Transvaginal and transabdominal ultrasonography of the uterine cervix during pregnancy.

Transvaginal and transabdominal ultrasound evaluation of the uterine cervix were compared in a study of 186 pregnant women. An empty bladder made transabdominal ultrasound measurement of the cervix more difficult, while bladder filling resulted in significant lengthening of the transabdominal cervical measurement. In contrast, transvaginal ultrasound cervical measurement was possible in all but 1 patient. Normal transvaginal ultrasound cervical measurements were significantly shorter on average than transabdominal cervical measurements, but compared closely with prior transabdominal ultrasound studies in which bladder filling was carefully controlled. Significant cervical shortening was not noted in most patients with a clinical diagnosis of incompetent cervix.     

Transvaginal sonography of the uterine cavity following curettage for early pregnancy failure.

In a study of 50 women presenting with sonographically confirmed early pregnancy failure, the uterine contents were measured in both sagittal and transverse planes before proceeding with evacuation of the retained products of conception. A repeat sonographic study of the empty uterine cavity was performed on the day after curettage and similar measurements were made, the subjects having been divided into four groups according to gestational age. There was no significant difference between the groups in the postoperative measurements of either uterine cavity width or area, nor was the size of the empty uterine cavity influenced by the volume of tissue within the uterus before evacuation. Whilst the measurement of width was similar both before and after evacuation of the uterus in all groups, the sagittal area was significantly smaller postoperatively. There was no evidence of retained tissue at any of the postoperative sonographic examinations, nor did any of the subjects in the study develop subsequent complications. Assuming the dimensions of the uterine cavity following curettage are representative of an empty uterus, this will form the basis of a prospective study to determine whether spontaneous abortion can be safely managed without curettage in selected cases, if the preoperative sonographic measurements fall within a specified range.     

Transvaginal ultrasonography for cervical assessment before induction of labor.

OBJECTIVE: To evaluate the value of ultrasonographic cervical assessment in predicting the outcome of labor induction and to compare its performance against the Bishop score. METHODS: The Bishop score was determined by digital examination, and transvaginal ultrasonography was performed in 105 women at 37 to 42 weeks' gestation scheduled for labor induction. Ultrasonographic parameters evaluated were cervical length, the presence of funneling, funnel width, and funnel length and were blinded to managing physicians. The primary outcome was the occurrence of active labor within 2 days (successful labor induction). The interval from the onset of induction to active labor (duration of induction) was the secondary outcome. Statistical analysis was performed by the chi2 test, Wilcoxon rank sum test, Pearson correlation, receiver operating characteristic curves, logistic regression, Cox proportional hazards model, and generalized Wilcoxon test for survival data. RESULTS: Induction of labor was successful in 93 women (89%). The area under the receiver operating characteristic curve for cervical length was greater than that of the Bishop score in predicting a successful labor induction (z = 2.18; P < .05). A cervical length of 3.0 cm or less had sensitivity of 75% (70 of 93) and specificity of 83% (10 of 12). Multiple logistic regression analysis showed a significant relationship between successful labor induction and cervical length but not the Bishop score (odds ratio = 0.24; 95% confidence interval, 0.096-0.59; P = .002). Only parity and cervical length had a significantly independent relationship with the duration of induction. CONCLUSIONS: Cervical length measured by transvaginal ultrasonography is a useful and independent predictor of successful labor induction and the duration of induction and provides better predictability of successful labor induction than the Bishop score does.     

Transvaginal sonography of the uterine cavity with hysteroscopic correlation in the investigation of infertility.

This report describes the correlation of hysteroscopic findings with preoperative transvaginal sonography in 200 patients being investigated for infertility. Real-time ultrasound examination was performed on days 7, 14 and 21 in spontaneous ovulatory cycles. Diagnostic hysteroscopy was performed in the subsequent cycle. The abnormalities detected using transvaginal sonography were intrauterine adhesions, submucous fibroids, endometrial polyps, endometritis and a non-specific irregular endometrium. A total of 182 patients were diagnosed correctly to have an abnormality by transvaginal sonography giving a false-positive rate of 5.5%. The sensitivity of transvaginal sonography in detecting endometrial pathology was 98.9% with a positive predictive value of 94.3%. The positive predictive values for specific abnormalities were 98.5% for intrauterine adhesions, 91.7% for submucous fibroids, 91.4% for endometrial polyps, 85.7% for endometritis and 85.7% for irregular endometrium. These data show a strong correlation between findings from transvaginal sonography and hysteroscopy. Transvaginal sonography may be used to detect intrauterine pathology and identify patients in whom hysteroscopy and hysteroscopic surgery are indicated.     

Monitoring the effacement of the uterine cervix by transperineal sonography: a new perspective.

The objective of this study is to monitor the process of effacement of the uterine cervix and demonstrate that transperineal sonography is the appropriate technique for this purpose. Eighty-six patients with normal, term pregnancies were studied at the beginning of labor. Transperineal sonography was performed in transverse and longitudinal planes. After the initial examination, patients were reexamined several times during a 1 to 4 hour period. We observed a progressive shortening of the canal and the synchronous opening of a funnel-shaped internal cervical os. When the funneling process reached the lower end of the cervix, both orifices fused, completing the process of effacement. The dilatation of the external os, which remained stationary during initial phase, increases very quickly once the effacement has been completed. Transperineal sonography efficiently imaged the changes described here.     

Ultrasound detection of nuchal cord prior to labor induction and the risk of Cesarean section.

OBJECTIVES: To investigate the ability of ultrasound to detect the presence of a nuchal cord immediately prior to induction of labor and the association of its presence with delivery by Cesarean section. METHODS: A transabdominal ultrasound scan using gray-scale and color Doppler imaging was performed immediately prior to induction of labor in 289 women in a prospective study to assess the presence of a nuchal cord. The presence of a nuchal cord was classified as present, absent or uncertain. The outcomes of labor, delivery and the neonates were obtained from the patient notes after delivery. RESULTS: A nuchal cord was present at 18% of deliveries. The incidence was not affected by parity, fetal position or reduced amniotic fluid volume. The sensitivity of ultrasound in diagnosing a nuchal cord was 37.5%, with specificity, positive and negative predictive values of 80%, 29% and 85%, respectively. The presence of a nuchal cord did not significantly increase the risk of delivery by Cesarean section (35% vs. 28%; relative risk = 1.22; 95% CI, 0.80-1.87), instrumental delivery for fetal distress, an abnormal cardiotocograph in labor or at delivery, an Apgar score < 7 at 1 min, arterial cord pH < 7.1 or neonatal unit admission. CONCLUSIONS: The sensitivity of the ultrasound diagnosis of a nuchal cord is low prior to induction of labor at term. A nuchal cord does not appear to increase the risk of Cesarean section or of poor neonatal outcome. The low ultrasound detection rate of a nuchal cord limits its use in decision making prior to induction of labor in high-risk pregnancies.     

经阴道彩色多普勒超声对宫颈淋巴瘤的诊断价值

目的 探讨宫颈淋巴瘤(LUCX)的超声表现特征。方法 回顾性分析11例经病理证实为LUCX的声像图特征,包括肿块的位置、形态、边界、内部回声、后方回声、血流情况、宫颈黏膜线完整性等。结果 11例LUCX主要症状为阴道异常出血,平均年龄(48.5±12.0)岁,病理诊断均为非霍奇金淋巴瘤(NHL)。超声表现为宫颈单发低回声或极低回声团,呈分叶状(6/11,54.5%),边界较清(7/11,63.6%),回声均匀(6/11,54.5%),肿块后方回声增强(8/11,72.7%),钙化或液化少见,宫颈黏膜线完整(7/11,63.6%),肿块内血流丰富(II-III级),以周边分布为主,RI：0.59-0.71。结论 LUCX声像图表现具有一定特征,经阴道彩色多普勒超声对LUCX的诊断和鉴别诊断具有重要价值。     

Clinical and ultrasound estimation of birth weight prior to induction of labor at term.

OBJECTIVES: To assess and compare the accuracy of clinical and sonographic fetal weight estimation in predicting birth weight prior to induction of labor. METHODS: In a prospective study of 262 women immediately prior to induction of labor, the fetal weight was estimated clinically by both the doctor (DR EFW) and the woman herself (WM EFW). A transabdominal scan was then performed to estimate the fetal weight sonographically using two different formulae-Shepard (SHEP EFW) and Hadlock (HAD EFW). The four estimated fetal weights were compared with the actual birth weight. RESULTS: The mean percentage error was - 1.9 +/- 9.3% for DR EFW, - 3.4 +/- 12.6% for WM EFW, - 2.3 +/- 11.6% for SHEP EFW and - 7.6 +/- 10.6% for HAD EFW. All four EFWs were significantly different from birth weight (t = - 4.7, - 5.5, - 3.5 and - 11.4, respectively, all P < 0.01). The corresponding proportion of the EFWs which were within 10% of birth weight were 71%, 59%, 62% and 42%, respectively. The sensitivity and specificity of detecting a fetus weighing < 3000 g were 56% and 98% for DR EFW, 90% and 89% for WM EFW, 93% and 83% for SHEP EFW and 100% and 76% for HAD EFW. The corresponding values for detecting a fetus weighing > 4000 g were 16% and 99%, 29% and 96%, 48% and 92% and 40% and 94%, respectively. CONCLUSIONS: Although, in general, clinical estimates of birth weight perform favorably compared with ultrasonographic estimates, ultrasound immediately prior to labor is more accurate at predicting the low- or high-birth-weight fetus.     

Transvaginal sonography in the diagnosis of acute appendicitis.

OBJECTIVES: To evaluate transvaginal sonography with power Doppler capacity in the diagnosis of acute appendicitis and in discriminating appendicitis from pelvic inflammatory disease. PATIENTS AND METHODS: We describe transvaginal sonographic findings of six women with acute appendicitis selected from 31 women seen in an emergency room setting for clinically suspected pelvic inflammatory disease. The study population underwent gray-scale transvaginal sonography, and specific sonographic landmark findings for acute appendicitis and pelvic inflammatory disease were used. Hyperemia of any infectious complex was identified by power Doppler. Laparoscopy was performed after transvaginal sonography and was used as the gold standard. RESULTS: Laparoscopy showed acute appendicitis in six (19%) of the 31 patients. A thick walled non-compressible gas-containing tubular structure with a diameter exceeding 6 mm was seen by transvaginal sonography in four of the six cases, consistent with uncomplicated appendicitis. A heterogeneous complex with surrounding hyperechogenic soft tissue was seen in two cases with gangrenous appendicitis. Power Doppler detected hyperemia in all six cases. Normal adnexal structures were imaged next to the inflamed appendix. The sonographic criteria consistent with acute appendicitis were clearly different from those of acute pelvic inflammatory disease. CONCLUSIONS: Transvaginal sonography provides an opportunity to distinguish between appendicitis and acute pelvic inflammatory disease. Prospective trials are needed in order to evaluate the impact of transvaginal sonography in the diagnosis of acute appendicitis.     

Transvaginal sonography in the assessment of distal ureteral calculi.

OBJECTIVES: To explore the morphological and functional findings of transvaginal sonography (TVS) in the diagnosis and management of distal ureteral calculi. METHODS: We retrospectively reviewed the imaging studies in seven cases of distal ureteral calculi (study group) and 20 cases of female volunteers without urinary tract infection (control group). All 27 patients had undergone TVS for assessment of the lower urinary tract. The variables measured on ultrasound included the presence or absence of distal ureteral calculi, the size and location of a calculus if present, the presence or absence of the ureter jet phenomenon, morphological changes of the ureteral papilla and adjoining tissue, and the height of the ureteral papilla, as well as vascular changes seen on Doppler imaging. RESULTS: In the controls, 80% of the ureteral papillae were triangular and 20% trapezoidal. The average (+/-SD) height of the ureteral papillae was 3.5 +/- 0.7 mm on the right and 3.6 +/- 0.9 mm on the left. There was no statistically significant difference between the heights of the right and left papillae (P = 0.619). In the study group, echogenic stones were identified in all seven patients and a hypoechogenic tubular structure connected to the involved papilla was identified in 6/7 patients. The average height of the involved papilla was 6.7 +/- 1.6 mm. Ureteric jets were visible in all patients in both the study and control groups. CONCLUSION: In patients with distal ureteral calculi, TVS provides a rapid, non-invasive and repeatable means of assessing the morphology and function of the distal ureter.     

Transvaginal and transabdominal sonography of the endometrium

The major applications of the sonographic depiction of the endometrium include the localization of the uterus relative to adnexal masses, determination of certain benign and malignant endometrial pathologies, and, potentially, as a parameter for consideration in gynecologic infertility. Transvaginal sonography affords detailed depiction of the endometrium and may provide future applications of sonography in endometrial disorders.     

Transvaginal sonography of the endometrium during induced cycles

The thickness and texture of the endometrium as depicted by transvaginal sonography were assessed in 23 patients who underwent a similar ovulation induction protocol including a gonadotropin-releasing hormone analogue (Lupron) and human menopausal gonadotropin (Pergonal). In the 9 patients who conceived, a multilayered endometrium was more frequently present than in the 14 who did not, even though the number of mature follicles, oocytes retrieved and transferred, and estradiol values were similar.     

Transvaginal sonography of cervical width and length during pregnancy.

Transvaginal ultrasonography has been proposed as a reliable method of assessing dimensions of the cervix. The purpose of the current investigation was to establish normative data for cervical width and length during pregnancy. This information may be helpful in predicting patients at risk for preterm birth. A transvaginal 5 or 7.5 MHz transducer was used on 132 consecutive low-risk pregnant women undergoing evaluation for gestational dating purposes. Even in cases of patient obesity or an empty bladder, high resolution was possible and permitted cervical measurement in all but one case. The external cervical width at the vaginal fornices was found to increase with advancing gestation (R = 0.512, P < 0.005). The cervical length from internal os to external os was found not to change with advancing gestation (R = 0.11, P = 0.30). Using these normative data, investigation is recommended to determine whether measuring cervical width and length is useful in predicting preterm labor and delivery.     

Transvaginal sonography in the diagnosis of pelvic malignant recurrence: integration of sonography and needle-guided biopsy.

The aim of this study was to evaluate the efficiency of transvaginal sonography and sonography plus needle biopsy in detecting pelvic malignant recurrence.We scanned 24 patients already treated for gynecological malignancy, 21 of whom underwent needle biopsy under sonographic guidance. Thirteen patients were affected by cervical cancer, ten by ovarian cancer, and one by endometrial-ovarian carcinoma.Sonography detected 16 solid or cystic-solid masses (median size 52 mm, range 15-85 mm), one case of ascites, and one liquid mass (hematoma). All the patients in whom a suspicious mass was detected had recurrence. In the six patients in whom no mass was visible, two had recurrence. Needle biopsy was able to demonstrate recurrence in 17 patients (also in two false-negative scans). In one, even though sonography detected a mass, the histological sample was negative, but recurrence was later diagnosed by laparotomy.Accuracy, sensitivity and specificity of transvaginal sonography were respectively 91.6%, 89.4% and 100%. The positive predictive value was 100% and the negative predictive value was 71.4%. Transvaginal sonography was shown to be a useful means of detecting pelvic recurrence.