Acceptability and accuracy of saline infusion sonohysterography in women with postmenopausal bleeding

To validate the diagnostic efficacy of saline infusion sonohysterography [SIS] in the evaluation of uterine cavity, in women with postmenopausal bleeding and endometrial thickness >/= 5 mm. Cross-sectional study. Military Hospital, Rawalpindi, from March 2005 to July 2008 and Combined Military Hospital, Multan, from September 2008 to June 2009. Seventy seven eligible participants included women complaining of postmenopausal bleeding were included; out of whom 69 completed the procedure satisfactorily. Pain scores during procedure were assessed to determine patient acceptability. Following saline infusion sonohysterography all patients also underwent an outdoor pipelle endometrial biopsy in a one-stop postmenopausal bleed clinic. Findings of sonohysterography were compared with hysteroscopy/ hysterectomy specimen. Majority of the patients 34 [49.2%] experienced no pain during the procedure, 51 [74%] women had a positive SIS and the findings were negative in 18 [26%] patients. The commonest abnormal finding on SIS was focal thickening in 23 [32%] and endometrial polyp in 12 [17%] cases. Saline infusion hysterosonography picked up 3 cases of false positive polyps [5.8%] and missed a case of submucous fibroid near cervix [1.8%]. Upon comparison of findings of hysteroscopy and hysterectomy in 53 cases, there was complete agreement in a total of 43 [88%] cases. The sensitivity of sonohysterography was 92% and specificity was 78%. All the ladies with abnormal SIS had diagnostic or therapeutic procedures and finally only 24 [35%] were managed on conservative follow-up. Normal SIS led to conservative management in 16 [88%].Sonohysterography in combination with endometrial biopsy is a useful technique useful for the evaluation of postmenopausal bleeding. Patient acceptability and diagnostic capability is high and it reduces demand for hysteroscopy

Efficacy of cervical cerclage in sonographically shortened cervix in women at moderate risk of preterm delivery

To compare the efficacy and safety of cervical cerclage following objective shortening of cervix by endovaginal ultrasound with elective cerclage in women at high risk of midtrimester miscarriage or preterm delivery. Quasi experimental. Place and Duration of study: Military Hospital Rawalpind., January 2005 to July 2008. Material and Cases of elective cerclage were matched for maternal age, previous history of single mid trimester loss or preterm delivery or preterm rupture of membranes before 34 weeks with women who had selective cerclage if cervical length became < 25mm. All patients were followed up till delivery and outcomes in the two groups were assessed in terms of duration of gestation and neonatal survival. 23 cases of elective cerclage were matched to 24 cases of selective cerclage. Transvaginal ultrasound indicated cerclage was performed in 50% of the control group due to decrease in cervical length. There was no significant difference in the number delivering before 25 weeks 2[8.6%] versus 3[12.4%], those delivering at gestation>35 weeks 17 [73%] versus 16[66.6%][p=0.94]. Neonatal survival was also similar 18[78%] versus 19[79%] p=0.96. Cervical length as measured by TVS is the best available technique for predicting preterm labour. In women deemed moderately high risk on the basis of history, sonographic cervical length indicated cerclage appears to reduce cerclage rates without comprising pregnancy outcome

Intrauterine growth restriction; relationship between abnormal umbilical artery doppler and adverse apgar score

To compare fetal outcome in normal umbilical artery Doppler findings to abnormal umbilical artery Doppler findings in pregnant women with fetal growth restriction Main outcome measures Umbilical artery Doppler studies apgar score at 1 minute and apgar score at 5 minutes after delivery. Cross sectional, comparative study. Department of Obstetrics and Gynaecology, Military Hospital and Combined Military Hospital, Rawalpindi From Jan 2005 to Jan2007. Patients with fetal growth restriction between 28 to 37 weeks of pregnancy were selected, in whom diagnosis was confirmed by ultrasonography. All patients were followed up with umbilical artery Doppler studies. The study group consisted of 48 women [group I], where the umbilical artery waveform was compromised. The outcome in these was compared with an equal number of controls, where growth restricted fetuses had normal Doppler waveforms [group II]. The mean age of patients in group I was 26.9 years and in group II was 28.6 years Fetuses with abnormal umbilical artery Doppler findings had higher incidence of maternal gestational hypertension and oligohydramnios. Rate of emergency cesarean section for fetal distress was also higher in this group. Growth restricted babies with abnormal umbilical artery Doppler waveforms had lower apgar scores. In babies with normal Doppler studies 91.6% had apgar score above 7 at 5 minutes after birth. In babies with raised RI 78.1%, in babies with abscent end diastolic flow 54.5% and in babies with Reversed end diastolic only 20% had apgar score above 7 at five minutes after birth. The difference was statistically significant [P=0.001]. Umbilical artery velocimetry can distinguish the group of growth restricted fetuses at risk of poor apgar. Growth restricted fetuses with normal Doppler studies are at a lower risk than those with abnormal Doppler findings in terms of poor apgar score