Interobserver variability of ultrasound measurements for the differential diagnosis of uterine prolapse and cervical elongation without uterine prolapse

Objectives Our study aims to determine the interobserver variability of different ultrasound measurements (pubis-cervix distance, pubis-uterine fundus distance, and pubis-Douglascul-de-sac distance) previously analyzed for the ultrasound differential diagnosis of uterine prolapse (UP) and cervical elongation CE without UP. Materials and methods We conducted a prospective observational study with 40 patients scheduled to undergo surgical correction of UP and CE without UP. All patients underwent pelvic floor ultrasound examination by an examiner (E1) who acquired ultrasound images. Using these images, E1 measured the distances for the ultrasound differential diagnosis of UP and CE without UP, and these distances were compared with those measured by the other examiner (E2). Values were analyzed by calculating ICCs with 95% CIs. Results For UP, excellent reliability was obtained for all measurements except the pubis-Douglascul-de-sac measurement at rest, which was moderate (ICC 0.596; p = 0.028) and for the difference between the pubis-Douglascul-de-sac measurement at rest and during the Valsalva maneuver, which was good (ICC 0.691; p < 0.0005). For CE without UP, interobserver reliability was excellent for all measurements analyzed except the pubis-cervix measurement during the Valsalva maneuver, which was moderate (ICC 0.535; p = 0.052) and for the pubis-Douglascul-de-sac measurement at rest, which was good (ICC 0.768; p < 0.0005). Conclusions There is excellent interobserver reliability in measurements of the difference in the distance from the pubic symphysis to the uterine fundus at rest and during the Valsalva maneuver for both UP and CE without UP, which are used for the ultrasound differential diagnosis of UP and CE without UP.

Transverse wedge excision of the uterine floor in bilateral extirpation of the uterine appendages. Вenttner (Arch. f. Gyn., Bd. 115)

In the surgical removal of inflamed tubes, with the ovaries left, or at least part of them. The author recommends, in suitable cases, excising the uterine fundus in a transverse direction, with the tip of the wedge reaching the mucosa.

Investigation the Effects of Adding Intravenous Transoxalic Acid and Its Complications in the Prevention of Postpartum Hemorrhage after Vaginal Delivery in Patients Admitted to Ali-ibn-Abitaleb Hospital in Zahedan

Background: This study was designed to investigate the effect of tranexamic acid and its side effects in preventing postpartum hemorrhage in patients referred to Ali ibn Abitaleb Hospital in Zahedan during 2020-2021. Methods: Patients were divided into two groups of 85 patients. Vital signs as well as drug side effects related to tranexamicity are monitored and recorded every15 minutes in the first hour and every 30 minutes in the second hour. Also, blood samples are taken from patients to measure hemoglobin and hematocrit within6 hours after delivery. The number and weight difference of droschitis used during 2 hours after delivery are also measured. In addition, PPH (Postpartum hemorrhage) cases in both groups were checked by repeated examination of the uterine fundus during the first 2 hours and after 6 weeks. Results: There was no statistically significant difference between the two groups in terms of the number of deliveries and further decrease in hemoglobin levels in the control group compared to the intervention group. Nausea, vomiting, and dizziness were observed in the intervention group and thrombosis was not observed in any group. According to the independent samples t-test, there was a statistically significant difference between the mean blood volume lost between the two groups. The mean hematocrit drop was statistically significant between the two groups. No blood transfusion was observed in any of the patients. Conclusion: Tranxamic acid injections can effectively reduce postpartum hemorrhage and reduce maternal hemoglobin and hematocrit following this complication.

Relationship between myometrial thickness and latency interval of pregnancy after preterm premature rupture of membranes

Background: Preterm premature rupture of membranes (PPROM) increases the risk of prematurity and leads to a number of other perinatal and neonatal complications. Prolonged latency interval increases probability of complications in mothers with PPROM. The aim of this study was to assess the relationship between the myometrial thickness and the length of latency interval after PPROM.Methods: This study included 62 pregnant women admitted due to spontaneous PPROM from 26 to 37 weeks gestational age. All selected cases were subjected to full medical history, full clinical examination, laboratory investigations, and ultrasound evaluation with measurement of myometrium thickness at lower uterine segment and uterine fundus, measurement of amniotic fluid index.Results: A total 32 (51.7%) of our patients had latency interval <1 week while the rest of patients had latency interval ≥1 week with mean latency interval value was 5.45±2.4 days. Sonographic evaluation of the myometrial thickness showed that the mean thickness at lower uterine segment was 6.6±1.26 mm and at fundus was 6.1±1.28 mm. we found that at cut off point ≥6.9 mm lower uterine segment myometrial thickness had 87.5% sensitivity and 93.3% specificity in prediction of latency interval≥1 week, while at cut off point≥6.4 mm uterine fundus myometrial thickness had 81.3% sensitivity and 63.3% specificity in prediction of latency interval more than 1 week.Conclusions: Sonographic evaluation of myometrial thickness appears to be helpful in prediction of latency interval in PPROM.

P–361 Endometrium optical coherence tomography (OCT) and histomorphometry in implantation window and their relationships with reproductive failure and implantation outcome

Study question How do endometrium OCT image characteristics during peri-implantation window correlate with histomorphometry and associate with implantation outcomes in women with reproductive failure? Summary answer Endometrium OCT intensity correlated with stromal cell density and gland size. Endometrium with recurrent implantation failure had low OCT intensity but reversed in successful implantation. What is known already OCT is a non-invasive imaging technique using low energy near-infrared light to capture micrometer-scale resolution images from optical scattering media. An image produced by OCT resembles tissue architecture observed in histology, so OCT imaging has been regarded as “optical biopsy”. Our previous findings demonstrated OCT is better than ultrasound to identify endometrial pathology. We also showed association of OCT signal with microvessel density in peri-implantation endometrium. However, other histomorphometry were not evaluated. It is still unclear whether endometrium OCT image characteristics are different in reproductive failure and can predict implantation outcomes. Study design, size, duration This was a prospective study conducted at teaching hospital of The Chinese University of Hong Kong from Jan 2018 to Dec 2019. 46 infertile women with or without recurrent miscarriage (RM) and implantation failure (RIF) were recruited in this study. Endometrium OCT imaging and subsequent biopsy were performed on the seventh day after luteal hormone surge (LH + 7) in natural cycle prior to the consecutive natural conception or embryo transfer (ET) cycle. Participants/materials, setting, methods At least 5 systematic random endometrium OCT images from uterine fundus, body and lower segment of each subject were included for intensity analysis by two independent observers. OCT intensity of each image was classified as low, moderate, high based on optical range and then average OCT intensity in each uterine region was calculated for group comparison. Endometrium glandular epithelial, stromal, endothelial, uNK cells were defined by standard H&E and specific immunostaining for histomorphometry and correlation. Main results and the role of chance OCT intensity significantly correlated with endometrial cell and gland parameters regardless classifications of reproductive failure and implantation outcome. Higher OCT intensity indicated higher stromal cell density, gland to stromal (G/S) ratio and average gland area, but fewer microvessel and uNK cells. None of the endometrium histomorphometry were significantly different among different reproductive failure types and implantation outcomes, suggesting it may not be sensitive enough to detect the abnormal histological features. However, OCT intensity was significantly lower in the uterine fundus and body of RIF group than in that of infertile and RM groups. There was no significant difference of OCT intensity in the lower part of the endometrium among three groups. It indicates that OCT intensity is a sensitive marker to differentiate endometrium with RIF from the endometrium with other conditions and also endometrium with RIF is characterized with less stromal cells and smaller glands. Compared with infertile group with unsuccessful implantation, OCT intensity was higher in all three parts of the uterus from the infertile group with successful implantation, but the results were not statistically different. The results further implied that endometrial cells and gland size may potentially contribute to the endometrium receptivity for implantation. Limitations, reasons for caution Current endometrium OCT imaging depth is within 3mm, change beyond this thickness is inaccessible but still the most important layer for implantation. This is a pilot and small study with lack of normal fertile control. Endometrium OCT imaging in the same natural conception or ET cycle will be more accurate. Wider implications of the findings: OCT imaging could be used as a potential noninvasive modality to evaluate peri-implantation window endometrium. It enables real-time and in-situ visualization of endometrium structure and pathology with no additional biopsy risk and examination delay. Larger clinical trials are needed to confirm its clinical applications and utilities. Trial registration number CREC 2016.160

A rare, ectopic (intravesical) location of a missing intrauterine contraceptive device, a case report

Ectopic location of Intrauterine Contraceptive Device (IUCD) or its migration from the normal position in the uterine fundus is a frequently encountered complication. It varies from uterine expulsion to displacement into the endometrial canal to uterine perforation or intravesical migration, which is an extremely rare case. Ultrasonography was used in the diagnoses of this reported case of an ectopic intravesical IUCD.

HUBUNGAN TINGGI FUNDUS UTERI, KADAR GULA DARAH, DAN KADAR HEMOGLOBIN IBU DENGAN BERAT BADAN BAYI BARU LAHIR

ABSTRACT UTERI FUNDUS HIGH RELATIONSHIP, BLOOD SUGAR AND CONDITIONSHEMOGLOBIN MOM WITH A NEW BORN WEIGHT Background : Maternal and infant mortality rates are indicators commonly used to determine the degree of public health, assessment of the success of other health development programs. Low birth weight accounted for 51% of neonatal deaths throughout birth. The size of the birth weight depends on how the intrauterine fetus develops during pregnancy. This birth weight is one of the indicators of newborn health.Purpose: This research to find out the relationship between Uterine Fundus Height, Blood Sugar Levels, Hemoglobin Levels of mothers with weight and newborns at Puskesmas Sindang Jaya Year 2020.Method : This research is an Analytical Survey research with Cross Sectional design. The sample in this study of pregnant women who gave birth from june to August as many as 40 people.Results : In the results that there is a statistically significant relationship between high fundus uteri, blood sugar levels, and hemoglobin levels of mothers with baby weight born in the puskesmas sindang jaya with p value of 0.013 for high fudus ureteri, p value 0.042 for blood sugar levels, and p value of 0.069 for hemoglobin levels. Which means that all three variables have a p value of <0.05). With the variable that most affects the baby's weight is a high variable fundus erteri with a value (OR : 24).Conclusion : There is a link between high uterine fundus, blood sugar levels, and hemoglobin levels of mothers with newborn weight at Puskesmas Sindang Jaya Year 2020Suggestion It is hoped that the next researcher can conduct further research because there are still many factors that can affect the weight of the newborn. Keywords : Baby Weight Born, Uterine Fundus Height, Blood Sugar Levels, Hemoglobin Levels. ABSTRAK Latar Belakang : Angka kematian ibu dan bayi adalah indikator yang lazim digunakan untuk menentukan derajat kesehatan masyarakat, penilaian terhadap keberhasilan pelayanan kesehatan program pembangunan kesehatan lainnya. Beratbayilahirrendahmenyumbang sebesar51%sebagaipenyebabkematianneonataldiseluruh kelahiran.Besar kecilnyaberatbadanlahirtergantungbagaimana pertumbuhan janinintrauterine selama kehamilan.Beratbadanlahirinilahyang menjadi salahsatuindikator kesehatanbayi baru lahir.Tujuan : Penelitian ini untuk mengetahui hubungan antara tinggi fundus uteri, kadar gula darah, dan kadar hemoglobin ibu dengan berat dan bayi baru lahir di Puskesmas Sindang Jaya Tahun 2020.Metode : Penelitian ini adalah penelitianSurvei AnalitikdenganrancanganCross Sectional. Sampel dalam penelitian ini ibu hamil yang melahirkan dari bulan juni-agustus sebanyak 40 orang.Hasil: Di dapatkan hasil bahwaterdapathubungan secarastatistiksignifikanantaratinggi fundus uteri, kadar gula darah, dan kadar hemoglobin ibu dengan berat badan bayi lahir di puskesmas sindang jaya dengan p value 0.013 untuk tinggi fudus uteri, p value 0.042 untuk kadar gula darah, dan p value 0.069 untuk kadar hemoglobin. Yang artinya dari ketiga variabel memiliki nilai p value <0,05. Dengan variabel yang paling mempengaruhi berat badan bayi adalah variabel tinggi fundus uteri dengan nilai (OR : 24).Kesimpulan : Ada hubungan antara tinggi fundus uterus, kadar gula darah, dan kadar hemoglobin ibu dengan berat badan bayi baru lahir di Puskesmas Sindang Jaya Tahun 2020Saran: Diharapkan bagi peneliti selanjutnya dapat melakukan penelitian lebih lanjut dikarenakan masih banyak faktor yang dapat mempengaruhi berat badan bayi baru lahir.Kata Kunci : Berat Bayi Lahir, Tinggi Fundus Uteri, Kadar Gula Darah, Kadar Hemoglobin.

Uterine Fundus Remodeling after Hysteroscopic Metroplasty: A Prospective Pilot Study

The septate uterus is the most common congenital uterine malformation and is treated by hysteroscopic metroplasty. There are few studies on the fundal uterine changes that occur after surgery. We designed a pilot prospective observational study to evaluate by three-dimensional transvaginal ultrasound (3D-TVS) the changes not only of the internal fundal uterine profile, but also of the external one, after hysteroscopic metroplasty. Sixty women who underwent hysteroscopic metroplasty for partial or complete uterine septum (U2a and U2b subclasses of ESHRE/ESGE classification) were enrolled. We performed 3D-TVS after surgery confirming optimal removal of the septum. However, at ultrasound follow-up after three months, we observed a significant increase (p < 0.001) in the residual septum (Zr) (3.7 mm (95% CI: 3.1–4.4)), the myometrial wall thickness (Y) (2.5 mm (95% CI: 2.0–3.0)) and the total fundal wall thickness (Y + Zr) (6.2 mm (95% CI: 5.5–6.9)). Forty-three patients (72%) required a second step of hysteroscopic metroplasty. Moreover, the shape of uterine fundus changed in 58% of cases. We actually observed a remodeling of the uterine fundus with modifications of its external and internal profiles. Therefore, we propose to always perform a second ultrasound look at least three months after the metroplasty to identify cases that require a second- step metroplasty.

A case of non-pueperal chronic uterine inversion managed successfully

Uterine inversion is prolapse of the uterine fundus and corpus turned inside out towards or through the cervix. The non-puerperal type of uterine inversion is a quite rare occurrence and it accounts for only 17% of all uterine inversion cases. We present a case of 45 year old multiparous female who presented to us with polymenorrhagia with fibroid polyp. Ultrasonography confirmed the clinical findings however Intraoperatively examination under anaesthesia revealed uterine inversion. On table we proceeded with Haultains method of uterine reposition followed by total abdominal hysterectomy. Patient recovered well and thus case was successfully managed.