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The evaluation of labor is the clinical process by which variables are analyzed in order to determine whether the patient is in labor, which by definition includes regular uterine contractions that increase in frequency and intensity, associated with dilation cervical. This is done through the anamnesis and physical examination, specifically through the evaluation of contractions and vaginal examination, the latter is intended to specify the degree of dilation, cervical effacement that the patient presents and also allows to a certain degree, establish the presentation, attitude and variety of position in which the fetus is located. From this premise, it is proposed that vaginal examination, since it is operator dependent, is not an objective evaluation, therefore, there is a need to reach consensus on the evaluation, and in order to carry it out, evaluation with ultrasound is proposed, which has as a purpose to objectify the variety of position and presentation of the fetus. Due to the above, this article aims to capture the knowledge that is currently possessed about the uses and methodology that intrapartum ultrasound presents.
Subject(s)
Humans , Female , Pregnancy , Umbilical Arteries/diagnostic imaging , Cesarean Section , Placenta/diagnostic imaging , Pregnancy Outcome , Ultrasonography, Prenatal , Ultrasonography, Doppler , Middle Cerebral Artery/diagnostic imagingABSTRACT
Background: Menstrual irregularities and abnormal heavy menstruation account for up to 26-35% of women attending Gynecological outpatient Department. Abnormal Uterine Bleeding (AUB), it is more common at extremes of age endometrial hyperplasia occurs in 5-10% of patients with post-menopausal bleeding out of which atypical hyperplasia has 26-32 % risk of having malignancy in future. Therefore, endometrial sampling for histopathology is important in the assessment of abnormal uterine bleeding is mandatory. Our study was conductive to know the effectiveness of pipelle type devices, versus Dilatation and curettage in obtaining quality endometrial tissue for histopathological examination.Methods: The study was undertaken in Department of obstetrics and gynaecology along with department of Pathology at Rajarshi Chhatrapati Shahu Maharaj, government medical college, Kolhapur after getting approval from the Hospital Committee on Clinical Research and Ethical Committee of the institution, during the period from October 2016 to March 2017 (six months). Total number of subjects included in study is Hundred after taking into consideration of inclusion and exclusion criteria.Results: The ease of doing procedure was much easier as compared to D&C and the Tissue sample obtained for histopathological examination were as par D&C. It was concluded that histopathology report was available in 92 of the 100 pipelle samples and 93 of 100 D&C samples. It was also, observed that increased endometrial thickness was not always associated with adequate tissue diagnosis.Conclusions: Pipelle is simple, affordable, patient friendly can be easily performed with minimal training, which can be performed in Outpatient Gynaecological Department. The diagnostic value and positive predictive value of Pipelle is at par with conventional D&C. So, pipelle can be recommended for all perimenopausal patients with AUB to rule out various, premalignant and malignant conditions of the endometrium.
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Background: The attitude of the fetal head during labour significantly influences the progress and outcome of delivery and is mainly diagnosed by vaginal examination during labour. The aim of the study was to quantify the extent of deflexion of the fetal head by measuring the fetal occiput spine angle (OSA) through transabdominal ultrasonography in the first stage of labour and to determine whether the fetal OSA can predict the mode of delivery.Methods: We conducted a prospective observational study on 145 nulliparous uncomplicated singleton pregnant women without occiput-posterior position of the fetus during active labour. The OSA was measured as the angle between the two tangential lines to the occipital bone and the vertebral body of the first cervical spine, during active labour and monitored until delivery. Intra- and interobserver reproducibility of the OSA measurement and the correlation between the OSA and mode of delivery were also evaluated.Results: For the study population, the mean value of the OSA measured in the active phase of the first stage was 124.2±11.5⁰. The OSA measurement showed excellent intraobserver agreement (r = 0.82; 95% confidence interval [95% CI] 0.70-0.80) and fair-to-good interobserver agreement (r = 0.62; 95% CI 0.51-0.71). The mean OSA was significantly less for the group of patients who required conversion to cesarean section due to labour arrest (n=32) as compared to those who had vaginal delivery (n=113) (116.25±9.2⁰ versus 126.53±11.1⁰, P<0.01). An OSA of ≥121° was associated with vaginal delivery in 80.5% (91/113) of women, whereas 87.5% (28/32) of the women who delivered by cesarean section had an OSA <121⁰.Conclusions: Measurement of the OSA, by sonography is feasible, reproducible and an objective tool to assess the degree of fetal head deflexion during labour and to predict the mode of delivery.
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Objective:To study the curative efficacy of transabdominal ultrasound-guided Lauromacrogol combined with radiofrequency ablation in the treatment of fibroid and its effects on the serum estradiol (E2),luteinizing hormone (LH),follicle stimulating hormone (FSH) levels.Methods:90 patients of fibroid who were treated from June 2014 to June 2015 in our hospital were selected as the research objects.According to random number table,those patients were divided into the observation group (n=45) and the control group (n=45).Both groups were routinely examined before operation,the control group was treated with transabdominal ultrasound radiofrequency ablation,while the observation group was treated with transabdominal ultrasound-guided percutaneous radiofrequency ablation combined with radiofrequency ablation,Then visual analogue scale (VAS),menstrual volume,uterine fibroid volume,uterine volume,E2,LH,FSH levels,myoma symptoms and quality of life score,curative effect were compared between two groups.Results:After treatment,the total effective rate of observation group was significantly higher than that of the control group [95.55％(43/45)vs75.55％(34/45)] (P＜0.05);the VAS score,menstrual volume were significantly lower than those of the control group[(1.05± 0.23)score vs.(3.62± 0.50)score,(192.35± 22.10)mL 1 vs.(236.54± 24.57)mL](P＜0.05);The myoma volume,uterine volume were significantly lower than those of the control group[(32.13± 13.20)cm3 vs(40.81± 14.11)cm3,(101.93± 9.89)cm3 vs(118.36±11.20)cm3](p＜0.05);the serum E2,LH,FSH levels were significantly lower than those before treatment,but there was no difference between the two groups (P ＞0.05);the fibroid symptoms score was significantly lower than that of the control group [(4.50 ± 1.02)score vs.(10.34± 2.21)score] (P＜0.05),the quality of life score was significantly higher than that of the control group [(95.36± 14.29)score vs.(80.84 ±14.06)score] (P ＜ 0.05).Conclusion:Transabdominal ultrasound-guided lauromacrogol combined with radiofrequency ablation could enhance the efficacy of fibroid,which might be related to the decrease of serum levels of E2,LH,and FSH.
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Benign prostatic hyperplasia (BPH) is the non-malignant enlargement of the prostate. Estimation of Prostate volume and dimensions contribute significantly to the management of BPH. Correlations between the trans-abdominal and trans-rectal ultrasound methods in estimating prostate volume and dimensions were studied with variable results. Ninety-one consecutive patients of 50 years or older with were scanned by Trans abdominal and transrectal sonographs (TA&TRUS) at the same session after obtaining the consent. All the scans were performed on a single ultrasound machine. The volume and dimensions of the prostate obtained by both methods were compared and correlated using Pearson correlation coefficient. The data was analysed further in groups based on volumes and ethnicity. Twenty-four patients were also scanned by other consultant radiologist and the data was analysed to compare the interobserver variations. Results: The mean age of the patients was 66.03±10.41 years. The mean prostate volume for ninety one patients by TA & TRUS was 44.4±35.1 ml and 46.2±34.7 ml, respectively (r = 0.965, p<0.001). Among the total patients 42 were of East Indian (EI) origin, 45 were of Caribbean African (CA) origin and 4 were of mixed race. The mean prostate volume of EI race by TA & TRUS was 35.3±23.3 and 38.9±25.9 ml respectively(r = 0.950, p<0.001). The mean prostate volume of CA race by TA & TRUS was 50.8±39.4 and 51.0±38.5 ml, respectively (r = 0.967, p<0.001). The mean prostate volume of observer A and observer B by TA & TRUS was 43.5±28.8 and 45.8±25.9 ml (r = 0.953, P<0.001) and 46.6±39 and 46.9±27.4 ml (r = 0.877, p<0.001) respectively. Conclusion: Strong correlation between TA & TRUS estimation of prostate volume and dimensions for volumes up to 100ml found in our study offers TAUS as a cost effective, less invasive, quick and well tolerable alternative to TRUS. TRUS however may be a reasonable choice for accurate measurements in larger (>100 millilitres) prostates, this needs to be further investigated by a larger sample size.
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Objective To study a noninvasive method in evaluating the bladder outlet obstruc-tion (BOO) and bladder function in patients with benign prostatic hyperplasia (BPH) based on the transabdominal ultrasonic measurement of intravesical prostatic protrusion (IPP). Methods The da-ta of 206 first visit BPH patients with lower urinary tract symptoms (LUTS) were retrospectively re-viewed. Patients were divided into 2 groups based on the degree of IPP: the research group with IPP greater than 10 mm(n=78) and control group with IPP 10 mm or less(n=128). Clinical data and uro-dynamic findings of the 2 groups were analyzed to find the clinical significance of IPP. Resells In-creased prostate volume(73.7±35.9 ml vs 62.8±36.5 ml), serum prostate specific antigen(1.81± 0.67 ng/ml vs 1. 64±0.36 ng/ml), post-voiding residual urine volume (PVR)(290.2±217.2 ml vs 228.2±167.9 ml), incidence of acute urine retention(33.3% vs 18.0%)and bladder trabeculation (23.1% vs 11.7%)had signicant differences between the 2 groups (P<0.05). Positive correlation was found between IPP and prostate volume as well as PVR (r=0.401 and 0.342, respectively). In the urodynamic study, significantly lower peak flow rate (Qmax) (7.6±4.1 ml/s vs 9.1±3.6 ml/s), higher incidence of detrusor overactivity (82.1% vs 17.2%) and low bladder compliance (35.9% vs 12.5%)were found in research group (P<0.01). In addition, maximum detrusor pressure(109.8± 84.9 cm H2O vs 84.9±44.1 cm H2O) and BOO index (BOOI) (75.2±27.1 vs 65.9±34.6) were significantly higher in the research group (p<0.05). The correlation study showed that r between IPP and Qmax, Pdet. max and BOOI was-0.284, 0.252 and 0.456, respectively. The incidence of acute urinary intention recurrence was higher in research group than in control group (64.3% vs 23.5%) (P<0.05). Conclusions IPP is a useful predictor in evaluating BOO and detrusor function. BOO and impaired detrusor function in obvious IPP patients are more severe. The obvious IPP pa-tients, especially those presenting with acute urine retention, may benefit more from early surgical in-tervention.
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OBJECTIVE: To assess the visualization rate and size of the cavum septum pellucidum (CSP) by transabdominal sonography in normal fetuses in the second and third trimesters of pregnancy. METHODS: The CSP was prospectively researched and measured using an axial transventricular plane in 308 consecutive uncomplicated singleton pregnancies between 15 and 41 weeks of gestation. RESULTS: The CSP was seen in 42.5% of cases at 15 weeks, 84.78% at 16-17 weeks, 100% at 18-37 weeks and 81.25% at 38-41 weeks. Compared to biparietal diameter (BPD), the visualization rate was 35.29% between 31 and 32 mm, 47.8% between 33 and 34 mm, 84% between 35 and 43 mm, 100% between 44 and 88 mm and 87.5% between 89 and 101 mm. Mean CSP width was 5.5+/-1.7 mm (range 2-9 mm). The CSP width was increased with gestational age and BPD, but with a slight decrease around term. CONCLUSION: In normal fetuses the CSP should always be visualized between 18 and 37 weeks, or with a BPD of 44-88 mm. Failure to observe the CSP in this interval, or possibly the presence of a large CSP, may indicate abnormal cerebral development and warrant further investigation. Conversely, absence of the CSP prior to 18 weeks, or later than 37 weeks, is a normal finding.