The proposed combined use of the cervical sonography and fetal fibronectin testing is a practical diagnostic tool for predicting preterm delivery with higher sensitivity and negative predictive value than any of these methods alone.
IntroductionHysteroscopy is considered the ‘gold standard’ procedure in assessing uterine pathology however it is more expensive and invasive method than ultrasonography. An alternative to the diagnostic hysteroscopy is sonohysterography.AimTo evaluate the usefulness of sonohysterography in detecting endometrial polyps in female patients diagnosed with infertility.Material and methodsWe compared the results of sonohysterographic examinations with hysteroscopy combined with histopathological findings.ResultsAll the 241 sonohysterography examinations were performed successfully. No complications were observed. Forty-three hysteroscopies (17.8%) and six sonohysterography examinations (2.5%) were performed in short total intravenous anesthesia because of a low pain threshold of the patients. After hysteroscopic resection polyps were diagnosed in 74 (30.7%) patients. In 72 cases both saline infusion sonography (sonohysterography, SIS) examination and hysteroscopy confirmed the occurrence of an endometrial polyp. In 7 examinations (4.2%) the diagnosed polyp was not confirmed in sonohysterography (false-positive results). Two SIS procedures (2.7%) did not confirm the occurrence of the polyp (false-negative results). Sensitivity, specificity accuracy and error of sonohysterography in detecting endometrial polyps were 97.3%, 95.8% 96.2% and 3.7%, respectively. Positive and negative predictive values were 91.1% (PPV) and 98.7% (NPV). The agreement between SIS and hysteroscopy combined with histopathological examination was very high (K = 0.91).ConclusionsSonohysterography is a safe and highly sensitive and specific method used in diagnostics of endometrial polyps. Its results closely correspond to those obtained in a hysteroscopic examination and histopathological analysis.
Objective: Fetal obstructive uropathy is simple to diagnose before the 24th week of life. Drainage of the pathologically enlarged fetal bladder avoids development of hydronephrosis and destruction of kidneys and, obviously, prevents development of secondary oligohydramnios and pulmonary hypoplasia. The aim of our study was to evaluate the usefulness of a fetal bladder shunt in cases of obstructive uropathy before the 24th week of gestation. Methods: From January 1997 we diagnosed 6 cases of fetal obstructive uropathy before the 24th week of gestation. In all cases oligohydramnios or ahydramnios was also observed. After evaluation of the renal function on the basis of fetal urine samples, we shunted 5 fetuses. After routine preparation of the operative field, a special puncture needle was inserted through the abdominal wall of mother and fetus into the fetal bladder. Through the needle a fetal bladder catheter was inserted between the fetal bladder and the amniotic sac. After shunt placement, fetal urine fills the amniotic sac and the fetal bladder is decompressed. After the procedure, the patients were hospitalized and serial sonographic examinations were performed to evaluate shunt function. Bladder size, presence and size of hydronephrosis, and volume of amniotic fluid were evaluated. Results: The Rocket Medical catheters have an excellent ‘shape memory’. All but 1 newborns had a good perinatal outcome. Mean Apgar score was 8 at 1 min, weight at delivery was between 1,700 and 3,100 g. No pulmonary hypoplasia was observed. All deliveries were after the 33rd week of gestation (range 33–38 weeks). The minimum drainage time was11 weeks, maximum 18 weeks. In 2 cases premature delivery occurred because of premature rupture of the membranes. One newborn died of respiratory distress syndrome. Conclusions: Early bladder drainage (before the 24th week of gestation) enables delivery of newborns with a good perinatal outcome, without pulmonary hypoplasia. This method of therapy limits renal damage and allows time for normal development of the fetal lungs.
Background
The purpose of the study was to assess the clinical value of transvaginal sonography in the group of women presenting with preterm contractions and cervical changes.
Methods
We prospectively evaluated 82 patients between 23 and 34 weeks of gestation presenting in our Department with signs and symptoms of preterm labor, intact membranes and cervical dilatation < 3 cm. In all cases transvaginal sonography was performed.
Results
The rate of preterm delivery (< 37 weeks) was 25.6% and 17.1% of the patients delivered ≤ 28 days from the examination. Among the analyzed parameters, the significant difference between patients delivered ≤ 28 and > 28 days from examination, was noticed only for the functional canal length (21.6 mm vs. 30.1 mm; P < 0.001). The analysis of ROC curves showed that functional canal length had the highest diagnostic capability. Two important thresholds were found – 20 mm and 31 mm. For predicting delivery ≤ 28 days the functional canal length ≤ 20 mm had sensitivity of 57.1%, specificity of 92.6%, PPV of 61.5% and NPV of 91.3%. The cutoff value of 31 mm had sensitivity of 100%, specificity of 47.1%, PPV of 28% and NPV of 100%. In multiple logistic regression analysis only FCL ≤ 20 mm (OR 8.18; P = 0.027) was independently associated with PTD.
Conclusions
The shortening of the functional canal length (≤ 20 mm) is predictive of impending preterm delivery and the functional canal length > 31 mm is the indicator of the absence of labor.
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