Sobreuso de ecografía transvaginal en un hospital universitario privado de Argentina: estudio de corte transversal / Transvaginal ultrasound overuse in a private university hospital in Argentina: a cross-sectional study

Introducción. Si bien contamos con recomendaciones basadas en la evidencia en contra de realizar tamizaje de cáncer ovárico con ecografía transvaginal debido a que aumenta el riesgo de resultados falsamente positivos y de cascadas diagnósticas, sin disminuir la mortalidad por esta enfermedad, su solicitud en mujeres sanas es frecuente. Sin embargo, no conocemos la magnitud de la implementación de esta práctica, que constituye un cuidado de bajo valor. Objetivo. Documentar el sobreuso de ecografías transvaginales realizadas en forma ambulatoria en un hospital universitario privado de Argentina. Métodos. Estudio de corte transversal de una muestra aleatoria de ecografías realizadas en forma ambulatoria durante 2017 y 2018. Mediante revisión manual de las historias clínicas, la solicitud de cada ecografía fue clasificada como apropiada cuando algún problema clínico justificaba su realización, o inapropiada cuando había sido realizada con fines de control de salud o por una condición clínica sin indicación de seguimiento ecográfico. Resultados. De un total de 1.997 ecografías analizadas, realizadas a 1.954 mujeres adultas (edad promedio 50 años),1.345 (67,4 %; intervalo de confianza [IC] 95 % 65,2 a 69,4) habían sido solicitadas en el contexto de un control de saludo sin un problema asociado en la historia clínica y otras 54 (8,3 %; IC 95 % 6,3 a 10,7), por condiciones de salud para las que no hay recomendaciones de realizar seguimiento ecográfico. Conclusiones. Esta investigación documentó una alta proporción de sobre utilización de la ecografías transvaginales en nuestra institución. Futuras investigaciones permitirán comprender los motivos que impulsan esta práctica y ayudarán a diseñar intervenciones para disminuir estos cuidados de bajo valor. (AU)

Background. Although we have evidence-based recommendations against screening for ovarian cancer with transvaginalultrasound because it increases the risk of false positive results and diagnostic cascades without reducing mortality from this disease, its request in healthy women is frequent. However, we do not know the magnitude of the implementation of this practice, which constitutes low-value care. Objective. To document the overuse of transvaginal ultrasounds performed on an outpatient basis in a private university hospital in Argentina. Methods. Cross-sectional study of a random sample of outpatient ultrasounds performed during 2017 and 2018. Through a manual review of the medical records, the request for each ultrasound was classified as appropriate when a clinical problem justified its performance or inappropriate when it was carried out for health control purposes or for a clinical condition that had no indication for ultrasound follow-up. Results. Of a total of 1997 ultrasounds analyzed, performed on 1954 adult women (average age 50 years), 1,345 (67.4 %;95 % confidence interval [CI] 65.2 to 69.4) had been requested in the context of a health check-up or without a documented problem in the medical history that would support its performance, and another 54 (8.3 %; 95 % CI 6.3 to 10.7), for health conditions for which there are no treatment recommendations to perform ultrasound follow-up. Conclusions. This research documented a high proportion of overuse of transvaginal ultrasound in our institution. Future research will allow us to understand the reasons that drive this practice and will help design interventions to reduce thislow-value care. (AU)

Safety of Transrectal or Transvaginal Drainage of Pelvic Abscesses / Segurança da drenagem transretal ou transvaginal de abscessos pélvicos

Abstract Objective The literature on the safety and long-term sequelae of transrectal and transvaginal drainage of pelvic abscesses is limited. We evaluated the outcomes and safety of pelvic abscess drainage by interventional radiology at our institution. Methods After obtaining institutional review board approval, we retrospectively evaluated the outcomes of transrectal and transvaginal pelvic abscesses drainage using computed tomography, endorectal ultrasound, and or fluoroscopy. Results The study included 26 patients, with an age range of 24 to 88 years old, out of whom 53.8% were men. A total of 46.1% of the participants were African Americans and 26.9% were Caucasians. The average body mass index was 28.4 (range: 15.6 to 41.9). The most common etiology was penetrating abdominal injury (27%), followed by appendectomy (23%), diverticular disease (11.5%), anastomotic leak (11.5%), and disorders of gynecological causes (11.5%). The mean abscess diameter was 6.3 cm (range: 3.3 to 10.0 cm). Transrectal drainage was performed in all except one patient who had a transvaginal drainage. Transrectal ultrasound was used for drainage in 92.3% cases, and fluoroscopy was used as an additional imaging modality in 75% of the cases. An 8- or 10-Fr pigtail catheter was used in>80% of the patients. Drains were removed between 2 and 7 days in 92.3% of the cases. The average follow-up was 30.4 months (range: 1 to 107 months), and no long-term complications were reported. Only one patient required subsequent operative intervention for an anastomotic leak. Conclusions Pelvic abscess drainage by transrectal route using radiological guidance is a safe and effective procedure.

Resumo Objetivo A literatura sobre a segurança e as sequelas no longo prazo da drenagem transretal e transvaginal do abscesso pélvico é limitada. Avaliamos os resultados e a segurança da drenagem do abscesso pélvico por radiologia intervencionista em nossa instituição. Métodos Após obter a aprovação do conselho de revisão institucional, avaliamos retrospectivamente os resultados da drenagem de abscessos pélvicos transretais e transvaginais por meio de tomografia computadorizada, ultrassom endorretal, e/ou fluoroscopia. Resultados Participaram do estudo 26 pacientes, com faixa etária de 24 a 88 anos, dos quais 53,8% eram homens. Um total de 46,1% eram afro-descendentes, e 26,9% eram brancos. O índice de massa corporal médio foi de 28,4 (gama: 15,6 a 41,9). A etiologia mais comum foi lesão abdominal penetrante (27%), seguida de apendicectomia (23%), doença diverticular (11,5%), fístula anastomótica (11,5%) e distúrbios de causas ginecológicas (11,5%). O diâmetro médio do abscesso foi de 6,3 cm(gama: 3,3 a 10,0 cm). A drenagem transretal foi realizada em todos os pacientes, com exceção de uma, que foi submetida a uma drenagem transvaginal. A ultrassonografia transretal foi utilizada para drenagem em 92,3% dos casos, e a fluoroscopia como modalidade adicional de imagem, em 75% dos casos. Um catéter duplo J de 8 ou 10 Fr foi usado em>80% dos pacientes. Os drenos foram retirados entre 2 e 7 dias em 92,3% dos casos. O acompanhamentomédio foi de 30,4meses (gama: 1 a 107 meses), e nenhuma complicação de longo prazo foi relatada. Apenas um paciente necessitou de intervenção cirúrgica subsequente para um vazamento anastomótico. Conclusão A drenagem do abscesso pélvico por via transretal com orientação radiológica é um procedimento seguro e eficaz.

Efecto de la frecuencia de aplicación de estrógenos locales sobre el grosor endometrial en mujeres posmenopáusicas / Effect of local estrogen application frequency on endometrial thickness in postmenopausal women

Resumen Introducción: Los estrógenos conjugados vía vaginal para aliviar la atrofia y sequedad vaginales pueden producir cambios endometriales. Objetivo: Conocer el efecto de la frecuencia de aplicación de estrógenos conjugados vía vaginal en el grosor endometrial en mujeres posmenopáusicas. Método: Se estudiaron 70 mujeres posmenopáusicas con sequedad vaginal que recibieron estrógenos conjugados en crema (0.625 mg/1 g) durante 12 semanas divididas de la siguiente manera según la frecuencia de aplicación: grupo 1, dos veces por semana (n = 35) y grupo 2, tres veces por semana (n = 35). Al inicio y final del tratamiento se determinó el valor estrogénico en la citología vaginal y se realizó ultrasonido endovaginal para medir el grosor endometrial. La comparación entre los grupos se realizó con U de Mann-Whitney y entre los valores pre y postratamiento con prueba de Wilcoxon. Resultados: De 70 mujeres reclutadas solo se estudiaron 38 mujeres, 19 en cada grupo, pareadas por valor estrogénico inicial. No se encontró diferencia entre los grupos, ni antes ni después del tratamiento, en el índice de maduración, valor estrogénico ni grosor endometrial. Conclusión: No hubo diferencias en el grosor endometrial entre las distintas frecuencias de aplicación de estrógenos conjugados en crema.

Abstract Introduction: Conjugated estrogens, when used by the vaginal route for the relief of vaginal dryness and atrophy, can produce endometrial changes. Objective: To know the effect of vaginal conjugated estrogens application frequency on endometrial thickness in postmenopausal women. Method: Seventy postmenopausal women with vaginal dryness who received conjugated estrogen cream (0.625 mg/1 g) for 12 weeks were studied. The women were divided according to application frequency as follows: group 1, twice-weekly (n = 35), and group 2, thrice-weekly (n = 35). At baseline and at end-of-treatment, vaginal cytology was examined to determine the estrogenic value, and an endovaginal ultrasound was performed to measure endometrial thickness. The comparison between groups was carried out with Mann Whitney's U-test, and the comparison between baseline and post-treatment values, with Wilcoxon's test. Results: Of 70 recruited women, only 38 were studied, 19 in each group, paired by baseline estrogenic value. No difference was found between groups, neither at baseline nor after treatment, in the maturation index, estrogenic value or endometrial thickness. Conclusion: There were no differences in endometrial thickness between the conjugate estrogen cream different application frequencies.

Síndrome de Mayer-Rokitansky-Küster-Hauser o agenesia de útero y vagina en una paciente joven / Mayer-Rokitansky-Küster-Hauser Syndrome or uterus and vagina agenesis in a young patient

Se describe el caso clínico de una paciente con síndrome de Mayer-Rokitansky-Küster-Hauser o agenesia de útero y vagina, pero con ovarios funcionantes, atendida por un equipo multidisciplinario en el Hospital Materno Norte Tamara Bunke Bider de Santiago de Cuba, cuyo diagnóstico se realizó a través del examen físico, el antecedente de amenorrea primaria y estudios complementarios como el cariotipo y la resonancia magnética de la pelvis.

The case report of a patient with syndrome of Mayer-Rokitansky-Küster-Hauser or uterus and vagina agenesis, but with functioning ovaries, assisted by a multidisciplinary team in Tamara Bunke Bider Northern Maternal Hospital in Santiago de Cuba, whose diagnosis was carried out through the physical exam, the history of primary amenorrhoea and complementary studies as the cariotype and magnetic resonance of the pelvis is described.

Pyometra and Pregnancy with Herlyn-Werner-Wunderlich Syndrome / Piometria e gravidez com síndrome de Herlyn-Werner-Wunderlich

ABSTRACT We describe a Herlyn-Werner-Wunderlich syndrome (HWWS) patient with previous history of infertility who got pregnant without treatment and presented a pyometra in the contralateral uterus throughout the gestational period, despite multiple antibiotic treatments. Due to the uterus' congenital anomaly and the possibility of ascending infection with subsequent abortion, this pregnancy was classified as high-risk. We believe that the partial horizontal septum in the vagina may have contributed to the closure of the gravid uterus cervix, thus ensuring that the pregnancy came to term, with an uneventful vaginal delivery.

RESUMO Os autores descrevem uma paciente com síndrome de Herlyn-Werner-Wunderlich (SHWW) e história prévia de infertilidade, que engravidou espontaneamente. Durante todo o período gestacional apresentou, apesar da instituição de antibioticoterapia, um piometra localizado ao útero não gravídico. Devido à anomalia congênita uterina e ao risco de infeção ascendente, com possível desfecho obstétrico desfavorável, esta gravidez foi classificada de alto risco. O septo vaginal horizontal e parcial poderá ter contribuído para ausência de disseminação da infecção, permitindo que a gravidez tenha chegado a termo, com um parto vaginal, sem intercorrências.

Hallazgos en resonancia magnética de las malformaciones uterovaginales: datos imprescindibles previos a una intervención quirúrgica / Magnetic resonance imaging findings of uterovaginal malformations: essential data prior to surgical intervention

La caracterización de las malformaciones congénitas del aparato genital femenino ha adquirido gran relevancia, principalmente en mujeres jóvenes con problemas de fertilidad. El origen de estas malformaciones procede de una alteración en el desarrollo embriológico de los conductos de Müller. El manejo terapéutico de estas entidades dependerá tanto del tipo de anomalía como de su gravedad. En la actualidad los múltiples avances tecnológicos en imagen permiten un diagnóstico preciso de estas malformaciones así como una posible planificación quirúrgica. Este trabajo tiene como objetivo revisar la clasificación de las malformaciones müllerianas así como estudiar los hallazgos en resonancia magnética que el cirujano debe conocer previo a la cirugía.

Morphologic characterization of congenital malformations of the female genital tract has acquired great importance, especially in the evaluation of female infertility.The origin of these malformations comes from an alteration in the embryological development of the Müllerian ducts. Technological advances in the field of radiology allow the diagnosis of these malformations, its possible treatment and surgical planning. This paper aims to review the classification of Müllerian anomalies and study the magnetic resonance findings that the surgeon should know prior to possible surgery.

Is uterine depth measurement by trans-vaginal ultrasound alone as accurate as measurement carried out by trans-abdominal ultrasound-guided trial transfer?

To assess the reliability of trans-vaginal-scan [TVS] in measuring the uterine depth [UD] in comparison with ultrasound-guided trial-transfer [UTT]. This prospective study was conducted in 66 consecutive patients undergoing in-vitro fertilization and embryo transfer [IVF-ET]. The study took place in a private IVF center in Jeddah, Saudi Arabia between November 2013 and January 2014. The patients underwent UD measurements using TVS and UTT, sequentially. All scans were performed by a single sonographer, and all UTT were carried out by a single physician who was blinded to the TVS measurement. The median [95% confidence interval] UD measurement using the TVS method was 6.9 cm [5.0-12.5] and UTT was 7.1 cm [5.9-13.5], [p<0.0001]. Fifteen patients [22.7%] had a difference of >1 cm between the 2 measurement modalities [group-B]. When measured by UTT, 93.3% of patients in group-B had UD >/= 8 cm, compared with 9.8% of patients in group-A, [p<0.0001]. Group-B had a significantly longer uterine cavity when measured by UTT [p<0.0001], and a trend towards significance when measured by TVS [p=0.055]. The TVS measurements generally underestimated UD when compared with UTT. Trans-vaginal-scan is less reliable than UTT and should not be used as a substitute. Larger sample-size studies involving different personnel, and equipment is needed

place of transvaginal color and pulsed Doppler sonography in the diagnosis of benign and malignant endometrial pathology in patients with post menopausal bleeding

Transvaginal color Doppler ultrasound [TVCDUS] may play significant role in diagnosis of endometrial pathology particulary endometrial carcinoma in women with postmenopausal bleeding [PMB]. Increasing experience in this field may help many women to overcome long waiting lists for surgery. In [65] women with postmenopausal bleeding we measured endometrial thickness [ET] [double layer] considering [8] mm as cut-off point to differentiate between benign and malignant endometrial lesions. We also looked for homogenicity, regularity of endometrium and integrity of sub endometrialhalo. [TVCDUS] was used to asses the vascularity, and vascular density of endometrium, myometrium and endometrial tumor. Resistance index [RI] and peak systolic velocity [PS] were also measured for endometrial, myometrial and uterine arteries. Correlation between [TVCDUS] and results of histopathology of endometrial specimens [24 hysterectomy and 41 D and C] was done. [ET] of [8] mm was found to be predictive for endometrial carcinoma with sensitivity of 100% and visualization rate of endometrial flow was significantly higher in case of carcinoma versus benign conditions of endometrium. Vascular density was significantly higher in case of carcinoma. [RI] of [0.42] was considered as cut-off point to differentiate between benign and malignant lesions with sensitivity of [80%]. [PI/ ] for myometrial and uterine arteries were not significantly different between cancer and benign conditions. TVCDUS has an important role in diagnosis of endometrial carcinoma especially in high risk group of women. Intra-tumoral blood flow is more sensitive marker of carcinoma than uterine blood flow. Adopting this method with increasing experience may result with considerable saving of both potential and economic costs

Role of transvaginal sonography in assessment of abnormal uterine bleeding in perimenopausal age group

Abnormal uterine bleeding [AUB] is a common problem which prompts more than 20% of all visits to outpatient clinics, and may account for more than 25% of all hysterectomies. The objective of this study was to determine the role of transvaginal ultrasonography in women of perimenopausal age group presenting with abnormal uterine bleeding. This descriptive study was conducted in Department of Obstructs and Gynaecology, Railway General Hospital, Rawalpindi. One hundred and forty-one women who attended the gynaecology clinic with abnormal uterine bleeding [menorrhagia, intermenstrual bleeding, or postcoital bleeding] between 40-47 years of age from January 2006 and April 2007 were included in this study. The mean age was 44 years. Among 141 women endometrial lesions were detected in 77 cases on histopathology after Dialatation and Curettage [D and C], while 57 [40.42%] of these were confirmed on transvaginal ultrasongraphy as an endometrial pathology prior to this invasive procedure. Among the 64 remaining patients, showing normal proliferative endometrium on histopathology, 46 cases [71.87%] showed no abnormality on tranvaginal examination. Transvaginal sonography can be safely used as an initial investigation in the management of abnormal uterine bleeding as it is a noninvasive procedure for the detection of endometrial pathology. The incidence of detection of an abnormal pathology by ultrasongraphy is high when focal lesions as fibroids, polyps or foreign body is concerned. Dilatation and curettage being a blind procedure requires hospitalization and general anaesthesia which can be safely replaced by an alternate valid, safe and non-invasive technique for evaluating the endometrial pathology in women of perimenopausal age group with abnormal uterine bleeding

Role of sonohystrography in checking caesarean section scars

Optimally performed hysterosalpingography and saline infusion sonohysterography can be relatively comfortable procedures for the patient that provide a great deal of useful diagnostic information. Thirty patients were divided into 2 groups: Group I [15 patients] had normal healthy uterine wall scar detected by hystroscopy, group 11[15 patients] had a uterine wall defect detected by hysteroscopy at the site of CS. Transvaginal sonohysterographic evaluation was done after slow intrauterine infusion of 10 to 20 ml of sterile isotonic saline. This results in a sensitivity of 93.33% specificity of 86.67%, positive predictive value of 87.5%, negative predictive value of 92.86% and an overall accuracy of 90% for sonohystrographic examination in diagnosing the presence of a uterine wall defect after CS. Transvaginal ultrasound holds promise as a useful tool for trying to answer important clinical questions in prospective trials

value of transvaginal ultrasonography in the endometrial evaluation of breast cancer patients using tamoxifen

To estimate the value of transvaginal ultrasonography [TVU] in evaluating the endometrium in breast cancer patients on tamoxifen, and to investigate the relationship between TVU and histologic endometrial findings in these patients. 107 breast cancer patients taking tamoxifen were included in this study. TVU was performed twice for each patient: prior to starting tamoxifen therapy and 1 year after taking tamoxifen. An endometrial thickness of >5 mm was considered abnormal. Endometrial biopsy was performed at the same time the 2nd TVU was done. The patients were divided into 2 groups: symptomatic [group A] and asymptomatic [group B], based on whether or not there was abnormal vaginal bleeding. 31 patients [29%] were symptomatic, while the remaining 76 [71%] were asymptomatic. The endometrial thickness increased after 1 year of taking tamoxifen from 4.84 +/- 0.4 mm to 6.34 +/- 2.1 mm in group A and from 4.73 +/- 0.3 mm to 5.67 +/- 1.95 mm in group B [p > 0.05]. Endometrial biopsy revealed 77 [71.96%] atrophic endometria and 21 [19.62%] polyps. A comparison between the 2 groups showed a significant difference in patients with endometrial atrophy and atypical hyperplasia. Patients who had an endometrial thickness of >5 mm had a significantly higher prevalence of atypical hyperplasia [p = 0.003] and polyps [p = 0.041]. The sensitivity, specificity, positive predictive and negative predictive values of TVU were 63.3, 28.57, 25.67 and 66.66%, respectively. Our study showed a discrepancy between TVU and endometrial biopsy findings, due to the specific histology of the endometrium in breast cancer patients using tamoxifen. Due to this discrepancy, TVU alone is not an effective screening test for endometrial pathology and its application alone might lead to an undesirably high frequency of invasive diagnostic procedures

Transvaginal sonography and cervical length changes in normal pregnancy

Transvginal sonography [TVS] is the gold standard for investigating cervical Length. The aim of this study was investigation of cervical length changes during normal pregnancy by TVS. This epidemiotogical study was carried out from 22[en] April 2006 to 21[st] April 2007 on 150 pregnant women who had contacted Ahwaz Imam Khomani Hospital. Cervical Length changes in normal pregnancies were studied by TVS in three trimesters. Gestational age of studied population was 8 to 37 weeks. Anova and Chi Square tests were used for statistical analysis. In the 2[nd] trimester the cervical length was at minimum [26mm] and mean cervical length was [40.72 mm]. In the 1[st] trimester cervical length was the maximum of [56 mm] and mean cervical Length was [39.03 mm]. Mean cervical length was the shortest [37.83 mm] in the under 20 years and longest [40 mm] in the over 35 year's age group. Transvaginal Sonography is useful, for cervical length evaluations and management of preterm deliveries and cervical insufficiency

radiological puzzle: incidental genitography leading to peritoneal extravasation of contrast medium, during voiding cysto-urethrography, in a patient with urogenital sinus

While attempting cysto-urethrography and genitography in a nine-year-old female there was extravasation of the contrast medium to tHe peritoneal cavity during voiding cysto-urethrography [VCU] due to congenital adrenal hyperplasia [CAH]. Spillage of peritoneal contrast medium during VCU is extremely rare, even in patients with CAH and a persistent uro-genital sinus. Early fluoroscopic detection is essential, in recognizing the occurrence of spillage amid preventing further unnecessary injection of contrast medium into the peritoneal cavity

Role of transvaginal ultrasound in cervical length changes during normal pregnancy

The objectives of this study was to examine the relationship between cervical length and gestational age in normal pregnancy in nulliparous versus parous women. We studied a cross-sectional sample of 321 pregnant women, including 185 nulliparous and 136 multiparous women. The inclusion criteria were sonographic confirmation of gestational age within the 12th week, the absence of any risk factors for preterm birth, and uncomplicated pregnancy with expected delivery during the 38th to 42nd weeks. Cervical length was measured in a straight line if the cervix did not show any curvature; in the presence of cervical curvature, the measurement was broken down into 2 or more segments. It was found that there was a relationship between gestational age and cervical length, which could be described with a linear function [R = 0.92; R2 = 0.85; P<001]. Moreover, there was no statistically significant difference between multiparous and nulliparous women. Our study shows that cervical length is comparable in nulliparous and multiparous women throughout pregnancy. In both groups, it actually shows a progressive, linear reduction between the 10th and 40th weeks. Reference ranges constructed for the whole gestational period might be more useful than a single cut off value for more efficient prevention and management of preterm birth

Women's perception of transvaginal sonography in a tertiary hospital in Nigeria

Available studies suggest that pregnant women's views on the desirability of routine ultrasound are influenced by their perceptions of its potential benefits and concern about possible adverse effects. To assess women's views of transvaginal sonography and to determine any correlation between their perception of the procedure and their prior knowledge and experience of it. Radiology department, federal medical centre, Asaba, Niger Delta, Nigeria. We surveyed women presenting with various gynecologic problems or complications of the first trimester. Data collection was by self-administered questionnaires using convenience sampling technique on women attending the clinic over a period of one year. Only women who had transvaginal sonography were included. A total of 250 women were recruited and interviewed. Transvaginal sonography was considered not embarrassing by 76%, acceptable by 86%, not painful by 87.2% and not stressful by 82% of the women. There were no statistically significant differences in the women's perception of the procedure whether they had prior knowledge and previous experience of the procedure or not [P > 0.05]. The majority of the women perceived transvaginal sonography favourably. Their perception of the procedure was favourable whether they had prior knowledge and previous experience of it or not

Transvaginal Ultrasonographic Cervical Measurement in Predicting Failed Labor Induction and Cesarean Delivery for Failure to Progress in Nulliparous Women

The aim of this study was to evaluate the value of transvaginal sonographic cervical measurement in predicting failed labor induction and cesarean delivery for failure to progress in nulliparous women. One hundred and sixty-one women scheduled for labor induction underwent transvaginal ultrasonography and digital cervical examinations. Logistic regression demonstrated that cervical length and gestational age at induction, but not the Bishop score, significantly and independently predicted failed labor induction. According to the receiver operating characteristic curves analysis, the best cut-off value of cervical length for predicting failed labor induction was 28 mm, with a sensitivity of 62% and a specificity of 60%. In terms of the likelihood of a cesarean delivery for failure to progress as the outcome variable, logistic regression indicated that maternal height and birth weight, but not cervical length or Bishop score, were significantly and independently associated with an increased risk of cesarean delivery for failure to progress. Transvaginal sonographic measurements of cervical length thus independently predicted failed labor induction in nulliparous women. However, the relatively poor predictive performance of this test undermines its clinical usefulness as a predictor of failed labor induction. Moreover, cervical length appears to have a poor predictive value for the likelihood of a cesarean delivery for failure to progress.

value of transvaginal sonography performed before diagnostic hysteroscopy for the evaluation of uterine cavity in infertile women

Hysteroscopy have gained general acceptance as a method for the investigation of infertility. The main advantage of hysteroscopy is the capability of inspecting the uterine cavity. Transvaginal sonography [TVS] is a noninvasive modality that provide excellent imaging of the uterus and of endometrial abnormalities. The present study was designed to evaluate the use of TVS as the initial diagnostic procedure before hysteroscopy for detecting intrauterine disorders. Seventy-eight infertile women were examined by TVS and diagnostic hysteroscopy in the late follicular phase of the menstrual cycle and the results were compared. The uterine cavity abnormalities were present in 19.2% of the infertile females involved in the study. The Transvaginal scnography had 87.5% sensitivity, 100% specificity for detecting endometrial polyps while it had 100% sensitivity and 100% specificity for detecting other intrauterine cavity abnormalities including intrautcrine adhesions, uterine septae and submucosal myomas. Examination of the uterine cavity is an integral part of any thorough evaluation of an infertile woman. Tranavaginal sonography, when performed during the follicular phase, can detect most uterine cavity abnormalities. It was an accurate tool in the identification of intrauterine adhesions, uterine septae and submucosal fibroids

Reliability of combined hysteroscopy and laparoscopy for management of cornual ectopic pregnancy

Active surgical treatment in the form of hysteroscopy under laparoscopic control was carried out on 15 women with diagnosed cornual ectopic pregnancy over 3 years period. The mean age of the patients was 26.2 years and most of cases were suffering from acute abdomen and vaginal bleeding after a period of amenorrhoea. Transvaginal ultrasound examination revealed an empty uterus, gestational sac separated <1cm from the most lateral edge of the uterine cavity and thin myometrial layer surrounding the sac. Color Doppler mapping of cornual region showed a vascular ring at the periphery. Serial beta hCG quantitative levels were static. General physical and abdominal examinations as well as laboratory profile of all cases were within normal. Patients were scheduled for operation within hours from their attendance, in all cases hysteroscopic management was done by using a small suction cannula for complete removal of the conceptus, avoiding the need for forceps or curette. Performing the procedure under laparoscopic control and injecting vasopressin minimised the risks of bleeding and rupture. The average operation time was 60 minutes and hospital stay ranged from [1-2] days. All patients tolerated the surgical procedure without complication. Based on the preceding results it would appear that this procedure is expeditious and showed immediate evidence of success or failure

Correlation of endometrial thickness, cycle day and histopathology in women with abnormal uterine bleeding

To correlate the endometrial thickness measured by transvaginal sonography [TVS], cycle day and menstrual status with histopathology in women with abnormal uterine bleeding and to evaluate the accuracy of transvaginal sonography in detecting intrauterine abnormalities as compared to hysteroscopy. This prospective study was conducted in the Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital between January 1998 and July 2002. Transvaginal sonography was performed in 160 women with abnormal uterine bleeding, followed within 48 hours by hysteroscopy and endometrial biopsy. Statistical analysis was performed by MacNamar's chi-square test and the various correlations were calculated. No statistically significant association was found between endometrial thickness and cycle day with histopathology. None of the women with endometrial thickness of <5 mm had atypia or malignancy. There was a highly significant association between menstrual status and histology. Transvaginal sonography and hysteroscopy were in agreement in 73.7% of the patients. An endometrial thickness of <5 mm in women with postmenopausal bleeding could mean that curettage can be avoided. No definite cut-off value could be assigned for the menstruating women. Transvaginal sonography is a good initial screening tool in the evaluation of women with abnormal uterine bleeding. Hysteroscopy and histological examination is indicated in cases of abnormal or inconclusive sonograms or if complaints persist after a normal sonogram. Transvaginal sonography seems to be an effective procedure to exclude endometrial and intrauterine abnormalities