Repeatability and Reproducibility of Potential Ultrasonographic Bishop Score Parameters.

Determination of the Bishop score (BS) is a traditional method of assessing the cervix in obstetrics and gynecology. This examination is characterized by subjectivity of assessment and low repeatability. In scientific studies intended to evaluate the results of the procedure based on the initial assessment, it is necessary to find an objective scale based on ultrasonography. We selected five ultrasound parameters, measured with a transvaginal transducer, that are equivalent to the individual BS axes (dilatation assessed in three-dimensional ultrasound (DL), angle of progression (AoP), vagino-cervical angle (VCA), strain elastography using the E-Cervix module, and cervical length (CL)). All selected parameters were characterized by good to excellent repeatability (intraclass correlation coefficient (ICC) = 0.878-0.994) and reproducibility (ICC = 0.826-0.996). Each of the selected parameters significantly correlated with its corresponding BS axis. The highest value of the correlation coefficient was achieved with CL (-0.75) and DL (0.71). Other parameters were characterized by an average to high correlation (AoP and station = 0.69, hardness ratio and consistency = -0.33, position and VCA = -0.38). The best correlation with the sum of the BS points was exhibited by AoP (0.52) and CL (-0.61). The selected ultrasound parameters analogous to the BS axes were characterized by high repeatability and significant correlation with the axes of the original clinical BS. Further research into the predictive properties of a multivariate model based on these parameters is needed.

Repeatability and reproducibility of quantitative cervical strain elastography (E-Cervix) in pregnancy.

Strain elastography of the uterine cervix may be useful in the diagnosis and prediction of obstetric complications. The inability to obtain quantitative results, with only the possibility of visual semiquantitative evaluation of the obtained elastograms, has been the limitation of the method thus far. E-Cervix is a software program that uses intrinsic compression to excite tissue and allows the evaluation of quantitative parameters on the basis of pixel distribution in an elastogram. The aim of this study was to assess the repeatability and reproducibility of quantitative cervical strain elastography (E-Cervix) of the uterine cervix and to assess the correlation of the obtained parameters with selected clinical features of patients in the third trimester of pregnancy. In total, 222 patients participated in the study. We assessed 5 ultrasound parameters: elasticity index (ECI), hardness ratio (HR), internal os strain (IOS), external os strain (EOS) and IOS/EOS ratio. Each study was performed according to a predetermined standardized protocol. For all assessed elastographic parameters, we obtained good intra- and interobserver reproducibility. The interclass correlation coefficient (ICC) ranged from 0.77 to 0.838 for intraobserver variability and from 0.771 to 0.826 for interobserver variability. We demonstrated a significant correlation of some obtained elastographic parameters with the basic clinical features of patients, such as age, the number of previous caesarean sections, pregnancy weight and BMI. In each case, the correlation was very low. Quantitative elastographic assessment with the use of E-Cervix is characterized by good repeatability. Some clinical features may affect the value of the parameters obtained. The clinical relevance of this interference requires further investigation.

Misoprostol vaginal insert and Foley catheter in labour induction - single center retrospective observational study of obstetrical outcome.

OBJECTIVES: Induction of labour is one of the most common procedures used in obstetrics and its prevalence tends to increase. In patients with an unripe cervix (Bishop score < 7) pre-induction procedures are used before the start of oxytocin induction. Currently there is no consensus among scientific societies on the optimal way of pre-induction. We have conducted a single-centre retrospective observational study comparing obstetric induction results of patients after 37 weeks of gestation who were pre-induced with misoprostol vaginal insert (MVI) with 200 µg of misoprostol (Misodel - Ferring Pharmaceuticals Poland) or Foley catheter (20 F, 60 mL baloon). MATERIAL AND METHODS: We have reviewed the medical records of 503 patients (group A pre-induced MVI - 135 patients, group B pre-induced Foley catheter - 368 patients) who were in a single, full-term pregnancy, pre-induced due to unripe cervixes (Bishop score < 7) with a Foley catheter or Misodel (MVI 200 µg). We compared obstetric results between groups. RESULTS: Group A patients had a lower chance of using oxytocin in labour induction/augmentation (OR = 0.21 95% CI = 0.13-0.32), and a greater chance of surgical delivery by caesarean section (OR = 2.14 95% CI = 1.42-3.23) and vacuum extraction (OR = 3.29 95% CI = 1.08-10.00). Group A patients also had a greater chance of abnormal CTG (OR = 2.66 95% CI = 1.5-4.7) compared to group B. The groups did not differ in terms of meconium stained amniotic fluid and postpartum haemorrhage. The percentage of children born with a pH from umbilical cord blood < 7.2 and < 7.1 and newborns of medium general condition (Apgar 4-7) did not differ between the groups. CONCLUSIONS: Neonatological results of children from Foley catheters and MVI induced delivery do not differ. Patients pre-induced with MVI rarely require labour augmentation with oxytocin. MVI-preinduced patients have a better chance of having a delivery by CS or VE compared to the Foley catheter.

Prevalence of Dyslipidaemia and Pre-Diabetes Among Women with Polycystic Ovary Syndrome (PCOS): Do We Overestimate Cardiovascular Risk?

PCOS is widely accepted as associated with an increased cardiovascular risk, however, without convincing evidence of an increased cardiovascular mortality. We assessed prevalence of obesity, glucose intolerance, and dyslipidaemia in 490 women with PCOS, aged 24.75±8.05 years, diagnosed according to the Rotterdam consensus criteria. Fifty-two percent of women had BMI<26 kg/m2, 81.8% had total cholesterol<200 mg/dl, 82.8% had LDL cholesterol<130 mg/dl (48.3%<100 mg/dl), 81.4% had triglycerides<150 mg/dl, 96.08% had fasting glucose<100 mg/dl, 90.3% had glucose<140 mg/dl at 120' of OGTT. The most frequent abnormality was low HDL cholesterol, as only 33.9% had LDL>60 mg/dl. Combination of several risk factors related to dyslipidaemia was, however, relatively rare, for example, a combination of raised total cholesterol and LDL cholesterol was present only in 2.9% of subjects. An increase in BMI, total cholesterol, LDL-cholesterol, and glucose concentrations at 120' of OGTT was more pronounced in women, who had raised concentrations of at least two androgens (n=172, 35.1%), yet there was no increase in insulin resistance parameters, that is, HOMA-IR, QUICKI, McAuley, or Belfiore index. Contrary to common belief, over 50% of women with PCOS have normal body weight, and with exception of lower HDL cholesterol, most have no significant dyslipidaemia or glucose intolerance. Women with normal or borderline abnormal androgens, who form the majority of PCOS subjects, seem to have more healthy metabolic profile. This might be one of the reasons for the absence of evidence of an increased CV mortality in women with PCOS.

Limitations of insulin resistance assessment in polycystic ovary syndrome.

BACKGROUND: Though insulin resistance (IR) is common in polycystic ovary syndrome (PCOS), there is no agreement as to what surrogate method of assessment of IR is most reliable. SUBJECTS AND METHODS: In 478 women with PCOS, we compared methods based on fasting insulin and either fasting glucose (HOMA-IR and QUICKI) or triglycerides (McAuley Index) with IR indices derived from glucose and insulin during OGTT (Belfiore, Matsuda and Stumvoll indices). RESULTS: There was a strong correlation between IR indices derived from fasting values HOMA-IR/QUICKI, r = -0.999, HOMA-IR/McAuley index, r = -0.849 and between all OGTT-derived IR indices (e.g. r = -0.876, for IRI/Matsuda, r = -0.808, for IRI/Stumvoll, and r = 0.947, for Matsuda/Stumvoll index, P < 0.001 for all), contrasting with a significant (P < 0.001), but highly variable correlation between IR indices derived from fasting vs OGTT-derived variables, ranging from r = -0.881 (HOMA-IR/Matsuda), through r = 0.58, or r = -0.58 (IRI/HOMA-IR, IRI/QUICKI, respectively) to r = 0.41 (QUICKI/Stumvoll), and r = 0.386 for QUICKI/Matsuda indices. Detailed comparison between HOMA-IR and IRI revealed that concordance between HOMA and IRI was poor for HOMA-IR/IRI values above 75th and 90th percentile. For instance, only 53% (70/132) women with HOMA-IR >75th percentile had IRI value also above 75th percentile. There was a significant, but weak correlation of all IR indices with testosterone concentrations. CONCLUSIONS: Significant number of women with PCOS can be classified as being either insulin sensitive or insulin resistant depending on the method applied, as correlation between various IR indices is highly variable. Clinical application of surrogate indices for assessment of IR in PCOS must be therefore viewed with an extreme caution.

[Complicated colonic diverticulitis at 34 weeks gestation]. / Powiklane zapalenie uchylka jelita grubego u pacjentki w 34 tygodniu ciqzy.

Peritonitis is a set of symptoms of varying etiology usually with an accompanying infection, systemic and local changes within the peritoneal cavity Colonic diseases, especially colon perforation, are one of the most common causes of peritonitis. The course of the disease may be turbulent due to sudden perforation. In case of limited peritonitis the disease is not as acute as the perforation hole is small and it can be sealed by the omentum and internal organs. Abdominal pain is usually located around the source of infection and is less severe. A 38-year-old patient at 34 weeks gestation was hospitalized in the obstetric-gynecological ward of the Health Care Center with a diagnosis of preterm delivery urinary infection and renal colic. Due to increasing peritoneal symptoms and deteriorating general condition of the patient, a decision to perform immediately exploratory laparotomy combined with the Cesarean section was made. The surgeon indicated a place in the left mesogastrium that could correspond with a drained interintestinal abscess and also found a large amount of fibrin in the lower floor of the peritoneal cavity The initial point of the abscess remained unknown and the patient received total parenteral nutrition for 10 days. On 5 postoperative day the drain was removed from the peritoneal cavity and since day 10 patient health was steadily improving. Bacteriological cultures revealed abundant growth of E. coli that showed sensitivity to the used antibiotics. On 22 postoperative day the patient and her child were discharged home in good condition. Five months later the patient was admitted to the surgical ward with acute abdominal pain with the diagnosis of an abscess in her left mesogastric and subgastric area, perforation of sigmoid diverticulum and fecal fistula. Our case illustrates great difficulties in diagnosing diseases of the abdominal cavity during pregnancy because causes and symptoms may be typical of this condition, as well as of unrelated diseases, including: kidney problems, appendicitis, cholecystitis and bowel disease. Examination of the pregnant patient presents a challenge and the symptoms are uncharacteristic. Tension of the abdominal wall, as well as the muscles of the digestive and urinary tract are reduced and the topography of the internal organs changes during pregnancy. The interpretation of laboratory tests becomes more difficult. In our case, the initial local peritonitis, caused by microperforation of the diverticulum, ran a latent course and was masked by both pregnancy and renal colic symptoms, consequently leading to diffuse peritonitis. The presented case demonstrates the importance of the problem and forces obstetricians to be more vigilant in determining the diagnosis and decision-making, because of its meaning for the health and even the life of the patient and her child.