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Showing 13 results for Ultrasonography

Yan Chen, Guoyun Wang, Fubo Xie, Bo Wang, Guowei Tao, Beihua Kong,
Volume 11, Issue 2 (4-2013)

Background: Uterine arteriovenous malformation is a rare but potential life-threatening source of bleeding. A high index of suspicion and accurate diagnosis of the condition in a timely manor are essential because instrumentation that is often used for other sources of uterine bleeding can be lead to massive hemorrhage.
Case: We describe here a case of uterine arteriovenous malformation. A 32-year-old woman presented abnormal vaginal bleeding following the induced abortion. A diagnosis of uterine arteriovenous malformation made on the basis of Doppler ultrasonraphy was confirmed through pelvic angiography. The embolization of bilateral uterine arteries was performed successfully.
Conclusion: Uterine arteriovenous malformation should be suspected in patient with abnormal vaginal bleeding, especially who had the past medical history incluing cesarean section, induced abortion, or Dillation and Curethage and so on. Although angiography remains the gold standard, Doppler ultrasonography is also a good noninvasive technique. The transcatheter uterine artery embolization offers a safe and effective treatment.
Maryam Dalili, Mohamad Ali Karimzadeh Meybodi, Mohamad Ghaforzadeh, Tahmineh Farajkhoda, Hossein Molavi-E Vardanjani,
Volume 11, Issue 4 (6-2013)

Background: Spontaneous preterm labor is one of the common obstetrics problems causing several physical, psychological and economical outcomes. Although due to these outcomes and the efficacy of cares for decreasing them, preterm labor screening is cost-effective and it is still one of the challenging issues in obstetrics.
Objective: In this study preterm labor screening by using cervical transvaginal sonography was evaluated.
Materials and Methods: This observational cohort study was performed in Yazd, Iran. Samples were selected from pregnant women at gestational age of 21-24 weeks who had single live fetus and referred to the obstetrics clinics of two selected hospitals in Yazd. Gestational age was estimated based on the sonography of the first trimester and cervical length measured by transvaginal sonography. Data analysis was done by using t and x2 test as well as ANOVA. Statistical significant level was considered as p<0.05.
Results: From 450 participants, 47 cases had preterm labor and 6 cases had positive funneling. Mean age of women with term labor was 26.09±4.13 years and that of women with preterm labor was 26.7±3.51 years (p=0.334). Duration of pregnancy and cervical length significantly differed between women with and without funneling (p=0.001). The sensitivity and specificity of screening based on cervical length of 25mm were 55.5% (50.9-60.1%) and 93.6% (91.2-96%) respectively.
Conclusion: Based on the results of the present study, transvaginal ultrasound assessment of cervical length in low risk women has an acceptable reliability for screening of preterm labor.
Mojgan Kalantari, Arezou Negahdari, Shima Roknsharifi, Mostafa Qorbani,
Volume 11, Issue 11 (12-2013)

Background: Abdominal circumference (AC), biparietal diameters (BPD) and femoral length (FL) are now the main parameters used to obtain estimated fetal weight (EFW). Although the role of soft tissue parameters in determining fetal weight was proved but clinical attention to mid-thigh soft tissue thickness (STT) is limited.
Objective: To find the impression of STT on birth weight (BW) and represent a new predictive formula.
Materials and Methods: One hundred and fourteen normal singleton term (36-42w) pregnancies with delivery within 72 hours were randomly selected to participate in this prospective cohort study. Variables measured for each case included: AC, BPD, FL, STT by ultrasonography before birth and actual neonatal BW. Linear regression model was used and R square and P-value were reported.
Results: The mean (SD) of BW was 3406 (405) gr. R square was best fit for the model that STT was added to AC, BPD, FL (r2: 0.77). R square for the model using BPD, AC, FL and model using BPD, STT, FL was the same (r2: 0.7). Best fit formula was Log (BW)= 2.461+0.003BPD+0.001AC+0.007STT+0.005FL. AC (R: 0.67, p<0.001), STT (R: 0.50, p<0.001), BPD (R: 0.59, p<0.001), FL (R: 0.66, p<0.001) were significantly correlated with birth weight. AC had also significant correlation with STT (p=0.001).
Conclusion: This study showed adding STT to other variables in predictive models of fetal weight would provide a nice estimation (r2=0.77) and in cases that measuring AC is suboptimal STT may be a good replacement.
Fatemeh Rahimi-Sharbaf, Ashraf Jamal, Elaheh Mesdaghinia, Masoumeh Abedzadeh- Kalahroudi, Shirin Niroomanesh, Fatemeh Atoof,
Volume 12, Issue 6 (8-2014)

Background: Placenta accreta is considered a life-threatening condition and the main cause of maternal mortality. Prenatal diagnosis of placenta accreta usually is made by clinical presentation, imaging studies like ultrasound and MRI in the second and third trimester. Objective: To determine accuracy of ultrasound findings for placenta accreta in the first trimester of pregnancy. Materials and Methods: In a longitudinal study 323 high risk patients for placenta accreta were assessed. The eligible women were examined by vaginal and abdominal ultrasound for gestational sac and placental localization and they were followed up until the end of pregnancy. The ultrasound findings were compared with histopathological examinations as a gold standard. The sensitivity, specificity, positive and negative predictive value of ultrasound were estimated for the first trimester and compared with other 2 trimesters in the case of repeated ultrasound examination. Results: Ultrasound examinations in the first trimester revealed that 28 cases had the findings in favor of placenta accreta which ultimately was confirmed in 7 cases. The ultrasound sensitivity and specificity for detecting placenta accreta in the first trimester was 41% [95% CI: 16.2-62.7] and 88% [95% CI: 88.2-94.6] respectively. Conclusion: Ultrasound screening for placenta accreta in the first trimester of pregnancy could not achieve the high sensitivity as second and third trimester of pregnancy.
Maryam Niknejadi, Farnaz Akhbari, Fatemeh Niknejad, Gholamreza Khalili, Marzieh Shiva,
Volume 12, Issue 8 (8-2014)

Background: Traditionally, septate uterus was diagnosed with invasive method like hysterosalpingography and hysteroscopy. Nowadays transvaginal ultrasonography was reported to be a sensitive tool for detection of septate uterus too.
Objective: The objective of the present study was to evaluate the application of two dimensional ultrasound (2-DUS) and real time three dimensional ultrasound (3-DUS) in differentiating various type of septated uterus. Hysteroscopy confirmation was assigned as the gold standard.
Materials and Methods: This retrospective study was performed among 215 infertile women with suspected septate uterus from October 2008 to July 2012. An inclusion criterion was septated uterus based on HSG or experiencing abortion, preterm labor, or recurrent IVF failure. Fusion anomalies were excluded from the study (unicornuate, bicornuate and didelphys anomalies). The results of 3D and 2D sonographies were compared, while they were confirmed by hysteroscopy result in detection of septated uterus. Kappa index for agreement between 2DUS and hysteroscopy, as well as 3-DUS and hysteroscopy in detection of septate uterus was carried out. By receiver operating characteristic (ROC) curve, cut off points for predicting the kind of anomalies were proposed.
Results: The women were evaluated by 2-DUS (n=89) and (II) 3-DUS (n=126). All women underwent hysteroscopy, following 2-DUS and 3-DUS at the same or subsequent cycle. The results of kappa (K) index were 0.575 and 0.291 for 3-DUS and hysteroscopy, as well as 2-DUS and hysteroscopy, respectively. Also, the cutoff points were 27% for arcuate and subseptate, and 35% for differentiating septate and subseptate.
Conclusion: Real time 3-DUS has better ability for visualization both uterine cavity and the fundal uterine, so it has higher agreement in detection of septate uterus than 2-DUS. 
Shohreh Irani, Firoozeh Ahmadi, Maryam Javam, Ahmad Vosoughtaghi Dizaj, Fatemeh Niknejad,
Volume 13, Issue 9 (10-2015)

Background: Several studies have assessed the correlation of fetal choroid plexus cyst (CPC) and the risk of congenital anomalies, but few ones have discussed isolated CPC (with no other abnormal sonographic finding).
Objective: The aim of this study was to determine the outcome of isolated fetal choroid plexus cyst and to specify its clinical significance.
Materials and Methods: This cross sectional study was carried out at Royan Institute in Tehran, Iran, between April 2009 and December 2012. All prenatal sonographies in this period of time were assessed using a computerized database and fetuses who had isolated CPC were recruited in the study. Sonography reports, mother serum screening test results, fetal echocardiography and amniocentesis were evaluated until birth. A follow-up phone call was made to all individuals to learn about the neonatal outcomes.
Results: Overall, 6240 prenatal sonographies were performed in this setting during this period. Isolated CPC was detected in 64 fetuses. The results of double test (N=30), triple test (N=5) and fetal echocardiography (N =24) were normal. Quadruple test result showed 3 abnormal out of 29 cases that all had normal karyotypes. Four samples were dropped out due to premature rupture of membranes (N=3) and intrauterine fetal death (N=1). It was found that the outcomes of all remaining fetuses (N=60) were normal and no anomaly ones were seen until birth.
Conclusion: Isolated CPC is a benign regressive condition with no clinical significance.
Sedigheh Ayati, Leila Pourali, Masoud Pezeshkirad, Farokh Seilanian Toosi, Sirous Nekooei, Mohammad Taghi Shakeri, Mansoureh Sadat Golmohammadi,
Volume 15, Issue 4 (6-2017)

Background: Placenta adhesive disorder (PAD) is one of the most common causes of postpartum hemorrhage and peripartum hysterectomy. The main risk factors are placenta previa and prior uterine surgery such as cesarean section. Diagnosis of placenta adhesive disorders can lead to a decrease of maternal mortality and morbidities.
Objective: The purpose of this study was to compare the accuracy of color Doppler ultrasonography and magnetic resonance imaging (MRI) in the diagnosis of PADs.
Materials and Methods:In this is cross-sectional study, Eighty-two pregnant women who were high risk for PAD underwent color Doppler ultrasound and MRI after 18 weeks of gestation. The sonographic and MRI findings were compared with the final pathologic or clinical findings. P<0.05 was considered statistically significant.
Results: Mean maternal age was 31.42±4.2 years. The average gravidity was third pregnancy. 46% of patients had placenta previa. The history of the previous cesarean section was seen in 79 cases (96%). The diagnosis of placenta adhesive disorder was found in 17 cases (21%). Doppler sonography sensitivity was 87% and MRI sensitivity was 76% (p=0.37). Doppler sonography specificity was 63% and MRI specificity was 83% (p=0.01).
Conclusion: Women with high-risk factors for PAD should undergo Doppler ultrasonography at first. When results on Doppler sonography are equivocal for PAD, MRI can be performed due to its high specificity.
Firoozeh Ahmadi, Farnaz Akhbari,
Volume 15, Issue 9 (9-2017)

Background: Perineural cysts formed within the nerve-root sheath at the dorsal root ganglion. They are most commonly located in the arachnoid covering the junction of the dorsal ganglion and nerve root. They are usually asymptomatic, incidental findings, usually located in the lumbar and sacral region of the spinal canal. It is important to consolidate the imaging findings of this rare disease so clinicians can become more clinically relevant in the evaluation of these cysts.
Case: Herein we report a case of perineural cyst misdiagnosed with hydrosalpinx by pelvic ultrasonography and finally diagnosed with magnetic resonance image.
Conclusion: Perineural cyst should be considered, in the presence of bilateral adnexal masses separated from the ovaries in pelvic sonography.
Homeira Vafaei, Neda Rahimirad, Seyedeh Marjan Hosseini, Maryam Kasraeian, Nasrin Asadi, Hadi Raeisi Shahraki, Khadijeh Bazrafshan,
Volume 15, Issue 11 (11-2017)

Background: Preterm labor and birth are associated with several neonatal complications including respiratory distress syndrome and intraventricular hemorrhage. Differentiating true and false labor pain is a dilemma to obstetricians.
Objective: To elucidate the role of cervical length measurement in prediction of birth in pregnant women with threatened preterm labor.
Materials and Methods: In this double blind randomized clinical trial, 120 women with gestational age <34 wk who presented painful uterine contractions randomly assigned to undergo measurement of cervical length. Patients were registered in the hospital and a unit number was given. Based on the unit numbers, patients were randomly assigned to two groups using a computerized random digit generator. All participants were managed accordingly (n=65) or to receive tocolysis as planned (n=55). Tocolysis was prescribed when cervical length was <15 mm while those with cervical length ≥15 mm were managed expectantly. Delivery within 7 days of the presentation was the primary outcome.
Results: This RCT showed in case group, 78.9% of patient with cervical length <15 mm were delivered within 7 days and only 21.1% of them maintained their pregnancy. Of those with cervical length ≥15 mm, only 15.2% were delivered within the study period and the rest (84.8%) maintained their pregnancy (p<0.001).
Conclusion: “Our results indicate that in women who presented preterm labor symptoms, cervical length measurement will result in decreased unnecessary tocolytic treatment. Women with cervical length ≥15mm should not receive tocolysis, however, withholding corticosteroid therapy in these patients needs further evidence.
Vajiheh Marsoosi, Reihaneh Pirjani, Mohamad Asghari Jafarabadi, Mina Mashhadian, Saeedeh Ziaee, Ashraf Moini,
Volume 15, Issue 11 (11-2017)

Background: Preterm labor is a major cause of perinatal morbidity and mortality and it might be predicted by assessing the cervical change.
Objective: To assess the association between absence of cervical gland area (CGA) and spontaneous preterm labor (SPTL).
Materials and Methods: This prospective cohort study was performed on 200 singleton pregnant women with a history of SPTL, second-trimester abortion in the previous pregnancy or lower abdominal pain in current pregnancy. Each patient underwent one transvaginal ultrasound examination between 14-28 wk of gestation. Cervical length was measured and CGA was identified and their relationship with SPTL before 35 and 37 wk gestation was evaluated using STATA software version 10.
Results: The mean of cervical length was 36.5 mm (SD=8.4), the shortest measurement was 9 mm, and the longest one was 61 mm. Short cervical length (≤18mm) was significantly associated with SPTL before 35 and 37 wk gestation. Cervical gland area (the hypoechogenic or echogenic area around the cervical canal) was present in 189 (94.5%) patients. Absent of CGA had a significant relationship with SPTL before 35 and 37 wk gestation (p=0.01 and p<0.001, respectively). Cervical length was shorter in women with absent CGA in comparison with subjects with present CGA: 37±10 mm in CGA present group and 23±9 mm in CGA absent group (p<0.001).
Conclusion: Our study showed that cervical gland area might be an important predictor of SPTL which should be confirmed with further researches.
Nidhi Sharma, Krishnamurthy Jayashree, Kulasekaran Nadhamuni,
Volume 16, Issue 2 (2-2018)

Background: Pregnancy induced hypertension (PIH) is a significant cause of maternal morbidity and mortality. Pregnancy-induced-hypertension can be prevented by identification of prenatal and antenatal factors. The uterine artery Doppler waveform transforms into a high flow with low resistance at 22-24 wk.
Objective: To study the maternal risk factors and uterine artery Doppler waveform in singleton mid-trimester pregnancy and predict the occurrence of pregnancy-induced hypertension.
Materials and Methods: This is a cohort study comprising of Doppler ultrasound examination of the uterine arteries at 20-23 wk gestation in 697 women with singleton pregnancies attending a routine target scan. The pregnant women were followed up. PIH was recorded in 57 (8.18%) of all pregnancies.
Results: Maternal age >34 yr, primiparity, the presence of chronic hypertension was also associated with increased risk of PIH. High pulsatility index (>95th percentile) as compared to low pulsatility index was a good tool for the detection of PIH (sensitivity 91.23% and specificity 99.06%, p<0.05). Presence of high pulsatility was a significant risk factor for early-onset PIH as compared to late-onset PIH.
Conclusion: Uterine artery Doppler can be safely performed at the time of routine target anomaly scan in the second trimester. It is simple, economical, feasible and with good detection rates.
Firoozeh Ahmadi, Somayeh Moukhah,
Volume 16, Issue 2 (2-2018)

Background: Uterine arteriovenous malformation (UAVM) is a rare vascular condition in reproductive age presented mostly with bleeding. Although this malformation is infrequent, it is potentially life-threatening. Transvaginal Doppler ultrasonography is a widely available, noninvasive and excellent diagnostic method.
Case: The case is a 30-yr-old woman with a history of eight-yr infertility.following intrauterine insemination treatment, she had a molar pregnancy. Despite methotrexate treatment, there was persistent vaginal bleeding. Assessment of this patient was done with transvaginal sonography and color Doppler. According to suspicious appearances, angiography was planned for confirmation of UAVM.
Conclusion: UAVM is one of the molar pregnancy complications. The first step for diagnosis of UAVM is transvaginal ultrasonography and color Doppler assessment. Embolization is the best treatment for women who intend to preserve fertility.
Nidhi Sharma, Mahalakshmi Saravanan, Lakshmanan Saravanan, Sindujhaa Narayanan,
Volume 17, Issue 11 (11-2019)

Color Doppler of perifollicular vascularity is a useful assessment tool to predict the growth potential and maturity of Graafian follicles. Power Angio is independent of the angle of insonation and morphometry and provides reliable clues to predict the implantation window of the endometrium. Color Doppler can be used for the prediction of ovarian hyperstimulation syndrome. It can also be used to identify the hyper responder and gonadotropin-resistant type of polycystic ovaries. The secretory scan of corpus luteum can accurately predict its vascularity and functional status. A corpus luteum with decreased blood flow is a very sensitive and specific indicator of threatened and missed abortions. Color Doppler and Power Angio need to be standardized and identical settings should be maintained if different patients, or if changes over time within the same patient are to be compared.

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