Primary amenorrhoea: analysis of 48 cases.

The clinical analysis of 48 patients of primary amenorrhoea seen at All India Institute of Medical Sciences, New Delhi for a period of 3 years, was performed. Twenty-six patients (54.2%) had muellerian anomalies, 11 (22.9%) had hypogonadotropic hypogonadism, 8 (16.6%) had hypergonadotropic hypogonadism and 3 (6.3%) had genital tuberculosis. The study highlights the role of transabdominal sonography in the work up of these cases. It suggests the reproductive potential of these cases by visualising the genital organs and makes laparoscopy and intravenous pyelography obsolete and selects the cases who deserve to be further investigated.

Place of transvaginal sonography in the evaluation of reproductive endocrinology.

A high frequency vaginal probe with improved resolution offers a remarkable sharp clear image of pelvic organs. This is possible because of its closed proximity with target organ and non-intervention by gut or omentum. Study of ovarian follicular dynamics (folliculometry), identification of proliferative, secretory and decidual changes of endometrium (endometrial dating) in different phases of menstrual cycle and imaging of mucus secretion in the cervical canal (cervical mucus study) in the pre-ovulatory phase is possible by transvaginal probe. It is non-invasive, acceptable to patients, and thus can be repeated any number of times. A close serial monitoring offers immense wealth of information about the anatomical as well as reproductive endocrinal status of the patient. Ovulation can be predicted in advance. The case of dysovulation can be identified in first cycle of study; corrective therapy can be started in another two or three cycles, aiming at achieving perfect folliculogenesis. Once well tuned synchronised cycle is restored, the pregnancy outcome is remarkable. Thus transvaginal sonography offers one of the best reproductive endocrinology evaluation in the hand of a modern gynaecological sonologist and infertility specialist.

Reliability of ultrasound in the assessment of cervical incompetence

This study included 40 pregnant women with cervical incompetence and 60 women with normal pregnancy. In normal pregnancy the mean internal os diameter was 11.5 +/- 3.0 mm during the 1st trimester and 14.5 +/- 3.2 mm during the 2nd trimester. In women with cervical incompetence these measurements were 17.9 +/- 3.6 mm during the 1st trimester [P < 0.001] and 20.1 +/- 3.4 mm in the 2nd trimester [P-< 0.001]. When a cut-off point of 15 mm was used as a threshold for diagnosing the condition in the first trimester, it produced a sensitivity of 87.5% and a specificity of 86.7% with a false negative rate of 12.5% and a false positive rate of 13.3%. In the 2nd trimester a threshold of 20 mm produced a sensitivity of 50% and a specificity of 96.7% false negative rate 29.3% and 7.7% false postitive rate. These false rates were higher than could be acceptable as a screening test for cervical incompetence