Uterine leiomyomas or uterine fibroids are the most common gynaecological tumours and occur in about 20-50% of women around the world. Ultrasonography (USG) is the first-line imaging examination in suspected fibroids and shows high sensitivity and specificity in diagnosing this condition. Ultrasound scans can be performed transvaginally (transvaginal scan – TVS) or transabdominally (transabdominal scan – TAS); both scans have advantages and limitations, but, in general, transvaginal sonography is superior to transabdominal sonography in most cases of pelvic pathology. Whether a leiomyoma is symptomatic or not depends primarily on its size and location. During ultrasound examination, leiomyomas usually appear as well-defined, solid, concentric, hypoechoic masses that cause a variable amount of acoustic shadowing. During the examination of leiomyomas differential diagnosis is important. Some of the most common misdiagnosed pathologies are adenomyosis, solid tumours of adnexa, and endometrial polyps. Misdiagnosis of a leiomyosarcoma has the most negative consequences, presenting symptoms are very similar to benign leiomyoma, and there is no pelvic imaging technique that can reliably differentiate between those pathologies. Magnetic resonance and computer tomography might be helpful in the diagnostics of uterine leiomyoma; however, ultrasound examination is the basic imaging test confirming the existence of leiomyomas, allowing the differentiation of myomas with adenomyosis, endometrial polyps, ovarian tumours, and pregnant uterus.
Cesarean sections account for approximately 20% of all deliveries worldwide. In Poland, the percentage of women delivering by cesarean section amounts to over 43%. According to studies, the prevalence of cesarean scar defects ranges from 24–70%. Due to the overall cesarean section rate, this is a medical problem affecting a large population of women. In such cases, ultrasonographic evaluation of a cesarean scar reveals a hypoechoic space filled with postmenstrual blood, representing a myometrial tear at the wound site. Such an ultrasound appearance is referred to as a niche, and it forms after a cesarean section at the site of the hysterotomy of the anterior uterine wall, most commonly within the uterine isthmus. Currently, the exact cause of niche formation remains unexplained, yet the risk factors for its development are universally acknowledged. They include the site of hysterotomy, multiple previous cesarean section deliveries, suturing technique and maternal diabetes or smoking. Ultrasound evaluation of the cesarean section scar is an important element of obstetric and gynecologic practice, especially in the case of further pregnancies. It facilitates an early diagnosis of a cesarean scar ectopic pregnancy, and the prediction of the risk for perinatal dehiscence in the case of a vaginal birth after a cesarean section.
Heterotopic caesarean scar pregnancy (CSP) is a coexistence of an intrauterine pregnancy with an ectopic pregnancy located in a caesarean scar. The are no universal treatment guidelines to manage this extremely rare condition. Vaginal bleeding is the most common symptom of heterotopic CSP, but most of the cases are asymptomatic. The management of heterotopic CSP is difficult especially in patients who want to preserve the intrauterine pregnancy. A 33-years-old patient, one caesarean section (CS) in history, at 6 weeks of gestation was admitted to the hospital to confirm the diagnosis of ectopic pregnancy. On transvaginal ultrasound a heterotopic pregnancy was visualized. One gestational sac (GS) was located within the uterus cavity, another one was implanted in the anterior wall of cervicoisthmic area in the caesarean scar ( Fig. 1). In both embryos the foetal heart rate was observed, the crown-rump length was 3.4 mm in the intrauterine pregnancy and 2.4 mm in the heterotopic CSP. The cervical canal was closed and measured 49 mm in length. There was no bleeding on the speculum examination. The patient was asymptomatic. Several treatment options were described in the literature: embryo aspiration of CSP, systemic or local injection of methotrexate, local injections of potassium chloride (KCl) or hyperosmolar glucose, laparoscopy or hysteroscopy. After being informed about the high risk of continuing the heterotopic CSP and possible complications of treatment, the patient decided to preserve the intrauterine pregnancy (IUP) and terminate the heterotopic CSP. Selective embryo termination was performed at 7 weeks of gestation by local ultrasound guided injection of KCl into the GS implanted in the caesarean scar. After the procedure the foetal heart rate was no longer visible in the heterotopic CSP, but confirmed in the IUP. Further pregnancy course was normal (Fig. 2) and there were no ultrasound abnormalities in the caesarean scar area (Fig. 3). The patient delivered a 3060g healthy male infant by elective CS at 37 weeks of gestation. The procedure and the puerperium were not complicated. During the CS only a minimal dehiscent was seen in the previous caesarean scar area (Fig. 4). Heterotopic CSP should be considered in patients with a CS in history, especially in cases where assisted reproductive technologies were used. Early diagnosis is the essential part of heterotopic CSP treatment. Transvaginal ultrasonography seems to be the ideal tool to detect heterotopic CSP in the 1 st trimester. Early detection and treatment of heterotopic CSP increases the probability of preserving the IUP.
Introduction and hypothesisOveractive bladder (OAB) and mixed urinary incontinence (MUI) are significant problems worldwide. Their broad definition makes them difficult to diagnose; therefore, specialists need a tool to confirm diagnosis. The Overactive Bladder Symptom Score (OABSS) is used in the objective diagnosis of OAB. We aimed to develop and evaluate the effectiveness of OABSS for patients in Poland suffering from OAB and MUI and to correlate it with UDI-6 and IIQ-7.MethodsA total of 824 women suffering from urinary incontinence (UI) aged between 18 and 75 years were included. SUI (n = 290); OAB (n = 285) and MUI (n = 249) were confirmed by medical history and urodynamic study. Of the subjects, 821 women completed the Polish version of OABSS on two separate visits: weeks 0 and 2. In addition, they undertook UDI-6 and IIQ-7 during Week 2. The Cronbach’s alpha (α) was used to estimate the internal consistency. Scores were compared using the intraclass correlation coefficient (ICC).ResultsWe observed statistically significant differences (p < 0.0005) between mean scores of OABSS among patients from the study groups OAB-SUI and MUI-SUI. We did not observe statistically significant differences between patients from the MUI and OAB groups (p > 0.11). Analysis also did not show statistically significant differences between visits.The internal consistency was very good: α = 0.89 (SUI); = 0.9 (OAB); = 0.82 (MUI). In all groups, test–retest reliability was excellent; ICC was >0.99.ConclusionsThe Polish version of the OABSS is a reliable tool for females suffering from UI. However, OABSS does not distinguish patients with MUI from patients with OAB.
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