P. Milart

Elastography in predicting preterm delivery in asymptomatic, low-risk women: a prospective observational study

BackgroundDespite the efforts to decrease the rate of preterm birth, preterm delivery is still the main cause of neonatal morbidity and mortality. Identifying patients threatened with preterm delivery remains one of the main obstetric challenges. The aim of this study was to estimate the potential value of elastographic evaluation of internal cervical os stiffness at 18-22 weeks of pregnancy in low risk, asymptomatic women in the prediction of spontaneous preterm delivery.MethodsThis prospective observational study included 333 low-risk, asymptomatic women presenting for the routine second trimester ultrasound scan according to the Polish Gynecological Society recommendation between 18-22 weeks of pregnancy. Ultrasound examinations of the cervix were performed transvaginally. The following data were recorded: elastographic color assessment of the internal os and ultrasound cervical length at 18-22 and 30xa0weeks of pregnancy; maternal age; obstetrical history; presence of cervical funneling at 30xa0weeks of pregnancy; gestational age at birth. Elastographic assessment of the internal os was performed using a color map: red (soft), yellow (medium soft), blue (medium hard) and purple (hard). If two colors were visible in the region of the internal os, the softer option was noted. Statistical analysis was performed using Statistica software (version 10, Statsoft Poland) using the following tests: chi square test to compare frequency of preterm deliveries in various categories of internal os assessment and Spearman correlation test to determine the correlation between elastographic assessment and cervical shortening. To determine the cut off category of internal os elastography assessment in selecting high preterm delivery risk patients we have calculated the sensivity, specifity, negative predictive value and positive predictive value.ResultsThe number of preterm deliveries (<37xa0weeks of pregnancy) was significantly higher in the red and yellow groups, than in the blue and purple groups. The sensivity, specifity, NPV and PPV for both red and yellow internal os assessment in predicting preterm delivery were 85.7%, 97.6%, 98.3% and 81.1% respectively.ConclusionsElastographic assessment of the internal cervical os at 18-22 weeks of pregnancy may identify patients with high risk of preterm delivery in low-risk, asymptomatic women.

Influence of ulipristal acetate therapy compared with uterine artery embolization on fibroid volume and vascularity indices assessed by three‐dimensional ultrasound: prospective observational study

To compare the effects of two alternative treatment options for uterine fibroids, ulipristal acetate (UPA) and uterine artery embolization (UAE), on fibroid volume and vascularity at 3‐month follow‐up.

Delayed Diagnosis of Herlyn-Werner-Wunderlich Syndrome due to Microperforation and Pyocolpos in Obstructed Vaginal Canal

BACKGROUNDnTo present a rare anomaly consisting of uterus didelphys, longitudinal vaginal septum, obstructed hemivagina with pyocolpos, fistula to the open vaginal canal, and ipsilateral renal agenesis, referred as Herlyn-Werner-Wunderlich syndrome (HWWS).nnnCASEnA 14-year-old girl with recurring purulent vaginal discharge lasting for a few months. Preoperative examination revealed one vaginal canal with one cervical opening on the right side. There was a fistula leading from the obstructed vaginal canal to the left vagina. Intravaginal ultrasound examination demonstrated a longitudinal vaginal septum and a closed pyocolpos on the right side. The longitudinal vaginal septum was excised by way of electrocauterization under direct vision.nnnCONCLUSIONnHWWS should be considered in the differential diagnosis in patients with uterus didelphys and unusual symptoms such as pyocolpos and vaginal discharge.

P45.02: Ultrasound examination of the female utrethra after short‐term intravaginal estrogen treatment

Objective: The depletion of estrogens during the menopause period seems to be the cause of improper metabolism thus influencing the morphological structures of the lower urinary tract (LUT). Transvaginal ultrasound examination provides the serious possibility of the detailed assessment of the female LUT structures. The aim of the study was to evaluate the influence of vaginally administered estrogens on ultrasonographic features of the urethra in menopausal women. Material and methods: The studied group consisted of 25 menopausal women not suffering from any form of urinary incontinence. The urethral wall thickness and urethral funneling were measured before, after 1, and after 3 months of treatment with vaginal estrogens. The selected variables were measured 3 times as a single dimension using a 7.5 MHz transvaginal probe (Medison SONOACE 9900 Prime) in the sagittal plane. Transvaginal power Doppler ultrasonography was used to study the pulsatility index (PI) and resistence index (RI) of arterial vessels in the examined structure. Results: The median values of urethral wall thickness and urethral funneling before, after 1 month and after 3 months of local administration of estrogens were 3.7, 3.8, 3.9 mm (Friedman ANOVA, ÷2 = 6.36, P = 0.042) and 3.7, 3.6, 3.6 mm (Friedman ANOVA, ÷2 = 8.61, P = 0.013) respectively. No significant changes in the PI and RI in the bladder wall arterial vessels were found. Conclusion: Short-term estrogen therapy results in significant thickening of urethral wall and in the decrease in the funneling diameter, although it does not affect the vascularization of the assessed tissues.

EP15.05: Influence of supracervical hysterectomy, ulipristal acetate and uterine artery embolisation on ovarian reserve: an observational study: Electronic Poster Abstracts

72% respectively, adenomyosis were 79%, 84%, 58%, 93% and 83% respectively, combined were 19%, 93%, 47%, 81% and 57% respectively. Conclusions: This study demonstrated that TVS is effective non-invasive method for the presurgical diagnosis of leiomyoma and adenomyosis. TVS is most sensitive for the detection of leiomyoma. However, the specificity of TVS is superior for the detection of adenomyosis and combined cases with leiomyoma and adenomyosis.

Comparison of the influence of three fibroid treatment options: supracervical hysterectomy, ulipristal acetate and uterine artery embolization on ovarian reserve – an observational study

BackgroundTo assess and compare the influence of three fibroid treatment options: supracervical hysterectomy, ulipristal acetate and uterine artery embolization on ovarian reserve.MethodsProspective, observational, open-label study performed at the 3rd Chair and Department of Gynecology of the Medical University of Lublin, Poland. Premenopausal Caucasian women with symptomatic uterine fibroids were recruited into 3 groupspatients qualified for supracervical hysterectomies; patients qualified for preoperative ulipristal acetate (UPA) treatment scheduled for supracervical hysterectomies or myomectomies; patients qualified for uterine artery embolization (UAE). The following markers of ovarian reserve were investigated: antral follicle count (AFC), anti-Mullerian hormone (AMH), inhibin B (INHB), follicle stimulating hormone (FSH) and estradiol (E2). These markers were assessed before and 3xa0months after supracervical hysterectomies, before and 3xa0months after UAEs, and before and after 3xa0months of UPA treatment, before the scheduled surgeries. Baseline characteristics (age, parity, dominant fibroid volume, hemoglobin level, BMI, as well as AFC, AMH, INHB, FSH and E2) were compared between the study groups by Kruskall-Wallis ANOVA. Pre- and post-interventional values of AFC, AMH, INHB, FSH and E2 in the studied groups were compared with the Wilcoxon matched pairs test.ResultsTwenty-six, 27 and 30 patients were included in the final analysis in the supracervical hysterectomy, UPA and UAE groups, respectively. Three months after supracervical hysterectomy INHB and E2 significantly decreased, while AFC, AMH and FSH remained unchanged. After 3xa0months of UPA treatment the values of all the assessed markers of ovarian reserve were not significantly different in comparison to baseline. Conversely, three months after UAE the values of AFC, AMH, INHB, and E2 were significantly decreased, while FSH was significantly increased.ConclusionsOf the compared fibroid treatment methods UAE seems to have the greatest impact on ovarian function and should not be offered to patients concerned about their ovarian function. Supracervical hysterectomy did not affect the most accurate markers of ovarian reserve, and therefore appears to be safe in terms of ovarian function. UPA did not change any of the studied markers of ovarian reserve and seems a reasonable option when ovarian function is concerned.

P07.08: Ultrasound evaluation of the uterine fibroids volume changes after uterine arteries embolization

layers represented by basal endometrial and was considered normal between 4 and 8 mm. Patients with endometrial abnormal elevated thickness (26 cases) were treated with didrogesteron 30 mg b.d. for 3 days and then 20 mg b.d for another 7 days. In these cases, the preventing treatment was conducted in a discontinuous manner, with 20 mg didrogesteron b.d., ten days, starting with the 15th day of the cycle, for 3 months. Patients with endometrial atrophy (11 cases) were treated with combined oral contraceptive containing 30 μg etinilestradiol and 150 μg levonorgestrel, 2–3 pills b.d. until the bleeding ceased followed by 1 pill b.d. for completing 21 days of therapy. In these cases the preventive treatment was done in the same discontinuous manner, with didrogesteron. Results: In both groups the bleeding ceased after a medium of 3, 6 days of treatment. One patient with endometrial hyperplasia needed after 6 days of treatment uterine haemostatic curettage. Four patients in the first group and one in the second have experienced in the following six months after completing preventive therapy bleeding recurrences. In these cases was applied the same treatment and no relapse was encountered another six months. Conclusions: The endometrial thickness ultrasound evaluation is a valuable criterion for the treatment of juvenile uterine functional bleeding. Hormonal therapy in such cases is highly efficient in bleeding cessation. Prevention of the illness’s receive needs in 16% of cases am additional treatment until maturation of the hypothalamushypophysis-ovarian axe is established.

P20.09: The impact of low maternal plasma glucose level after glucose challenge test on fetal growth

Introduction: Intrauterine growth restriction (IUGR) is a major cause of perinatal morbidity and mortality. IUGR is characterized by the presence of a fetus with a weight lower than the 10th centile for gestational age estimated by ultrasound examination or a delivery of a neonate with a birth weight lower than 2.5 kg at term. The causes of IUGR are divided into fetal, placental and maternal ones. Maternal anemia, malnutrition, infections (rubella, cytomegalovirus), toxic substances (alcohol, smoking) may affect fetal growth. Objectives: The aim of the study was to determine the relationship between the low maternal plasma glucose level after glucose challenge test (GCT) and fetal growth restriction. Material and Methods: The studied population consisted of 141 pregnant women with a singleton gestation. The women underwent the GCT between the 24th and 27th week of pregnancy. In all patients ultrasound examination was performed between 20th and 24th week of gestation and the estimated fetal weight (EFW) was evaluated. Low maternal plasma glucose level after GCT was defined as less than 100mg/dL. Patients with glucose level higher than 140mg/dL after GCT were excluded from the study. The data obtained from the remaining women (n = 134) were compared with the fetal birth weight measured after delivery. The Yates’ chi-square test was used to perform statistical calculation. Results: The frequency of IUGR in the studied population was 12.6% (17/134). Conclusion: The study showed that in women with the plasma glucose levels lower than 100 mg/dL after GCT the frequency of IUGR was significantly higher than in those with normal results of GCT.

P32.09: Bilateral loss of end-diastolic frequencies in the uterine arterial waveform in predicting the risk of brain sparing effect in intrauterine growth restriction

Intrauterine growth restriction (IUGR) is an important issue in perinatology. Design: The aim of the study was to assess the bilateral loss of end-diastolic frequencies (NOTCH) in the uterine arterial waveform in predicting risk of brain sparing effect (BSE) in the IUGR fetuses. Material and Methods: Ultrasound (US) scans in 24 fetuses with signs of IUGR between 20 and 24 weeks of pregnancy and before delivery were performed. Uterine arterial waveform and cerebral-placental ratio (the pulsation indices in the middle cerebral artery divided by the pulsation indices in the umbilical artery) were evaluated. All fetuses were singletons and had follow-up to the delivery. Results: 15 fetuses were born at term, whereas another 9 before term. Nevertheless in all cases birth weight was under 10th centile. 21 (87.5%) abnormal flow pattern in uterine arterial waveform in US scans between 20 and 24 weeks of pregnancy were discovered. In US examination performed before delivery BSE in 8 (33.3%) fetuses was observed. In all fetuses with BSE, NOTCH events were observed in uterine arterial waveform. 25%(2/8) fetuses had unilateral, and 75%(6/8) bilateral loss of end-diastolic frequencies in the uterine arterial waveform. Conclusion: The results of the study indicate that bilateral loss of end-diastolic frequencies in the uterine arterial waveform is closely related to the increased risk of BSE at the time of the delivery.

P48.05: Transvaginal ultrasound evaluation of bladder and urethra wall thickness in postmenopausal women with urinary stress and urge incontinence

Vaginal ectopic ureter associated with ipsilateral dysplastic pelvic kidney and bicornuate uterus is a rare congenital urogenital anomaly. A six-year-old girl had suffered from purulent vaginal discharge for three years. She was first misdiagnosed as vulvovaginitis. Ultrasound later revealed double uterine cavities, hydrocolpos, and lobulated cystic lesion identified as the left hydroureter connecting the vagina. A tiny pinhole was detected on the left upper vagina wall. Intravenous pyelography demonstrated right compensatory hypertrophic renal system without visible of the left side. Magnetic resonance imaging delineated the defect and entire urogenital systems. The patient received laparoscopic left ureteronephrectomy and was discharged uneventfully. Integrated radiographic and endoscopic examinations were required for preoperative diagnosis of urogenital tract anomalies in a young girl.