History, pelvic examination findings and mobility of ovaries as a sonographic marker to detect pelvic adhesions with fixed ovaries.

AIM: To compare the performance of history and examination findings combined with transvaginal ultrasound (TVS) 'soft marker' evaluation of ovarian mobility for the prediction of fixed ovaries secondary to endometriosis at laparoscopy. METHODS: This was a prospective observational study performed at the University Gynecology unit, National Hospital of Colombo Sri Lanka. Women who were scheduled for laparoscopic assessment of their pelvis to investigate subfertility or chronic pelvic pain were enrolled. All women underwent history evaluation for dysmenorrhea and dyspareunia, vaginal examination and detailed presurgical TVS. TVS was used to assess 'soft marker' of ovarian mobility. 'Fixed' ovaries on ultrasound were defined as one or other of the ovaries being fixed or adherent to the internal iliac artery or pelvic sidewall laterally or to the uterus medially. These findings were compared with 'fixed' ovaries confirmed at laparoscopy. RESULTS: A total of 106 patients were analyzed. Mean age was 33.3 years (standard deviation, 5.1). Sensitivity, specificity, positive and negative predictive values of each of the screening methods against laparoscopy in detecting endometriosis were as follows: dyspareunia, 45.9%, 76.8%, 51.5% and 72.6%; dysmenorrhea, 75.7%, 69.6%, 57.1% and 84.2%; positive vaginal examination, 73%, 88.4%, 77.1% and 85.9%; fixed ovaries with TVS, 78.4%, 94.2%, 87.9% and 89%; and a combination of history, examination findings and detection of fixed ovaries in TVS, 91.9%, 60.9%, 55.7% and 93.3%, respectively. CONCLUSION: A combination of clinical and TVS-based 'soft marker' of ovarian mobility provides a valid method for identifying fixed ovaries secondary to endometriosis.

Abdominal obesity in females: a problem in South Asia receiving insufficient attention.

Abdominal obesity (AO) has become a major health problem to most of the Asian communities. The severity and consequences of AO are higher among females. It has virtually become an epidemic in most South Asian countries and the health care systems in this region are likely to be challenged by one of the biggest health issues in the near future. Yet, the recognition of the magnitude of the problem by health authorities is poor. The purpose of this paper is to motivate health care professionals, planners and policy makers towards better control of the epidemic of AO while highlighting the paucity of evidence on clinical management of AO from the South Asian region.

Comparison of transabdominal versus transvaginal ultrasound to measure thickness of the lower uterine segment at term.

OBJECTIVE: To compare the accuracy of transvaginal (TVS) versus transabdominal (TAS) ultrasound to assess the thickness of the lower uterine segment (LUS). METHODS: Eighty-three pregnant women admitted for an elective cesarean delivery were enrolled. LUS thickness was measured using both TVS and TAS prior to the cesarean. The actual thickness of the LUS was measured using a sterile metal ruler after the neonate had been delivered. RESULTS: Seventeen women had unscarred uteri (20.1%); 41 had had one previous cesarean (49.4%); and 25 had had two previous cesareans (30.1%). Mean thickness of the LUS measured after delivery was 7.58+/-1.3 mm in unscarred uteri; 5.09+/-1.4 mm for one cesarean; and 3.92+/-1.1 mm for two cesareans (P<0.01). Actual thickness of the LUS showed a significant correlation with TVS among the total (r(s)=0.89); with unscarred uteri (r(s)=0.68); with 1 cesarean (r(s)=0.89); and 2 cesareans (r(s)=0.68), while with TAS the correlations were significant only with the total (r(s)=0.53) and 2 previous cesareans (r(s)=0.63) (P<0.01). CONCLUSION: TVS is a more accurate method of assessing the thickness of the LUS compared with TAS.

Uterine compression sutures for post-partum bleeding with atony; modification of the B-Lynch suture.

We have described a modification of the B-Lynch uterine compression suture which is simple and effective. This technique apposes the anterior and posterior uterine walls, obliterating the cavity and thereby provides effective control of post-partum haemorrhage as a result of uterine atony. It comprises of vertical compression sutures and is distinct from B-Lynch and Haymen's suture by having an additional firm puncture just below the uterine fundus. This means that the suture is transfixed at the uterine fundus, thus eliminating the risk of the sutures sliding off at the uterine fundus.