B.J. Mein

Transperineal use of a pocket‐sized ultrasound machine versus conventional transvaginal ultrasound: A blinded comparison of cervical length in pregnancy

Spontaneous preterm birth is a leading cause of neonatal mortality and morbidity and its prediction remains a particular challenge in obstetrics1. Measurement of sonographic cervical length (CL) is a useful aid in managing women at risk of preterm labor and assisting in the effective use of healthcare resources. CL measurement by transvaginal sonography (TVS) is considered to be the ‘gold standard’, however, in cases in which there may be clinical or patient reluctance, transperineal (TPS)/translabial sonography can be offered as an alternative. Previous studies have demonstrated good correlation between the measurement of CL using TPS and TVS approaches, however, in these studies, ultrasound examinations were performed using high-specification ultrasound machines (HSUM), with a curvilinear ultrasound probe2–4. Pocket-sized ultrasound machines (PUM) have attracted interest recently due to their portability and affordability. They can provide a simple ultrasound service at the bedside, especially in remote locations or low-resourced communities5. Currently, however, a TVS probe is not provided with PUM units. If the PUM method, using TPS, is proven to be feasible and comparable to HSUM TVS, it may enable CL measurement in a point-of-care setting. Here we present our study, in which we evaluated the feasibility and accuracy of TPS measurement of CL with a PUM, in a blinded comparison with conventional HSUM TVS. This was a prospective, observational cohort study of 113 non-consecutive pregnant women, who required TVS at 11–40 weeks’ gestation as part of their clinical management. All women gave consent to undergo conventional HSUM TVS followed by PUM TPS for measurement of CL. HSUM TVS was performed by a qualified sonographer and PUM TPS was performed by one of the study investigators, also a qualified sonographer or sonologist, who was blinded to the indication for the ultrasound examination and the TVS findings. The PUM had a 1.7–3.8-MHz phased array transducer with a 13 × 19 mm Figure 1 Ultrasound images in a patient with a short cervix, using: (a) high-specification ultrasound machine with transvaginal sonography (HSUM) and (b) pocket-sized ultrasound machine with transperineal sonography (PUM). Calipers are placed at internal os (left caliper) and external os (right caliper). Cervical length on HSUM was 1.37 cm (a) and on PUM was 1.4 cm (b).

Transperineal use of a pocket-sized ultrasound machine vs conventional transvaginal ultrasound: a blinded comparison of cervical length in pregnancy.

Spontaneous preterm birth is a leading cause of neonatal mortality and morbidity and its prediction remains a particular challenge in obstetrics1. Measurement of sonographic cervical length (CL) is a useful aid in managing women at risk of preterm labor and assisting in the effective use of healthcare resources. CL measurement by transvaginal sonography (TVS) is considered to be the ‘gold standard’, however, in cases in which there may be clinical or patient reluctance, transperineal (TPS)/translabial sonography can be offered as an alternative. Previous studies have demonstrated good correlation between the measurement of CL using TPS and TVS approaches, however, in these studies, ultrasound examinations were performed using high-specification ultrasound machines (HSUM), with a curvilinear ultrasound probe2–4. Pocket-sized ultrasound machines (PUM) have attracted interest recently due to their portability and affordability. They can provide a simple ultrasound service at the bedside, especially in remote locations or low-resourced communities5. Currently, however, a TVS probe is not provided with PUM units. If the PUM method, using TPS, is proven to be feasible and comparable to HSUM TVS, it may enable CL measurement in a point-of-care setting. Here we present our study, in which we evaluated the feasibility and accuracy of TPS measurement of CL with a PUM, in a blinded comparison with conventional HSUM TVS. This was a prospective, observational cohort study of 113 non-consecutive pregnant women, who required TVS at 11–40 weeks’ gestation as part of their clinical management. All women gave consent to undergo conventional HSUM TVS followed by PUM TPS for measurement of CL. HSUM TVS was performed by a qualified sonographer and PUM TPS was performed by one of the study investigators, also a qualified sonographer or sonologist, who was blinded to the indication for the ultrasound examination and the TVS findings. The PUM had a 1.7–3.8-MHz phased array transducer with a 13 × 19 mm Figure 1 Ultrasound images in a patient with a short cervix, using: (a) high-specification ultrasound machine with transvaginal sonography (HSUM) and (b) pocket-sized ultrasound machine with transperineal sonography (PUM). Calipers are placed at internal os (left caliper) and external os (right caliper). Cervical length on HSUM was 1.37 cm (a) and on PUM was 1.4 cm (b).

Effect of three‐ vs four‐dimensional ultrasonography on maternal attachment

Maternal attachment begins its course during early pregnancy with thoughts and feelings for the unborn baby gradually increasing and attachment intensifying in the first weeks after birth of the baby.1.

EP03.01: Interclass observer reliability in measuring uterocervical angle: Electronic Poster Abstracts

A retrospective study was conducted on 200 women who attended the Perinatal Ultrasound Department for their fetal anatomy ultrasound between 18 and 22 weeks of gestation. A transvaginal examination is offered to assess the cervical length with this ultrasound. Four independent investigators were asked to measure the uterocervical angle. Retrospective angle measurements were obtained using Viewpoint 4D software. The angle is formed by the cervix and the anterior lower uterine segment (Image 1). The 4 raters were evaluated for consistency of measurement and summarised with an inter-class correlation index (Table 1). Table 1 Conclusion

Screening the second-trimester fetal heart in women with an increased body mass index using three-dimensional volume sweep

To determine the percentage of fetal cardiac anatomy as detailed in the International Society of Ultrasound in Obstetrics and Gynecology Practice Guidelines on sonographic screening examination of the fetal heart, which can be visualised in women with a body mass index (BMI) >30 kg/m2 using three‐dimensional (3D) volume sweeps.

EP26.03: Prediction of pouch of Douglas obliteration by analysing offline ultrasound and laparoscopic videosets: a diagnostic accuracy and interobserver study

follow-up. Patient was discharged stable. Ultrasound performed six months later noted a left ovarian cyst with low-level echoes. On follow-up, she was noted to have recovered completely and a scan performed a year later did not demonstrate any abnormalities in the pelvis. Conclusion: Patient was virgo intacta. Transrectal scan was attempted but unsuccessful. Transabdominal ultrasound was restricted by body habitus, hence resulting in suboptimum demonstration of the dermoid.

P23.01: Doppler colour scoring system using offline video analysis in women with an incomplete miscarriage: inter- and intraobserver reproducibility study

G.T. Leong7, C. Lu5, B.J. Mein6, M. Espada4, B. Shakeri4, B. Nadim4, S. Reid2, I. Casikar3, G. Condous1 1Obstetrics and Gynecology, Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia; 2Nepean Hospital, Chiswick, NSW, Australia; 3Early Pregnancy, Acute Gynecology and Advanced Endosurgery Unit, Nepean Hospital, Enu Plains, NSW, Australia; 4Obstetrics and Gynecology, Nepean Hospital, Penrith, NSW, Australia; 5Computer Science, Aberystwyth University, Aberystwyth, United Kingdom; 6Perinatal Ultrasound, Nepean Hospital, Kingswood, NSW, Australia; 7University of Sydney, Sydney, NSW, Australia

Congenital Epulis: a clinical case presentation

Congenital Epulis (CE) is a rare, benign tumour of the mucosa of the mouth in a neonate. It presents as an intraoral tumour and is rarely diagnosed prenatally. Complications include neonatal airway compromise, difficulty feeding and aesthetic considerations. Ultrasound is useful in aiding decisions regarding site, age, method of delivery and preparing parents and staff for the appearances of the tumour at birth. We present a case where CE was identified at 35 weeks gestational age during a routine third trimester prenatal ultrasound.

OP19.04: Intra‐observer agreement in the prediction of pouch of Douglas obliteration using 2‐D off‐line analysis of the TVS ‘sliding sign’

rectovaginal septum. When no lesion was seen, observers were asked to judge if the acquisition of the volume was defective, or if no lesion on the rectovaginal septum was evident; defective acquisition cases were discarded, a total number of 83 cases were evaluated. In order to calculate the performance of the introital 3D US, seven discordant cases were reviewed by a third observer. Interobserver agreement was assessed by calculating kappa index (κ), and Sensitivity, Specificity, PPV and NPV by the three observers were also determined. Results: Interobserver agreement was 0.816 (95% CI [0.69–0.93]) (representing a very good agreement). Sensitivity was 74.1%, Specificity 85.5%, PPV 71.4% and NPV 87%. Conclusions: Our results show that introital 3D US for diagnosis of deep endometriosis of the rectovaginal septum is reproducible with very good interobserver agreement.

OP19.06: The prediction of pouch of Douglas obliteration using off-line analysis of the TVS ‘sliding sign’: diagnostic accuracy and inter-observer agreement

Objectives: To describe ultrasound findings in patients with acute salpingitis and to determine if it is possible using ultrasound to discriminate between acute salpingitis and other painful conditions mimicking clinical symptoms/ findings of acute salpingitis. Methods: 52 patients underwent a standardized transvaginal ultrasound scan before diagnostic laparoscopy because of clinical suspicion of acute salpingitis. The laparoscopist was blinded to scan results. Final diagnosis was based on laparoscopy, histology of the endometrium or other histology where relevant. Results: 29 patients had a final diagnosis of cervicitis (n = 3), endometritis (n = 9), or salpingitis (n = 17), 23 (44%) had a diagnosis unrelated to genital infection. In 4 cases the salpingitis was mild, in 8 moderate, in 5 severe (pyosalpinx). Bilateral adnexal masses and bilateral masses lying adjacent to the ovary were seen more often at scan in patients with salpingitis than with other diagnoses (14/17 vs. 6/35, P = 0.000; 11/17 vs. 6/35, P = 0.001). In salpingitis, the masses lying adjacent to the ovaries were on average 2–3 cm in diameter, solid (n = 14), unilocular (n = 4) or multilocular (n = 3) cystic, or multilocular solid (n = 1), and well vascularized at color Doppler. Spectral Doppler results overlapped between patients with different diagnoses. The sensitivity with regard to acute salpingitis of subjective assessment of scan findings by the sonologist was 82%, specificity 77%, positive and negative likelihood ratio (LR+) 3.6 and 0.23. Those of scan findings of bilateral masses lying adjacent to the ovary were 65%, 83%, LR+ 3.8 and LR− 0.42. The corresponding figures for bilateral adnexal masses were 82%, 83%, 4.8 and 0.22. Conclusions: In patients with clinical suspicion of acute salpingitis, absence of bilateral adnexal masses at scan decreases the odds of acute salpingitis 5-fold.