RESUMO
RESEARCH QUESTION: What is the prevalence of T-shaped uteri among fertile women based on ESHRE/ESGE and Congenital Uterine Malformation by Experts (CUME) criteria? DESIGN: A prospective cohort study of 258 women of reproductive age with a history of at least one natural pregnancy resulting in live birth. Participants were recruited from the family planning clinic between January 2018 and March 2020. The ESHRE/ESGE classification of congenital anomalies of the female genital tract was used for describing abnormal findings. CUME criteria were also used for diagnosing T-shaped uterus. Uterine cavity volume was measured. RESULTS: Mean age of participants was 35.4 ± 6.2 years. Participants were diagnosed with the following: congenital uterine abnormality (nâ¯=â¯9 [3.6%]); partial septate uterus (nâ¯=â¯5 [2.0%]) and hemiuterus (nâ¯=â¯2 [0.8%]). Two women (0.8%) were diagnosed with T-shaped uterus and borderline T-shaped uterus based on the ESHRE/ESGE criteria and CUME. Mean lateral indentation angle, lateral indentation depth and T-angle were 156.2° ± 9.53°, 2.85 ± 0.93 mm and 73.3° ± 9.85° in patients with normal uterine cavity. In patients with T-shaped and borderline T-shaped uteri, respective figures were 115° versus 121°, 10 mm versus 7.6 mm and 27.5° versus 70°. Median volume of the uterine cavity in patients with normal uterine cavity and T-shaped uterus was 3.71 ml (minimum 2.0 to maximum 9.03 ml, interquartile range 1.93) and 3.2 ml (2.9 and 3.62 ml), respectively. CONCLUSIONS: The prevalence of T-shaped uteri in fertile women is low, which corresponds to previous reports of women with poor reproductive history.
Assuntos
Anormalidades Urogenitais/epidemiologia , Útero/anormalidades , Útero/anatomia & histologia , Adolescente , Adulto , Estudos de Coortes , Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Prova Pericial , Feminino , Humanos , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Gravidez , Prevalência , Estudos Prospectivos , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Turquia/epidemiologia , Ultrassonografia/métodos , Ultrassonografia/normas , Anormalidades Urogenitais/diagnóstico , Útero/diagnóstico por imagem , Adulto JovemRESUMO
PURPOSE: To evaluate the proposed criteria in a large sample and in additional subgroups in order to test the validity of the hysteroscopic features widely-accepted as suggestive of CE. METHOD(S): All patients (n: 2675) underwent outpatient hysteroscopy, with the vaginoscopic approach technique. Hysteroscopic features such as, stromal oedema, diffuse or focal hyperaemia, "strawberry aspect", micropolyposis and endometrial polyps, are often indicate the presence of chronic endometritis. All hysteroscopic features, alone and in combination were applied in 7 (seven) different subgroups of the sample: total sample, women in reproductive age, women with infertility issues/IVF screening, women with history of recurrent miscarriages, menopausal women, and women with hysteroscopic indication of Abnormal Uterine Bleeding (AUB) in women of reproductive age and postmenopausal bleeding (PMB). From each case, endometrial samples were obtained and immunohistochemistry, identifying CD-138, was applied in order to diagnose CE. RESULT(S): A total of 2675 patients were included of which, 1444 women were found with at least one of the proposed hysteroscopic features mentioned above. Stromal oedema, focal or diffuse hyperaemia and "strawberry aspect" in combination with micropolyposis demonstrated higher rates of diagnostic accuracy in the detection of CE correlated to histologic confirmation. Micropolyposis, stromal oedema, focal or diffuse hyperaemia and "strawberry aspect" offer great diagnostic accuracy in the hysteroscopic detection of Chronic Endometritis, regardless reproductive status and/or clinical presentation. Endometrial polyps are not valid hysteroscopic features in cases of suspected CE. CONCLUSION(S): Diagnostic hysteroscopy can accurately diagnose cases of CE, based on stromal oedema, focal or diffuse hyperaemia and "strawberry aspect", in combination with micropolyposis. In subgroups of infertile women, higher diagnostic accuracy based on the hysteroscopic features mentioned, was more likely to be achieved. Whether endometrial polyps are suggestive of CE, when identified during office hysteroscopy, remains controversial.
Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Endometrite/diagnóstico , Endometrite/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Diagnóstico Obstétrico e Ginecológico/estatística & dados numéricos , Endometrite/diagnóstico por imagem , Feminino , Grécia , Humanos , Histeroscopia/métodos , Histeroscopia/normas , Histeroscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e EspecificidadeAssuntos
Humanos , Feminino , Gravidez , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/normas , Técnicas de Diagnóstico Obstétrico e Ginecológico/instrumentação , Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , COVID-19/prevenção & controle , COVID-19/epidemiologia , Brasil/epidemiologia , Saúde Ocupacional/normas , Pandemias , Vigilância em Saúde Pública/métodosRESUMO
Abnormal uterine bleeding in premenopausal women is a common gynaecological symptom and composes of abnormality in the frequency, duration, regularity, and flow volume of menstruation. It could constitute the presentation of various gynaecological malignancies. An appropriate history and physical examination are mandatory to ascertain the diagnosis. Depending on the clinical condition, a complete blood picture, thyroid function test, clotting profile, chlamydia test, cervical smear, and pregnancy test can be performed. Ultrasound should be performed in cases with a pelvic mass, unsatisfactory physical examination, persistent symptoms, or no response to medical treatment. In women aged ≥40 years, an out-patient endometrial biopsy with Pipelle should be performed. In women aged <40 years with risk factors for endometrial cancer, persistent symptoms, or no response to medical treatment, an endometrial biopsy should be performed to rule out endometrial cancer. Hysteroscopy or saline infusion sonohysterography is more sensitive than ultrasound for diagnosing endometrial pathology. Details of the above recommendations are presented.
Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Ginecologia/normas , Pré-Menopausa , Hemorragia Uterina/diagnóstico , Adolescente , Adulto , Biópsia/normas , Endométrio/diagnóstico por imagem , Feminino , Hong Kong , Humanos , Histeroscopia/normas , Ultrassonografia/normas , Adulto JovemRESUMO
BACKGROUND: Gestational diabetes mellitus (GDM) has lifelong implications for the woman and her infant. Treatment reduces adverse maternal and perinatal outcomes although uncertainty remains about the optimal diagnostic criteria. The GEMS Trial aims to assess whether detection and treatment of women with GDM using the lower International Association of Diabetes in Pregnancy Study Groups diagnostic criteria compared with the higher criteria recommended in New Zealand reduces infant morbidity without increasing maternal morbidity. METHODS: GEMS is a multicentre, randomised trial. Women with a singleton pregnancy at 24 to 34 weeks' gestation are eligible who give written informed consent. Women are randomly allocated to the Lower Criteria Group or the Higher Criteria Group. Women with a normal OGTT by their allocated criteria receive routine care (Higher criteria: fasting plasma glucose < 5.5 mmol/L, AND 2 hour < 9.0 mmol/L; Lower criteria: fasting plasma glucose < 5.1 mmol/L, AND 1 hour < 10.0 mmol/L, AND 2 hour < 8.5 mmol/l). Women with GDM on OGTT by their allocated criteria receive standard care for GDM (Higher criteria: fasting plasma glucose ≥ 5.5 mmol/L, OR 2 hour ≥ 9.0 mmol/L; Lower criteria: fasting plasma glucose ≥ 5.1 mmol/L, OR 1 hour ≥ 10.0 mmol/L, OR 2 hour ≥ 8.5 mmol/L). The primary outcome is large for gestational age (birth weight > 90th centile). Secondary outcomes for the infant include a composite of serious outcomes, gestational age, anthropometry, Apgar score < 4 at 5 minutes, lung disease, use of respiratory support, hypoglycaemia, hyperbilirubinaemia, infection, and encephalopathy; and for the woman, a composite of serious outcomes, preeclampsia, induction of labour, mode of birth, weight gain, postpartum haemorrhage and infectious morbidity. A study with 4,158 women will detect an absolute difference of 2.9% in the proportion of large for gestational age infants from 10.0% using the lower criteria to 12.9% with the higher criteria. DISCUSSION: The GEMS Trial will provide high-level evidence relevant for clinical practice. If use of the lower diagnostic criteria results in significantly fewer large for gestational age infants and/or improves maternal and perinatal outcomes these criteria should be recommended for diagnosis of gestational diabetes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry registration number ACTRN12615000290594 . Date registered: 27th March 2015.
Assuntos
Diabetes Gestacional/diagnóstico , Doenças do Recém-Nascido/prevenção & controle , Complicações na Gravidez/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Multicêntricos como Assunto , GravidezAssuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Programas de Rastreamento/normas , Guias de Prática Clínica como Assunto , Gestantes , Nascimento Prematuro/prevenção & controle , Medicina Preventiva/normas , Vaginose Bacteriana/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/prevenção & controle , Estados Unidos/epidemiologia , Vaginose Bacteriana/tratamento farmacológicoAssuntos
Betacoronavirus , Infecções por Coronavirus , Técnicas de Diagnóstico Obstétrico e Ginecológico , Segurança de Equipamentos/normas , Higiene , Pandemias , Pneumonia Viral , COVID-19 , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Feminino , Doenças dos Genitais Femininos/diagnóstico , Humanos , Higiene/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Gravidez , SARS-CoV-2 , Sociedades MédicasRESUMO
This document contains the definitions of infertility and recurrent pregnancy loss as defined by the Practice Committee of the American Society for Reproductive Medicine. It replaces the document, "Definitions of Infertility and Recurrent Pregnancy Loss: a Committee Opinion," last published in 2013 (Fertil Steril 2013;99:63).
Assuntos
Aborto Habitual/diagnóstico , Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Infertilidade Feminina/diagnóstico , Medicina Reprodutiva/normas , Adulto , Prova Pericial , Feminino , Humanos , Gravidez , Medicina Reprodutiva/métodos , Técnicas de Reprodução Assistida/normas , Sociedades Médicas/normas , Estados UnidosRESUMO
BACKGROUND: Haemorrhagic morbidity is more common in women with abnormal placentation, that is placenta praevia or morbidly adherent placenta. The incidence of abnormal placentation is increasing due to rising caesarean section rates. Concerns regarding blood safety, blood shortages and soaring costs of blood processing have generated growing enthusiasm for blood conservation strategies. The aim of our study was to look at intraoperative cell salvage (IOCS) use and allogeneic transfusion patterns in patients with abnormal placentation. METHODS: Patients with abnormal placentation were identified from the hospital database over a 2-year period between 2015 and 2016. Information collected for those that had IOCS setup included estimated blood loss, volume of blood collected and returned, pre- and postoperative haemoglobin levels and use of allogeneic blood. RESULTS: A total of 139 cases of abnormal placentation were identified. Abnormal placentation accounted for 62% of all cases of IOCS usage and was established for 53 patients with abnormal placentation. The re-transfusion rate was 18.5%. Five patients received IOCS blood only. The allogeneic transfusion rate was 7.5% in patients who had IOCS setup compared with 6.9% in those who did not (p = 1.00). Median blood loss was greater for patients who had IOCS blood returned compared with patients who had not (p = 0.004). The median volume of blood returned was 520 (114-608) mL. Preoperative haemoglobin levels were lower for patients who received a combination of cell salvage and allogeneic blood (p = 0.006). CONCLUSIONS: IOCS contributed to a reduction or elimination of allogeneic transfusion for a proportion of this high-risk cohort and should be an integral component of a hospitals' blood conservation strategy.
Assuntos
Procedimentos Médicos e Cirúrgicos sem Sangue/métodos , Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Recuperação de Sangue Operatório/métodos , Placentação/fisiologia , Adulto , Feminino , Humanos , Irlanda , Gravidez , Centros de Atenção TerciáriaRESUMO
OBJECTIVE: To evaluate the diagnostic accuracy of intraoperative laparoscopic imaging tools in reference to that of histopathology for detecting endometriotic lesions and to compare them with conventional white-light inspection by performing a systematic review with meta-analysis. DATA SOURCES: We searched the MEDLINE, EMBASE, and CENTRAL databases in addition to citations and reference lists until the end of February 2019. METHODS OF STUDY SELECTION: Two authors screened 1038 citations for eligibility. We included randomized controlled trials or prospective cohort studies published in English, assessing the accuracy of intraoperative imaging tools for diagnosing endometriosis during laparoscopy. We considered studies using histopathologic evaluation as a standard criterion. TABULATION, INTEGRATION, AND RESULTS: Seven studies were eligible, including 472 women and 1717 histopathologic specimens, and they involved study of the use of narrow-band imaging (2 studies), 5-aminolevulinic acid-induced fluorescence (2 studies), autofluorescence imaging (1 study), indocyanine green (1 study), and a 3-dimensional robotic laparoscopy (1 study). Two authors extracted data and assessed the validity of the included studies. Bivariate random-effects models and McNemar's test were used to compare the tests and evaluate sources of heterogeneity. Four studies were attributed a high risk of bias, and biopsies of normal-looking peritoneum were not performed to verify the results in 3 studies; both factors were identified as significant sources of heterogeneity, leading to the overestimation of the sensitivity and underestimation of the specificity of imaging tools. In all studies, additional endometriotic lesions were diagnosed with the enhanced imaging tool compared with white-light inspection alone. In the 4 studies that appropriately performed control biopsies (171 women, 448 specimens), enhanced imaging techniques were associated with a higher sensitivity and specificity compared with white-light inspection (0.84 and 0.89 compared with 0.75 and 0.76, respectively, p ≤.001). Adverse events were uncommon (nâ¯=â¯5) and reported only with the use of exogeneous photosensitizers. There were no reports of long-term changes in patient-reported outcomes arising from better detection of endometriosis lesions. CONCLUSION: Studies report that enhanced imaging allows for the detection of additional endometriotic lesions missed by conventional white-light laparoscopy. The benefits of finding these additional lesions using enhanced imaging compared with white-light inspection alone on long-term postoperative outcomes have not been determined, and these tools should be considered only in a research context at this time.
Assuntos
Diagnóstico por Imagem/métodos , Técnicas de Diagnóstico Obstétrico e Ginecológico , Endometriose/diagnóstico , Endometriose/cirurgia , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/cirurgia , Biópsia , Diagnóstico por Imagem/efeitos adversos , Diagnóstico por Imagem/classificação , Técnicas de Diagnóstico Obstétrico e Ginecológico/efeitos adversos , Técnicas de Diagnóstico Obstétrico e Ginecológico/classificação , Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Técnicas de Diagnóstico Obstétrico e Ginecológico/estatística & dados numéricos , Endometriose/patologia , Feminino , Humanos , Aumento da Imagem , Biópsia Guiada por Imagem , Período Intraoperatório , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Imagem de Banda Estreita , Imagem Óptica , Doenças Peritoneais/patologia , Exame Físico/métodos , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Endometriosis-associated pain (EAP) has a significant impact on the quality of life of those affected and their families. Recognizing that endometriosis is a chronic condition associated with an impairment in function and negative social impact, there is a shift toward reducing diagnostic delays and initiating timely management. This article provides a comprehensive and practical approach to the clinical diagnosis of EAP, which can subsequently facilitate prompt and directed treatment. The key components of the history, physical examination, and high-quality imaging to evaluate suspected EAP and related pain conditions are presented. Currently, biomarkers have limited utility in the diagnosis of endometriosis, but research in this area continues; development of a reliable noninvasive test for endometriosis may further improve early identification of this condition.
Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Endometriose/complicações , Endometriose/diagnóstico , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Guias de Prática Clínica como Assunto , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Doenças Peritoneais/complicações , Doenças Peritoneais/diagnóstico , Exame Físico/métodos , Exame Físico/normas , Qualidade de VidaRESUMO
Controversies surrounding the effect of ES on pregnancy outcome in women with RIF are mostly due to the poorly defined target population. We evaluated the effect of ES on clinical outcomes in women with strict criteria of RIF before IVF/ICSI. We also examined the effect of ES on the expression of markers of endometrial receptivity. Women with failed implantation after transfer of seven or more top quality day 3 embryos or three blastocysts underwent the scratch procedure on exact days of the cycle prior to IVF/ICSI. Results were compared to no scratch control group. Using histopathology, immunohistochemistry, and scanning electron microscopy, we also examined the effect of injury on the endometrial receptivity in a separate series of observations with double ES. Cumulative pregnancy rate was significantly higher in the study group as compared to control (54.8% vs. 29.0%; p < .05). The effect of ES on the clinical outcome was seen during fresh ET, but not on the next FET cycles. ES improves impaired endometrial receptivity by partially normalizing the expression of estrogen and progesterone receptors (ERs, PRs) and pinopodes. We concluded that in a well-defined subpopulation of infertile women with RIF, ES significantly enhances pregnancy rates. ES has a specific impact on endometrial receptivity normalizing the expression of some markers.
Assuntos
Aborto Habitual/terapia , Implantação do Embrião/fisiologia , Transferência Embrionária/métodos , Endométrio/cirurgia , Infertilidade Feminina/terapia , Aborto Habitual/diagnóstico , Adulto , Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Endométrio/patologia , Feminino , Fertilização in vitro/métodos , Humanos , Infertilidade Feminina/diagnóstico , Masculino , Projetos Piloto , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Adulto JovemRESUMO
OBJECTIVE: To compare the efficacy of the International Ovarian Tumor Analysis (IOTA) simple rules versus pattern recognition to differentiate between benign and malignant ovarian masses. METHODS: A prospective cross-sectional study conducted at Kasr El Aini Hospital, Cairo, between April 2016 and October 2018 of 396 women with ovarian masses measuring more than 5 cm who were candidates for surgery. All patients underwent two-dimensional transvaginal sonography: level 2 with IOTA simple rules followed by level 3 with pattern recognition. Patients subsequently underwent ovarian cystectomy or oophorectomy and the specimens were examined histopathologically. Accuracy was measured by comparing sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. RESULTS: IOTA simple rules specified 44/50 cases as malignant and 220/242 as benign (sensitivity and specificity of 88.0% and 90.9%, respectively). Pattern recognition identified 83/94 cases as malignant and 281/302 as benign (sensitivity and specificity of 88.3% and 92.7%, respectively). No statistically significant difference in accuracy was found between the two methods. CONCLUSION: IOTA simple rules are an effective tool for detecting ovarian malignancy when performed by nonexpert sonographers. When results are inconclusive, pattern recognition should be performed additionally by an expert sonographer. CLINICAL TRIALS REGISTRATION: NCT02800031.
Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Neoplasias Ovarianas/diagnóstico , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , UltrassonografiaRESUMO
AIM: Preterm premature rupture of membranes (PPROM) is responsible for approximately one-third of premature births worldwide, and although the diagnosis is often straightforward, this condition can still present difficulties. The purpose of this research was to compare the accuracy of several PPROM diagnostic tests. METHODS: A total of 94 pregnant women with clinical suspicion of PPROM who were between 20 and 36 weeks of pregnancy were examined by vaginal speculum, and tests were performed for phenol, pH, insulin-like growth factor binding protein-1 (IGFBP-1) and placental alpha-microglobulin-1 (PAMG-1). All patients were followed up until the diagnosis was fully defined, and a diagnosis of PROM was confirmed by a definitive evolution of the clinical symptoms (visualization of vaginal amniotic fluid or persistence of oligohydramnios). RESULTS: After excluding the cases that could not be definitively diagnosed, a good diagnostic performance of the immunochromatographic tests was observed that was superior to that of the clinical tests. Similar accuracies were observed for IGFBP-1 (98.7%) and PAMG-1 (93.9%). However, while the IGFBP-1 test differed from a vaginal pH ≥7 (88.9%) and the phenol test (85.7%), this did not occur for the PAMG-1 test. The performance of the tests was modified only by the presence of bleeding (with lower specificity rates for pH and phenol), without interference of gestational age or maternal morbidities. CONCLUSION: Immunochromatographic tests are good tools but should be used sparingly in resource-poor settings because they are expensive, and there is no significant difference between PAMG-1 and traditional tests.
Assuntos
alfa-Globulinas/metabolismo , Líquido Amniótico/metabolismo , Ruptura Prematura de Membranas Fetais/diagnóstico , Proteína 1 de Ligação a Fator de Crescimento Semelhante à Insulina/metabolismo , Fenol/metabolismo , Vagina/química , Adulto , Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Feminino , Seguimentos , Idade Gestacional , Humanos , Concentração de Íons de Hidrogênio , Imunoensaio , GravidezRESUMO
OBJECTIVE: To compare the diagnostic accuracy of different hormonal biomarkers and to find the most effective hormonal biomarker for the diagnosis of endometriosis. DATA SOURCES: We conducted a systematic search using PubMed, EMBASE, Cochrane Library, and China Biomedical Literature to identify relevant studies from the first day of databases to August 2018. METHODS OF STUDY SELECTION: Two independent reviewers screened for study eligibility and extracted data. Random controlled trials, cross-sectional studies, case-control studies, and cohort studies evaluating the diagnostic accuracy of hormonal markers for endometriosis were included. TABULATION, INTEGRATION, AND RESULTS: We included 17 studies that involved 1279 participants and evaluated 7 hormonal biomarkers. The pooled sensitivity and specificity in endometriosis were .79 (.71, .86) and .89 (.82, .94) for aromatase, .30 (.18, .46) and .80 (.65, .90) for human chorionic gonadotropin/luteinizing hormone receptor, .75 (.66, .83) and .47 (.34, .60) for estrogen receptor (ER)-α, .65 (.56, .74) and .68 (.55, .80) for ER-ß, .45 (.38-.52) and .92 (.85-.97) for serum prolactin, .69 (.51, .83) and .30 (.16, .49) for estrogen sulfotransferase, and .73 (.60-.84) and .48 (.33-.63) for 17ß-hydroxysteroid dehydrogenase type 2 (17ßHSD2). Compared with human chorionic gonadotropin/luteinizing hormone receptor, ER-α, ER-ß, estrogen sulfotransferase, and 17ßHSD2, aromatase had a higher sensitivity, specificity, positive likelihood ratio, and diagnostic odds ratio. The specificities of aromatase and serum prolactin were comparable, but the sensitivity, positive likelihood ratio, and positive likelihood ratio of serum prolactin were much lower than that of aromatase. CONCLUSION: Aromatase may be an excellent diagnostic test for endometriosis. However, because of the moderate quality of the included studies and the limited sample size, this result requires more research to validate. (PROSPERO registration number: PROSPERO 2018 CRD42018105126.).
Assuntos
Biomarcadores/sangue , Técnicas de Diagnóstico Endócrino/normas , Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Endometriose/diagnóstico , Estudos de Casos e Controles , Estudos Transversais , Testes Diagnósticos de Rotina/normas , Endometriose/sangue , Feminino , Hormônios/sangue , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
The endometrium is a dynamic, repetitively cycling tissue that mediates the implantation of the blastocyst. Evaluation of this complex tissue necessitates sophisticated methods that can assess its functional potential. Beginning in the 1950s with simple histological endometrial "dating," these methods have crossed into the molecular era with the use of arrays aimed at dating, functional tests that assess for proliferation and differentiation, and tests that screen for inflammatory markers. In addition to these specialized tests, histologic evaluation for pathologic conditions-such as growth disorders (i.e. polyps and hyperplasia), inflammatory lesions, and retained products of conception-are critical for a complete assessment of the patient with recurrent implantation failure. Whatever the means of testing, the goal is to reveal actionable findings that can assist in offering the best options to patients who have failed multiple transfers with high quality embryos.
Assuntos
Aborto Habitual/diagnóstico , Técnicas de Diagnóstico Obstétrico e Ginecológico , Implantação do Embrião/fisiologia , Endométrio/patologia , Infertilidade Feminina/diagnóstico , Aborto Habitual/etiologia , Aborto Habitual/terapia , Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Prática Clínica Baseada em Evidências , Feminino , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/terapia , GravidezRESUMO
OBJECTIVE: To investigate the test characteristics of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) criteria for intrauterine inflammation or infection or both (triple I) and rates of adverse outcomes in a cohort of febrile intrapartum women. METHODS: This retrospective cohort study included women at 24 weeks of gestation or greater from June 2015 to September 2017 at a single tertiary hospital with a temperature 100.4°F or greater (38.0°C) during labor or within 1 hour postpartum, all of whom had blood culture data. Women with a fetal demise, expectantly managed preterm prelabor rupture of membranes, or nonobstetric infections were excluded. Documented fever was defined as a single temperature 102.2°F or greater (39.0°C) or a temperature 100.4°F or greater (38.0°C) but less than 102.2°F (39.0°C) on two measurements 45 minutes apart. We defined two analysis groups: 1) suspected triple I, defined as women with documented fever with clinical signs of infection; and 2) isolated maternal fever, defined as women with at least one temperature 100.4°F or greater (38.0°C) who did not meet criteria for suspected triple I. We assessed test characteristics of suspected triple I to predict 1) confirmed triple I, defined as suspected triple I with placental pathology diagnostic of infection; and 2) adverse clinical infectious outcome, defined as a composite of maternal and neonatal adverse infectious outcomes. We also calculated the incidence of adverse clinical infectious outcomes for both groups. RESULTS: Three hundred thirty-nine women were analyzed: 212 with suspected triple I and 127 with isolated maternal fever. Baseline demographic and obstetric characteristics were similar between groups. The incidence of adverse clinical infectious outcomes was 11.8% among women with suspected triple I and 9.5% among women with isolated maternal fever (P=.50). The sensitivity and specificity of suspected triple I for confirmed triple I were 71.4% (95% CI 61.4-80.1%) and 40.5% (95% CI 33.6-47.8%), respectively, and for an adverse clinical infectious outcome were 67.6% (95% CI 50.2-82.0%) and 38.1% (95% CI 32.6-43.8%), respectively. CONCLUSION: Applying the NICHD criteria to guide clinical diagnosis and management of intrauterine infection or inflammation may overlook an important proportion of laboring febrile women at risk for adverse infectious outcomes.
Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Febre , Inflamação/diagnóstico , Cuidado Pré-Natal/normas , Transtornos Puerperais/diagnóstico , Doenças Uterinas/diagnóstico , Adulto , Estudos de Coortes , Árvores de Decisões , Feminino , Humanos , Incidência , Recém-Nascido , Inflamação/epidemiologia , National Institute of Child Health and Human Development (U.S.) , Guias de Prática Clínica como Assunto , Gravidez , Transtornos Puerperais/epidemiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Estados Unidos , Doenças Uterinas/epidemiologiaAssuntos
Ginecologia/tendências , Obstetrícia/tendências , Diagnóstico Pré-Natal/tendências , Editoração , Congressos como Assunto , Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Técnicas de Diagnóstico Obstétrico e Ginecológico/tendências , Feminino , Fetoscopia/métodos , Fetoscopia/tendências , Ginecologia/métodos , Humanos , Obstetrícia/métodos , Gravidez , Diagnóstico Pré-Natal/métodos , Editoração/organização & administração , Editoração/tendênciasRESUMO
OBJECTIVES: To perform an external validation of the diagnostic performance of the three-step strategy proposed by the International Ovarian Tumor Analysis (IOTA) group for classifying adnexal masses as benign or malignant, when ultrasound is performed by non-expert sonographers in the first two steps. The second objective was to assess the diagnostic performance of an alternative strategy using simple-rules risk (SRR), instead of simple rules (SR), in the second step. METHODS: This was a prospective observational study conducted at two university hospitals, from September 2015 to August 2017, of consecutive patients diagnosed with an adnexal mass. All women were evaluated by ultrasound using the IOTA three-step strategy. Non-expert sonographers performed the first step (use of simple descriptors to classify the masses) and the second step (use of SR if the mass could not be classified in the first step); masses that could not be classified in the first two steps were categorized by an expert sonographer based on their subjective assessment (third step). The reference standard was histological diagnosis in patients who underwent surgery or at least 12 months of follow-up in cases managed expectantly. The sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios and overall accuracy of the IOTA three-step strategy were estimated. Furthermore, we evaluated retrospectively an alternative two-step strategy using SRR in the second step to categorize the masses not classifiable with simple descriptors, classifying the lesions as being of low, intermediate or high risk for malignancy. The diagnostic performance of this strategy was estimated by calculating its sensitivity and specificity, assuming surgical intervention for intermediate- or high-risk lesions. RESULTS: The study included 283 patients (median age, 48 (range, 18-90) years), of whom 165 (58.3%) were premenopausal and 118 (41.7%) postmenopausal. Two hundred and sixteen (76.3%) women underwent surgery (154 benign and 62 malignant masses) and 67 (23.7%) were managed expectantly with serial ultrasound follow-up for at least 12 months. All expectantly managed masses were considered benign because no sonographic changes suggestive of malignancy were observed during follow-up. Simple descriptors could be applied in 126 (44.5%) masses. Of the remaining 157 lesions, 112 (39.6%) could be characterized using SR. Therefore, 238 (84.1%) masses could be classified by non-expert sonographers in the first two steps. Of the remaining 45 (15.9%) masses, all could be classified by an expert sonographer. Overall sensitivity, specificity, LR+ and LR- of the IOTA three-step strategy were 95.2%, 97.7%, 42.1 and 0.05, respectively. The diagnostic accuracy was 97.2%. Following the two-step strategy using SRR in the second step, of the 157 lesions not classified with simple descriptors, 42, 38 and 77 presented low, intermediate or high risk for malignancy, respectively. Based on this method, 210 women would have undergone surgical treatment. The sensitivity and specificity of this two-step strategy were 98.4% and 63.8%, respectively. CONCLUSIONS: The IOTA three-step strategy shows high accuracy for discriminating between benign and malignant adnexal lesions when used by non-expert sonographers. An alternative strategy using the SRR calculator in the second step might improve on this diagnostic performance by decreasing the number of surgical interventions and increasing sensitivity. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.