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Taiwanese Journal of Obstetrics &... Dec 2015We sought to identify patients at risk of incomplete transvaginal oocyte retrieval, develop a risk assessment formula to identify patients who would benefit from a... (Comparative Study)
Comparative Study
OBJECTIVE
We sought to identify patients at risk of incomplete transvaginal oocyte retrieval, develop a risk assessment formula to identify patients who would benefit from a transabdominal approach, and compare complication and pregnancy rates between these two approaches.
MATERIALS AND METHODS
In this retrospective case control study in a private in vitro fertilization center, 95 cases of women undergoing transabdominal follicular aspiration for oocyte retrieval (15 transabdominal only and 80 transabdominal and vaginal combined) were compared with 278 controls of women undergoing the transvaginal aspiration only. Transabdominal oocyte retrieval was performed when one or more ovaries could not be retrieved via the transvaginal approach. Main study outcomes included need for transabdominal retrieval, pregnancy rates, and complications.
RESULTS
A risk assessment scoring system was developed as follows: difficulty seeing ovaries on ultrasound (+4), history of pelvic surgery (+3), and body mass index of 30 kg/m(2) or greater (+2). With a cutoff score of 4 or greater, the overall sensitivity is 75%, specificity is 80%, positive predictive value is 57%, and negative predictive value is 90%. No statistically significant differences were found for pregnancy rates or complications.
CONCLUSION
The transabdominal approach is an alternative option that would increase the total number of oocytes retrieved with no statistical difference in complication or pregnancy rates. We also developed a scoring system that can serve as a useful screening tool for identifying women at increased risk of transabdominal oocyte retrieval.
Topics: Abdominal Cavity; Adult; Body Mass Index; Case-Control Studies; Female; Humans; Oocyte Retrieval; Ovarian Follicle; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Ultrasonography, Interventional; Vagina
PubMed: 26700987
DOI: 10.1016/j.tjog.2015.02.004 -
Medical Ultrasonography Jun 2023Diagnostic ultrasound in obstetrics and gynaecology has experienced a fantastic evolution during the past seven decades. Initial steps with A-mode technology were... (Review)
Review
Diagnostic ultrasound in obstetrics and gynaecology has experienced a fantastic evolution during the past seven decades. Initial steps with A-mode technology were followed by B-mode and B-mode real-time imaging, then by Doppler and colour Doppler ultrasound, and finally by 3D/4D ultrasound. Other evolutionary steps were the development of high-resolution transabdominal and transvaginal transducers providing high quality images in the first, second and third trimesters of pregancy, as well as in gynaecology and breast imaging.The progression from two-dimensional (2D) to three-dimensional ultrasound (3D) and 3D real-time imaging (4D) has brought new options in displaying anatomical structures. In comparison with CT or MRI, it is not a static but functional technique, cheap and safe, and applicable at any time.
Topics: Ultrasonography; Obstetrics; Gynecology; Humans; Female; Pregnancy; Imaging, Three-Dimensional; Equipment Safety; History, 20th Century; History, 21st Century
PubMed: 36047427
DOI: 10.11152/mu-3845 -
Medical Ultrasonography Aug 2022To conduct a systemic review of published data on reference values for both transabdominal and transvaginal ultrasound in gynecology.
AIM
To conduct a systemic review of published data on reference values for both transabdominal and transvaginal ultrasound in gynecology.
MATERIALS AND METHODS
Literature from 1970 to 2020 of reference values for the female pelvis in healthy subjects was reviewed. According to the determination of reference intervals for laboratory values reference values are generally determined using 95%-reference intervals and their associated 90%-confidence intervals. The list of articles was supplemented with extensive crosschecking of the reference lists of all retrieved articles.
RESULTS
A total of 33 studies were included and analyzed. The diagnostic performance of transvaginal ultrasound (TVUS) has a higher sensitivity and specificity than transabdominal ultrasound (TAUS) for high quality imaging of the uterus and the bilateral adnexa. The length of normal uterus is about 50-80 mm in fertile age. There is no consensus about the cut off value of the thickness of the endometrium in asymptomatic postmenopausal women, while a measurement of >5 mm and postmenopausal bleeding is suspect and requires further examination. The distribution of normal ovarian volumes is narrow with small volumes in postmenopausal women.
CONCLUSION
Normal values are helpful in delimiting the pathological changes in the female pelvis. While sonomorphologic criteria are more important than the ovarian size for the assessment of ovarian masses and reference values of the uterus in adults have little impact on routine practice, normative values in pediatric patients are important for the detection of pathologies. Normative values of the internal genital organs in females are sufficiently validated; still further research is required to assess the role of normative values in routine clinical practice and in sonographic screening for endometrial and ovarian cancer.
Topics: Child; Endometrium; Female; Humans; Pelvis; Sensitivity and Specificity; Ultrasonography; Uterus
PubMed: 35045137
DOI: 10.11152/mu-3584 -
World Journal of Gastroenterology May 2015Inflammatory bowel disease (IBD) is one of the most common chronic gastrointestinal diseases in pediatric patients. Choosing the optimal imaging modality for the... (Review)
Review
Inflammatory bowel disease (IBD) is one of the most common chronic gastrointestinal diseases in pediatric patients. Choosing the optimal imaging modality for the assessment of gastrointestinal disease in pediatric patients can be challenging. The invasiveness and patient acceptance, the radiation exposure and the quality performance of the diagnostic test need to be considered. By reviewing the literature regarding imaging in inflammatory bowel disease the value of ultrasound in the clinical management of pediatric patients is highlighted. Transabdominal ultrasound is a useful, noninvasive method for the initial diagnosis of IBD in children; it also provides guidance for therapeutic decisions and helps to characterize and predict the course of the disease in individual patients. Ultrasound techniques including color Doppler imaging and contrast-enhanced ultrasound are promising imaging tools to determine disease activity and complications. Comparative studies between different imaging methods are needed.
Topics: Child; Colitis, Ulcerative; Contrast Media; Crohn Disease; Humans; Intestines; Predictive Value of Tests; Prognosis; Risk Factors; Ultrasonography, Doppler, Color
PubMed: 25954096
DOI: 10.3748/wjg.v21.i17.5231 -
American Journal of Obstetrics and... Jan 2022Determining fetal head descent, expressed as fetal head station and engagement is an essential part of monitoring progression in labor. Assessing fetal head station is... (Observational Study)
Observational Study
BACKGROUND
Determining fetal head descent, expressed as fetal head station and engagement is an essential part of monitoring progression in labor. Assessing fetal head station is based on the distal part of the fetal skull, whereas assessing engagement is based on the proximal part. Prerequisites for assisted vaginal birth are that the fetal head should be engaged and its lowermost part at or below the level of the ischial spines. The part of the fetal head above the pelvic inlet reflects the true descent of the largest diameter of the skull. In molded (reshaped) fetal heads, the leading bony part of the skull may be below the ischial spines while the largest diameter of the fetal skull still remains above the pelvic inlet. An attempt at assisted vaginal birth in such a situation would be associated with risks. Therefore, the vaginal or transperineal assessments of station should be supplemented with a transabdominal examination. We suggest a method for the assessment of fetal head descent with transabdominal ultrasound.
OBJECTIVE
To investigate the correlation between transabdominal and transperineal assessment of fetal head descent, and to study fetal head shape at different labor stages and head positions.
STUDY DESIGN
Women with term singleton cephalic pregnancies admitted to the labor ward for induction of labor or in spontaneous labor, at the Cairo University Hospital and Oslo University Hospital from December 2019 to December 2020 were included. Fetal head descent was assessed with transabdominal ultrasound as the suprapubic descent angle between a longitudinal line through the symphysis pubis and a line from the upper part of the symphysis pubis extending tangentially to the fetal skull. We compared measurements with transperineally assessed angle of progression and investigated interobserver agreement. We also measured the part of fetal head above and below the symphysis pubis at different labor stages.
RESULTS
The study population comprised 123 women, of whom 19 (15%) were examined before induction of labor, 8 (7%) in the latent phase, 52 (42%) in the active first stage and 44 (36%) in the second stage. The suprapubic descent angle and the angle of progression could be measured in all cases. The correlation between the transabdominal and transperineal measurements was -0.90 (95% confidence interval, -0.86 to -0.93). Interobserver agreement was examined in 30 women and the intraclass correlation coefficient was 0.98 (95% confidence interval, 0.95-0.99). The limits of agreement were from -9.5 to 7.8 degrees. The fetal head was more elongated in occiput posterior position than in non-occiput posterior positions in the second stage of labor.
CONCLUSION
We present a novel method of examining fetal head descent by assessing the proximal part of the fetal skull with transabdominal ultrasound. The correlation with transperineal ultrasound measurements was strong, especially early in labor. The fetal head was elongated in the occiput posterior position during the second stage of labor.
Topics: Adult; Female; Fetus; Head; Humans; Labor Presentation; Labor Stage, First; Labor Stage, Second; Pregnancy; Ultrasonography, Prenatal
PubMed: 34389293
DOI: 10.1016/j.ajog.2021.07.030 -
The Journal of Adolescent Health :... Mar 2018To determine whether ovarian morphology imaged using transabdominal ultrasonography reflects clinical and metabolic features in adolescents with polycystic ovary...
PURPOSE
To determine whether ovarian morphology imaged using transabdominal ultrasonography reflects clinical and metabolic features in adolescents with polycystic ovary syndrome (PCOS).
METHODS
A retrospective pilot study was conducted in 33 adolescents (12-18 years) with PCOS as defined by hyperandrogenism and irregular cycles. Adolescents underwent the following assessments at a random time during the menstrual cycle: transabdominal ultrasonography, physical examination (height, weight, and systolic and diastolic blood pressure), fasting hormonal tests (free, percent free, and total testosterone, androstenedione, follicle stimulating hormone, luteinizing hormone), and metabolic tests (including an oral glucose tolerance test, fasting and 2-hour insulin and glucose, homeostatic model assessment of insulin resistance, and whole-body insulin sensitivity index). Ultrasound images were analyzed offline for ovarian area (OA), ovarian volume (OV), follicle number per cross section (FNPS), and follicle distribution pattern. Associations among endocrine and metabolic variables with sonographic features were assessed by Spearman's rank correlation coefficients and stepwise multiple linear regression.
RESULTS
Total testosterone and androstenedione, but not free testosterone, or percent free testosterone, positively correlated with OA (ρ = .515, ρ = .422, respectively), OV (ρ = .451, ρ = .382), and FNPS (ρ = .394, ρ = .474). Luteinizing hormone:follicle stimulating hormone ratio also positively correlated with ovarian size (OA, ρ = .520 and OV, ρ = .409). Unexpectedly, body mass index (ρ = -.503) and fasting glucose levels (ρ = -.393) were inversely correlated with FNPS. Total testosterone was an independent predictor of FNPS, OA, and OV as judged by stepwise multiple regression analyses.
CONCLUSIONS
Some aspects of ovarian morphology in adolescents with PCOS using transabdominal ultrasonography associate with markers of reproductive dysfunction and provide rationale to further investigate how ovarian morphology may reflect concurrent metabolic dysfunction.
Topics: Adolescent; Adult; Body Mass Index; Female; Follicle Stimulating Hormone; Glucose Tolerance Test; Humans; Infertility, Female; Luteinizing Hormone; Metabolic Diseases; Ovarian Follicle; Ovary; Pilot Projects; Polycystic Ovary Syndrome; Retrospective Studies; Ultrasonography
PubMed: 29217212
DOI: 10.1016/j.jadohealth.2017.09.005 -
Deutsches Arzteblatt International Dec 2014Fibroids are the most common benign tumors in women. One-third of all women of reproductive age undergo treatment for symptomatic fibroids. In recent years, the spectrum... (Review)
Review
BACKGROUND
Fibroids are the most common benign tumors in women. One-third of all women of reproductive age undergo treatment for symptomatic fibroids. In recent years, the spectrum of available treatments has been widened by the introduction of new drugs and interventional procedures.
METHODS
Selective literature review on the treatment of uterine fibroids, including consideration of several Cochrane Reviews.
RESULTS
Fibroids can be treated with drugs, interventional procedures (uterine artery embolization [UAE] and focused ultrasound treatment [FUS]), and surgery. The evidence regarding the various available treatments is mixed. All methods improve symptoms, but only a few comparative studies have been performed. A meta-analysis revealed that recovery within 15 days is more common after laparoscopic enucleation than after open surgery (odds ratio [OR], 3.2). A minimally invasive hysterectomy, or one performed by the vaginal route, is associated with a shorter hospital stay and a more rapid recovery than open transabdominal hysterectomy. UAE is an alternative to hysterectomy for selected patients. The re-intervention rates after fibroid enucleation, hysterectomy, and UAE are 8.9-9%, 1.8-10.7%, and 7-34.6%, respectively. The main drugs used to treat fibroids are gonadotropin-releasing hormone analogs and selective progesterone receptor modulators.
CONCLUSION
Multiple treatment options are available and enable individualized therapy for symptomatic fibroids. The most important considerations in the choice of treatment are the question of family planning and, in some cases, the technical limitations of the treatments themselves.
Topics: Antineoplastic Agents; Combined Modality Therapy; Evidence-Based Medicine; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Leiomyoma; Minimally Invasive Surgical Procedures; Organ Preservation; Treatment Outcome; Ultrasonography; Uterine Neoplasms
PubMed: 25597366
DOI: 10.3238/arztebl.2014.0877 -
Medical Ultrasonography Dec 2011Transabdominal ultrasound is clinically useful in detecting Crohn's disease (initial diagnosis) by evaluating bowel wall thickness and surrounding structures including... (Review)
Review
Transabdominal ultrasound is clinically useful in detecting Crohn's disease (initial diagnosis) by evaluating bowel wall thickness and surrounding structures including periintestinal inflammatory reaction, extent and localization of involved bowel segments and detection of extraluminal complications such as fistula, abscesses, carcinoma and ileus. Transabdominal ultrasound presently is accepted as a clinically important first line tool in assessing patients with Crohn's disease irrespective of their clinical symptoms and/or disease activity. It helps to better characterize the disease course in individual patients and can guide therapeutic decisions. In this review the current literature will be analysed.
Topics: Contrast Media; Humans; Inflammatory Bowel Diseases; Magnetic Resonance Imaging; Predictive Value of Tests; Sensitivity and Specificity; Transducers; Ultrasonography, Doppler, Color
PubMed: 22132403
DOI: No ID Found -
Ugeskrift For Laeger Mar 2014This focused review describes the current use and future perspectives regarding transabdominal bowel sonography (TABS). The technique for B-mode and Doppler is described... (Review)
Review
This focused review describes the current use and future perspectives regarding transabdominal bowel sonography (TABS). The technique for B-mode and Doppler is described and the use of ultrasound contrast and elastography is discussed. Pathology and subsequent imaging findings are focused on appendicitis, diverticulitis, inflammatory bowel diseases and within paediatric conditions along with other common intestinal pathology. In conclusion we find that TABS is a fast, efficient, low-cost and non-ionization imaging technique without any patient discomfort.
Topics: Child; Gastrointestinal Diseases; Humans; Ultrasonography
PubMed: 25096012
DOI: No ID Found -
Ultrasound in Medicine & Biology Dec 2021The incidence and mortality rates of pancreatic cancer (PC) are increasing. It is important to discriminate PC from the other pancreatic lesions; however, differential... (Meta-Analysis)
Meta-Analysis Review
The incidence and mortality rates of pancreatic cancer (PC) are increasing. It is important to discriminate PC from the other pancreatic lesions; however, differential diagnosis based on conventional transabdominal ultrasound (US) remains challenging even though US is often the first examination performed. Transabdominal contrast-enhanced ultrasound (CEUS) has high diagnostic accuracy for PC. This meta-analysis aimed to examine the utility of low-mechanical-index CEUS with enhancement for PC diagnosis. A systematic meta-analysis of all potentially relevant articles was performed. Fixed-effects or random-effects models were used to investigate pooled sensitivity, specificity, positive likelihood ratio (LR) and negative LR. The study enrolled 983 patients from nine eligible studies. The pooled estimates of sensitivity and specificity were 92% (95% confidence interval [CI]: 0.89-0.94) and 76% (95% CI: 0.71-0.81), respectively. The diagnostic odds ratio (DOR) for CEUS was high (53.62). The area under the summary receiver operating characteristic curve was 0.95. Funnel plots revealed no publication bias, and there was no significant relationship between the DORs and study characteristics, including continent, type of contrast agent, contrast agent dosage and scan phase. Only number of patients affected diagnostic ability. This meta-analysis indicates that CEUS with enhancement pattern is useful for diagnosis of PC.
Topics: Contrast Media; Diagnosis, Differential; Humans; Pancreas; Pancreatic Neoplasms; Sensitivity and Specificity; Ultrasonography
PubMed: 34465494
DOI: 10.1016/j.ultrasmedbio.2021.08.005