Diagnostic Accuracy of Lower Uterine Segment Scar Thickness ≤1.6mm in Prediction of Scar Dehiscence in patients

Background: Cesarean section uterine scar dehiscence (CSD) is a rare but notable complication of Lower segment cesarean section (LSCS) surgery. The cause for a uterine scar dehiscence is based on the etiology behind the uterine scar defect or any event that would predispose the cesarean scar to dehisce. Globally accepted option for assessing the CS scar is transvaginal ultrasonography of the non-pregnant uterus. Objective: To determine the diagnostic accuracy of lower uterine segment scar thickness≤1.6mm in the prediction of scar dehiscence in patients with previous one LSCS who are undergoing repeat LSCS after trial of labour taking intraoperative findings as gold standard. Material and methods: This cross sectional study was conducted in Services Hospital, Lahore for 6 months. The Non probability consecutive sampling technique was used to include women with previous one LSCS at 36-38 weeks were asked to get their TVS done for scar thickness. Women with scar thickness≤1.6mm and scar thickness>1.6mm were identified. Their intraoperative findings of scar dehiscence were confirmed. All the data was entered and analyzed on SPSS version 20. Results: The mean age of patients was 29.87±6.07 years. The emergency LSCS was done in 599(49.1%) patients and elective LSCS was done in 621(50.9%) patients. The sensitivity, specificity & diagnostic accuracy of TVS was 98.31%, 99.05% & 98.69% respectively. Conclusion: According to our study results the TVS for uterine scar is a very useful and effective tool in the prediction of scar dehiscence in patients with previous one LSCS taking intraoperative findings as gold standard. Keywords: Transvaginal sonography, TVS, Uterine, Scar, dehiscence, LSCS, Intraoperative

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Diagnostic Accuracy of Hysterosonography in Diagnosis of Uterine Lesions by Taking Hysteroscopy as Gold Standard

10.53350/pjmhs211571902 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1902-1905

Author(s):

Farah Naz ◽

Adnan Ahmed ◽

Samina Shaikh ◽

Hafeez ur Rehman ◽

Tahir Baig ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Gold Standard ◽

Pregnancy Loss ◽

Recurrent Pregnancy Loss ◽

Diagnostic Technique ◽

Reproductive Age ◽

Transvaginal Sonography ◽

Cross Sectional ◽

Reproductive Age Women ◽

Specificity And Sensitivity

Background and Aim: Evaluation of uterine abnormalities is infertility core partto be assessed in impaired reproduction cases. Uterine abnormalities can be assessed by various radiological imaging modalities such as transvaginal sonography, hysterosalpingography and hysterosonography. The current study aims to evaluate the diagnostic accuracy of hysterosonography in diagnosis of uterine lesions by taking hysteroscopy as gold standard. Materials and Methods: This observation-based cross-sectional study was carried out on 108 reproductive-age women at the Department of Obstetrics and Gynecology of Liaquat University of Medical and Health Sciences, Jamshoro during the period from January 2020 to June 2020.These women had uterine abnormalities such as recurrent pregnancy loss, abnormal uterine bleeding, infertility, and clinically diagnosed lesions of intrauterine. All individuals underwent hysteroscopy evaluation.Global sensitivity analysis technique was used to calculate the bias-adjusted specificity and sensitivity of hysterosonography. Uterine abnormalities were assessed by hysteroscopy taking it as a gold standard. SPSS version 20 was used for data analysis. Results:The mean age of the women was 27.3 ± 5.63 with age range 20 to 34 years and parity ranged from 0 to 5. Out of 108 patients, 49 (45.4%) had positive findings of abnormal uterine lesions including myomas in 13 (12.3%), polyps 17 (15.7%), uterine septum 7 (6.4%) and intrauterine adhesions 12 (11.1%). Among all, forty-nine (45.4%) women had infertility, previous cesarean section 20 (19.1%), recurrent pregnancy loss 18 (16.6%), and menstrual disorders 21 (19.4%).Diagnostic accuracy of hysterosonography in terms of specificity, sensitivity, and Positive prediction value (PPV) was 94%, 77%, and 74% for uterine lesions respectively while taking hysteroscopy as a gold standard. Conclusion: The present study concluded that uterine lesions among reproductive-age women could be easily assessed with higher accuracy of hysterosonography. Based on the specificity and sensitivity of hysteroscopy as a gold standard for hysterosonography is the most reliable, safe and accurate diagnostic technique for uterine lesions. Keywords:Hysterosonography, Uterine lesions

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Diagnostic Accuracy of MRC in Benign and ML in Obstructive Jaundice Patients, Taking Histopathology as Gold Standard

10.53350/pjmhs2115123421 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3421-3423

Author(s):

Kamran Naseem ◽

Malik Mudasir Hassan ◽

Sarah Nisar

Keyword(s):

Magnetic Resonance ◽

Obstructive Jaundice ◽

Diagnostic Accuracy ◽

Gold Standard ◽

False Negative ◽

Magnetic Resonance Cholangiopancreatography ◽

True Negative ◽

Cross Sectional ◽

Standard Material ◽

Malignant Lesions

Objectives: To find out the diagnostic accuracy of magnetic resonance cholangiopancreatography in benign and malignant lesions in patients of obstructive jaundice, taking histopathology as gold standard. Material and methods: This cross sectional study was conducted at Department of Radiology, Bahawal Victoria Hospital, Bahawalpur October 2019 to April 2020. A total of 164 patients with suspected cases of obstructive jaundice and age 25-65 years of either gender were included. Then magnetic resonance cholangiopancreatography (MRCP) was performed in every patient by 1.5 Tesla MR System using a torso phased-array coil. After this, each patient was undergone operation in the concerned ward. Findings of MRCP were compared with the findings of histopathology. Results: In MRCP positive patients, 78 were true positive (TP) and 13 were false positive (FP). Among 73, MRCP negative patients, 08 were false negative (FN) whereas 65 were True Negative (TN). Overall specificity, sensitivity, NPV, PPV and diagnostic accuracy of magnetic resonance cholangiopancreatography in benign and malignant lesions in patients of obstructive jaundice, taking histopathology as gold standard was 90.70%, 83.33%, 85.71%, 89.04% and 87.20% respectively. Conclusion: This study concluded that magnetic resonance cholangiopancreatography (MRCP) is the non-invasive modality of choice with diagnostic accuracy in diagnosing in benign and malignant lesions in obstructive jaundice patients. Keywords: obstructive jaundice, sensitivity, magnetic resonance imaging.

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PREDICTIVE ACCURACY OF CERVICAL LENGTH IN MID TRIMESTER ON TRANSABDOMINAL ULTRASOUND FOR CESAREAN SECTION

Journal of Humanities, Social and Management Sciences (JHSMS) ◽

10.54112/bcsrj.v2020i1.43 ◽

2020 ◽

Vol 2020 (1) ◽

Author(s):

A Khalid ◽

MN Anjum ◽

U Daraaz ◽

K Hussain ◽

MA Omer

Keyword(s):

Cesarean Section ◽

Diagnostic Accuracy ◽

Gold Standard ◽

Predictive Accuracy ◽

Mode Of Delivery ◽

Cross Sectional Study ◽

Cervical Length ◽

Transabdominal Ultrasound ◽

Cross Sectional ◽

Sensitivity Specificity

The Cesarean section (CS) delivery is a most frequent surgical technique worldwide. The CS increasing rate and its related problems have drawn an attention towards CS related morbidity. As recommended by WHO, C-section could be carried out only when required medically. In mid-pregnancy cervical extended length predicts the probability of CS early in the pregnancy. The objective of the study is to find the predictive accuracy of cervical length (CL) on transabdominal ultrasound for cesarean section in mid trimester taking mode of delivery as gold standard. It was a cross sectional study in which 362 females were enrolled. Females were undergoing transabdominal ultrasonography for assessment of cervical length. A 2x2 contingency table was generated to calculate sensitivity, specificity, positive predictive valve (PPV), negative predictive value (NPV) and diagnostic accuracy of transabdominal ultrasound taking actual mode of delivery as gold standard. The mean age of the females was 27.92 + 5.75 years while mean parity and mean CL were 2.22 + 1.30 and 35.83 + 7.96 mm, respectively. Among 30 females who had cervical length <25 mm, 24 had CS and 6 had spontaneous vaginal delivery (SVD). Among 332 females who had cervical length >25 mm, 96 had CS and 236 had SVD. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of transabdominal ultrasound for cesarean section were 20.0%, 97.5%, 80.0%, 71.1% and 71.8%, respectively. Study concluded that cesarean section takes place among pregnant females when cervical length is ≤25mm on transabdominal ultrasound during mid trimester.

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Diagnostic accuracy of TI-RADS classification in differentiating benign and malignant thyroid nodules-a study from Southern Punjab, Pakistan

BioMedica ◽

10.51441/biomedica/5-504 ◽

2021 ◽

Vol 37 (3) ◽

pp. 1-14

Author(s):

Sumera Nighat ◽

Mahwish Zahra ◽

Azhar Mahmood Javed ◽

Shabbir Ahmad ◽

Sadia Anwar ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Gold Standard ◽

Thyroid Nodules ◽

Local Population ◽

False Negative ◽

Imaging Evaluation ◽

True Negative ◽

Cross Sectional ◽

Study Results

Background and Objective: Thyroid imaging reporting and data system (TI-RADS) is developed to determine the risk of malignancy in patients with thyroid nodules. The aim of this study was to determine the diagnostic accuracy of TI-RADS classification for diagnosing malignant thyroid nodules taking Fine needle aspiration cytology (FNAC) as a gold standard in the local population. Methods: In this cross-sectional validation study, 201 patients presenting with thyroid nodules at the Department of Radiology, Bakhtawar Amin Hospital Multan, Pakistan from July 2020 to December 2020 were included. In all patients, thyroid nodules were evaluated on grey scale (B-mode) modality. TI-RADS score was calculated for each patient. Patients with TI-RADS score 4 and 5 were labelled as having malignant nodules. After that FNAC samples were taken and sent for histopathologic evaluation of thyroid nodules. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TI-RADS taking FNAC as a gold standard were determined. Results: The mean age of the patients was 47.8 ± 4.5 years; there were 129 (67.2%) women and 72 (35.82%) men. There were 42 patients who tested true positive and 36 patients tested false positive and 12 patients were false negative and 111 patients true negative. The TIRADS sensitivity was 77.8%, specificity was 75.5%, PPV was 53.8%, and NPV 90.2%. the diagnostic accuracy was 76.1%. Conclusion: Differentiating benign thyroid nodules from malignant using the TI-RADS score has a high diagnostic accuracy. Our study results support the TIRADS as a first-line imaging evaluation for diagnosis of thyroid malignancy.

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Efficacy of Combined Laparoscopic and Hysteroscopic Repair of Post-Cesarean Section Uterine Diverticulum: A Retrospective Analysis

BioMed Research International ◽

10.1155/2016/1765624 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Cuilan Li ◽

Shiyan Tang ◽

Xingcheng Gao ◽

Wanping Lin ◽

Dong Han ◽

...

Keyword(s):

Cesarean Section ◽

Combined Treatment ◽

Clinical Manifestations ◽

Abnormal Uterine Bleeding ◽

Lower Uterine Segment ◽

Improvement Rate ◽

Uterine Scar ◽

Lost To Follow Up

Background. Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding and increase the risk of uterine scar rupture. In this study, we aimed to evaluate the efficacy of combined laparoscopic and hysteroscopic repair, a newly occurring method, treating post-cesarean section uterine scar diverticulum.Methods. Data relating to 40 patients with post-cesarean section uterine diverticulum who underwent combined laparoscopic and hysteroscopic repair were retrospectively analyzed. Preoperative clinical manifestations, size of uterine defects, thickness of the lower uterine segment (LUS), and duration of menstruation were compared with follow-up findings at 1, 3, and 6 months after surgery.Results. The average preoperative length and width of uterine diverticula and thickness of the lower uterine segment were recorded and analyzed. The average durations of menstruations at 1, 3, and 6 months after surgery were significantly shorter than the preoperative one (p<0.05), respectively. At 6 months after surgery, the overall success improvement rate of surgery was 90% (36/40). Three patients (3/40 = 7.5%) developed partial improvement, and 1/40 (2.5%) was lost to follow-up.Conclusions. Our findings showed that combined treatment with laparoscopy and hysteroscopy was an effective method for the repair of post-cesarean section uterine diverticulum.

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Diagnostic Accuracy of HRCT Chest in Detection of Covid-19 Infection Taking PCR as Gold Standard

10.53350/pjmhs211561679 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1679-1681

Author(s):

Afaque Ali ◽

Majid Shaikh ◽

Ahsanullah . ◽

Adeel Ahmed ◽

Abid Ali Sahito ◽

...

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Gold Standard ◽

Cross Sectional Study ◽

Radiology Department ◽

High Resolution Computed Tomography ◽

Cross Sectional ◽

Head Of Department

Objective: To determine the diagnostic accuracy of High-resolution computed tomography (HRCT) chest in detection of covid-19 infection taking PCR as gold standard. Study Design: Cross-sectional study Setting: Radiology department of Tabba Hospital, Karachi. Duration: From March 2019 to September 2020 Material and Methods: All the clinically suspected patients of covid-19, of any age, both genders and those referred to radiology for High-resolution computed tomography (HRCT) chest to detect the covid-19 infection were included. After two days, patients’ PCR reports were collected from the ward, after taking informed consent and permission from head of department. The diagnostic accuracy of HRCT was established with respect to sensitivity, PPV, NPV, and specificity by taking PCR as gold standard. All the information was collected via study proforma. Results: Total 70 patients suspected for COVID-19 were studied, and the patients’ mean age was 58.23±9.52 years. Males were in majority 54(77.1%). As per HRCT findings, COVID-19 infection was positive in 46 patients, however, 48 patients were detected positive for COVID-19 infection as per PCR findings. In the detection of COVID-19 infection, HRCT chest showed sensitivity of 91%, specificity of 90%, PPV of 83%, NPV of 84% and diagnostic accuracy of 94%; by taking PCR as gold standard. Conclusion: High-resolution computed tomography (HRCT) is a reliable diagnostic approach in promptly detecting the COVID-19; with 91% sensitivity, 90% specificity, 83% positive predictive value, 84% negative predictive value and 94% diagnostic accuracy. Keywords: Accuracy, HRCT, COVID-19

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Caesarean section at Koudougou regional hospital centre: indications and prognosis

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205211 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4792

Author(s):

Djiguemde Nebnomyidboumbou Norbert Wenceslas ◽

Lankaonde Martin ◽

Savadogo-Komboigo B. Eveline ◽

S. I. B. Sansan Rodrigue ◽

Ouedraogo Wendlassida Estelle ◽

...

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Caesarean Section Rate ◽

Cross Sectional Study ◽

Cross Sectional ◽

Important Place ◽

History Of ◽

Group 3 ◽

Group 5 ◽

Uterine Scar

Background: Objective was to study the indications and the prognosis of cesarean section in the obstetrics and gynecology department of CHR Koudougou from August 1st to October 16th 2018.Methods: This was a cross-sectional study for descriptive purposes with prospective collection of data over the month and monitoring of parturients up to the 42nd day post caesarean section. The study covered the period from August 1 to October 16, 2018. Gestures received in the work room and those hospitalized for a scheduled cesarean were involved in this study.Results: This study involved 316 deliveries. The caesarean section rate was 34.8% (n=110). The average age was 26.75 years with extremes of 12 and 42 years. Term pregnancies represented 90.9%. History of cesarean section was observed in 47, 3%. The main groups contributing to the caesarean section rate represent: Groups 5 (9.5%), Group 1 (9.2%), Group 3 (5.1%), the scar uterus (17.3%) and suffering fetal (14.6%). The reported complications were 15.5% including 3.6% parietal suppuration and 0.8% stillbirth.Conclusions: The caesarean section occupies an important place in the maternity service of the RHC of Koudougou. Robson's group 5 was the largest contributor to the overall cesarean rate in our study. Measures should be taken in this group so that the uterine scar does not become an absolute indication for cesarean.

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Evaluation of the diagnostic accuracy of transvaginal sonography versus hysteroscopy in detection of submucous myomas in peri and postmenopausal women with abnormal uterine bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20213856 ◽

2021 ◽

Vol 10 (10) ◽

pp. 3885

Author(s):

Kushla Pathania ◽

Surbhi Sharma

Keyword(s):

Diagnostic Accuracy ◽

Postmenopausal Women ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Transvaginal Sonography ◽

Cross Sectional ◽

Predictive Values ◽

Menopausal Women ◽

Submucous Fibroid ◽

Post Menopausal

Background: Abnormal uterine bleeding is a very common gynaecological condition that affects all age groups. This study was aimed at assessing the usefulness of TVS in comparison with hysteroscopy in AUB evaluation. Aim was to evaluate the diagnostic accuracy of transvaginal sonography versus hysteroscopy in detection of submucous myomas in peri and postmenopausal women with abnormal uterine bleeding.Methods: The present study was prospective cross sectional study conducted in the Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child Indira Gandhi Medical College Shimla for period of one year w.e.f. 1st May 2018 to 30th April 2019. The study was started after hospital ethical committee approval. 76 patients peri and post-menopausal women were enrolled in the study after taking written consent.Results: On TVS- all the study subjects underwent TVS examination, submucous fibroid was detected in 10 subjects (n= 76) i.e. 13.1% (all perimenopausal). On hysteroscopy submucous fibroid was detected in 11 (14.4%) subjects, on histopathology it was confirmed in 11 subjects (14.4%). Out of 11, 8 patients underwent hysterectomy, 1 myomectomy, 2 patients had hysteroscopic removal of fibroid. 1 subject with AUB-LSM was wrongly diagnosed as AUB-P. Sensitivity, specificity, positive and negative predictive values of transvaginal sonography versus hysteroscopy was 90.09%, 100%, 100%, 98.5% respectively.Conclusions: TVS is an important initial modality for evaluating the patient of AUB. It is quick, simple, painless, least invasive, less expensive and readily available procedure and does not need full bladder like TAS. On the other hand, hysteroscopy has a better diagnostic accuracy as it provides the option of see and treat which is recommended for peri and post-menopausal women with AUB.

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Ceasarean scar pregnancies, diagnosis and management

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181361 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1592

Author(s):

Atmajit Singh Dhillon ◽

Sandeep Sood

Keyword(s):

Cesarean Section ◽

Care Service ◽

Tertiary Care ◽

Expectant Management ◽

Transvaginal Sonography ◽

Colour Doppler ◽

History Of ◽

Gestational Sac ◽

Uterine Scar ◽

High Index Of Suspicion

Background: Objective of present study was to describe evaluation and management of pregnancies implanted into uterine Cesarean section scars, Ceasarean scar pregnancies (CSP), is defined as gestational sac implanted in the myometrium at the site of a previous ceasarean scar. Also known as Ceasarean ectopic pregnancy.Methods: In all antenatal patients attending the antenatal outpatient department of a tertiary care service hospital a transvaginal sonography was done for determining the gestational age as well as the viability of the pregnancy. In all patients with a history of previous Cesarean section(s), special effort was made to assess the possibility of implantation into the uterine scar by means of an early transvaginal and colour doppler ultrasound.Results: Twelve Cesarean section scar pregnancies were diagnosed in a five-year period, of a tertiary care service hospital. Five (42%) patients with Cesarean scar pregnancies were treated surgically, four patients medically (33%), and two patients expectantly (17%) and one patient opted to continue the pregnancy. Surgical management was successful in all cases, although two of five (40%) women suffered bleeding (300-500ml). In the group of women who were managed medically the success rate was 3/4(75%). Expectant management was successful in one of two cases (50%). One patient who opted to continue pregnancy, underwent a ceasarean hysterectomy at 33 weeks of gestation for placenta accreta.Conclusions: Incidence of ceasarean section scar pregnancies is increasing as is the increasing rate of ceasarean deliveries. A high index of suspicion in all cases of post ceasarean pregnancies, coupled with early transvaginal ultrasonography along with colour doppler confirmation and institution of early and individualized treatment, optimizes the clinical outcome. Although rare, the patient and her relatives must be made aware of the possibility of recurrent CSP.

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Comparison of Melatonin Levels in the Colostrum between Vaginal Delivery and Cesarean Delivery

American Journal of Perinatology ◽

10.1055/s-0037-1608681 ◽

2017 ◽

Vol 35 (05) ◽

pp. 481-485 ◽

Cited By ~ 1

Author(s):

Ziya Kalem ◽

Tuncay Yuce ◽

Batuhan Bakırarar ◽

Feride Söylemez ◽

Müberra Namlı Kalem

Keyword(s):

Cesarean Section ◽

Cesarean Delivery ◽

Vaginal Delivery ◽

Mode Of Delivery ◽

Elective Cesarean Section ◽

Enzyme Linked Immunosorbent Assay ◽

Cross Sectional ◽

Emergency Cesarean ◽

Study Results ◽

Elective Cesarean

Objective This study aims to compare melatonin levels in colostrum between vaginal and cesarean delivery. Study Design This cross-sectional study was conducted with 139 mothers who gave live births between February 2016 and December 2016. The mothers were divided into three groups according to the mode of delivery: 60 mothers (43.2%) in the vaginal delivery group, 47 mothers (33.8%) in the elective cesarean delivery, and 32 mothers (23.0%) in the emergency cesarean delivery group. Colostrum of the mothers was taken between 01:00 and 03:00 a.m. within 48 to 72 hours following the delivery, and the melatonin levels were measured using the enzyme-linked immunosorbent assay (ELISA) and compared between the groups. Results The melatonin levels in the colostrum were the highest in the vaginal delivery group, lower in the elective cesarean section group, and the lowest in the emergency cesarean group (265.7 ± 74.3, 204.9 ± 55.6, and 167.1 ± 48.1, respectively; p < 0.001). The melatonin levels in the colostrum did not differ according to the demographic characteristics of the mothers, gestational age, birth weight, newborn sex, the Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores, and for the requirement for neonatal intensive care. Conclusion Our study results showed that melatonin levels in the colostrum of the mothers who delivered vaginally were higher than those who delivered by cesarean section. Considering the known benefits of melatonin for the newborns, we believe that vaginal delivery poses an advantage.

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