Ovarian torsion: diagnosis by color Doppler ultrasonography.

BACKGROUND: Ovarian torsion, although a rare gynecologic emergency, is a threat to women of all ages. Traditionally, ultrasonography and laparoscopy facilitated early diagnosis and treatment of this condition. This case report highlights the usefulness of color Doppler ultrasonography in the diagnosis of ovarian torsion. CASE: A 25-year-old patient who conceived after ovulation induction was treated conservatively for mild ovarian hyperstimulation and threatened abortion. She subsequently underwent selective first-trimester multifetal reduction and was admitted and treated for suspected pelvic infection. On the 17th post-procedure morning, ovarian torsion was diagnosed using color Doppler ultrasonography. CONCLUSION: Because gynecologists face serious management dilemmas when confronted with ovarian torsion, this technique of using color Doppler ultrasonography should provide a highly specific finding in complete ovarian torsion, aiding the clinician in prompt diagnosis and treatment.

Colour-coded duplex sonography for the assessment of fallopian tube patency.

Tubal patency was studied in 53 infertile women by means of colour-coded duplex sonography (CCDS) with transcervical injection of normal saline. In 47 women the patency was studied using a 2.5 MHz transabdominal transducer while in the last six cases, a 5.0 MHz vaginal probe was used. The results were compared with a conventional hysterosalpingogram (HSG) and laparoscopic chromopertubation. When the results of CCDS were compared with those of HSG and laparoscopy, there was a 92.5% agreement, that is, there was patency or occlusion of the Fallopian tubes. In addition, CCDS demonstrated all the soft tissues and their mobility. The colour signals generated by the air bubbles make it possible to demonstrate tubal patency on both sides separately. Vaginal CCDS offers a much better resolution with the advantage of lesser volume of normal saline being utilised. Tubal patency can be demonstrated in the presence of anatomical complications and requires only a small quantity of normal saline. This new tubal patency test is offered, not as a substitute for HSG, laparoscopy, hysteroscopy or salpingoscopy, but as a screening technique in the armamentarium of infertility investigations.

Selective reduction of multifetal pregnancies in the first trimester using colour Doppler ultrasonography.

In pregnancies with multiple gestation, an adverse outcome is directly proportional to the number of fetuses within the uterus, primarily because of an increased predisposition to premature delivery. Although there is a good deal of information about multifetal reduction in triplets and quadruplets and even quintuplets, there is very little on sextuplets, and virtually nothing on septuplets. Among the different techniques proposed for selective termination, two approaches have been more widely adopted: transcervical aspiration and transabdominal needling of the embryo using grey scale ultrasonography, but as yet there is no report on multifetal reduction using colour Doppler ultrasound. A method for selective termination of multiple pregnancy using transabdominal colour Doppler ultrasonography has been described here for the first time in a case of septuplets.

Fallopian tube patency using color Doppler.

OBJECTIVE: To evaluate a new test for tubal patency using color Doppler ultrasonography in infertile women. METHOD: Between October 1991 and March 1992 results of our new technique were compared with those of hysterosalpingography (HSG) and laparoscopy in 27 cases. The new technique of evaluating tubal patency using color Doppler has been described in detail. RESULT: There was 92.59% agreement, i.e. patency or occlusion of the fallopian tubes when the results of our test were compared with those of hysterosalpingography and laparoscopic chromopertubation. The HSG and laparoscopy findings were in 100% agreement. CONCLUSION: Color Doppler ultrasonography is now a very important investigation in the assessment of fallopian tube patency and compares favorably with the existing 'gold standards' namely HSG and laparoscopic chromopertubation.

Squatting position for delivery.

The study was conducted on 200 normal pregnant women who were randomly classified into 2 groups of 100 cases each. The control group comprised mothers in supine position throughout labour and delivery (46 primigravidae and 54 multigravidae). The squatting group consisted of cases who were kept ambulatory during the 1st stage and were asked to squat on ordinary delivery cots during the 2nd stage of labour. Third stage of labour was conducted in supine position. The squatting group comprised 42 primigravidae and 58 multigravidae. There was a mean difference (shortening) of 3 hours in primigravidae and 2 hours in multigravidae in the duration of 1st stage of labour between the squatting and control groups. In the duration of 2nd stage of labour the mean differences in primigravidae and multigravidae of the squatting and control groups were 20 and 13.5 minutes respectively. In the squatting group there were 79 normal vaginal delivery, 16 forceps delivery and 5 caesarean sections whereas in the control group there were 80, 18 and 2 cases respectively. Although foetal complications were comparable in both the groups, the incidence of maternal injuries was observed in 14 cases in control group and 38 cases in squatting group. It was concluded that without proper birthing chairs which can give good perineal support, the usual supine position is preferable.

Fallopian tubes and ultrasonography: the Sion experience.

OBJECTIVE: To compare the accuracy of three new ultrasonographic methods of detecting tubal patency and pathology with established methods like hysterosalpingography (HSG) and laparoscopy. DESIGN: Sixty-seven cases were evaluated by performing the Sion test using endosonography to check for tubal patency. The Sion procedure includes filling up the pouch of Douglas with approximately 300 mL of sterile normal saline to elucidate not only the patency but visualize the motility, the fimbriae, and peritubal adhesions, if present. We have compared the accuracy of this procedure with HSG and laparoscopy in 24 infertile women. Color-coded duplex Doppler sonography was used in 38 patients to check for tubal patency. RESULTS: Our experience at the Sion Hospital using the three new ultrasonographic techniques for evaluating the status of the fallopian tubes is very encouraging. The accuracy with the three modes shows agreement in > 90% of cases with established investigative modalities such as HSG and laparoscopy. CONCLUSION: These three new investigative modalities are offered not as substitutes for HSG, laparoscopy, hysteroscopy, or salpingoscopy but as office-screening procedures that would be complementary to the armamentarium of infertility investigations already available.

Obstetric performance following conservative surgery for pelvic relaxation.

Over a period of three years (January 1987 to December 1990), 78 cases of conservative surgery for pelvic relaxation, either at our hospital or in some other hospitals, were studied. All of these patients were admitted in active labor or as cases of abortions. The complex nature of the problem of pelvic relaxation or genital prolapse is evident from the fact that we have encountered as many as six conservative operations in our series. The reproductive performance of a patient along with the time taken for the conception to occur after the surgery are emphasized in our study.

Why deliver in the supine position?

This study was conducted at the Lokmanya Tilak Municipal General Hospital, Bombay, India during the year 1990. The aim was to compare the routinely used supine position versus ambulation in the first stage and squatting position during the second stage of labour. Our study was comprised of 200 patients both primigravidas and multigravidas; 100 were kept in the supine position throughout labour and 100 were kept ambulatory in the first stage and adopted the squatting position during the second stage. The study showed a shortening of both stages of labour in the squatting group but the incidence of complications was less in the control group. It was concluded that without proper birthing chairs which can give excellent perineal support, the usual supine position is preferable in our setup.

Reproductive performance following sleeve excision anastomosis operation for genital prolapse.

Genital prolapse is a disorder of pelvic support and is one of the most frequent disorders encountered in our gynaecological practice. Our social and cultural background predisposes to this condition to occur at an age which is reported to be earlier than any part of the world. Over a period of 4 years, 1986-1989, 17 cases were studied in whom the Sleeve Excision anastomosis operation was carried out, either at the Lokmanya Tilak Municipal General Hospital, Sion, Bombay, India or in some other hospital. All these patients were either admitted in active labour or as cases of abortions or were being treated for infertility. The incidence of full-term normal vaginal delivery in our study was 66.6% and the incidence of Caesarean section was 8.3%. There was 1 case of posterior wall rupture following previous sleeve excision anastomosis operation. The recurrence rate of prolapse in our series was only 7.7%. The Sleeve excision anastomosis operation has given excellent anatomical and obstetric results in our study and future multicentric trials will be necessary to study its effect on subsequent fertility to arrive at any final conclusion.

The Sion test.

Endosonography as a tool for checking the patency of Fallopian tubes was an expected development in the progress the field of gynaecology was taking. We at Sion Hospital have used transvaginal sonography in evaluating the patency of Fallopian tubes with a technique which encompasses a thorough pelvic scan as well. We offer The Sion Test not as a substitute for hysterosalpingography, laparoscopy or hysteroscopy but as a screening technique in infertility investigation. The Sion Test can be performed in the gynaecologists' office at the same time as the pelvic examination. A series of 50 infertile patients had a diagnostic laparoscopy and hysterosalpingography after our test was done. We have compared the accuracy of the 3 methods of evaluating tubal patency and have found our test an excellent screening technique for investigations in infertility.

Reproductive performance following Shirodkar's abdominal sling operation.

Over a period of 4 years from January 1986 to December 1989, 79 cases in whom Shirodkar's abdominal sling operation carried out, were studied. All the patients were admitted either in active labour or as cases of abortions or for the treatment of infertility. The incidence of full term normal vaginal delivery in this study was 69.56% and the incidence of caesarean section was only 2.9%. There was one case of posterior wall rupture following previous Shirodkar's sling operation. The recurrence rate of prolapse was only 8.69%.