Objectives: To test the accuracy of TVS applying the IDEA approach for suspected rectosigmoid DE and to determine the frequency of other pelvic diseases mimicking DE in patients undergoing surgery. Materials und Methods: Prospective single center observational study including consecutive women undergoing TVS for clinically suspected rectosigmoid DE followed by conservative or surgical therapy. TVS findings were compared with those obtained by laparoscopy and confirmed histologically. Results: Of the 671 included patients, 128 women opted for medical therapy, and 6 patients decided for surgery but did not give consent to participate in the study. 537 women were enrolled in the final analysis. 279 (52%) exhibited surgically confirmed rectosigmoid DE. The sensitivity and specificity, positive and negative predictive value (PPV, NPV), positive and negative likelihood ratio (LR+/-) and accuracy of TVS for diagnosing DE in the rectosigmoid were 93.5%, 94.6%, 94.9%, 93.1%, 17.24, 0.07, 94.04%. 12 women who were clinically suspected for DE and mimicked sonographic signs fulfilling the IDEA criteria did exhibit other pathologies. Diagnoses were as follows: vaginal Gartner duct cyst (3/291;1.0%), anorectal abscess (3/291;1.0%), rectal cancer (2/291;0.7%), hydrosalpinx (2/291;0.7%), metastatic endometrial cancer (1/291;0.35%) and Crohn’s disease (1/291;0.35%). Conclusion: TVS for diagnosing colorectal DE applying the IDEA criteria is highly accurate for presurgical diagnosis. However, additional pelvic pathologies are encountered in 4-5% of women attending for suspected rectosigmoid DE. These need to be taken into account when investigating patients for suspected DE. Ziel: Die Prüfung der diagnostischen Aussagekraft der TVS nach dem IDEA-Protokoll bei Verdacht auf rektosigmoidale TIE und Bestimmung der Häufigkeit möglicher anderwertiger pathologischer Veränderungen. Material und Methode: Prospektive TVS-basierte Beobachtungsstudie mit konsekutivem Einschluss von Patientinnen mit klinischem Verdacht auf rektosigmoidale TIE. Die Ergebnisse der TVS wurden mit den Ergebnissen der chirurgischen Therapie verglichen. Ergebnisse: Von den 671 Patientinnen, die sich einer TVS unterzogen, 128 Frauen entschieden sich für eine medikamentöse Therapie. 6 Patientinnen entschieden sich für einen chirurgischen Eingriff, gaben aber keine Zustimmung zur Teilnahme an der Studie. 537 Patientinnen wurden in die Studie aufgenommen. 279 (52%) Patientinnen wiesen histologisch verifizierte rektosigmoidale TIE auf. Die Sensitivität und Spezifität, der PPV der NPV, die LR+ und die LR- sowie die Genauigkeit der TVS zur Diagnose von rektosigmoidealen TIE lagen bei 93,5 %, 91,8 %, 94,9 % 89,7 %, 11,54, 0,07, 92,9 %. 12 Frauen, bei denen ein klinischer und sonografischer Verdacht auf rektosigmoidale TIE bestand wiesen andere Pathologien auf: Gartner-Gang Zyste der Vaginalwand (3/291;1,0 %), anorektaler Abszess (3/291;1,0 %), Rektumkarzinom (2/291;0,7 %), Hydrosalpinx (2/291;0,7 %), metastasierendes Endometriumkarzinom (1/291;0,35 %) und Morbus Crohn (1/291;0,35 %). Schlussfolgerungen: Die TVS zur prächirurgischen Diagnose der rektosigmoidalen TIE unter Anwendung des IDEA-Protokolls ist aussagekräftig. Bei etwa 4-5 % der Patientinnen mit sonografischen, IDEA-basierten Zeichen einer rektosigmoidalen TIE, müssen anderwertige Krankheiten in Betracht gezogen werden.

The sacral plexus (SP) and sacral nerve roots can be identified and assessed on transvaginal ultrasonography (TVS). What are the clinical implications of this work?Incorporating visualization of the SP into presurgical pelvic TVS may improve preoperative planning and counseling in women undergoing laparoscopic dissection of sacral nerve roots for deep endometriosis.

Objectives: Severe neonatal hypoglycemia (SNH) can cause brain injury and long-term neurodevelopmental impairment. The aim of this study was to investigate the diagnostic effectiveness of ultrasound markers measured in the third trimester as predictors of SNH and determine if current practice can be improved. Methods: An unselected cohort of 6250 singleton fetuses had a universal 36 week scan in a single tertiary referral centre (2016)(2017). The variables included in the analysis were the criteria used in current practice to predict SNH (birthweight (BW) < 10 th centile, pre-existing diabetes, gestational diabetes, gestational age at delivery) and cerebro-placental ratio (CPR), AC growth velocity (ACGV), maternal body mass index (BMI) and fetal gender. The ACGV was defined as the Z-score AC difference between 20 and 36 weeks. Our outcome was SNH defined as glycemia < 2.0 mmol/l within 4 hours of delivery and requiring admission to neonatal unit. Univariate and multivariate logistic regression analyses were used to assess the association between these variables and SNH. The receiver-operating characteristics curve (ROC) analysis was used to investigate the predictive accuracy of the current practice model and determine if adding new markers could improve the detection of SNH. Results: A total of 143 (2.3%) neonates had SNH. The current practice model showed an area under the curve (AUC) of 0.69 (95% confidence interval (CI), 0.68-0.71). Our predictive model (AUC, 0.77; 95% CI, 0.76-0.78) included the current practice variables and CPR (odds ratio (OR) 0.44; 95% CI, 0.28-0.69), ACGV (OR 1.43; 95% CI, 1.19-1.72), BMI (OR 1.01; 95% CI, 1.001-1.015) and male gender (OR 1.90; 95% CI, 1.28-2.82). Adding CPR < 5 th centile (OR 3.42; 95% CI, 2.01-5.82) and ACGV > 90 th centile (OR 2.30; 95% CI, to the current practice model showed AUC 0.73 (95% CI, 0.72-0.74). Conclusions: Using CPR and ACGV in addition to the predictive criteria currently used in clinical practice improves the identification of neonates at risk of SNH. axial or anteverted/retroflexed uterus was associated with a negative sliding sign (p < 0.001). Conclusions:We have shown that the prevalence of POD obliteration on ultrasound evaluation in the general population

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Objectives: We aimed to assess the knowledge of the lay general population regarding the utility and availability of tools to diagnosis endometriosis, with special attention on ultrasound. Methods: An international cross-sectional e-mail survey study was performed between August and October 2019. Questions were designed by the study team and piloted on a small group of volunteers. The e-survey was distributed globally via patientand community-endometriosis groups using social media. The survey consisted of 23 questions and focused on the diagnosis of endometriosis. The primary study outcome was to understand the international knowledge of ultrasound utility for diagnosing endometriosis. Responses were summarised using numbers and percentages, and comparisons were made using chi-squared tests. Results: There were 5302 respondents, representing 73 countries, with a mean age of 25.5 years. Female-identifying individuals made up the majority of the respondents (98.5%). 84.0% of respondents stated they had been previously diagnosed with endometriosis, 71.5% of which were diagnosed at the time of surgery. Ultrasound and MRI were the methods of diagnosis in 6.5% and 1.8%, respectively. 28.8% and 16.6% of respondents believed ultrasound and MRI could diagnose endometriosis, respectively. In those diagnosed by surgery, 21.7% knew about ultrasound as a method of diagnosis compared to 51.5% knowing in those not diagnosed by surgery (p < 0.001). 58.4% of respondents do not believe they could access an advanced TVS in their region. Conclusions: The majority of respondents had previously been diagnosed with endometriosis. As such, the respondents may represent an above-average educated sample for endometriosis diagnosis. Still, there are major gaps in the understanding of diagnosing endometriosis using non-invasive imaging for this study population. To reduce the reliance on invasive diagnostic laparoscopy, we must work to improve the awareness of the lay population on the utility of non-invasive imaging, especially ultrasound.