Transvaginal Sonography In Diagnosis Research Articles

Commentary: Three-dimensional transvaginal ultrasound diagnosis of interstitial ectopic pregnancy in a unicornuate uterus: A case report

A rare case of unicornuate uterus with interstitial ectopic pregnancy (IEP) was diagnosed using three-dimensional transvaginal ultrasound (3D-TVUS). The ultrasound revealed a "lancet-shaped" endometrial corona, a gestational sac near the uterus base extending towards the uterine serosa, and visible interstitial lines. The patient underwent laparoscopic surgery for a lesion in the right fallopian tube. 3D-TVUS was crucial in precisely locating the gestational sac, aiding in effective treatment. Interstitial ectopic pregnancies risk severe hemorrhaging upon rupture. Rapid, accurate diagnosis is vital for lifesaving treatment and preventing critical complications.

Population-based study of the reproductive risk factors for transvaginal ultrasound diagnosed uterine fibroids in Nigerian women

There has been no previous systematic, epidemiological study of the reproductive risk factors for uterine fibroids (UF) in African populations despite African women having the highest burden of UF in the world. Improved knowledge of the associations between UF and reproductive factors would contribute to better understanding of the etiology of UF and may suggest novel opportunities for prevention and therapeutic interventions. We used nurse administered questionnaires to survey the demographic and reproductive risk factors of UF among 484 women who are members of the African Collaborative Center for Microbiome and Genomics Research (ACCME) Study Cohort in central Nigeria, and who had transvaginal ultrasound diagnosis (TVUS). We used logistic regression models to the evaluate associations between reproductive risk factors and UF, adjusted for significant covariates. In our multivariable logistic regression models, we found inverse associations with number of children (OR = 0.83, 95%CI = 0.74–0.93, p-value = 0.002), parity (OR = 0.41, 95%CI = 0.24–0.73, p-value = 0.002), history of any type of abortion (OR = 0.53, 95%CI = 0.35–0.82, p-value = 0.004), duration of use of Depot Medroxyprogesterone Acetate (DMPA) (p-value for trend = 0.02), menopausal status (OR = 0.48, 95%CI = 0.27–0.84, p-value = 0.01), and a non-linear positive association with age (OR = 1.04, 95%CI = 1.01–1.07, p-value = 0.003). Other reproductive risk factors that have been reported in other populations (age at menarche and menopause, and oral contraceptives) were not associated with UF in this study. Our study confirms some of the reproductive risk factors for UF that have been found in other populations and shows that some of them are stronger in the Nigerian population. The associations we found with DMPA suggest opportunities for further research to understand the mechanisms of action of progesterone and its analogues in the etiology of UF, their potential use for prevention and treatment of UF.

The role of transvaginal sonography in diagnosis of female infertility: a study protocol

Infertility has an increased incidence in today’s world. It has a negative impact on both the psychological and physical aspects of a person. In order to tackle this issue, it is necessary to know the cause of infertility. Transvaginal ultrasound is an accurate, cost-effective and rapid method in diagnosing the causes of infertility which can reduce the need of invasive procedures like hysteroscopy. The main aim of this study is to describe the role of transvaginal ultrasonography in diagnosing various causes of female infertility.

OC09.02: The influence of severe endometriosis on the accuracy of transvaginal ultrasound diagnosis of uterosacral ligament endometriosis

OC09.02: The influence of severe endometriosis on the accuracy of transvaginal ultrasound diagnosis of uterosacral ligament endometriosis

Validation of self-report of uterine fibroid diagnosis using a transvaginal ultrasound scan

Self-report of uterine fibroids (UF) has been used for epidemiologic research in different environments. Given the dearth of studies on the epidemiology of UF in Sub-Saharan Africa (SSA), it is valuable to evaluate its performance as a potential tool for much needed research on this common neoplasm in SSA women. We conducted a cross-sectional study of self-report of UF compared with transvaginal ultrasound diagnosis (TVUS) among 486 women who are members of the African Collaborative Center for Microbiome and Genomics Research (ACCME) Study Cohort in central Nigeria. We used log-binomial regression models to compute the classification, sensitivity, specificity, and predictive values of self-report compared to TVUS, adjusted for significant covariates. The prevalence of UF on TVUS was 45.1% (219/486) compared to 5.4% (26/486) based on self-report of abdominal ultrasound scan and 7.2% (35/486) based on report of healthcare practitioner’s diagnosis. Self-report correctly classified 39.5% of the women compared to TVUS in multivariable adjusted models. The multivariable adjusted sensitivity of self-report of healthcare worker diagnosis was 38.8%, specificity was 74.5%, positive predictive value (PPV) was 55.6%, and negative predictive value (NPV) was 59.8%. For self-reported abdominal ultrasound diagnosis, the multivariable adjusted sensitivity was 40.6%, specificity was 75.3%, PPV was 57.4%, and NPV was 60.6%. Self-report significantly underestimates the prevalence of UF and is not accurate enough for epidemiological research on UF. Future studies of UF should use population-based designs and more accurate diagnostic tools such as TVUS.

Comparison of the application value of transvaginal ultrasound and transabdominal ultrasound in the diagnosis of ectopic pregnancy.

Ectopic pregnancy (EP) is one of the most common acute abdominal diseases in gynecology. Once the condition of EP is delayed, it may lead to massive hemorrhage, shock, and even death in a short time, seriously threatening the patient's life. Early diagnosis is the key to preventing and improving the prognosis of EP. Transabdominal ultrasound (TAS) and transvaginal ultrasound (TVS) are the main diagnostic methods for abdominal diseases. The purpose of this study is to explore the application value and effect of TAS and TVS in the diagnosis of EP, hoping to provide more valuable references for the diagnosis of EP. To explore the application value of TAS and TVS in the diagnosis of EP and to improve the level of clinical diagnosis. A total of 140 patients with EP admitted to our hospital from July 2018 to July 2020 were selected for this study. All patients were divided into two groups according to the examination methods. 63 patients who underwent abdominal ultrasound examination were set as the TAS group, while 77 patients who underwent TVS examination were set as the TVS group. We compared the diagnostic accuracy and misdiagnosis rates between the two types of ultrasound examinations, as well as the postoperative pathological results of the two diagnostic methods for different types of ectopic pregnancies. We also analyzed the sonograms for the presence of mixed ectopic masses, adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the ectopic sac shadow, and the detection of fluid in the rectal fossa of the uterus, such as the adnexal area, yolk sac, and embryo, etc. In addition, the diagnosis time, days of gestational sac appearance, operation time, endometrial thickness, and blood flow resistance index were compared as well. After performing both types of ultrasound examinations in 140 patients with EP, we found that the diagnostic accuracy of TVS was significantly higher than that of TAS, and the misdiagnosis rate was significantly lower than that of TAS. The differences were statistically significant (P < 0.05). In addition, the detection rate of TVS was better than that of TAS for the presence of mixed masses, adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the shadow of the ectopic sac, and sonograms such as the adnexal area, yolk sac, and embryo, etc. The coincidence rate of its postoperative pathological examination results was significantly higher than those of TAS. The diagnosis time and the days of gestational sac appearance by TVS were significantly shorter than that by TAS, and the operation time was earlier than that by TAS. What's more, the detection rates of the endometrial thickness £ 1.5 mm and blood flow resistance £ 0.5 were significantly higher in TVS diagnosis of EP than in TAS. All differences were statistically significant (P < 0.05). Compared with TAS, TVS has the advantages of high detection accuracy and good sonogram performance.

A Study of Transvaginal Ultrasonography in diagnosis of Endometrial Pathology in abnormal Uterine Bleeding

Objective: To evaluate the utility of transvaginal ultrasonography (TVS) in assessing the pathologic causes of Abnormal Uterine Bleeding (AUB). Methodology: The descriptive study was conducted in Gynecology Unit Nishtar Hospital Multan from July-2021 to July-2022. A total of 80 women with diagnosis of AUB were recruited. Every patient with an AUB underwent TVS. The thickness of the endometrium, its echogenicity, the size of the uterus, and any uterine or adnexal abnormality observed. Results: Mean age was 46.16±9.50 years with range 25-60 years. Regarding menopausal status, 35 (43.75%) females were pre-menopausal and 45 (56.25%) were post-menopausal.On TVS findings, normal proliferative endometrium was found in 26 (32.5%) cases, endometrial polyps in 22 (27.5%) cases,myomas in 12 (15.0%) cases, hyperplasia in 12 (15.0%) cases, endometrial atrophy in 5 (6.25%) cases, and suspicious looking endometrium in 3 (3.75%) cases. Practical Implications: The study is very useful, knowledgeable, cost efficient and cost effective. Conclusion: TVS is a safe, rapid and cost-effective modality for the diagnosis of endometrial pathologies. Endometrial polyps, myomas and hyperplasia are common cause of AUB. Keywords: Transvaginal ultrasonography, abnormal uterine bleeding, polyps.

Judging Urgency in 343 Ectopic Pregnancies Prior to Surgery - The Importance of Transvaginal Sonographic Diagnosis of Intraabdominal Free Blood.

Assessing urgency in ectopic pregnancies (ECP) remains controversial since the disorder covers a large clinical spectrum. Severe conditions such as acute abdomen or hemodynamic instability are mostly related to intra-abdominal blood loss diagnosed as free fluid (FF) on transvaginal sonography (TVS). The aims of the current study were to investigate the value of FF and to assess other potentially predictive parameters for judging urgency. Retrospective cohort analysis on prospectively collected cases of proven ECP (n = 343). Demographics, clinical and laboratory parameters, and findings on TVS and laparoscopy (LSC) were extracted from the digital patient file. FF on TVS and free blood (FB) in LSC were evaluated. Low urgency was defined as FB (LSC) < 100 ml and high urgency as FB (LSC) ≥ 300 ml. The best subset of variables for the prediction of FB was selected and predictors of urgency were evaluated using receiver operator characteristic (ROC) curves. Clinical symptoms, age, β-HCG, hemoglobin (HB) preoperative, and FF were examined in multivariate analysis for the cutoff values of 100 ml and 300 ml. FF was the only independent predictor for low and high urgency; HB preoperative was only significant for high urgency offering marginal improvement. ROC analysis revealed FF as an excellent discriminatory parameter for defining low (AUC 0.837, 95% CI 0.794-0.879) and high urgency (AUC 0.902, 95 % CI 0.860-0.945). Single assessment of FF on TVS is most valuable for judging urgency. However, the exact cutoff values for a low- and high-risk situation must still be defined.

3D transvaginal ultrasound diagnosis of uterine septa according to different classifications: are there other measurements that correlate to reproductive outcome in small indentation length?

High discrepancy between current classifications was observed in the definition of uterine septa, especially for indentation lengths >5 <10mm. To assess the discrepancy between current classifications in the diagnoses of septate uterus and to correlate them with reproductive outcomes; to detect 3D transvaginal ultrasound (TVS) additional measurements, which can better correlate small indentation lengths >5 <10mm to reproductive failures. Observational study enrolling 664 women of reproductive age with 3D ultrasound diagnosis of an indentation length ≥3mm. For each patient a detailed reproductive history was taken before performing 3D transvaginal examination. Patients with previous uterine surgery or metroplasty were excluded. Indentation lengths >5 <10mm showed high discrepancy in the diagnosis of uterine septum between different classifications. For these small indentations additional 3D measurements (indentation angle, septal width and septal length/ fundal myometrial thickness (L/M) ratio) were correlated to infertility and recurrent miscarriage. Among the cohort, 215 patients showed an indentation length >5 <10mm; 136 tried to conceive: 69 (51%) were infertile, 38 (28%) had recurrent miscarriages (≥2) and 5 (4%) had at least one delivery. Recurrent miscarriage significantly correlated to an indentation angle >134°; whereas infertility to an indentation width <32mm and a L/M ratio >75%. Wide discrepancies between different classifications are more evident in indentation lengths >5 <10mm. Additional measurements on 3D coronal section may help to evaluate the risk of infertility or recurrent miscarriage. Additional 3D TVS measurements, beyond septal lengths, in particular for small fundal indentation, may help in predicting the risk of developing adverse reproductive outcomes.

Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding

Introduction: Transvaginal Sonography has emerged as important modality in investigating AUB, but it cannot diagnose endometrial pathology in absence of histopathology of endometrium. Addition of Color doppler (CDTU) to TVS can help in diagnosis by evaluation of blood flow through vascular patterns and Uterine artery indices. Objective: To evaluate the role of Trans vaginal Ultrasonography and Colour Doppler (CDTU) in abnormal uterine bleeding and correlating them with histopathological diagnosis. Methods: TVS and Colour Doppler were performed in 70 patients with AUB. TVS included evaluation of endometrium, size of uterus, any uterine or adnexal pathology. Vascular pattern of Spiral arteries of endometrium, and uterine arteries was analysed. Uterine artery indices (RI and PI) were calculated. 1.83 was taken as cut off for PI and 0.81 was taken as cut off for RI. The results were then compared with histopathology of endometrium. Results: On TVS, the causes of AUB were Leiomyoma in 17.1%, polyp in 10%, PCOS in 8.5%, Adenomyosis in 5.7%, and Endometrial growth in 2.8%. 11 patients had suspected malignancy by uterine indices of RI ( and PI ) were calculated. 1.83 was taken as cut off for PI and 0.81 was taken as cut off for RI. The results were then compared with histopathology of endometrium. Results: On TVS, the causes of AUB were Leiomyoma in 17.1%, polyp in 10%, PCOS in 8.5%, Adenomyosis in 5.7%, and Endometrial growth in 2.8%. 11 patients had suspected malignancy by uterine indices of RI (&lt;0.81 ) and PI (&lt;1.83) of uterine artery by CDTU. Specificity and Sensitivity of TVS with CDTU for AUB M was 100% and 90.77% respectively. Positive predictive value was 45.45% and negative predictive value was 100%. Conclusion: Colour Doppler of the uterine artery and endometrial spiral arteries with vascular impedance, improves the diagnostic accuracy of TVS for the prediction of endometrial pathologies and facilitates in screening for malignant and premalignant lesions.

Deep Learning-Based Three-dimensional Transvaginal Ultrasound in Diagnosis of Intrauterine Adhesion

This study was aimed to enhance and detect the characteristics of three-dimensional transvaginal ultrasound images based on the partial differential algorithm and HSegNet algorithm under deep learning. Thereby, the effect of quantitative parameter values of optimized three-dimensional ultrasound image was analyzed on the diagnosis and evaluation of intrauterine adhesions. Specifically, 75 patients with suspected intrauterine adhesion in hospital who underwent the hysteroscopic diagnosis were selected as the research subjects. The three-dimensional transvaginal ultrasound image was enhanced and optimized by the partial differential equation algorithm and processed by the deep learning algorithm. Subsequently, three-dimensional transvaginal ultrasound examinations were performed on the study subjects that met the standards. The March classification method was used to classify the patients with intrauterine adhesion. Finally, the results by the three-dimensional transvaginal ultrasound were compared with the diagnosis results in hysteroscope surgery. The results showed that the HSegNet algorithm model realized the automatic labeling of intrauterine adhesion in the transvaginal ultrasound image and the final accuracy coefficient was 97.3%. It suggested that the three-dimensional transvaginal ultrasound diagnosis based on deep learning was efficient and accurate. The accuracy of the three-dimensional transvaginal ultrasound was 97.14%, the sensitivity was 96.6%, and the specificity was 72%. In conclusion, the three-dimensional transvaginal examination can effectively improve the diagnostic efficiency of intrauterine adhesion, providing theoretical support for the subsequent diagnosis and grading of intrauterine adhesion.

English

BACKGROUND Abnormal uterine bleeding is an important cause of morbidity in the female population, which can be attributed to several reasons. Trans-vaginal sonography and saline-infusion sonography are the mainstay of diagnosis and govern the further management of this condition. This study was conducted to evaluate the thickness and pattern of endometrium with transvaginal sonography and determine any abnormality in the uterine cavity which can be attributed to saline infusion sonography (SIS) in cases of abnormal uterine bleeding (AUB). METHODS The study was conducted among 122 women with complaints of abnormal uterine bleeding attending Outpatient Department and indoor cases of a tertiary care hospital over a period of twelve months. RESULTS The most common presenting complaint was heavy menstrual bleeding in 27.04 % cases. Maximum (44.26 %) cases had normal finding on transvaginal sonography; most common pathological finding was leiomyoma (22.31 %), and endometrial hyperplasia (15.5 %). More than one third (37.7 %) of patients had no abnormalities on saline infusion sonography; while 62.3 % had one or more pathologies; the most common lesion was fibroid in 25.4 % cases. Normal proliferative and secretary endometrium was found on histopathological examination in 50 % cases, while remaining half cases had one or more pathology, most common pathology detected was endometrial hyperplasia in 25.4 % cases. On trans-vaginal sonography (TVS), 11 cases of endometrial polyp were missed, which were detected after infusion of saline and confirmed by histopathological examination. The diagnostic indices of SIS were superior to TVS in diagnosis of any pathology. Sensitivity of TVS was 86.94 % and SIS was 91.94 %. Specificity of TVS (75.41 %) was greater than SIS (68.33 %). CONCLUSIONS TVS and SIS scanning techniques play a very important role in endometrial disorders in woman with AUB. KEYWORDS SIS, Transvaginal, AUB, Endometrium

Transvaginal Ultrasonography and Hysteroscopy in Evaluation of Abnormal Uterine Bleeding- A Cross-sectional Study

Introduction: In perimenopausal age group particularly, 70% of all gynaecological consultations are for Abnormal Uterine Bleeding (AUB). About 30% of women seek medical assistance for AUB during their reproductive age group and about one third of hysterectomies are carried out for AUB alone. Aim: To determine the sensitivity, specificity, positive predictive value and negative predictive value of Transvaginal Ultrasonography (TVS) versus hysteroscopy in detecting uterine abnormalities Materials and Methods: A cross-sectional study in patients with AUB, admitted to the Department of Obstetrics and Gynaecology at RGGWCH, Puducherry between February 2016 and February 2017 who met the inclusion criteria were included. Sample size was 85 cases. After taking detailed history and physical examination the patient was investigated to rule out organic causes of AUB and then TVS and hysteroscopy were done. Any intrauterine pathology was looked for and endometrial sampling was taken from the abnormal sites for Histopathological Examination (HPE). Both TVS and hysteroscopy results were compared with histopathology which is the gold standard. Results: The sensitivity of TVS in diagnosis of uterine fibroid in comparison to hysteroscopy was 94.74% and the specificity was 71.21%. The sensitivity of hysteroscopy in diagnosis of endometrial hyperplasia in comparison to HPE was 75% and the specificity was 87.01%. The sensitivity of TVS in diagnosis of endometrial hyperplasia in comparison to HPE was 37.5% and the specificity was 90.91%. The sensitivity of hysteroscopy in diagnosis of polyp in comparison to HPE was 100% and the specificity was 97.3%. The sensitivity and specificity of TVS in diagnosis of polyp in comparison to HPE were 9.09% and 93.24%, respectively. Conclusion: TVS had a high sensitivity to detect fibroids but its value in detecting hyperplasia and polyps was in question in this study. But hysteroscopy had a maximum sensitivity to detect polyps and high sensitivity to detect endometrial hyperplasia compared to histopathology which is a gold standard investigation.

VP63.17: A retrospective study on the diagnostic accuracy of transvaginal sonography of adenomyosis in a single tertiary hospital

To be able to evaluate the diagnostic performance of transvaginal sonography in the diagnosis of adenomyosis from March 2017 to September 2019. A two-year retrospective study who had transvaginal ultrasound diagnosis of adenomyosis and underwent hysterectomy and histopathologic confirmation of adenomyosis. Frequency and proportion were used for nominal variables, median and range for ordinal variables, and mean and standard deviation for interval/ratio variables. Sensitivity, specificity, predictive value, and likelihood ratio of the transvaginal sonography in detecting adenomyosis was performed; 95% CI intervals were reported. 242 women were included, mean age was 45.69 ± 5.76 years and 54% had adenomyosis by transvaginal ultrasound. Institutional use of TVS demonstrated low to moderate sensitivity (67.1%), specificity (70.2%) and overall accuracy (68.18%) in diagnosing adenomyosis. The PPV was good at 80.9% but the NPV was relatively low at 53.2%. The positive and negative likelihood ratios predict approximately 15% increase and 15% decrease in pre-test probabilities of disease, respectively. Patients who had adenomyosis on histopathology, 67.1% probability that TVS will turn positive for adenomyosis (sensitivity). Patients without adenomyosis on histopathology, we have 70.2% probability that TVS will be negative for adenomyosis (specificity). Patients who had adenomyosis on histopathology are 2.25 times more likely to yield a positive result on TVS and 0.47 times less likely to yield a negative result on TVS for adenomyosis (LR-). When TVS is positive for adenomyosis, we have 80.9% probability that the patient has adenomyosis on histopathology (PPV). When TVS is negative for adenomyosis, we have 53.2% probability that the patient doesn't have adenomyosis on histopathology (NPV). Overall, the accuracy of TVS in detecting adenomyosis is 68.18%, using histopathology as a reference standard.

Accuracy of Transvaginal Ultrasonography for Diagnosis of Endometriosis Taking Laparoscopy as Gold Standard

&lt;p&gt;&lt;strong&gt;Background and Objective:&lt;/strong&gt; Endometriosis is a common gynaecological disease with a diverse clinical presentation. Laparoscopy has long been considered the gold standard diagnostic modality for endometriosis but with the evolution of non-invasive, high resolution transvaginal ultrasonography, it is frequently used as the first line diagnostic technique in making a preoperative diagnosis for endometriosis. This study was designed to determine the diagnostic accuracy of transvaginal ultrasonography (TVS) in diagnosis of endometriosis taking laparoscopy as gold standard.&lt;br /&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 118 women of child bearing age who presented with symptoms of pelvic endometriosis in the department of gynecology, Bakhtawar Amin Hospital Multan were included. The study duration was from June 01, 2018 to May 31, 2020. Patients were first investigated on TVS examination to diagnose endometriosis. Afterwards, diagnostic laparoscopy was performed in all patients to confirm the diagnosis of endometriosis. Accuracy of TVS was determined in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).&lt;br /&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean age of the patients was 31.7 &amp;plusmn; 7.4 years. Most common presenting complaint was dysmenorrhea in 89 (75.4%) patients followed by dyspareunia in 36 (30.5%), chronic pelvic pain in 30 (25.4%) patients and subfertility in 18 (15.3%) patients. On TVS, endometriosis was diagnosed in 69 (58.5%) patients. While on diagnostic laparoscopy, endometriosis was diagnosed in 75 (63.6%) patients.The sensitivity of TVS in diagnosis of endometriosis was calculated as 82.7%, specificity as 83.7%, PPV as 89.9% and NPV as 73.5%.&lt;br /&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; TVS appears to be the alternative and safe modality for diagnosis of endometriosis. It can be used as an alternative to diagnostic laparoscopy for the early diagnosis of endometriosis. It has a good sensitivity and specificity for diagnosis of endometriosis.&lt;/p&gt;

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.

Transvaginal Ultrasound Diagnosis of Polycystic Ovarian Syndrome and its Correlation with Biochemical Parameters

Transvaginal Ultrasound Diagnosis of Polycystic Ovarian Syndrome and its Correlation with Biochemical Parameters

Pre-operative classification of molar pregnancy: How good is ultrasound?

Histopathology is the reference standard for diagnosing hydatidiform molar pregnancy (HMP). To assess the performance of pre-operative transvaginal ultrasound (TVS) to predict HMP. A retrospective diagnostic accuracy study was performed on women who had both TVS and histopathological examination of uterine curettings between January 2011-February 2017. TVS diagnosis of partial MP (PMP) included assessment of fetal parts and/or empty gestational sac with small cystic spaces adjacent to gestational sac. TVS diagnosis of complete MP (CMP) included assessment of complex, echogenic intra-uterine mass(es) containing multiple small cystic areas. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (PLR/NLR) for TVS were reported. Reference standard was histology. There were 4917 consecutive women who underwent TVS; 1636 underwent surgical curettage for miscarriage. Forty out of 4917 (0.6%) had HMP histologically; 25/40 (62.5%) had suspected HMP and 15/40 (37.5%) did not; 24/40 (60.0%) had CMP of which 19/24 (79.1%) were suspected on TVS and 5/24 (20.8%) were not; 16/40 (40.0%) had PMP of which 6/16 (37.5%) were suspected on TVS and 10/16 (62.6%) were not. The sensitivity, specificity, PPV, NPV, PLR and NLR of pre-operative TVS to predict HMP were: 60.0, 99.1, 63.2, 99.0% 68.4, 0.4; for CMP: 79.2, 99.8, 86.3, 99.6%, 421.7, 0.2; for PMP: 37.5, 99.3, 35.3, 99.4%, 54.3, 0.6. Histology remains the gold standard for diagnosing HMP. TVS is an acceptable diagnostic tool for HMP. When there are no ultrasound features of HMP, almost all these women will not have an underlying HMP.

Combined Laparoscopic-Hysteroscopic Isthmoplasty Using the Rendez-vous Technique Guided Step by Step

To demonstrate the surgical technique of Rendez-vous isthmoplasty for the treatment of symptomatic cesarean scar defect. In this video, the authors show the complete procedure in a step-by-step manner to standardize and facilitate the comprehension and performance of the procedure in a simple and safe way. Step-by-step video demonstration of the surgical technique. Private hospital in Curitiba, Paraná, Brazil. The patient is a 36-year-old woman without any comorbidities, G3 C3, and with radiologic transvaginal ultrasound diagnosis of isthmocele grade 3 (over 25 mm) identified in the superior third of the cervical canal. The main steps of combined laparoscopic-hysteroscopic isthmoplasty using the Rendez-vous technique are described in detail. A combined laparoscopic-hysteroscopic approach was performed. Under general anesthesia, the patient was placed in 0° supine decubitus, with her arms alongside her body. Operative setup included 15 mm Hg pneumoperitoneum, created using the closed Veress technique, and 4 trocars: a 10-mm trocar at the umbilicus for a 0° laparoscope, a 5-mm trocar in the right iliac fossa, a 5-mm trocar in the left iliac fossa, and a 5-mm trocar in the suprapubic area. The procedure begins after a systematic exploration of the pelvic and abdominal cavities. Step 1: Identification of key anatomic landmarks and exposure of the operation field. Step 2: By carrying out blunt and sharp dissection with cold scissors or a harmonic scalpel, the visceral peritoneal layer over the isthmus area is opened, a vesicouterine space is developed, and the bladder is pushed down at least 2 cm from the lower edge of the isthmocele. Step 3: Final Phrase: By hysteroscopic exploration of the cervical canal using the vaginoscopic approach, identification and delimitation of the isthmocele its performed by recognizing the diverticular mucosal hyperplasia, and then the hysteroscopic light is pointed directly toward the cephalic limit of the scar defect. Step 4: Laparoscopic lights are decreased in intensity and the "Halloween sign" is identified (hysteroscopic transillumination). The light of the hysteroscope is pointed to the top of the cesarean scar defect allowing the laparoscopist to identify the upper and lower edges of the scar. Step 5: Laparoscopic resection of all scar tissue, excision of all the edges of the pseudo cavity. Step 6: Adequate intracorporeal suturing technique, with a 2-layer myometrial repair using intracorporeal running and interrupted stitches of polydioxanone 2-0, is done, while ensuring preservation of the cavity by not including the endometrial tissue in the myometrial suture [1-3]. Step 7: Installation of the methylene blue dye to locate any leakage. The surgery ended without any intraoperative complications and within 60 minutes. The patient was discharged on the first day postoperatively and became pregnant 6 months after surgery, with a final C-section delivery of a healthy term newborn at 39-weeks gestational age. Combined Rendez-vous isthmoplasty is feasible, safe, and effective in experienced hands, giving the surgeon a comprehensive evaluation of the anatomy of the isthmocele, and increasing the odds of a complete resection and restoration of the anatomy [4-7]. In this patient, the procedure was uneventful, without any intra- or postoperative complications, and the symptoms were completely controlled.

Comparison of Transvaginal Ultrasound, Saline Infusion Sonohysterography versus Diagnostic Hysteroscopy in Evaluation of Endometrial Cavity Pathology amongst Women with Abnormal Uterine Bleeding in Low Resource Setting

Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa is limited due to lack of equipment and qualified personnel. As such, there is a need for an alternative diagnostic procedure that is as accurate as hysteroscopy, but also affordable, easy to administer, and acceptable by women with endometrial pathologies. Transvaginal Sonography (TVS) and Saline Infusion Sonohysterography (SIS) are proposed. However, their diagnostic accuracy versus hysteroscopy has not been determined in low resource setting. Objective: To compare the diagnostic efficacy of TVS and SIS versus diagnostic hysteroscopy in evaluation of endometrial pathology among pre-menopausal and post-menopausal women and to determine the etiology of AUB amongst these women. Methodology: A prospective cohort study was done at a hospital in Nairobi, Kenya between May and September 2019. Forty patients with AUB were recruited using consecutive sampling, and women who consented were recruited. The etiology of AUB was recorded. All participants underwent TVS, SIS and Diagnostic Hysteroscopy (DH) evaluation in the first half of the menstrual cycle and the findings recorded on a patient’s information sheet. The sociodemographic and bleeding characteristics of patients and the outcomes of TVS, SIS, and DH evaluations were also recorded and the data was analysed using version 5 of the Software for Statistics and Data Science (STATA). Summary statistics on the etiology of AUB were presented and the sensitivity of TVS and SIS versus DH as the gold-standard evaluated using two by two tables and the ROC curve. Results: The mean age of participants was 38.1 ± 8.8 years, range of 25 - 71 years. Heavy Menstrual Bleeding (HMB) was reported in 70.0% of participants, while about 12.0%, 7.5%, and 7.5% had post-menopausal bleeding, amenorrhea, and hypomenorrhea. The incidence of submucosal fibroids and endometrial polyps was 17.5% and 15.0% via TVS, 47.5% and 20.0% via SIS and 52.5% and 20% via DH respectively. The overall sensitivity, specificity, Positive Predictive Value (PPV), Positive Predictive Value (NPV), and diagnostic accuracy of SIS were 92.1%, 83.3%, 96.9%, 62.5%, and 90.0% while TVS was 38.2%, 100%, 100%, 22.2%, and 47.5%. The sensitivity, specificity, PPV, and NPV of TVS in diagnosis of endometrial polyp were 75.0%, 100%, 100%, and 94.0%. SIS did better with a sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%. Conclusion: Our data suggests SIS had a higher diagnostic accuracy than TVS and showcased a comparable diagnostic accuracy to hysteroscopy. SIS is more suitable safe alternative technique for investigating AUB in pre/post-menopausal women in low resource setting where hysteroscopy is unavailable or unaffordable.