Transvaginal ultrasonographic measurement of endometrial thickness in the detection of endometrial abnormalities.

A prospective clinical study was performed to determine an appropriate cut-off point value of endometrial thickness for the detection of endometrial abnormalities among women with abnormal uterine bleeding. Two hundred and forty nine women with abnormal uterine bleeding who had indication for fractional uterine curettage were enrolled. Endometrial thickness was measured by transvaginal ultrasonographic examination in each patient before performing fractional uterine curettage on the same day. The results were compared with the final histological diagnosis from fractional uterine curettages. Endometrial abnormalities were identified in 69 out of 249 cases (27.7%) as hyperplasia in 57 cases(22.9%) and endometrial cancer in 12 cases (5.0%). The appropriate cut off point value of endometrial thickness was 4 mm below which no abnormal endometrial was found. This cut-off point yielded a sensitivity of 100%, a specificity of 18.3%, a positive predictive value of 31.9%, a negative predictive value of 100%, a false positive rate of 68.2%, a false negative rate of 0% and an accuracy of 40.5%. In conclusion, endometrial thickness measurement by transvaginal ultrasonography is a simple diagnostic method for identifying endometrial abnormalities in women with abnormal uterine bleeding. The cut-off point value of below 4 mm can identify endometrial abnormalities, thus unnecessary fractional uterine curettage can be avoided.

Validity of frozen section in cervical conization.

Objective: To evaluate the validity of pathological diagnosis of cervical cone specimens prepared by frozen section compared with paraffin section. Study design: Diagnostic test evaluation. Setting: Pathology division, Department of Obstetrics and Gynecology, faculty of Medicine Siriraj Hospital, Mahidol University. Methods: Cervical cone specimens from 78 patients who underwent cold knife conization at Siriraj Hospital from October 1997 to September 1998 were processed by frozen section technique and the pathological diagnoses were made immediately. The remaining cone tissue from each specimen was processed to produce permanent paraffin sections for a final diagnosis. The frozen and permanent pathological diagnoses were compared. Results: The pathological diagnosis from frozen section was in complete agreement with the permanent section in 60.26% of patients. When the subjects were divided into three groups; normal and CIN I, CIN II-III and MIC and invasive cancer, the Kappa analysis for agreement of the pathological diagnoses between the two methods was 0.46 (fair agreement). For the diagnosis of invasive cancer by frozen section, the sensitivity, specificity, positive and negative predictive value, false negative and false positive were 62.5, 97, 71.4, 95.8, 37.5 and 1.9%, respectively. There were three cases of invasive cancer on permanent paraffin section which were diagnosed by frozen section as MIC in tow cases and CIN III in the other. Conclusion: Frozen section evaluation of a cervical cone specimen carries only a moderate degree of agreement with permanent paraffin section. For the diagnosis of invasive cancer in this study, frozen section has a low sensitivity and a high false negative rate. The diagnosis of microinvasive cancer was subject to significant error. The diagnosis of microinvasive cancer by frozen section needs additional careful review of the permanent section.

Rudimentary horn pregnancy.

A case of pregnancy in rudimentary horn is presented, and a discussion of this rare and potentially catastrophic phenomenon follows. The correct diagnosis was only made at laparotomy for acute abdominal pain when the patient was 16 weeks pregnant. Definite clinical palpation of the pregnant uterus together with ultrasonographic evidence of a viable fetus misled the diagnosis. When this condition is suspected the diagnosis may be aided by ultrasound searching of the uterus.

Rupture of the gravid uterus.

Rupture of the gravid uterus, the most tragic obstetric emergence, is said to occur infrequently nowadays due to efficient antenatal and intranatal intensive care. Forty-six incidents of uterine rupture were reviewed among 197, 254 deliveries during 1978-1987, that is 1 per 4288 deliveries. There were 20 cases of previous scarred rupture, 18 traumatic, and 8 cases of spontaneous ruptures. A rupture of a previously scarred uterus had an approximately equal number of classical and low transverse scars. Maternal and fetal prognoses were much better with low transverse scars. A rupture of the previously unscarred uterus was a more dramatic event. It tended to be longitudinal and complete, and fetal prognoses were relative poor. About 28% of the ruptures were diagnosed prior to delivery, 33% were noticed at operation, and 39% were observed only after delivery and diagnosed by manual uterine exploration. The majority of cases were managed by hysterectomy rather than repair. Under special circumstances, the uterus may be repaired for subsequent reproduction. Maternal mortality was 2.2% and fetal loss 42.6%, 37% suffering from asphyxia at birth. Preventative measures, early diagnosis, and prompt treatment are emphasized.

Acute appendicitis in pregnancy and puerperium : A review of 30 cases.

The diagnosis of appendicitis is frequently difficult in the pregnant woman. As the pregnancy progresses, the difficulties in the diagnosis increase so much that treatment is delayed. This causes danger to both mother and fetus. A review of 30 cases of appendicitis in pregnancy and the puerperium over a 5-year period (1982-1986), at Siriraj Hospital is presented. There was no maternal mortality nut some morbidity. As for the fetus, an adoration rate of 22.2% was found in the second trimester, where as the cases in the third trimester had a prematurely rate of 41.6%. It is considered that early operation will decrease complications and is the treatment of choice at all stages of pregnancy and the puerperium. Tocolytic agents may have a beneficial effect on the course of the pregnancy and should be given prophylactically to all patients beyond 16 weeks to prevent uterine contractions and premature labour.