Accuracy of sonohysterography in detecting intrauterine pathology and in distinguishing endometrial polyps from submucosal myomas

To determine the accuracy of sonohysterography to detect intrauterine pathology and to distinguish endometrial polyps from submucosal myomas. 40 women with suspected intrauterine pathology that suggested a submucosal myoma or an endometrial polyp on transvaginal ultrasonography underwent sonohysterography followed by hysteroscopy. The final diagnosis was established by operative hysteroscopy and its guided biopsy. El-Minis University Hospital. Hysteroscopy confirmed 39 [97.5%] out of the 40 diagnoses of intracavitary lesions made on sonohysterography. In the remaining case a fibroid suspected to be submucosal was actually intramyometrial at hysteroscopy. Endometrial polyps were detected by sonohysterography in 16 cases, 14 [87.5%] of these cases showed polyps at hysteroscopy. The remaining two cases had submucous fibroids at hysteroscopy. Submucous myomas were also detected by sonohysterography in 20 cases, 18 [90%] of these were accurate, one was a polyp and one was intramyometrial myoma at hysteroscopy. There were 4 cases in whom sonohysterography has detected an intracavitary lesion but could not detect whether it was a polyp or a fibroid. Two of these cases were endometrial polyps and two were submucous myomas at hysteroscopy. In only 8.3% of cases was a fibroid diagnosed incorrectly by sonohysterography to be a polyp or vice versa. The nature and site of the mass could be predicted accurately by sonohysterography in 80% of the studied women. Taking hysteroscopy as a gold standard for the detection of endometrial polyps and submucosal myomas, sonohysterography showed a sensitivity of 82.3%, a specificity of 91.3%, a positive predictive value of 87.5%, a negative predictive value of 87.5% and a diagnostic accuracy of 87.5% in detecting endometrial polyps compared with a sensitivity of 81.8%, a specificity of 88.8%, a positive predictive value of 90%, a negative predictive value of 80% and a diagnostic accuracy of 85% in detecting submucosal myomas. Sonohysterography is an accurate tool in detecting intrauterine pathology and in distinguishing endometrial polyps from submucosal myomas. In addition, it is easy to perform, well accepted by the patient and inexpensive

Association of bacterial vaginosis with adverse pregnancy outcome

Objective was to examine whether there is a relationship between bacterial vaginosis, premature rupture of membranes [PROM] and preterm labor [PTL]. Two hundred pregnant women at less than 34 weeks gestation were screened for bacterial vaginosis. The diagnosis of bacterial vaginosis [B.V] was based on vaginal pH >/- 4.5 and gram stain of vaginal smears. The occurrence of [PROM] and [PTL] was recorded for each case. Setting: El- Minia University Hospital. The prevalence of [B.V] among healthy pregnant women, women with [PROM] and those delivering prematurely was [13/125 = 10.4 percent], [7/23=30.43 percent] and [14/52= 26.73 percent] respectively. Women with bacterial vaginosis were found to be more likely to develop PROM and preterm labor when compared to healthy pregnant women [P-value = 0.0026 and 0.0030] respectively. Bacterial vaginosis [B.V] occurs in a significantly higher proportion of women with adverse pregnancy outcome compared to those with healthy pregnancy. Bacterial vaginosis should be thought of when dealing with a case of adverse pregnancy outcome especially if it is of unknown origin

Transvaginal sonographic evaluation of the cervix and lower uterine segment in women with threatened preterm delivery

The purpose of this study was to evaluate the role of transvaginal ultrasonography of the cervix and lower uterine segment for the prediction of preterm delivery in women presenting with threatened preterm delivery. 50 pregnant women with threatened preterm delivery were clinically evaluated by digital and transvaginal ultrasonographic examinations. The ultrasonographic parameters evaluated included length, the presence of endocervical funneling, and lower uterine segment thickness. The diagnostic indexes and predictive values of these ultrasonographic parameters were compared to determine the best ultrasonographic parameter for prediction of preterm delivery. El- Minia University Hospital. The preterm delivery rate was 38%. As regards the transvaginal ultrasonographic parameters used in this study, significant differences were found between preterm and term delivery for the presence of funneling [percentage 63.1% vs 32.2%, P < 0.01], cervical length [mean values 19.49 +/- 4.73 mm vs 30.35 +/- 5.51 mm, P < 0.001] and anterior lower uterine segment thickness [mean values 5.82 +/- 1.34 mm vs 9.24 +/- 3.04 mm, P < .01] respectively. In contrast, there were no significant differences in cervical dilatation and effacement between preterm and term delivery [P > 0.05 for each]. In comparing the diagnostic indexes end predictive values of the ultrasonographic parameters used in this study, the cervical length had the highest diagnostic indexes and predictive values for preterm delivery

Evaluation of endometrial thickness by transvaginal ultrasonography in women with postmenopausal bleeding

To determine the diagnostic value of transvaginal ultrasonography in the detection of endometrial abnormalities in women with postmenopausal bleeding. Study 150 women with postmenopausal bleeding were clinically evaluated by transvaginal ultrasonography and curettage. The endometrial thickness as measured by transvaginal ultrasonography was compared with the histopathological diagnosis of the curettage specimens. El-Minia University Hospital. Women receiving hormone replacement therapy [n= 30] with a normal endometrium had a mean endometrial thickness of 5.22 +/- 3.74 mm [n=16] and women receiving hormone replacement therapy with an abnormal endometrium had an endometrial thickness of 11.2 +/- 6.6mm [n=14]. The corresponding figures for women who did not use hormone replacement therapy [n=120] were 4.44 +/- 2.16 mm [n=63] and 14.63 +/- 8.9 mm [n=57] respectively. The mean endometrial thickness of atrophic endometrium, hyperplasia, polyp, cancer and proliferative / secretory endometrium were each 3.09 +/- 1.67 mm, 11.76 +/- 6.98 mm, 10.87 +/- 4.71 mm, 21.95 +/- 8.09 mm and 4.52 +/- 1.88 mm respectively. At a cutoff limit of 5mm for endometrial thickness, the sensitivity of transvaginal ultrasonography for detecting a histologically abnormal endometrium was 91.5%, the specificity 86%, the positive predictive value 85.5% and the negative predictive value 91.8%. Transvaginal ultrasonography with measurement of endometrial thickness is a safer and a non invasive outpatient procedure which has the advantage of not only predicting endometrial abnormality but also and perhaps more importantly, excluding pelvic pathology