ABSTRACT
OBJECTIVES: Handheld point-of-care abdominal ultrasound (POCUS) may be used by primary care physicians while vaginal ultrasound is limited to use in specialist care. We aimed to compare abdominal handheld ultrasound to vaginal ultrasound in determining first trimester viable intrauterine pregnancy and estimate gestational length. DESIGN: Prospective cohort study. SETTING: Gynaecologic outpatient clinic; women referred from GPs during early pregnancy. Handheld ultrasound using VscanExtend® was performed by fourth-year medical students with limited training. Transvaginal ultrasound using high-end devices was performed by ordinary hospital staff. SUBJECTS: Women in the first trimester of pregnancy referred for termination of pregnancy or with symptoms of early pregnancy complications. MAIN OUTCOME MEASURES: Rate of confirming vital intrauterine pregnancy (visualizing foetal heart beats) and measurement of crown-rump length (CRL) using handheld abdominal versus vaginal ultrasound. RESULTS: In all 100 women were included; 86 confirmed as viable intrauterine pregnancies and 14 pathological pregnancies (miscarriages/extrauterine pregnancies). Handheld abdominal ultrasound detected fetal heartbeats in 63/86 (73% sensitivity) of healthy pregnancies and confirmed lack of fetal heartbeats in all pathological pregnancies, total positive predictive value (PPV) 100% and total negative predictive value (NPV) 38%. From gestational week 7, handheld abdominal ultrasound confirmed vitality in 51/54 patients: PPV 100% and NPV 79%. CRL (n = 62) was median 1 mm shorter (95% confidence interval 1-2 mm) measured by handheld abdominal versus vaginal ultrasound. CONCLUSION: Handheld ultrasound has an excellent prediction confirming viable intrauterine pregnancy from gestational week 7. Validation studies are needed to confirm whether the method is suitable in primary care assessing early pregnancy complications.KEY POINTSWhen early pregnancy vitality needs to be confirmed, women will traditionally be referred to secondary care for transvaginal comprehensive ultrasonography performed with high-end devices by imaging specialists.In this study personnel with limited former training (fourth-year medical students) performed transabdominal POCUS using a handheld device, investigating 100 first trimester pregnancies for confirmation of viability.Using handheld ultrasound viable pregnancy was confirmed from gestational week 7 with 79% positive and 100% negative predictive value.If handheld ultrasound used in primary care confirms vital intrauterine pregnancy, the need for specialist referral could be reduced.
Subject(s)
Ultrasonography, Prenatal , Crown-Rump Length , Female , Humans , Pregnancy , Pregnancy Trimester, First , Prospective Studies , UltrasonographyABSTRACT
The first five cases of human tick-borne encephalitis in Norway were reported from Tromöya, in Aust-Agder County. Serum specimens from 317 dogs in the same geographic area were collected. An enzyme immunoassay demonstrated antibody to human tick-borne encephalitis virus in 52 (16.4%) of the dogs, which supports the notion of an emerging disease.
Subject(s)
Communicable Diseases, Emerging/veterinary , Dog Diseases/epidemiology , Encephalitis, Tick-Borne/veterinary , Animals , Antibodies, Viral/isolation & purification , Communicable Diseases, Emerging/blood , Communicable Diseases, Emerging/epidemiology , Dog Diseases/blood , Dog Diseases/virology , Dogs , Encephalitis, Tick-Borne/blood , Encephalitis, Tick-Borne/epidemiology , Enzyme-Linked Immunosorbent Assay , Female , Humans , Male , Norway/epidemiologyABSTRACT
BACKGROUND: The first person reported with tick-borne encephalitis (TBE) in Norway fell ill in 1998; the second patient caught the disease in autumn 1999. Both had been to the island of Tromøy in Aust-Agder county. Searches for TBE antibodies were intensified in persons with encephalitis and a seroprevalence study was carried out. MATERIAL AND METHODS: Sera from persons with encephalitis were tested for IgM and IgG antibodies to TBE virus with enzyme immunoassay and a neutralization test. Stored sera from persons living on Tromøy in 1997-2000 were studied for IgG antibodies. RESULTS: We report three cases of TBE, two had encephalitis in September-October 2000. The third patient, with antibodies to TBE virus found by retrospective testing, had the disease in August 1997. IgG antibodies to TBE virus were found in 3 out of 126 (2.4%) samples from Tromøy. INTERPRETATION: We report the first case of TBE in Norway. Of the first five Norwegian cases, four had been on Tromøy before they fell ill, three of them as tourists. In previous studies, IgG antibodies to TBE virus were found in 0.3-0.4% of persons from different parts of Agder counties. The seroprevalence studies indicate that Tromøy may have a higher incidence of TBE than the rest of the two southern counties. Our results confirm that TBE occurs in the coastal area of southern Norway.
