role of some labor admission tests in the prediction of the perinatal outcome in high-risk pregnancies

To study the role of some labor admission tests [Cardiotocography CTG, vibroacoustic stimulation VAS-, biophysical profile scoring BPP and Doppler] in the prediction of the perinatal outcome in high risk pregnancies. Prospective randomized comparative study. Labor ward of the Department of Obstetrics and Gynecology, - El Minia University Hospital, El Minia, Egypt, Four hundred high risk pregnant women in spontaneous early labor [cervical dilatation 3-5 cm] with singleton pregnancy, vertex presentation with estimated gestational age between 37 to 42 weeks. Patients were randomly allocated into 4 matched groups- 100 patients each - according to the admission test done as follow; Group I: Cardiotocography CTG group; Group II: Vibroacoustic stimulation VAS group; Group III: Biophysical profile BFP group; Group IV: Doppler group. The predictive values [sensitivity, specificity, positive and negative predictive values PPV and, NPP and accuracy] and the relative risk RR with 95% confidence interval [95% CI] of labor admission tests for the prediction of the perinatal outcome. BPP had the highest statistically significant sensitivity [70%] followed by VAS [66.7%] among admission tests [P<0.05, for each]. BPP had the highest statistically significant positive predictive value PPV [77.8%] among admission tests [P < 0 05]. The specificity and NPP of admission tests were comparable [P > 0.05, for each]. The RR [95% CI] for adverse [poor] perinatal outcome with abnormal admission test was statistically significant for abnormal [<6] BPP [23; 95% CI [7.3 5:75.74]] followed by VAS [10.5; 95% CI [4.14 : 20.64] 1 [p<0.05, for each]. The RR [95% CI] of non-reactive CTG and abnormal Doppler were statistically insignificant [P>0.05, for each]. Of all admission tests the predictive value of BPP appears to be the most statistically significant BPP has the highest sensitivity followed by VAS. The BPP has the highest PPV of all admission tests. The RR of abnormal [low] BPP for the prediction of poor [adverse] perinatal outcome is the most statistically significant followed by VAS among labor admission tests. The predictive value of intra-partum Doppler is midway between VAST and CTG. CTG has a poor predictive value among labor admission tests due to high false positive results; addition of another complementary test is recommended. Larger randomized controlled trials are recommended to establish the exact role of labor admission tests in low and high risk pregnancy population

Evaluation of endometrial thickness by transvaginal ultrasonography in women with postmenopausal bleeding

To determine the diagnostic value of transvaginal ultrasonography in the detection of endometrial abnormalities in women with postmenopausal bleeding. Study 150 women with postmenopausal bleeding were clinically evaluated by transvaginal ultrasonography and curettage. The endometrial thickness as measured by transvaginal ultrasonography was compared with the histopathological diagnosis of the curettage specimens. El-Minia University Hospital. Women receiving hormone replacement therapy [n= 30] with a normal endometrium had a mean endometrial thickness of 5.22 +/- 3.74 mm [n=16] and women receiving hormone replacement therapy with an abnormal endometrium had an endometrial thickness of 11.2 +/- 6.6mm [n=14]. The corresponding figures for women who did not use hormone replacement therapy [n=120] were 4.44 +/- 2.16 mm [n=63] and 14.63 +/- 8.9 mm [n=57] respectively. The mean endometrial thickness of atrophic endometrium, hyperplasia, polyp, cancer and proliferative / secretory endometrium were each 3.09 +/- 1.67 mm, 11.76 +/- 6.98 mm, 10.87 +/- 4.71 mm, 21.95 +/- 8.09 mm and 4.52 +/- 1.88 mm respectively. At a cutoff limit of 5mm for endometrial thickness, the sensitivity of transvaginal ultrasonography for detecting a histologically abnormal endometrium was 91.5%, the specificity 86%, the positive predictive value 85.5% and the negative predictive value 91.8%. Transvaginal ultrasonography with measurement of endometrial thickness is a safer and a non invasive outpatient procedure which has the advantage of not only predicting endometrial abnormality but also and perhaps more importantly, excluding pelvic pathology