Diagnostic and therapeutic value of ultrasound screening pelvic masses

To ascertain the superiority of Ultrasound screening over traditional bimanual pelvic examination in diagnosis and treatment of pelvic masses. Design: Retrospective study of 1000 consecutive patients attending the outpatient clinic for various complaints. Settings: Ultrasound clinic, a tertiary care gynae-obstetric unit in private sector, Islamabad. Subjects: One thousand consecutive patient who attended the outpatients for gynaecological checkup or first antenatal visit. Main outcome measures: Adnexal masses assessed bimanually, and with ultrasound scan and Doppler study of their blood vessels, the diagnosis then confirmed by observation, aspiration, laparoscopy or laparatomy, then follow up evaluated with ultrasound. eighty six% of adnexal pathology was missed on bimanual vaginal examination if the masses were cystic, less than 7 cms, and the patient obese and tender. Pathological changes were suspected in 230 patients at first ultrasound scan and confirmed in 100 after repeat scan in 2 weeks. 24 patients with clear cysts were aspirated under ultrasound control and aspirated fluid sent for cytology. 16 patient underwent laparoscopic evaluation and 32 were put an pituitary suppression for multiple small functional cysts. Only 28 underwent laparotomy. Ultrasound scan combined with abdominal and vaginal probes along with pulse wave Doppler is a very useful and non-ivasive tool in the diagnosis and treatment of adnexal masses and each gynecologist should aspire to have the machine besides the examination couch like the BP apparatus and the speculum, and learn to use it as recommended in the XIV FOGO World Gongress of Montreal, Canada 1994

Active management of preterm labour and preterm prelabour rupture of membranes

Hundred cases of preterm labour [before 36 weeks] with cervix 4 cm or less dilated and preterm prelabour rupture of membranes [excluding cases of uterine overdistension, maternal medical disorders and fetal congenital abnormalities] were treated with bed rest and sedation. Labour set in within 2-6 days with high fetal morbidity and mortality. Another fifty similar patients were given in addition to rest in hospital for 48 hours, 1000 ml of 5% dextrose in six hours, intravenous antibiotics [after sending off cultures from the vagina per speculum], cotricosteroids and a single dose of analgesia/sedation injection. In 85% painful contractions ceased and membranes stopped leaking until near term. In 10% painful contractions ceased, but leakage continued for 2-7 weeks, and the gain in intrauterine life led to 100% neonatal survival with short hospital stay in the neonates born after 31 weeks. Only 5% failed to respond to treatment and after delivery these premature neonates developed pneumonia and speticaemia from the same organisms that were colonizing their maternal genital tract and had entered the fetus via the infected amniotic fluid. It is recommended that all patients in preterm labour or preterm prelabour rupture of membranes [excluding overdistension] be given besides bed rest and sedation, corticosteroids and antibiotics intravenously for 48 hours and then orally for eight more days. Tocolytics are not recommended. This regime saves babies