Transvaginal Ultrasound Measurement Research Articles

Inhibin A-A Promising Predictive Parameter for Determination of Final Oocyte Maturation in Ovarian Stimulation for IVF/ICSI.

The number of mature oocytes is a key factor in the success of Assisted Reproductive Techniques (ART). Exogenous gonadotropins are administered during ovarian stimulation in order to maximize the number of oocytes available for fertilization. During stimulation, monitoring is mandatory to evaluate individual response, to avoid treatment complications and assist in the determination of the optimal day for final oocyte maturation and oocyte retrieval. Routine monitoring during stimulation includes transvaginal ultrasound examinations and measurement of serum estradiol (E2). Due to multifollicular growth of follicles of varying size, serum E2 levels are commonly supraphysiological and often variable, rendering E2-measurement during ovarian stimulation unreliable as a determinant of oocyte maturity. In contrast to serum E2, serum Inhibin A levels increase once a minimum follicle size of 12–15 mm is achieved. Due to this fact, serum Inhibin A levels could present in combination with ultrasound monitoring a more reliable parameter to determine the optimal follicle size for final oocyte maturation, as only follicles with a size of 12 mm and beyond will contribute to the serum Inhibin A level. This prospective observational, cross-sectional study demonstrates, that on the day of final oocyte maturation serum Inhibin A is strongly correlated to the number of follicles ≥15 mm (0.72) and to the number of retrieved and mature oocytes (ρ 0.82/0.77, respectively), whereas serum E2 is moderately correlated to the parameters mentioned above (ρ 0.64/0.69/0.69, respectively). With an area under the curve (AUC) of 0.91 for Inhibin A, compared to an AUC of 0.84 for E2, Inhibin A can be regarded as a better predictor for the optimal timing of trigger medication with a threshold number of ≥10 mature oocytes. It can be concluded from this data that serum Inhibin A in combination with transvaginal ultrasound monitoring may be a more powerful tool in the decision making process on trigger timing as compared to E2.

Preterm Birth Prevention in Appalachian Kentucky: Understanding Barriers and Facilitators Related to Transvaginal Ultrasound Cervical Length Surveillance Among Prenatal Care Providers.

Background: Appalachian Kentucky has higher-than-average rates of preterm birth (PTB)—a health disparity associated with increased maternal and fetal/neonatal morbidity and neonatal mortality. Transvaginal ultrasound (TVU) cervical length measurement is the best predictor of PTB risk, but is underutilized in Appalachia. This study explores prenatal care providers' TVU-related knowledge and practices, and identifies barriers and facilitators, which impact the adoption of this evidence-based technology.Materials and Methods: This study recruited providers from three Appalachian Kentucky health care sites. Prenatal care providers took part in semistructured interviews and completed brief survey scales. Questions focused on PTB knowledge, TVU-related barriers, and suggestions for clinician and/or patient-focused interventions. Transcripts were coded using a multistage process based in grounded theory. Descriptive statistics were calculated.Results: Eleven physicians, one nurse practitioner, one physician assistant, and one midwife completed interviews. Average participant age was 44 years with 17 years in practice; 43% of providers were female. Practitioners described the sociodemographic characteristics, health behaviors (e.g., smoking, opioid abuse), and comorbid conditions (e.g., obesity, hypertension, and diabetes) endemic in Appalachia that heightened their patients' PTB risk. TVU use was reported as important by all respondents, but not all were satisfied with their level of training. The most commonly identified barriers to TVU were patient access to transportation and social support. Participants stressed a need for changing community perceptions regarding consequences of PTB.Conclusions: Providers identified multiple TVU-related barriers and facilitators. These data will inform the design of a multifaceted dissemination and implementation strategy targeting PTB prevention in Appalachia.

Development and validation of predictive models for QUiPP App v.2: tool for predicting preterm birth in asymptomatic high-risk women.

Accurate mid-pregnancy prediction of spontaneous preterm birth (sPTB) is essential to ensure appropriate surveillance of high-risk women. Advancing the QUiPP App prototype, QUiPP App v.2 aimed to provide individualized risk of delivery based on cervical length (CL), quantitative fetal fibronectin (qfFN) or both tests combined, taking into account further risk factors, such as multiple pregnancy. Here we report development of the QUiPP App v.2 predictive models for use in asymptomatic high-risk women, and validation using a distinct dataset in order to confirm the accuracy and transportability of the QUiPP App, overall and within specific clinically relevant time frames. This was a prospective secondary analysis of data of asymptomatic women at high risk of sPTB recruited in 13 UK preterm birth clinics. Women were offered longitudinal qfFN testing every 2-4 weeks and/or transvaginal ultrasound CL measurement between 18 + 0 and 36 + 6 weeks' gestation. A total of 1803 women (3878 visits) were included in the training set and 904 women (1400 visits) in the validation set. Prediction models were created based on the training set for use in three groups: patients with risk factors for sPTB and CL measurement alone, with risk factors for sPTB and qfFN measurement alone, and those with risk factors for sPTB and both CL and qfFN measurements. Survival analysis was used to identify the significant predictors of sPTB, and parametric structures for survival models were compared and the best selected. The estimated overall probability of delivery before six clinically important time points (< 30, < 34 and < 37 weeks' gestation and within 1, 2 and 4 weeks after testing) was calculated for each woman and analyzed as a predictive test for the actual occurrence of each event. This allowed receiver-operating-characteristics curves to be plotted, and areas under the curve (AUC) to be calculated. Calibration was performed to measure the agreement between expected and observed outcomes. All three algorithms demonstrated high accuracy for the prediction of sPTB at < 30, < 34 and < 37 weeks' gestation and within 1, 2 and 4 weeks of testing, with AUCs between 0.75 and 0.90 for the use of qfFN and CL combined, between 0.68 and 0.90 for qfFN alone, and between 0.71 and 0.87 for CL alone. The differences between the three algorithms were not statistically significant. Calibration confirmed no significant differences between expected and observed rates of sPTB within 4 weeks and a slight overestimation of risk with the use of CL measurement between 22 + 0 and 25 + 6 weeks' gestation. The QUiPP App v.2 is a highly accurate prediction tool for sPTB that is based on a unique combination of biomarkers, symptoms and statistical algorithms. It can be used reliably in the context of communicating to patients the risk of sPTB. Whilst further work is required to determine its role in identifying women requiring prophylactic interventions, it is a reliable and convenient screening tool for planning follow-up or hospitalization for high-risk women. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Ultrasound assessment of uterine morphology in menorrhagia: case control study

This was a prospective study to evaluate transvaginal ultrasound measurements in investigating patients with menorrhagia through detailed morphological assessment of the uterus and ovaries by comparing the study group with menorrhagia with a control group with no previous history of menorrhagia. 92 women participated in the study of whom 46 had a history of menorrhagia and 46 were control cases. Mean age of participants was 34.6 years with mean BMI of 27.2. Uterine volume was significantly larger in the index group (p = .024) having reduced uterine mobility (p = .002). 36% of women with menorrhagia were found to have vascular flow within the inner half of the myometrium (p = .002). Women in the study group documented higher pain score both during menstruation and during transvaginal examination compared with controls (p = .008). Uterine fibroids were found in 15% of women with menorrhagia, not significantly more frequently than women without menorrhagia (8.7%) (p = .33).Impact statementWhat is already known on this subject? Transvaginal ultrasound is the non-invasive diagnostic tool of choice in evaluating uterine morphology for menorrhagia in the recognition of the subtle myometrial changes of adenomyosis, fibroids and polyps.What do the results of this study add? Reduced mobility of the uterus against the rectum was more frequent in the study group suggesting the presence of adhesions between the uterus and rectum most likely due to history of endometriosis. Women with menorrhagia had a higher pain score experienced during transvaginal ultrasound as a result of a retroverted and less mobile uterus, hence the movement of the probe against structures which are adherent to each other can cause discomfort during the scan.What are the implications of these findings for clinical practice and/or further research? This study was performed in the hope that the findings obtained will help medical practitioners to provide more accurate information to patients regarding the cause of their menorrhagia, as well as potentially tailoring more specific treatments for menorrhagia based on their ultrasound findings.

One-day clinic concept for bleeding in postmenopause

Objective: The aim of this study was to compare the efficacy of blind endometrial biopsy by Pipelle with that of hysteroscopy biopsy with biopsy forceps under direct view and the safeties of transvaginal ultrasound measurements.

Effects of antibiotic therapy in women with the amniotic fluid “sludge” at 15–24 weeks of gestation on pregnancy outcomes

Objective: The aim of this prospective study was to assess the efficacy of antibiotic therapy for the prevention of adverse pregnancy outcomes in women with the amniotic fluid “sludge” at 15–24 weeks of gestation.Methods: 245 women underwent transvaginal ultrasound cervical length measurement at 15–24 weeks of pregnancy and 29 out of them with amniotic fluid “sludge” were included in the study. Eight women with the “sludge” had cervical length >25 mm (Group I), seven—an asymptomatic short cervix (Group IIa) and 14 women with a short cervix had symptoms like low abdominal pain, back pain, and menstrual-like cramps (Group IIb). All participants received intravenous, oral and/or vaginal antibiotic therapy. Participants in Group IIa were additionally given vaginal progesterone (VP), and in Group IIb—VP and indomethacin. Placentas from women with preterm birth (PTB) underwent histological examination.Results: The amniotic fluid “sludge” detected at an ultrasound scan between 15–24 weeks of gestation was associated with long-term maternal infections, histological chorioamnionitis, and was viewed as a marker of intra-amniotic infection. Absence of intravenous antibiotic therapy during midtrimester of pregnancy in these women was associated with neonatal infection with intrauterine onset in 61.1%, postpartum endometritis in 23.1%, and rate of PTB 46.2%. Intravenous antibiotic therapy eliminated sonographic presence of the sludge and resulted in prevented of neonatal and postpartum infections, prevented the risk of PTB in women with the cervical length >25 mm, in those with an asymptomatic short cervix receiving VP, and in 70% of symptomatic women with a short cervix, who received them in combination VP/indomethacin. For those women whose approach was not fully beneficial, it allowed to delay delivery in 11–17 weeks.Conclusions: Although we found that intravenous antibiotic therapy at 15–24 weeks of gestation in women with amniotic fluid “sludge” can protect from infection-related complications and demonstrated high beneficial effects of adding antibiotics to anti-inflammatory drug (indomethacin) and/or VP in women with a short cervix, further larger studies are needed.

The reproducibility of the novel utilization of five-dimensional ultrasound and power Doppler in the prediction of endometrial receptivity in intracytoplasmic sperm-injected women: a pilot prospective clinical study.

The ultimate goal of this study is to reassess the five-dimensional implantation markers and pregnancy predictors on the day of human chorionic gonadotropin injection in the intracytoplasmic sperm injection and embryo transfer programs. A pilot prospective clinical trial. The Assisted Reproductive Technology Unit of Ain Shams Maternity Teaching Hospital during the period from April 2014 to December 2017. The study was conducted on 400 women undergoing intracytoplasmic sperm injection (ICSI). Those women were not older than 40years, with normal uterine cavity and with no previous uterine scars. The ovarian stimulation protocol, used in this study for all patients, was the long protocol, before ovarian stimulation therapy, patients were instructed to use oral contraceptive pills from day 2 starting in the preceding cycle, then the standard regimen. On the day of hCG administration, 5D transvaginal ultrasound measurements were performed by the same observer after the patients had emptied their bladders. Measurements included endometrial volume and 3D power Doppler parameters, endometrial vascularization index, flow index, and vascularization flow index. The present study shows that endometrial volume ≥ 5 in the prediction of endometrial receptivity in ICSI patients had good sensitivity and low specificity in a group application; in an individual application it had good predictive negative value and bad predictive positive value. So it could be used as a good test to exclude success. Overall pregnancy rate was 40.5%; endometrial volume, flow index, vascularization index, and vascularization flow index were significantly lower in the nonpregnant group than those of the pregnant group. The area under curve in the receiver operating characteristic for three-dimensional ultrasound and power Doppler angiography parameters was statistically significant, but their values were suggestive but not conclusive in the prediction of endometrial receptivity in ICSI patients, no cutoff points with good diagnostic characteristics could be obtained. Five-dimensional ultrasound and power Doppler angiography is a useful exam to assess the endometrial receptivity in IVF/ICSI and embryo transfer cycles.

Accuracy and efficacy of embryo transfer based on the previous measurement of cervical length and total uterine length.

Aim of the study was to examine the accuracy of embryo transfer based on the previous measurement of cervical length and total uterine length. The study has taken place in an academic-assisted reproduction clinic. 248 patients with infertility requiring IVF/ICSI treatment have been included. All patients underwent IVF/ICSI cycles with antagonist protocol and were treated with controlled ovarian stimulation using recombinant FSH (100-400IU/day). On the day of oocyte retrieval, all patients were given vaginally natural micronized progesterone in a dose of 200mg/tds. All patients had transvaginal ultrasound measurement of cervical length and endometrial cavity length prior to embryo transfer and measurement of embryo distance (intrauterine air bubbles) from fundal surface of uterine cavity and internal cervical os immediately after embryo transfer. Embryo transfer was performed on days 2-3. Primary outcome was to estimate the accuracy of embryo transfer based on the measurement of the embryo distance from middle of uterine cavity after embryo transfer and secondary outcome was to assess the effect of embryo distance from uterine fundus and internal cervical os to clinical pregnancy rate. The clinical pregnancy rate was 42.7%. The mean embryo distance from the middle of endometrial cavity was 0.48 ± 0.02cm, the mean embryo distance from the uterine fundus was 0.88 ± 0.32cm, and from the internal cervical os was 1.67 ± 0.45cm. Multiple regression analysis showed that the embryo distance from middle of cavity was related to endometrial cavity length and to the embryo distance from the fundus and it was not related to Cx length, total uterine length, embryo distance from internal Cx os, and embryo transfer length. Embryo transfer with the previous measurement of total uterine length and estimation of embryo transfer length can be performed with very good accuracy by a single operator.

The effect of cervical canal length on maternal and neonatal outcomes in placenta previa and the predictive value of transvaginal ultrasound measurement of cervical canal length for emergency early cesarean section

Objective To analyze the effect of cervical canal length on maternal and neonatal outcomes in placenta previa and the predictive value of transvaginal ultrasound measurement of cervical canal length for emergency early cesarean section. Methods From January 2014 to December 2017, 63 pregnant women with placenta previa in the General Hospital of Changzhi Lu'an Group were selected in this study.The length of the cervical tube was measured by vaginal ultrasound in the late pregnancy.According to the length of cervical canal during delivery, 63 cases were divided into control group (cervical canal length >25cm, 39 cases) and study group(cervical canal length ≤ 25cm, 24 cases). The maternal and infant outcomes of the two groups were compared, and the diagnostic efficacy of the cervical canal length to the early cesarean section of the placenta preg before 36 weeks of pregnancy was assessed by drawing the receiver operating characteristic curve to evaluate the area and the best diagnostic threshold under the curve, and calculated the sensitivity and specificity. Results The gestational weeks of delivery in the study group was significantly shorter than that in the control group(t=5.95, P 0.05). The birth weight and the 5 min Apgar score in the study group were significantly lower than those in the control group(t=5.48, 4.65, all P<0.05). The incidence rate of neonatal asphyxia in the study group was significantly higher than that in the control group(χ2=5.19, P<0.05). The area of the cervical canal length was 0.87, with the sensitivity of 84.62%, the specificity was 78.38%, and the best diagnostic threshold was 26.5 mm for the pregnant women who was predicted the placenta previa before 36 weeks of pregnancy. Conclusion The incidence rates of adverse outcomes, such as premature birth, prenatal bleeding and neonatal asphyxia, are higher in pregnant women with shorter cervical tube length.The measurement of cervical canal length by vaginal ultrasound for pregnant women with placenta previa can be used as an important evaluation method to predict the early cesarean section of pregnant women, and help to strengthen the clinical intervention, take management to prevent serious perinatal complications. Key words: Cervical length measurement; Placenta previa; Ultrasonography; Vagina; Cesarean section; Pregnant women; Infant, newborn; Pregnancy outcome

Transvaginal Ultrasound Measurement of Cervical Length and Posterior Cervical Angle versus Bishop Scoring in Assessment of Induction of Labour

Background: Induction of labour is a widely used intervention on the modern labor. The Bishop score, since its description in 1964, remains the gold standard for assessing favorability for induction of labor. However, the preinduction ‘favorability’ of the cervix as assessed by the Bishop score is very subjective and several studies have demonstrated a poor predictive value for the outcome of induction especially in women with a low Bishop score. Aim of the work: The objective of the study was to evaluate the Transvaginal ultrasonographic measurements in predicting the success of induction of labour. Patients and Methods: In this study 70 women 35-42 weeks pregnancy underwent induction of labor. Before induction a digital examination of the cervix was performed & the Bishop score noted. Cervical length, posterior cervical angle& cervical funneling were then assessed by a transvaginal ultrasound. Results & conclusion: successful induction correlated significantly with the Bishop score and ultrasonographically measured cervical length, and the posterior cervical angel and ultrasound measurements were suggested to be better than the Bishop score in prediction of successful vaginal delivery.

Transvaginal Ultrasound Measurement of Cervical Length and Posterior Cervical Angle versus Bishop Scoring in Assessment of Induction of Labour

Induction of labour is a widely used intervention on the modern labor. The Bishop score, since its description in 1964, remains the gold standard for assessing favorability for induction of labor.

EP15.19: Assessing myometrial infiltration by measuring the tumour‐free distance and depth of invasion through 2D transvaginal ultrasound among patients with endometrial cancer

To determine the diagnostic accuracy of 2D transvaginal ultrasound (TVS) in assessing myometrial infiltration by measuring tumour-free distance (TFD) and depth of invasion (DOI) among patients with endometrial cancer admitted for elective surgery in Philippine General Hospital. This prospective validation study involved 49 patients with endometrial cancer admitted from October 1, 2016 to February 28 2017. All patients had 2D transvaginal ultrasound at least within 1 week prior to surgery. The tumour-free distance and depth of invasion were measured and compared with histopath results. The diagnostic accuracy was computed and test of association was done using 2x2 Fischer Exact test at 0.05α while AUC-ROC was plotted. The association between transvaginal ultrasound and histopath result in assessing myometrial infiltration was statistically significant (p=0.004). The TVS measurement for myometrial infiltration demonstrated 94.4% sensitivity and 43.8% specificity in detecting >50% infiltration wherein a likelihood would likely to occur by 1.68 times higher than those with <50% based on the final histopathology. Moreover, the accuracy values of TVS reflected in the AUC index were as follows, a TFD cut off value of ≤0.82cm had higher sensitivity (46.88%) and specificity (100%) in predicting >50% myometrial infiltration while a DOI ratio of 0.50 is the cut off value which initiated a sensitivity (16.7%) and specificity (75%) in predicting >50% infiltration. Finally, TFD (AUC =0.749) yielded a higher accuracy as compared with DOI (AUC=0.388) in predicting myometrial infiltration. Myometrial infiltration assessment by measuring the tumour-free distance through 2D transvaginal ultrasound among endometrial cancer patients demonstrated clinically acceptable accuracy with higher sensitivity in detecting >50% myometrial infiltration. TFD (cut off value of ≤0.82cm) has a higher accuracy compared with DOI in predicting >50% myometrial infiltration. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

SONOGRAPHIC CERVICAL CANAL LENGTH AND/ OR A BISHOP SCORE ASSESSMENT AS A PREDICTOR FOR SUCCESSFUL INDUCTION OF LABOR

Objectives: To compare transvaginal sonography for cervical length measurement and digital examination for Bishop score assessment in women undergoing labor induction at term. Patients and Methods: A prospective study involved 140 women subjected to induction of labor. Preinduction assessment of Modified Bishop score and transvaginal ultrasound measurement of cervical length was done. Results: One hundred and forty nulliparous women had CL 7. Cervical length had superior sensitivity (83.74% vs. 65.4%) and marginally better positive (95.4% vs. 94.1%) and negative (37.5% vs. 21.8%) predictive values. Conclusions:Transvaginal sonography for cervical length measurement is better tolerated than digital examination for Modified Bishop score assessment.

Comparison of transvaginal ultrasonographic and digital cervical assessment in predicting successful induction of labour in nulliparous pregnancy beyond 40 weeks with unfavourable cervix – A prospective cohort study

Introduction: To date, the Bishop score remains as the standard method to predict the successfulness of labour induction. Possible role of transvaginal ultrasound measurement of cervical length provides conflicting evidences. This study compares the value of transvaginal ultrasound cervical length (TVSCL) and the Bishop score (BS), in predicting the success of labour induction in nulliparous pregnancy beyond 40 weeks with unfavourable cervix. Method: In this prospective cohort study pre induction TVSCL and Bishop score were measured in 392 nulliparous women who underwent induction with vaginal Prostaglandin (PGE2) at 40 weeks+6 days. Achieving a cervical dilation of 8cm was considered as a successful induction. Predictive value of TVSCL and BS, in determining successful induction, and amniotomy to successful induction time interval (TI) were analyzed using chi-square test, unpaired t-test, multiple logistic regression, Pearson’s co-efficient and receiver-operating characteristics (ROC) curves. Results: Induction of labour was successful in 75.5% (n=296) of the women. There was a significant difference in mean TVSCL, between successful and failed induction groups (P=0.02). Best cut-off value of TVSCL for predicting successful induction was 3.3cm. However TVSCL failed to demonstrate significant discriminatory value (Area under the ROC curve (AUC)= 0.545;95% CI,0.496-0.597;P=0.17). Meanwhile the AUC for the Bishop score >3 was significant (AUC=0.548;95%CI,0.548-0.647;P=0.006). However, sensitivity and specificity of the Bishop score in predicting induction success were 76.0% and 44.8% respectively. There was no significant association between TVSCL and TI (R=0.02, P=0.06). Conclusion: TVSCL is not an accurate predictor for the outcome of labour induction in nulliparous pregnancy beyond 40 weeks with unfavourable cervix. Nevertheless, the Bishop score appears to be of poor predictive value.

Ultrasonograph versus β-human chorionic gonadotropin titer for verification of termination of missed first trimester miscarriage

Introduction Miscarriage is one of the common complications of pregnancy. Up to 20% of recognized pregnancies will end in miscarriage. However, when women were followed with serial serum human chorionic gonadotropin (hCG) measurements, the actual miscarriage rate was found to be 31%. Many pregnancies are lost spontaneously before a woman recognizes that she is pregnant, and the clinical signs of miscarriage are mistaken for a heavy or late menses. In some countries with low resources, ultrasound may be not available in all medical centers. So, confirmation of complete termination of first trimesteric miscarriage may be not possible, and these cases may present with complications of inadequate treatment. So, we need to study other method for verification of successful management such as β-hCG titter. Objective The aim was to assess the usefulness of testing serum β-hCG titer to confirm the effective medical termination of the first trimester miscarriage. Patients and methods A prospective study was conducted at the Department of Obstetrics and Gynecology at Al Zahraa university Hospital in the period between December 2017 and April 2018. A total of 34 pregnant women with first trimester miscarriage (7–13 weeks from the first day of last menstrual period) were submitted for medical termination of miscarriage, and each case was subjected to ultrasonography 7 days after termination of miscarriage (for measurements of endometrial thickness) and serum β-hCG at 3 and 7 days after termination of miscarriage. Results Endometrial thickness decreased after termination of miscarriage (with cut-off value &lt;15 mm). Moreover, β-hCG decreased after medical termination of miscarriage. In our study, receiver operating characteristics curve was used to define the best cut-off value of β-hCG, which was greater than 34 mIU/ml, with sensitivity of 90%, specificity of 70.8%, positive predictive value of 56.4%, and negative predictive value of 94.4%, with diagnostic accuracy of 83.5%. Conclusion Measuring β-hCG level is an effective alternative to transvaginal ultrasound measurements of endometrial thickness to verify the completion of termination of early miscarriage.

Reproducibility of the transvaginal sonographic assessment of bladder wall thickness

ObjectiveTo assess whether transvaginal sonographic measurements of bladder wall thickness (BWT) have adequate reproducibility to detect differences in BWT potentially indicative of detrusor overactivity in women with overactive bladder. Study designThree reproducibility studies were undertaken to assess (A) total measurement error, (B) intra-observer variability and (C) inter-observer measurement in the interpretation of scans. Women recruited to the Bladder Ultrasound Study underwent a transvaginal ultrasound scan to obtain a measurement of BWT. When a second observer was available, women who agreed to have two transvaginal scans by different operators were recruited into study A. For study B the first observer reassessed a sample of the recorded images at a later date whilst for study C, a random selection of BWT images were read by a second assessor. Analytical variability, percentage of variability attributable to measurement error, within-person variation and the smallest real difference detectable were estimated. ResultsOne hundred and twenty-one women took part: 27 had repeat scans, 37 had scans re-read by the same observer, and 57 had scans read by two observers. In study A, 39% of the total variability in measurements was explained by measurement error (the remainder to within person change); the standard deviation (SD) of measurement error was 0.76mm and the smallest detectable clinical difference was 2.1mm. The SD of measurement error from scan interpretation was 0.42mm within observers (study B) and 0.35mm between observers (studyC). ConclusionThe high levels of measurement error for a small measurement of BWT means it is unlikely Transvaginal ultrasound measurements have insufficient reliability and reproducibility to be an accurate diagnostic test.

Evaluation of Transvaginal Ultrasound plus CA-125 Measurement and Prophylactic Salpingo-Oophorectomy in Women at Different Risk Levels of Ovarian Cancer: The Modena Study Group Cohort Study

Objective: To evaluate the effectiveness of transvaginal ultrasound (TVU) and serum CA-125 measurement in women at different risk of developing ovarian cancer/fallopian tube cancer (OC/FTC) and the incidence of primary peritoneal cancer (PPC) after risk-reducing salpingo-oophorectomy (RRSO). Methods: Between 2002 and 2014, 661 women at different risk of OC/FTC/PPC due to a family history or BRCA1/2 gene mutation were offered TVU and CA-125 measurement or RRSO as prevention strategies. The detection rate of OC/FTC/PPC was evaluated, and the sensitivity and specificity for CA-125 measurement and TVU were calculated. Survival and event analysis was performed for diagnosed patients. Results: After a median follow-up of 112 months, 12 OC/FTC/PPC cases were detected (2.6/1,000 persons/year). The screening sensitivity was 70%, with 73% for BRCA carriers. Six (50%) of 12 cancers were stage I or II. Among 41 women who underwent RRSO, 2 BRCA1 carriers developed a PPC (4.9%). At 61-month follow-up, overall and event-free survival were 75 and 64%, respectively. Conclusions: The cancer detection rate in women with BRCA mutation or a strong family history supports the effectiveness of our surveillance program for early diagnosis. Screening for women at lower risk of OC/FTC is not recommended. A residual risk of PPC after RRSO remains for BRCA1 carriers.

Value of endometrial thickness assessed by transvaginal ultrasound for the prediction of endometrial cancer in patients with postmenopausal bleeding.

Histological confirmation of endometrial cancer by dilatation/curettage (D/C) in women with postmenopausal bleeding (PMB) can be challenging due to anesthesiological and/or surgical risks. Thus, less invasive methods for diagnostics are required to identify patients with minimal risk for endometrial cancer (EC) to avoid unnecessary surgical intervention. The objective of this single-center cohort study was to assess the diagnostic validity of transvaginal ultrasound (TVUS) measurements of endometrial thickness (ET) in patients with PMB for the detection of EC. A retrospective analysis of data from patients presenting between January 2005 and August 2014 at the Department of Obstetrics and Gynecology, University Hospital Ulm, Germany, with PMB and subsequent D/C was performed. Complete data with TVUS documentation of ET and histological results of tissue samples were available from 254 patients. In addition, data on age, body mass index (BMI), ASA-score, diabetes, hypertension, and hematological laboratory values (for a smaller subsample) were recorded. To identify independent risk factors, a multivariate logistic regression with endometrial cancer as binary response variable (yes/no) was performed. Diagnostic efficacy data for different ET cutoff points (≤1 to ≤26mm) were obtained by a receiver operator characteristic (ROC) curve analysis. The multivariate logistic regression revealed a significant independent predictive value for age and ET. However, none of the analyzed ET cutoff points showed optimal diagnostic validity, as all cutoff points with sensitivity rates above 90% (≤1 to ≤5mm) had false positive rates of 70% and higher. There is no ET cutoff point that provides good diagnostic accuracy and/or reliably excludes the presence of endometrial cancer in patients with PMB. Thus, our data analysis supports the actual German approach of histological evaluation of any PMB to confirm or exclude EC.

Effects of long-term exogenous testosterone administration on ovarian morphology, determined by transvaginal (3D) ultrasound in female-to-male transsexuals

Does long-term exogenous testosterone administration result in polycystic ovarian morphology (PCOM), determined by (3D) transvaginal ultrasound (TVU) in female-to-male transsexuals (FtMs). Long-term exogenous testosterone administration in FtMs does not result in PCOM determined by (3D) TVU. The role of androgens in the pathophysiology of polycystic ovary syndrome (PCOS) is still unclear. From animal studies, intra-ovarian androgens have been suggested to disturb folliculogenesis, through a pro-atretic effect on growing follicles. It remains debatable whether exogenous androgens induce PCOM in humans. In the past histomorphologic studies indicated that androgen administration in FtMs could cause PCO-like changes. However, ultrasound morphology is an established criterion for PCOS, TVU data of ovaries after prolonged androgen exposure are lacking. Prospective, observational, case-control study, in an academic setting, performed in 2014-2015, including 56 FtMs and 80 controls. The study population consisted of adult FtMs treated with long-term testosterone, as part of their cross-sex hormone treatment, and scheduled for sex-reassignment surgery (bilateral salpingo-oophorectomy). Prior to the operation, under anaesthetics TVU measurements (3D transvaginal probe 3-9 MHz; HD11, Philips Ultrasound, Inc.) of the ovaries were performed. The control group consisted of females from a general population who underwent the same TVU and analysis. Antral follicle count (AFC) (3D) and ovarian volume (3D) were calculated using specialized software. PCOM was defined as AFC of 12 or more follicles (2-10 mm) in at least one ovary. Prevalence rates of PCOM were not significantly different in the FtMs compared to controls, determined by (3D) TVU: 32.1% (17/53) versus 30.7% (23/75), P = 0.87. Testosterone levels in FtMs are supraphysiological, and may not be comparable to the testosterone levels in women with PCOS. However, we applied a unique and ethically acceptable opportunity of exploring the effects of androgens on human ovaries. This first explorative study shows that long-term exogenous testosterone administration in adult women does not seem to induce PCOM determined by TVU. None. The trial was registered at the Dutch Trial Register (www.trialregister.nl), registration number NTR4784.

Uterine Curettage Versus Presumptive Methotrexate for Non-Viable Pregnancy of Unknown Location [33H

INTRODUCTION: When managing a non-viable pregnancy of unknown location (PUL), it is unknown which factors influence the decision to perform a uterine curettage versus presumptive administration of methotrexate. METHODS: A prospective, anonymous electronic survey of PUL case scenarios was administered to physicians registered with the American Medical Association Physician Masterfile and to all Obstetrics and Gynecology residents and academic faculty located in the United States. RESULTS: A total of 214 physicians responded. When presented with a patient diagnosed with a PUL by transvaginal ultrasound and serial βhCG measurements demonstrating an inappropriate trend for a viable pregnancy, 78 (37.0%) would offer uterine curettage before administrating methotrexate while 67 (31.7%) would offer methotrexate presumptively. The odds of choosing uterine curettage was more than four-fold higher among academic physicians compared to resident physicians (adjusted OR 4.05, 95% CI 1.62-10.10). There was no difference between private practice physicians and resident physicians. Compared to physicians in the Northeast, physicians in the South were much more likely to select uterine curettage as their initial management strategy (adjusted OR 2.48, 95% CI 0.99-6.20). CONCLUSION: Resident physicians appear to be significantly more likely to presumptively administer methotrexate compared to academic physicians in the context of a non-viable PUL. If confirmed by larger studies, this finding has direct implications for future resident education.