Targeted and tailored diagnostic strategies in women with perimenopausal bleeding: advantages of the sonohysterographic approach.

BACKGROUND AND AIM OF THE WORK: Diagnosis and treatment of endometrial pathology nowadays ranges from clinical examination to transvaginal ultrasound (TVS), saline infusion sonohysterography (SIS), hysterosalpingography (HSG) and hysteroscopy (HYS). However, many gynaecologists prescribe blind endometrial biopsies, such as Vacuum ABRAsion (VABRA), as single strategy. The purpose of this work is to evaluate whether the procedure of VABRA should still be performed alone in perimenopausal women with abnormal uterine bleeding, compared to biopsies and samples obtained after a previous transvaginal sonohysterography. METHODS: We retrospectively reviewed the records of 216 patients referred to our Ultrasonography and Day-Surgery Center between November 2005 and December 2006 with persistent premenopausal uterine bleeding, spotting or postmenopausal bleeding. One hundred and five out of 216 pts.(48.6%), defined as Group "A", underwent a sole endometrial sampling by VABRA; 111 out of 216 pts. (51.4%), Group "B", had a SIS first. RESULTS: Vabra showed a poor sensitivity in the diagnosis of polyps (19%) and submucosal myoma, with a negative predictive value of 73.4%. Likelihood ratio for test negative was 0.81, with an overall diagnostic accuracy of 75%. CONCLUSIONS: This study confirms that blind endometrial biopsies should no longer be performed as the only diagnostic strategy in perimenopausal women with abnormal uterine bleeding. On the other hand, a sonohysteroscopy-guided approach allows an accurate detection of focal lesions; nevertheless, it should not be forgotten that SIS is an ultrasound based procedure, and may provide further information on endometrial thickness, myomas, ovaries and pelvis.

Ultrasound screening in second and third trimester of pregnancy: an update.

Ultrasound screening of structural fetal malformations is mainly based on the use of ultrasounds during the second trimester of pregnancy. The diagnostic sensibility of ultrasounds varies in the different multicentric studies reported in literature and is correlated to different factors: gestation period, type of malformation, number of ultrasounds performed, operator experience, etc. Third trimester ultrasounds may identify late-onset malformations and offer adequate information for postnatal assistance.

Diagnostic accuracy of fetal renal pelvis anteroposterior diameter as a predictor of significant postnatal nephrouropathy: second versus third trimester of pregnancy.

OBJECTIVE: The objective of the study was to determine the most effective fetal renal pelvis anteroposterior diameter thresholds and the best gestational age in predicting significant neonatal nephrouropathy and neonatal nephrouropathy requiring surgery. STUDY DESIGN: Eighty-three newborns with prenatal ultrasound evidence of unilateral or bilateral fetal renal pelvis dilatation (anteroposterior diameter 4 mm or more) before the 26th week of gestation were systematically and prospectively investigated prenatally and postnatally. RESULTS: Receiver operating characteristic curve analysis showed that third-trimester anteroposterior diameter cut-offs were more reliable than second-trimester cut-offs in predicting significant neonatal nephrouropathy, the best threshold being 8 mm. No significant differences were found between the 2 trimesters in the screening of fetuses at risk of neonatal nephrouropathy requiring surgery. CONCLUSION: Significant neonatal nephrouropathy is better predicted at the third trimester, the best threshold being 8 mm, but the screening of patients at greater risk of surgery is also possible during the second trimester. An anteroposterior diameter of 11 mm or more, with an odds ratio of 128.33 (95% confidence interval 11.68 to 1408.98), is a very effective cut-off and a reliable prognostic indicator of neonatal nephrouropathy requiring surgery, even before the 26th week.