Evaluation of sonohysterography in detecting endometrial polyps - 241 cases followed with office hysteroscopies combined with histopathological examination.

INTRODUCTION: Hysteroscopy is considered the 'gold standard' procedure in assessing uterine pathology however it is more expensive and invasive method than ultrasonography. An alternative to the diagnostic hysteroscopy is sonohysterography. AIM: To evaluate the usefulness of sonohysterography in detecting endometrial polyps in female patients diagnosed with infertility. MATERIAL AND METHODS: We compared the results of sonohysterographic examinations with hysteroscopy combined with histopathological findings. RESULTS: All the 241 sonohysterography examinations were performed successfully. No complications were observed. Forty-three hysteroscopies (17.8%) and six sonohysterography examinations (2.5%) were performed in short total intravenous anesthesia because of a low pain threshold of the patients. After hysteroscopic resection polyps were diagnosed in 74 (30.7%) patients. In 72 cases both saline infusion sonography (sonohysterography, SIS) examination and hysteroscopy confirmed the occurrence of an endometrial polyp. In 7 examinations (4.2%) the diagnosed polyp was not confirmed in sonohysterography (false-positive results). Two SIS procedures (2.7%) did not confirm the occurrence of the polyp (false-negative results). Sensitivity, specificity accuracy and error of sonohysterography in detecting endometrial polyps were 97.3%, 95.8% 96.2% and 3.7%, respectively. Positive and negative predictive values were 91.1% (PPV) and 98.7% (NPV). The agreement between SIS and hysteroscopy combined with histopathological examination was very high (K = 0.91). CONCLUSIONS: Sonohysterography is a safe and highly sensitive and specific method used in diagnostics of endometrial polyps. Its results closely correspond to those obtained in a hysteroscopic examination and histopathological analysis.

[Cervical ectopic pregnancy--a case report]. / Ciaza szyjkowa--opis przypadku.

Authors present a case of a viable cervical pregnancy in a 31 year old woman. Conservative management with intramuscular methotrexate and local injection of KCl was applied. We describe the ultrasound and biochemical findings in this case and discuss those reported in the literature along with the available treatment options.

Two-step test: the combined use of fetal fibronectin and sonographic examination of the uterine cervix for prediction of preterm delivery in symptomatic patients.

PURPOSE: Our purpose was to assess the possibility of combined use of fetal fibronectin testing and sonographic examination of the uterine cervix for prediction of preterm deliveries. METHODS: We prospectively evaluated 82 patients with preterm labor. In each case fibronectin testing and sonographic examination of the cervix were performed. The primary outcome measure was preterm delivery within 28 days. RESULTS: Seventeen point one percent of the examined women delivered within 28 days. Among the analyzed sonographic parameters of the cervix only the functional canal length was significantly correlated with delivery (21.6+/-7.0 mm vs. 30.1+/-6.5 mm, p<0.001). Positive fetal fibronectin was found in 71.4% of patients delivered within 28 days and in 7.4% delivered after 28 days (p<0.001). In multiple logistic regression analysis only positive fibronectin testing (OR 11.25, p=0.005) and functional canal length < or =20 mm (OR 8.18, p=0.027) were independently associated with preterm delivery. We propose two-step testing: begin with the sonographic assessment of the cervix with functional canal length 31 mm as a negative one. The fibronectin testing should be performed only in patients with length 21-31 mm. Two step testing had overall sensitivity of 86%, specificity of 90%, positive predictive value of 63% and negative of 97% for predicting delivery within 28 days. CONCLUSIONS: The proposed combined use of the cervical sonography and fetal fibronectin testing is a practical diagnostic tool for predicting preterm delivery with higher sensitivity and negative predictive value than any of these methods alone.