diagnosed on ultrasonography at B. J. Medical College Ahmedabad,. Gujarat University, India. Both patients presented with primary amenorrhoea and cyclical ...
23rd World Congress on Ultrasound in Obstetrics and Gynecology obliteration. The association between POD obliteration at TVS and surgical findings was significant for the following features: right and left ovarian fixation (p = 8.1E-10 and 3.4E-11, respectively), right and left ovarian endometrioma (p = 2.6E-06 and 1.8E-05, respectively), DIE nodules in general (p = 1.1E-18) and DIE nodules specifically involving the anterior rectum, rectosigmoid colon, and left uterosacral ligament (p = 5.7E-13, 2.5E-05, 0.005, respectively). The need for bowel surgery was also significantly associated with POD obliteration at TVS (p = 5.4E-15). Conclusions: This study helps to define the surgical findings that may be associated with a negative ‘‘sliding sign’’, or POD obliteration, during TVS. The pre-operative identification of TVS markers such as POD obliteration may alert the clinician to the possibility of difficult endometriosis surgery, which may extend beyond POD obliteration.
P17.02 The reproducibility of the three dimensional (3D) ultrasonography in the diagnosis of deep endometriosis: effect of a specific training S. Guerriero1 , S. Ajossa1 , C. Peddes1 , M. Perniciano1 , B. Soggiu1 , J. Alcazar2 , F. Sedda1 , G.B. Melis1 1 Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy; 2 University of Navarra, Pamplona, Spain
Objectives: To investigate the intraobserver and interobserver agreements of three-dimensional ultrasonography (3D US) in the diagnosis of deep endometriosis evaluating also the effect of specific training. Methods: Two sonographers (one expert with more than 15 years of experience in gynecologic ultrasonography, operator A and one with 3 years of experience in ultrasonography but one year in gynecologic ultrasonography and use of 3D, operator B) performed a retrospective review of 3D volumes from a random sample of 35 patients with clinical suspicion of deep pelvic endometriosis submitted to surgery. Each examiner was to review the 3D volumes using virtual navigation and multiplanar display twice, 1 week apart for assessing intraobserver agreement. Reviewing was performed with examiners blinded to each other. After six months of specific training in a II levels ultrasonography laboratory the less expert operator re-evaluated the same volumes using the same modalities. Intraobserver and interobserver agreement were assessed by calculating the kappa index (κ) with 95% confidence intervals (CIs). Results: Intraobserver agreement was good for both examiners with different degrees of experience (kappa 0.8754, 95% CI 0.7013-1 for operator A and 0.7087 95% CI 0.5002- 0.9172 , for operator B respectively ) but increases in the less expert operator to 0.8794, 95%CI 0.7423-1. Interobserver agreement was good (kappa 0.7094, 95% CI 0.5007-0.9181) but increases after the training of the less expert operator to 0.8394, 95% CI 0.6808-0.998. Conclusions: The use of 3D in the diagnosis of deep endometriosis is a reproducible technique and, although the difference was not statistically significant, the use of specific training seems further increase the reproducibility. This study was supported in part by the Regione Autonoma della Sardegna (project code CPR-24750).
P17.03 Congenital transverse vaginal septum presenting as primary amenorrhoea and abdominal mass: ultrasonographic diagnosis H.V. Oza1 , V. Oza2 , V. Chaudhari1 1
Obstetrics and Gynecology, B.J. Medical College, Ahmedabad, India; 2 Obstetrics and Gynecology, Navjivan Maternity and Nursing Home, Ahmedabad, India
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Poster abstracts
Mullerian duct anomalies are most fascinating disorders that gynaecologists encounter. Among which transverse vaginal septum is a vertical fusion disorder. Its prevalence is 1 in 30,000 to 1 in 84,000. Here we describe two cases of transverse vaginal septum diagnosed on ultrasonography at B. J. Medical College Ahmedabad, Gujarat University, India. Both patients presented with primary amenorrhoea and cyclical abdominal pain. On ultrasonography one patient showed hematometra with scant hematocolpos and other patient showed hematometra with hematosalpinx. After proper preoperative assessment both patients evaluated under general anaesthesia and found having transverse vaginal septum which were incised and hematometra drained. Followed by successful circumferential excision. Vaginal mucosa is approximated with absorbable suture throughout its circumference. Both patients resumed normal menstrual cycle on follow up. Ultrasonography is the modality of choice in initial evaluation of female pelvis in childhood and adolescence, where clinical examination is very limited. In these cases, a specific knowledge of changes in female pelvis during childhood and puberty is essential to avoid inaccurate diagnosis. If patient with obstructive features is not treated in a timely fashion, consequences can be severe, extending even to endometriosis and infertility. Increasing awareness of this rare entity calls for more meticulous evaluation before any surgical intervention in patients with complex genitourinary anomalies.
Supporting information can be found in the online version of this abstract
P17.04 Technology making ectopic pregnancy more of histological diagnosis F. Ajibade, M. Shendy, S. Hirsi-Farah, M. Awad Royal Berkshire Hospital, Reading, United Kingdom Ectopic pregnancy remains one of the leading causes of maternal mortality & morbidity worldwide. The incidence of ectopic pregnancy is increasing due to ART & increase incidence of PID. The use of TV ultrasound, serum B-Hcg has contributed to early diagnosis & medical care of problems in early pregnancy. The developments have lead to early suspicions of problems in early pregnancy before clinical symptoms resulting in medical Tx. Majority of ectopic pregnancies in the fallopian tubes are easily identified with diagnostic laparoscopy especially if ruptured. Laparoscopy remains the gold standard for diagnosis and Tx of ruptured ectopic. However laparoscopy can miss up to 4% of early ectopic pregnancies. An attempt for early diagnosis can cause difficulty in guarantee the content within the tube during diagnostic laparoscopy. Visual diagnosis at laparoscopy can be a problem were tubal pathologies such as hydrosalpinx, hemosalpinx; tubal dysplasia & tubal epithelia dysplasia co-exist with early pregnancy. Association of severe tubal epithelium dysplasia with some gynaecological malignancies have been described. Mx of symptomatic patient in such situation can be a diagnostic challenge. We present at 28 years patient, G2 para1 at 5+3wk gestation with increasing pain & lower abdominal tenderness not responding to analgesia. Pelvic Ultrasound scan suggested Lt adnexal mass 2.1 x 1.5 cm. Serum B-Hcg plateau 48 hrs apart at 814iu & 881iu. Diagnostic laparoscopy revealed distended Lt tube suspected of ectopic pregnancy & blood in POD. Salpingectomy was done. The histology showed Lt tube with epithelial dysplasia without atypia & areas of necrosis. No evidence of chorionic tissues. Follow up serial B-Hcg gradually dropped over a period of 3 weeks with -ve pregnancy test on day 26 post-operative. This case further illustrate that distended tube on laparoscopy in symptomatic patient in early pregnancy may not be ectopic pregnancy. It further poses the risks of missing some tubal pathology associated with medical management of early ectopic pregnancy.
Ultrasound in Obstetrics & Gynecology 2013; 42 (Suppl. 1): 113–179.
