Clinical Obstetric Practice Research Articles

The role of ultrasound in the clinical practice of obstetrics

To assess the performance of three-dimensional (3D) ultrasound with color Doppler in the diagnosis of bladder endometriosis compared with magnetic resonance imaging (MRI) and cystoscopy.Canadian Task Force classification II-3.Department of gynecology and obstetrics of a university hospital.Eight women who reported urinary tract symptoms suggestive of bladder endometriosis between May 2012 and November 2013.For all cases, we assessed the size of the endometriotic nodule, its location on the bladder wall, and the distance between the lesion and the ureteral meatus, with pelvic 3D ultrasound (full bladder), uro-MRI, and cystoscopy. The results were compared with the postoperative histopathologic findings.The pathology results differed from those produced by imaging by a mean ± SD of −3.5 ± 6.4 mm on transvaginal ultrasound (TVUS) and −5.75 ± 11.9 mm) for MRI. There was no significant difference between imaging and pathology findings (p = .20) or between the 2 imaging findings (TVUS and MRI) (p = .73). Results showed a trend toward better accuracy for 3D ultrasound than MRI with smaller SDs (p = .08). Cystoscopy and ultrasound were compared; however, without any tools to assess the distance in cystoscopy, no statistical result was possible.Ultrasound seems to be superior to cystoscopy and is at least as effective as MRI in diagnosing and planning the surgery for bladder endometriosis.

Amniocentesis for Prenatal Genetic Studies

Prenatal genetic studies on amniotic fluid samples obtained early in pregnancy are becoming part of clinical obstetric practice. Most identifiable chromosomal abnormalities and more than 40 biochemical disorders can now be diagnosed in utero, aside from the important fetal sexing in sex-linked diseases. Our experience with 100 consecutive amniotic fluid samples from 94 pregnancies is described. A diagnosis was made from 99% of the amniotic fluids received, with only one sample lost to contamination. Four confirmed affected fetuses were diagnosed prenatally. Abortion followed amniocentesis in 1 case, and a probably unrelated fetal death occurred in another. No errors have become apparent in the outcome of 58 pregnancies. Obstetricians are urged to consider the indications for amnioccntesis for genetic disorders in every patient.

Estrogen assays in the clinical practice of gynecology and obstetrics.

Section on Gynecic Endocrinology of the Department of Obstetrics and Gynecology, Michael Reese Hospital and Medical Center, Chicago, Illinois 60616

BOOK REVIEW

Books reviewed in this article: The History of the Society of Obstetricians and Gynaecologists of Canada, 1944–1966. By W. G. Cosbie. Combined Textbook of Obstetrics and Gynaecology: For Students and Practitioners. 8th edition. Edited by Sir Dugald Baird. Foetal and Neonatal Hypoxia in Relation to Clinical Obstetric Practice. By E. Saling (translated from the German by F. E. Loeffler). Living with the Pill. Edited by S. Raven. The Ovary: Proceedings of The Second Annual Symposium on the Physiology and Pathology of Human Reproduction. Edited by H. C. Mack. Structural Basis of Renal Disease. Edited by E. L. Becker. New Aspects of Human Genetics. Edited by C. E. Ford and H. Harris.

Clinical use of ultrasound in obstetrics and gynecology

During the past three years ultrasound diagnostic procedures have been significant and useful aids in the clinical practice of obstetrics and gynecology at the University of Colorado Medical Center. The technique has had its most important applications in the preoperative diagnosis of hydatidiform mole, in the estimation of fetal maturity, and for localization of the placenta. Other areas of clinical application are in the diagnosis of multiple pregnancy, fetal position, and intrauterine fetal death. Approximately 10 per cent of our obstetric patients receive ultrasound diagnostic procedures. Ultrasound is used much less frequently in gynecology but does have value in the differential diagnosis of ascites, abdominal cysts, and peritoneal carcinomatosis.