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