K. Hillaby

First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar

To describe first‐trimester ultrasound diagnosis and management of pregnancies implanted into uterine Cesarean section scars.

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.

Accuracy of ultrasound subjective ‘pattern recognition’ for the diagnosis of borderline ovarian tumors

To assess the value of pattern recognition for the preoperative ultrasound diagnosis of borderline ovarian tumors (BOTs).

The value of detection of normal ovarian tissue (the ‘ovarian crescent sign’) in the differential diagnosis of adnexal masses

The aim of the study was to evaluate whether the presence of normal ovarian tissue adjacent to an adnexal tumor (the ‘ovarian crescent sign’) could assist in the preoperative differential diagnosis of adnexal lesions.

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.

Cesarean Scar Pregnancy

Cesarean scar pregnancy (CSP) presents a diagnostic as well as a therapeutic challenge. Since more cesarean deliveries (CDs) are performed, its frequency is increasing. Although there are no general guidelines for the management of this rather threatening entity, this chapter deals with a set of diagnostic and treatment criteria of this complication of pregnancy. Awareness and timely diagnosis of CSP by a very early transvaginal ultrasound scan (TVS) of a new pregnancy in a patient with previous CD may enable early treatment and mitigate complications.

OC019: The efficacy of ultrasound‐based protocol for the diagnosis of tubal ectopic pregnancy

Background: Ultrasonography is highly reliable in the management of women with early pregnancy complications. An endometrial cut-off < 15 mm with no retained products of conception has been used to classify complete miscarriage (CM) on transvaginal sonography (TVS). However despite a history of heavy vaginal bleeding, a proportion of these women have an undiagnosed ectopic pregnancy (EP). We evaluated the need for hormonal follow up in women with a history and scan findings suggestive of CM. Materials and methods: Prospective observational study. 5918 consecutive women presented to the Early Pregnancy Unit − 223 (3.8%) were classified CM on the basis of a history of heavy vaginal bleeding and the above sonographic criteria. 56 were not pregnant and 24 were lost to follow up. 143 were included in the analysis. Serum human chorionic gonadotrophin (hCG) levels were taken at presentation and 48 hours later. All women were followed up until hCG < 5 U/L or a cyesis was visualised on TVS. Results: 131/143 (91.6%) CM confirmed according to hCG follow up. 8/143 (5.6%) confirmed to be EP requiring further treatment. 2/143 (1.4%) persisting pregnancies of unknown location (PUL) requiring methotrexate therapy. 2/143 (1.4%) intrauterine pregnancies – one blighted ovum and one ongoing IUP. If hCG levels rose, 10/12 (83%) required intervention. Conclusions: Diagnosis of complete miscarriage based on history and scan findings alone is unreliable, as up to 6% will have an ectopic pregnancy. If hCG levels do not fall, these women should be followed closely until the location of the pregnancy is confirmed.

OC25.03: A prospective evaluation of the ovarian crescent sign and the risk of malignancy index (RMI) for the diagnosis of ovarian malignancy

IUGR group. Small thymus was determined by two and three standard deviations (SD) compared with normal. We calculated the sensitivity, specificity, and predictive values (PPV and NPV) of the small thymus in the diagnosis of the IUGR. Results: Using 2 SD as the cutoff value, 11 of 17 fetuses with small thymus were IUGR at birth. All three fetuses with normal thymus were normal or constitutionally small. Sensitivity, specificity, PPV, and NPV were 100%, 33%, 65%, and 100%. Using 3 SD, 10 of 12 fetuses with small thymus were IUGR. Six of eight fetuses with normal thymus were normal or constitutionally small. Sensitivity, specificity, PPV, and NPV were 83% 75%, 83%, and 75%. Conclusion: Small thymic diameter may be a useful finding in the diagnosis of IUGR on the prenatal ultrasound.

OC117: The value of detection of normal ovarian tissue in the differential diagnosis of ovarian cysts

Objective: Was to examine prospectively the longitudinal course of pregnancy in cases of ARED-Flow detected between 24/0 and 34/0 gw. and to compare outcome with a control group of gestational age-matched control group. Methods: During the 6years study period 1995–2000, 60 fetuses of singleton pregnancies with ARED-Flow in the umbilical artery were included in the study. Fetuses with malformations and aneuploidy were excluded. Surveillance was performed by repeated Dopplermeasurements of arterial and venous vessels, CTG and maternal parameters. Delivery (c.s.) was dated when either reversed Flow in the DV, decelerations in CTG or maternal pre-eclampsia occurred. Results: Mortality 16 (27%) intrauterine death (birthweight in 9 cases < 500 g), 44 (73%) liveborns, 7 (12%) neonatal death. Indication for delivery: 72% deterioration of fetal parameters, 28% pre-eclampsia. Following our protocol, 50% of fetuses with ARED Flow will be delivered after 6 days. Control group: 44 preterm neonates born in the same period in same centre. Significant differences between ARED fetuses and control: lower pH values (p = 0.001), lower birth weight (p = 0.0001), more broncho-pulmonal dysplasia (p = 0.002), more intestinal complications (p = 0.01) in the ARED group. Other tested parameters (intraventricular hemorrhage, neurological development et al.) were not significantly different. Conclusions: Diagnosis of ARED-flow indicates a group of severely hypotrophic, acidemic fetuses with a high mortality rate. Although the incidence of intraventricular haemorrhage (20%) and neurological defects (40%) was high, difference to preterm neonates was not significant. It can be speculated, that prolongation of pregnancy using venous Doppler improves the outcome.

P125: Study to evaluate the diagnostic accuracy of transvaginal ultrasound scanning in the detection of endometrial polyps

Objective: The aim of this study was to evaluate the accuracy of transvaginal ultrasound scanning (TVS) in the detection of endometrial polyps. Materials and methods: During a period of two years all women with history of abnormal bleeding were examined by B-mode transvaginal ultrasound. Women with endometrial polyps identified on the scan and those with abnormally thick endometrium not suitable for outpatient biopsy, were referred for hysteroscopy. Results: 192 patients were included. Ultrasound correctly identified 101 of 126 endometrial polyps, diagnosed at hysteroscopy. 35 women had a false positive diagnosis of endometrial polyp on ultrasound scan, with normal uterine cavity or submucous fibroids detected at hysteroscopy. 31 women with uniformly thickened endometrium on the scan had the diagnosis confirmed at hysteroscopy. The sensitivity of transvaginal ultrasound to detect endometrial polyps was 80.2%, with a specificity of 47.0%. The positive predictive value was 74.4%, negative predictive value was 55.4%. Conclusion: Transvaginal sonography is a sensitive tool for detection of endometrial polyps. However, the false positive rate is high and therefore the diagnosis should be confirmed by saline infusion sonohysterography, before an operative hysteroscopy is scheduled.