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Article
Diagnostic Efficacy of Transvaginal Colour Doppler Sonography in Ectopic Pregnancy

Author: Lilyan W. Sersam
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 1 Pages: 63-70
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Ectopic pregnancy continues to be a major cause of maternal morbidity and mortality . A dramatic increase in incidence over time has been reported in several countries. The advent and wide application of ultrasound has greately improved the possibility of non- surgical diagnosis of ectopic pregnancy . Images obtained by the higher frequency and better resolution transvaginal ultrasound scan (TVS) probes facilitates the earlier diagnosis of ectopic pregnancy. The addition of Doppler ultrasound have revolutionised the non-invasive diagnosis of ectopic pregnancy.METHODS:Patients presenting to Al-Yarmouk Teaching Hospital with clinical suspicion of ectopic pregnancy were evaluated using TVUS. Colour flow imaging was performed and resistance indices (RIs) of the artery blood flow were calculated . The pulsatility indices (PIs) of both uterine arteries were also measured and serum β-hCG was quantitated . The Doppler flow results were correlated with surgical findings at laparoscopy or explorative laparotomy .RESULTS:Forty-seven women were enrolled .Six patients with intrauterine gestation were excluded . Tubal pregnancy was diagnosed by TVUS in 28 of 32 patients with ectopic pregnancy, while 30 of 32 patients were diagnosed by colour Doppler sonography. Colour flow in the trophoblastic tissue was detected in 59.3% of the tubal pregnancies, and the mean (±SD) RI of the trophoblastic flow was (0.49 ±0.1) . The RIs tended to decrease at higher β- hCG levels. The average PI of the uterine arteries was (2.29 ± 0.3) . The PIs of the ipsilateral uterine arteries were significantly lower than the contralateral ones. The sensitivity of colour Doppler in the diagnosis of ectopic pregnancy was (93.8%) with accuracy of (85.4%)CONCLUSION:Colour imaging is a good supplementary diagnostic tool in modern management of ectopic pregnancy . The addition of colour Doppler flow imaging to transvaginal sonography allows increased sensitivity in the detection of ectopic pregnancy.


Article
Performance of Ultrasound as a Second Line Test to Serum Ca125 in Ovarian Cancer Screening in Postmenopausal Women

Authors: Nada Salih Amin --- Asmaa Mohammed Abid
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 1 Pages: 29-36
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Epithelial ovarian cancer is uncommon before 40 years of age but the incidence then rises steeply until the mid sixth and seventh decades for which performance of transvaginal ultrasonography as a screening test for ovarian cancer in asymptomatic postmenopausal women with an elevated serum CA 125 had been performed.OBJECTIVE: Prospective ovarian cancer screening trial had been performed to estimate sensitivity, specifity and positive predictive value of different ultrasound criteria for detection of index cancer (e.g. primary invasive epithelial carcinoma of ovary) in postmenopausal women.PATIENTS AND METHODS:This study was carried out at the department of obstetrics and gynecology in AL-Yarmouk Teaching Hospital from October 2002 through October2003.The study included 110 Postmenopausal women ≥ 45 years, they underwent measurement of serum CA125.Women with CA 125 of 30 IU/ml (or more) were recalled for an ultrasound examination. RESULTS: Of the 110 women included in this study, 9 women underwent 30 scans during a follow up of one year. The sensitivity for detection of ovarian cancer of different ultrasound criteria was 100% for abnormal ovarian morphology, 100% for abnormal ovarian volume and 50% for complex abnormal ovarian morphology. The highest specificity (100%) and positive predictive value (100 %) was achieved by using complex abnormal ovarian morphology.CONCLUSION: A variety of ultrasound criteria had achieved high sensitivity, specificity and positive predictive value for ovarian cancer screening in postmenopausal women with an elevated CA 125. Ovarian morphology and ovarian volume used to interpret ultrasound had achieved increased sensitivity for ovarian cancer screening. While complex abnormal ovarian morphology had achieved increased in the specificity and the positive predictive value for ovarian cancer screening.KEYWORDS: ovarian cancer, CA125, transvaginal ultrasound.


Article
Comparism Between Transvaginal Cervical Length Measurement and Digital Examination in Prediction of Imminent preterm Delivery

Authors: Maha M. AL-Bayati --- Asmaa Mohammed Abid --- Shaima Kadhim Jasim
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 2 Pages: 195-201
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Preterm labour is a major cause of perinatal morbidity and mortality, so it is important to predict preterm delivery using the clinical examination of the cervix and uterine contraction frequency. New markers for the prediction of preterm birth have been developed such as transvaginal ultrasound measurement of cervical length as this method is widely available.OBJECTIVE: To determine, whether transvaginal cervical length measurement predicts imminent preterm delivery better than digital cervical length measurement in women presented with preterm labour and intact membranes. PATIENTS AND METHODS: Two hundred women presented with preterm labour between 24 and 36+6 weeks of gestation were included in this study. All women subjected for digital and transvaginal ultrasound cervical length measurement and the outcome measures were occurrence of preterm delivery within 48 hours and within 7 days. RESULTS: Assessment of cervical length measurement using transvaginal ultrasound for the 200 women presented with preterm labour with intact membrane revealed that 8 (4%) delivered within 48 hours and 16 (8%) delivered within 7 days. According to the Bishop score, the test was positive if the Bishop score was ≥8, or 4-7 with cervical length ≤30 mm. The cut-off value for transvaginal ultrasound cervical length considered as 30 mm in the study group. CONCLUSION: Transvaginal sonographic measurement of cervical length can predict imminent preterm delivery in women presented with preterm uterine contractions and Bishop score between 4 - 7 compared with digital cervical length measurement.


Article
Can vaginal ultrasound replace diagnostic curettage in the detection of endometrial pathology in post-menopausal bleeding?

Authors: Media Ghazi Sedeq --- Shawnam Nasih Dawood --- Aska Farooq --- Shahla K. Alalaf
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2019 Volume: 23 Issue: 2 Pages: 233-241
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Post-menopausal bleeding due to endometrial abnormalities is a common diagnostic challenge facing the ultrasonogists and referring gynecologists. This study aimed to detect the validity of transvaginal ultrasound to detect endometrial pathologies and its sensitivity and specificity for determining endometrial carcinoma in women with postmenopausal bleeding.Methods: A diagnostic accuracy study of transvaginal ultrasound and diagnostic curettage was conducted for evaluation of endometrial pathology in the College of Medicine, Hawler Medical University from October2016to January 2018. The sample size included 55 women with post-menopausal vaginal bleeding. The ultrasound findings were compared with histopathological results of endometrial biopsy.Results: Out of 55 women, 49.09% had endometrial atrophy, 29.09% had endometrial hyperplasia, 16.36% had endometrial polyp, 3.64% had endometrial carcinoma, and 1.82% had hyperplasia with atypia according to histopathological findings. The sensitivity of ultrasound in detecting cancer was 66.7%, the specificity was 100%, the positive predictive value (PV) was 100%, and the negative predictive value was 98.1%. The total agreement rate was 98.2%.Conclusion: Transvaginal ultrasound is an excellent diagnostic tool to determine whether further investigation with histopathological examination of endometrial biopsy is necessary for postmenopausal vaginal bleeding.


Article
Determination of Endometrial Thickness Threshold for Prompt Biopsy in Postmenopausal Women Without Vaginal Bleeding

Authors: Nada S. Amen --- Manal Madani Abdul Qader
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 3 Pages: 292-296
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Transvaginal sonography is performed as part of a pelvic sonogram in postmenopausal women and images of the endometrium are frequently obtained . In asymptomatic postmenopausal women without vaginal bleeding, the threshold separating normal from abnormally thickened endometrium is not known.OBJECTIVE:To determine an endometrial thickness threshold using transvaginal sonography for prediction of endometrial cancer in postmenopausal women without vaginal bleeding (asymptomatic) .METHOD:The study group includes 100 asymptomatic postmenopausal women without vaginal bleeding, We measure the sensitivity and specificity of trasvaginal sonography in the prediction of cancer in asymptomatic postmenopausal women without vaginal bleeding at endometrial thickness ≤5mm ,5-10 mm &>10mm ,RESULTS:Four cases (4) of cancer were detected at >10mm endometrial thickness. In asymptomatic postmenopausal women without vaginal bleeding the sensitivity 100% ,specificity 47.91% ,positive predictive values 7.40% and negative predictive values 100% at 10mm endomtrial thickness while at 5mm endomtrial thickness,the sensitivity 100% ,specificity 9.3% ,positive predictive values 4% and negative predictive values 100%CONCLUSION:In asymptomatic postmenopausal women promotion for endometrial sampling if endometrial thickness >10mm seen by trasvaginal sonography give better positive predictive value, sensitivity & specificity than>5mm endometrial thicknes


Article
Predictors of poor first trimester outcome in asymptomatic women : the value of embryonic heart rate , mid sac diameter / yolk sac ratio & mid sac diameter / crown rump length

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Abstract

Background: Ultrasound provides a powerful tool for assessing early pregnancy and detecting pregnancy failure at first trimester and promoting rapid effective management. Several criteria have been established to predict the pregnancy outcome particularly in symptomatic women . Aim: To evaluate asymptomatic women at the first trimester of pregnancy , to assess the efficacy of certain ratios as mid sac diameter (MSD) / yolk sac ratio & crown rump length (CRL)/mid sac diameter (as indicator of early first trimester oligohydramnios) in predicting poor 1st trimester outcome Type of the study: A cross-sectional study.Patients & Methods: A sixty three asymptomatic women were enrolled in this prospective study . Transvaginal sonography was performed for confirmation of pregnancy viability & exclusion of multiple pregnancies 6-8 weeks of gestation & follow up ultrasound repeated at the beginning of second trimester to confirm the continuation of pregnancy and viability of fetus. Several parameters assessed and tested against each others as embryonic heart rate , the size and morphologic criteria of gestational sac , yolk sac and the crown rump length Results: The women were classified into two groups: group A are those with successful outcome at the first trimester and group B are those with poor outcome of the 1st trimester . Decrease embryonic heart rate below 100 beat per minute and low mid sac diameter/ yolk sac size ratio of < 1.9 , were found to be significant predictors of poor outcome however mid sac diameter/crown rump length ratio was not found to have a similar significance Conclusion: In addition to the classical parameters assessed by trans-vaginal ultrasound, other important parameters need to be routinely applied as the embryonic heart rate that predict poor outcome when less than 100 bpm . In addition to the ratio of mid sac diameter to the yolk sac diameter which , if less than 1.9 , may point to abnormal first trimester fate.


Article
Prediction of Prolonged Pregnancy in Nulliparous Women by Transvaginal Ultrasound Measurement of Cervical Length at 37 Weeks of Pregnancy.
تنبؤ طول فترة الحمل عند النساء الحوامل لاول مرة بأعتماد قياس طول عنق الرحم بواسطة السونار المهبلي في فترة ال 37 اسبوع من الحمل

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Abstract:Background: Prolonged pregnancy occurs in approximately 10% of all singleton pregnancies. It is a common cause of increased fetal, maternal and neonatal risks.Objective: To evaluate transvaginal ultrasound measurement of cervical length at 37 weeks gestation as a predictor of prolonged pregnancy in nulliparous women.Patients and methods: This study had been conducted in Al-Kadhymia teaching hospital which enrolled 100 nulliparous women with singleton gestation at 37 weeks. Cervical length was measured by transvaginal ultrasonography at 37 weeks gestation.Results: Cervical length at 37 weeks gestation was longer in women who delivered at > 40 weeks than those delivered at ≤40 weeks and the best cut-off value of cervical length at 37 weeks for the prediction of prolonged pregnancy was 30 mm with a sensitivity of 67% and specificity of 100%. Conclusion: Cervical length at 37 weeks gestation assessed by transvaginal ultrasonography can predict the likelihood of prolonged pregnancy in nulliparous women. Key wards: Prolonged pregnancy, nulliparity, transvaginal ultrasound

الخلاصة:خلفية الدراسة: تاخر موعد الولادة يحدث فيما يقرب من 10% من كل حالات الحمل المفردة .وهي سبب شائع في زيادة المخاطر للجنين والام والطفل حديث الولادة .الهدف من الدراسة : لتقييم قياس طول عنق الرحم بواسطة السونار المهبلي في الاسبوع ال37 من الحمل لتوقع طول مدة الحمل في السيدات اوليات الحمل المرضى وطريقة العمل: تمت الدراسة في مستشفى الكاظمية التعليمي ,و تضمنت الدراسة 100 سيدة اولية الحمل بحمل مفرد في الاسبوع 37 من الحمل . وتم قياس طول عنق الرحم لديهن بواسطة السونار المهبلي في الاسبوع 37 من الحمل.النتائج: كان طول عنق الرحم في الاسبوع 37 من الحمل اطول لمن ولدن في فترة ما بعد 40 اسبوع مقارنة بالنساء اللاتي ولدن قبل الاسبوع 40 وكانت نقطة الحسم لطول عنق الرحم في السبوع 37 للتنبؤ بطول فترة الحمل هي 30 ملم وهي ذات حساسية 67% وبخصوصية 100% الاستنتاج : طول عنق الرحم في الاسبوع 37 من الحمل والمقاس بواسطة السونار المهبلي له قابلية التنبؤ بأحتمالية طول مدة الحمل في السيدات اوليات الحمل الكلمات المفتاحية: الحمل المتأخر ، اولية الحمل ، السونار المهبلي

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