Reproducibility of transvaginal ultrasonographic measurements of endometrial thickness in patients with postmenopausal bleeding.

The aim of the study was to establish the reproducibility of transvaginal sonographic measurements of endometrial thickness in patients with postmenopausal bleeding (PMB). In a prospective blind study, two examiners measured the endometrial thickness in 48 patients presenting with PMB by transvaginal sonography on two separate occasions, 30 min apart. The analysis of variance performed at each endometrial thickness measured by the two examiners revealed no statistical difference. However, it was shown that the most accurate measurements are up to the level of 4 mm (mean deviation of 0.1 +/- 0.2 mm, range 0.7). Once the endometrial thickness reaches 5-6 mm the mean deviation becomes 0.3 +/- 1.2 mm with a range of variation of 4 mm. In conclusion, measurements of endometrial thickness in patients presenting with PMB can be repeated quite accurately up to a level of 4 mm thickness.

A 3 year, prospectively-designed study of late selective multifetal pregnancy reduction.

The aim of our study was to evaluate the pregnancy outcomes of late selective multifetal reduction (MFPR). We performed a 3 year, prospectively-designed study in which 28 patients underwent MFPR at a mean gestational age of 20.2 +/- 3.9 weeks (range 14-29 weeks). The indications for MFPR included: multiple gestation (> or = 3) (57%), structural anomaly (29%), and chromosomal abnormality (14%). The procedure was performed using ultrasonographically-guided intracardiac injection of potassium chloride. The mean gestational age at delivery was 36.6 +/- 2.2 weeks (range 31-40 weeks). Nine patients (32%) delivered before 36 weeks of gestation. The mean birth weight was 2370 +/- 614 g (range 1510-3250 g). Discordancy was evident in four twins (14%), and intrauterine growth retardation in four pregnancies. One case (3.5%) presented with oligohydramnios, and one with pregnancy-induced hypertension. One case of late abortion due to passive cervical dilatation 4 weeks after the MFPR was observed. Procedure-related amnionitis followed by late abortion occurred in one case. A total of 57% of the patients delivered vaginally and 43% delivered by Caesarean section. We concluded that late selective MFPR is associated with favourable perinatal outcome. Late MFPR may facilitate the detection of structural and chromosomal anomalies prior to the procedure, and the accomplishment of selective reduction of the affected fetus.

Transvaginal sonohysterography for the early diagnosis of residual trophoblastic tissue.

We prospectively evaluated 29 patients with early postabortion or postpartum bleeding, suspected of having possible retained trophoblastic tissue by transvaginal sonography and transvaginal sonohysterography. All patients received methyl-ergometrine maleate (Sandoz) and amoxicillin and clavulinic acid (Pharmascope) orally for 5 days and were then reevaluated. Ten patients (34.5%) had a normal uterine cavity on both transvaginal sonography and sonohysterography. Nineteen patients (65.5%) were suspected of having residual trophoblastic tissue by transvaginal sonography. Of these, five (26%) showed normal uterine cavity by sonohysterography. One patient (8.3%) reported heavy bleeding with clots after the conservative treatment. Repeated examination revealed normal uterine cavity. The remaining patients underwent curettage, and histopathologic examination revealed trophoblastic tissue. Transvaginal sonohysterography is more accurate than transvaginal sonography for diagnosing residual trophoblastic tissue in patients with postpartum and postabortion bleeding. Its use may eliminate unnecessary curettage procedures.

Transvaginal ultrasonographic measurements of endometrial thickness: a reproducibility study.

OBJECTIVE: The study was undertaken to assess the reproducibility of endometrial thickness measurements by transvaginal ultrasonography (TVS). METHODS: In a prospective blind study, two examiners measured the endometrial thickness of 25 patients by TVS on two separate occasions 30 minutes apart. RESULTS: The reliability test performed for each examiner was statistically less significant for the intra-observer variation of each observer (r = 0.95 and r = 0.93), than between both examiners (r = 0.85). Although there was no statistically significant difference between the observations, the mean range of observations was 2.12 + 1.27 mm. CONCLUSIONS: A safety margin of error should be taken into consideration while recommending a cutoff under which no curettage is needed.

Transvaginal sonohysterography: a new aid in the diagnosis of residual trophoblastic tissue.

OBJECTIVE: The study was undertaken to evaluate the diagnostic accuracy of transvaginal sonohysterography in postabortion and postpartum patients suspected of having residual trophoblastic tissue. METHODS: Twenty two women with late postabortion and postpartum bleeding were evaluated by transvaginal sonography and transvaginal sonohysterography. The patients were prospectively divided into two groups according to the sonohysterographic findings. Women with an empty uterine cavity or with free-floating masses received conservative treatment. Those with suspected attached residual trophoblastic tissue underwent curettage. RESULTS: Sonohysterography confirmed the findings of two-dimensional sonography of an empty uterus in 8 patients; however, a free floating endometrial mass was found in 4 patients and that of an empty uterine cavity in another 2 of 14 patients suspected of having residual trophoblastic tissue by the two-dimensional ultrasound. All 14 patients who were treated conservatively ceased bleeding. The 4 patients with a free-floating mass reported ejection of a vaginal mass within 6 days of treatment. Eight patients underwent curettage. Residual trophoblastic tissue was found in all of them. CONCLUSION: Transvaginal sonohysterography is a simple and effective method for the evaluation of residual trophoblastic tissue in patients with postpartum and post-abortion bleeding. Its use may eliminate unnecessary curettage procedures.

Sensitivity and specificity of sonohysterography for the evaluation of the uterine cavity in perimenopausal patients.

Sonohysterography is a technique for evaluating the uterine cavity by the instillation of sterile saline solution through an 8 Fr Foley catheter, before performing an ultrasonographic evaluation. The sensitivity and specificity of the procedure were evaluated in comparison to hysteroscopy. In a prospective double-blind study, 47 postmenopausal patients were evaluated first by sonohysterography, and within 1 week by hysteroscopy. After comparing the hysteroscopic and sonohysterographic results, sonohysterography showed a sensitivity of 86% and specificity of 100%. Sonohysterography is an accurate mode of diagnosis for pathologic intrauterine processes in perimenopausal patients.

The sensitivity and specificity of vaginal sonography in detecting endometrial abnormalities in women with postmenopausal bleeding.

OBJECTIVE: To evaluate the sensitivity and specificity of vaginal sonography in the detection of endometrial abnormalities in patients with postmenopausal bleeding (PMB). METHODS: In a prospective study, 54 patients with PMB were examined with vaginal ultrasonography prior to dilatation and curettage. The mean endometrial thickness was compared with the histopathological results. A cutoff value of 5 mm was prospectively chosen to evaluate the sensitivity and specificity of this method. RESULTS: The calculated sensitivity for the measurement of endometrial thickness as a predictor of endometrial pathology was 89%, and the specificity was 83%. We found carcinoma associated with an endometrial thickness of 6 mm. CONCLUSIONS: Although its sensitivity was high, we feel that an endometrial thickness > 5 mm should constitute a cause for concern but not a definitive indication of pathology. Thus we believe that, at this point, the role of vaginal sonography as an aid in determining which women with PMB should undergo curettage has yet to be determined.

Prenatal sonographic diagnosis of metastatic neuroblastoma: report of a case and review of the literature.

Congenital malignant tumours are rare. Neuroblastoma is the most common solid tumour, accounting for about 30-50 per cent of tumours evident during the neonatal period. A case of metastatic, rapidly growing neuroblastoma, diagnosed prenatally by ultrasound at 32 weeks' gestation, is presented.