bluuebunny/crossref_metadata_2025_split huggingface dataset:
The use of intra‐operative saline sonovaginography to define the rectovaginal septum in women with suspected rectovaginal endometriosis: a pilot study
Authors: Reid Shannon , Bignardi Tommaso , Lu Chuan , Lam Alan , Condous George 
Published: December 2015

Objectives: The aim of this study was to perform saline sonovaginography (SVG) in women with suspected rectovaginal endometriosis (RVE) in order to establish the thickness of the rectovaginal septum (RVS) in this population and to predict the presence or absence of RVE.Methods: Prospective observational pilot study. Women undergoing laparoscopy for possible endometriosis on the basis of history or clinical examination were offered to participate in the study. All women underwent saline SVG during general anesthesia just prior to their laparoscopy. RVS nodules were visualised as hypoechoic lesions of various shapes. The sonologist predicted whether or not a nodule was present in the retrocervical area or in the RVS. The thickness of the posterior vaginal wall ± RVS was then taken at three points in the mid‐sagittal plane: at the posterior fornix (retrocervical area), at the middle third of the vagina (upper RVS) and just above the perineal body (lower RVS). The diagnosis of RVE was established using the gold standards of laparoscopy and histological confirmation. The RVS thickness was then compared between women with RVE and the absence of RVE.Results: Twenty‐three women were enrolled in the study. Mean age was 38 years (33–44 years). A history of endometriosis was present in 72.7% (8/11). RVE was confirmed in 17.4% (4/23). Visualisation of a hypoechoic nodule at saline SVG demonstrated sensitivity and specificity of 75% and 95%, respectively. All rectovaginal nodules were located in the retrocervical region. Mean diameter (SD) of RVE nodules was 27.3 (± 9.4) mm. Mean thickness of vaginal wall ± RVS at the posterior fornix, at the middle third of the vagina and just above the perineal body was 5.1, 1.4 and 4.0 mm, respectively. These measurements were not significantly different in the presence of a rectovaginal nodule.Conclusions: Using saline SVG, we have established the mean RVS thickness in a small group of women with suspected RVE. Although the numbers are small, there was no correlation between RVS thickness and presence of RVE. The visualisation of hypoechoic lesions at saline SVG seems to be the best ultrasonographic predictor for RVE. SVG is a valuable pre‐operative tool for the assessment of RVS and for the prediction of RVE, which allows for the mapping and planning of advanced endometriosis surgery.
Obstetric ultrasonography practice in Fiji
Authors: Kumar Sanjalesh 
Published: December 2015

AbstractIn Fiji, a Pacific island nation, ultrasonography practice is still in its infancy. Ultrasounds are performed by radiographers who independently interpret the ultrasonographic images and write the diagnostic reports on behalf of the radiologists. This paper presents research on the practices and procedures that are used to perform the mid‐trimester obstetric ultrasonography examinations at an urban public hospital in Fiji. The participants comprised a cohort of “on‐the‐job” trained radiographers, radiologists and obstetricians involved in obstetric ultrasonography. In‐field observations, questionnaires and interviews yielded predominantly qualitative data. The radiographers' scanning criteria were evaluated against the stipulated ASUM mid‐trimester guidelines.This study revealed that even the most experienced radiographers barely met 50% of ASUM's mid‐trimester scanning requirements. They spent less than five minutes performing a scan and insufficient expertise, training and supervision, excessive workload and a lack of resources were major constraints affecting the standards of ultrasonography practice in Fiji. However, the absence of a standard protocol was also a major cause for disparate scanning patterns amongst the radiographers. This paper highlights the gaps and limitations associated with the obstetric ultrasonography practice in Fiji, and suggests the need for international assistance in ultrasonography education.
The term “pregnancy of unknown location” is here to stay
Authors: Condous George , Winder Simon , Reid Shannon 
Published: December 2015

AbstractThe term “pregnancy of unknown location” is an ultrasound classification and not a final diagnosis. The use of this terminology is here to stay and should continue as long as there is an appreciation for what it really means. It is the responsibility of the clinician, who follows up these women with a PUL, to ensure that a final diagnosis is achieved while preserving the well‐being of these women.
Spontaneous septostomy in monochorionic diamniotic twins resulting in cord entanglement and fetal demise
Authors: Fleming Tina , Miller Trent 
Published: December 2015

AbstractMonoamniotic twins are known to be at risk of cord entanglement, and have an elevated perinatal morbidity and mortality associated with this. We present a case of cord entanglement in a monochorionic diamniotic (MCDA) twin pregnancy thought to be due to spontaneous septostomy. Unfortunately the cord entanglement was detected postpartum, and ultimately resulted in the demise of one of the twins. Literature review reveals this as a recognised, albeit rare, phenomena.
Prenatal diagnosis of a left ventricular diverticulum
Authors: Paoletti Debra , Robertson Meiri 
Published: December 2015

AbstractA congenital left ventricular diverticulum is a rare prenatal finding. The four‐chamber view of the heart is a standard part of the 18–20 week morphology scan, and evaluation of the heart with colour Doppler imaging has greatly enhanced the detection of rare and subtle cardiac anomalies.
Estimating fetal weight for best clinical outcome
Authors: Westerway Susan Campbell 
Published: December 2015

Clinical decisions are often based on the results of third trimester sonograms, particularly with small or large babies and so accuracy of estimating fetal weight (EFW) is essential. There are numerous EFW formula available and yet in Australia no one formula has been recommended for use due to the lack of clinical evidence as to their accuracy.Objectives: 1 To assess inter/intra observer error for fetal parameter measurements with multiple observers. 2 To compare six of the most commonly used EFW formulae and analyse inter/intra formulae variations for different weight range.Method: EFW of 121 pregnancies assessed within 7 days of birth by measuring the BPD, OFD, HC, AC, FL and comparing to actual birth weight.Results: Inter‐observer error: 1.3 to 3.1%. Intra‐observer error: 1.1 to 1.9% depending on fetal parameter. Accuracy of each EFW formula changed with different weight ranges. For all formulae the highest random error occurred in the macrosomic group. The lowest random error in all weight groups was the Hadlock B formula incorporating the HC/AC/FL (7.7%).Conclusion: Considering the possible problems of head moulding this study suggests the use of: Hadlock FP et al (1982) – Formula B – incorporating HC/AC/FL.
Massive ovarian cystic teratomas diagnosed at a rural Nepal camp
Authors: Williams Alan 
Published: December 2015

This case report presents the findings of significantly large sized (> 8 cm) symptomatic unilateral cystic teratomas in two perimenopausal patients in remote Nepal.Ovarian dermoid cysts consist of cystic, solid and fat tissue. Traditionally, cells differentiate along the various germ lines, essentially recapitulating various body tissues. The characteristic sonographic features include a dermoid plug, dermoid mesh, a fat‐fluid level and the “tip of the iceberg” sign.The presence of two or more of these typical features confidently supports an ultrasound‐based diagnosis of ovarian dermoid cyst.The presence of intratumoral hair, teeth, fat, and skin tissue revealed at surgery confirmed the initial ultrasound based diagnosis.
Targeted liver ultrasound for chronic liver disease: time to focus?
Authors: Gibson Robert N 
Published: December 2015

AbstractIncreasing prevalence of chronic liver disease has led to dramatically increased demands on ultrasound for diagnosis, monitoring and surveillance of complications. Targeted ultrasound of the liver provides an efficient and possibly more accurate means of meeting this demand. It uses a matrix to guide the ultrasound examination to address the specific clinical questions commonly asked in this population. It is easy to implement and can be modified to meet local preferences and emerging technologies.
A review of congenital diaphragmatic hernia
Authors: Marlow Jay , Thomas Joseph 
Published: December 2015

AbstractBackground: Congenital diaphragmatic hernia (CDH) is a simple diaphragmatic defect that is seen frequently in antenatal scans. Though the surgical repair is relatively easy in the neonate, the mortality is high due to pulmonary hypoplasia and pulmonary vascular changes.Materials and Methods: The goals of prenatal imaging are to establish the diagnosis. Assessment in a tertiary scanning center would identify prognostic factors which assist in counselling and planning antenatal management. However, the pulmonary hypoplasia associated with the CDH in moderate and severe cases makes the prognosis poor.Conclusions: Fetal intervention such as, fetal tracheal occlusion, is being trialled and may change the outcomes in the future.
The use of interventional ultrasound in early pregnancy complications
Authors: Reid Shannon , Casikar Ishwari , Condous George 
Published: December 2015

AbstractBackground: The use of ultrasound to establish pregnancy location, viability and gestational age in the first trimester is well established. In addition to the conventional uses of ultrasound in early pregnancy, interventional ultrasound may also be used to guide clinicians during surgical procedures for the management of early pregnancy complications (i.e. treatment of ectopic pregnancy, caesarean section scar pregnancy, molar pregnancy, retained products of conception, and removal of intra‐uterine devices in early pregnancy).Aims: This review discusses the role of interventional ultrasound as it pertains to the management of first trimester complications, particularly with regard to the use of ultrasound in conjunction with surgical modalities.Materials and Methods: This review was based on recently published research, as cited in the PubMed database, regarding the use of either transvaginal or transabdominal ultrasound to assist with the management of early pregnancy complications.Conclusions: In addition to the diagnostic capabilities of ultrasound in early pregnancy, interventional ultrasound plays an important role in the management of various first trimester pregnancy complications. With the advent of more conservative approaches to early pregnancy complications, interventional ultrasound is a viable option which is not only safe in experienced hands but also enables fertility preservation.
Pelvic congestion syndrome
Authors: Robertson Meiri , McCuaig Ruth 
Published: December 2015

AbstractBackground: The precise aetiology of pelvic congestion syndrome (PCS) remains poorly understood but is believed to be multifactorial having mechanical, hormonal and psychological components.Materials and methods: Minimally invasive techniques of embolisation or sclerotherapy of the ovarian veins has become the mainstay of treatment for PCS. Studies report a technical success rates from 89–100% and clinical success rates of 58–100%.Conclusions: Embolisation and sclerotherapy can be done as a day surgery procedure concurrently with diagnostic venography and given current evidence provide better long term pain relief than medical therapy.
Heterotopic pregnancy: a report of two cases
Authors: Farnaghi Soheil , Kothari Alka 
Published: December 2015

AbstractBackground: A heterotopic pregnancy is defined as the presence of a concomitant intrauterine and extrauterine pregnancy. Its estimated incidence is 1/30,000 in spontaneous pregnancies. It is also reported to be as high as 1 in 3900 when the pregnancy is a result of assisted reproductive technology (ART). However, clomiphene citrate (CC) could be associated with a higher rate of heterotopic pregnancy as it amplifies the rate of twinning. Furthermore, heterotopic pregnancies are a diagnostic and therapeutic challenge for obstetricians. If undiagnosed, they are associated with significant maternal morbidity and mortality.Case presentation: We present two cases of coincidental intra and extra‐uterine pregnancy. In the first case, heterotopic pregnancy was a result of induction of ovulation with CC. There was a delay in the diagnosis of the ectopic pregnancy component resulting in an emergency laparoscopy. Fortunately, after the laparoscopy the intrauterine pregnancy was not affected and it is progressing satisfactorily. Alternatively, the second case occurred spontaneously and was treated with methotrexate as the intrauterine pregnancy miscarried on its own accord.Conclusions: These cases highlight the fact that as clinicians, we should be aware of the possibility of a heterotopic pregnancy in any patient presenting with pelvic pain, even when an intrauterine pregnancy has been confirmed. This is even more imperative after induction of ovulation by CC or ART. We would also like to emphasise that an early diagnosis is critical to safeguard the intrauterine pregnancy and avoid maternal morbidity and mortality due to the ectopic pregnancy.
Spontaneous expulsion of large submucosal uterine fibroid without embolisation – a case study
Authors: De Cure Natalie , Sullivan Tegan , Robertson Meiri , Hallam Lavinia , Whale Karen 
Published: December 2015

AbstractBackground: This case involved a 35‐year‐old G6P0 with multiple uterine fibroids detected at 12 weeks gestation. Fibroid growth was monitored throughout pregnancy, and intrauterine growth restriction (< 5th centile) was detected at 20 weeks. Fetal demise occurred at 22+ weeks gestation at which time the largest of fibroids measured 150 × 100 × 118 mm and labour was induced.Materials and methods: Serial ultrasounds following delivery showed features of reduced vascularity and separation of the fibroid from the myometrium, consistent with spontaneous degeneration. Our patient re‐presented with severe pain and went on to expel the fibroid spontaneously 41 days post induction of labour. Histopathology confirmed fibroid degeneration.Conclusion: This case demonstrates spontaneous fibroid degeneration and expulsion without embolisation. This may have resulted from the hormonal and mechanical effects of induction of labour. This case also demonstrated the effects of large intrauterine fibroids on fetal growth and increased risk of fetal demise, highlighting the importance of closer monitoring of fetal growth in such pregnancies.
Rationalising the change in defining non‐viability in the first trimester
Authors: Infante Fernando , Casikar Ishwari , Menakaya Uche , Condous George 
Published: December 2015

AbstractIntroduction: With the publication of four papers in late 2011, international cut‐offs for definitions of non‐viability in the first trimester of pregnancy were challenged. These definitions were inconsistent across different international guidelines. For example, a gestational sac with absent yolk sac or embryo and a mean diameter of ≥ 16 mm would be classified as a miscarriage in the USA, whereas the same sac would have to measure ≥ 20 mm in the UK or Australia to meet this definition. Likewise, an embryo with no detectable heartbeat and a CRL of ≥ 5 mm would also meet criteria for missed miscarriage in the USA, compared to a CRL ≥ 6 mm in the UK or Australia.Methods: Later in 2011 and then in 2012, guidelines across the three countries were updated and are now consistent, defining an empty gestational sac with a mean diameter of > 25 mm as a non‐viable pregnancy and/or an embryo with CRL > 7 mm and no detectable heartbeat. In this paper we explore the rationale that led to these changes in order to potentially avoid wrongly diagnosing miscarriage at the decision boundary measurements and in turn avoiding inadvertent termination of potentially viable pregnancies.Conclusion: Although reducing women's anxiety and making a definitive diagnosis as early as possible is desirable, the need for absolute certainty is paramount before diagnosis of the death of an early pregnancy is made.
The value of early recognition of fetal lymphangioma
Authors: Farnaghi Soheil , Kothari Alka 
Published: December 2015

AbstractIntroduction: Lymphangiomas are very rare benign tumors of the lymphatic system, appearing as uniseptate or multiseptate cystic masses, which are usually located in the cervical or axillary area. Postnatal outcome depends on the size and location of the lesion. An increasing number of such congenital abnormalities are detected on routine conventional prenatal ultrasonography. Although prenatal evaluation for the prognosis of fetal lymphangioma has been based on two‐dimensional ultrasonography, magnetic resonance imaging may help in assessing the extent of a lesion. Isolated lymphangiomas generally have a favourable prognosis and sclerotherapy or surgical resection is effective in most of the cases.Case presentation: We present two cases of fetal axillary lymphangioma. In the first case, the lymphangioma was diagnosed antenatally, so parents were comprehensively counselled and post natal follow up was organised at a tertiary hospital. The second case remained undiagnosed until birth. This caused significant distress to both the parents and clinicians, especially after a coincident traumatic delivery.Conclusion: Both these cases emphasise that early diagnosis of fetal lymphangioma is critical and a combination of ultrasonography and magnetic resonance imaging can facilitate detection of lesions which are relatively limited and accessible to therapy in utero. This would also enable clinicians to perform a karyotype and comprehensively consult parents regarding the treatment and delivery options as well as outcome of the pregnancy.
A pictorial guide for the second trimester ultrasound
Authors: Bethune Michael , Alibrahim Ekaterina , Davies Braidy , Yong Eric 
Published: December 2015

AbstractIntroduction: The second trimester ultrasound remains an important screening tool for detecting fetal abnormalities. This pictorial guide for the second trimester ultrasound is designed to assist practitioners to produce a high quality diagnostic survey of the fetus by demonstrating and describing recommended images.Methods: Each image is discussed in detail and has an associated drawn line diagram to aid in the identification of the important features of that image. There is a description of the salient landmarks and relevant measurements.Result: The authors hope this article may act as a useful guide to all practitioners performing second trimester ultrasounds.
Simplifying ultrasound assessment of the fetal heart: Incorporating the complete Three Vessel View into routine screening
Authors: Mogra Ritu 
Published: December 2015

AbstractIntroduction: As our experience and ultrasound resolution have improved significantly in last 30 years it is possible to detect most of the major cardiac abnormalities prenatally with high degree of accuracy.Method: Current screening techniques have poor detection rate for congenital heart diseases (CHD) and nearly half of the major cardiac abnormalities mainly of Great Arteries goes unrecognised. A high detection rate for major CHDs can be achieved in a screening setting by improving techniques of routine screening in the low risk population.Conclusion: This article summarises the alternative strategies to examine the outflow tracts and Great Arteries, its correct interpretation and examples of abnormal views.
Diagnostic accuracy of basic lung ultrasound in breathless patients over 60 years of age; stressing the protocol
Authors: Baker Kylie , Mitchell Geoffrey , Thompson Angus G , Stieler Geoffrey 
Published: December 2015

AbstractIntroduction: Emergency department differentiation of pulmonary oedema from chronic obstructive airways disease causing acute breathlessness is inaccurate 25% of the time despite clinical acumen, clinician‐reported chest x‐ray and ECG. This research investigates whether a basic lung ultrasound protocol (LUS) could improve identification of pulmonary oedema in breathless elderly patients. Method: Researchers prospectively sampled patients over 60 years, describing any breathlessness on presentation to a suburban emergency department. LUS studies were acquired by experienced or novice sonologists, interpreted by a blinded reviewer and compared with cardiologist chart audit for diagnosis at admission (gold standard). The admitting doctor's diagnosis, blinded to LUS, was compared with the chart audit result.Results: 204 LUS were collected, 145 by experienced sonologist and 59 by inexperienced. Diagnostic accuracy compared to cardiologist audit was 86.2% (95% CI 80.9 to 90.3), significantly higher than 70.2%, diagnostic accuracy for admission diagnosis, difference in proportion of 16% (95%CI 7.7 to 24.4%).Conclusion: A simple lung scanning protocol can help exclude pulmonary oedema in any breathless elderly patient.
Is bedside ultrasound now a routine part of specialist obstetrics and gynaecology outpatient consultation?
Authors: Van Der Wal Sarah , Robson Stephen J , Choong Shawn 
Published: December 2015

AbstractIntroduction: Portable ultrasound is extensively used in the delivery suite, and there is anecdotal evidence that ultrasound is increasingly common in routine outpatient gynaecological practice. We could find no published data regarding the prevalence of ‘rooms’ ultrasound use in outpatient gynaecology.Methods: A survey instrument was developed containing demographic questions about ‘rooms’ ultrasound use, and three clinical vignettes regarding dysmenorrhoea in a young woman, bleeding in early pregnancy, and postmenopausal bleeding. For each vignette, respondents were asked whether they would refer for ‘formal’ ultrasound or rely on their own findings. The anonymous questions were sent to every obstetrician/gynaecologist in private practice in Australia.Results: 438 surveys were posted and 242 returned (response rate 55%). 226 respondents (93.8%) reported using ultrasound in their consulting rooms, with 201 (88.9%) using transvaginal ultrasound. For the dysmenorrhoea vignette, 59% of respondents would rely on their own ultrasound findings and not refer for additional imaging. For the bleeding in early pregnancy vignette, 91% would rely on their own ultrasound findings and not refer for additional imaging. For post‐menopausal bleeding, 54% would rely on their own clinical and ultrasound findings and would not refer for additional imaging. Conclusion: The majority of practitioners would not refer for tertiary ultrasound if their own imaging revealed apparent normal findings.
Sonographic demonstration of stomach pathology: Reviewing the cases
Authors: Deslandes Alison 
Published: December 2015

AbstractIntroduction: The stomach can be the source of complaints for many patients attending for upper abdominal ultrasound. It is not routinely imaged as part of most upper abdominal ultrasound protocols, with sonographers and sonologists alike commonly muttering the line; “I can't see the stomach on ultrasound”. However, this is incorrect, as the gastric antrum can almost always be visualised sonographically.Discussion: It is possible to detect a range of pathologies affecting the stomach sonographically, from common, largely tolerable conditions such as hiatus hernias through to life‐threatening neoplasms. Conclusion: The stomach can easily be assessed during routine abdominal ultrasound providing the sonographer has knowledge of stomach anatomy, normal ultrasound appearances and limitations to its visualisation. While endoscopy is the gold standard for investigation of the stomach and upper gastrointestinal tract, many patients will initially present for abdominal ultrasound due to its easy, non‐invasive nature, ready availability and low cost. For patients with mild abdominal symptoms, a normal abdominal ultrasound may be the extent of their imaging investigations meaning stomach pathologies may go undiagnosed.