scholarly journals The diagnostic role of the β-hCG discriminatory zone combined with the endometrial pattern for ectopic pregnancy in Chinese women

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Qi Lu ◽  
Yiwei Wang ◽  
Xiao Sun ◽  
Yuhong Li ◽  
Jing Wang ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Chinese Women ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Diagnostic Value ◽  
Wide Range ◽  
Endometrial Pattern ◽  
Diagnostic Role ◽  
Β Hcg

Abstract Previous studies have regarded the discriminatory serum β-hCG zone (DSZ) as a valuable tool for the diagnosis of ectopic pregnancy (EP). However, the wide range of the DSZ makes achieving a clinical diagnosis of EP difficult, and these reports do not indicate whether the DSZ is suitable for an EP diagnosis in Chinese women. Several studies have indicated that the endometrial pattern in patients with EPs is different from that in patients with intrauterine pregnancies (IUPs). The aims of this study were to define the DSZ cutoff value for Chinese women, test whether the endometrial pattern is a suitable predictor for EP, and assess the diagnostic value of these indicators. We enrolled participants with IUPs or EPs with abdominal pain and/or vaginal bleeding, and serum β-hCG level measurements and transvaginal ultrasound (TVS) were performed to assess the diagnostic value of the indicators for EP. The sensitivity and specificity for identifying an EP were improved by combining the DSZ, endometrial thickness and trilaminar pattern indexes. The results of this study might be helpful toward providing further options for the diagnosis of EP, especially for patients without hemoperitoneum or colporrhagia.

Role of Serum β-HCG doubling in Diagnosis of Early Pregnancy and its Management Strategy

2020 ◽  
Vol 16 ◽  
Author(s):  
Divya Mirji ◽  
Shubha Rao ◽  
Akhila Vasudeva ◽  
Roopa P.S
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Management Strategy ◽  
Transvaginal Ultrasound ◽  
Expectant Management ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Β Hcg ◽  
Pregnancy Of Unknown Location

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected with early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and ß-HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and ß-HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum ß-HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their ß-HCG. Those who had an IUP, 11% had a suboptimal increase in ß-HCG. Conclusion: PUL rate in our unit was 6%. Majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial ß-HCG values, clinical assessments and upon the consent of the patient.

A Clinico-pathological Study of Transvaginal Endometrial Thickness Measurement in Asymptomatic Postmenopausal Patients and Patients with Postmenopausal Bleeding

2019 ◽  
pp. 1
Author(s):  
Ayse Filiz Gokmen Karasu ◽  
Seda Ates ◽  
Tugba Gurbuz ◽  
Nurhan Sahin ◽  
Taha Takmaz ◽  
...  
Keyword(s):  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Thickness Measurement ◽  
University Hospital ◽  
Postmenopausal Bleeding ◽  
Pathological Study ◽  
Endometrial Polyps ◽  
Endometrial Sampling ◽  
Proliferative Endometrium

<p><strong>Objective:</strong> We aimed to determine the frequency of endometrial pathologies of patients who presented to our outpatient clinic with postmenopausal bleeding (PMB) and asymptomatic menopausal patients with a finding of thickened endometrium on transvaginal ultrasonography.</p><p><strong>Study Design:</strong> This study was performed at Bezmialem University Hospital. Women who presented to our clinic from January 2015 to January 2017 were analyzed. Patients were divided to two groups. All patients underwent transvaginal ultrasound with a 7.5 MHz probe. Endometrial sampling was performed by either blind D&amp;C (dilatation &amp; curettage) or pipelle sampling. We excluded patient specimens that were obtained by hysteroscopy.</p><p><strong>Results:</strong> Electronic records of a total of 368 patients in menopause were inspected. Out of these patients; 287 (78%) underwent endometrium sampling indicated by bleeding. Eighty-one patients (22%) were asymptomatic; however, a thickened endometrium echo on TVUSG examination (≥ 5 mm) was suspected. The median age was 57 (42-85). In both groups the two leading causes of endometrial pathology was; endometrial polyps followed by proliferative endometrium. The frequency of endometrial cancer was 9.4 % for the PMB group and 1.2 % in the asymptomatic patient group</p><p><strong>Conclusion:</strong> Evaluation of PMB as soon as possible is essential for diagnosing endometrial pathologies. Role of endometrial thickness is decisive in detecting patients at high risk for malignancy especially with comorbid conditions. Histopathological evaluation is mandatory for ruling out malignancy.</p>

scholarly journals 332 The diagnostic role of shunt series radiographs (SSR) in children presenting to the children’s emergency department (CED) with suspected ventriculoperitoneal (VP) shunt failure

2020 ◽  
Vol 37 (12) ◽  
pp. 852.3-853
Author(s):  
Angharad Griffiths ◽  
Ikechukwu Okafor ◽  
Thomas Beattie
Keyword(s):  
Clinical Outcome ◽  
Sensitivity And Specificity ◽  
Clinical Information ◽  
Flow Diagram ◽  
List Type ◽  
Shunt Failure ◽  
Vp Shunt ◽  
Wide Range ◽  
Diagnostic Role

Aims/Objectives/BackgroundVP shunts are used to drain CSF from the cranial vault because of a wide range of pathologies and, like any piece of hardware, can fail. Traditionally investigations include SSR and CT. This project examines the role of SSR in evaluating children with suspected VP shunt failure.Primary outcome: Sensitivity and specificity of SSR in children presenting to the CED with concern for shunt failure.Methods/DesignConducted in a single centre, tertiary CED of the national Irish Neurosurgical(NS) referral centre (ED attendance:>50,000 patients/year). 100 sequential SSR requested by the CED were reviewed. Clinical information was extracted from electronic requests. Shunt failure was defined by the need for NS intervention(Revision).Abstract 332 Figure 1Abstract 332 Figure 2Results/ConclusionsSensitivity and specificity is presented in figure 1 (two by two table).100 radiographs performed in 84 children.22% shunts revised (see flow diagram).7 SSR’s were abnormal.85% (n=6) shunts revised. [5 following abnormal CT].Of the normal SSR’s; 16 had abnormal CT and revised.85/100 received CT.64 of 85 CT’s (75%) were normal.□6 of the 64 had focal shunt concern.SSR’s shouldn’t be used in isolation. NPV&PPV, Sensitivity&Specificity is low.SSR’s are beneficial where there’s concern over focal shunt problems (injury/pain/swelling) or following abnormal CT.VP shunt failure is not well investigated with SSR alone.SSR’s could be omitted where there is no focal shunt concern/after normal CT (without impacting clinical outcome) reducing radiation exposure and reduce impact on CED’s.59 SSR’s could have been avoided without adverse clinical outcome.

scholarly journals Transvaginal ultrasound compared with serum β-hCG level for diagnosis of ectopic pregnancy in symptomatic patients

2020 ◽  
Vol 9 (3) ◽  
pp. 1228
Author(s):  
Somayeh Zeynizadeh Jeddi ◽  
Noushin Mobaraki ◽  
Akbar Pirzadeh
Keyword(s):  
Serum Level ◽  
Ectopic Pregnancy ◽  
Imaging Modality ◽  
Transvaginal Ultrasound ◽  
Correct Diagnosis ◽  
Expert Radiologist ◽  
Significant Difference ◽  
Time Gap ◽  
The Mean ◽  
Β Hcg

Background: Ultrasonography (US) is the most important imaging modality in detecting both intrauterine and ectopic pregnancies. The aim of this study was to comparison transvaginal ultrasound with serum β-hCG level for diagnosis of ectopic pregnancy (Ep) in referred women to Ardabil city hospital.Methods: In this cross-sectional study, a total of 207 women with diagnosis of Ep were enrolled during 2018. All women underwent transvaginal US in the first 24 hours and US done by an expert radiologist. Serum levels of β-hCG at first 24 hours and the time gap between US examination and last menstrual period (LMP) were compared between women with positive and negative US findings. Data collected by a checklist and analyzed by statistical method in SPSS version 21.Results: The primary US were positive in 174 women (84.1%) and negative in 33 women (15.9%). The mean of time gap between US and LMP in women with diagnosed EP was significantly higher than other women (median, 42 days versus 45 days, p=0.042). Also, the mean of serum level of β-hCG had significant difference between two groups. In logistic regression analysis results showed that the time gap between US and LMP hadn’t significant impact on EP diagnosis. The best discriminative zone was set at a serum β-hCG level of 105.65 mIU/ml with a sensitivity and specificity of 82% and 27%, respectively and the under-ROC area was 58%.Conclusions: According to our findings, the median serum level of β-hCG in women with undiagnosed Ep were significantly lower than women with correct diagnosis of Ep but the mean and median of time gap between US and LMP in women with diagnosed EP was more than women without Ep. Also, the proposed discriminative zone for serum level of β-hCG in our study is different from the previous studies.

scholarly journals Avaliação ultrassonográfica no espessamento endometrial: revisão de literatura

2017 ◽  
Vol 4 (4) ◽  
pp. 60
Author(s):  
Débora Filardi Silveira ◽  
Carlos Alberto Rodrigues Junior ◽  
Fellipe Camargo Ferreira Dias ◽  
Camila Filardi Silveira ◽  
Caroline Filardi Silveira
Keyword(s):  
Transvaginal Ultrasound ◽  
Abnormal Uterine Bleeding ◽  
Reproductive Age ◽  
Female Population ◽  
Ultrasound Evaluation ◽  
Endometrial Pattern ◽  
Uterine Mucosa ◽  
Uterine Synechia ◽  
Uterine Diseases

Introdução: A avaliação ecográfica do endométrio permite a análise minuciosa da mucosa uterina na prática clínica ginecológica, com o intuito de auxiliar no manejo das patologias endometriais. Neste artigo, fazemos uma revisão narrativa para avaliar o real papel da ecografia pélvica na visualização das doenças endometriais. As alterações uterinas, como pólipos, miomas, sinéquias uterinas, hiperplasia e câncer endometrial são morbidades frequentes na população feminina, tanto nas pacientes em idade reprodutiva como nas que estão na pós-menopausa. Os métodos de avaliação endometrial têm obtido diversos avanços nos tempos atuais, sendo o ultrassom transvaginal o método de escolha para investigação inicial das doenças endometriais, tanto nas pacientes com sangramento genital, quanto nas mulheres assintomáticas principalmente na pós-menopausa. Conclusão: A ecografia é o exame primordial e elementar na investigação de pacientes com sangramento uterino anormal ou sob suspeita de outras doenças que alteram o padrão endometrial, conduzindo o prognóstico do quadro investigado.   Palavras-chave: Ultrassonografia, Doenças Uterinas, Endométrio. ABSTRACT Introduction: The ultrasound evaluation of the endometrium allows a detailed analysis of the uterine mucosa in gynecological clinical practice, in order to assist in the management of endometrial pathologies. In this article, we make a narrative review to evaluate the real role of pelvic ultrasound in the visualization of endometrial diseases. Uterine changes such as polyps, fibroids, uterine synechia, hyperplasia, and endometrial cancer are frequent morbidities in the female population, both in postmenopausal and post-reproductive age patients. Methods of endometrial evaluation have achieved several advances in the present times, with transvaginal ultrasound being the method of choice for the initial investigation of endometrial diseases, both in patients with genital bleeding and in asymptomatic women, especially postmenopausal women. Conclusion: Ultrasonography is the primary and elemental examination in the investigation of patients with abnormal uterine bleeding or under suspicion of other diseases that alter the endometrial pattern, leading to the prognosis of the investigated condition. Keywords: Ultrasonography, Uterine Diseases, Endometrium.

The role of sonographic endometrial patterns and endometrial thickness in the differential diagnosis of ectopic pregnancy

2005 ◽  
Vol 192 (5) ◽  
pp. 1370-1375 ◽  
Author(s):  
Ahmad O. Hammoud ◽  
Ihab Hammoud ◽  
Emmanuel Bujold ◽  
Bernard Gonik ◽  
Michael P. Diamond ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Ectopic Pregnancy ◽  
Endometrial Thickness

scholarly journals Unruptured unilateral twin ectopic pregnancy: a rare case report

2020 ◽  
Vol 9 (5) ◽  
pp. 2151
Author(s):  
Nayanika Gaur ◽  
Piyush K. Goyal ◽  
Manish Jha
Keyword(s):  
Case Report ◽  
Ectopic Pregnancy ◽  
Transvaginal Ultrasound ◽  
Complete Recovery ◽  
Intrauterine Pregnancy ◽  
Serum Progesterone ◽  
Post Surgery ◽  
Β Hcg ◽  
The Right

Unilateral twin ectopic pregnancy is a rare entity with an incidence of 1 in 125,000 pregnancies. This is a case of a 26-year-old primigravida with a spontaneous unilateral twin ectopic gestation, diagnosed on transvaginal ultrasound, treated laparoscopically by doing unilateral salpingectomy and confirmed with histopathology. The doubt for ectopic pregnancy was raised when the serum β-HCG level was constantly >1500 mIU/ml and serum progesterone level was <5 pg/ml and no intrauterine pregnancy was seen. On a follow-up scan, twin gestational sac was noted in right adnexa along with a large haemorrhagic cyst in the right ovary. On post-surgery follow-up, patient was found to have had complete recovery. This case report discusses the incidence and rarity, yet possibility of twin ectopic gestations, the need for early diagnosis and its management.

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