Transvaginal Research Articles

Comparison between trans-vaginal and trans-abdominal ultrasound examination of the cervix in the second trimester of pregnancy: a prospective study.

To compare transvaginal (TV) and trans-abdominal (TA) ultrasound assessment of cervical length (CL) at the time of the second-trimester scan for fetal anomalies. This was a prospective study including consecutive pregnant women attending the low-risk ultrasound clinic of two fetal medicine centres in Italy. The inclusion criteria were women between 19+0 and 22+0weeks of gestation, attending the prenatal ultrasound clinic for the routine second trimester screening for fetal anomalies. The primary outcome was to compare the CL measurement obtained at TV compared to TA ultrasound; the secondary outcome was to report the inter and intra-observer variability of CL measured with the two different approaches. All women underwent TV and TA assessment of the cervix performed by two experienced certified operators, blinded to each other. Intra-class correlation coefficients (ICC) and Bland-Altman analyses were used to analyse the data. Two hundred and fifty women were included in the analysis. All women had anteverted uterus. The mean gestational age at ultrasound was 20.7±0.7weeks; 1.2 % (3/250) scans were performed at 19weeks, 49.2 % (123/250) at 20weeks, 44.8 % (112/250) at 21weeks and 4.8 % (12/250) at 22weeks of gestations. Identification of the major landmarks of CL at TA ultrasound was achieved in all the included cases. There was good reliability between CL measured at TA (ICC 0.95, 95 % CI 0.93-0.97 for observer 1 and 0.92 %, 95 % CI0.89-0.94 for observer 2) and TV ultrasound 0.97, 95 % CI0.96-0.98 for observer 1 and 0.96, 95 % CI 0.95-0.97 for observer 2). There was also good reliability between the two observers for both the TA and TV assessment of the CL. Mean TA CL was 41.4±5.5 for observer 1 and 40.5±4.8 for observer 2 with no significant differences between the two measurements (mean difference 0.92 mm, 95 % CI-9.7 to 11.2). Likewise, there was no difference between the CL measured at TV ultrasound between the two observers (mean difference-0.83 mm, 95 % CI-5.97 to 4.30). Finally, there was no difference in the mean CL measured at TA compared to TV, either considering the overall population of women (mean difference:-0.43, 955 CI-8.65 to 7.79), or when stratifying the analysis according to the parity status and the operator. Among experienced operators, there was no difference between TV and TA ultrasound assessment of the CL at the time of the routine anomaly scan for fetal anomaly.

The effect of preinduction cervical length measurement with three different ultrasonographic methods on predicting delivery time.

This study aimed to evaluate the effect of preinduction cervical length (CL) measurement by transvaginal (TV), transperineal (TP), and transabdominal (TA) ultrasonography (USG) on the time of delivery and to compare these three sonographic methods in terms of superiority over one another. This study included TV, TP, and TA CL measurements in pregnant women who were planned to undergo induction of labor at 37 weeks' gestation or later. The correlations between the said three methods and BISHOP scores were evaluated. These three methods were compared in terms of superiority in predicting the time of delivery. Pregnant women at 37-42 weeks' gestation undergoing labor induction were included, and all three methods were used for CL measurements. Three methods were correlated with each other (p < 0.001) and with BISHOP scores (p < 0.001). The correlation between all three methods and BISHOP scores indicates that TP and TA USG can be used instead of TV USG. On the other hand, while TA USG did not give a clear result in the accurate estimation of vaginal delivery time, TP, and TV USG gave both accurate and close results. When all these data are evaluated, it is concluded that TPU can be used safely instead of TVU, especially in patients receiving induction.

Intra-Sonographer Correlation Between Transabdominal and Transvaginal Cervical Length Measurements and Associated Patient Demographics.

To assess transvaginal (TV) and transabdominal (TA) cervical length (CL) measurements' variability and patient factors associated with TA CL accuracy. We hypothesized that patient factors would affect the accuracy of TA CL. This was a prospective cohort study. During anatomy ultrasound, TA and TV CL measurements were obtained, distance from placental edge to internal cervical os assessed, and demographic questionnaires completed. Patients between 18 to 22 weeks and 6 days were included and those <18 year old or with a twin gestation were excluded. TA CL >0.5 cm different from TV length was considered inaccurate. A total of 530 patients were included. Exactly 18.7% had a prior cesarean, 9.8% a preterm birth, and 2.2% a cervical procedure. Mean age and BMI were 31.1 years and 27.8 kg/m2 . Median number of living children was one. Median TA and TV CL were 3.42 and 3.53 cm. Exactly 36% (95% CI: 32-40%) of TA CL measurements were inaccurate. CL of 3.4 cm corresponded to a mean difference of zero between TA and TV CL. TA ultrasound had a sensitivity of 25% and a specificity of 98.5% to detect TV CL <2.5 cm. On multivariable analyses, Hispanic ethnicity was associated with inaccurate TA measurement (OR 0.48, 95% CI: 0.24-0.96, P = .04). On average, TA CL underestimates TV CL when TV CL >3.40 cm and overestimates TV CL when TV CL <3.40 cm. Additional co-variates did not impact accuracy. TA ultrasound has low sensitivity to predict short cervix. Relying solely on TA CL to identify those who need intervention may miss diagnoses. It may be reasonable to develop protocols in which TV CL is used for TA CL <3.4 cm.

Comparison between trans-vaginal and recto-vaginal techniques for transferring embryos in the dromedary camels

The present study was conducted in two breeding seasons to compare the effect of two non-surgical techniques for embryo deposition intrauterine, trans-vaginal (TV) versus recto-vaginal (RV) techniques, on the pregnancy rate and early pregnancy loss (EPL) in dromedary camels. Embryos were collected from 70 donors and transferred to 210 recipients by TV (n = 256 transfers) or RV technique (n = 186 transfers). Pregnancy diagnosis was conducted on Day 10 after embryo transfer (ET) by using the progesterone-ELISA test and by trans-rectal ultrasonography at Day 60 of gestation. EPL was calculated as the recipients that were diagnosed pregnant on Day 10 post-ET and lost their pregnancy between Days 20–60 of their gestation. Using the RV technique in ET of a single embryo showed higher pregnancy rates at Day 19, especially with the embryos of folded, semi-transparent shapes, or those collected after superovulation with the recovery of >4 embryos per flush. While, the pregnancy rates at 60 days showed increases after ET with the RV technique of single, folded, transparent, and semi-transparent, medium-size embryos and/or those collected after superovulation with any number of the recovered embryos than those transferred by the TV technique. The rate of EPL was increased when the TV technique was used for ET of single, spherical, folded, semi-transparent, medium-sized embryos and those collected without or with the superovulation and recovery of >4 embryos per flush. In conclusion, using the RV technique to deposit the embryos intrauterine improves the pregnancy rate and reduces EPL compared to the TV technique.

Transabdominal and transvaginal ultrasound assessment of cervical length - can transvaginal approach be avoided?

This study aimed to compare transabdominal (TA) and transvaginal (TV) ultrasound assessment of cervical length during pregnancy and to establish cervical length above which transvaginal measurement is not necessary. Cervical length was measured using TA and TV method in the first (11 + 0-13 + 6 weeks), the second (20 + 0-21 + 6 weeks) and the third trimester (28 + 0-31 + 6 weeks) in 250 women with singleton pregnancy and low risk for preterm birth. If the cervical length measured in the second trimester of pregnancy with transabdominal approach is ≥ 28.5 mm and ≥ 30.5 mm in the third trimester, it can be assumed with 100% sensitivity the cervical length measured with transvaginal method will be > 25 mm. Transabdominal cervical length measurement in the second and third trimester allows 89% and 65% of patients, respectively, to avoid transvaginal scan. Second and third trimester screening by transabdominal cervical length measurements in a group of pregnant women with low risk for preterm birth is useful to determine which patients require transvaginal measurement.

Uterine artery pulsatility index assessment at 11 and 13+6 weeks gestation: A comparative study in Ecuador

Early detection of preeclampsia remains a challenge to the health system to reduce maternal and neonatal mortality rates. Using the mean uterine artery pulsatility index (MeanUAPI) with other maternal markers could contribute to comprehensive care during pregnancy. We performed a cross-sectional study in 579 women to evaluate if there is a difference in MeanUAPI values using two different insonation routes by pulsed Doppler transabdominal (TA) and transvaginal (TV) in patients without risk factors between 11-13 + 6 weeks of pregnancy in two cities located in highlands of Ecuador. The average age was 29 years. A total of 376 (65%) patients were evaluated via TA with a MeanUAPI of 1.61 points. While 203 (35%) were evaluated via TV with a MeanUAPI of 1.57 points, the statistical test did not find a statistically significant difference between the two ways (p=0.406). Therefore, any route could be used to predict preeclampsia with this method during this period.

Transvaginal approach for rectovaginal fistula: experience from a single institution

Transvaginal (TV) repair, featuring its feasibility, effectiveness, safety, and technically less demandingness, is one of the surgical approaches for management of rectovaginal fistula (RVF). However, there are limited numbers of publications available on the transvaginal approach for RVF repair. To this end, the purpose of this study is to evaluate the preliminary outcomes of the transvaginal approach performed by the team, and to further assess its feasibility, safety and effectiveness in the management of RVF. A retrospective analysis was conducted at a single institution. Patients with RVF who had undergone three transvaginal surgical techniques, i.e. transvaginal fistulectomy and stratified suture, transvaginal flip and ligation fistula tract and transvaginal fistula stapled closure were included. Besides, the demographics, operative data, postoperative complications and follow-up outcomes of the patients were collected prospectively. A total of 49 female patients (mean age, 35.76 ± 13.97years) underwent transvaginal approach, 42 of which were followed up with a median follow-up of 26months (range 3-82months), and 29 had closure of the fistula (successful closure rate of 59.1%). The successful closure rates were only significantly different between previous repair times (p = 0.031), and several minor complications including postoperative pain (n = 3), constipation (n = 1), and lower urinary tract infection (n = 1) were observed. Symptomatic improvement was reported in all patients with failed closure. Transvaginal approach for RVF repair is effective, safe, and feasible, and is therefore considered an alternative to transrectal advancement flap for low and mid-level traumatic RVF with normal sphincter function. With the advantage of better surgical access, transvaginal approach is recognized as the initial choice for the surgical repair of RVF.

Comparison of laparoscopic adnexal mass extraction via the transumbilical and transvaginal routes

This study was performed to compare the transumbilical (TU) and transvaginal (TV) routes for adnexal mass removal from the abdominal cavity. Data from 93 women who underwent laparoscopic (LS) surgery for the removal of benign adnexal masses at three centres between January 2016 and December 2020 were examined retrospectively. The specimen retrieval times in the TU and TV groups were 9.0 ± 2.0 and 9.8 ± 2.5 min, respectively (p = .373). Additional analgesic was required in 13.8% and 14.3% of cases in the TU and TV groups, respectively. The mean 3-month (2–4 months) postoperative visual analogue scale (VAS) score was lower in the TV group than in the TU group. The postoperative vaginal length did not differ between the TU and TV groups (8.9 (8.7–9.1) vs. 8.7 (8.4–9.1) cm; p = .465). Oophorectomy and the TU route were found to be independent risk factors for the worsening of the VAS score. Sexual function index scores were similar in the two groups. The TV method for specimen removal in LS surgery may cause less pain in the early postoperative period and less dyspareunia in the later period without shortening the length of the vagina. Impact Statement What is already known on this subject? Compared with open procedures, minimally invasive surgery (MIS) is associated with faster recovery times, better patient quality of life and lower postoperative complication rates. The removal of an adnexal mass from the abdominal cavity is performed most commonly using the suprapubic, transumbilical (TU) or transvaginal (TV) route. What do the results of this study add? The specimen retrieval times in the TU and TV groups were 9.0 ± 2.0 and 9.8 ± 2.5 min, respectively (p = .373). The mean 3-month (2–4 months) postoperative visual analogue scale (VAS) score was lower in the TV group than in the TU group. Oophorectomy and the TU route were found to be independent risk factors for the worsening of the VAS score. Sexual function index scores were similar in the two groups. What are the implications of these findings for clinical practice and/or further research? In conclusion, specimen removal via the TV route in LS surgery may cause less pain in the early postoperative period and less dyspareunia in the later period without reducing the length of the vagina.

Complications and management of natural orifice specimen extraction in colorectal cancer: a narrative review

Background and Objective: Surgery is the principal treatment for colorectal cancer today. As minimally invasive surgical approaches develop, the mini-laparotomy has been used for specimen extraction. To reduce the pain and incision-related complications associated with mini-laparotomy incisions, the technique of natural orifice specimen extraction (NOSE) has been developed and gained popularity over the years. In colorectal surgery, depending on the tumor location and gender of the patient, transanal, transrectal, transcolonic or transvaginal (TV) NOSE routes can be chosen as an addition to laparoscopic surgery. While the advantages of the NOSE technique are well documented, complications, the management of complications and postoperative outcomes can still be challenging. The purpose of this review article is to analyze complications of nose in colorectal cancer surgery and their treatment.

Implementing a Universal Cervical Length Screening Program in a Large Hospital System: It Takes Some Time to Achieve Consistent Results

Objective: The aim of the study was to describe changes in the acceptance of transvaginal (TV) cervical length (CL) assessment and in the variance of CL measurements among operators, after implementation of universal TV-CL screening at 18+0 – to 23+6 weeks/days of gestation. Design: Retrospective cohort. Participants/Materials, Setting, Methods: This study was performed after universal TV-CL screening was implemented at the University of Texas Health Science Center in Houston, TX, USA, for all women undergoing an anatomy ultrasound (US) between 18 0/6 and 23 6/7 weeks/days of gestation. Pregnant women carrying singletons without prior history of preterm delivery who underwent anatomy US evaluation between September 2017 and March 2020 (30 months) were included. The complete study period was divided into five epochs of 6 months each. Changes in patient’s acceptance for the TV scan, in CL distribution, in the prevalence of short cervix defined as ≤15, ≤20, or ≤25 mm, and in the performance of US operators across the five epochs were evaluated. Success rate was defined as the percentage of TV-CL measurements obtained in relation to the number of second-trimester anatomy scans. Results: A total of 22,207 low-risk pregnant women evaluated by 36 trained sonographers (operators) were analyzed. Overall, the acceptance for TV-CL measurement was 82.3% (18,289/22,207), increasing from 76.7% in the first epoch to 82.8% (p < 0.0001) in the last epoch. The mean CL did not significantly change from 38.6 mm in the first epoch to 38.5 mm in the last epoch (p = 0.7); however, the standard deviation decreased from 7.9 mm in the first epoch to 7.04 mm in the last epoch (p = <0.01). The prevalence of a short cervix ≤25 mm was 2.2% (n = 399/18,289), ≤20 mm was 1.2% (224/18,289), and ≤15 mm was 0.9% (162/18,289). This prevalence varied only for CL ≤25 mm from 3.02% (88/2,907) in the first epoch to 1.77% (64/3,615) in the last epoch (p = 0.0009). There was a variation in CL measurements among operators (mean 3.3 mm). Sonographers with less than 1 year of experience had a lower success rate for completing TV-CL examinations than more experienced sonographers (80.8% vs. 85.8%; p < 0.03). In general, 77% (27/35) of operators had a success rate ≥80% for completing TV-CL scans. Limitations: Characteristics of individuals who accepted versus those who declined TV-CL were not compared; CL values were not correlated with clinical outcomes. Conclusions: During the first 6 months after implementation of a universal CL screening program, there was greater variation in CL measurements, lower acceptance for TV US, and a higher number of women diagnosed with a CL ≤25 mm, as compared to subsequent epochs. After the first 6 months, these metrics improved and remained stable. Most operators improved their performance over time; however, there were a few with a low success rate for TV-CL and others who systematically over- or underestimate CL measurements.

Over/under: examining the cost difference in vaginal vs. laparoscopic cuff closure following a laparoscopic hysterectomy

Vaginal cuff closure following a total laparoscopic hysterectomy (TLH) can be approached laparoscopically or transvaginally. Route of closure is primarily determined by surgeon preference and may also be influenced by clinical/patient characteristics. The objective of this study is to compare the proportion of laparoscopic (LSC) closure to the proportion of transvaginal (TV) closure of the vaginal cuff following a TLH. We also aim to compare the cost utility of both cuff closure approaches. This is a retrospective cross-sectional study of all TLH cases performed at our institution between June 2018 – May 2019. We collected patient demographics, surgery parameters (vaginal cuff closure method, necessity for X-ray), and time measurements between case milestones (case start-to-end, X-ray completed, patient out of room). Of note, our institution carries a unique protocol that may not be the standard across other institutions, which mandates an abdominal X-ray (AXR) to evaluate for retained foreign bodies in patients with a BMI ≥35 when a laparoscopic case includes a TV cuff closure. This protocol does not apply in LSC cuff closure following TLH. Exclusion criteria included conversion to open procedure and involvement of concomitant procedures. Based on review of existing literature, operating room (OR) costs have been estimated to range between $30 - $81 per minute and post-operative radiologic images cost about $168 per procedure. Data were analyzed with Chi-square test and two-tailed t-test (α = 0.05). During the study period, 120 qualifying TLH cases were performed. Eighty-seven patients (73%) underwent LSC closure and thirty-three patients (27%) underwent TV closure. Mean age and BMI did not significantly differ between LSC and TV closure groups. Fifteen patients in the LSC closure group and nineteen patients in the TV closure group had BMI > 35. Service type differs between the two groups (p<.001). For the LSC closure group, the mean case time was shorter by a mean difference of 66 minutes (133 minutes for LSC versus 199 minutes for TV; 95% CI = -84.1, -47.8). If all TV closures were done laparoscopically, this translates to a potential cost saving of $1,980 - $5,346 per case. The mean time difference between case end time and out of OR time was shorter by 15.75 minutes in cases that did not require AXR. Nineteen patients who had a TV closure after TLH also required AXR for BMI>35. Thus, 19 AXR would be potentially avoided if TV closures were replaced by LSC closures. With added OR time and cost of AXR, there is a potential saving of $12,169 - $27,431 per year if LSC closures were chosen. Compared to TV cuff closure, LSC vaginal cuff closure following a TLH may afford a cost benefit due to decreased operating room time. Given our institutional policy, further cost savings can be seen by avoiding additional AXR.

Urinary Metabolites Reveal Hyperinsulinemia and Insulin Resistance in Polycystic Ovarian Syndrome (PCOS).

The identification of insulin resistance and hyperinsulinemia in polycystic ovary syndrome (PCOS) is not a minor issue. The homeostasis model assessment of insulin resistance index (HOMA) is the most used index of IR (Insulin Resistance), validated in overweight and obese patients but not in normal-weight PCOS subjects, who can still present with increased insulin secretion by an oral glucose tolerance test (OGTT). The evaluation of insulin secretion and resistance represents a still unresolved problem. The aim of this study is to identify a possible yet noninvasive method to properly evaluate the insulin metabolism in young non-diabetic subjects. Girls aged 14–22 years, afferent to the center of Gynecological Diseases in Childhood and Adolescence of Cagliari (Italy), were screened for PCOS. A total of 42 subjects comprised the study group. Hormonal assays, OGTT, transabdominal (TA) or transvaginal (TV) US, and urine collection for 1H-NMR analysis were assayed in the early follicular phase. A 1H-NMR coupled multivariate statistical analysis was performed. The OPLS model indicated that the NMR profile of urine had a good fit and prediction ability for the AUC OGTT with R2 = 0.813. Metabolomics can be a promising tool to the potential identification of biomarkers of an exaggerated insulin response to OGTT and can encourage substantial progress for a more accurate and early diagnosis in PCOS.

Impact of vesicovaginal fistula repair on urinary and sexual function: patient-reported outcomes over long-term follow-up.

While the anatomical closure rates of vesicovaginal fistula (VVF) following transabdominal (TA) and transvaginal (TV) repairs seem comparable, studies comparing urinary and sexual outcomes following successful repair are lacking. We aimed to report patient-reported outcomes on sexual and urinary functions after long-term follow-up with successful repair. We retrospectively reviewed 81 women who had successful VVF repair at our institute. Pre-, intra- and post-operative details were retrieved from electronic data software. Patient-reported sexual and urinary function outcomes were assessed using the Female Sexual Function Index (FSFI) questionnaire and International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF), respectively, at last follow-up. We also compared such outcomes among TA and TV repairs. Of 81 women, 28 (34.6%) had TA and 53 (65.4%) had TV repairs. Mean age was 37.5years and mean fistula diameter was 12.9mm. The most common aetiology was hysterectomy. Thirty-three patients (40.7%) had previous failed repairs. At a mean follow-up of 29.8months, 24 (34.3%) women had sexual dysfunction and 15 (18.5%) women experienced urinary dysfunction. The TA and TV groups had comparable mean FSFI scores (28.7 ± 6.1 vs. 30.9 ± 5.2, p = 0.13) and ICIQ-SF scores (0.7 ± 1.7 vs. 0.5 ± 1.4, p = 0.59). In multivariate analysis, fistula size and site were significant predictors of urinary dysfunction whereas multiparity was the most significant predictor of sexual dysfunction. Sexual and urinary dysfunction is found in a considerable number of women after VVF repair. However, our data suggest comparable long-term sexual and continence outcomes between TA and TV repairs.

COMPARISON THE SUCCESS RATE OF VESICOVAGINAL FISTULA REPAIR SURGICAL WITH TRANSVAGINAL AND TRANSABDOMINAL PROCEDURE : META ANALYSIS

Objective: This paper aims to evaluate the success rate of vesicovaginal fistula (VVF) repair surgery by transvaginal (TVAG) and transabdominal (TPA) procedure. Method: Literatures were searched on the online database, PUBMED and Google Scholar. All of the studies should be belonging on to inclusion criteria. The literatures had qualitative analyze by the authors and bias criteria based on Review Manager 5.3 application. It also had quantitative analyzed by the same application. Results: The literatures have 191 patients (transvaginal-n=107; transabdominal-n=84). The data was homogen (Chi2&lt;df; P&gt;0,05). The forest plot showed that TPA has a higher success rate than TVAG, still not statistically significant (test overall effect P&gt;0,05; 95%CI was 0,59 to 5,30). Conclusion: Transabdominal procedure has a higher success rate.

Shear Wave Elastography of the Maternal Cervix: A Comparison of Transvaginal and Transabdominal Ultrasound Approaches.

This work aimed to compare the use of shear wave elastography on the maternal cervix with transvaginal (TV) and transabdominal (TA) ultrasound approaches to assess differences in shear wave speeds (SWSs) obtained for possible clinical use. In both TV and TA ultrasound approaches, SWS measurements were attempted at the anterior and posterior portions of the internal and external cervical os on 38 gravid participants. A larger number of SWS measurements were obtained at the anterior portion of the cervix by both approaches. The numbers of reliable measurements of the SWS obtained at the anterior and posterior portions of the internal and external os were 99, 65, 103, and 77 in the TA approach and 93, 53, 110, and 87 in the TV approach, respectively. The mean difference in -the SWS obtained between the TV and TA ultrasound approaches was statistically significant at the anterior and posterior portions of the internal os, with differences of 0.67 and 0.52 m/s (P < .05). Differences were not significant at the external os both anteriorly and posteriorly, with differences of 0.15 and - 0.07 m/s (P > .05). Both TA and TV ultrasound approaches may be used to obtain SWSs in the maternal cervix. This study has shown that SWSs obtained by each approach need to be considered independently, as the TV approach produced significantly greater SWSs at the internal os compared to the TA approach, but the values were similar at the external os.

Ultrasonographic Transabdominal Measurement of Uterine Cervical Length for the Prediction of a Midtrimester Short Cervix.

This study was aimed to estimate the value of transabdominal (TA) ultrasound measurement of cervical length (CL), as an alternative of transvaginal (TV) ultrasound, for universal screening of short cervix in the midtrimester. We conducted a prospective cohort study of nulliparous women with singleton pregnancy at 20 to 24 weeks of gestation. All participants underwent TA ultrasound followed by TV ultrasound with acquisitions of images and videos of the uterine cervix. A second sonographer, blinded to the participants' data and pregnancy outcomes, measured the CL using TA and TV images and videos. Pearson's correlation test and receiver operating characteristic (ROC) curve analyses were performed. A total of 805 participants were recruited, including 780 (97%) where TA CL measurement was feasible. We observed a strong correlation of CL between TA and TV (correlation coefficient: 0.57; p < 0.0001) with a mean TA measurement being 4 mm (95% confidence interval [CI]: -6 to 14 mm) below the mean TV measurement (mean of differences: 5 ± 4 mm). We observed that a TA CL <30 mm was highly predictive of a short cervix defined as a TV CL ≤25 mm (area under the ROC curve: 0.97; 95% CI: 0.95-0.99; p < 0.0001) with a sensitivity of 100% and a false-positive rate of 22%. Universal short cervix screening in nulliparous women could be performed using TA ultrasound, which could allow the avoidance of TV ultrasound in more than three quarter of women. In low-risk population, TV ultrasound could be reserved to women with TA CL <30 mm. · Cervical length (CL) measurement with transabdominal (TA) ultrasound is feasible in most cases and is strongly correlated with CL measured with transvaginal (TV) ultrasound.. · Using a cut-off of 30 mm for TA ultrasound as a first-step screening of short cervix in nulliparous women, three-quarter of TV ultrasound could have been avoided.. · Use of TA CL screening could alleviate some of the logistical challenges of universal TV CL screening..

MP05-10 ACCURACY OF MEDIA COVERAGE ABOUT THE 2019 US FOOD AND DRUG ADMINISTRATION BAN ON TRANSVAGINAL MESH FOR PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse (MP05)1 Apr 2020MP05-10 ACCURACY OF MEDIA COVERAGE ABOUT THE 2019 US FOOD AND DRUG ADMINISTRATION BAN ON TRANSVAGINAL MESH FOR PELVIC ORGAN PROLAPSE Shagnik Ray*, Marisa Clifton, and Kevin Koo Shagnik Ray*Shagnik Ray* More articles by this author , Marisa CliftonMarisa Clifton More articles by this author , and Kevin KooKevin Koo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000819.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: On 4/16/2019, the US Food and Drug Administration (FDA) banned the sale of surgical mesh for transvaginal (TV) repair of pelvic organ prolapse (POP). Given the clinical prevalence of POP and urinary incontinence (not included in the ban), we analyzed media coverage of the ban and its potential impact on patient perceptions of mesh surgery. METHODS: We queried the NexisUni database(>15000 news sources indexed), for English-language articles about TV mesh or the FDA, published between 1 week before the ban (4/8/19) and 7/1/19. We excluded news ticker results and articles about mesh without mentioning FDA. Content analysis was based on discussion of the ban, mesh use indications, quoted sources, and mesh complications. The extent of media coverage of TV mesh was tracked using Google Trends. RESULTS: Of 290 news articles retrieved, 57 articles met inclusion criteria. The volume of news reports about TV mesh increased ∼ 400% the week of the FDA announcement, equal to twice the coverage anytime during the preceding year. Most articles focused on the regulatory effect of the ban (51 articles, 89%) and the implications on manufacturers (25 articles, 44%). Relatively few articles discussed the FDA’s prior actions on TV mesh for POP; only 18 (31%) and 13 (22%) articles cited the 2011 FDA Public Health Notification and 2016 Update, respectively. Regarding the indications for mesh surgery, the majority of articles either did not mention an indication for mesh surgery (17 articles, 30%) or discussed both POP and incontinence (16 articles, 28%). However, 45 (79%) articles did not specify that the ban applied only to POP and not incontinence, while 1 (2%) article stated this distinction incorrectly. A plurality of articles (26 articles, 46%) cited mesh-related complications (most commonly pain, bleeding, “permanent injury”), but only 6 (11%) articles quoted surgeons who use TV mesh, compared to 16 (28%) articles quoting lawyers. Despite evidence-based statements on mesh by 3 professional organizations including the AUA, only 1 (2%) article cited 1 statement (American Urogynecologic Society). CONCLUSIONS: The 2019 FDA ban on transvaginal mesh for POP received extensive media coverage, but 80% of articles did not accurately distinguish between the banned use of mesh for POP versus urinary incontinence. Given the prevalence of both conditions, the findings raise concern about patients’ perceptions of and future access to mesh surgery regardless of indication. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e44-e45 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shagnik Ray* More articles by this author Marisa Clifton More articles by this author Kevin Koo More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of transabdominal and transvaginal ultrasonography for the assessment of cervical length in the third trimester of pregnancy

ObjectiveThis study aimed to compare TA and transvaginal (TV) ultrasound assessment of cervical length (CL), as well as to assess the feasibility of the TA approach in the third trimester of pregnancy. Materials and methodsThis was prospective study of low-risk women at 31–34 gestational weeks who underwent TA and TV CL measurements during a routine 3rd trimester scan. All examinations were performed by one operator who was blind to the measurements. Differences between the two methods were evaluated. Results240 women were initially enrolled in the study. Paired TA and TV measurements were obtained in 123 (51.3%) women. The mean TV CL was 35.2 ± 6.8 mm and the mean TA CL was 34.7 ± 6.5 mm. There was a significant correlation between the CL measured by the two different methods (r = 0.816). No significant differences were identified between the mean CL measurements of the two techniques (t = −1.360; p = 0.176). Moreover, regarding the feasibility of TA technique, it was less likely to obtain TA CL images in cases with a cephalic fetal presentation (p = 0.028). ConclusionAt 31–34 gestational weeks, with an empty bladder, the cervix can be visualized by the TA approach in only about half of the cases (51.3%). The TA CL measurements show a significant correlation with the TV ones. More research is needed to determine the potential predictive value of the TA ultrasound for preterm labor.

Prediction of time of delivery using cervical length measurement in women with threatened preterm labor

Objective To evaluate the use of transvaginal (TV) sonographic cervical length (CL) measurement alone in predicting time of delivery in women who present in threatened preterm labor. Methods A retrospective cohort study at Royal Brisbane and Women’s Hospital of all women who presented between 22 weeks and 0 days and 35 weeks and six-day gestation in threatened preterm labor and were admitted for ongoing management including a TV sonographic CL measure. The accuracy of CL for predicting time of delivery was compared between women with a short cervix (CL < 25 mm) and those with a normal cervix (CL ≥25 mm). The predictive accuracy of CL for spontaneous preterm delivery was analyzed with different outcome-specific thresholds. Results One hundred and forty-six women with threatened preterm labor met the inclusion criteria; of which 74 (50.7%) had a short cervix and 72 (49.3%) had a normal cervix. The group with short cervix were more likely to deliver prematurely before 37-week gestation, as well as a shorter time interval between initial presentation and delivery and delivery within 14 days from presentation (p = .0002, p = .0001, and p = .0001, respectively). Similarly, with respect to the area under the receiver operator characteristic curves, CL measurement was found to be significant for time of delivery before or after 37 weeks (p < .0001), preterm delivery before 34 (p = .0003) and 31 (p < .0001) weeks; and preterm delivery within 14 days from presentation (p < .0001). Cervical length measurement has a high negative predictive value ranging from 94.9 to 97.1% depending on the different CL threshold used. Conclusions Cervical length measurement at the time of presentation was significantly associated with the risk of preterm delivery in women presenting with threatened preterm labor and a short cervix. Cervical length measurement was also helpful in predicting time of delivery within 14 days from presentation. The negative predictive value and predictive accuracy of CL as a single measure were of significance.

An Inconvenient Truth: The Added Value of Transvaginal Imaging of the Internal Iliac and Adnexal Veins for Pelvic Congestion Syndrome

Pelvic congestion syndrome is a chronic condition involving varicose veins in the pelvic area, resulting in dull aching pain, pelvic heaviness, palpable varicosities, and dyspareunia. The primary diagnostic modalities, computed tomography (CT) angiography and magnetic resonance (MR) angiography, can be time-consuming, expensive, and carry the risks of diagnostic radiation (CT) and intravenous contrast (CT and MR), and may not offer dynamic vascular information (CT). Recently, an increased role for ultrasound has been proposed in the diagnosis of pelvic congestion; however, the role of transvaginal (TV) duplex ultrasound has not been thoroughly investigated. Our study aims to evaluate the utility of a TV approach in the evaluation of valvular incompetence time (VIT) in seconds of the internal iliac and adnexal veins. A waiver of consent was granted by our Institutional Review Board for this retrospective review. A cohort of 36 women undergoing ultrasound evaluation for pelvic congestion syndrome was analyzed. Transvaginal and transabdominal (TA) images were obtained with reverse Trendelenburg positioning for imaging of the internal iliac veins with Valsalva maneuver to evaluate VIT, at the same visit, and the yield of each approach was compared for the presence of VIT. The number of vessels visualized, VIT, diagnostic success, and number of abnormal vessels were recorded. Between September 2018 and February 2019, 36 women underwent both TA and TV imaging. A total of 72 (100%) internal iliac veins were visualized by TV, but only 15 (21%) by TA. Of the 72 internal iliac veins imaged, 12 (17%) were shown to have valvular incompetence by TV exam, whereas only 2 (3%) were identified by TA, both of which were identified TV. Transabdominal images, when limited, were usually due to bowel gas. Transvaginal images had a higher yield for detection of internal iliac vein VIT, suggesting that the TV approach may be more sensitive and potentially more accurate versus a TA-only protocol.