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L Valentin

Publications and source records attributed to L Valentin.

At least 37 records · Page 2Linked to original sources
PubMed2004

Ultrasound dating at 12-14 or 15-20 weeks of gestation? A prospective cross-validation of established dating formulae in a population of in-vitro fertilized pregnancies randomized to early or late dating scan.

OBJECTIVES: To determine the accuracy of established ultrasound dating formulae when used at 12-14 and 15-20 gestational weeks. METHODS: A total of 363 singleton pregnancies conceived after in-vitro fertilization (IVF) and randomized to a dating scan at 12-14 or 15-20 gestational weeks were studied. 'True' gestational age was calculated on the basis of the day of oocyte retrieval and was compared to gestational age calculated on the basis of seven dating formulae including the fetal biparietal diameter (BPD) and three dating formulae including BPD and fetal femur length (FL). The mean of the differences between estimated and true gestational age (systematic measurement error) and their SD (random measurement error) were calculated for each formula. RESULTS: Three formulae showed systematic errors of less than -0.7 days at both early and late scanning. Two formulae overestimated gestational age at both early and late scanning by 5.7 and 3.1 vs. 2.3 and 2.8 days, respectively, while five formulae manifested very different systematic errors at early and late scanning. The formulae used for clinical management underestimated gestational age by a mean of 3 days when dating was performed at 12-14 weeks, and by a mean of 0.8 days when dating was done at 15-20 weeks. The random error was on average 1 day less when the scan was carried out early (2 vs. 3 days; P < 0.0005). Mean true gestational age at delivery in IVF pregnancies with spontaneous start of labor was 279 days (SD 12.9); excluding preterm deliveries it was 281 days (SD 8.1). CONCLUSIONS: Ultrasound dating formulae originally intended for use in the middle of the second trimester do not necessarily perform well when used for dating earlier in gestation. The systematic and random error of any dating formula must be assessed for the gestational age interval in which the formula is intended to be used.

Chi-Square Distribution↗
PubMed2003

Cervical changes in twin pregnancies observed by transvaginal ultrasound during the latter half of pregnancy: a longitudinal, observational study.

OBJECTIVE: To determine what constitutes normal cervical changes in twin gestations during the latter half of pregnancy, and whether there are differences in the pattern of cervical change between women expecting twins giving birth at term (> or = 36 completed gestational weeks, GW) and preterm. METHODS: Twenty women (12 nulliparous, eight parous) expecting twins were examined with transvaginal ultrasound every week from 24 GW until delivery. Cervical length and width were measured, the inner cervical os was assessed as being closed or open, and any dynamic cervical changes were noted. Examination results were unavailable to the staff involved in the care of the women. RESULTS: Eight women (40%) delivered preterm spontaneously at 32-35 GW. Cervical length remained unchanged ( approximately 10 mm) in one woman, who delivered preterm. It decreased in the remaining 19 women. The median shortening rate for women manifesting a continuous shortening of the cervix was 2.9 (0.8-5.2) mm/week in women giving birth preterm vs. 1.8 (0.8-2.4) mm/week in those who gave birth at term (P = 0.08). Median cervical length at the first examination was similar in women who delivered preterm and at term (39 vs. 41 mm), but at 32 GW the cervix was shorter in women who delivered preterm (median, 18 vs. 31 mm, P = 0.02). Cervical width remained unchanged in 63% (5/8) of the women who delivered preterm vs. 8% (1/12) of those who gave birth at term (P = 0.02). The cervix became wider in the remaining women. Median cervical width at the first examination was similar in women who delivered preterm and at term (38 vs. 38 mm), but in women who delivered preterm the cervix was thinner at 0-6 days before spontaneous start of labor (median, 40 vs. 48 mm, P = 0.07). An opening of the inner cervical os was seen < or = 27 GW in 88% (7/8) of the women who delivered preterm vs. 17% (2/12) of those who delivered at term (P = 0.006), the corresponding figures for dynamic changes being 63% (5/8) vs. 17% (2/12) (P = 0.06). Dynamic changes were seen in a greater proportion of the examinations in women who delivered preterm (median, 25% vs. 4%, P = 0.07). CONCLUSIONS: The pattern of cervical changes from 24 GW to delivery differs between twin pregnancies delivering preterm (at 32-35 GW) and at term (> or = 36 GW). In twin pregnancies delivered preterm cervical shortening is more rapid, the cervix does not broaden to the same extent as in twins delivered at term, an open inner cervical os and dynamic cervical changes are seen earlier in gestation, and dynamic cervical changes are seen more often. Cervical changes in women with twins who give birth as early as at 24-31 GW may be different.

Adult↗
PubMed2003

Frequency and type of adnexal lesions in autopsy material from postmenopausal women: ultrasound study with histological correlation.

OBJECTIVE: To determine the prevalence and histology of adnexal cysts in autopsy material from postmenopausal women. METHODS: The study included 104 adnexa from 52 consecutive women with a mean age of 79 (range, 64-96) years, who underwent autopsy and died from causes other than gynecological cancer or intraperitoneal cancer of extragenital origin. The adnexa were removed, put in sterile saline in separate plastic containers and examined sonographically using an 8-MHz transvaginal transducer. Each lesion detected at ultrasound examination was measured with calipers on the frozen ultrasound image and was classified according to its ultrasound morphology. The adnexa were then put in 4% formaldehyde solution and sent for histological examination. RESULTS: At ultrasound examination, 56% (29/52) of the women had adnexal lesions, cysts being detected in 54% (28/52) and solid lesions in 12% (6/52). At least one adnexal cyst with a largest diameter of 2-10 mm, > 10 mm, > 20 mm, > 30 mm and > 40 mm, respectively, was found in 33% (17/52), 21% (11/52), 12% (6/52), 8% (4/52) and 4% (2/52) of the women. The largest lesion measured 65 mm in diameter. At ultrasound examination we found 36 intra-ovarian cysts (26 inclusion cysts, three cystically degenerated corpora albicantia, five simple cysts, one serous cystadenoma and one 3-mm cyst not confirmed by the pathologist), 19 extra-ovarian cysts (all simple cysts according to the pathologist), five solid intra-ovarian lesions (two fibromas, one cystadenofibroma, one Brenner tumor and one case of dystrophic calcification), and one solid extra-ovarian lesion (fibroma). In addition, the pathologist detected one 20-mm solid corpus albicans, eight extra-ovarian simple cysts of 1-8 mm, and 77 intra-ovarian inclusion cysts of 1-4 mm. CONCLUSION: Small (< or = 50 mm) benign adnexal cysts and small benign solid tumors are so common in postmenopausal women that their presence may be regarded as normal. Our results support conservative management of adnexal lesions with benign ultrasound morphology incidentally detected at ultrasound examination in postmenopausal women.

Adnexal Diseases↗
PubMed2003

Results of endosonographic imaging of the anal sphincter 2-7 days after primary repair of third- or fourth-degree obstetric sphincter tears.

OBJECTIVES: To describe the endosonographic image of the anal sphincter 2-7 days after delivery in women who had undergone a primary repair of an obstetric sphincter tear. METHODS: Forty-eight women who had suffered a third- or fourth-degree sphincter tear at delivery and had undergone primary sphincter repair were examined with endoanal sonography 2-7 days after delivery. A score from 0 to 16 was used to describe the extent of the endosonographic defects, a score of 0 indicating no defect and a score of 16 a defect > 180 degrees involving the whole length and depth of the sphincter. Clinical information was retrieved from the delivery and operation records after the analysis of the ultrasound images and the classification of the sonographic defects had been completed. RESULTS: Clinically, 34 (71%) women had a partial third-degree tear, 11 (23%) had a total third-degree tear, and three (6%) had a fourth-degree tear. Forty-three (90%; 95% CI, 77-97%) women had sonographic defects, all hypoechoic. Twenty-three (54%) sonographic defects were confined to the proximal part of the anal canal and involved less than half of the length of the anal canal. Thirty (63%) defects were confined to the external sphincter. Five of nine women (56%) with an endosonographic sphincter defect score >/= 8 had undergone primary sphincter repair by a doctor in training vs. 9 of 39 women (23%) with an endosonographic sphincter score < 8 (P = 0.05), despite the fact that 86% (12/14) of the tears sutured by doctors in training were clinically partial third-degree tears vs. 65% (22/34) of those sutured by specialists (P = 0.15). Five (15%) of 34 women with a clinical partial third-degree tear had an endosonographic sphincter score >/= 8 vs. four (29%) of 14 with a clinical total third- or fourth-degree sphincter tear (P = 0.26). CONCLUSIONS: Most women (90%) with a clinical third- or fourth-degree obstetric sphincter tear have endosonographic sphincter defects if they are examined 2-7 days after primary repair. The extent of the endosonographic defects seems to be determined mainly by the surgical experience of the doctor performing the repair, and not by the clinical degree of the tear.

Anal Canal↗
PubMed2003

Rectal endosonography can distinguish benign rectal lesions from invasive early rectal cancers.

OBJECTIVE: To determine whether an experienced ultrasound examiner, using good ultrasound equipment with high multifrequency probes, can discriminate between a high grade or low grade dysplastic adenoma (pT0) and very early invasive rectal cancers (pT1). SUBJECTS AND METHODS: Sixty consecutive patients with clinically possibly pT0 or pT1 rectal tumours referred for transanal local excision underwent endorectal ultrasound examination. Lesions where the endorectal ultrasound image showed the mucosal layer to be expanded but the submucosal layer to be intact (uT0) were considered to represent a low grade or high grade dysplasia adenoma (pT0). An irregularity or disruption of the submucosal layer (uT1) was considered to characterize early invasive rectal cancers (pT1). The ultrasound staging was compared with the histological staging made on the basis of the diagnoses in the excised specimens. RESULTS: The histopathological diagnoses were: invasive rectal cancer (n = 18, 10 pT1, 4 pT2, 4 pT3 cancers); high grade dysplastic adenoma (n = 21); low grade dysplastic adenoma (n = 18); non adenomatous benign lesions (n = 3). Endorectal ultrasound incorrectly classified two of the invasive cancers (both pT1 tumours) as noninvasive lesions. Five of 42 pT0 tumours were overstaged as uT1 tumours. Overstaging was more common in patients who had undergone a previous excision and in tumours with peritumoral inflammation and desmoplastic reaction. The sensitivity of endorectal ultrasound with regard to invasive cancer was 89% (16/18), specificity 88% (37/42), positive predictive value 76% (16/21), negative predictive value 95% (37/39), and accuracy 88% (53/60). Among pT0 and pT1 tumours, the corresponding figures were 80% (8/10), 88% (37/42), 62% (8/13), 95% (37/39), and 87% (45/52). CONCLUSION: Endorectal ultrasound can distinguish between noninvasive lesions and invasive rectal cancers clinically of stage pT0 or pT1.

Adenoma↗
PubMed2002

The natural history of adnexal cysts incidentally detected at transvaginal ultrasound examination in postmenopausal women.

OBJECTIVE: To determine the natural history of adnexal cysts incidentally detected at transvaginal ultrasound examination and judged to be benign in postmenopausal women. METHODS: One hundred and thirty-four postmenopausal women referred for ultrasound examination and found to have an adnexal cyst judged to be benign and not causing any symptoms were followed with transvaginal ultrasound at 3, 6 and 12 months, and then every 12 months. The referring physician treated the patient at his/her own discretion. RESULTS: One hundred and sixty cysts were found, 121 (76%) being unilocular and 39 more complicated. Seventy-two cysts (45%) had a largest diameter of 3-19 mm and 88 (55%) had a largest diameter of 20-80 mm. Median follow-up time was 3 (range, 0.3-8) years. In twelve women (9%) the cysts were removed during follow-up, all their cysts (n = 14) being benign. The indication to operate was a change in cyst morphology or increased cyst size in five (4%) women. In 39 (29%) women, the cysts disappeared; in 18 (13%), new cysts developed; and, in 65 (49%), the number of cysts and their location remained unchanged. Regression of cysts was observed in 54% (33/61) of women < 60 years vs. in 8% (6/73) of those > or = 60 years (P = 0.0001). Ultrasound findings remained unchanged in 34% (21/61) of women < 60 years vs. in 77% (56/73) of those > or = 60 years (P = 0.0001). CONCLUSIONS: The results support conservative management of adnexal cysts incidentally detected at transvaginal ultrasound examination and judged to be benign in postmenopausal women. Whether such cysts need to be followed-up at all and, if they do, how often and for how long, remains an open question.

Adnexal Diseases↗
PubMed2002

Intra- and interobserver reproducibility of ultrasound measurements of cervical length and width in the second and third trimesters of pregnancy.

OBJECTIVES: To determine intra- and interobserver reproducibility of ultrasound measurements of cervical length and width in the second and third trimesters of pregnancy. DESIGN: Twenty healthy women in the second or third trimester of pregnancy underwent transvaginal ultrasound examination of the cervix by two examiners. Three replicate meaurements of cervical length and width were taken by each observer for each woman. Intraobserver repeatability was expressed as the difference between the highest and lowest measurement value obtained by one observer, and as the repeatability coefficient and intraclass correlation coefficient. Interobserver reproducibility was expressed as the difference between the mean of the three measurements of each observer, limits of agreement, and interclass correlation coefficient. The repeatability coefficient/limits of agreement define the range within which 95% of the differences between two measurements by the same observer/two observers are likely to fall. RESULTS: Intra- and interobserver differences did not vary in any systematic way over the range of values measured. For cervical length measurements the repeatability coefficient was +/- 5.4 mm for Observer 1 and +/- 5.9 mm for Observer 2. The intraclass correlation coefficient for cervical length measurements was 0.93 for both observers. The corresponding coefficients for cervical width measurements were +/- 3.9 mm and +/- 7.3 mm, and 0.97 and 0.91. The interclass correlation coefficient for cervical length measurements was 0.76, the mean interobserver difference was 0.4 mm, and the limits of agreement were -10.0 mm to 10.8 mm. For cervical width measurements the interclass correlation coefficient was 0.74, the mean interobserver difference was -0.02 mm, and the limits of agreement were -12.4 mm to 12.4 mm. There was no systematic difference between the first, second and third cervical length measurements and no systematic bias between the two observers, and the results were not affected by which of the two examiners started the examination (three-way analysis of variance). The same was true of cervical width measurements. CONCLUSIONS: Our results do not support the contention that the first measurement of cervical length is the longest. There is substantial intra- and interobserver variability in the results of measurements of cervical length and width, even when experienced observers perform the measurements under standardized conditions. It is important to consider the possibility of 'measurement error' when ultrasound measurements of cervical length and width are used in clinical practice to monitor women at high risk of delivering preterm or to screen for preterm birth.

Cervix Uteri↗
PubMed2002

An algorithm including results of gray-scale and power Doppler ultrasound examination to predict endometrial malignancy in women with postmenopausal bleeding.

OBJECTIVE: To determine if power Doppler ultrasound examination of the endometrium can contribute to a correct diagnosis of endometrial malignancy in women with postmenopausal bleeding and endometrium > or = 5 mm. METHODS: Eighty-three women with postmenopausal bleeding and endometrium > or = 5 mm underwent gray-scale and power Doppler ultrasound examination using predetermined, standardized settings. Suspicion of endometrial malignancy at gray-scale ultrasound examination (endometrial morphology) was noted, and the color content of the endometrium at power Doppler examination was estimated subjectively (endometrial color score). Computer analysis of the most vascularized area of the endometrium was done off-line in a standardized manner. Stepwise multivariate logistic regression analysis was carried out to determine which subjective and objective ultrasound and power Doppler variables satisfied the criteria to be included in a model to calculate the probability of endometrial malignancy. RESULTS: Endometrial thickness, vascularity index (vascularized area/endometrial area), and use of hormone replacement therapy (HRT) satisfied the criteria to be included in the model used to calculate the 'objective probability of endometrial malignancy'. Endometrial morphology, endometrial color score and HRT use satisfied the criteria to be included in the model to calculate the 'subjective probability of malignancy'. Endometrial thickness > or = 10.5 mm had a sensitivity with regard to endometrial cancer of 0.88 and a specificity of 0.61. At a fixed sensitivity of 0.88, the specificity of the 'objective probability of malignancy' (0.81) was superior to all other ultrasound and power Doppler variables (P = 0.001-0.02). The 'objective probability of malignancy' detected more malignancies at endometrium 5-15 mm than endometrial morphology (5/7 vs. 1/7, i.e. 0.71 vs. 0.14; P = 0.125) with a similar specificity (49/57 vs. 51/57, i.e. 0.86 vs. 0.89). CONCLUSION: Power Doppler ultrasound can contribute to a correct diagnosis of endometrial malignancy, especially if the endometrium measures 5-15 mm. The use of regression models including power Doppler results to estimate the risk of endometrial cancer deserves further development.

Aged↗
PubMed2002

Intraobserver and interobserver reproducibility of ultrasound measurements of endometrial thickness in postmenopausal women.

OBJECTIVES: To determine intraobserver and interobserver reproducibility of ultrasound measurements of endometrial thickness in postmenopausal women. DESIGN: Forty-eight postmenopausal women underwent transvaginal ultrasound examination by two examiners. Each observer took three replicate measurements of the endometrium in each woman. Intraobserver repeatability was expressed as the difference between the highest and lowest measurement values obtained by one observer, the repeatability coefficient, and the intraclass correlation coefficient. Interobserver reproducibility was expressed as the difference between the mean of the three measurements of each observer, limits of agreement, and interclass correlation coefficient. The repeatability coefficient and the limits of agreement define the range within which 95% of the differences between two measurements are likely to fall. Data were analyzed for all women, as well as separately for women with endometrium < or = 6 mm and > 6 mm. The agreement between observers in classifying women as having endometrium < or = 4.4 mm or > or= 4.5 mm was determined by calculating Cohen's kappa. RESULTS: In women with endometrium 6 mm were 0.99 and 0.99, 0.7 mm (0-2.9) and 1.0 mm (0.2-3.4), and 1.7 mm and 1.9 mm. In women with endometrium < or = 6 mm the interclass correlation coefficient was 0.77, and the mean interobserver difference was 0.2 mm +/- 1.8 mm (2 standard deviations), when calculations were based on the mean of three measurements per observer (+/- 1.9 mm when calculations were based on only one measurement per observer). The corresponding figures for women with endometrium > 6 mm were 0.98, 0.2 mm +/- 3.1 mm (+/- 3.2 mm). The agreement between observers in classifying women as having an endometrium < or = 4.4 mm or > or = 4.5 mm was very good (kappa 0.81). CONCLUSIONS: The reproducibility of endometrial measurements seems to be clinically acceptable and to allow reliable discrimination between postmenopausal women with endometrium < or = 4.4 mm and > or = 4.5 mm. In clinical practice, it is enough to take one endometrial measurement when performing transvaginal ultrasound examination.

Aged↗
PubMed2001

Dynamics of single-stranded DNA migration in denaturing polyacrylamide slab-gel electrophoresis.

We describe an original apparatus for the study of the dynamics of single stranded DNA migration. Four detectors based on laser-induced fluorescence (LIF) are equidistantly placed on one migration lane, allowing repeated measurements of the same DNA band at different positions along migration. This article presents the characteristics and performances of this system and focuses on the data analysis, showing how the multiple detection scheme enables the study of band broadening and band resolution during a migration run. Our results suggest the existence of anomalous (nonthermal) diffusion of DNA molecules during the electrophoretic process.

Bacteriophage M13↗
PubMed2001

Comparison of Endorette and dilatation and curettage for sampling of the endometrium in women with postmenopausal bleeding.

UNLABELLED: MAIN QUESTION: To compare the diagnostic properties of Endorette and D&C in women with postmenopausal bleeding, to relate the properties to endometrial thickness as measured by ultrasound, and to assess the women's experiences of the two methods. METHODS: In a prospective study, 133 consecutive women with postmenopausal bleeding were examined with transvaginal ultrasound. After measuring the endometrial thickness, Endorette sampling was performed without anesthesia. Dilatation and curettage (D&C) was carried out under general anesthesia within six weeks. After completion of each sampling procedure the women filled in a questionnaire regarding their experience of the sampling. RESULTS: Endorette sampling failed in 16% (21/133) of the women. More than half (56%) of the women experienced moderate or strong pain during Endorette sampling, and the doctor underestimated the pain in 62% of the women. Endorette failed to diagnose two of seven (29%) endometrial cancers found at D&C. In one of these two cases, the examiner suspected that the Endorette device had not reached the uterine fundus. In women with endometrium < 7 mm, Endorette and D&C showed similar results with regard to obtaining a sufficient endometrial sample and to distinguishing normal endometrium, benign pathological endometrium and malignancy. In women with endometrium > or =7 mm, Endorette yielded insufficient samples significantly more often than D&C (23% vs 6%, p=0.02; the McNemar test) and missed all polyps and most (77%) hyperplasias diagnosed by D&C. CONCLUSION: Endorette and D&C have similar diagnostic properties in women with postmenopausal bleeding and endometrium < 7 mm. D&C is superior to Endorette in women with endometrium > or =7 mm.

Aged↗
PubMed2001

Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding.

OBJECTIVE: To determine the prevalence of focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium > or = 5 mm and the extent to which such lesions can be correctly diagnosed by D&C. METHODS: In a prospective study, 105 women with postmenopausal bleeding and endometrium > or = 5 mm at transvaginal ultrasound examination underwent diagnostic hysteroscopy, D&C and hysteroscopic resection of any focally growing lesion still left in the uterine cavity after D&C. Twenty-four women also underwent hysterectomy. If the histological diagnosis differed between specimens from the same patient, the most relevant diagnosis was considered the final one. RESULTS: Eighty percent (84/105) of the women had pathology in the uterine cavity, and 98% (82/84) of the pathological lesions manifested a focal growth pattern at hysteroscopy. In 87% of the women with focal lesions in the uterine cavity, the whole or parts of the lesion remained in situ after D&C. D&C missed 58% (25/43) of polyps, 50% (5/10) of hyperplasias, 60% (3/5) of complex atypical hyperplasias, and 11% (2/19) of endometrial cancers. The agreement between the D&C diagnosis and the final diagnosis was excellent (94%) in women without focally growing lesions at hysteroscopy. CONCLUSION: If there are focal lesions in the uterine cavity, hysteroscopy with endometrial resection is superior to D&C for obtaining a representative endometrial sample in women with postmenopausal bleeding and endometrium > or = 5 mm.

Adult↗
PubMed2001

Comparison of 'pattern recognition' and logistic regression models for discrimination between benign and malignant pelvic masses: a prospective cross validation.

OBJECTIVES: To test prospectively the diagnostic performance of two logistic regression models for calculation of individual risk of malignancy in adnexal tumors (the 'Tailor model' and the 'Timmerman model'), and to compare them to that of 'pattern recognition' (subjective evaluation of the gray-scale ultrasound image and color Doppler ultrasound examination). DESIGN: Consecutive women with a pelvic mass judged clinically to be of adnexal origin underwent preoperative ultrasound examination including color and spectral Doppler examination. The same examination techniques and definitions as those used in the studies in which the logistic regression models had been created were used. The Tailor model was tested in 133 women (35 of whom hada malignancy) and the Timmerman model in 82 women (29 of whom had a malignancy). A subset of 79 women (28 of whom had a malignancy) was used to compare the performance of the Tailor model and the Timmerman model by calculating and comparing the areas under the receiver operating characteristics curves of the two models. Sensitivity and specificity with regard to malignancy were calculated for all three methods. RESULTS: Pattern recognition performed better than the two logistic regression models (sensitivity around 85%, specificity around 90%). Using a risk of malignancy of > 50% to indicate malignancy (as suggested in the original publications), the sensitivity of the Tailor model was 69% and the specificity 88% (n = 133). The corresponding values for the Timmerman model were 62% and 79% (n = 82). The receiver operating characteristics curves showed the two logistic regression models to have similar diagnostic properties (area under the curve, 0.87 vs. 0.84; P = 0.25; n = 79). The diagnostic performance of the mathematical models was much poorer in this study than in those in which the models had been created. CONCLUSION: The poor diagnostic performance of the mathematical models can probably be explained by subtle differences in definitions and examination technique and by differences between the original tumor populations and the study population. For mathematical models to be generally useful, they probably need to be created on the basis of a very large number of tumors, and the variables in the model must be unequivocally defined and the examination technique meticulously standardized.

Adenofibroma↗
PubMed2001

Patterns of normal change in cervical length and width during pregnancy in nulliparous women: a prospective, longitudinal ultrasound study.

OBJECTIVES: To determine what constitutes normal changes in the uterine cervix visible at transvaginal ultrasound examination from 24 gestational weeks until delivery in nulliparous women delivering at term. DESIGN: Cervical length and width were measured using transvaginal ultrasound, and the inner cervical os was assessed as being closed or open every 2 weeks from gestational week 24 until delivery in 19 healthy nulliparae delivering at term. RESULTS: In all but one woman cervical length decreased, and in all but one woman cervical width increased, with advancing gestation. Three patterns of change in cervical length were observed: a continuous decrease ( n = 10), an accelerated shortening rate after approximately 30 gestational weeks ( n = 5), or a sudden drop in length between the last two examinations ( n = 3). The median rate of decrease in cervical length was 1 (range, 0.6-1.9) mm/week for women with continuous shortening of the cervix. For women with accelerated shortening the corresponding figure was 2.2 (range, 1.8-2.7) mm/week after the start of accelerated shortening. Two patterns of increase in cervical width (cervical broadening) were noted: a continuous increase ( n = 12), or an accelerated broadening rate from around 32 weeks ( n = 6). The median rate of increase in cervical width was 0.8 (range, 0.3-2.0) mm/week for women with continuous broadening of the cervix. For women with accelerated broadening rate the corresponding figure was 1.7 (range, 1.0-6.4) mm/week after the start of increased broadening rate. Opening of the internal cervical os was observed at least once in eight of the 19 women (42%) and was first observed at 30 gestational weeks. Dynamic changes (i.e. opening and closing of the inner cervical os during examination) were seen in six women (32%) and were first detected at 31 gestational weeks. CONCLUSIONS: There are different patterns of normal change in cervical length and width during pregnancy in nulliparous women. This must be taken into account if repeated ultrasound examinations of the cervix during pregnancy are used to identify nulliparae at increased risk of preterm delivery.

Adult↗
PubMed2001

Rebleeding and endometrial growth in women with postmenopausal bleeding and endometrial thickness < 5 mm managed by dilatation and curettage or ultrasound follow-up: a randomized controlled study.

OBJECTIVE: To compare the frequency of rebleeding and endometrial growth during a 12-month follow-up period between women with postmenopausal bleeding and an endometrial thickness < 5 mm managed by dilatation and curettage, and those managed by ultrasound follow-up. DESIGN: Consecutive women with postmenopausal bleeding and an endometrial thickness < 5 mm were randomized to ultrasound follow-up after 3, 6, and 12 months (n = 48) or to primary dilatation and curettage with ultrasound follow-up at 12 months (n = 49). At all follow-up examinations, the endometrial thickness was measured and the women were asked about rebleeding. The endometrium was sampled at the 12-month examination, if sampling had not been performed previously because of rebleeding or endometrial growth. RESULTS: Rebleeding was reported by 33% (16/48) of the women in the ultrasound group and by 21% (10/48) of those in the dilatation and curettage group (P = 0.17). Endometrial growth to >or= 5 mm was found in 21% (10/48) of the women in the ultrasound group and in 10% (5/48) of those in the dilatation and curettage group (P = 0.16). No endometrial pathology was found in women with isolated rebleeding. Endometrial pathology during follow-up was found more often in women with endometrial growth than in those without (33% vs. 4%; P = 0.008). CONCLUSION: Rebleeding and endometrial growth are common during a follow-up period of 12 months in women with postmenopausal bleeding and an endometrial thickness < 5 mm, irrespective of whether or not dilatation and curettage is primarily carried out. If these women are managed by ultrasound follow-up, endometrial sampling should be performed if the endometrium grows, but not necessarily in the case of rebleeding without endometrial growth.

Aged↗
PubMed2001

Intraobserver reproducibility of Doppler measurements of uterine artery blood flow velocity in premenopausal women.

OBJECTIVE: To determine the intraobserver repeatability of Doppler measurements of uterine artery blood flow velocity and the contribution of various factors to within-subject variance. DESIGN: Seventeen healthy premenopausal women underwent vaginal Doppler ultrasound examination of the uterine artery by the same observer. Three measurements were taken at each of three sites: 1) the currently recommended sampling site; 2) the ascending branch of the uterine artery at a level between the lower and middle third of the corpus uteri; 3) 1.5 cm lateral to the recommended sampling site. Three measurements were taken at each site. For each measurement, three uniform consecutive cardiac cycles were analyzed. Peak systolic velocity, time-averaged maximum velocity, and pulsatility index were calculated. Each Doppler shift spectrum was analyzed twice. Thus, for each women, 18 measurement results per sampling site were obtained. Analysis of variance was used. RESULTS: The effect of sampling site on measurements of peak systolic velocity and time-averaged maximum velocity was non-significant, but pulsatility index values obtained at the distal sampling site were slightly higher than those obtained at the other sites (P = 0.01). Repetition accounted for most of the within-subject variance. Averaging the results of the three repeat measurements yielded increased intraclass correlation coefficients: 0.79-0.89 for peak systolic velocity, 0.80-0.92 for time-averaged maximum velocity and 0.86-0.93 for pulsatility index. CONCLUSION: As the effect of repetition on the results of Doppler measurements of uterine artery blood flow velocity is large, the average of several repeat measurements should be used to enhance measurement reproducibility. However, it is not worth doing more than one analysis of a Doppler shift spectrum, and it is not worth analyzing more than one cardiac cycle per spectrum.

Adult↗
PubMed2001

Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium > 5 mm.

OBJECTIVES: To determine the ability of transvaginal ultrasound, with or without saline infusion, to detect focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium > 5 mm, and to determine the accuracy of conventional ultrasound, saline contrast sonohysterography and diagnostic hysteroscopy under general anesthesia to diagnose endometrial polyps, submucous myomas and uterine malignancy. DESIGN: In a prospective study, 105 women with postmenopausal bleeding and endometrium > 5 mm underwent conventional ultrasound examination and saline contrast sonohysterography. Diagnostic and operative hysteroscopy under general anesthesia was then performed. The presence of focally growing lesions and the type of lesion (endometrial polyp, submucous myoma, malignancy or unclear focal lesion) were noted at ultrasound examination and at hysteroscopy. RESULTS: There was almost perfect agreement (96%) between saline contrast sonohysterography and hysteroscopy in the diagnosis of focally growing lesions. Saline contrast sonohysterography and hysteroscopy both had a sensitivity of approximately 80% with regard to diagnosing endometrial polyps (false-positive rates of 24% and 6%, respectively), whereas conventional ultrasound missed half of the polyps (sensitivity, 49%; false-positive rate, 19%). Hysteroscopy was superior to both saline contrast sonohysterography and conventional ultrasound with regard to discriminating between benign and malignant lesions (sensitivity, 84%, 44%, and 60%; false-positive rate, 15%, 6% and 10%, respectively). The risk of malignancy was increased seven-fold (odds ratio, 7.3; 95% confidence interval, 1.9-27.8) in women with distension difficulties at saline contrast sonohysterography, and two thirds of the women with a poorly distensible uterine cavity had a malignant diagnosis. CONCLUSION: Saline contrast sonohysterography is as good as hysteroscopy at detecting focally growing lesions in the uterine cavity in women with postmenopausal bleeding. However, neither hysteroscopy nor saline contrast sonohysterography can reliably discriminate between benign and malignant focal lesions. Distension difficulties at saline contrast sonohysterography should raise a suspicion of malignancy.

Adult↗