A. Tailor

Ultrasound screening for congenital uterine anomalies

The aim of this study was to investigate the prevalence of congenital uterine anomalies in 1046 women attending gynaecological ultrasound clinics for a variety of indications. Using three‐dimensional ultrasound, anomalies were found in 55 women (5.4%), including 32 (3.1%) with an arcuate uterus and 23 (2.3%) with major anomalies. The prevalence of uterine anomalies was similar to the findings in women undergoing elective sterilisation, but lower than in studies of women with recurrent miscarriage.

Expectant management of tubal ectopic pregnancy: prediction of successful outcome using decision tree analysis

To establish whether a decision tree based on a combination of clinical, morphological and biochemical parameters could be constructed to help in the selection of women with tubal ectopic pregnancies for expectant management.

Sonographic prediction of malignancy in adnexal masses using an artificial neural network

Objective To generate a neural network algorithm which computes a probability of malignancy score for pre‐operative discrimination between malignant and benign adnexal tumours.

Prediction of early pregnancy viability in the absence of an ultrasonically detectable embryo

To identify clinical, ultrasound and biochemical parameters that may allow prediction of pregnancy viability in women without a detectable embryo on ultrasound examination.

Prospective evaluation of three different models for the pre‐operative diagnosis of ovarian cancer

Objective To test the accuracy of the risk of malignancy index, the revised risk of malignancy index and Tailors regression model to diagnose malignancy in women with known adnexal masses.

Results from an ultrasound‐based familial ovarian cancer screening clinic: a 10‐year observational study

To assess the use of transvaginal sonography as a screening test for familial ovarian cancer and, secondarily, to determine the value of a family history of malignant disease and the potential role of serum CA 125 levels in the screening procedure.

Comparison of Transvaginal Color Doppler Imaging and Color Doppler Energy for Assessment of Intraovarian Blood Flow

Objective To investigate any systematic differences in the analysis of blood flow velocity waveforms derived by color Doppler imaging and color Doppler energy examination of corpora lutea and adnexal tumors, to test whether the accuracy for diagnosing ovarian malignancy differs between end points derived by color Doppler imaging and color Doppler energy, and to compare the reproducibility of flow velocity waveform analysis obtained by both methods. Methods Fifty-six asymptomatic women with presumed corpora lutea and 67 women with known adnexal masses were included in the study. They all were examined using transvaginal sonography with color Doppler imaging and color Doppler energy. Pulsed Doppler sonography was used to obtain flow velocity waveforms to determine the pulsatility index (PI), resistance index (RI), peak systolic velocity, and time-averaged maximum velocity, The tumors were classified retrospectively according to histologic criteria. Results There were 52 women with benign, three with borderline, and 12 with malignant ovarian tumors. Repeated-measures analysis of variance revealed no systematic differences in the values of all four measurements performed under color Doppler imaging and color Doppler energy for all cases of corpora lutea and adnexal tumors (PI: P = .153, RI: P = .197, peak systolic velocity: P = .355, time-averaged maximum velocity: P = .159). All cases of borderline and malignant tumors had detectable pulsatile blood flow with color Doppler imaging and color Doppler energy. Forty-two (80.8%) of the benign tumors had flow detectable with color Doppler imaging, compared with 40 (76.9%) with color Doppler energy (P = .480). Analysis of receiver operating characteristic curves showed a marginal but nonsignificant improvement in diagnostic performance with color Doppler energy compared with color Doppler imaging for all four measurements (PI: P = .182, RI: P = .178, peak systolic velocity: P = .254, time-averaged maximum velocity: P = .238). The intraclass correlation coefficients for all four measurements were superior with color Doppler imaging compared with color Doppler energy. Conclusion Flow velocity waveform analysis and diagnostic accuracy for ovarian malignancy are not significantly different between color Doppler imaging and color Doppler energy. Examinations with color Doppler imaging appear to be more reproducible than those with color Doppler energy.

A comparative study of the risk of malignancy index and the ovarian crescent sign for the diagnosis of invasive ovarian cancer

To compare the value of the risk of malignancy index (RMI) and the ovarian crescent sign (OCS) in the diagnosis of ovarian malignancy.

Misoprostol for induction of labour at term

Sic We read with interest the recent randomised comparative trial by Danielian et al. and the systematic review by Hofmeyr et al. (Vol 106, August 1999)’,’ on the use of misoprostol as an agent for induction of labour. We believe that we are one of the few units in the UK to be using this preparation routinely for all women having induction of labour. We compared the outcomes of 177 women between January and June 1997 whose labours were induced with dinoprostone with 243 women whose labours were induced between January and June 1998 with misoprostol. We demonstrated a significant difference in induction-tkelivery interval when misoprostol was compared with dinoprostone, a significant reduction in the use of oxytocin augmentation and a non-significant reduction in the instrumental delivery rate and caesarean section rate. We also compared umbilical venous pH, umbilical venous base excess, Apgar scores and admission to the special care baby unit between the two groups and could find no clinically important differences. There was a significantly increased rate of tachysystole in the misoprostol group but not of hyperstimulation. There were no untoward maternal or fetal events. Both articles referred to above and the editorial comment in the same edition of the British Journal of Obstetrics and Gynaecology expressed caution with the use of misoprostol for routine induction of labour. One point made was that the increased pain in the group induced by misoprostol should limit its use but this has to be balanced against the much greater efficacy of the drug and all practising obstetricians will be familiar with the woman who remains undelivered after several days of dinoprostone. We have found that failed induction is very uncommon when misoprostol is used. Secondly, there are considerable cost savings involved in using this more effective induction agent. We have calculated that on the basis of reduced drug costs and a significantly shorter period of hospital stay our annual savings in a district general hospital with a delivery rate of 4200 was

OC232: Screening for familial ovarian cancer—a 10 year observational study

69,000. Clearly safety concerns must be considered but Hofmeyr et al. and Danielian et al. could find no evidence of clinically adverse events and the latter also referred to two meta-analyses in his paper which came to similar conclusions. We noticed that one of the authors of the systematic review by Hofmeyr et al. works with the WHO and yet the conclusion of their paper was that it should not be introduced into more widespread use without further controlled trials. We have this luxury in the West but we feel that the potential for the use of misoprostol could have been more positively commented on, particularly its use in the third world. One of the authors of this letter (R.H.) has had experience recently with obstetric units in the former Soviet Union and it is clear that misoprostol which is cheap, effective and does not require refrigeration has a powerful capacity to reduce maternal morbidity and mortality in countries where standard induction agents (i.e. dinoprostone) cannot be afforded or are in variable supply.