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

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 Journal of International Society of Ultrasound in Obstetrics and Gynecology.

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

Negative sliding sign by ultrasound in repeat cesarean section predicts 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.

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

A practical guide to counting 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 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 best use of resources available in a particular setting.

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

Novel emerging infectious diseases in pregnancy

Last two decades have seen epidemics of several infectious diseases which were previously not so prevalent worldwide. Pregnant mothers are especially prone to many infections because of anatomical and physiological changes that accompany pregnancy. The immune tolerance to semiallogenic fetus is because of down regulation of immunity, which puts the pregnant women at high risk of other infectious diseases reports a paper published in May 2017 issue of Journal Obstetrics and Gynecology.

https://obgynupdated.blogspot.in/2018/02/novel-emerging-infectious-disease-in.html

Innovative force sensing technology enables the surgeons to feel again from a distance

SensOR Medical Laboratories, a medical device start-up based out of Toronto, Canada has developed a novel force-sensing electronic skin called ForceFilm, that when paired with the existing laparoscopic tools enables the surgeons to get the ‘tactile sensation’ so easily felt during open surgeries.

Handling the tissues from a distance makes it difficult to get the idea of the amount of force applied and increases the rate of surgical complications.

https://obgynupdated.blogspot.in/2018/02/innovative-force-sensing-technology.html

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

Photo courtesy: YouTube video clip by Green Journal

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.

Real-time ultrasound-based technique of ‘slide test’ is the non-invasive way of detecting pelvic and intrabdominal adhesions preoperatively. The test measures the relative motion between abdominal and uterine wall.

The researchers recruited 370 women with previous cesarean section. The women underwent transabdominal sonography and a video-clip was recorded at deep inspiration in sagittal plane lateral to the midline.

The findings of preoperative ultrasonography were correlated with adhesions found during surgery by surgeons who were not aware about the preop USG findings.

Statistical analysis of these findings showed that when less or no movement was detected between the uterus and abdominal wall (negative ‘slide test’), it correctly identified patients with severe adhesion in 56% of cases (sensitivity 56%, 95% CI 35–76). It also predicted absence of severe adhesions correctly in 95% of patients (specificity 95%, 95% CI 93–97).

When the USG findings was combined with history of adhesions in previous surgery, severe adhesions were correctly predicted in 64% of patients and absence of adhesions was predicted in 94% of patients.

The surgeons noted a longer delivery time and significant blood loss in patients with negative sliding sign.

Thus, it was seen that ‘slide test’ is a simple, reliable and non-invasive screening test in repeat cesarean cases to predict technical difficulty during surgery.

Here is a short video of visceral slide test from video gallery of Journal Obstetrics and Gynecology.

This short video clip explains the equipment needed, how to perform, and how to interpret the visceral slide test. An example of a normal test and an abnormal ultrasound visceral slide test are illustrated, including a laparoscopic view of the patient with an abnormal test.

Video courtesy of Erica C. Dun, MD, MPH.

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