Transvaginal Transducer Research Articles

The association between gynecological complaints and the uterine sonographic features in women with a history of cesarean section

PurposeThe aim of this study is to investigate the association between post-cesarean sonographic uterine measures, dysmenorrhea, and bleeding disorders.MethodsThis is a cross-sectional study where 500 women with a history of only one cesarean section (CS) were recruited. A transvaginal transducer, GE RIC6-12-D was used for the acquisition of volumetric datasets 18 ± 7 months postpartum. Uterine length (UL), cervical length (CL), niche length (L), niche depth (D), niche width (W), fibrosis length (FL), fibrosis depth (FD), residual myometrial thickness (RMT), endometrial thickness (EM), scar to internal os distance (SO), anterior myometrial thickness superior (sAMT) and inferior (iAMT) to the scar, and the posterior myometrial thickness opposite the scar (PMT), superior (sPMT), and inferior to it (iPMT) were measured. Logistic regression with odds ratios (OR), 95% confidence intervals (CI) and ROC curves were utilized.ResultsThe proportion of patients with incident post-cesarean bleeding disorders and dysmenorrhoea was 36% (CI 32%, 40%) and 17% (CI 14%, 21%) respectively. Univariate logistic regression showed that only UL was associated with bleeding disorders [OR 1.04 (CI 1.01,10.7) p value 0.005], whereas dysmenorrhea was associated with RMT [OR 0.82 (CI 0.71,0.95) p value 0.008], SO [OR 0.91 (CI 0.86,0.98) p value 0.01], and RMT ratio [OR 0.98 (CI 0.97,0.99) p value 0.03]. Multivariate logistic regression for dysmenorrhoea including SO and RMT remains statistically significant with p values <0.05 and area under the curve of 0.66.ConclusionThere is an association between sonographic appearance of CS scars and dysmenorrhoea. Nevertheless, the association is weak and other biological post-cesarean characteristics should be explored as potential causes.

Repeatability and Reproducibility of Potential Ultrasonographic Bishop Score Parameters.

Determination of the Bishop score (BS) is a traditional method of assessing the cervix in obstetrics and gynecology. This examination is characterized by subjectivity of assessment and low repeatability. In scientific studies intended to evaluate the results of the procedure based on the initial assessment, it is necessary to find an objective scale based on ultrasonography. We selected five ultrasound parameters, measured with a transvaginal transducer, that are equivalent to the individual BS axes (dilatation assessed in three-dimensional ultrasound (DL), angle of progression (AoP), vagino-cervical angle (VCA), strain elastography using the E-Cervix module, and cervical length (CL)). All selected parameters were characterized by good to excellent repeatability (intraclass correlation coefficient (ICC) = 0.878-0.994) and reproducibility (ICC = 0.826-0.996). Each of the selected parameters significantly correlated with its corresponding BS axis. The highest value of the correlation coefficient was achieved with CL (-0.75) and DL (0.71). Other parameters were characterized by an average to high correlation (AoP and station = 0.69, hardness ratio and consistency = -0.33, position and VCA = -0.38). The best correlation with the sum of the BS points was exhibited by AoP (0.52) and CL (-0.61). The selected ultrasound parameters analogous to the BS axes were characterized by high repeatability and significant correlation with the axes of the original clinical BS. Further research into the predictive properties of a multivariate model based on these parameters is needed.

History of ultrasound in obstetrics and gynaecology from 1971 to 2021 on occasion of the 50 years anniversary of EFSUMB.

Diagnostic ultrasound in obstetrics and gynaecology has experienced a fantastic evolution during the past seven decades. Initial steps with A-mode technology were followed by B-mode and B-mode real-time imaging, then by Doppler and colour Doppler ultrasound, and finally by 3D/4D ultrasound. Other evolutionary steps were the development of high-resolution transabdominal and transvaginal transducers providing high quality images in the first, second and third trimesters of pregancy, as well as in gynaecology and breast imaging.The progression from two-dimensional (2D) to three-dimensional ultrasound (3D) and 3D real-time imaging (4D) has brought new options in displaying anatomical structures. In comparison with CT or MRI, it is not a static but functional technique, cheap and safe, and applicable at any time.

ISUOG Practice Guidelines (updated): fetal cardiac screening.

ISUOG Practice Guidelines (updated): fetal cardiac screening.

Ultrasound visualization of the central nervous system during embryonic and fetal periods: Neurosonoembryology utilizing multiple three-dimensional transvaginal ultrasound technology.

To study the ultrasonographic features of the central nervous system (CNS) in normally developing embryos and fetuses with a crown-rump length (CRL) of 10-84mm, utilizing a high-frequency transvaginal probe in conjunction with various three-dimensional (3D) imaging modes. From January 2020 to February 2021, 210 normally developing embryos and fetuses in early pregnancy were enrolled and classified based on their gestational age. A high-frequency transvaginal transducer was used to perform 2D and 3D ultrasounds, and the 3D images were saved. These images were then processed using multiple 3D technologies, such as HD live silhouette, OmniView, and TUI. Additionally, the circumference of the vermis was measured through the posterior fontanelle. Beginning at the 10mm CRL stage of embryonic development, high-frequency transvaginal 3D ultrasound imaging was able to clearly visualize the prosencephalon, mesencephalon, and rhombencephalon. Notable changes were observed in the rhombencephalon during the 16-22mm CRL stage, including the visualization of the pontine flexure and cerebellar primordium. At 23-40mm CRL, there was a distinct pontine flexure, and the developing cerebellum, the fourth ventricle, and choroid plexus of the fourth ventricle (4th VCP) could be observed. The roof of the rhombencephalon was partitioned by the 4th VCP into the anterior membranous area (AMA) located rostrally and the posterior membranous area situated caudally. Additionally, the original Blake's pouch was identifiable. Among fetuses measuring 41-84mm CRL, the AMA progressively decreased in size as the vermis developed. From the mid-sagittal view, the orientation of the 4th VCP seemed to shift from being perpendicular to the neural tube's long axis to being parallel to it. Furthermore, there was a significant correlation between CRL and vermis circumference. Using three-dimensional transvaginal ultrasound scanning, detailed visualization of the morphological changes in the CNS during normal embryonic development from 7 to 13+6 weeks is possible. This technology can aid in accurately characterizing the embryonic origin of the CNS.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

Comparative Assessment of Hormonal, Echographic and Spectral Parameters in Chronic Endometritis and Chronic Salpingo-Oophoritis

The purpose of the study was to assess the effectiveness and clinical significance of the use of spectral analysis of molecular markers for an objective assessment of the clinical course of chronic endometritis and salpingo-oophoritis. Materials and methods. The paper presents survey data of 100 women aged 18-47 years with a diagnosis of chronic endometritis and chronic salpingo-oophoritis. Laboratory methods of blood tests were carried out according to the generally accepted methods when patients were admitted for examination. The assessment of the hormonal status was carried out using standard kits from the company "Immunotec" (Czech Republic) on a radioisotope analyzer "Gamma-800" (Narcotest). All subjects underwent ultrasound of the pelvic organs using the Voluson E8 apparatus, using transabdominal transducers of 11 Hz and 18 Hz and a transvaginal transducer with a frequency of 20 Hz and 31 Hz. To study molecular markers, we used the method of molecular Raman spectroscopy. We used a standard two-beam infrared spectrometer "SPECORD-75 IR" in the frequency range of 4000-400 cm-1. Statistical data processing was carried out using Microsoft Excel 2000 and SPSS 10.0.5 software. Results and discussion. The results of our research showed that the use of hormonal and echographic studies, although they are informative methods in the diagnosis of chronic endometritis and salpingo-oophoritis, are not specific enough. One of the important points of pathogenesis, both for acute and chronic inflammatory diseases of the genitals, is the development of endogenous intoxication. A manifestation of acute inflammation against the background of intoxication is a change in the biosynthesis of "acute phase proteins". Spectral analysis of molecular markers allows detecting chronic endometritis / salpingo-oophoritis with higher accuracy (98%), sensitivity (99%) and specificity (97%). Stretching and bending vibrations of -CO and its derivatives are most intensely manifested. At the same time, depending on the pathological process, a shift in the position of the maxima in the absorption spectra was noted. The magnitude of the shift between the wave numbers obtained in patients with endometritis and salpingo-oophoritis was 1000/1500 cm-1, which is important for the identification and differentiation of components in the mixture. Conclusion. For samples of the spectrum of blood plasma in patients with chronic endometritis, characteristic bands with maxima are located in the region of 1510 cm-1, 1520 cm-1, 1535 cm-1. The absorption spectrum corresponds to 0.13-0.18. In patients with chronic salpingo-oophoritis, 1720cm-1 is characteristic for the 1600/1750cm-1 band, but 3420cm-1 for the 3300/3680cm-1 band. In this case, the absorption of waves during this process has significant differences – 0.16-0.25 for the first band and 0.06-0.20 for the second, on average 0.11

Ультразвуковая диагностика брюшной беременности малого срока

A clinical observation of an early abdominal pregnancy is presented. The diagnosis was made by direct visualization of the fertilized egg in the abdominal cavity during ultrasound imaging; its mean internal diameter was 2.6 mm. No common clinical features of the disease were observed: no menstrual delay, abnormal menstruation, bloody vaginal discharge; urine test was negative before the day of expected menstruation (17 days before the patient’s visit). Ultrasound imaging was performed using a 3D/4D transvaginal transducer. Key words: abdominal pregnancy, tubal pregnancy, ectopic pregnancy, ultrasound diagnosis, three-dimensional ultrasound

ИНФОРМАТИВНОСТЬ УЛЬТРАЗВУКОВОГО ИССЛЕДОВАНИЯ ОРГАНОВ МАЛОГО ТАЗА ПРИ РЕЦИДИВИРУЮЩЕМ НАРУЖНОМ ГЕНИТАЛЬНОМ ЭНДОМЕТРИОЗЕ

Background. In the structure of gynecological diseases, endometriosis ranks II after inflammatory diseases of the genitals and uterine myoma. The incidence of genital endometriosis is 92–94%, with an annual incidence ranging from 0,1% to 0,3%. The disease is characterized by tumor-like type of growth, affection of adjacent organs, and severe complications that lead to disability in patients. Aim. To study the informative value of ultrasound examination of the reproductive system organs in recurrent external genital endometriosis. Material and methods. Forty-eight patients with recurrent external genital endometriosis were examined. The mean age of the patients was (34,96±1,1) years. The history of endometriosis was in the range of (10,0±1,41) years (9–11). Recurrence rate averaged (2,02±0,44) years (1–4). The duration of remission averaged (6,1±0,84) years (1–15). All the patients underwent ultrasound examination with a transvaginal transducer. The length, width, anteroposterior uterine size, M-echo, and length and width of both ovaries were determined. Echographic features of endometrioid ovarian cysts and retrocervical endometrioid infiltrate were evaluated during ultrasound examination. The findings were compared with the echographic findings in women (n=20) with no history of endometriosis (comparison group). Results and discussion. Transvaginal ultrasonography in recurrent external genital endometriosis showed a significant increase in the echographic dimensions of uterine length (54,3±0,41) mm, width (47,9±0,13) mm, anteroposterior dimension (56,1±0,18) mm, endometrial thickness (6,6±0,09) mm, and increased echographic dimensions of both ovaries (p&lt;0,05). Transvaginal ultrasound examination is informative in the diagnosis of endometrioid ovarian cysts. In 75,6% of patients, it manifests as a fluid mass with a heterogeneous suspension. In 75% of patients, retrocervical endometrioid infiltrate manifests as a heterogeneous, hypoechogenic, painful mass located behind the uterus. Conclusion. Transvaginal ultrasound is informative in the diagnosis of endometrioid ovarian cysts. Echographic diagnosis of endometrioid infiltrates of the vesicoureteral peritoneal fold, sacroiliac, broad uterine ligaments, and pelvic peritoneum presents difficulties, which justifies the necessity of laparoscopic diagnosis.

Anatomy of the sonographic post-cesarean uterus

PurposeWe aim to describe the sonographic uterine anatomy after a cesarean section (CS), test the reproducibility of predefined measurements from the BSUM study, and report the distribution of these measurements.MethodsThis is a descriptive observational study where 200 women with a history of only one CS were recruited 12–24 months postoperatively. A 5–13 MHz micro-convex transvaginal transducer was used for the acquisition of volumetric datasets for evaluating the CS scars. We defined 15 distinct measurements including the residual myometrial thickness (RMT). RMT ratio was calculated as a percentage of RMT to the assumed pre-cesarean anterior uterine wall thickness. A P value below 0.05 is utilized for significant statistical analysis.ResultsPatients were included on average 18.5 months post-cesarean. The uterus was anteflexed in 82.5% and retroflexed in 17.5%. Myometrial defects at the site of CS manifest in two forms, either as a niche or as fibrosis. Patients are classified into four groups: those with isolated niches (45%), combined niches and fibrosis (38.5%), isolated fibrosis (11%), and lacking both (5%). The median RMT ratio for these groups was 63.09, 40.93, 59.84, and 100% with a standard deviation of 16.73, 12.95, 16.59, and 0, respectively. The interclass correlation coefficient (ICC) remained above 0.9 for all distinct measurements among these groups except for those of RMT, where ICC varied between 0.47 and 0.96. The RMT ratio shows a constant ICC at 0.94 regardless of the group.ConclusionThe post-cesarean uterus is often anteflexed, and a myometrial loss of about 50% is normally expected. The pattern of this loss is in the form of a predominantly sharp-edged and echogenic niche, fibrosis, or a combination of both. The proposed RMT ratio takes these changes into consideration and results in a reproducible quantification. We hypothesize that different adverse outcomes could be attributed to the different scar patterns.

ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 2: performance of targeted neurosonography.

ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 2: performance of targeted neurosonography.

AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography.

AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography.

Evaluation of Current Disinfection Practice of Transvaginal Ultrasound Probes in a Philippine Tertiary Referral Hospital: A Comparative Study on the Performance of Manual Reprocessing Methods

Objectives. There are no standard infection control regulations in transvaginal ultrasound probe disinfection followed in the most prominent local public tertiary referral hospital. Likewise, no studies have evaluated the efficacy of the current method that uses an inexpensive multipurpose antiseptic spray solution. This study aims to evaluate the efficacy of the current practice of manual disinfection of TVS probes and compare it with the performance of an acceptable manual reprocessing method. Methods. A prospective, randomized, controlled study was carried out using a crossover, quasi-experimental design, collecting 119 total samples from the ultrasound transducers before (35 samples) and after disinfection with two manual reprocessing methods, either a locally manufactured multipurpose antiseptic spray (A-Septic® Multipurpose Antiseptic Spray) that is currently used for disinfection or Mikrozid Sensitive®, a ready to use impregnated wipes (42 samples each arm). Disinfection efficacy was evaluated based on microbial culture results. Results. Before disinfection, bacterial growth was observed in 77.1% (27/35) of the probes. After disinfection, 80.95% (34/42) remained contaminated with the antiseptic spray and 21.43% (9/42) with the wipes. The cultures revealed many environmental and pathogenic bacterial isolates, including Burkholderia, Staphylococcus, Acinetobacter, Diphtheroids, and Pseudomonas. Conclusions. The currently used method for disinfecting transvaginal transducers in the division is not adequate for decontamination and decreasing the risk of cross contamination among patients. The results call for aggressive disinfection measures and highlight the need to update local standards and formulate and institutionalize these recommendations.

Prevalence of negative sliding sign representing pouch of Douglas obliteration during pelvic transvaginal ultrasound for any indication

Pouch of Douglas (POD) obliteration can be predicted with a high degree of certainty and reproducibility using the dynamic transvaginal ultrasound (TVS) sliding-sign technique. So far, studies on POD obliteration prediction have focused on tertiary-care populations with high prevalence of endometriosis; however, POD obliteration may exist in individuals with asymptomatic endometriosis or other conditions. Our primary aim was to determine the prevalence of a negative sliding sign, representing POD obliteration, in a cohort of patients undergoing TVS for any gynecological indication. This was a prospective observational study of consecutive women with an indication for gynecological TVS, conducted at a high-volume ultrasound practice between July and August 2018. Clinical and surgical history, indication for TVS and TVS findings were documented. The prevalence of TVS-confirmed POD obliteration, determined by interpretation of the sliding sign, was calculated for the entire cohort and for the subgroups of women with and without risk factors for endometriosis. High risk for endometriosis was defined as having (1) a TVS referral for endometriosis-like pelvic pain or endometriosis specifically and/or (2) clinical symptoms or signs suggestive of endometriosis. Low risk was defined as the absence of these characteristics. During the study period, 1043 consecutive women underwent TVS. After excluding those who underwent transabdominal ultrasound, had a history of hysterectomy or with missing data, 909 women were analyzed. The prevalence of a negative sliding sign in the entire cohort was 47/909 (5.2%). A negative sliding sign was observed in 22/639 (3.4%) women with a low risk for endometriosis and 25/243 (10.3%) of those with a high risk for endometriosis (difference in proportions, 6.9% (95% CI 2.8-10.9%); P < 0.001). We have demonstrated an overall prevalence of a negative sliding sign, suggesting POD obliteration, of 5.2% (or 1/20) in women seeking TVS for a gynecological indication. The prevalence of negative sliding sign in low-risk women is not negligible (3.4% or 1/29 women). These women are most likely to have asymptomatic endometriosis or another important etiology of POD obliteration. The prevalence of a negative sliding sign is approximately three-times higher in women with signs and/or symptoms of endometriosis (10.3% vs 3.4%). Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Transvaginal Ultrasonographic Findings of Infertile Females in Population of Lahore

Failure of conception in women after frequent unprotected intercourse for one year is known as infertility. Ultrasound examination can detect certain pathologies that may result in primary or secondary infertility. Objective: To describe the various transvaginal ultrasonographic findings of infertile females in population of Lahore. Methods: The study was started after the consent of ethical committee of the University of Lahore. All the patients were registered in this study after signing the informed consent form. Toshiba Xario with transvaginal transducer frequency ranging from 9-12 MHz was used. Pathologies were evaluated through transvaginal scanning and sonographic data was kept in the ultrasound machine. A consecutive sampling technique was used and data was further evaluated with the help of Statistical Package for the Social Sciences version 24. Results: Among 138 females, PCOS was seen in 40.6% of the subjects. The second most common pathology was ovarian cyst which was seen in 10.9% of subjects. And the incidence of multiple fibroids was 5.1% as third most common pathology in both primary and secondary infertility cases. Most ovarian pathologies were found to be bilateral. 12.3% subjects had no findings on ultrasound. Conclusion: PCOS was the utmost common pathology connected with primary and secondary infertility. The second and third most common pathologies were ovarian cyst and multiple fibroids respectively. Keywords: female infertility, PCOS, PID DOI: 10.7176/JBAH/10-12-05 Publication date: June 30 th 2020

ISUOG Safety Committee Position Statement on safe performance of obstetric and gynecological scans and equipment cleaning in context of COVID-19.

ISUOG Safety Committee Position Statement on safe performance of obstetric and gynecological scans and equipment cleaning in context of COVID-19.

Impact of the newly recommended antral follicle count cutoff for polycystic ovary in adult women with polycystic ovary syndrome.

What is the impact of the newly recommended antral follicle count (AFC) cutoff for polycystic ovary (PCO) on the diagnostic status of polycystic ovary syndrome (PCOS)? Among patients with phenotypes requiring the presence of PCO for diagnosis, approximately half (48.2%) were excluded from having PCOS based on the new AFC cutoff, although these excluded women had worse metabolic and hormonal profiles than the controls and were indistinguishable from the remaining patients with regard to major hormonal and metabolic parameters. In the Rotterdam criteria, PCO is defined as either 12 or more follicles measuring 2-9mm in diameter or an increased ovarian volume >10cm3. Recently, an international PCOS guideline development group recommended an AFC threshold for PCO of ≥20 in adult women when using transducers with a high-resolution frequency, including 8MHz. The current study used a case control design. PCOS was diagnosed according to the Rotterdam criteria. Ultrasonography examinations were conducted with wide band frequency (5-9MHz) transvaginal transducers and the centre frequency was 8MHz. In patients who show both irregular menstruation and hyperandrogenism (HA), a diagnosis of PCOS can be made irrespective of the ovarian criteria change. Patients who were diagnosed according to HA and PCO (n= 86) or irregular menstruation and PCO (n= 443) were initially included among a total of 1390 adult women with PCOS (aged 20-40years). Regardless of the AFC, if the ovarian volume is ≥10cm3, a diagnosis of PCO can still be made. Thus, only patients who had an ovarian volume of <10cm3 were analysed. Subjects who had an AFC of 12-19 and an ovarian volume <10cm3 were designated as the 'low AFC group' (n= 255) and were the main focus of the study because they were excluded from having PCOS based on the new cutoff. Subjects with an AFC ≥20 and an ovarian volume <10cm3 were designated as the 'high AFC group' (n= 101). A total of 562 premenopausal women without PCOS were enrolled as controls. Among patients with irregular menstruation and PCO or HA and PCO phenotypes, approximately half (48.2%, 255/529) were excluded from having PCOS, which corresponded to one-fifth (18.3%, 255/1390) of the total adult patients. However, compared to the control group, these excluded women had worse metabolic profiles and were more androgenised. Notably, they were indistinguishable from the 'high AFC group' with regard to major hormonal and metabolic parameters (BMI and diabetic classification status, and the prevalence of insulin resistance, metabolic syndrome and HA). We cannot exclude the possibility of inter- and intraobserver variation in the evaluation of AFC. With the newly recommended follicle count cutoff, a substantial proportion of women with PCOS might be classified as not having PCOS despite visiting a hospital due to irregular menstruation or hyperandrogenic symptoms. A practical approach to them would involve controlling the menstrual or hyperandrogenic symptoms in hand and regularly evaluating them regarding newly developed or worsening PCOS-related symptoms or metabolic abnormalities. This study was supported by a grant from the Seoul National University Hospital Research Fund (No. 2520140090), Republic of Korea. The authors have no conflicts of interest to disclose. Not applicable.

153. Spiral arterial blood flow during pregnancy; a systematic review and meta-analysis

Objectives To evaluate the physiological adaptation of blood flow in human uterine spiral arteries throughout the course of normotensive and hypertensive pregnancies based on existing literature. Methods A systematic literature review and meta-analysis on the change of arterial uterine spiral arteries, measured by Doppler ultrasonography, was conducted. Literature search was performed in Pubmed, EMBASE and Cochrane Library. The search was limited to papers published in English. Both first and second selection were performed by two independent researchers. Weighted means of the Doppler indices were calculated for the three pregnancy trimesters. Results Seven longitudinal prospective and four cross-sectional studies were included with publication dates ranging from 1995 to 2015. Ultrasound measurements were performed at certain gestational ages using transvaginal or transabdominal transducers. In normotensive pregnancies, pulsatility index (PI) decreased from 0.76 (95% CI: 0.65–0.86) in the first trimester to 0.51 (95% CI: 0.45–0.57) (p Conclusions PI and RI in uterine spiral arteries both decreased with advancing gestational age with the largest decrease between the first and second trimester. This is in concordance with previous histological hypertrophic decidual vasculopathy- and Doppler uterine artery findings. Longitudinal studies examining comprehensively the predictive value of spiral artery Doppler for hypertensive pregnancies are yet to be determined.

96 Follicular Fluid and Serum Biochemical Composition in Alpacas (Vicugna pacos) with Different Nutritional Planes

The importance of nutrition on composition of follicular fluid and oocyte quality is recognised in several species but limited information is available on alpacas and would explain the high rate of early embryo mortality. The aim of this study was to analyse the biochemical composition of serum and follicular fluid (FF) from alpacas (Vicugna pacos) with different nutritional planes. Twelve adult female alpacas between 6 and 8 years old were assigned randomly to either a high (n = 6) or low (n = 6) plane of nutrition. Nutritional planes were defined by the grazing condition of the natural pasture with (high) or without (low) supplementation with 200 g of concentrate/day (total digestible nutrients: 52%, protein: 16%, and metabolizable energy: 2.8 Mcal kg−1). The nutritional conditions were imposed 1 month before the start of the experiment.The concentrations of total glucose, cholesterol, triglycerides, and proteins were determined with a semi-automatic biochemical analyzer (SINOWA, China). When an ovulatory follicle ≥7 mm was detected by ultrasonography using a 5-MHz linear-array transducer (SSD-500, Aloka, Tokyo, Japan), a transvaginal transducer with an attached needle guide (UST-945BP-5, Aloka) was used to collect follicular fluid. Follicular puncture was performed using a disposable 19-gauge # 12 mm hypodermic needle connected to a 50-mL conical tube via a silicon tube. A caudal epidural anaesthesia was induced with 4 mL of 2% lidocaine. Blood samples were obtained by jugular venipuncture into serum vacutainers and kept at room temperature for 30 min. Follicular fluid and serum were centrifuged at 1500 × g for 20 min, decanted, and stored at –20°C until analysed. Results were analysed by Student’s t-test. The results are presented in Table 1. The results suggest differences in biochemical composition of glucose and cholesterol in follicular fluid, which could explain the oocyte quality and embryo survival in alpacas. Table 1.Biochemical composition of follicular fluid (FF) and serum from alpacas (Vicugna pacos) under 2 nutritional planes Research was supported by INNOVATE PERU Grant 405-PNICP-PIAP-2014.

EP24.13: Cervical ectopic pregnancy: case series of 6 cases

A “cervical pregnancy” is an ectopic pregnancy that has implanted in the uterine endocervix. It typically aborts within first trimester, however, if it is implanted closer to the uterine cavity-so called cervicoisthmic pregnancy, it may continue longer. Placental removal in a cervical pregnancy may result in major hemorrhage. It can be confused with miscarriage as abortion in progress with sac passing through the cervix. Hence it is important to diagnose it correctly. We discuss the diagnostic features on ultrasound, importance of Colour Doppler in correct diagnosis and role of USG in follow up and treatment options in these cases. We analysed the ultrasound findings of cervical ectopic pregnancy in 6 cases. The study was performed on Phillips HD 11 XE & IU 22 ultrasound machine using C 5-2 convex & C 8-4 V transvaginal transducer. The size of gestational sac, trophoblastic reaction and vascularity, presence of embryo, its cardiac activity if present was documented. The gestational age at diagnosis was 6-9 weeks. All 6 cases showed empty endometrial cavity, closed internal os, three cases showed presence of only gestational sac (without fetal pole) with trophoblastic vascularity, three showed presence of embryo within sac; two with cardiac activity and one without cardiac activity. Five patients underwent curetting. One live ectopic was treated with methotrexate first and curetting was done later. Another live ectopic was treated with KCl injection for fetal reduction and then curetting was done. One was treated with methotrexate, patient started bleeding on 3rd day and aborted completely. A cervical ectopic pregnancy is a very rare form of extrauterine pregnancy. Its correct diagnosis helps in timely intervention. Surgical evacuation of the pregnancy alone is not recommended because the cervix is unable to contract and prolonged bleeding may follow. Hence expectant management with methotrexate is recommended in non-emergency cases. USG as imaging modality not only helps in diagnosis but also in follow up if it's treated on methotrexate.