Transvaginal Doppler Sonography Research Articles

The role of hysteroscopy with morcellator without anesthesia in the management of abnormal uterine bleeding.

To evaluate the feasibility of hysteroscopy with morcellator without anesthesia and the diagnostic accuracy of 2D, 3D and power Doppler transvaginal sonography (TVS) in patients with abnormal uterine bleeding (AUB). This was a retrospective study including women with AUB. All patients underwent 2D, 3D and power Doppler TVS evaluation of the uterine cavity, and patients with suspicion on ultrasound (US) of endometrial pathology (EP) underwent hysteroscopy with morcellator without anesthesia. The painful symptomatology was assessed during the procedure using a visual analogue scale (VAS). Additionally, histological evaluation was performed. A total of 182 women underwent US imaging, of whom 131 (72%) had hysteroscopy. 130/131 patients completed the hysteroscopic examination with good compliance (VAS <4). One patient (0.8%) was unable to complete the procedure due to nulliparity and cervical stenosis. Of the 130 patients the US diagnosis was confirmed in 120 (92.3%), while in 10 patients (7.7%) the hysteroscopic diagnosis was different from the US diagnosis. Histological examination confirmed benign endometrial polyps in 115/130 patients (88.5%), while premalignant conditions were diagnosed in 3/130 patients (2.3%) and malignant conditions in 2/130 (1.5%). Of the 10 patients with endometrial thickening, two were diagnosed with a malignant condition. This study confirmed the feasibility of managing patients with AUB and suspicion of EP using "see-and-treat" hysteroscopy with morcellator without anesthesia. This procedure has the potential to yield desired outcomes while minimizing pain and discomfort, presenting a feasible outpatient approach for both treating and preventing endometrial carcinoma without requiring anesthesia.

Pain reduction as the main parameter for monitoring improvement in Health-Related Quality of Life (HRQoL) following endovascular treatment of Pelvic Congestion Syndrome (PCS)

The purpose of this study was to evaluate pain reduction as the main parameter for monitoring improvements in Health-Related Quality of Life (HRQoL) in a female patient following endovascular treatment of Pelvic Congestion Syndrome (PCS).A 38-year-old female patient with chronic intermittent, “dragging” abdominal pain, lasting more than two years, mainly in the lower abdomen, radiating to the sacral region, underwent SARS CoV-2 infection in October 2021, and COVID-19, which lasted 10 days. Eight months later, complaints of pain in the lower abdominal area, during the mentrual cycle, during prolonged standing, after sports activities and during and after intercourse, increased. The patient was compelled to begin diagnosis of these complaints due to the severe pain and concerns about whether she had contracted cancer of the cervix uteri. She was diagnosed on transvaginal ultrasound-Doppler and Angio-MR of the pelvic vessels with PCS. Treatment was undertaken at the Department of Vascular Surgery and Endovascular Interventions, St. John Paul II Hospital, Krakow, Poland. Intraoperatively, after confirmation through selective angiography, of previously diagnosed insufficiency of the left ovarian vein (LOV) and of the parametrial veins (PMV), the selective obliteration was performed with an adhesive dedicated to endovascular closure of veins and vascular malformations (Glubran2). The range of pain intensity, according to theVisual Analogue Scale (VAS), in Exam. 1 (before surgery), was in the premenstrual period (BM) 7.0 points, which increased during menstruation (DM) or after intense activity (AIA) to 8.0 points, and occasionally during and after intercourse even to 9.0 points. These values were very high, indicating that pain significantly affected the patient's quality of life. The extent of pain severity decreased significantly in Study 2 (two months after surgery) and Study 3 (four months after surgery) and was 2.0 points in the premenstrual period (BM), which increased only slightly during menstruation (DM) or after intense activity (AIA) to 3.0 points, and decreased again to 2.0 points during and after intercourse. The patient reported that the procedure significantly and positively affected her functioning in daily life, especially in caring for a young child, which is evidence of the achievement of HRQoL improvement.Endovascular treatment for Pelvic Congestion Syndrome (PCS) was effective in reducing pain and improving the Health-Related Quality of Life (HRQoL) of a patient with PCS.

Evaluation of the effects of raloxifene treatment on uterus in asymptomatic postmenoposal patients by transvaginal Doppler ultrasonography

Aims: To evaluate the effects of raloxifene treatment on uterus in asymptomatic postmenopausal patients by Doppler transvaginal ultrasonography (TvUS). Methods: Randomized controlled prospective study, 57 healthy postmenopausal asymptomatic patients, aged 45-60, who applied Okmeydanı Training and Research Hospital Obstetrics and Gynecology Outpatient Clinic between 2003-2004. Four patients were excluded from the study because they did not apply the treatment regularly. All of the patients were in natural menopause. They had not received any hormone replacement therapy before. Their body mass index (BMI) was below 30 kg/m2 and had no systemic diseases. The patients were divided into two groups as those who received raloxifene (n: 27) and those who did not (n: 26). Raloxifene was given 60 mg/day for 6 months. In all patients enrolled in the study, endometrial and uterine volume, pulsatility (PI) and resistance indices (RI) were evaluated by TvUS Doppler. Endometrial biopsies (EB) were obtained with pipelle at 0 and 6 months. Results: There was no significant difference in terms of age, height, weight and BMI (p&lt;0.05). Parity, menopause time and endometrial thickness were similar (p&lt;0.05). EB results were similar (p&lt;0.05). Uterine volumes at month 0 and 6 were similar (p&lt;0.05). PI and RI were found to be similar in the right and left arteries at baseline (p&lt;0.05). While PI and RI on the right side were similar at 6 months, left uterine artery PI was found to be significantly higher in the treated group. Left uterine artery RI was similar. Conclusion: Raloxifene treatment neither did stimulate the endometrium, nor increased the uterine volume or uterine blood flow. It did not have any stimulating effect on the uterine tissue.

Evaluation of serum VEGF-A and interleukin 6 as predictors of angiogenesis during peri-implantation period assessed by Transvaginal Doppler Ultrasonography amongst women of prior reproductive failure: a cross-sectional analytical study.

Background: Infertility is a wide spectrum of disorder affecting many couples and is defined as the inability of a couple to achieve pregnancy. A series of investigations are required to know the reason behind infertility, yet a small percentage (08-37%) of couples exist, in which no obvious cause is delineated. Different hormones, growth factors and interleukins are responsible for successful ovulation, implantation and further growth of embryo. Endometrial receptivity is an important predictor of the outcome of implantation and further growth of embryo. Methods: The study would be conducted in a tertiary care centre over a period of two years from July 2022 till July 2024 on non-pregnant unexplained infertile women (63) who will undergo In vitro Fertilisation and Embryo Transfer (IVF-ET) in the following cycle and the result will be compared with the fertile women (21) with same demographic features. The levels of serum Vascular Endothelial Growth factor–A, interleukin-6 will be measured on day 21 of the menstrual cycle in both the group, simultaneously, transvaginal ultrasonography and doppler findings will be measured in both groups to see for endometrial receptivity. The values will be compared for any significance. A new Scoring system will be generated of these three parameters PREDICGIO scoring system after pilot study on ten patients. The values of Serum VEGF-A, IL6 and Doppler findings will be compared between fertile and infertile group to see for significant difference. Conclusion: The current study helps in determining the suboptimal vasculogenesis and angiogenesis in women with failure in reproduction. It will also help to a great extent in managing patients of reproductive failure with immunomodulator drugs thus providing external angiogenic factors to help in conceiving and carrying pregnancy till term.

Doppler in threatened abortion

Threatened Abortion is one of the most common complication in early pregnancy. Its incidence varies between 20-25%. Transvaginal Color Doppler ultrasonography has permitted assessment of uteroplacental circulation in early pregnancy, irregularities of which have been linked to pregnancy complications such as hypertension, fetal growth restriction (FGR), fetal distress, and early pregnancy failure). The capability of trans-vaginal Doppler sonography to analyze the pattern of circulation in even terminal branches of the uteroplacental circulation has encouraged research for its potential use in predicting early and late pregnancy complications related to abnormal placentation. Impaired vascular remodelling in the maternal - fetal interface is one of the most significant factors associated with early and late complications in pregnancy.

Cesarean scar pregnancy mimicking a pseudo-gestational sac: A case report with magnetic resonance imaging findings

Introduction: A corpus luteal cyst may reportedly be misidentified as an ectopic gestational sac. We report a case of cesarean scar pregnancy mimicking a pseudo-gestational sac, to differentiate between the two entities and diagnose correctly. Case Report: A 42-year-old woman with four previous cesarean sections, at 7 weeks of gestation, was suspected of an unknown site pregnancy. Transvaginal Doppler ultrasonography showed a small cystic structure accompanied by neither a yolk sac nor surrounding marginal flow, adjacent to the uterine scar, and a 16-mm-large low-echo area with a white ring in the left adnexa. Pelvic magnetic resonance imaging also demonstrated a small cystic structure without contrast enhancement resembling a pseudo-gestational sac adjacent to the cesarean scar. Moreover, a cystic structure with ring-enhancement beside the left ovary, which mimicked an ectopic gestational sac, was also detected. Given these imaging findings and slightly elevated serum β-human chorionic gonadotropin (β-hCG) levels, ectopic pregnancy in the left fallopian tube could not be ruled out. She underwent laparoscopic surgery and uterine content removal, which resulted in intrauterine miscarriage. The cystic structure partially resected from a marginal area in the ovary appeared to be a luteal cyst. Conclusion: For correct diagnosis and appropriate treatment, the clinical circumstances should be fully considered without excessive reliance on imaging findings.

Effects of hysterosalpingo-contrast sonography examination on endometrial receptivity among women with unexplained infertility

Hysterosalpingo-contrast sonography (HyCoSy) is the preferred method for evaluating fallopian tubal patency, and it is associated with improved rates of natural pregnancy among infertile patients. However, the mechanism underlying the improvement in pregnancy rates following HyCoSy remains unclear. This study aimed to investigate the effect of HyCoSy examination on endometrial receptivity as well as pregnancy rates among infertile women. This prospective study included 120 women with unexplained infertility who visited our department between June 2018 and February 2021. These patients were classified into the study group (n = 60) and the control group (n = 60) depending on their willingness to undergo three-dimensional HyCoSy in the present cycle (study group) or 6months later (control group). Endometrial characteristics, including endometrial thickness and pattern as well as the endometrial blood flow distribution pattern, were measured twice by transvaginal Doppler ultrasonography in the preovulatory phase before and after HyCoSy examination. Participants were followed for 6months to observe the outcome of spontaneous conception. Compared with the control group, the study group had a significantly higher cumulative pregnancy rate at 6months after HyCoSy (21.6% [13/60] vs 5.0% [3/60], P = 0.007). More patients in the study group showed improved endometrial blood flow distribution (P = 0.021, χ2 = 7.699), but no differences in endometrial thickness and pattern were observed between the groups (P > 0.05). HyCoSy examination may improve endometrial perfusion and has a therapeutic effect on improving spontaneous pregnancy among women with unexplained infertility.

Transvaginal Doppler Ultrasonography and MRI for Prediction and Diagnosis of Adherent Placenta in High-Risk Group in the Second Half of Pregnancy

Transvaginal Doppler Ultrasonography and MRI for Prediction and Diagnosis of Adherent Placenta in High-Risk Group in the Second Half of Pregnancy

Assessment of cervical vascularization density in patients with locally advanced squamous cell cervical carcinoma evaluated in colour Doppler and power Doppler functions

PurposeThe aim of the prospective study was to assess changes during treatment and prognostic significance of cervical vascularization density in patients with cervical squamous cell carcinoma (SCC) staged II B and III B and to find relationship of cervical vascularization density with tumour diameter, grading, staging and age of patients.MethodsThe study group included 50 patients who underwent transvaginal Doppler ultrasonography prior to chemoradiotherapy, after external beam radiation therapy (EBRT) and 6 weeks after HDR brachytherapy. The colour Doppler (CD) vascularity index (CDVI) and the power Doppler (PD) vascularity index (PDVI) in cervical tumour were examined.ResultsCDVI and PDVI values decreased significantly during radiotherapy (0.13 (95% CI 0.09–0.16); 0.09 (95% CI 0.07–0.11) and 0.05 (95% CI 0.03–0.06) for CDVI (p < 0.001) and 0.26 (95% CI 0.22–0.31); 0.18 (95% CI 0.14–0.22) and 0.08 (95% CI 0.06–0.11) for PDVI (p < 0.001)). No statistically significant associations of CDVI and PDVI with tumour diameter, grading, staging and age of patients were found. The higher (above median) CDVI values before EBRT were associated with better OS (p = 0.041). The higher (above median) PDVI values before EBRT were associated with superior DFS (p = 0.011) and OS (p < 0.001). DFS and OS did not differ significantly regarding CDVI and PDVI values after EBRT and after the treatment.ConclusionsIn the study group, cervical vascularization density evaluated in CD and PD functions did not depend on tumour diameter, grading, staging and age of patients and decreased during radiotherapy. The prognosis for our patients with CDVI and PDVI before the treatment above the median value was better than compared to patients with these parameters below the median value.

Survey of changes in ovarian and uterine artery blood flow and indexes by transvaginal Doppler sonography in POI patients and effect of acupuncture on their fertility

Background: Primary ovarian insufficiency (POI) is a common cause of infertility and usually defined by the triad of amenorrhea, estrogen deficiency, and elevated luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in women &lt; 40 years of age. The aim of the present study was to investigate the relationship between uterine and ovarian blood flow with acupuncture and fertility ratio in patients of the Firoozgar Hospital Infertility Clinic. Methods: Twenty-nine patients with POI were included in this clinical trial. FSH, LH, estradiol (E2), and anti-Müllerian hormone (AMH) levels were measured. Patients with Turner syndrome were identified and excluded from the study. Selected patients were evaluated using transvaginal color Doppler sonography used to measure ovarian volume, endometrial thickness, flow rates, and uterine and ovarian artery indexes. Patients were treated with acupuncture twice a week for 5 weeks. After the end of treatment, hormonal assays and an ultrasound examination were repeated to check the changes. Results: Indexes of the uterine arteries (Resistance Index, Pulsatility Index) before versus after the intervention were significantly different (P &lt; 0.00) and uterine vascularity increased after treatment in 22 patients (75.8%). LH and FSH hormone levels were significantly decreased after the intervention (P &lt; 0.00), while AMH and E2 levels were significantly increased after treatment (P &lt; 0.00). The post-intervention right ovarian reserve was significantly increased (P = 0.02), whereas there was no significant difference in left ovarian reserve before vs. after treatment (P = 0.39). Spontaneous menstruation was detected after acupuncture in 16 patients. Conclusions: Our study demonstrated changes in vascularity, hormone levels, menopausal symptoms, and menstrual induction in patients after acupuncture intervention. Keywords: POI, acupuncture, arterial indexes.

Assessment of cervical volume and spectral Doppler parameters in tumour dominant vessel of patients with locally advanced squamous cell cervical carcinoma

We evaluated cervical volume and spectral Doppler parameters: peak systolic velocity (PSV), resistance index (RI) and pulsatility index (PI) in the tumour dominant vessel of 50 patients with cervical squamous cell carcinoma (SCC) staged IIB and IIIB and their changes during treatment. The patients underwent transvaginal Doppler ultrasonography prior to treatment, after external beam radiation therapy (EBRT) and 6 weeks after brachytherapy. Radiotherapy decreased cervical volume and PSV values of the tumour dominant vessel. The PSV values before EBRT in G1 + G2 tumours were higher than in G3 tumours. No correlations between cervical volume, PSV, RI and PI values with disease-free survival (DFS) and overall survival (OS) were found. We concluded, that sonographic assessment of changes in cervical volume of patients with locally advanced cervical SCC during treatment did not allow to predict treatment results. Spectral Doppler parameters PSV, RI and PI of tumour dominant vessel did not predict prognosis for these patients. Impact Statement What is already known on this subject? Transvaginal Doppler sonography is considered as a useful diagnostic method in patients with cervical carcinoma. However, despite numerous studies, the value of spectral Doppler parameters in tumour dominant vessel and cervical volume of patients with locally advanced cervical SCC is still not well defined. What the results of this study add? In our prospective study, we found that sonographic assessment of changes in cervical volume of patients with locally advanced cervical SCC during treatment did not allow to predict treatment results and spectral Doppler parameters of tumour dominant vessel did not predict prognosis for these patients. What the implications are of these findings for clinical practice and/or further research? Our study underlines the limited value of spectral Doppler technique in patients with cervical carcinoma. Further research should be focussed on identifying and validating novel prognostic and predictive factors.

The role of transvaginal color doppler indices to predict malignancy in abnormal uterine bleeding according to PALM-COEIN classification

IntroductionThe objective of this study is to analyze the differences in transvaginal color Doppler parameters in premenopasual women with abnormal uterine bleeding (AUB) among PALM-COEIN groups. Materials and MethodThis cross-sectional study was performed in a training and educational hospital, included 147 premenopausal women with AUB. Patients were divided into four groups according to PALM-COEIN. All subjects were evaluated by transvaginal Doppler sonography and uterine artery (UA) pulsatility and resistive indexes (PI, RI) were calculated then compared. ResultsFour groups named AUB-P, AUB-E, AUB-M and AUB-O included 39, 30, 32 and 46 patients, respectively. The mean age of patients was 44.82 (35–55 years), EC rate was 3.4 %. UA-PI was lower in the AUB-M group compared with AUB-P and AUB-O (p < 0.001). UA-RI was different among gruops (p < 0.001). UA-RI was lowest in the AUB-M, and highest in the AUB-O (0.60 ± 0.15; 0.85 ± 0.05 respectively). The cut-off values of ET, UA-PI and UA-RI for detecting AUB-M were 13.5, 1.55 and 0.71 respectively. ConclusionTransvaginal color Doppler sonography may be beneficial in detecting the etiology of AUB in premenopausal women.

Pelvic Venous Disorders in Women due to Pelvic Varices: Treatment by Embolization: Experience in 520 Patients

PurposeThe purpose of this study was to determine the efficacy and safety of embolization treatment in pelvic venous disorders in women refluxing in the ovarian and or internal iliac veins in women with chronic pelvic pain. Materials and MethodsA retrospective study conducted from January 2000 to June 2017 in 617 patients diagnosed with pelvic venous disorders (PeVDs) with a mean age of 43.2 ± 7.2 years were treated using an embolization procedure. A total of 520 were included, and 97 patients were excluded. The main inclusion criteria were PeVD symptoms for more than 6 months and transvaginal Doppler ultrasonography (TV-DUS) diagnosis of varicose veins in the pelvis with a diameter greater than 6 mm. The main objective was to embolize the 4 main pelvic venous plexi (ovarian and internal iliac veins) whenever possible. Follow-up was performed using clinical symptoms (visual analog scale) and TV-DUS at 1, 3, 6, and 12 months and then every year up to 5 years. ResultsThe technical success (embolization of the 4 main pelvic veins) was achieved in 84.4% of the patients. The average follow-up was 58.7 ± 5.7 months. The visual analog scale was improved from 7.63 ± 0.9 points pretreatment to 0.91 ± 1.5 at 5 years. A total of 26 patients (5%) presented with symptom recurrence and pelvic varicose veins. There were 57 minor complications (10.9%) and 11 major complications (2.1%), with 7 cases (1.34%) of device migration to the lung. ConclusionsThe embolization of pelvic varicose veins is a safe and effective procedure. The selection of the embolic agents and the number of veins needed to be treated.

Usefulness of Grey Scale and Doppler transvaginal sonography in diagnosis of ovarian torsion

Background: Ovarian torsion diagnosis is a great challenge as delay in diagnosis can cause severe morbidity. Early accurate diagnosis is crucial to preserve ovarian function. Ultrasonography being the primary imaging modality plays a vital role in the evaluation of suspected ovarian torsion by helping surgeons reach the correct diagnosis, thus avoiding unnecessary intervention. This study aims to determine the diagnostic accuracy of isolated and combined sonographic features of ovarian torsion on grey scale and Doppler transvaginal ultrasonography.&#x0D; Patients and methods: From radiology database, from January 2016 till December 2019, sonographic signs of ovarian torsion in 113 women with suspected ovarian torsion on ultrasonography and subsequent surgical diagnosis were evaluated. Ultrasound findings were compared with surgical findings to determine the accuracy, sensitivity, specificity, and positive and negative predictive values of individual and combined ultrasound signs.&#x0D; Results: Diagnostic accuracy of ultrasound for ovarian torsion was 85.8%. Abnormal ovarian Doppler flow was the most accurate individual sonographic sign with accuracy, sensitivity, specificity and positive predictive value of 85.8%, 83.5%, 100% and 100% respectively followed by ovarian enlargement and ovarian edema. Combined ultrasound signs resulted in higher sensitivity and positive predictive values, and lower specificity and negative predictive values for ovarian torsion. Increasing the number of sonographic parameters increased the specificity but decreased sensitivity. High accuracy, sensitivity, positive predictive value, specificity and negative predictive value was seen when combination of three or two sonographic parameters was used as diagnostic criteria.&#x0D; Conclusion: Transvaginal sonography is a convenient, reliable and extremely useful imaging modality for preoperative diagnosis of ovarian torsion with high specificity, sensitivity, positive predictive value and diagnostic accuracy helping treating physicians to take prompt decisions regarding timely surgical intervention. However, due to low negative predictive values, absence of sonographic signs does not rule out ovarian torsion and high index of clinical suspicion remains of utmost importance.

Evaluation of International Endometrial Tumor Analysis Sonographic Criteria in diagnosis of Endometrial Carcinoma

Postmenopausal vaginal bleeding is a sign that should not be Ultrasound imaging has become an effective diagnostic tool of gynecological practice throughout the years. Endometrial diagnosis typically involves invasive investigational approaches. Today, however, with the advent of high-resolution transvaginal ultrasound and Doppler ultrasonography (non-invasive diagnostic tool), is an alternative candidate to replace invasive approaches. The aim of this study is to evaluate the contribution of the terms and definitions described by the IETA group when designing a malignancy model for better diagnosis of malignancy in cases with postmenopausal uterine bleeding. In the present study 120 patients with postmenopausal bleeding were included in the study. The study was conducted from April 2017 to April 2019 at Tanta University hospitals, Obstetrics &amp; Gynecology and Diagnostic Radiology departments. Both patients were subjected to the following: full history taking, general examination, local examination, 2D transvaginal ultrasonography, Doppler study, hysteroscopy examination, endometrial biopsy. Symptomatic postmenopausal women with endometrial thickness &gt; 5 mm have been chosen because women with a lower endometrial thickness have a very low incidence of cancer and a prospective evaluation.

Predictive value of cervical size change rate and shape detected by mid-pregnancy ultrasound for premature delivery

Objective To evaluate the predictive value of cervical size change rate and morphological distribution detected by ultrasound in the second trimester of pregnancy for preterm delivery. Methods From June 2016 to June 2018, 300 pregnant women who underwent antenatal testing and gave birth in , the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were selected in this research.The length, width and shape of cervix were measured by transvaginal color doppler ultrasonography at 14 and 28 weeks respectively.According to whether or not premature delivery occurred, they were divided into premature delivery group and full-term delivery group.The differences of cervical length, cervical inner mouth width, cervical length shortening rate, cervical inner mouth width increasing rate and cervical shape distribution between preterm and full-term pregnant women were compared, and the correlation between the above indicators and the occurrence of premature delivery were analyzed. Results The length of cervix in the preterm delivery group [(21.41±6.28)mm] was significantly shorter than that in the full-term delivery group at 28 weeks of gestation [(34.17±5.76)mm](t=10.295, P=0.000), and the width of cervical inner mouth in the preterm delivery group [(9.54±2.57) mm] was significantly longer than that in the full-term delivery group [(4.06±0.91)mm] (t=25.416, P=0.000). The shortening rate of cervical length [(39.28±8.65)%] and the increasing rate of cervical width [(149.74±15.09)%] in the preterm pregnant women during the second trimester were significantly higher than those in the full-term pregnant women [(10.15±5.29)% and (16.33±3.84)%] (t=21.471, 39.420; P=0.000, 0.000). The proportion of T-type cervix in the preterm delivery group (77.17%) was significantly higher than that in the full-term delivery group (63.28%) (χ2=10.935, P=0.001). According to the correlation analysis, the length of cervix was negatively correlated with premature birth (r=-0.612, P=0.035), and the width of cervical inner mouth, the shortening rate of cervical length in the second trimester and the increasing rate of cervical inner mouth width in the second trimester were positively correlated with premature birth (r=0.743, 0.665, 0.807; P=0.013, 0.026, 0.004). Conclusion Ultrasound monitoring of cervical size change rate and cervical morphology during the second trimester of pregnancy is helpful to the early prediction of preterm labor, which should be paid attention to clinically. Key words: Pregnancy trimester, second; Premature birth; Ultrasonography, doppler, color; Cervical length measurement; Prenatal diagnosis

A PROSPECTIVE STUDY ON TRANSVAGINAL DOPPLER SONOGRAPHY OF ENDOMETRIUM IN WOMEN WITH POSTMENOPAUSAL BLEEDING.

Objectives: This present study was to evaluate the clinical profile and Transvaginal Doppler Sonography findings of endomterium in women with postmenopausal bleeding.&#x0D; Methods: Detail history, clinical examinations and relevant investigations were performed to all cases of PMB. BMI was calculated. Transvaginal sonography of the uterus and Doppler analysis of the blood flow were performed using vaginal probe at 5-7.5 megahertz. Endometrial thicknesses as well as other pathologies in the cavity were noted. Resistive index was calculated.&#x0D; Results: Data was analyzed by using SPSS version 26 software. One sample statistical methods was used. Mean ± standard deviation was observed. P-value was taken equal to less than 0.05 for significant differences.&#x0D; Conclusions: Highest prevalence of PMB was seen in women with age greater than 50 years. Most of the cases had BMI 20-25 kg/m2. Most of the benign and malignant cases had parity status P3-P4 and P1-P2 respectively. Endometrial thickness of malignant PMB cases was significantly greater than benign PMB cases. Resistive index of malignant PMB women was significantly lower than benign PMB women. Hence, promotion of healthy lifestyles and contraceptives in early reproductive life and awareness for the need of early screening should be recommended to reduce the prevalence of PMB. And early diagnosis and management of post menopausal bleeding are needed for prevention from malignancy.&#x0D; Key words: Postmenopausal Bleeding, Benign, Malignancy, Transvaginal Doppler Sonography.

Assessment of Different Methods of Ovulation Induction on Endometrial and Ovarian Blood Flow by Transvaginal Ultrasound Doppler

Assessment of Different Methods of Ovulation Induction on Endometrial and Ovarian Blood Flow by Transvaginal Ultrasound Doppler

Assessment of Different Methods of Ovulation Induction on Endometrial and Ovarian Blood Flow by Transvaginal Ultrasound Doppler

The study was performed in a prospective randomized fashion in order to compare the value of tansvaginal ultrasound, and the value of combined colour Doppler imaging of uterine, ovarian blood flow and transvaginal folliculometry in assessment of ovulation induction of infertile women. Ovulation rate was taken as the gold standard for assessment of ovulation induction result Analysis of the results provided the following information: A) Better sensitivity & specificity of colour Doppler indices in detection of ovulation. B) Better timing of human chorionic gonadotrophin administration & better ovulation rate when colour Doppler was used in cycle monitoring. It can be concluded from the results of this study that combined use of transvaginal sonography& colour Doppler imaging is more reliable in assessment of ovulation & is more useful in monitoring of follicular growth and vascularity in clomiphene citrate induced cycles than the use of transvaginal ultrasound alone. The study opens a new field of ongoing research on the valuable application of colour Doppler studies in the management of gynecologic infertility due to ovarian cause.

Role of transvaginal Doppler sonography in cases of irregular uterine bleeding with depot medroxyprogesterone acetate

Objectives To evaluate role of transvaginal Doppler sonography in cases of irregular uterine bleeding with depot medroxyprogesterone acetate (DMPA). Background Abnormal uterine bleeding is the leading cause of cessation of DMPA use. The definite mechanism of abnormal uterine bleeding has remained vague. Transvaginal Doppler is a noninvasive technique for studying Doppler changes of uterine and spiral artery in cases of abnormal uterine bleeding with DMPA. Patients and methods A case–control study was done on two groups of users of DMPA, one group included 21 cases with abnormal uterine bleeding, and the second group included 21 cases with amenorrhea. Transvaginal sonography was done, and endometrial thickness was measured in greatest sagittal section of the uterus. Uterine and spiral artery pulsatility index (PI) and resistance index (RI) were measured. Data were collected and tabulated. Results Significant changes in PI and RI of uterine and spiral arteries were detected. Uterine artery RI and PI were lower in bleeding group (P = 0.003 and 0.021, respectively), and spiral artery RI and PI were lower in bleeding group (P = 0.0007 and 0.0003, respectively). Conclusion Abnormal uterine bleeding with DMPA is associated with hemodynamic changes in transvaginal Doppler in form of increased blood flow in uterine and spiral arteries as indicated by significant decrease in RI and PI of both arteries.