MRI diagnostic value in pregnant patients with acute abdominal and pelvic pain

The use of ultrasonography during pregnancy provides a tremendous amount of valuable information about fetal and maternal well-being. However, in some cases the image quality may be poor. Excellent soft-tissue contrast resolution and multiplanar imaging capability, in combination with lack of ionizing radiation, make magnetic resonance imaging a promising modality for use in pregnant women. The purpose of this study was to show the usefulness of magnetic resonance imaging in the evalluation of pregnant women with acute abdominal or pelvic pain. in Alyamamah Maternity Hospital and Hammadi General Hospital. prospective observational study. 25 pregnant patients were referred for magnetic resonance imaging examination because of acute abdominal or pelvic pain with insufficient ultrasonographic findings between September 2003 and August 2005. Multiplanar multisequence magnetic resonance imaging of the abdomen and pelvis were obtained in each patient. The magnetic resonance imaging interpretations were compared with follow-up medical, surgical and obstetric final diagnosis to determine the correctness of the interpretation. Correlation of magnetic resonance imaging interpretations with final diagnosis showed correct identification of disease entities in all but one patient with acute appendicitis, falsely diagnosed by magnetic resonance imaging as normal findings. Magnetic resonance imaging showed an accuracy rate of 96% in diagnosing acute abdominal and/or pelvic pain in pregnant women with unclear ultrasound diagnosis. The Specificity and positive predictive value were 100% but sensitivity was 94.7% and negative predictive value was 85.7 Abdominal and pelvic diseases in pregnant patients can be well evaluated by magnetic resonance imaging, when it is an available modality. It can provide important information that may influence a patient's treatment options, which range from operating emergently to delaying treatment until after delivery. Magnetic resonance imaging should be reserved for cases in which results of ultrasonography are inconclusive and patient care depends on further imaging.

Clinical, sonographic and doppler flow effects of levonorgestrel releasing intrauterine system in menorrhagic women

Menorrhgia is one of the commonest gynecological problems, yet medical treatment has been disappointing. Levonorgestrel released from an intrauterine system suppresses endometrial growth and causes marked reduction of menstrual loss menorrhagic women. To study the mechanism by which Levonorgestrel releasing intrauterine system, [Mirena, Schering], can control menorrthagia by evaluating its effect on blood flow in the uterine and subendometrial region, and endometrial thickness using color Doppler. Setting: in Alyamamah Maternity Hospital and Hammadi specialized Hospital. Design: prospective observational study. Patients and thirty two patients were included in this study complaining of menorrhagia. Levonorgesttrel releasing intrauterine system, [Mirena, Schering], was inserted. Menstrual blood loss was measured using the pictorial blood loss assessment chart, pulsatility index of uterine artery, subendometrial blood flow and endometrial thickness were measured before and six months after insertion. Levonorgestrel releasing intrauterine system reduced menstrual blood loss. There was no significant difference in pulsatility index of uterine artery before and after insertion, but, there was highly significant reduction in the blood flow in the subendomentrial region. Also, there was highly significant reduction in the endometrial thickness. Through its local effect on endometrium, Levonorgestrel releasing intrauterine device a good option for treatment of menorrhagia so, it is advisable before resorting to any invasive surgical maneuver

Antiphospholipid autoantibodies in women with unexplained infertility and recurrent first trimester abortion

To assess the presence of antiphospholipid auto-antibodies [aPLA] in women who are suffering from unexplained infertility or recurrent first trimester abortion to evaluate their pathogenic role in these disorders. King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia. Between January 2004 and June 2005, a prospective study was carried out on 20 women with unexplained infertility [group A], 20 women with recurrent first trimester abortion [group B], compared to 20 healthy women as control [group C]. IgA, IgM, and IgG against phospholipids were detected in the sera of all cases. It was found that IgA, IgM, and IgG levels were significantly higher in groups A, B when compared to group C. Venereal Disease Research Laboratory [VDRL] test was positive in 2 [10%] cases in group A and in 3 [15%] cases in group B but it was negative in group C. Lupus anticoagulant [LA], tested by the activated partial thromboplastin time [APTT], was prolonged in 4 [20%] group A and 3 [15%] cases in group B. From the results of this study it can be concluded that reproductive performance may be affected by the abnormal presence of antiphospholipid auto-antibodies

Can Saline Contrast Sonohysterography Replace Hysteroscopy in Diagnosing Intracavitary Uterine Lesions in Infertile Women?

Patients with some mullerian duct anomalies and other intracavitary uterine pathology are known to have a higher incidence of infertility and repeated pregnancy loss. The role of imaging is to detect, and distinguish surgically correctable lesions from inoperable forms. A large overlap exists when comparing uterine cavitary configuration using imaging techniques. Much of the final diagnosis was based on laparoscopic or hysteroscopic findings. Assess ment the accuracy of saline contrast Sonohysterography [SCSH] in reducing diagnostic hysterocopy for diagnosing uterine abnormalities in women with infertility. 87 infertile women with suspected uterine cavity pathology as diagnosed by hysterosalpingography or trans-vaginal sonography were included in this study. Patients underwent SCSH followed by diagnostic hysteroscopy as a gold st and ard diagnostic procedure. SCSH has a good diagnostic value compared with hysteroscopy. It has a sensitivity of 94.6%, specificity of 76.9%, positive predictive value of 95.8% negative predictive value of 71.4% and an accuracy rate of 91.9%. The best accuracy rate of SCSH was for diagnosing myoma and endometrial hyperplasia, with accuracy rate of about 100%. For polypoidal lesions, SCSH gives an accuracy rate of 97.1%. The diagnostic accuracy of SCSH in cases of uterine malformation was the least [75%].SCSH as a preliminary diagnostic tool is a simple and fast procedure that can minimize cost and skilled endoscopic techniques in developed countries with limited resources