Pelvic Examination Research Articles

Diagnostic value of 4D pelvic floor ultrasound for postpartum mild to moderate pelvic organ prolapse in primiparas based on medical thermal imaging monitoring

Traditional diagnostic methods often rely on the doctor’s experience, which can lead to missed diagnosis or misdiagnosis. With the development of wireless network medical technology, it provides a new possibility for the diagnosis of pelvic floor ultrasound. The purpose of this study was to evaluate the diagnostic value of 4D pelvic floor ultrasound based on wireless network medical technology in puerperal mild to moderate pelvic organ prolapse, and to explore its feasibility in clinical application. In this study, puerperal women were selected for 4D pelvic floor ultrasound examination after delivery, and image data was transmitted in real time to remote experts for analysis combined with wireless network technology. The sensitivity, specificity and application effect of the technique were evaluated by comparing the ultrasound results with the clinical diagnosis results. The results show that compared with traditional methods, wireless network medical technology can significantly improve the efficiency of image transmission and diagnosis accuracy. Therefore 4D pelvic floor ultrasound based on wireless network medical technology can effectively diagnose the postpartum mild and moderate pelvic organ prolapse of first-time partrients, which has high clinical application value, not only improves the diagnostic efficiency, but also provides a new development direction for telemedicine, and is worthy of promotion and application in clinical practice.

CONHECIMENTOS SOBRE RASTREIO E DIAGNÓSTICO PRECOCE DE CÂNCER DE COLO UTERINO ENTRE AS MULHERES QUE FREQUENTAM UM AMBULATÓRIO DE UM CENTRO UNIVERSITÁRIO NA CIDADE DE PORTO VELHO – RO - BRASIL

Cervical cancer (CCU) is one of the most common types among women, making early diagnosis essential for better prognoses. It is characterized by slow progression, but it is amenable to screening and rapid detection, which can lead to effective treatment and a promising prognosis. Human papiloma virus (HPV) infection, especially by subtypes 16 and 18, is a necessary but not sufficient condition for the development of cervical cancer. The oncotic cytology test (Pap smear) aims to detect precursor lesions of CCU. This study investigated the level of knowledge about cervical cancer screening and early diagnosis among women attending an outpatient clinic at a University Center in Porto Velho, RO. A qualitative and descriptive approach was used through questionnaires to assess understanding of the preventive exam (Pap smear), risk factors, and preventive practices. The results showed: (i) high adherence to the cervical cancer preventive exam among participants; (ii) non-use of condoms (70%); (iii) educational actions on the preventive exam (60%); (iv) structural and personal barriers limiting access to the preventive exam; (v) 56.7% of participants had information about HPV; (vi) 83.3% of participants reported knowledge of cervical cancer; (vii) lack of knowledge about the frequency of the preventive exam in 55% of participants; (viii) 88.3% believe that early diagnosis improves prognosis and treatment success. The results of this study may help to develop effective educational interventions that encourage the preventive exam, contributing to reducing incidence and mortality rates associated with CCU, and improving women’s health in the region.

Surveillance visits for ovarian cancer: Is it time to reconsider the pelvic exam?

Surveillance visits for ovarian cancer: Is it time to reconsider the pelvic exam?

A Rare Case of the Bladder Endometriosis and Overview of the Literature

Endometriosis is a chronic, non-cancerous condition characterized by the growth of endometrial tissue outside the uterus. Isolated involvement of the bladder is rare and often part of a broader deep infiltrating pelvic endometriosis. Bladder endometriosis should be considered in cases of unexplained dysuria and urinary symptoms not clarified by imaging or pelvic examination. Magnetic resonance imaging can be used as a diagnostic aid. This case report presents two patients diagnosed with bladder endometriosis postoperatively. Conservative treatment with gestagen preparations was administered. After 3-6 months of follow-up, ultrasonography and symptom assessment showed no recurrence. Clinicians should be aware of bladder endometriosis as a potential cause of persistent urinary symptoms, given its rarity and often delayed diagnosis.

Ovarian–Adnexal Reporting and Data System (O-RADS) MRI Scoring: Diagnostic Accuracy, Interobserver Agreement, and Applicability to Machine Learning

Abstract Objectives To evaluate the interobserver agreement and diagnostic accuracy of ovarian–adnexal reporting and data system magnetic resonance imaging (O-RADS MRI) and applicability to machine learning. Material and methods Dynamic contrast-enhanced pelvic MRI examinations 471 lesions were retrospectively analyzed and assessed by three radiologists according to O-RADS MRI criteria. Radiomic data were extracted from T2, and post-contrast fat-suppressed T1-weighted images. Using these data, an artificial neural network (ANN), support vector machine, random forest, and naive Bayes models were constructed. Results Among all readers, the lowest agreement was found for the O-RADS 4 group (kappa: 0.669 (95% confidence interval [CI] 0.634–0.733)), followed by the O-RADS 5 group (kappa: 0.709 (95% CI 0.678–0.754)). O-RADS 4 predicted a malignancy with an area under the curve (AUC) value of 74.3% (95% CI 0.701–0.782), and O-RADS 5 with an AUC of 95.5% (95% CI 0.932–0.972),(p < 0.001). Among the machine learning models, ANN achieved the highest success, distinguishing O-RADS groups with an AUC of 0.948, a precision of 0.861, and a recall of 0.824. Conclusion The interobserver agreement and diagnostic sensitivity of the O-RADS MRI in assigning O-RADS 4–5 were not perfect, indicating a need for structural improvement. Integrating artificial intelligence into MRI protocols may enhance their performance. Advances in knowledge Machine learning can achieve high accuracy in the correct classification of O-RADS MRI. Malignancy prediction rates were 74% for O-RADS 4 and 95% for O-RADS 5.

Maternal factors associated with early-onset neonatal sepsis among caesarean-delivered babies at Mbarara Regional Referral Hospital, Uganda: a case-control study

BackgroundBabies born via caesarean section in low-income settings face a higher risk of early-onset neonatal sepsis (EONS), which has greater mortality than late-onset sepsis. However, maternal factors contributing to EONS among caesarean-delivered babies in these settings, including Uganda, are not well documented. We determined maternal factors associated with EONS among term babies delivered by caesarian section at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda.MethodsWe conducted an unmatched case-control study at MRRH from December 2019 to March 2020. Cases were caesarean section-delivered term babies with EONS (within 72 h). Controls were caesarean section-delivered term babies without EONS. We enrolled mother-baby pairs for both groups, obtaining maternal data via structured questionnaires The diagnosis of EONS was made using the WHO Young Infant Integrated Management of Childhood Illnesses algorithm. Cases were consecutively recruited while controls were recruited by simple random sampling in a ratio of 1:2. We excluded newborns whose mothers were too ill to consent. We used multivariable logistic regression analysis to identify maternal factors associated with EONS.ResultsWe enrolled 52 cases and 104 controls. The mean age for the mothers was 27 (± 5.5) years. Neonates born to referred mothers had higher odds of EONS than those born to non-referred mothers (AOR = 6.2, 95% CI: 1.8–21). Additionally, decision-to-delivery time > 1 h for emergency caesarean section (AOR = 16, 95% CI: 4.2–65), antepartum hemorrhage (AOR = 8.0, 95% CI: 1.6–40), primiparity (AOR = 4.8, 95% CI: 1.1–21), and > 3 vaginal examinations after membrane rupture (AOR = 4.3, 95% CI: 1.5–12) were associated with EONS.ConclusionsPrime gravidity, antepartum hemorrhage, multiple vaginal examinations after membrane rupture, long decision-to-delivery time, and referral status were associated with EONS among term babies delivered by caesarean section at MRRH. To reduce EONS risk, clinicians should limit post-membrane rupture vaginal exams or consider prophylactic antibiotics if multiple exams are needed. Screening babies born to primiparous women, those referred, those with antepartum hemorrhage, multiple vaginal exams after membranes rupture, and long decision-to-delivery times, could aid prompt recognition of EONS and timely interventions. Implementing standard procedures to reduce caesarean decision-to-delivery time could reduce risk for EONS in this setting.

Outcomes of primary transobturator mid-urethral sling surgery in women of different ages

IntroductionOlder age is associated with greater likelihood of urinary incontinence and unmet care needs. It was hypothesized that age might influence clinical and ultrasound outcomes of transobturator mid-urethral sling (TOS) surgery. The aim of this study was to compare 1-year postoperative clinical and ultrasonographic outcomes of TOS surgery among women of different ages. MethodsA retrospective analysis of a cohort of women who underwent primary and isolated TOS surgery for uncomplicated urodynamic stress incontinence was undertaken. All women underwent pre-operative and 1-year postoperative evaluations including clinical interview, pelvic examination, urodynamic studies and introital four-dimensional ultrasound. To be eligible for surgery, women needed to be independent in their daily life, and to have an acceptable level of surgical risk on pre-operative assessment. The primary outcome was the rate of stress urinary incontinence (SUI) after surgery. The secondary outcomes comprised postoperative adverse events and ultrasound findings. ResultsIn total, 162, 213, 60 and 29 women aged <51, 51–64, 65–74 and ≥75 years, respectively, were included in this study. At 1-year postoperative assessment, older women were more likely to report SUI and bothersome SUI, while the severity of SUI and postoperative adverse events were similar in older women compared with other age groups. Ultrasound revealed that the sling tended to be looser and higher in older women. ConclusionTOS surgery is effective and safe for women of all ages who are independent in their daily life and who have an acceptable level of surgical risk. The sling tended to be looser and higher in older women.

Screening for Sexually Transmitted Infections in Adolescents with Genitourinary Complaints: Is There a Still Role for Endocervical Gram Stains?

Study objective: Adolescent females are disproportionately affected by Sexually Transmitted Infections (STIs). Endocervical Gram stain smears taken during gynecological examination are inexpensive, relatively easy procedures to perform and interpret. The purpose of this study was to evaluate the performance characteristics of Gram smears in the diagnosis of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and Trichomonas vaginalis (TV) in a female adolescent population presenting to the Emergency Department (ED) with genitourinary complaints. Methods: This study was a retrospective, cohort analysis of consecutive females (ages 13 – 19) seen at three academic medical centers over a two-year study period. All patients underwent a pelvic exam with diagnostic testing for STIs. Positive criteria for a Gram stain included greater than ten white blood cells per high-power field, gram-negative intracellular/extracellular diplococci (suggesting GC), or direct visualization of TV organisms. Polymerase Chain Reaction (PCR) assays were used as the gold standard definition for CT/GC infection. Direct microscopic visualization of organisms on a separate wet mount prep was considered the gold standard for TV infection. Demographic information, clinical findings of cervicitis, and the results of diagnostic testing were obtained from ED records using standardized abstraction forms. Results: During the study period, 1303 adolescent females were evaluated for genitourinary complaints. A total of 181 adolescents (12.9%) had at least one documented STI. Overall, 298 patients (22.9%) had positive gram stains. The sensitivity, specificity, and positive likelihood ratio for Gram stain in the diagnosis of STI were 28.7% (95% CI, 22.2 to 35.9), 78.1% (95% CI, 75.5 to 80.5), and 1.31 (95% CI 1.0 to 1.7), respectively. The sensitivity of Gram stain to Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis were 35.9% (95% CI 26.8 to 45.8), 34.5% (95% CI 18.0 to 54.3), and 5.7% (95% CI 1.3 to 15.7), respectively. The consistency of the data recording was excellent, with a median kappa statistic of 0.89. Conclusions: The positive likelihood ratio of inflammation on endocervical Gram stain is too low to recommend its use to direct empiric treatment of adolescents at risk for sexually transmitted infections. Diagnostic uncertainty or treatment failures should prompt specific laboratory testing.

Transvaginal double-layer parallel in-situ suturing for early complex vesicovaginal fistula repair: Case report.

Complex vesicovaginal fistulas (VVFs) with large defects pose significant surgical challenges. Traditional repair methods often require extensive tissue separation and multilayer suturing, risking local blood supply and healing. This study introduces a novel modified transvaginal repair technique that simplifies the procedure while preserving tissue vascularity. It employs double-layer parallel in situ suturing for early repair of complex VVF. A 50-year-old woman was admitted with continuous vaginal urine leakage for 4 days following trauma. Speculum examination revealed a 3-cm longitudinal oval laceration at the 11 o'clock position in the dorsal lithotomy site, with continuous fluid leakage through the fistula. Self-inflicted complex VVF. The patient underwent prophylactic placement of bilateral double-J stents and continuous catheterization, followed by surgical repair using a modified transvaginal technique involving double-layer parallel in situ suturing. Postoperative evaluations showed successful healing with no urinary leakage. The vaginal sutures were removed on day 24, and follow-up at 1 year confirmed no recurrence of the fistula or lower urinary tract symptoms, significantly improving the patient's quality of life. The modified transvaginal repair technique using double-layer parallel in situ suturing is a simple and effective approach for early repair of complex VVF, highlighting its potential for broader clinical application. Future studies with larger cohorts are needed to validate these findings.

Type 1 diabetes mellitus; ovarian reserve; anti-Müllerian hormone; ovarian function

BACKGROUND: Prolonged course of diabetes mellitus often leads to the development of vascular complications, insufficiency of ovarian function. The occurrence of diabetes mellitus in women before pregnancy (pregestational diabetes mellitus) it can have various adverse consequences for the mother, fetus, child and the course of pregnancy. Pregnancy planning in women with pregestational diabetes significantly improves the outcomes of pregnancy and childbirth. AIM: The aim of this study was to analyze gonadotropic and ovarian function parameters in patients with type 1 diabetes mellitus depending on the age of onset, duration and compensation level of the disease. MATERIALS AND METHODS: The patients included into this clinical prospective study were divided into two groups. The main group consisted of 216 patients with type 1 diabetes mellitus aged 18 to 39 years (mean age: 27.1 ± 3.1 years). The control group consisted of 30 healthy women of reproductive age. Chemiluminescent immunoassay was used to determine blood serum levels of anti-Müllerian hormone, follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, testosterone, free testosterone, and sex hormone-binding globulin from day 2 to day 5 of the menstrual cycle. Serum progesterone levels were measured on days 20–23 of the menstrual cycle for three consecutive cycles. Glycated hemoglobin levels were also studied in the blood serum of patients with type 1 diabetes mellitus. All the patients underwent pelvic ultrasound examination to assess the cohort of antral follicles and ovarian volume. RESULTS: The average age of menarche in patients with type 1 diabetes mellitus who developed the disease at the age of under 10 years was 14.2 ± 1.2 years. This was higher than in the group of girls with the onset of the disease over the age of 10 years (13.5 ± 1.2 years) and in women of the control group (11.9 ± 1.1 years). When assessing the ovarian reserve in patients with type 1 diabetes mellitus, we found a decrease in anti-Müllerian hormone level and antral follicle count in the group of women with disease onset at the age of under 10 years. We did not find differences in the ovarian reserve parameters in patients depending on disease duration. Normogonadotropic normoprolactinemic ovarian insufficiency was detected in 154 (71.3%) of 216 patients, while the rest 62 (28.7%) women had an ovulatory menstrual cycle. In patients with anovulation, luteal phase deficiency and ovulatory menstrual cycle, we found no differences between the age of development of type 1 diabetes mellitus, its duration, glycated hemoglobin levels, total daily insulin dose and insulin dose per kilogram of body mass. In patients receiving intensive insulin therapy with continuous subcutaneous insulin infusion, glycated hemoglobin level was lower than in those receiving multiple dose insulin injection therapy. CONCLUSIONS: The average age of menarche in patients with type 1 diabetes mellitus is higher than in healthy women. The ovarian reserve parameters in patients with early onset of the disease, before 10 years of age, are lower than in patients who developed type 1 diabetes mellitus after 10 years of age. Duration of pregnancy planning period depends on compensation level of the disease and lasts from six to 12 months. This requires the doctor and patient to prepare for the implementation of reproductive tasks as early as possible, especially in patients whose disease onset occurred in pre-pubertal period.

A Validated Calculator to Estimate Risk of Chorioamnionitis in Laboring and Induced Patients at Term.

Chorioamnionitis is associated with neonatal morbidity and infection-related mortality, but our ability to predict intrapartum infection is limited. We sought to derive and validate a prediction model for chorioamnionitis among patients presenting to labor and delivery at term. This was a planned secondary analysis of a large cohort study from 2014 through 2018 at an academic tertiary care center. To derive a prediction model for chorioamnionitis, we limited our analysis to full-term (≥37 weeks) patients with a singleton gestation undergoing labor induction and presenting in labor. Both nulliparous and multiparous patients were included. Patients with a planned cesarean delivery, fever on admission, or missing data were excluded. The model was derived using multivariable logistic regression. Refinement of the prediction model with internal calibration was performed. External validation was performed utilizing a publicly available database (Consortium on Safe Labor) and applying the same inclusion and exclusion criteria. The discriminative power of each model was assessed using a bootstrap, bias-corrected area under the curve. The chorioamnionitis rates in the derivation and external validation groups were: 5% (1,005/19,966) and 5.8% (n = 3,005/52,171), respectively. In multivariable modeling, maternal age, nulliparity, gestational age, smoking status, group B streptococcus colonization, hours ruptured, number of cervical exams, length of labor, epidural use, internal monitoring, and meconium were significantly associated with infection. A calculator was created and externally validated with an area under the curve of 0.82 (95% confidence interval, 0.81-0.82). External validity was further confirmed with a calibration intercept of 0.81. This is the first infection calculator created and validated for the prediction of developing chorioamnionitis in patients undergoing induction of labor at term. This calculator can be used to augment patient counseling and guide intrapartum infection surveillance in laboring patients.

Prevalence of pelvic examinations on anesthetized patients without informed consent.

The pelvic examination is a fundamental tool for the evaluation and diagnosis of women's health conditions and an important skill for all medical students to learn as future physicians for the early detection of treatable conditions such as infection or cancer. Although the American College of Obstetricians and Gynecologists (ACOG) asserts that performing pelvic examinations under anesthesia for educational purposes should only occur if the patient provides explicit and informed consent, there still have been reports of medical students performing pelvic examinations on anesthetized patients across the country, and many states are now starting to pass bills requiring informed patient consents to conduct pelvic examinations under anesthesia. The objectives of this study are to evaluate the prevalence of pelvic examinations performed by osteopathic medical students on anesthetized patients without consent while fulfilling their third-year OB-GYN clerkship requirements. The survey was administered and distributed to all osteopathic medical schools in the country via the Student Osteopathic Medical Association's (SOMA's) chapter emails, outreach emails, and SOMA's social media accounts to collect data. Inclusion criteria included third- or fourth-year osteopathic medical students who completed their OB-GYN clerkship rotations when taking the survey. The exclusion criteria included any osteopathic medical student who had not completed their OB-GYN clerkship rotation. We utilized descriptive analysis to summarize the final data. We received 310 responses. The final number of responses was 291 after meeting the exclusion criteria. Most osteopathic medical students (94.2 %, n=274) considered the practice of performing pelvic examinations on anesthetized patients without their explicit consent unethical. Among theparticipants, 40.9 % (n=119) admitted to performing pelvic examinations on patients under anesthesia while on OB-GYN rotations, but most of them (57.1 %, n=68) did so without obtaining prior consent from the patients. Notably, the number of pelvic examinations performed by medical students on patients under anesthesia ranged widely from 1 to 25 with a median number of 10. Moreover, 58.9 % (n=70) indicated that they had not been properly educated to obtain specific consent before performing pelvic examinations under anesthesia. Many participants cited efficiency of practice, lack of policy awareness and personal education by medical students, andfailure to refuse to perform pelvic examinations on anesthetized patients as trainees when asked by their seniors or preceptors. This study demonstrates that although most osteopathic medical students consider performing pelvic examinations on anesthetized patients unethical, many still admit to practicing pelvic examinations on patients under anesthesia, while on OB-GYN rotations for efficiency of practice, lack of policy awareness and personal education, and being in unique positions in which grades are determined by seniors and preceptors for their willingness to do what is asked even if the practice does not align with their conviction. This study highlights the importance of ongoing research and implementation of policies at institutional and state levels that will procure the value of pelvic examinations while protecting and upholding the ethics of patients' rights and autonomy of medical students.

Pelvic myofascial pain is associated with restriction of sexual activity in women with pelvic pain: a cross-sectional study.

Background Dyspareunia and restriction of sexual activity are often reported by patients with chronic pelvic pain, but less is known about which conditions or factors contribute most to these symptoms. Methods This is a cross-sectional study of consecutive new patients who presented to a chronic pelvic pain and endometriosis referral clinic between January 2013 and December 2015. Patients completed a detailed questionnaire prior to their first visit and underwent a comprehensive standardised pelvic examination at their first visit. Patients were grouped according to description of sexual activity as 'normal activity without pain', 'normal activity but painful', 'severely restricted by pain', or 'absent due to pain.' Primary outcome was restriction of sexual activity due to pain. Multinomial logistic regression was performed with 'normal activity without pain' group as reference category and adjusted for age, depression, history of endometriosis, and pelvic myofascial pain. Results Over half of the 187 patients with chronic pelvic pain described severely restricted (n =75, 40.1%) or absent (n =21, 11.2%) sexual activity due to pain. Pelvic myofascial pain was highly prevalent in this population and pelvic myofascial tenderness score was associated with higher odds of sexual activity that was severely restricted by pain (OR 1.05, 95% CI 1.01-1.09, P =0.006) or absent due to pain (OR 1.09, 95% CI 1.04-1.13, P Conclusion Dyspareunia and sexual dysfunction are highly prevalent among patients with chronic pelvic pain, and pelvic myofascial pain is strongly associated with restriction of sexual activity due to pain.

Uterine Sarcoma or Degenerating Fibroid? Validating the New Consensus Magnetic Resonance Imaging Algorithm for Evaluating Atypical Uterine Masses.

The aim of the study is to assess the validity of a recently published consensus magnetic resonance imaging (MRI) diagnostic algorithm for differentiating degenerating leiomyomas from uterine sarcomas and other atypical appearing uterine malignancies. Atypical uterine masses on pelvic MRI were identified using a radiology report search engine and teaching files with the keywords "atypical leiomyoma," "atypical fibroid," and "sarcoma." All cases were pathology-proven. Two radiologists blinded to clinical, surgical, and pathologic reports retrospectively and independently reviewed 40 pelvic MRI examinations dated 1/2007-9/2022 to determine whether the masses appeared benign or malignant, using the 2022 consensus atypical uterine mass flow chart. Imaging features assessed included intermediate/high signal intensity (SI) at T2-weighted imaging, high diffusion weighted imaging SI (equal or higher SI than endometrium or lymph nodes on high b value imaging), apparent diffusion coefficient (ADC) value ≤0.905 × 10-3 mm2/s, peritoneal metastases, and abnormal lymph nodes. Among the 40 atypical uterine mass cases reviewed, 24 masses were benign (22 leiomyomas, 1 adenomyoma, and 1 borderline ovarian tumor) and 16 masses were malignant (6 leiomyosarcomas, 6 carcinosarcomas, 2 endometrial stromal sarcomas, 1 high-grade adenosarcoma, and 1 low-grade uterine sarcoma). Sensitivity, specificity, positive predictive value, and negative predictive value of whether a mass was benign or malignant were 75%, 95.8%, 92.3%, and 85% for reader 1, and 81.2%, 91.7%, 86.7%, and 88% for reader 2, respectively. Interrater agreement was strong, with a kappa statistic of 0.89. When excluding nonleiomyosarcoma uterine malignancies, sensitivity and negative predictive value improved to 100%. The new consensus pelvic MRI algorithm for evaluating atypical uterine masses has good specificity, sensitivity, positive predictive value, and negative predictive value for determining malignancy, particularly for uterine sarcomas that are leiomyosarcomas. However, if ADC value is near but not below 0.905 × 10-3 mm2/s, the mass may still be malignant, especially if a b value lower than 1000 is used. If the atypical uterine mass is predominantly endometrial, morphological features on T2 and postgadolinium sequences should guide suspicion, as some atypical appearing nonleiomyosarcoma uterine malignancies may have an ADC value greater than 0.905 × 10-3 mm2/s.

Fetomaternal outcomes in vaginal discharge during pregnancy: A prospective comparative study

Background: Vaginal discharge (VD) is a common symptom in women during the reproductive period, especially during pregnancy. Pathological VD during pregnancy is an important public health concern because it has a sociopsychological impact on women and influences fetomaternal outcomes. Aims and Objectives: The study aims to estimate the prevalence of pathological discharge in pregnant women. The study also focuses on the demographic profile and various risk factors associated with pathological VDs and their consequences on fetal and maternal health. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology in a tertiary care center in Northern India. A total of 150 pregnant women with complaints of VD in the second and third trimesters with confirmation on speculum examination were recruited and evaluated for the etiology of discharge. Patients were followed until delivery and data regarding fetomaternal outcomes was collected. Results: The prevalence of pathological VD among enrolled women was 39.33% and various etiologies were candidiasis (15.33%), bacterial vaginosis (10.66%), aerobic vaginitis (8.67%), and trichomoniasis (4.67%). These infections were significantly related to pre-term delivery and pre-term pre-labor rupture of membranes. Furthermore, the incidence of prematurity, and low birth weight neonates requiring neonatal intensive care unit care was significantly high in babies born to mothers with pathological VD. Conclusion: Vaginal infections affect both maternal and neonatal health, thus, increasing the likelihood of poor perinatal outcomes. Hence, we propose that routine screening for pathological VD for all pregnant women should be introduced into standard antenatal care.

Correlation between ultrasound features and histopathological finding in cases of adenomyosis: a cross-sectional study

Background Adenomyosis is a gynecological disorder characterized by hypertrophy and hyperplasia of the surrounding myometrium and the presence of ectopic endometrial glands and stroma inside the myometrium. Aims To compare the accuracy of preoperative ultrasound (US) features with the histopathological results for the diagnosis of adenomyosis, and to determine its sensitivity for diagnosis. Patients and methods A total of 100 perimenopausal and postmenopausal patients (aged 40 to 60 years old) presented with abnormal uterine bleeding. Every patient underwent a thorough history taking, general examination, and pelvic examination. The selected patients were subjected to all laboratory investigations, abdominal and vaginal US, and abdominal or vaginal hysterectomy followed by histopathological examination. Results 45 (45%) patients had adenomyosis by transvaginal US and 52 (52%) patients had adenomyosis by histopathology with a P value of 0.105 which means that there is no significant difference between transvaginal US and histopathology in the diagnosis of adenomyosis. Transvaginal US had an 89.0% diagnostic accuracy for adenomyosis, with 82.7% sensitivity, 95.8% specificity, 95.6% positive predictive value, and 83.6% negative predictive value. Conclusion Transvaginal US is an important diagnostic technique for adenomyosis, and there is no significant difference between ultrasound and histology in the diagnosis of the condition.

Estimation of Radiation Equivalent Dose and Lifetime Attributable Risk from Pediatric CAP CT Examination

Aim: This study aims to estimate equivalent doses (EqDs) and life attributable risks (LARs) for pediatric patients who underwent chest–abdominal–pelvic (CAP) CT examinations in Madinah, Saudi Arabia. Methodology: This retrospective study collected data from 120 pediatric patients who underwent CAP CT examinations. The data were categorized by the age and gender of the pediatric patients. Then, the EqDs were computed using the NCICT (National Cancer Institute dosimetry system for computed tomography) program, and LARs were estimated from the equivalent dose (EqD) results using age- and gender-specific cancer risk models found in the Committee on the Biological Effects of Ionizing Radiation (BEIR) VII Phase 2 (2006). Results: The EqD range was 0.9 to 7.55 mSv for the prostate and colon (males and females), respectively. LARs for female breast and lung cancers were considered to have the highest values among the age groups. Nevertheless, LARs of the colon, liver, and leukemia cancers were higher for males than females. The LAR range of cancer incidence was 0.6 to 63.1 per 100,000 cases for prostate (aged 10–≤15 years) and breast (females aged 1≤–&lt;5 years), respectively. The LAR range of cancer mortality was 0.1 to 41.9 per 100,000 cases for prostate (aged 10–≤15 years) and lung (females aged 1≤–&lt;5 years). Conclusions: LARs of all cancer incidence and mortality from CAP CT examination were higher for pediatric females than males (with an average of 54%). This highlights the importance of considering pediatric patient gender and implementing optimization and protective measures in CAP CT examinations. LARs of breast and lung (for females) and colon (for males) cancers were found to have the highest values among the age groups. However, LARs of cancer incidence and mortality for colon, liver, and leukemia for males were higher than those for females.

Diagnosis and Management of Preterm Prelabor Rupture of Membranes: A Comprehensive Review of Major Guidelines.

Preterm prelabor rupture of membranes (PPROM) represents a significant contributor of maternal and neonatal morbidity complicating a significant proportion of pregnancies worldwide. The aim of this review was to summarize and compare the most recently published guidelines on the diagnosis and management of this critical pregnancy complication. A comparative review of 3 recently updated national guidelines from the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynaecologists, and the Society of Obstetricians and Gynaecologists of Canada on PPROM was conducted. There is an overall agreement that the diagnosis of PPROM should be mainly based on sterile speculum examination and patient's history, followed by additional tests in equivocal cases, although the accuracy and contribution of both ultrasound and amniotic proteins tests in the diagnosis remain debatable. Following PPROM confirmation, all guidelines recommend the performance of vaginal and rectal swabs, the evaluation of fetal and maternal status, the administration of antibiotics and corticosteroids, and the immediate induction of labor, if severe complications are identified. Expectant management from viability until late preterm period is universally recommended; nevertheless, there are discrepancies on the optimal timing of delivery. Magnesium sulfate should be administered in case of imminent preterm delivery; however, there is no consensus on the upper gestational age limit. Recommendations on inpatient and outpatient management of PPROM are also inconsistent. Moreover, there is no common guidance on the use of tocolysis or antibiotic regimens. Finally, all medical societies agree that closer surveillance of future pregnancies is required. PPROM remains the most common identifiable risk factor of preterm delivery, despite constant improvement in prenatal provision of care. Thus, the establishment of consistent international practice protocols for the timely and accurate diagnosis and the optimal management of this complication seems of vital importance and will hopefully lead to significant reduction of the associated adverse outcomes.

Case Study- Ovarian Cyst

Fluid-filled sacs or pockets within or on the surface of an ovary are known as ovarian cysts. On either side of the uterus, women have two ovaries, each roughly the size and shape of an almond. Throughout the reproductive years, ova, or eggs, are released monthly in cycles after developing and maturing in the ovaries. Ovarian cysts affect a lot of women at some point. The majority of ovarian cysts are benign and cause little to no discomfort. Without therapy, the majority vanishes in a few of months. On the other hand, ovarian cysts, particularly those that have burst, might present with severe symptoms. Get routine pelvic exams and be aware of the symptoms that may indicate a potentially dangerous issue to safeguard your health.

376 Trauma-Informed Pelvic Examinations: Positive Impact of Educational Session on Emergency Medicine Learners

376 Trauma-Informed Pelvic Examinations: Positive Impact of Educational Session on Emergency Medicine Learners