Utilidad de la ecografía transvaginal para la predicción de parto prematuro luego de un cerclaje cervical: revisión de la literatura

Introducción : el tratamiento de la insuficiencia cervical es el cerclaje cervical. Pese a este tratamiento el riesgo de parto prematuro persiste elevado en mujeres con insuficiencia cervical. La mejor forma y utilidad del seguimiento ecográfico de mujeres cercladas es desconocida. El objetivo de esta revisión fue evaluar la capacidad pronóstica de la ecografía transvaginal para predecir riesgo de parto prematuro luego de un cerclaje cervical. Materiales y métodos : realizamos una revisión sistemática de la literatura incluyendo estudios que evaluaran el valor pronóstico de la ecografía transvaginal luego de un cerclaje cervical, para predecir parto prematuro. Resultados : incluimos 14 estudios en la revisión. El parámetro más frecuentemente asociado con parto prematuro fue la longitud cervical posterior al cerclaje, aunque con capacidad predictiva moderada. El punto de corte para definir pacientes en riesgo varió entre 15-28 mm. Conclusión : la longitud cervical disminuida posterior a un cerclaje se asocia con mayor riesgo de parto prematuro. No se ha establecido un valor de corte único ni la utilidad clínica del seguimiento ecográfico de mujeres cercladas.

Introduction : The management of cervical insufficiency involves a cervical cerclage. Despite this treatment, patients with cervical insufficiency remain at high risk of preterm delivery. The best method and utility of ultrasound monitoring for women with cervical cerclage is unknown. The objective of this revision was to evaluate the prognostic performance of ultrasonographic cervical assessment to predict preterm labor after a cervical cerclage. Material and methods : We conducted a systematic literature review, including studies that assessed the prognostic value of transvaginal ultrasound after cervical cerclage in predicting premature birth. Results : We included 14 studies in our review. The most frequently evaluated parameter was cervical length after the cerclage, although with only moderate predictive capacity. The length used to define prognosis varied from 15 to 28 mm. Conclusion : Short cervical length after a cerclage is associated with a higher risk of preterm delivery. A single cutoff value and the clinical utility of ultrasound monitoring for women with cervical cerclage have not been established.

Teratoma de ligamento redondo, reporte de caso y revisión de la bibliografía / Round ligament teratoma, case report and literature review

Resumen ANTECEDENTES: El teratoma es un tumor casi siempre benigno, con una amplia variabilidad en su localización, extremadamente rara, en el ligamento redondo. CASO CLÍNICO: Paciente de 30 años, con antecedente de un embarazo a término. En la revisión ecográfica se reportó una lesión quística paraovárica izquierda de 46 x 35 mm, sin componente sólido, graso ni calcificaciones. En el examen ginecológico se palpó una masa por encima del útero, orientada hacia el lado izquierdo, no dolorosa. El resto del examen físico trascurrió sin otras alteraciones. La impresión diagnóstica inicial fue de teratoma abdominopélvico sustentada en la ecografía transvaginal en la que los ovarios se observaron normales, con una masa de ecogenicidad mixta de 50 x 40 x 46 mm, con áreas ecolúcidas y ecogénicas de intensidad variable hacia la fosa iliaca izquierda superior, sin contacto con el ovario. El ligamento redondo se seccionó a ambos lados de la masa y se extrajo sin complicaciones; el reporte histopatológico fue de: teratoma quístico maduro. CONCLUSIONES: El ligamento redondo es una localización infrecuente de los quistes dermoides que debe considerarse en los diagnósticos diferenciales de las masas pélvicas; es susceptible de tratamiento quirúrgico por vía laparoscópica.

Abstract BACKGROUND: Teratoma is an almost always benign tumor, with a wide variability in its location; its location in the round ligament is extremely rare. CLINICAL CASE: 30-year-old patient, with a history of a full-term pregnancy. On routine ultrasound examination, a 46 x 35 mm left paraovarian cystic lesion was reported, with no solid, fatty component or calcifications. In the gynecological examination a mass was palpated above the uterus, oriented to the left side, non-painful. The rest of the physical examination passed without other alterations. The initial diagnostic impression was of abdomino-pelvic teratoma supported by transvaginal ultrasound in which the ovaries were normal, with a mass of mixed echogenicity of 50 x 40 x 46 mm, with echolucent and echogenic areas of variable intensity towards the left superior iliac fossa, without contact with the ovary. The round ligament was sectioned on both sides of the mass and removed without complications; the histopathologic report was: mature cystic teratoma. CONCLUSIONS: The round ligament is an infrequent location of dermoid cysts that should be considered in the differential diagnoses of pelvic masses; it is amenable to surgical treatment laparoscopically.

Evaluation of current disinfection practice of transvaginal ultrasound probes in a Philippine Tertiary Referral Hospital: A comparative study on the performance of manual reprocessing methods

Objectives@#There are no standard infection control regulations in transvaginal ultrasound probe disinfection followed in the most prominent local public tertiary referral hospital. Likewise, no studies have evaluated the efficacy of the current method that uses an inexpensive multipurpose antiseptic spray solution. This study aims to evaluate the efficacy of the current practice of manual disinfection of TVS probes and compare it with the performance of an acceptable manual reprocessing method. @*Methods@#A prospective, randomized, controlled study was carried out using a crossover, quasi-experimental design, collecting 119 total samples from the ultrasound transducers before (35 samples) and after disinfection with two manual reprocessing methods, either a locally manufactured multipurpose antiseptic spray (A-Septic® Multipurpose Antiseptic Spray) that is currently used for disinfection or Mikrozid Sensitive®, a ready to use impregnated wipes (42 samples each arm). Disinfection efficacy was evaluated based on microbial culture results. @*Results@#Before disinfection, bacterial growth was observed in 77.1% (27/35) of the probes. After disinfection, 80.95% (34/42) remained contaminated with the antiseptic spray and 21.43% (9/42) with the wipes. The cultures revealed many environmental and pathogenic bacterial isolates, including Burkholderia, Staphylococcus, Acinetobacter, Diphtheroids, and Pseudomonas. @*Conclusions@#The currently used method for disinfecting transvaginal transducers in the division is not adequate for decontamination and decreasing the risk of cross contamination among patients. The results call for aggressive disinfection measures and highlight the need to update local standards and formulate and institutionalize these recommendations.

Perceptions and Willingness to Undertake Transvaginal Sonography by Women at the Sally Mugabe Central Hospital, Zimbabwe

ntroduction: The acceptability and willingness to undergo Transvaginal Sonography by the patients havegeneratedmixedreactionsindifferenthealthcare settings. There is little that is known aboutZimbabweanwomen'sperceptionsandwillingness to undergo Transvaginal Sonography and there are no specific guidelines to guide its use. Aim:To evaluate the perception and willingness to undergo Transvaginal Sonography among women attending Obstetrics and Gynaecology clinic at SallyMugabeCentralHospitalinHarare, Zimbabwe.Methods:Across-sectionalsurveyusingastructured questionnaire was conducted between 1 and 30 June 2022. Atotal of 170 women attending the obstetrics and gynaecology clinic at Sally MugabeCentralHospitalwereselectedbyconsecutive sampling to participate in the study.Results:The majority of women (81.76%) had no previous TVS experience, with an equally large proportion (60.84%) not having seen a TVS probe before. Most of the women would prefer female sonographers (85.37%) to conduct the examination. In addition, about 58% of the participants concurred that a chaperone should be present. Less than half of the females (47.93%) were eager to have a TVS done on them. Equally, just 45% of the females said they would encourage others to have a TVS scan. The difference in willingness to undergo a TVS study stratified by employment status was statistically significant (chi-square 7.26, p = 0.03). Conclusion: Our study findings revealed that a large proportion of females had no previous TVS experience, with an equally large proportion not having seen a TVS probe before. Only a sizeable proportion of women were willing to accept TVS provided it is conducted by female sonographers and or in the presence of a chaperone. The findings underscoretheimportanceofeducationandawareness of the benefits of TVS in terms of diagnosis on maternal health outcomes, in the Zimbabwean population.

MRI and Transvaginal Ultrasound Findings of Atypical Polypoid Adenomyoma: A Case Report / 中国医学科学杂志(英文版)

Atypical polypoid adenomyoma (APA) is an uncommon type of polypoid characterized by fibroid stroma and endometrial glands. It occurs mostly in premenopausal women and rarely in postmenopausal women with irregular vaginal bleeding. In our current case, a 76-year-old woman presented with irregular vaginal bleeding. The final pathological diagnosis of the mass was APA. APA is not easy to diagnose before surgery. On the one hand, there was no obvious particularity in imaging features and clinical features, especially for uncomfortably identifying endometrial cancer. On the other hand, APA has a pedicle, attaching to any part of the uterine cavity, which can cause pseudocoel between the mass with the uterine cavity wall. So, when it comes to getting the pathological tissue in the absence of hysteroscopy, it is easy to access to the pseudocoel and obtain endometrial tissue rather than the pathological tissue of the mass. Therefore, preoperative imaging examination is of great significance diagnosis way of thinking to clinicians for APA. In the meantime, pathological tissue of APA can be obtained by hysteroscopy in visual conditions.

Métodos de estudio de pacientes con sangrado uterino posmenopáusico: recomendaciones prácticas / Study methods of patients with postmenopausal uterine bleeding: practical recommendations

Resumen El sangrado uterino posmenopáusico se define como aquel sangrado que ocurre después del cese definitivo de la menstruación en la etapa reproductiva de la mujer como consecuencia de la claudicación biológica de los ovarios, o como un sangrado no esperado en mujeres con terapia de reposición hormonal sistémica de la menopausia. Representa el 5% de las consultas ginecológicas y, si bien su origen suele ser por causas benignas, puede requerir una evaluación minuciosa para descartar patologías malignas del endometrio. El objetivo de este trabajo es establecer un flujograma diagnóstico basado en la evidencia para la evaluación de las pacientes con sangrado uterino posmenopáusico.

Abstract Postmenopausal uterine bleeding is defined as the bleeding that occurs after the last menstruation due to loss of ovarian function, or a non-scheduled bleeding in patients with hormonal therapy. It represents 5% of the gynecologic visits, and even though its origin is often benign, it requires a thorough evaluation to discard malignant diseases. The objective of these review is to propose a diagnostic algorithm based on the available evidence for the evaluation of patients with postmenopausal uterine bleeding.

Accuracy of Transvaginal Ultrasound in the Diagnosis of Intrauterine Lesions / Acurácia da ultrasonografia tranvaginal no diagnóstico de lesões intrauterinas

Abstract Objective To evaluate the accuracy of transvaginal ultrasound in the diagnosis of intrauterine lesions, using hysteroscopy as the gold standard. Methods This was a prospective observational study with 307 patients. All patients underwent hysteroscopy after a previous transvaginal ultrasound to compare the results. The hysteroscopy was performed by experienced examiners, and transvaginal ultrasounds were performed in various public and private services, which is reflective of routine healthcare practices in obstetrics and gynecology. The sensitivity, specificity, and accuracy of the transvaginal ultrasound were calculated using hysteroscopy as the gold standard. The level of agreement between the two exams was calculated using the Kappa test. Results Themean age was 56.55±12.3 years. For endometrial polyps, we observed a sensitivity of 39.8%, specificity of 72.7%, accuracy of 52.8%, and Kappa index of 0.11 (p=0.025). For fibroids, the sensitivity was 46.7%, specificity was 95.0%, accuracy was 87.9%, and Kappa index was 0.46 (p<0.001). For endometrial thickening, the sensitivity was 68.7%, specificity was 41.7%, accuracy was 47.6%, and Kappa index was 0.06 (p=0.126). For endometrial atrophy, we found a sensitivity of 6.7%, specificity of 99.3%, accuracy of 90.2%, and Kappa index of 0.10 (p=0.006). For the other findings, the sensitivity was 15.6%, specificity was 99.6%, accuracy was 87.3%, and Kappa index was 0.23 (P<0.001). Conclusion Our study demonstrated a low level of accuracy of transvaginal ultrasound for the diagnosis of endometrial lesions, when performed by a non-experienced professional. Thus, it is important to consider the use of hysteroscopy to avoid unnecessary and inappropriate treatments.

Resumo Objetivo Avaliar a acurácia do ultrassom transvaginal para o diagnóstico de lesões intrauterinas, tendo a histeroscopia como padrão de referência. Métodos Foi realizado um estudo observacional prospectivo em 307 pacientes, submetidas à histeroscopia após ultrassonografia prévia para comparação dos resultados. A histeroscopia foi realizada por duas médicas com experiência, e os exames de ultrassom foram realizados em diversas fontes, públicas ou privadas, como ocorre no cotidiano da assistência à saúde em nosso meio. Foram avaliados sensibilidade, especificidade e acurácia, tendo a histeroscopia como padrão-ouro. O nível de concordância foi avaliado pelo teste de Kappa. Resultados A idade média foi de 56,55±12,3 anos. Os resultados para pólipo endometrial foram: sensibilidade 39.8%, especificidade 72,7%, acurácia de 52,8%, e índice Kappa 0,11 (p=0,025). Para mioma, sensibilidade 46,7%, especificidade 95,0%, acurácia 87,9%, e índice Kappa 0,46 (p<0,001). Para espessamento endometrial, sensibilidade 68,7%, especificidade 41,7%, acurácia 47,6%, e índice Kappa de 0,06 (p=0,126). Para atrofia, sensibilidade 6,7%, especificidade 99,3%, acurácia 90,2%, e índice Kappa 0,10 (p=0,006). Para outros achados, sensibilidade 15,6%, especificidade 99,6%, acurácia 87,3%, e índice Kappa 0,23 (p<0,001). Conclusão Nosso estudo demonstrou baixo nível de acurácia da ultrassonografia transvaginal para o diagnóstico de lesões endometriais, quando realizada por profissional não experiente. Assim, é importante considerar o uso da histeroscopia para evitar tratamentos desnecessários e inadequados.

The impact of routine transvaginal ultrasound measurement of the cervical length on the prediction of preterm birth: A retrospective study in a tertiary hospital / O impacto da medição por rotina do comprimento cervical por ecografia transvaginal na predição de parto pré-termo: Um estudo retrospetivo num hospital terciário

Abstract Pretermbirth (PTB) is a major obstetric problem associated with high rates of neonatal morbidity and mortality. The prevalence of PTB has not changed in the last decade; thus, the establishment of a screening test and effective treatment are warranted. Transvaginal ultrasoundmeasurement of the cervical length (TUCL) has been proposed as an effective method to screen pregnant women at a higher risk of experiencing PTB. Objective To evaluate the applicability and usefulness of second-trimester TUCL to predict PTB in a cohort of Portuguese pregnant women. Methods Retrospective cross-sectional cohort study including all singleton pregnant women who performed their second-trimester ultrasound (between weeks 18 and 22þ6 days) from January 2013 to October 2017 at Centro Hospitalar Universitário São João. Results Our cohort included 4,481 women. The prevalence of spontaneous PTB was of 4.0%, with 0.7% occurring before the 34th week of gestation. The mean TUCL was of 33.8mm,and percentiles 3, 5 and 10 corresponded toTUCLs of 25.0mm, 27.0mmand 29.0mmrespectively. The multiple logistic regression analysis, including maternal age, previous PTB and cervical surgery showed a significant negative association between TUCL and PTB, with an odds ratio (OR) of 0.92 (95% confidence interval [95%CI]: 0.90-0.95; p<0.001). The use of a TUCL of 20mm is the best cut-off, when compared with the 25-mm cut-off, improving the prediction of risk. Conclusion The present study showed an inverse association between TUCL and PTB, and that the inclusion of other risk factors like maternal age, previous PTB and cervical surgery can improve the screening algorithm. Furthermore, it emphasizes that the TUCL cut-off that defines short cervix can differ according to the population.

Resumo O parto pré-termo (PPT) é uma grande complicação obstétrica que se associa a elevadas taxas de morbimortalidade neonatal. A sua prevalência não tem alterado na última década, sendo esencial determinar uma forma de rastreio e tratamento eficaz. A medição ecográfica transvaginal do comprimento cervical tem sido proposta como um método eficaz de rastreio das grávidas com risco aumentado de PPT. Objetivo Avaliar a aplicabilidade e utilidade da medição ecográfica transvaginal do comprimento cervical na previsão de PPT numa amostra de grávidas portuguesas. Método Estudo de coorte retrospectivo incluindo todas as grávidas com gestação unifetal que realizaram ecografia do 2° trimestre (de 18 a 22semanasþ6 dias) no Centro Hospitalar Universitário de São João entre janeiro de 2013 e outubro de 2017. Resultados A nossa amostra incluiu 4.481 mulheres. A prevalência de PPT espontâneo foi de 4,0%, sendo que 0,7% ocorreu antes das 34 semanas de gestação. A média do comprimento cervical por ecografia transvaginal foi 33,8mm, e os percentis 3, 5 e 10 da amostra corresponderam a comprimentos cervicais de 25,0mm, 27,0mm e 29,0mm, respetivamente. A regressão logística múltipla, que incluiu a idade materna, PPT anterior e antecedentes de conização, demonstrou uma associação estatisticamente significativa entre o comprimento cervical e o risco de PPT, com um risco relativo de 0,92 (intervalo de confiança de 95% [IC95%]: 0.90-0.95; p<0.001). A utilização de um valor de referência de comprimento cervical de 20mm, quando comparado com o valor de referência de 25 mm, melhora a previsão do risco de PPT. Conclusão Este estudo demostra uma associação entre o comprimento cervical avaliado por ecografia tranasvaginal e o risco de PPT, e salienta que a inclusão de outros fatores de risco, como idade materna, PPT anterior e antecedentes de conização podem melhorar o algoritmo de rastreio. Realça ainda que o valor de comprimento cervical utilizado para definir "colo curto" varia de acordo com a população em estudo.

Non-surgical diagnosis and management of chronic ectopic: A case report / The Health Sciences Journal

@#Chronic ectopic pregnancy is a rare form of ectopic gestation that contributes to the increased maternal morbidity and mortality in the frst trimester of pregnancy. Diagnosis is often challenging as it presents with subtle clinical signs and symptoms, imposing the need for surgical exploration and management. This is a case of a 27-year-old gravida 3 para 2 (2002) who presented with vaginal bleeding of three weeks duration, was hemodynamically stable with unremarkable physical examination fndings. The diagnosis of a chronic ectopic pregnancy was established with a conservative, non-surgical approach through the combination of clinical symptoms, transvaginal sonography, and b-hCG monitoring. Management was likewise conservative with multiple dose methotrexate chemotherapy, eventually yielding a decrease in b-hCG from 80.0 mIU/mL to 1.0 mIU/mL.

Association of 2D and 3D transvaginal ultrasound findings with adenomyosis in symptomatic women of reproductive age: a prospective study

OBJECTIVE: To evaluate the association of two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound (TVUS) findings with adenomyosis symptoms. METHODS: This prospective study conducted between January and December 2018 enrolled 78 women aged 18 to 40 years with abnormal uterine bleeding (AUB), infertility, and/or pelvic pain. All patients underwent 2D and 3D TVUS. Signs of adenomyosis on TVUS were identified according to the consensus of the Morphological Uterus Sonographic Assessment group. RESULTS: The prevalence of adenomyosis on TVUS was 55.12%. Patients with adenomyosis were older (p=0.002) and had more dysmenorrhea, AUB, and endometriosis than those without adenomyosis. When comparing the presence of symptoms with each adenomyosis feature, on 2D TVUS, severe dyspareunia was significantly associated with the presence of a poorly defined junctional zone (JZ) (p=0.023) and on 3D TVUS, patients with AUB had a more irregular (p=0.003), poorly defined (p=0.028), and interrupted JZ (p=0.011). After logistic regression analysis, signs of adenomyosis on TVUS remained significantly associated only with age over 30 years (OR: 1.2; 95% CI: 1.0-1.2) and AUB (OR: 7.65; 95% CI: 2-29). Patients with diffuse adenomyosis were older and presented with more infertility and AUB than patients with focal or no adenomyosis. CONCLUSION: The findings of adenomyosis by 2D and 3D TVUS showed association with age and AUB. 3D TVUS alterations in the JZ were associated with AUB and dyspareunia. Diffuse adenomyosis was associated with older age, a greater prevalence of infertility, and AUB.

Diagnostic value of saline infusion sonohysterography for detecting endometrial lesion and comparing it with hysteroscopy and histopathology in postmenopausal bleeding

Background: Different diagnostic tools are available to evaluate endometrial lesion such as hysteroscopy, sonohysterography and transvaginal ultrasound. The present study aimed to determine the diagnostic value of saline infusion sonohystrography (SIS) in diagnosis of intrauterine lesions in women with postmenopausal bleeding (PMB).Methods: This cross-sectional study recruited 100 married women with chief complain of PMB referred to gynecologic clinics at the Zenana hospital, Jaipur from March 2019 to February 2020. All participants were in the post-menopausal period that showed abnormal endometrial thickness (>4 mm) or endometrial focal lesions through transvaginal ultrasound. Participants underwent SIS, hysteroscopy plus endometrial biopsy in order. The gold standard was the histopathology of endometrial specimen reported by pathologist.Results: Mean age of women was 57.14 years. It is evident that sensitivity, specificity, positive predictive value and negative predictive value of SIS for the diagnosis of endometrial atrophy was 79.16%, 100%, 100% and 83.87% respectively which is higher than that of hysteroscopy and equivalent to histopathology. SIS and hysteroscopy are equally efficient in diagnosing endometrial polyp and submucous fibroid. And are better than histopathology. Histopathology is better than SIS and hysteroscopy for the diagnosis of endometrial proliferation.Conclusions: Findings show that, SIS probably is a proper method for detecting endometrial focal lesion including polyps and myomas. Future studies may help to define further advantages of this procedure.

A comparative study between magnetic resonance imaging and transvaginal sonography for evaluation of uterine fibroid using histopathology as a gold standard

Background: Uterine fibroids constitute a substantial bulk of patients presenting to Gynaecology department. Many newer imaging modalities have evolved for their correct evaluation, but in a developing country like India, ultrasound is still being used as a screening as well as diagnostic modality. So, this study was done to compare ultrasound and magnetic resonance imaging for evaluation of uterine fibroids in terms of their sensitivity, specificity Trans vaginal  and positive predictive value using Histopathology as a gold standard so as to improvise on current clinical practices in this country.Methods: An ethically approved prospective study was done upon 50 patients with suspected uterine masses at SMS Hospital Jaipur. All included patients underwent Trans vaginal Ultrasound (TVS) and Magnetic resonance imaging (MRI) and were accordingly treated surgically. Histopathology report was traced postoperatively. Data was collected and subjected to various statistical tests including Cohen’s kappa.Results: Most of the patients were <50 years and presented with complains of pain abdomen. Among total 50 cases, the sensitivity of TVS and MRI was 44% and 92%, specificity was 96% and 88%, PPV was 91.67% and 88.46%, NPV was 63.16% and 91.67% respectively, kappa was 0.40 and 0.80 i.e. agreement between TVS and MRI v/s HPE was 40% and 80% respectively. The diagonal agreement between transvaginal USG and MRI, was 63%.Conclusions: TVS is a good screening modality but MRI is definitely better for proper characterization and localization of fibroids enabling clinicians to select the most appropriate management in everyday clinical practice.

Co-relation of endometrial thickness by transvaginal sonogram with histopathology pattern in abnormal uterine bleeding: a study from South India

Background: Under normal circumstances, a woman's uterus sheds a limited amount of blood during each menstrual period (around 80 ml). Bleeding that occurs erratically or excessive menstrual bleeding is called abnormal uterine bleeding (AUB). The causes of AUB are many and varied. Initial investigations include transvaginal ultrasound and histopathologic assessment of the endometrium. Objective of this study was to evaluation of endometrial thickness with trans-vaginal ultrasound and its correlation with histopathology by dilatation and curettage in abnormal uterine bleeding. To determine the efficacy of transvaginal ultrasound in evaluating the endometrial thickness. To correlate the endometrial thickness by transvaginal ultrasound with endometrial histopathology in women with AUB.Methods: It is a retrospective observational study. All reproductive and perimenopausal age group women who underwent dilatation and curettage for abnormal uterine bleeding during the period June 2014-June 2016 was taken and analyzed and correlated with their endometrial thickness measured with Transvaginal ultrasound.Results: Around 478 patients who underwent endometrial sampling over a period of two years were analyzed. Maximum number of patients were in the fourth decade and the overweight category 36.6%. Proliferative endometrium was the most common histopathologic picture (44.76%). Detection of precancerous lesions were-5.87% and endometrial cancer was 1.05%.Conclusions: An ET of 8 mm and above gave 100% sensitivity and negative predictive value for precancerous and cancerous lesions.

Transvaginal ultrasound compared with serum β-hCG level for diagnosis of ectopic pregnancy in symptomatic patients

Background: Ultrasonography (US) is the most important imaging modality in detecting both intrauterine and ectopic pregnancies. The aim of this study was to comparison transvaginal ultrasound with serum β-hCG level for diagnosis of ectopic pregnancy (Ep) in referred women to Ardabil city hospital.Methods: In this cross-sectional study, a total of 207 women with diagnosis of Ep were enrolled during 2018. All women underwent transvaginal US in the first 24 hours and US done by an expert radiologist. Serum levels of β-hCG at first 24 hours and the time gap between US examination and last menstrual period (LMP) were compared between women with positive and negative US findings. Data collected by a checklist and analyzed by statistical method in SPSS version 21.Results: The primary US were positive in 174 women (84.1%) and negative in 33 women (15.9%). The mean of time gap between US and LMP in women with diagnosed EP was significantly higher than other women (median, 42 days versus 45 days, p=0.042). Also, the mean of serum level of β-hCG had significant difference between two groups. In logistic regression analysis results showed that the time gap between US and LMP hadn’t significant impact on EP diagnosis. The best discriminative zone was set at a serum β-hCG level of 105.65 mIU/ml with a sensitivity and specificity of 82% and 27%, respectively and the under-ROC area was 58%.Conclusions: According to our findings, the median serum level of β-hCG in women with undiagnosed Ep were significantly lower than women with correct diagnosis of Ep but the mean and median of time gap between US and LMP in women with diagnosed EP was more than women without Ep. Also, the proposed discriminative zone for serum level of β-hCG in our study is different from the previous studies.

Spontaneous pregnancy rate after saline infusion sonogram treat done under high pressure

Background: Failure to achieve conception after 12 months of regular unprotected intercourse is defined as infertility. The aim of this study was evaluating SIS done under high pressure (SIStreat) as a treatment procedure, for relieving simple tubal obstruction and on cumulative pregnancy rate in infertile women.Methods: A prospective, interventional trial was done (October 2017 - November 2018) on 106 eligible women. All patients performed SIS. Patient with tubes patent under low pressure were assigned as control group, the rest of them were subjected to SIStreat, this group was farther divided into Group 2-a (patent under high pressure) and Group 2-b (occluded under high pressure). All patients had regular intercourse for 6 months. Pregnancy was confirmed by serum B-HCG.Results: we compared patients who performed conventional SIS (n = 100 cases) to patients who performed SIStreat afterwards (n = 84) according to the number of patent tubes. There was a high statistically significant difference in favor of SIStreat group (p < 0.001). Also, there was no significant difference in pregnancy rate between control group 62.5% and Group 2-a 45.7% (p = 0.226).Conclusions: SIStreat is a whole new procedure for opening fallopian tubes (diagnosed occluded by SIS). Patients who were successfully treated by SIStreat had cumulative pregnancy rate comparable to patients who were diagnosed to have patent tubes using conventional SIS.

Hysteroscopic salpingosonography: a novel technique for infertile patients

Background: Infertility is akin to curse in our country. Patients of infertility run from pillar to post to get relief. Government Hospitals in India lie at the tail end of window-shopping of infertility centres by the patients having exhausted all their resources. Patients report without any detailed records, lost reports, coming after long hiatus of having stopped treatment in desperation, making one wonder how to proceed. At the other end are patients who have undergone laparotomy for various reasons like intestinal obstruction, tubercular abdomen, adnexal masses and their tubal status is not very clear on HSG. So, repeat laparoscopy in the former group and performing ab initio in the latter, involves putting the patients to the risk of general anesthesia, injury to internal organs due to anticipated adhesions. Although Hassan’s technique of open trocar entry is well accepted the first port entry, whatever be the mode, is an entry open to risks.Methods: In a selected group of infertile women, a baseline TVS was done on 2/3 day of menses and on the 7/8 day of menstrual cycle hysteroscopy was done which was immediately followed by another transvaginal ultrasound. The descriptive statistics is presented in the form of percentages and appropriate graphs.Results: Among the 54 patients who underwent this procedure, 65% had normal uterine cavity. 18% were referred for IVF. 9.2% conceived post procedure.Conclusions: Successive use of transvaginal ultrasound after hysteroscopy i.e Hysteroscopic sonosalpingography is a useful procedure in a select group of infertile patients.

Assessment of Lower Segment Ceasarean Scar by Transvaginal Ultrasound and MRI

Objective: To assess lower segment scar on ultrasound and MRI followed by comparing with the intraoperative findings of scar in lower uterine segment. Methods: This was a prospective observational comparative study with a sample size of 40. Patients were recruited from the antenatal clinic. The study included women with previous one lower segment cesarean section and not willing for trial of labour after birth and those with previous one lower segment cesarean with no H/O previous vaginal birth. Routine obstetric examination was done at 36-37 weeks POG. A detailed obstetric ultrasound was performed. Patients before undergoing elective repeat lower segment cesarean section had Transvaginal ultrasonography (TVS) and MRI for evaluation of previous cesarean uterine scar. Result: The mean age of study group was 29.28 ± 3.48 yrs. The mean scar thickness in study group on TVS was 3.36 mm ± 1.2 mm. Mean scar thickness on MRI was 3.5 mm± 1.12mm. During intra-operative assessments of scar, in 82.5% cases scar was intact while in 15% cases scar was dehiscent. There was a positive correlation between all three modalities i.e. TVS , MRI and intra-operative findings. Conclusion: In this observational comparative done to correlate scar thickness measured on TVS and MRI with the intra-operative scar thickness, based on the findings we conclude that both TVS and MRI can be used for measurement of scar thickness.

Prediction of spontaneous preterm birth by cervical length changes in twin pregnancies / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the predictive value of cervical length（CL）changes in spontaneous preterm birth（SPTB）in twin pregnancies in the second and third trimesters of pregnancy.METHODS: A retrospective analysis was made of 166 cases of twin pregnant women who underwent transvaginal ultrasound to measure CL during the second trimester of pregnancy（20~25 weeks）and the third trimester of pregnancy（28~32 weeks）from January 2014 to December 2017 in the Third Hospital of Peking University and Tongzhou Maternal and Child Health Hospital of Beijing.Evaluate the predictive value of CL changes in SPTB before 32 and 34 weeks.The area under the receiver-operating characteristics（ROC）curve was compared by bootstrap method.Assessment of the value of CL in the third trimester of pregnancy and CL in the second trimester of pregnancy alone in predicting SPTB before 32 and 34 weeks.RESULTS: Of the 166 cases,90 were full-term delivery and 76 were premature delivery.The median CL of mid and late pregnancy was 34 mm and 29 mm respectively,and it was 35.5 mm and 31 mm,and in full-term delivery.32.5 mm and21 mm in premature delivery,respectively.There were significant differences among the three groups（All P25 mm and CL shortening≥ 20%,it can better predict preterm birth before 32 weeks.

Transvaginal ultrasound in laparoscopic myomectomy for reduction of residual myoma and reduction of fibroid recurrence / 中国内镜杂志

Objective To explore the application of vaginal ultrasound in laparoscopic myomectomy for the reduction of fibroid residue and reduce the recurrence of fibroids value. Methods 120 patients were randomly divided into observation group and control group according to the patient's admission time, all the patients received laparoscopic surgery, while the observation group operation was cooperated with vaginal ultrasound continued to eliminate the remaining uterine fibroids. After operation, all the patients were followed up for 12 months. The operation of the two groups was observed, the remnants of postoperative myoma and the recurrence of myoma at 12 months after the operation were recorded. Results The observation group's treatment time, blood loss, postoperative exhaust time and hospital stay compared with the control group had no significant difference (P > 0.05). One case of hematoma, one case of ureteral injury, two cases of bladder injury and one case of rectal injury occurred in the observation group. One case of hematoma, one case of bladder injury, two cases incision infection and two cases of rectal injury occurred in the control group. Comparing the incidence of intraoperative complications between the two groups show no significant difference (P > 0.05). The average diameter of fibroids in the observation group was significantly smaller than that in the control group (P < 0.05). In the observation group, only 4 patients showed fibroid remnants that were significantly smaller than those in the control group (P < 0.05). One case of recurrence occurred in the observation group at 9 months and 12 months after operation, while in the control group, at 3, 6, 9, and 12 months after the operation 1, 2, 5, and 7 cases recurred, respectively. The patients in the observation group had a significantly lower incidence of recurrence than those in the control group (P < 0.05). Conclusion The use of colposcopy in patients underwent laparoscopic myomectomy to guide the removal of residual fibroids can significantly reduce the residual fibroids, it is worth to clinically promote.

Assessment of length of maternal cervix between 18 and 24 weeks of gestation in a low-risk brazilian population / Avaliação do comprimento do colo uterino materno entre 18 e 24 semanas de gestação em uma população brasileira de baixo risco

Abstract Purpose To determine cervical biometry in pregnant women between 18 and 24 weeks of gestation and the ideal mode of measurement of cervical length in cases of curved and straight cervical morphology. Methods The uterine cervices of 752 low-risk pregnant women were assessed using transvaginal ultrasound in a prospective cross-sectional study. In women with straight uterine cervices, cervical biometry was performed in a continuous manner. In women with curved uterine cervices, the biometry was performed using both the continuous and segmented techniques (in segments joining the cervical os). Polynomial regression models were created to assess the correlation between the cervical length and gestational age. The paired Student t-test was used to comparemeasuring techniques. Results The cervical biometry results did not vary significantly with the gestational age and were best represented by linear regression (R2 = 0.0075 with the continuous technique, and R2 = 0.0017 with the segmented technique). Up to the 21st week of gestation, there was a predominance of curved uterine cervix morphology (58.9%), whereas the straight morphology predominated after this gestational age (54.2%). There was a significant difference between the continuous and the segmented measuring methods in all the assessed gestational ages (p < 0.001). Conclusion Cervical biometry in pregnant women between 18 and 24 weeks was represented by a linear regression, independently of the measuring mode. The ideal measuring technique was the transvaginal ultrasound performed at a gestational age 21 weeks.

Resumo Objetivo Determinar a biometria cervical em gestantes entre a 18ª e 24ª semanas, e ainda a forma ideal de mensuração do comprimento do colo uterino em casos de morfologias curva e reta. Métodos Foram realizadas avaliações ultrassonográficas via vaginal dos colos uterinos de 752 gestantes de baixo risco em um estudo prospectivo transversal. Nos colos uterinos retos a biometria cervical foi feita de forma contínua, enquanto nos colos uterinos curvos, a biometria foi realizada de duas formas, contínua e fracionada (em segmentos unindo os orifícios do colo). Para avaliar a correlação entre o comprimento do colo uterino e a idade gestacional, foram criados modelos de regressão polinomial. Para se comparar a técnicas de medida do colo uterino, utilizou-se o teste t-Student pareado. Resultados A biometria do colo uterino não variou de forma significativa com a idade gestacional, sendo melhor representada por uma regressão linear (R2 = 0,0075 na forma contínua, e R2 = 0,0017 na forma fracionada, respectivamente). Observamos que até a 21ª semana houve predominância de colos curvos (58,9%), porém após esta idade gestacional a morfologia retilínea predominou (54,2%). Houve diferença estatisticamente significativa entre a forma de mensuração contínua e fracionada em todas as idades gestacionais avaliadas (p < 0,001). Conclusão A expressão da biometria cervical em gestantes entre 18 e 24 semanas é praticamente uma reta, independente da forma de mensuração. A forma ideal de medida é por ultrassonografia transvaginal realizada em idade gestacional 21 semanas.