Differentiation of benign and malignant adnexal masses: value of a morphologic scoring system.

OBJECTIVE: The purpose of this study was to assess the value of conventional gray-scale ultrasonography, based on a morphologic scoring system, in the differential diagnosis of malignant and benign adnexal tumors. MATERIAL AND METHODS: A total of 58 adnexal masses in 51 patients were classified prospectively as suggestive of malignant or benign, on the basis of gray-scale ultrasonographic morphology. The results were correlated with histopathological diagnosis. RESULTS: Histopathology of 42 masses was found to be benign and 16 masses were found to be malignant. On gray-scale analysis 15 of 16 malignant masses were classified as suggestive of malignant and 37 of 42 benign masses were classified as suggestive of benign. The sensitivity, specificity, positive predictive value and negative predictive value are calculated as 93%, 88%, 75%, and 97%, respectively. CONCLUSION: Prediction of malignancy using gray scale ultrasonograhy based on a morphological scoring system was reliable (NPV = 97%, PPV = 93%). However further investigations about the assessment of adnexal masses with ultrasonography are needed

Unscarred uterine rupture after induction of labor with misoprostol: a case report.

The rupture of an unscarred uterus is very rare and presents an emergency situation that threatens the life of the fetus and mother. The agents used for induction of labor, like oxytocin and/or prostaglandins, can be responsible for this catastrophic event. We report a case of intrapartum rupture of an intact uterus after using intravaginal misoprostol for cervical ripening and labor induction in a term pregnancy and we discuss the other cases reported in the literature.

The evaluation of misoprostol-related tachysystole in normal and high risk pregnancies.

OBJECTIVE: To determine whether misoprostol-related tachysystole is due to the cumulative effect of the drug. METHODS: A group of preeclamptic patients were chosen and data were compared to non-preeclamptic patients to prove the hypothesis. Among 90 patients evaluated, 45 were preeclamptic while 45 were non-preeclamptic. Six out of 43 preeclamptic patients were diagnosed as having HELLP syndrome. All patients were induced by 50 microg of misoprostol applied to the posterior vaginal fornix with 4-hour intervals for a maximum of three times. RESULTS: Two patients from both groups were left out of the study leaving 86 patients to evaluate. The number of misoprostol tablets used in the preeclamptic group was significantly higher (2.32 +/- 0.64 preeclamptic vs 1.81 +/- 0.76 tablets non-preeclamptic group; [p = 0.001]) while the number of women giving birth after only one tablet of misoprostol was significantly lower (2/24 preeclamptic vs. 14/32 non-preeclamptic group [p = 0.006, OR 0.116; 95% CI 0.02-0.58]). Although the frequency of tachysytolic patterns observed was different between the two groups, (35% preeclamptic vs 16% non-preeclamptic) this difference was not statistically significant (p = 0.082). It is important to note that an increase of only one case having tachysystole in the preeclamptic group would have converted this difference to significant. CONCLUSION: Relatively hard induction of labor in preeclamptic patients leads to an increase in the amount of misoprostol used and hence to an increased incidence of tachysystole secondary to the cumulative effect of the drug. These findings seem to support our hypothesis and prove the presence of the cumulative effect of misoprostol.