ABSTRACT
Ectopic pregnancy continues to be a major cause of maternal morbidity and mortality. A dramatic increase in incidence over time has been reported in several countries. The advent and wide application of ultrasound has greately improved the possibility of non- surgical diagnosis of ectopic pregnancy . Images obtained by the higher frequency and better resolution transvaginal ultrasound scan [TVS] probes facilitates the earlier diagnosis of ectopic pregnancy. The addition of Doppler ultrasound have revolutionised the non-invasive diagnosis of ectopic pregnancy. Patients presenting to AI-Yarmouk Teaching Hospital with clinical suspicion of ectopic pregnancy were evaluated using TVUS. Colour flow imaging was performed and resistance indices [PIs] of the artery blood flow were calculated. The pulsatility indices [PIs] of both uterine arteries were also measured and serum beta-hCG was quantitated. The Doppler flow results were correlated with surgical findings at laparoscopy or explorative laparotomy. Forty-seven women were enrolled .Six patients with intrauterine gestation were excluded. Tubal pregnancy was diagnosed by TVUS in 28 of 32 patients with ectopic pregnancy, while 30 of 32 patients were diagnosed by colour Doppler sonography. Colour flow in the trophoblastic tissue was detected in 59.3% of the tubal pregnancies, and the mean [ +/- SD] RI of the trophoblastic flow was [0.49 +/- 0.1]. The PIs tended to decrease at higher beta- hCG levels. The average PI of the uterine arteries was [2.29 +/- 0.3]. The PIs of the ipsilateral uterine arteries were significantly lower than the contralateral ones. The sensitivity of colour Doppler in the diagnosis of ectopic pregnancy was [93 .8%] with accuracy of [85 .4%] Colour imaging is a good supplementary diagnostic tool in modern management of ectopic pregnancy. The addition of colour Doppler flow imaging to transvaginal sonography allows increased sensitivity in the detection of ectopic pregnancy
ABSTRACT
To determine the role of endovaginal ultrasound of the cervix as a predictor of preterm delivery in patients with premature uterine contractions. A study carried out in Al-Yarmouk Teaching Hospital, Department of Obstetric and Gynecology, in co-operation with Department of Radiology, college of medicine, Al- Mustansiriya University, Baghdad - Iraq. Prospective study carried on one hundred pregnant women with a gestational age ranging from [24 - 34 weeks] complaining of premature uterine contractions, with intact membranes and less than 3 cm cervical dilatation. We measured the endocervical canal length, the presence of funneling, funnel length, funnel width and cervical index. This results showed that cervical index had the strongest correlation with the risk of subsequent preterm birth: value of> 0428 can detect 70.6% of cases of preterm birth, and for each [0.1 unit] increase in the cervical index there is 2.4 times increase in the relative risk of ending in preterm birth. Coming next in importance was the endocervical canal length, as for each [1mm] decrease in it is length the relative risk of ending in preterm birth increases by 1.4 times. The presence of funneling with a funnel width >/= 5 mm increases the risk of preterm birth by 5.3 times compared to those with no funneling
Conclusion: Transvaginal sonography of the cervix has important role in the prediction of patients at high risk for preterm delivery and those in false preterm labor, and from all the cervical biometric measurements, cervical index exhibited higher diagnostic and predictive values, coming next in importance is the endocervical canal length