Pulmonary hypertension in preterm infants with moderate-to-severe bronchopulmonary dysplasia (BPD).

AIM: To describe clinical characteristics of pulmonary hypertension (PH) associated with moderate to severe BPD (MSBPD) in premature infants born ≤32 weeks gestation. METHODS: This was a single centre retrospective cohort study, with reanalysis of echocardiographic studies for PH of infants born ≤32 weeks gestation with MSBPD admitted to a tertiary surgical neonatal service. RESULTS: In total, 268 babies with MSBPD were included in the study. Incidence of BPD-associated PH (BPD-PH) was 12.6% (34), of which 41% infants were observed to have severe PH. On multivariate analysis, need for positive pressure respiratory support at 36 weeks post menstrual age (PMA) was independently associated with PH (p = 0.001; 95% CI 2-13.5) Presence of PH and severity of PH were associated with increased mortality. Of babies with MSBPD-PH, 32% died before discharge from the neonatal unit. CONCLUSION: Babies with MSBPD and PH are more likely to die before discharge from the neonatal unit. Need for positive pressure respiratory support at 36 weeks PMA is independently associated with PH. Babies with MSBPD with less than severe PH are also associated with increased mortality when compared to babies with MSBPD with no PH.

European guidelines on perinatal care: corticosteroids for women at risk of preterm birth.

of recommendationsCorticosteroids should be administered to women at a gestational age between 24+0 and 33+6 weeks, when preterm birth is anticipated in the next seven days, as these have been consistently shown to reduce neonatal mortality and morbidity. (Strong-quality evidence; strong recommendation). In selected cases, extension of this period up to 34+6 weeks may be considered (Expert opinion). Optimal benefits are found in infants delivered within 7 days of corticosteroid administration. Even a single-dose administration should be given to women with imminent preterm birth, as this is likely to improve neurodevelopmental outcome (Moderate-quality evidence; conditional recommendation).Either betamethasone (12 mg administered intramuscularly twice, 24-hours apart) or dexamethasone (6 mg administered intramuscularly in four doses, 12-hours apart, or 12 mg administered intramuscularly twice, 24-hours apart), may be used (Moderate-quality evidence; Strong recommendation). Administration of two "all" doses is named a "course of corticosteroids".Administration between 22+0 and 23+6 weeks should be considered when preterm birth is anticipated in the next seven days and active newborn life-support is indicated, taking into account parental wishes. Clear survival benefit has been observed in these cases, but the impact on short-term neurological and respiratory function, as well as long-term neurodevelopmental outcome is still unclear (Low/moderate-quality evidence; Weak recommendation).Administration between 34 + 0 and 34 + 6 weeks should only be offered to a few selected cases (Expert opinion). Administration between 35+0 and 36+6 weeks should be restricted to prospective randomized trials. Current evidence suggests that although corticosteroids reduce the incidence of transient tachypnea of the newborn, they do not affect the incidence of respiratory distress syndrome, and they increase neonatal hypoglycemia. Long-term safety data are lacking (Moderate quality evidence; Conditional recommendation).Administration in pregnancies beyond 37+0 weeks is not indicated, even for scheduled cesarean delivery, as current evidence does not suggest benefit and the long-term effects remain unknown (Low-quality evidence; Conditional recommendation).Administration should be given in twin pregnancies, with the same indication and doses as for singletons. However, existing evidence suggests that it should be reserved for pregnancies at high-risk of delivering within a 7-day interval (Low-quality evidence; Conditional recommendation). Maternal diabetes mellitus is not a contraindication to the use of antenatal corticosteroids (Moderate quality evidence; Strong recommendation).A single repeat course of corticosteroids can be considered in pregnancies at less than 34+0 weeks gestation, if the previous course was completed more than seven days earlier, and there is a renewed risk of imminent delivery (Low-quality evidence; Conditional recommendation).

Sildenafil in Pulmonary Hypertension Associated with Bronchopulmonary Dysplasia: Friend or Foe?

INTRODUCTION: Sildenafil is a phosphodiesterase-5 inhibitor used to treat pulmonary hypertension, although its efficiency remains disputed in the neonatal population. We aimed to assess the clinical use of this drug in extremely premature infants diagnosed with pulmonary hypertension associated to bronchopulmonary dysplasia. STUDY DESIGN: This is a retrospective study of 18 patients born at ≤ 32 weeks gestational age with pulmonary hypertension complicating moderate to severe bronchopulmonary dysplasia, which was diagnosed on echocardiography at 36 weeks corrected gestational age. Median corrected gestational age at starting sildenafil was 48 weeks (range 32-60). In 4 cases there was a period of > 2 weeks between the evidence of moderate-severe pulmonary hypertension and starting sildenafil. In all other cases it was started as soon as the diagnosis was suspected or confirmed. RESULTS: All infants tolerated the use of sildenafil. However, 5 babies (26.31%) died despite ongoing intensive care, and 5 babies (26.31%) died after having care redirected due to severe chronic lung disease (1 due to co-existing neurological abnormality), with on overall mortality of this study of 52.62%. Eight babies (42.1%) survived: 5 continued on sildenafil until hospital discharge, 1 continued on transfer to the paediatric intensive care unit and 2 stopped while inpatients. Upon follow up to 2 years of age, out of the 5 patients who continued upon hospital discharge, 4 stopped at 6, 7, 12 and 18 months respectively, with 1 child being lost to follow up. Two patients (10.52%) restarted sildenafil use later in childhood. Echocardiographic evidence of improvement was noted in 58% (11 cases), with no improvement in 6 cases (32%) and incorrect original diagnosis in 1 case (5%). One infant died less than a week from the initiation of treatment. CONCLUSION: sildenafil use showed no clinical improvement of pulmonary hypertension complicating moderate to severe bronchopulmonary dysplasia in extremely premature infants.

Maternal HPV Infection and the Estimated Risks for Adverse Pregnancy Outcomes-A Systematic Review.

BACKGROUND: Human Papilloma Virus (HPV) represents the most prevalent genital infection in young women of reproductive age. OBJECTIVE: This systematic review aims to estimate the effect of HPV infection during pregnancy and assess the correlation between HPV and adverse pregnancy outcomes. MATERIALS AND METHODS: The search strategy has been developed based on the PICOS framework: Population (pregnant women infected with HPV), Intervention (HPV infection confirmed by molecular tests), Comparator (pregnant women without HPV infection), Outcomes (adverse pregnancy outcomes) and Study design (observational studies). We searched PubMed, Web of Science, and Scopus databases on 8 January 2022 by using the following keywords: "HPV", "prematurity", "preterm birth", "miscarriage", "premature rupture of membranes", "adverse pregnancy outcome", "low birth weight", "fetal growth restriction", "pregnancy-induced hypertensive disorders", "preeclampsia". Selection criteria were HPV infection confirmed within maximum 2 years before pregnancy with a molecular test and adverse pregnancy outcomes. (Results: Although numerous studies are conducted on this topic, data are still controversial regarding identifying maternal HPV infection as a risk factor for adverse pregnancy outcomes. More prospective large cohort studies are needed to prove a causative relationship.

Maternal and neonatal outcomes following in vitro fertilization: A cohort study in Romania.

Although in recent years the number of pregnancies obtained through in vitro fertilization (IVF) has increased significantly, a higher incidence of complications has been identified in this group. The widespread development and use of IVF has led to an increasing rate of multiple pregnancies and thus their associated complications. However, whether these complications occur due to assisted reproduction or infertility problems remains to be elucidated. In the present study, a comparison was made of IVF pregnancies with spontaneous conception, and the risk of obstetric and neonatal complications was assessed. An ambispective observational cohort study was carried out between January 2017 and October 2021 at Elias University Emergency Hospital, Romania. The exposed cohort included 132 IVF pregnancies and the control cohort included 157 spontaneous pregnancies. The IVF group included 110 pregnancies with fresh embryo-transfer and 22 pregnancies with cryopreserved embryo-transfer. Obstetric, perinatal and neonatal complications were analysed by multivariable logistic analysis. The results showed that, IVF pregnancies had a higher risk of pregnancy-induced hypertension (OR=6.42, 95% CI=1.72-23.92) and placental abnormalities (OR=5.49, 95% CI=1.07-28.17). Neonates obtained through IVF had a higher risk of prematurity (OR=6.52, 95% CI=2.99-14.20), low birth weight (LBW) (OR=17.18, 95% CI=7.06-41.87), small for gestational age (OR=4.10, 95% CI=1.95-8.59) and were more frequently hospitalized in the Neonatal Intensive Care Unit (NICU) (OR=11.91, 95% CI=5.72-24.81). Nulliparous women were associated with an increased risk of NICU admission (OR=0.46, 95% CI=0.25-0.88) and risk of LBW (OR=0.37, 95% CI=0.19-0.75). Maternal age ≥35 years had no influence as a confounding variable. In conclusion, this cohort study showed that IVF pregnancies have a higher risk of obstetric and neonatal complications than pregnancies obtained by spontaneous conception.

Obstetric and Perinatal Complications Associated with Assisted Reproductive Techniques - Review.

Recently, the use of assisted reproductive techniques (ART) has witnessed a significant increase worldwide. Although most of these pregnancies have a good prognosis, studies show that ART is associated with a risk of obstetric and perinatal complications, compared to pregnancies conceived spontaneously. It is considered that the risk is directly proportional to the number of transferred embryos, thus multiple pregnancies are an independent risk factor that supports the large-scale implementation of single embryo transfer protocols. Simultaneously, studies report obstetric and perinatal complications in singleton pregnancies obtained after ART and it is not possible to establish whether parental or procedural factors are the causal determinants. The purpose of this article is to summarize the risk of maternal-fetal complications associated with ART.

Eye anomalies in children born through ART.

Due to the increasing rate of couples suffering from infertility, recently, the use of assisted reproductive technology (ART) has increased by 5%-10% per year. Some ART pregnancies are at risk of obstetric and neonatal complications, but it is unknown whether the procedures used or the etiology of infertility influences this risk. Multiple ART pregnancies are responsible for the increased rate of prematurity and its associated complications. Also, it has been demonstrated that ART pregnancies have a higher risk of congenital anomalies. The rate of ART-associated ocular abnormalities is incompletely known due to a small number of studies conducted regarding this pathology. In this paper, we presented a review of literature on ocular anomalies associated with ART in order to raise awareness of the need to implement ophthalmological screening in children from pregnancies obtained by ART. Abbreviations: ART = assisted reproductive techniques, IVF = in vitro fertilization, ICSI = intracytoplasmic sperm injection, LBW = low birth weight, ROP = retinopathy of prematurity.

Monochorionic vs Dichorionic Twins: Kanet Test vs Postnatal Neurodevelopment.

The twin pregnancy is a risk pregnancy, being associated with a series of fetal and neonatal complications when compared to singleton pregnancies. Ultrasound assessment of the fetal brain is mandatory in the prenatal screening for fetal, congenital and acquired anomalies. Fetal neurosonography is useful in the prenatal diagnosis of cerebral anomalies, combining ultrasonography with fetal ultrasound. In this study, we assessed the Kanet score in two populations of pregnant women with dichorionic twin pregnancies (DC twin) (n=67) and monochorionic twin pregnancies (MC twin) (n=24). In the two groups we included pregnancies with normal fetal growth and pregnancies with discordant fetal growth (DC twin) and selective intrauterine reatriction (MC twin). For both groups, we assessed the antenatal Kanet score during three visits and compared the results with the neurodevelopment immediately after birth up to the two-year-old children. The calculation of the average values of the Kanet score for dichorionic pregnancies revealed normal, maximal average values at all three visits, for all fetuses, no matter if they had normal growth or discordant growth. At the first and third visit, we observed statistically significant differences between the average Kanet scores in DC twins with discordant growth vs. DC twins with normal growth. The analysis of average values of the Kanet score in the group of MC twin pregnancies revealed statistically significant differences between monochorionic twins with discordant growth vs. twins with normal growth at all three visits (p=0.0001), with average values between 17.30 and 19.62 being deemed normal. Amiel-Tison score was used as a standard tool for the neurological assessment both immediately after birth and for children up to two years of age.

The wide spectrum of ultrasound diagnosis of holoprosencephaly.

AIM: Holoprosencephaly (HPE) is the most common brain malformation. A wide spectrum of anatomical variants are characterized by a lack of midline separation of the cerebral hemispheres. The aim of this study was to assess the ultrasound diagnostic criteria for HPE. MATERIAL AND METHOD: A database of 175 fetuses with central nervous system anomalies identified by ultrasound was collected retrospectively from 2006 to 2016 in this multicenter, retrospective, observational study. Among them 18 cases (10.2%) with HPE were identified. RESULTS: The prevalence of HPE was 2.5:10.000 with the sex distributionmale:female of 1:1.6. Six cases were alobar subtype, 3 were semilobar, 7 were lobar and 2 were middle interhemispheric variant. In the second trimester, we consider that the abnormal fusion of the lateral ventricles and the absence of the cavum septum pellucidum are the most important landmarks for HPE. Facial abnormalities varied considerably. CONCLUSION: This study illustrates the heterogeneity of HPE with different cerebral and facial appearances.

Three-dimensional scan of the uterine cavity of infertile women before assisted reproductive technology use.

The primary objective was to assess the utility of routine 3-dimensional (3D) ultrasound in the evaluation of infertile women and to estimate the prevalence of uterine anomalies before the use of assisted reproductive technology (ART), using the European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy classification system. A second objective was to assess the effect of uterine anomalies on the pregnancy rate in patients who underwent assisted reproductive techniques.We retrospectively studied 668 patients treated in the Department Obstetrics Gynecology and Neonatology "Sf Ioan" Clinical Emergency Hospital and in the Department of Medical and Surgical Specialties, Faculty of Medicine "'Transilvania" University of Brasov between July 2016 and February 2017 for subfertility. Patients were examined using 2-dimensional (2D) and 3-dimensional (3D) transvaginal ultrasound. Müllerian duct anomalies were present in 6.13% of patients, with the most common anomaly being a dysmorphic uterus (class U1c in 42.68% of patients), 17 patients (20.73%) with incompletely septate uterus (class U2a), 12 patients (14.63%) with a completely septate uterus (classU2b), 8 patients (9.75%) with a partly bicorporeal uterus (classU3a), and 6 patients (7.31%) with a completely bicorporeal uterus (class U3b). Only 1 (1.21%) patient had an aplastic uterus without a rudimentary cavity (class U5b). The pregnancy rate in the presence of uterine anomalies was 55% and the pregnancy rate in control group patients was 39.8%. The incidence of pregnancy in the group with uterine anomalies was statistically similar with the control group of normal uterus (P < .11). For ongoing pregnancy rate and live birth rate, our data indicated a slightly elevated rate for both of those indexes in the anomalies group. The incidence of miscarriage in the presence of uterine anomalies was 24% and 6.7% in the control group, which is statistically significant (P = .05).3D ultrasound evaluation of the uterus should be considered before ART in order to make an accurate diagnosis of the uterine congenital anomaly and improve ART results.

Adnexal masses in pregnancy: perinatal impact.

The incidence of adnexal masses in pregnancy has increased significantly over the last decades and this is mostly because of the widespread use of ultrasound for pregnancy surveillance. Although a clear majority of adnexal masses found in the first trimester are functional cysts, which have a small diameter and disappear spontaneously, those that do persist into the second and third trimester require ultrasound surveillance for proper management. The presence of a large adnexal mass in the third trimester of pregnancy represents solid grounds for delivery via Caesarean section (C-section) both because of the risk of dystocia and the advantage of one-step approach of cystectomy/oophorectomy at the time of C-section. This is a retrospective study of all the third trimester pregnancy related adnexal masses that delivered in our Hospital in the last 10 years via C-section where cystectomy was also performed. Our aim was to look at the histological type of ovarian mass and to compare our results to those previously published by other authors. We also wanted to see whether the clinical suspicion based on prenatal ultrasound aspect, where this was available, was similar to the postnatal histology report. Secondary outcomes were gestational age at delivery, fetal weight and Apgar score. We found that dermoid cysts are the most common type of adnexal mass with an incidence of 46%, followed by mucous cysts 27%, serous cysts 18% and endometrioses 9%, which is consistent with the data published by other authors in larger series. In terms of prenatal clinical diagnosis, detailed ultrasound assessment of the ovarian mass was available only in less than half of these cases, but in these, the clinical suspicion was confirmed by histology report. In our series, we had no case that required premature delivery because of adnexal mass-related complications and fetal outcome was very good with normal birth weight and high Apgar score. Although this is a small series of cases, it confirms the incidence previously published of the different histological types of ovarian tumors. It also shows that fetal outcomes are very rarely affected by the presence of ovarian masses and premature iatrogenic delivery for maternal well-being is the only note wordy one of them.

Morphological and ultrasound findings in the placenta of diabetic pregnancy.

The purpose of this study is to analyze the morphological, histological, immunohistochemical and ultrasound findings in the placenta of maternal type 1 and gestational diabetes, to compare the pathological changes of the placental structure in the two types of metabolic disruptions, but also to establish correlations with the expression of these findings, influenced by different associated conditions. This multicenter study includes 53 pregnancies, of which 37 with pregestational and 16 with gestational diabetes. All cases undergone specific obstetric ultrasound assessment and detailed placental scan. There were assessed 49 singleton and four twin pregnancies, all of which having live births as fetal outcome. Maternal preexisting hypertension, preeclampsia and obesity were the main associated conditions. Placental ultrasound scan revealed increased placental thickness even from the second trimester, with significant increases in the first half, and placentomegaly at the end of the third trimester. Macroscopic analysis of the placentas and umbilical cords has shown that the placentas of women with diabetes are heavier, and abnormal cord insertion has been also found. Gross analysis of maternal and fetal surfaces of the placentas revealed certain changes in both metabolic conditions. We observed 14 types of placental pathological findings in pregestational and 11 in gestational diabetes. In diabetic placenta, it is not appropriate to discuss about specific changes, but rather about a pathological diabetic pattern, influenced by associated conditions. Preconceptional and first trimester glycemic control is the key element, and euglycemia throughout pregnancy is a purpose whose accomplishment depends the maternal-fetal outcome.

Retraction: Human Papilloma Virus' Life Cycle and Carcinogenesis.

[This retracts the article , PMID: 28465751.].

Antenatal diagnosis and prognostic factors of aneurysmal malformation of the vein of Galen: A case report and literature review.

RATIONALE: Vein of Galen aneurysmal malformation (VGAM) is a rare complex malformation of the cerebral vascular system consisting of arteriovenous shunts between the vein of Galen and the cerebral arteries. PATIENT CONCERNS: We present the case of a 31-year-old pregnant woman, para 1, gravida 1. DIAGNOSES: At 26 weeks' gestation who was examined for an anechoic mass on the cerebral median midline with color and pulsed Doppler. She presented with positive flow on the color and pulsed Doppler test, associated with hydrocephalus, cortical hypoplasia, cardiomegaly, jugular vein distension. INTERVENTIONS: No intervention for VGAM was done. OUTCOMES: This case of a VGAM was associated with negative prognostic factors. LESSONS: The ultrasound color Doppler together with the 3D power Doppler allowed reconstruction of the vascular connections and of the relationship of these with other anatomical structures, which contributed to establishing the prognosis.

The importance of perinatal autopsy. Review of the literature and series of cases.

Perinatal autopsy remains the gold-standard procedure used to establish the fetal, neonatal or infant abnormalities. Progressively, perinatal pathology has become a specialized field with important roles of audit for fetal prenatal diagnostic tools, in parents counseling regarding future pregnancies, in scientific research, for epidemiology of congenital abnormalities and teaching. The differences between prenatal ultrasound and autopsy reports represent a strong argument for the autopsy examination following termination of pregnancy. The reasons for such discrepancies are related to the ultrasonographic or pathological examination conditions, the type of the anomalies, the expertise and availability of the operators. Several facts led to an undesirable increase of refusals from parents to consent to a conventional invasive autopsy: the centralization of pathology services, the poor counseling provided by non-experts in fetal medicine and the clinicians' over-appreciation of the importance of the ultrasound diagnostic investigation. Although non-invasive alternatives have been tested with promising results, conventional autopsy remains the gold standard technique for the prenatal diagnosis audit. We report and analyze several cases of prenatally diagnosed malformed fetuses with different particularities that underline the necessity of perinatal autopsy. We discuss the antenatal findings and management and post-mortem autopsies in the respective pregnancies.

Morphological, imaging and surgical aspects in a complex case of uterine leiomyosarcoma - case report and review of the literature.

Leiomyosarcoma is a rare condition so there are relatively few and small case series and no prospective studies to provide clear guidelines regarding management. We report on a case that presents some particularities that further underline diagnostic and treatment difficulties posed by the affliction of such a rare tumor. This is the case of a 43-year-old woman who had a large tumor arising from the uterus, with a spectacular growth rate over a short period. The patient, with congenital spastic tetraparesis and hydrocephalus, came for belly enlargement with rapid increase in size over the previous two months. Physical exam and ultrasound lead to the conclusion of a large abdominal mass. A computed tomography scan showed a mass arising from the pelvis and a large amount of ascites. An exploratory laparotomy was performed and the histopathology report confirmed the diagnosis of uterine leiomyosarcoma. Leiomyosarcoma poses challenging problems regarding histological grading and, due to its rate of growth, real surgical difficulties. Final diagnosis is done by histopathological examination after surgical excision. Frequently, it is late diagnosed when complete removal of the tumor is often impossible.

Multicentric studies of the fetal neurobehavior by KANET test.

Assessment of fetal neurobehavior and detection of neurological impairment prenatally has been a great challenge in perinatal medicine. The evolution of four-dimensional (4D) ultrasound not only enabled a better visualization of fetal anatomy but also allowed the study of fetal behavior in real time. Kurjak Antenatal Neurodevelopmental Test (KANET) was developed for the assessment of fetal neurobehavior and the detection of neurological disorders, based on the assessment of the fetus by application of 4D ultrasound in the same way that a neonate is assessed postnatally. KANET is a method that has been applied for the past 10 years and studies show that it is a strong diagnostic tool and can be introduced into everyday clinical practice. We present all data from studies performed up to now on KANET.

Synchronous bilateral primary ovarian carcinoma - case presentation.

Bilateral synchronous primary ovarian carcinoma, histopathologically identical or different is a rare entity encountered in clinical practice. We present the case of a 38-year-old patient who is admitted with the presence of a massive pelvic abdominal tumor formation of 45÷35÷25 cm occupying the lower pelvic and upper abdominal floor, reaching halfway distance between the umbilicus and sternum and lateral bilaterally in the two abdominal flanks until iliac wing. The mixed transabdominal÷transvaginal ultrasound and computed tomography (CT), establish the diagnosis of bilateral ovarian tumor. The CA-125 level is 1822 IU÷mL. The exploratory laparotomy identifies two distinct bilateral ovarian tumors, ascites liquid and pelvic and lumbo-aortic lymphadenopathy, thus the surgery involves hysterectomy with bilateral ovariectomy, pelvic and paraaortic lymphadenectomy and omentectomy. Histopathological and immunohistochemistry (IHC) diagnosis highlights a well-differentiated serous carcinoma on the left ovary and right ovary. The six-month check after surgery as well as the one-year check showed the efficiency of postsurgery chemotherapy and did not signal the presence of relapses. The particularity of this case lies in the presence of bilateral synchronous primary ovarian carcinoma, histopathologically and IHC indicated serous carcinoma present with a difficult differential diagnosis including clear cell carcinoma at a young patient.

Ultrasound and MRI comprehensive approach in prenatal diagnosis of fetal osteochondrodysplasias. Cases series.

AIM: To present the systematic ultrasonographic assessment in fetal osteochondrodysplasias and to evaluate the fetal MRI intake, as a complementary exploration to US, in the prenatal diagnosis and perinatal prognosis of fetal nonlethal osteochondrodysplasias. Material and methods: In this tertiary multicentre study were included 37 cases diagnosed prenatally with various entities in the category of nonlethal fetal osteochondrodysplasias. The initial diagnosis was carried out by the routine or detailed ultrasound examination. Fetal MRI was accomplished for selected cases. RESULTS: Nonlethal skeletal dysplasia was suspected and then diagnosed after 17 gestational weeks. The suspicion of osteochondrodysplasia as a reference diagnosis element has required systematic and thorough ultrasound examination. Fetal MRI is a valuable exploration, complementary to prenatal ultrasound bringing in very useful details for the diagnosis of osteochondrodysplasias. The global diagnosis of skeletal dysplasia depends to a great extent on the genetic or biochemical abnormality that causes them. CONCLUSIONS: US is always the fundamental screening exploration for fetal assessment in nonlethal osteochondrodysplasias. The details brought by the fetal MRI are useful, and the exploration is harmless for the fetus and the mother. Certain diagnosis cannot be accurate and complete without the contribution of genetics, maternal and fetal medicine, obstetrics or radiology.

Diagnosis of endometriotic lesions by sonovaginography with ultrasound gel.

AIMS: The aim of the study was to evaluate the diagnostic ability of sonovaginography (SVG) with ultrasound gel in patients with endometriosis. MATERIAL AND METHODS: We conducted a multicentre prospective study, which included 193 patients with symptoms highly suggestive for endometriosis. All patients were investigated by transvaginal sonography and SVG with gel and afterwards underwent laparoscopic surgery. For each category of endometriotic lesions investigated, we calculated and compared the sensitivity, specificity,  positive predictive value and negative predictive value of the imagisticinvestigations used. RESULTS: In the case of endometriotic lesions of the uterosacral ligaments, SVG with gel had a sensitivity of 78.5% and a specificity of 96% (p=ns). The lesions of the vagina and rectovaginal septum were diagnosed with a sensitivity of 79%, respectively 94% (p=ns), obtaining a specificity of 99%, respectively of 97% (p=0.007). The lesions of the Douglas pouch were identified with a sensitivity of 81% (p=0.015), and those of the rectosigmoid with a 94% sensitivity (p=0.010). We obtained lower sensitivity (67%) in detecting the lesions of the urinary bladder (p=ns). CONCLUSIONS: SGV with ultrasound gel represents a useful investigation tool for the evaluation of endometriotic lesions in the posterior pelvic compartment.