Color Doppler sonography in obstetrics and gynecology

The Diagnostic Accuracy of Transabdominal and Transvaginal Color Doppler Ultrasound for Pregnant Women with Vasa Previa and Velamentous Cord Insertion

Objective

The objective of this study is to evaluate feasibility and accuracy of transabdominal color Doppler ultrasound (TA-CDUS) and transvaginal color Doppler ultrasound (TV-CDUS) as screening methods for pregnant women with vasa previa (VP) and velamentous cord insertion (VCI).

Methods

A retrospective diagnostic accuracy study was performed on 5,434 pregnant women from 2018 to 2021, who underwent both TA-CDUS and TV-CDUS. Diagnostic performance of TA-CDUS and TV-CDUS was determined using specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and positive and negative likelihood ratios (LR+ and LR-), using the delivery information (gross examination) as the "Gold-standard". Patient records were reviewed for demographics and diagnosis.

Results

The combination of VP and VCI was diagnosed in 37/5434 (0.68%) women at delivery. The sensitivity, specificity, PPV, NPV, and overall test accuracy of TA-CDUS were 72.97%, 99.85%, 77.14%, 99.81%, and 99.67%, respectively, for diagnosing VP with VCI. The corresponding values for TV-CDUS were 89.19%, 99.87%, 82.50%, 99.93%, and 99.80%, respectively. Moreover, the sensitivity of combination of TA-CDUS and TA-CDUS in determining VP with VCI was 97.30%, specificity 99.98%, PPV 97.30%, NPV 99.98%, and accuracy 99.96%. No significant difference in the misdiagnosis and missed diagnosis was found between the examination by TA-CDUS and TV-CDUS.

Conclusions

Both TA-CDUS and TV-CDUS can be acceptable diagnostic tools for assessment of pregnant women with VP and VCI, with a better application of TV-CDUS with higher accuracy. The combination of TA-CDUS and TV-CDUS could provide an objective imaging basis for choosing clinical treatment strategies and predicting prognosis.

Sigmoid cancer mimicking ovarian echotexture on transvaginal ultrasound: Case report with literature review

Ultrasound is a first line imaging modality for the evaluation of female pelvic pain. Pelvic pain constitutes one of the most common reasons for presentation to the emergency department with increasing use of point of care ultrasound. Infrequently, point of care or formal ultrasound evaluation may lead to misdiagnosis of extraovarian disease. This can have serious consequences, especially if an extraovarian malignancy is mistaken for a normal ovary or an ovary with a benign process. We present a case of a 41-year-old female who presented to the emergency department for a chief complaint of pelvic pain and vaginal bleeding. Transvaginal ultrasound demonstrated a left adnexal mass, later characterized as a sigmoid colon cancer on MRI and pathology, simulating ovarian echotexture with peripheral hypoechoic components resembling follicles. This article will review the literature of various cases of extraovarian pathology misidentified as ovarian processes and highlight the importance of considering these extraovarian mimickers to prevent potential morbidity and mortality of a missed diagnosis.

Are the spectral Doppler indices of ovarian arteries indicative of antral follicular development and predictive of ovulatory responses and embryo yields in superovulated ewes?

Nineteen ewes received 200 mg of pFSH administered in eight decreasing doses from Days 1 to 4, starting three days before CIDR® device removal. Ten ewes received an injection of 350 μg of estradiol benzoate at CIDR® device insertion (Group E) and nine animals served as controls (Group C). B-mode and spectral Doppler ultrasonographic examinations were performed daily throughout superovulatory treatment to enumerate ovarian antral follicles and to determine ovarian blood flow indices, respectively. There were no differences (P > 0.05) in superovulatory responses between left and right ovaries/uterine horns or the two groups of animals. End-diastolic velocity (EDV) and mean velocity (Vm) values were greater (P < 0.05) on Days 1 and 2, and peak systolic velocity (SVp) was greater (P < 0.05) on Day 3 in Group C than in Group E. In Group E 15 correlations was recorded among indices (SVp, Vm, EDV, flow velocity integral-FVI, and pulsatility index-PI) and follicles numbers in different size classes on Days 1, 2 and 4, and seven correlations among indices (SVp, EDV, Vm, and vascular resistance index-RI) and superovulatory/embryo results (numbers of regressing corpora lutea, numbers/percentages of degenerated embryos and viability rates) on Days 1, 2 and 3. In Group C, there were three correlations among EDV and RI and medium-sized/large follicle numbers on Days 1 and 3, and five correlations among indices (EDV, RI and PI) and superovulatory/embryo results (numbers of luteinized unovulated follicles, degenerated embryos and unfertilized eggs) on Days 2 or 4. There was a lack of consistency in the velocimetric correlates of antral follicle numbers and superovulatory responses between the left and right side. Therefore, the usefulness of ovarian arterial indices to predict ovine superovulatory outcomes remains equivocal and requires further confirmatory studies.

Doppler Assessment of Uterine Blood Flow in Pre-eclampsia: A Review

Doppler ultrasonography plays an ever-increasing role in obstetric imaging. Although commonly purported to assess blood flow, most studies in this area report purely on velocimetric parameters, rather than true volumetric flow. This review article highlights the physiological importance of this distinction, and reports on a literature review of uterine artery Doppler interrogation in the context of pre-eclampsia, which identified only four original research papers that attempted to assess blood flow. Attention is needed for true volumetric flow assessment in pre-eclampsia research, which may permit a more complete conceptualisation of the pathogenesis and haemodynamic consequences of this condition.

Doppler velocimetry of the ovarian artery as a tool to detect LH surge in stimulated cycles

Our aim was to assess the velocimetric pattern of the ovarian artery as a possible marker of LH surge in stimulated cycles. A total of 130 women undergoing ovarian stimulation for intrauterine insemination were randomized in two groups. Each woman was stimulated with 75 IU of recombinant FSH starting from the third day of the cycle. Velocimetric indices of the dominant ovarian artery were compared between patients with spontaneous LH surge and those needing HCG administration to trigger dominant follicle rupture. The pulsatility index and the ratio between peak systolic flow and lowest diastolic flow were significantly higher in women that had a spontaneous triggering of ovulation. These parameters had a high and very significant positive correlation with the dosage of luteinizing hormone. Threshold values of 2.60 for PI and 7.68 for S/D had a high sensitivity and specificity to predict LH surge. These velocimetric results demonstrated that an increased resistance in the dominant ovarian artery is correlated to LH surge in stimulated cycles. It may represent a sign of relevant clinical utility in timing of intrauterine insemination and/or natural intercourse.

Gabor Than Award Lecture 2006: pre-eclampsia and villous trophoblast turnover: perspectives and possibilities

Placental apoptosis is exaggerated in pre-eclampsia and cytotrophoblast proliferation is enhanced. This imbalance may be a primary pathogenic event, whereby excessive syncytiotrophoblast apoptosis counters cytotrophoblast fusion, promoting the liberation of syncytial material which perturbs the maternal vascular endothelium. We have previously shown that primary trophoblasts and explant cultured villous fragments from pre-eclamptic pregnancies elicit greater levels of terminal differentiation and apoptosis. This review considers current opinions in trophoblast cell turnover in normal pregnancy and pre-eclampsia. In the context of other findings, this review highlights: (i) the disparity in expression of pro-apoptotic transcription factor p53 in the syncytiotrophoblast in pre-eclampsia, (ii) the importance of reactive oxygen species and hypoxia in initiating villous trophoblast apoptosis and (iii) the concept that aberrant intervillous haemodynamics, as opposed to oxygen per se, initiates excessive syncytiotrophoblast shedding. Finally, therapeutic ways of restoring the syncytiotrophoblast in pre-eclampsia and preventing excessive placental apoptosis are considered, including a role for mitotic manipulators and growth factor replacement strategies.