ABSTRACT
INTRODUCTION: The assessment of fetal head engagement by digital examination is highly subjective even though this method remains the gold standard. Ultrasound could be a new way to specify the fetal head engagement with objective and reproductible measurements. OBJECTIVE: To compare the clinical data and the transperineal ultrasound results for the diagnosis of fetal head engagement. PATIENTS AND METHODS: We conducted a prospective longitudinal study on a series of 70 patients and compared the clinical assessment of fetal engagement to the ultrasound measurements. Ultrasound examination was performed in the delivery room. The probe was placed on the ano-vulvar area. The measure used was: distance perineum-external table of fetal head bone. RESULTS: The ultrasound measures of the distance [perineum-external table of fetal head bone] went from 13 to 75 mm; and the measures of the distance [perineum-succedaneum bump] went from 22 to 68 mm. We tried to retain a value threshold of the distance [perineum-external table of fetal head bone] above which the diagnosis of engagement would be countered. The threshold so proposed is of 55 mm with a positive predictive value in 98%, a sensibility in 87% and specificity in 93%. DISCUSSION AND CONCLUSION: Transperineal ultrasound is a simple and easy method to define fetal head engagement by measuring the distance between perineum and fetal head. This new tool can be very useful in the delivery room when clinical examination is inconclusive hampered, for example, by the presence of a succedaneum bump.
Subject(s)
Head/diagnostic imaging , Head/embryology , Labor Presentation , Labor, Obstetric , Ultrasonography, Prenatal , Adult , Female , Humans , Longitudinal Studies , Palpation , Perineum/diagnostic imaging , Pregnancy , Prospective Studies , TunisiaSubject(s)
Adrenal Gland Diseases/diagnosis , Hematoma/diagnosis , Puerperal Disorders/diagnosis , Adult , Female , HumansABSTRACT
No symptom is pathognomonic for deep pelvic endometriosis. It presents essentially in the form of a painful syndrome dominated by deep dyspareunia and painful functional symptoms that recur according to the menstrual cycle. It is essential to investigate deep endometriosis lesions and draw up a precise map, which is the only way to be sure that exeresis will be complete. The treatment of first intention remains surgery, and medical treatment is only palliative in the majority of cases. Success of treatment depends on how radical surgical exeresis is. Patients should be aware of these specific major complications. Rating scales are recommended in diagnosis and therapeutic follow up. It is advisable to explain that pain improves, either partially or completely, in about 80% of patients.
Subject(s)
Endometriosis/pathology , Pelvic Pain/etiology , Dyspareunia/diagnostic imaging , Dyspareunia/etiology , Echocardiography , Endometriosis/complications , Endometriosis/diagnostic imaging , Endometriosis/surgery , Female , Humans , Pain, Postoperative/epidemiology , Physician-Patient Relations , Postoperative Complications/epidemiology , Treatment OutcomeSubject(s)
Echinococcosis , Ovarian Cysts , Pregnancy Complications, Parasitic , Adult , Echinococcosis/diagnosis , Echinococcosis/surgery , Female , Humans , Middle Aged , Ovarian Cysts/diagnosis , Ovarian Cysts/surgery , Ovariectomy , Pregnancy , Pregnancy Complications, Parasitic/diagnosis , Pregnancy Complications, Parasitic/surgery , Treatment OutcomeABSTRACT
Being an independent entity or a type of eclampsia, the HELLP syndrome always represent a serious complication of the renovascular disease. This retrospective study realised during five years revealed 11 cases including 3 cases occurring in the post partum. For all this patients, this complication happened during the 3rd term of pregnancy. The mean period of gestation when it occurred was the 34th week of pregnancy. In 36% of cases, the discovery of the HELLP syndrome was fortuitous by routine laboratory tests. The symptoms and signs are dominated by the digestive ones. In case of severe maternal complication or when the foetal lungs reach maturity, the interruption of pregnancy is the rule. In the other cases, expectative attitude with an intense observation may be proposed when the 32nd week of pregnancy isn't reached.
Subject(s)
HELLP Syndrome/pathology , Adolescent , Adult , Diagnosis, Differential , Female , Humans , Pregnancy , Pregnancy Trimester, Third , PrognosisABSTRACT
The authors suggest an analytic study of 35 cases of a adenomyosis discovered on operatory pieces of hysterectomy. The incidence over 28%. The pick of frequency is situated between 40 and 50 years old. The history of voluntary interruption of pregnancy and early abortion are found in 60% of cases. 8 patients have scary uterus post cesarean section or myomectomy. The symptoms and signs are dominated by vaginal bleeding which is found in 71% of cases. Pelvic pain is present in 34% of cases. The adenomyosis is rarely isolated. It is associated to uterine fibroma in 62% of cases. Their symptoms and signs are often the same. Hysterographie can head the diagnosis in 7% of cases. The endovaginal ultrasound and the IRM may help in the diagnosis.
