Sonographic, hysteroscopic, and pathologic findings in patients with abnormal uterine bleeding

Abnormal uterine bleeding AUB is the cause of gynecological referral in about 50% of perimenopausal women. The main aim in investigating this condition is to exclude focal, premalignant, or malignant endometrial disease. This is achieved via sonographic, hysteroscopic, and pathologic examinations. To evaluate the sonographic, hysteroscopic, and pathologic findings in women with AUB in a new one stop clinic. Prospective, observational study of 240 premenopausal and 55 postmenopausal consecutive patients with abnormal uterine bleeding. All patients 35 years or more with AUB not related to pregnancy were included. Exclusion criteria included active pelvic infection, severe cardiopulmonary co morbidity, cervical cancer, and initiation of contraception within the last 3 months. All the patients had vaginal sonographic examination, office hysteroscopy, and endometrial biopsy on one stop bases. Diagnostic indices of the different methods. Endometrial biopsy was the gold standard for diagnosing hyperplasia or cancer and combined hysteroscopy and biopsy 'was the gold standard for focal lesion and global endometrial disease. For focal lesion vaginal ultrasound had 42% sensitivity, 87% specificity, 3.2 positive predictive value, and 0.67% negative predictive value. Office hysteroscopy had corresponding figures of 91%, 100%, 91, and 0.09 respectively. Endometrial biopsy had corresponding figures of 17%, 100%, 17, and 0.83 respectively. Office hysteroscopy is the gold standard for diagnosing endometrial focal lesions and combined VUS and EB failed to detect more than 50% of them. This makes that 14% of patients wrongly diagnosed of being free of endometrial focal lesion. So, OH should be included in the initial evaluation of patients with AUB

standard policy of use of WHO partograph in the active management of labor

This study evaluated the introduction of active standard management policy of labor in a large teaching hospital. In the first six months of the study, a partograph without preset lines was used, but acceleration was practiced without standard guidelines [Group I: 636 patients]. In the following six months, the WHO partograph with a present alert and action lines and an active management protocol were used [Group II: 630 patients]. There was a significant reduction of the duration of labor in group II and labors lasting more than 12 hours were reduced from 15% to 4.4% in primigravida and from 6.9% to 1.5% in multipara. The increased use of amniotomy to augment labor in group II led to a significant reduction in the use of oxytocin. The number of instrumental and abdominal deliveries also decreased. The frequency of babies with respiratory depression at birth was also reduced

Reliability of ultrasound in the assessment of cervical incompetence

This study included 40 pregnant women with cervical incompetence and 60 women with normal pregnancy. In normal pregnancy the mean internal os diameter was 11.5 +/- 3.0 mm during the 1st trimester and 14.5 +/- 3.2 mm during the 2nd trimester. In women with cervical incompetence these measurements were 17.9 +/- 3.6 mm during the 1st trimester [P < 0.001] and 20.1 +/- 3.4 mm in the 2nd trimester [P-< 0.001]. When a cut-off point of 15 mm was used as a threshold for diagnosing the condition in the first trimester, it produced a sensitivity of 87.5% and a specificity of 86.7% with a false negative rate of 12.5% and a false positive rate of 13.3%. In the 2nd trimester a threshold of 20 mm produced a sensitivity of 50% and a specificity of 96.7% false negative rate 29.3% and 7.7% false postitive rate. These false rates were higher than could be acceptable as a screening test for cervical incompetence

Fetal biophysical profile follow-up can safely prolong the conservative management of premature rupture of the membranes

This study aimed to evaluate the use of the biophysical profile scoring follow up to early predict the occurrence of intrauterine infection in cases of premature rupture of the membranes. This assisted the proper management of such cases. Follow up of 102 pregnancies of >/25 weeks complicated with premature rupture of the membranes were assisted with biophysical profile scoring, leucocytic count, and C-reactive protein detection. Amniotic fluid cultures were done, and at delivery neonatal cultures were obtained to diagnose cases with infection. The results showed that a biophysical profile of 6 or less was superior in the prediction of the occurrence of intrauterine infection that happened in 28 cases. Its value in the exclusion of non-infected cases led to pregnancy prolongation by an average of 1.5 weeks. Leucocytosis and C-reactive protein were of 1.5 weeks. Leucocytosis and C-reactive protein were less accurate in this respect. It was concluded that conservative management of pregnancies complicated with premature rupture of the membranes could be safely prolonged with the biophysical profile monitoring of these cases

Can the sonar accurately differentiate between a premature and a postmature fetus? an improved approach

When the last menstrual period is not known and the pregnant woman comes for examination in the last trimester, the sonologist faces the problem of dating that pregnancy. During that period the classic growth diameters [biparietal, femur, or abdominal diameters] can not accurately differentiate between a premature fetus and a post-mature one suffering from being small for dates. This study tried to find an answer for that problem. It included 120 pregnant women in the third trimester. The classic ultrasonic examination was done for each. In addition, three parameters [the distal femoral epiphysis [DFE], the proximal tibial epiphysis [PTE], and the grade of fetal intestinal maturity] were evaluated. It was found that when the DFE is more than 5 mm and the PTE is more than 4 mm with a grade 4 colonic maturity, that fetus is definitely not premature and his lung is mature with a corresponding L/S ratio more than 2. The accuracy of that combination gave a sensitivity and a specificity of 100% with no false positive or negative results. It was concluded that measurement of the distal femoral and proximal tibial epiphysis besides determination of the fetal colonic maturity are of value in estimating fetal lung maturity and could aid the decision of pregnancy termination if dating is not available. It should be routine measurements in fetal ultrasonic examination

comparative trial of magnesium sulphate and diazepam in the management of eclampsia

The objective of the study was to compare the use of diazepam and magnesium sulfate in the management of eclamptic cases. A total of 118 patients were randomly allocated to convulsion-control with either diazepam or magnesium sulfate. Vaginal delivery was planned if the cervix is ripe and delivery was expected within 4 hours, otherwise CS was performed after control of fits. Post delivery care took place in the Intensive Care Unit. The Apgar scores were less in the diazepam group than in the magnesium sulfate. There were two maternal deaths in the diazepam and no one in magnesium sulfate group. It was concluded that magnesium sulfate may be superior to diazepam in the management of eclampsia. An additional advantage is the absence of suppression of the maternal or fetal consciousness

use of nifedipine in the management of eclampsia and severe pre-eclampsia

The objective of the study was to evaluate the usefulness of nifedipine as an antihypertensive drug in the management of severe cases of preeclampsia and eclampsia. 260 patients [105 eclamptic and 155 with severe degree of hypertensive diseases of pregnancy [HDP], were treated with sublingual nifedipine as a first line antihypertensive drug. Eclamptic fits when present or impending were controlled with either diazepam or magnesium sulfate. Results indicated that there was a significant drop [p <0.01] in all parameters of blood pressure after nifedipine therapy. There was a strong correlation between the pre-treatment blood pressure and the magnitude of its reduction [p <0.01]. Fetal biophysical profile and heart rate tracings showed no deleterious effects of nifedipine. It was concluded that nifedipine therapy for eclampsia and severe hypertensive diseases of pregnancy is effective and safe for both mother and her fetus. It could be used as a first line antihypertensive in such cases

Fetal biophysical profile and perinatal outcome in high risk pregnancy

This prospective study was performed to determine the impact of fetal biophysical profile [BPP] on the perinatal outcome of the high risk pregnancies. Also, the study was designed to assess the efficiency and the accuracy of BPP for predicting abnormal fetal outcome measured by low 5-minute Apgar score, fetal distress in labor, small for gestational age infants and perinatal mortality. 204 patients were included in the study. All were monitored with biophysical profile scoring [non-stress test, fetal movements, tone, breathing movements and amniotic fluid volume]. The last test within one week of delivery was used for analysis. Clinical management was dependent on the results of this monitoring. Results indicated that fetal biophysical profile was a good test in predicting normal fetal outcome [specificity was 85.89%, negative predictive value 91.78%], however, the ability of BPP in predicting abnormal outcome is still questionable [sensitivity 64.7%, positive predictive value 45.83%]. The false positive rate of the BPP in terms of diagnosis of low 5-minute Agpar score was 73.47%, for fetal distress 68.89%, for IUGR 61.33%, for perinatal mortality 87.76%. When both the NST and FM were normal the perinatal mortality was zero. It was concluded that the use of the fetal BPP monitoring improved the perinatal mortality rate. The management protocol has to be refined based on the present results. Cases with multiple risk factors must be managed cautiously when the score results are equivocal, extending the period of observation may give clear decisions in such cases. Individual risk factors need evaluation of the individual variables of the BPP

Sonograhpic evaluation of fetal macrosomia

This study included 86 high risk pregnant patients who were classified as follows: 14 with diabetes mellitus [DM], 13 with iron deficiency anaemia, 13 with rheumatic heart disease, 13 with preeclamosia [PET], 10 with chronic hypertension, 15 with history of large birth weight babies and 7 with chronic nephritis, in addition a control group to 41 normal pregnant women. Macrosomia was found in 7.3% of the control group compared to 20.9% of the high risk group as a whole. The incidence of macrosomia among diabetic patients was very high reaching to 64.3% in the high risk group as a whole, the following parameters: EFW, FML, AC, HC/AC were of diagnostic value because of their reasonable sensitivities, i.e. 48.9%, 40.5%, 38.4% and 33.7% respectively. BPD and HC were not of diagnostic value because of their low sensitivities i.e. 11.1% and 20.5% respectively. All the mentioned parameters carried a high specificity. In diabetic macrosomia the sensitivity and the specificity of the different ultrasonic parameters were almost comparable to those of the high risk group as a whole. The false negative rate in the high risk group as a whole was relatively low, 12.5% compared to 57.2% in diabetic macrosomia. In conclusion, no single parameter can be used for detection of macrosomia in the different high risk groups. The ultrasonic parameters have their own limitations in detection of macrosomia because of their high false negative rates. Better ultrasonic parameters have to be developed and evaluated such as thigh thickness and subcutaneous fat assessment

Ultrasonic detection of intrauterine growth retardation [IUGR]

To test the reliability of ultasound measurements in the detection of IUGR, 86 high risk pregnancies and 41 normal controls were followed by sonar biparietal diameter, head circumference [HC] abdominal circumference [AC], femur length [FL], HC/AC ratio, FL/ACratio, amniotic fluid volume measurements and estimated fetal weights [EFW] were obtained within 10 days of delivery. The effectiveness of each ultrasound variable in the antenatal recognition of IUGR fetuses was assessed. AC was the most sensitive parameter [91.9%] followed by EFW [80.6%], however the positive predictive values were disappointing [28.5% and 36.1% respectively]. Other measurements were less accurate. In cases with chronic nephritis the growth pattern differed and the most sensitive parameter was the HC [60%]. This study establishes the limits of ultrasound derived growth variables in the antenatal identification of IUGR fetus