Sep 18, 2011 - The use of gel-foam to evaluate tubal patency: a pilot study. D. Van Schoubroeck ... alternative for confirming correct placement of the Essure®.
18–22 September 2011, Los Angeles, CA, USA
Poster abstracts
the pre-ovulatory stage. There were no sig. differences in any of the indices between the uterine arteries in women who were anovulatory at either visit. Sig. differences seen when the dom. and non-dom. uterine arteries of the ovulatory group were compared to the mean values from the 2 vessels in the non-ovul group. Resistance was higher (PI 3.11 ± 0.23; RI 0.91 ± 0.02) in the anov group than in the dom(EDV 5.04 ± 0.24 cm/s). These differences were only evident in the mid-luteal phase (pre-ovulatory data not shown). As our results suggest that there is a sig relaxation of the dom uterine artery in mid-luteal phase and this is not seen in anov cycles our initial hypothesis was accepted. Conclusions: Ovulation influences ipsilateral uterine blood flow by reducing impedence in mid-luteal phase. Anov women show higher impedance than ovulatory women in the mid-luteal phase. This may have implications for uterine receptivity at the time of frozen embryo transfers.
3D transvaginal US, for 62 (94%). The women whose implants were not visualized by the abdominal approach had either a retroverted uterus or a BMI > 30. Laparoscopic tubal sterilization was finally recommended to 5 women: 2 (3%) whose microinserts were not visualized and 3 (4.5%) whose microinserts were not correctly positioned according to both ultrasound approaches. Conclusions: Transabdominal 3D ultrasound is an interesting alternative for confirming correct placement of the Essure microinserts. Despite visualization problems in cases of a retroverted uterus and BMI > 30, it provides better imaging of the uterine fundus. This technique is easy and reproducible and could replace the 3D transvaginal ultrasound in most cases. It is less invasive than 3D transvaginal US, pelvic X-Ray, or hysterosalpingography. Further studies are needed to confirm our results and validate transabdominal 3D US as a confirmation test after Essure hysteroscopic tubal sterilization.
P30.02 The use of gel-foam to evaluate tubal patency: a pilot study
P30.04 Sonographic dynamics of the cervix during spontaneous and induced ovarian cycles
D. Van Schoubroeck, T. Van den Bosch, C. Meuleman, C. Tomassetti, T. D’Hooghe, D. Timmerman
M. A. Abdel-Aleem
Obstetrics & Gynecology, University Hospitals K.U.Leuven, Leuven, Belgium
Obstetrics and Gynecology, Women Health Centre, Assiut, Egypt
Objectives: To evaluate the feasibility and reliability of gel-foam instillation sonography (GeFIS) in the diagnosis of tubal patency. Methods: Non-randomized, observational study, in women planned for a diagnostic hysteroscopy and laparoscopy for fertility evaluation. During GeFIS the same gel as used for gel instillation sonography (GIS) is diluted with sterile saline using a simple mechanical method to create a ‘‘gel foam’’. The small air bubbles within the foam are strongly echogenic on ultrasound examination. GeFIS was performed using a three dimensional (3D)-Voluson E8 ultrasound machine and a transvaginal 3D probe. Tubal patency at GeFIS was defined as the visualization of continuous flow during at least 10 seconds in the corneal part of the tube, and the visualization of the tube’s lumen over its entire length. The results of GeFIS are compared with the laparoscopic findings at chromopertubation using methylene-blue instillation (MBT). Results: Seven patients were evaluated so far. All GeFIS procedures were successful. Twelve out of 14 tubes were patent: 1 patient had a proximal block and 1 had a distal block. The findings at GeFIS were concordant with MBT in all cases. Conclusions: GeFIS is a simple and relatively cheap method to evaluate tubal patency. GeFIS may become the cornerstone of the routine fertility investigation, together with the 3-D ultrasound evaluation of the uterine cavity.
Objectives: To appraise the value of ‘cervicosonography’ in predicting occurrence of pregnancy. To display US appearance of the cervix during various phases of the ovarian cycle (sponatneous and induced) and relating this to follicular development, endometrial thickness and serum estradiol. Methods: An observational cross-sectional study. This trial was conducted at the Department of Obstetrics and Gynecology, Women’s Health Center, Assiut, between August 2008 and March 2010. Infertile women with documented normal semen analysis of husband, normal HSG presented for infertility outpatient clinic [hospital and private]. We included 59 patients who were followed up for 3 successive ovarian cycles for ovulation monitoring whether spontaneous or induced cycles using either CC or gonadotrophins and timed intercourse. A total of 136 cycles were documented and concluded as ‘ovulatory’. All patients had transvaginal ultrasonography done 3–4 times per ovarian cycle; once day 5–8, once day 9–11, 12–15, once day 16–19 if required. The following parameters were recorded; follicular development, endometrial thickness, endocervical mucosal echogenicity, and endocervical mucus. Primary outcome measures: thickening of the endocervix and appearance of cervical mucus; documented by TVS. Secondary outcome measures: occurrence of clinical pregnancy. Results: Cervical mucus was seen when mean follicular diameter was 16.5 mm and median endometrial thickness was 7.5 mm. Both appearance of endocervical mucus and thickening of endocervical mucosa ≥ 4.65 mm were essential for the pregnancy to occur. Conclusions: Cervix is a dynamic structure changing under the effect of ovarian hormones. Endocervical changes and appearance of cervical mucus is a good bioassay to the ovulatory state and may obviate the need for measurement of serum estradiol.
P30.03 Localization of essure microinserts with 3d transabdominal ultrasound after hysteroscopic sterilization P. Bouhanna, N. N. Lotersztajn, C. C. Harb, G. Bader Department of Obstetrics and Gynecology and Reprod, Poissy, France Objectives: To evaluate three-dimensional (3D) transabdominal ultrasound (US) as a minimally invasive confirmation test to localize Essure microinserts 3 months after ambulatory hysteroscopic sterilization. Methods: This single-center prospective cohort study included all 66 patients who underwent hysteroscopic Essure sterilization in a tertiary care hospital. 3D transvaginal and 3D transabdominal US were used to determine the position of the Essure microinserts across the utero-tubal junction 3 months after the procedure. Results: The microinserts were visualized without problems by 3D transabdominal ultrasound for 55 of the 66 patients (83%) and by
Ultrasound in Obstetrics & Gynecology 2011; 38 (Suppl. 1): 168–281
P30.05 Diagnostic accuracy of sonohysterography in detection of intrauterine lesions in infertile patients M. Nik Nejadi Radiology, Royan Institute, Tehran, Islamic Republic of Iran Objectives: To evaluate the diagnostic accuracy of sonohysterography in the detection of intrauterine lesions among infertile patient and comparing its results with hysteroscopy as a gold standard.
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