Usefulness of three dimensional transvaginal ultrasonography and hysterosalpingography in diagnosing uterine anomalies.

INTRODUCTION: Uterine anomalies may lead to infertility recurrent miscarriage, preterm labour intrauterine growth restriction and post-partum haemorrhage. Infertility and recurrent miscarriage are relatively common problems in the female population. Diagnostic algorithms in such cases include the evaluation of uterine anatomy Magnetic resonance imaging (MRI) is the most accurate technique for visualizing the female genitourinary tract anatomy but as it is expensive and not readily available, it is not useful in everyday practice. Hysterosalpingography (HSG) is a frequently performed procedure that plays an important role in evaluating the uterus and fallopian tubes. The most typical indication for HSG is infertility and recurrent miscarriage, which are common problems in the female population. However this procedure is invasive, exposes the patient to ionizing radiation, carries a risk of complications and does not show the external contour of the uterus, which is essential for differentiating uterine anomalies. Three dimensional transvaginal ultrasound (3D TV USG) is a noninvasive and quick, imaging method that may be used in diagnosing uterine anomalies. This method allows evaluate the external contours of the uterus, making it comparable to MRI. OBJECTIVE AND METHODS: In this study we discuss the advantages and disadvantages of HSG and 3D TV USG in diagnosing uterine anomalies. Additionally we present the results of HSG and 3D TV USG of 155 patients referred to our Department because of infertility and/or suspected uterine anomalies. RESULTS: After performing HSG, in the studied group 118 patients were diagnosed with a normal uterus, 4 with unicornuate (including 1 patient with an unicornuate uterus, with rudimentary horn), and 6 with didelphys uterus. In 22 cases, due to the lack of evaluation of external contour of the uterus, we could not differentiate arcuate, septate and bicornuate uterus. After performing 3D TV USG we confirmed the HSG diagnosis and precise differentiated 22 disputable cases. 8 with arcuate, 11 with septate (2 complete and 9 partial) and 3 with complete bicornuate uterus. In 5 patients, severe pain and lack of cooperation during HSG made the acquisition of diagnostic X-ray images impossible. In these cases 3D TV USG allowed the anatomic assessment of the uterus, a normal uterus was found in all of them. All uterine anomalies were then confirmed by hysteroscopy and/or laparoscopy CONCLUSIONS: Basing on a review of the literature and our results, we conclude that HSG is not the optimal method for diagnosing uterine anomalies, while 3D TV USG can accurately show the uterus anomalies and may become an alternative method to MRI.

Correlation between atherogenic risk and adiponectin in gestational diabetes mellitus.

INTRODUCTION AND OBJECTIVE: Gestational diabetes mellitus (GDM) is a pregnancy complication which increases the risk for maternal and foetal complications during pregnancy, and also significantly increases the cardiovascular risk for women's health in the postpartum. Current literature provides contradictory information on the role of adiponectin (AdipoQ) in the course of GDM. The aim of the study was to measure AdipoQ concentration in blood of women with GDM and to find correlations between this adipokine and clinical and biochemical parameters of the atherogenic risk. MATERIAL AND METHODS: The GDM group included 50 women diagnosed with GDM between 24 - 28 weeks of gestation who underwent routine prenatal tests for GDM in compliance with the guidelines of the Polish Diabetes Association. All patients underwent clinical and laboratory evaluation at GDM diagnosis. Laboratory tests included serum AdipoQ concentration, fasting glucose and insulin, OGTT, lipid parameters, C-reactive protein and fibrinogen in serum. RESULTS: The GDM group showed significantly elevated fasting glucose, insulin, HOMA-IR values, total cholesterol, LDLcholesterol and triglicerydes as compared with the control group (p<0.05). The atherogenic index, CRP, fibrinogen in women with GDM were significantly higher than in the control group (p<0.05). AdipoQ concentrations did not differ significantly between the groups during gestation (p=0.7054). No correlations, except with the neonatal weight (r= - 0.29, p<0.05), were found between AdipoQ and the studied parameters. CONCLUSIONS: Based on the conducted studies, it may be conclude that women with early diagnosed and promptly treated GDM have a normal adiponectin level, although insulin resistant changes and increased cardiovascular risk in basic metabolic parameters are observed. Moreover, adiponectin does not reflect the atherogenic risk in pregnant women with GDM.