Here are the top 5 most read ultrasound posts of 2018

With only a few hours left for the calendar year 2018 to come to an end, take a look at the top 5 most read ultrasound posts of the year as we gear up to look forward to another year of medical advances and health research. 

Blob and Bagel sign on Ultrasound can be labeled as definitive for Ectopic Pregnancy

Women with the Blob and Bagel ultrasound sign should be reclassified from having ‘probable’ ectopic pregnancy (EP) to ‘definitive’ EP and should be treated as such reports the result of a large retrospective cohort study published March 11, 2018, in Journal of Ultrasound in Obstetrics and Gynecology.

Ectopic Pregnancy is still the leading cause of first-trimester maternal deaths and constitutes 4% of all pregnancy-related deaths. The incidence of ectopic is highest in women undergoing In-Vitro Fertilization (IVF) and ranges from 4% to 11% of all pregnancies.

https://obgynupdated.blogspot.com/2018/03/blob-and-bagel-sign-on-ultrasound-can.html

Novel cross-over sign in cesarean scar pregnancy helps predicts the risk of invasive placentation

First trimester ultrasound scan evaluating the relationship between the gestational sac and the endometrial line in women with cesarean scar pregnancy(CSP) helps predicts the development of abnormally invasive placenta (AIP) and consecutive intra and post-operative surgical morbidities reports the results of a retrospective case series published in the Journal of International Society of Ultrasound in Obstetrics and Gynecology.

Recent advances in prenatal imaging and increase rate of cesarean sections have led to increased diagnosis of CSP. Although, most of the patients with CSP present with severe hemorrhage or rupture uterus, that requires emergency surgical management, few advances further, evolving into AIP. 

https://obgynupdated.blogspot.com/2018/02/novel-cross-over-sign-in-cesarean-scar.html

Negative sliding sign by ultrasound in repeat cesarean section predicts the presence of severe intrabdominal adhesions

A negative sliding sign by ultrasonography (USG) in patients with previous cesarean section helps alert the surgeon to expect massive intraabdominal adhesions, difficult repeat cesarean section and need of blood transfusion during surgery reports the results of a prospective observational study published ahead of print in the February issue of Journal Obstetrics and Gynecology.

Postoperative adhesion formation is quite prevalent after an abdominal or pelvic surgery and any method which can predict the existence of such adhesion could optimize the outcome of current surgery.

https://obgynupdated.blogspot.com/2018/02/negative-sliding-sign-by-ultrasound-in.html

GE Healthcare introduces its new automated breast ultrasound for dense breast

There could not have been a more appropriate time for the launch of GE Healthcare new Invenia Automated Breast Ultrasound (ABUS) 2.0 than October, which is celebrated as breast cancer awareness month. The Invenia ABUS is the only FDA approved 3D ultrasound system for supplemental screening for breast cancer along with mammography.

In conjunction with mammography, it increases the chances of cancer detection in the dense breast by 55%. All breasts are not the same, the density of breast is determined by a proportion of fat and breast tissue—when the percentage of breast tissue exceeds that of fat, breasts are labeled as being dense.

https://obgynupdated.blogspot.com/2018/10/ge-healthcare-introduces-its-new.html

A practical guide to count ovarian antral follicles by ultrasound

A consensus opinion highlighting the main techniques of ovarian antral follicle count (AFC), and providing recommendations for future research is published in the special issue on Reproductive Medicine of the journal Ultrasound in Obstetrics and Gynecology.

The consensus makes several recommendations for varied methods used in counting the antral follicles, but no single method is superior over others and the choice should make the best use of resources available in a setting.

https://obgynupdated.blogspot.com/2018/02/a-practical-guide-to-count-ovarian.html

Here are the top 10 most read posts of 2018

With only a few hours left for the calendar year 2018 to come to an end, take a look at the top 10 most read posts of the year as we gear up to look forward to another year of medical advances and health research. 

ACOG guidance on prevention of surgical-site infection in gynecologic surgery

Surgical site infections (SSIs) after gynecological surgery is a significant cause of postoperative morbidity leading to repeated hospital visits.  These infections also incur heavy social and economic burden on patients and the healthcare system.

The recent ACOG practice bulletin is published in the June issue of Journal of Obstetrics and Gynecology and replaces Practice Bulletin Number 104, May 2009, and Committee Opinion Number 571, September 2013.

https://obgynupdated.blogspot.com/2018/06/acog-guidance-on-prevention-of-surgical.html

New approach to ovarian cystectomy: Transvaginal natural orifice transluminal endoscopic surgery

Natural orifice transluminal endoscopic surgery (NOTES) is a challenging minimally invasive procedure where ‘scarless’ abdominal surgeries are performed through an endoscope inserted through a natural orifice (mouth, anus, vagina, and urethra) and is considered as a less invasive approach to laparoscopic surgeries. 

NOTES is considered a logical next step in the evolution of minimally invasive surgery, and the first NOTES procedure in humans is often considered to be a transgastric appendectomy performed in India in 2006 which was presented but not reported in manuscript form.

https://obgynupdated.blogspot.com/2018/01/new-approach-to-ovarian-cystectomy.html

Blob and Bagel sign on Ultrasound can be labeled as definitive for Ectopic Pregnancy

Women with the Blob and Bagel ultrasound sign should be reclassified from having ‘probable’ ectopic pregnancy (EP) to ‘definitive’ EP and should be treated as such reports the result of a large retrospective cohort study published March 11, 2018, in Journal of Ultrasound in Obstetrics and Gynecology.

Ectopic Pregnancy is still the leading cause of first-trimester maternal deaths and constitutes 4% of all pregnancy-related deaths. The incidence of ectopic is highest in women undergoing In-Vitro Fertilization (IVF) and ranges from 4% to 11% of all pregnancies.

https://obgynupdated.blogspot.com/2018/03/blob-and-bagel-sign-on-ultrasound-can.html

Novel cross-over sign in cesarean scar pregnancy helps predicts the risk of invasive placentation

First trimester ultrasound scan evaluating the relationship between the gestational sac and the endometrial line in women with cesarean scar pregnancy(CSP) helps predicts the development of abnormally invasive placenta (AIP) and consecutive intra and post-operative surgical morbidities reports the results of a retrospective case series published in the Journal of International Society of Ultrasound in Obstetrics and Gynecology.

Recent advances in prenatal imaging and increase rate of cesarean sections have led to increased diagnosis of CSP. Although, most of the patients with CSP present with severe hemorrhage or rupture uterus, that requires emergency surgical management, few advances further, evolving into AIP. 

https://obgynupdated.blogspot.com/2018/02/novel-cross-over-sign-in-cesarean-scar.html

Negative sliding sign by ultrasound in repeat cesarean section predicts the presence of severe intrabdominal adhesions

A negative sliding sign by ultrasonography (USG) in patients with previous cesarean section helps alert the surgeon to expect massive intraabdominal adhesions, difficult repeat cesarean section and need of blood transfusion during surgery reports the results of a prospective observational study published ahead of print in the February issue of Journal Obstetrics and Gynecology.

Postoperative adhesion formation is quite prevalent after an abdominal or pelvic surgery and any method which can predict the existence of such adhesion could optimize the outcome of current surgery.

https://obgynupdated.blogspot.com/2018/02/negative-sliding-sign-by-ultrasound-in.html

GE Healthcare introduces its new automated breast ultrasound for dense breast

There could not have been a more appropriate time for the launch of GE Healthcare new Invenia Automated Breast Ultrasound (ABUS) 2.0 than October, which is celebrated as breast cancer awareness month. The Invenia ABUS is the only FDA approved 3D ultrasound system for supplemental screening for breast cancer along with mammography.

In conjunction with mammography, it increases the chances of cancer detection in the dense breast by 55%. All breasts are not the same, the density of breast is determined by a proportion of fat and breast tissue—when the percentage of breast tissue exceeds that of fat, breasts are labeled as being dense.

https://obgynupdated.blogspot.com/2018/10/ge-healthcare-introduces-its-new.html

A practical guide to count ovarian antral follicles by ultrasound

A consensus opinion highlighting the main techniques of ovarian antral follicle count (AFC), and providing recommendations for future research is published in the special issue on Reproductive Medicine of the journal Ultrasound in Obstetrics and Gynecology.

The consensus makes several recommendations for varied methods used in counting the antral follicles, but no single method is superior over others and the choice should make the best use of resources available in a setting.

https://obgynupdated.blogspot.com/2018/02/a-practical-guide-to-count-ovarian.html

ACOG update: Letrozole is the first line therapy for ovulation induction in PCOS

The American College of Obstetricians and Gynecologists (ACOG) now recommends Letrozole (aromatase inhibitor) as the first-line treatment for ovulation induction in women with Polycystic Ovarian Syndrome (PCOS) due to data demonstrating increased ovulation rates, clinical pregnancy rates and live-birth rate vs clomiphene citrate. The guidelines are published as Practice Bulletin No. 194 in the June issue of Journal Obstetrics and Gynecology.

This replaces the Practice Bulletin Number 108, published October 2009, which recommends letrozole as first-line therapy for ovulation induction only in women with PCOS and a BMI greater than 30.

https://obgynupdated.blogspot.com/2018/05/acog-update-letrozole-is-first-line-for.html

Sonographically measured fetal head circumference ≥35 cm at term increases the odds of cesarean delivery

Sonographically measured fetal head circumference ≥35 cm, within a week of delivery increases the odds of unplanned cesarean section by 75% report the results of multicenter observational study accepted for publication in American Journal of Obstetrics and Gynecology.

Currently, In the US, one in every third baby is born by cesarean section and the high rate is a cause of concern for the healthcare industry.

https://obgynupdated.blogspot.com/2018/01/sonographically-measured-fetal-head.html

FDA approves a bedside test for assessing the risk of spontaneous preterm birth

QIAGEN won FDA approval for marketing its Novel PartoSure® point of care test for estimating the risk of spontaneous preterm birth in patients who present with symptoms of preterm labor. PartoSure represents a breakthrough in research and development of diagnostic tests for preterm birth.

Predicting preterm birth is a diagnostic challenge and nearly 85% of patients admitted to the hospital for threatened preterm labor (PTL) do not deliver within the next 7 days, resulting in unnecessary interventions.

https://obgynupdated.blogspot.com/2018/04/fda-approves-bedside-test-for-assessing.html

In case you missed it: Here are the top 5 posts this month

Blob and Bagel sign on Ultrasound can be labeled as definitive for Ectopic Pregnancy

Women with the Blob and Bagel ultrasound sign should be reclassified from having ‘probable’ ectopic pregnancy (EP) to ‘definitive’ EP and should be treated as such reports the result of a large retrospective cohort study published March 11, 2018, in Journal of Ultrasound in Obstetrics and Gynecology.

https://obgynupdated.blogspot.com/2018/03/blob-and-bagel-sign-on-ultrasound-can.html

The Dos and Don’ts in Pregnancy: An evidence-based review

Every Pregnant woman receives tons of advice regarding precautions she needs to take to optimize the pregnancy outcome. In this digital age, she is constantly exposed to ideas and suggestions about the dos and don’ts in pregnancy, a lot of which is confusing and conflicting, as a result, the woman is often unsure of what is correct for her and the baby. She often turns to her healthcare provider to direct her regarding her daily routine in pregnancy, but the healthcare provider is also exposed to myriads of opinion on this topic.

https://obgynupdated.blogspot.com/2018/03/the-dos-and-donts-in-pregnancy-evidence.html

New oral drug treatment found highly effective in reducing menopausal hot flashes

A neurokinin 3 receptor (NK3R) antagonist (MLE4901) rapidly reduced hot flashes for short and long-term in postmenopausal women; thus, eliminating the need for estrogen therapy report researchers from Imperial College London. The study was published on March 12, ahead of print in North American Menopause Society Journal Menopause. 

The neurokinin 3 receptor (NK3R) antagonist (MLE4901) is manufactured by Millendo Therapeutics Inc, based at Ann Arbor, Michigan.

https://obgynupdated.blogspot.com/2018/03/new-oral-drug-treatment-found-highly.html 

A new study quantifies the risk of occult gynecological malignancy in women undergoing hysterectomy or myomectomy for benign indications 

The risk of finding occult gynecological malignancy in women undergoing hysterectomy or myomectomy is not negligible, especially in women more than 55 years in age reports the results of a large population-based study published ahead of print in Journal of Obstetrics and Gynecology. 

This timely and interesting study not only looked at the prevalence of gynecological malignancy in women undergoing hysterectomy and myomectomy for benign conditions but also looked at the utility of power morcellators in selected patient populations.

https://obgynupdated.blogspot.com/2018/03/new-study-quantifies-risk-of-occult.html 

Could modified PapTest help detect endometrial and ovarian malignancy?

A new multiplex PCR-based test called PapSEEK was able to detect endometrial and ovarian malignancy from fluid samples collected during routine Pap test, reported Yuxuan Wang, MD, of Johns Hopkins University School of Medicine in Baltimore.

The authors also used a longer sampling brush that sweeps cells from the lining of the uterus called Tao brush, to further increase the sensitivity of detection for the less accessible tumors.

https://obgynupdated.blogspot.com/2018/03/could-modified-paptest-help-detect.html

Blob and Bagel sign on Ultrasound can be labelled as definitive for Ectopic Pregnancy

. blob sign of ectopic pregnancy.

Women with the Blob and Bagel ultrasound sign should be reclassified from having ‘probable’ ectopic pregnancy (EP) to ‘definitive’ EP and should be treated as such reports the result of a large retrospective cohort study published March 11, 2018, in Journal of Ultrasound in Obstetrics and Gynecology.

Ectopic Pregnancy is still the leading cause of first-trimester maternal deaths and constitutes 4% of all pregnancy-related deaths. The incidence of ectopic is highest in women undergoing In-Vitro Fertilization(IVF) and ranges from 4% to 11% of all pregnancies.

The broken arrow depicts the right ovary and the solid arrow shows ectopic pregnancy characterized by the ‘bagel sign’.

With the advent of high-resolution transvaginal ultrasound (TVS), more ectopic pregnancies are diagnosed at clinically early and hemodynamically stable stages that are amenable to various modes of management. In modern times TVS has replaced laparoscopy as the diagnostic tool of choice.

Barnhart et al have published a recent consensus statement of nomenclature, definitions, and outcome of pregnancy of unknown location (PUL) in Journal Fertility and Sterility. In which, research papers originating from the US diagnose EP based on findings of an extrauterine gestational sac with the visualization of a yolk sac or embryo, while literature from the UK and European countries diagnose EP based on finding of an extrauterine inhomogeneous mass (blob sign), or an extrauterine empty gestational sac (bagel sign). 

   

This study was undertaken with an aim to determine whether these ultrasound markers can be used to definitely predict EP, instead of just raising a probability of its presence. The study recruited 849 of 7490 consecutive women who attended the Early Pregnancy Unit (EPU) of the Nepean Hospital, Sydney, Australia over a period of 10 years.

At TVS, 240 of 849 women were diagnosed as probable EP, of which 174 (72.5%) exhibited the blob sign and 66 (27.5%) exhibited bagel sign. The rest 609 were labeled as PUL, of which 47 received a final diagnosis of EP (including 24 blob signs, 19 bagel signs and four gestational sacs with embryo/yolk sac.

Nearly 51% of patient with blob sign and 59% of patients with bagel sign underwent laparoscopic salpingectomy, and HPE proved the diagnosis in 97% of patients with blob sign and 96% of patients with bagel sign.

The sensitivity for the blob and bagel signs in the prediction of definite tubal EP was 89.8% and 83.3%, respectively, the specificity was 99.5% and 99.6%, PPV was 96.7% and 95.2% and NPV was 98.3% and 98.6%.

All the parameters were comparable to the corresponding parameters of the extrauterine gestational sac with yolk sac and/or embryo on TVS used in the prediction of definite tubal EP.

The authors concluded that Blob and bagel signs are the commonest presentation of tubal ectopic on TVS, and because of high PPV of >95%, it can be used for the definitive diagnosis of EP. Majority of women who present with EP during early pregnancy can have a definitive diagnosis with only standalone TVS, with laparoscopy being used as the treatment modality.

Abstract

Consensus statement

Media courtesy: Wikimedia Commons, research gate