3D ultrasound for the diagnosis of IUAs [sensitivity 100% vs 85.7%, diagnostic accuracy 100% vs 98.4% for SIS and 3D ultrasound respectively] and endometrial polyps [sensitivity 100% vs 86.9%, diagnostic accuracy 100% vs 95.3% for SIS and 3D ultrasound respectively]. On the other hand, 3D ultrasound was more accurate than SIS in diagnosing submucus myomas [sensitivity 100% vs 77.7%, diagnostic accuracy 100% vs 90.6% for 3D ultrasound and SIS respectively]. 3D ultrasound and SIS are sensitive modalities for evaluation of uterine cavity abnormalities. Both were of equal diagnostic accuracy in diagnosing septate uterus. SIS was more accurate in the diagnosis of intrauterine adhesions and endometrial polyps while 3D ultrasound was more accurate in the diagnosis of submucus myomas

dimensional ultrasound evaluation of the uterine cavity before and after myomectomy in cases of multiple fibroids

The aim of this work was to evaluate the role of three - dimensional [3D] transvaginal ultrasonography [TVS] of the uterine body and cavity in cases of multiple myomas going to do myomectomy and its impact on the integrity of the cavity after myomectomy. The present study was carried on 42 patients with multiple fibroids planned for myomectomy. They were divided into two groups; 16 patients [group I] were examined before and within three months after myomectomy by transabdominal, conventional 2D and 3D TVS in multiplanar mode at the coronal view. 26 patients [group 2] who did myomectomies within three months were examined by 3D ultrasound only after the operation. In both groups, the uterus was evaluated for size, shape of the cavity, presence of intrauterine adhesions and any submucous myomas or polyps. The results of the present study showed that the two groups were comparable as regards the age, gravidity, parity and number of myomas diagnosed preoperatively [p>0.05]. Intraoperatively, fibroids were pure interstitial in 75% of patients in group [1] and 80.77% of patients in group [2], however, fibroids were combined submucous and interstitial in 25% and 19.23% of patients in group 1 and 2 respectively with insignificant difference between both groups [P > 0.05]. The uterine cavity was opened in 31.25% and 15.38% of patients of group 1 and 2 with significant difference between the two groups, [p<0.05]. Postoperatively, 3D TVS revealed normal uterine cavity in all patients of group 1 [100%] and in 88.5% of patients in group 2 with insignificant differences between the two groups, p> 0.05. Three patients in group 2 [11.5%] showed abnormal coronal view in multiplanar mode of 3D scan. Two patients showed intrauterine adhesions with cavity distortion in one of them. One patient showed missed submucous fibroid. Preoperative evaluation of the uterine cavity with 3D TVS in patients planed for myomectomy allows better identification of the position of the uterine fibroids, thus, providing surgeons with guidelines for easy removal of the fibroids and avoid distortion of the uterine cavity when it is opened. Also, postoperative 3D evaluation allows early postoperative diagnosis and management of operative complications and insures an intact uterine cavity for subsequent spontaneous pregnancy or pregnancy following assisted reproductive technology [ART]