Color and pulsed Doppler sonography, gray-scale imaging, and serum CA 125 in the assessment of adnexal disease.

OBJECTIVE: To compare color and pulsed Doppler sonography with gray-scale ultrasound imaging and serum CA 125 levels in establishing accurate preoperative diagnoses of adnexal masses. METHODS: Medical records of 109 patients referred with preexisting adnexal lesions were reviewed retrospectively by comparing preoperative ultrasonic data (gray-scale imaging and color and pulsed Doppler findings) with serum CA 125 levels. RESULTS: Eighty-three masses were removed surgically, confirming seven malignancies and 76 benign tumors, and 26 masses were followed; 15 regressed and 11 persisted. Color and pulsed Doppler sonography showed the highest sensitivity, followed by gray-scale imaging, whereas serum CA 125 levels revealed the highest specificity in distinguishing malignant from benign adnexal tumors. All three methods had high negative predictive values (96-100%), whereas only serum CA 125 had a positive predictive value greater than 50%. CONCLUSION: Color and pulsed Doppler sonography, which demonstrate a tumor angiogenic activity, are as accurate as gray-scale imaging in the assessment of adnexal lesions. Together with serum CA 125 marker levels, they produce high negative predictive values, providing reassurance that an adnexal mass is benign.

Placental abruption in association with advanced abdominal pregnancy. A case report.

BACKGROUND: Recognition of advanced abdominal pregnancy and care of the patient afflicted with it may present formidable challenges. Aside from the difficulty of diagnosing the problem and thereby delaying necessary intervention, management can be difficult at best, even when the condition is relatively uncomplicated. When it is compounded by a life-threatening complication, such as uncontrollable hemorrhage, it challenges the skills of the most experienced obstetrician and the resources of the best-equipped facility and its personnel. CASE: Partial placental separation was encountered at surgery; it progressed intraoperatively despite the care taken to avoid disturbing the placental implantation site. Severe hemorrhage was controlled by a combination of aortic compression, packing and use of large "liver" sutures incorporating the uterine wall for tamponade of the principal placental implantation site, on the mesentery. CONCLUSION: It is important to be prepared to deal with the complication of intense intraabdominal bleeding in the course of intraoperative management of abdominal pregnancy.