P12.01: Pelvic floor biometry after the delivery in Chinese primiparous women
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22nd World Congress on Ultrasound in Obstetrics and Gynecology Poster abstracts Results: Thirty-eight women were diagnosed of Cesaeran scar defect at TUS. The number of previous Caesarean sections in patients with uterine dehiscence and ectopic pregnancy in Cesarean scar is shown in Table 1. Eleven patients (29%) showed a uterine dehiscence. Seven cases were repaired by laparoscopy and 4 cases required hysterectomy. Five ectopic pregnancies (13%) were diagnosed at TUS. Two patients required hysterectomy, 2 were treated with local methotrexate guided by TUS and 1 was surgically sutured. Two patients (5%) had a complete uterine rupture. One of them diagnosed 6 months after Cesarean section and required hysterectomy. The other which was diagnosed during puerperium period was treated by surgical repair. Conclusions: TUS is useful for detecting Cesarean scar defects providing information for a treatment in case of complications. P11.10: Table Number of previous Cesarean 1 2 3 4 Dehiscense 5 4 1 1 Ectopic pregnancy 3 – 1 1 P11.11 Interobserver variation in measurements of Cesarean scar defect and myometrium with 3D ultrasonography L. D. Madsen , J. Glavind, N. Uldbjerg, M. Dueholm Obstetrics and Gynecology, Aarhus University Hospital, Aarhus N, Denmark Objectives: To evaluate the Cesarean scar defect depth and the residual myometrial thickness with 3-dimensional (3D) sonography concerning interobserver variation. Methods: Ten women were randomly selected from a larger cohort of Cesarean scar ultrasound evaluations. All women were examined 6–16 months after their first Cesarean section with 2D transvaginal sonography and had 3D volumes recorded. Two observers independently evaluated ‘‘off-line’’ each of the 3D volumes stored. Residual myometrial thickness (RMT) and Cesarean scar defect depth (D) was measured in the sagittal plane with an interval of 1 mm across the entire width of the endometrium. RMT was defined as the shortest distance from the scar defect to the uterine serosa among all RMT measures, and D was defined similarly as the largest depth of the scar defect extending from the uterine cavity. The median value for RMT and D for each observer as well as the median difference in RMT and D between the two observers was calculated. Results: The median value of RMT was 6.0 mm in observer 1 (range 2.0 – 7.8) and 5.7 mm in observer 2 (range 2.1 – 7.6). Median difference in RMT between the two observers was 1.3 mm (range 0.1–3.3). The median value of D was 2.6 mm in observer 1 (range 1.2–5.4) and 2.4 mm in observer 2 (range 1–4.9), and the median difference was 1.0 mm (range 0.3 – 2.8) between observer 1 and 2. Conclusions: The 3D interobserver variation concerning measures of RMT and D seems good. The role of 3D sonography in evaluations of Cesarean section scar size and residual myometrium needs further investigation. P11.12 The ultrasound morphological structure of ovaries, AMH and indices of color Doppler imaging in autoimmune oophoritis: are they interrelated? K. Tokhunts Obstetrics & Gynecology, Yerevan State Medical University, Yerevan, Armenia Objectives: Autoimmune oophoritis remains an almost undiagnosed pathology in wide clinical practice up to date. Autoimmune oophoritis is characterized by certain histologic changes such as characteristic inflammatory infiltration in the inner theca-layer of growing follicles. It is obvious that such morphological changes of ovarian tissue should be visible by ultrasound. Methods: In detailed ultrasound examination of ovaries in 34 women with high levels of anti-ovarian antibodies (61.1–131.4 IU/ml) a significant increase of echogenicity of ovarian stroma was detected. All patients then underwent diagnostic laparoscopy with histologic examination of ovarian biopsy specimens. Results: Revealed were different degrees of changes characteristic for autoimmune ovarian pathology. The AMH level in serum of examined women was significantly lower (0.28–0.89 ng/mL) than normal (1.0–3.5 ng/mL), and it correlated with the degree of lymphoid infiltration and fibrous changes in ovarian structures. In Doppler examination sometimes avascularization of stroma was seen. In examination of intraovarian artery blood flow, monotonous curves were revealed with maximal flow velocity of 5.1 – 11.3 cm/sec which corresponds to the mean flow velocity of early proliferation stage of non-ovulating ovary. The numeric values of RI (0.65 – 0.93) also did not significantly change during the menstrual cycle and were greater than those of healthy females in ovulatory cycle. Conclusions: Women with autoimmune oophoritis had changes in ultrasound structure of the ovaries such as increased echogenicity of the stroma, intraovarian blood flow, low levels of AMH depending on the degree of histological manifestations of autoimmune injury, which allows to recommend detailed workup directed at detection of antiovarian antibodies in women with olygo/opso- or amenorrhea with above listed ultrasound findings and low levels of AMH. P12: UROGYNECOLOGY AND PELVIC FLOOR P12.01 Pelvic floor biometry after the delivery in Chinese primiparous women S. Chan , R. Cheung, A. Yiu, L. Lee Department of O&G, The Chinese University of Hong Kong, Hong Kong Objectives: This study aims at evaluating the pelvic floor biometries after the delivery in Chinese primiparous women. The relationship with mode of delivery (MOD) was explored. Methods: Nulliparous Chinese women with singleton pregnancy were assessed at 10–13 weeks of gestation, and at 8 weeks, 6 months and 12 months after delivery. Trans-labial 3D-ultrasound was performed at rest, at Valsalva maneuver and at pelvic floor contraction during each visit. MOD was determined by obstetric indications. Offline analysis of USG volume data set were done by an investigator blinded to the information. Position of the bladder neck, middle compartment (most inferior part of cervix) and posterior compartment (ano-rectal junction) and the hiatal area were measured. Results: In all, 131 women completed the study. Their mean age was 30.7 ± 3.6 years, mean gestation at delivery was 275 ± 12.6 days and mean birth weight was 3.0 ± 0.4 kg. 106 (81%) had vaginal delivery (62% normal delivery and 19% instrumental delivery) and 25 (19%) had caesarean section (CS) (5 elective and 20 emergency). There was no difference of gestation at delivery and neonatal birth weight between the groups of MOD. When compared to the first trimester biometries, there was significant descent of middle compartment and increase in hiatal area at rest, VM and PFMC till 12 months after delivery in vaginal delivery group. There was also significant bladder neck descent at rest and at VM at 12 months. In CS group, there was also significant descent of middle compartment at rest, at VM and PFMC till 12 months after delivery; however, there was only increase in hiatal area during VM. Conclusions: At one year after delivery, there was significant descent of middle compartment of women at rest, at VM and PFMC for both vaginal delivery and CS. However, there was significant increase in hiatal area at VM only in CS, while there was increase in hiatal area also at rest and at PFMC in women with vaginal delivery. 216 Ultrasound in Obstetrics & Gynecology 2012; 40 (Suppl. 1): 171–310
Transcript of P12.01: Pelvic floor biometry after the delivery in Chinese primiparous women
22nd World Congress on Ultrasound in Obstetrics and Gynecology Poster abstracts
Results: Thirty-eight women were diagnosed of Cesaeran scar defectat TUS. The number of previous Caesarean sections in patients withuterine dehiscence and ectopic pregnancy in Cesarean scar is shownin Table 1. Eleven patients (29%) showed a uterine dehiscence.Seven cases were repaired by laparoscopy and 4 cases requiredhysterectomy. Five ectopic pregnancies (13%) were diagnosed atTUS. Two patients required hysterectomy, 2 were treated with localmethotrexate guided by TUS and 1 was surgically sutured. Twopatients (5%) had a complete uterine rupture. One of them diagnosed6 months after Cesarean section and required hysterectomy. Theother which was diagnosed during puerperium period was treatedby surgical repair.Conclusions: TUS is useful for detecting Cesarean scar defectsproviding information for a treatment in case of complications.
P11.10: Table
Number of previous Cesarean 1 2 3 4Dehiscense 5 4 1 1Ectopic pregnancy 3 – 1 1
P11.11Interobserver variation in measurements of Cesarean scardefect and myometrium with 3D ultrasonography
L. D. Madsen, J. Glavind, N. Uldbjerg, M. Dueholm
Obstetrics and Gynecology, Aarhus University Hospital,Aarhus N, Denmark
Objectives: To evaluate the Cesarean scar defect depth and theresidual myometrial thickness with 3-dimensional (3D) sonographyconcerning interobserver variation.Methods: Ten women were randomly selected from a largercohort of Cesarean scar ultrasound evaluations. All women wereexamined 6–16 months after their first Cesarean section with2D transvaginal sonography and had 3D volumes recorded. Twoobservers independently evaluated ‘‘off-line’’ each of the 3D volumesstored. Residual myometrial thickness (RMT) and Cesarean scardefect depth (D) was measured in the sagittal plane with an intervalof 1 mm across the entire width of the endometrium. RMT wasdefined as the shortest distance from the scar defect to the uterineserosa among all RMT measures, and D was defined similarly as thelargest depth of the scar defect extending from the uterine cavity.The median value for RMT and D for each observer as well as themedian difference in RMT and D between the two observers wascalculated.Results: The median value of RMT was 6.0 mm in observer 1(range 2.0–7.8) and 5.7 mm in observer 2 (range 2.1–7.6). Mediandifference in RMT between the two observers was 1.3 mm (range0.1–3.3). The median value of D was 2.6 mm in observer 1 (range1.2–5.4) and 2.4 mm in observer 2 (range 1–4.9), and the mediandifference was 1.0 mm (range 0.3–2.8) between observer 1 and 2.Conclusions: The 3D interobserver variation concerning measures ofRMT and D seems good. The role of 3D sonography in evaluationsof Cesarean section scar size and residual myometrium needs furtherinvestigation.
P11.12The ultrasound morphological structure of ovaries, AMHand indices of color Doppler imaging in autoimmuneoophoritis: are they interrelated?
K. Tokhunts
Obstetrics & Gynecology, Yerevan State Medical University,Yerevan, Armenia
Objectives: Autoimmune oophoritis remains an almost undiagnosedpathology in wide clinical practice up to date. Autoimmuneoophoritis is characterized by certain histologic changes such ascharacteristic inflammatory infiltration in the inner theca-layer of
growing follicles. It is obvious that such morphological changes ofovarian tissue should be visible by ultrasound.Methods: In detailed ultrasound examination of ovaries in 34 womenwith high levels of anti-ovarian antibodies (61.1–131.4 IU/ml) asignificant increase of echogenicity of ovarian stroma was detected.All patients then underwent diagnostic laparoscopy with histologicexamination of ovarian biopsy specimens.Results: Revealed were different degrees of changes characteristicfor autoimmune ovarian pathology. The AMH level in serumof examined women was significantly lower (0.28–0.89 ng/mL)than normal (1.0–3.5 ng/mL), and it correlated with the degreeof lymphoid infiltration and fibrous changes in ovarian structures.In Doppler examination sometimes avascularization of stroma wasseen. In examination of intraovarian artery blood flow, monotonouscurves were revealed with maximal flow velocity of 5.1–11.3 cm/secwhich corresponds to the mean flow velocity of early proliferationstage of non-ovulating ovary. The numeric values of RI (0.65–0.93)also did not significantly change during the menstrual cycle and weregreater than those of healthy females in ovulatory cycle.Conclusions: Women with autoimmune oophoritis had changes inultrasound structure of the ovaries such as increased echogenicity ofthe stroma, intraovarian blood flow, low levels of AMH dependingon the degree of histological manifestations of autoimmune injury,which allows to recommend detailed workup directed at detectionof antiovarian antibodies in women with olygo/opso- or amenorrheawith above listed ultrasound findings and low levels of AMH.
P12: UROGYNECOLOGY AND PELVICFLOOR
P12.01Pelvic floor biometry after the delivery in Chineseprimiparous women
S. Chan, R. Cheung, A. Yiu, L. Lee
Department of O&G, The Chinese University of Hong Kong,Hong Kong
Objectives: This study aims at evaluating the pelvic floor biometriesafter the delivery in Chinese primiparous women. The relationshipwith mode of delivery (MOD) was explored.Methods: Nulliparous Chinese women with singleton pregnancywere assessed at 10–13 weeks of gestation, and at 8 weeks,6 months and 12 months after delivery. Trans-labial 3D-ultrasoundwas performed at rest, at Valsalva maneuver and at pelvic floorcontraction during each visit. MOD was determined by obstetricindications. Offline analysis of USG volume data set were doneby an investigator blinded to the information. Position of thebladder neck, middle compartment (most inferior part of cervix)and posterior compartment (ano-rectal junction) and the hiatal areawere measured.Results: In all, 131 women completed the study. Their mean age was30.7 ± 3.6 years, mean gestation at delivery was 275 ± 12.6 daysand mean birth weight was 3.0 ± 0.4 kg. 106 (81%) had vaginaldelivery (62% normal delivery and 19% instrumental delivery) and25 (19%) had caesarean section (CS) (5 elective and 20 emergency).There was no difference of gestation at delivery and neonatalbirth weight between the groups of MOD. When compared tothe first trimester biometries, there was significant descent of middlecompartment and increase in hiatal area at rest, VM and PFMC till12 months after delivery in vaginal delivery group. There was alsosignificant bladder neck descent at rest and at VM at 12 months. InCS group, there was also significant descent of middle compartmentat rest, at VM and PFMC till 12 months after delivery; however,there was only increase in hiatal area during VM.Conclusions: At one year after delivery, there was significant descentof middle compartment of women at rest, at VM and PFMC for bothvaginal delivery and CS. However, there was significant increase inhiatal area at VM only in CS, while there was increase in hiatal areaalso at rest and at PFMC in women with vaginal delivery.
216 Ultrasound in Obstetrics & Gynecology 2012; 40 (Suppl. 1): 171–310
