The role of multimodality radiological imaging in extrauterine misplaced IUCD: A case report

Intrauterine contraceptive device (IUCD) is among the commonly used contraceptive methods in the world including sub-Saharan Africa but have been associated with a number of complications that although rare, can occur. Uterine perforation is the most serious complication of the IUCD. Surgical management is required in cases with complete uterine perforation, in which the IUCD is partially or completely within the peritoneal cavity. We present a case of a 27year old para 2 woman reporting with mild lower abdominal pains and the absence of IUCD string in the vagina after its insertion following evacuation of the uterus 2 years prior to this study. With the utilization of multiple imaging modalities, an exploratory laparotomy was done to remove the migrated IUCD and repair of the perforated bowel and urinary bladder.  Keywords: Migrated IUCD, uterine perforation, ultrasonography, radiography, Computed Tomography Le dispositif contraceptif intra-utérin (IUCD) fait partie des méthodes contraceptives couramment utilisées dans le monde, y compris en Afrique subsaharienne, mais a été associé à un certain nombre de complications qui, bien que rares, peuvent survenir. La perforation utérine est la complication la plus grave de l'IUCD. Une prise en charge chirurgicale est nécessaire dans les cas de perforation utérine complète, dans laquelle l'IUCD est partiellement ou complètement dans la cavité péritonéale. Nous présentons le cas d'une femme Para 2 de 27 ans qui a rapporté avec des légères douleurs abdominales basses et l'absence de fil du dispositif contraceptif intra-utérin dans le vagin après son insertion suite à l'évacuation de l'utérus 2 ans avant cette étude. L'utilisation des multiples modalités d'imagerie , une laparotomie exploratoire a été réalisée pour retirer l'IUCD migré et réparer l'intestin et la vessie perforés. Mots-clés: IUCD migré, perforation uterine, échographie, radiographie, Tomodensitométri

Differentiating placenta accreta spectrum from scar dehiscence with underlying, non‐adherent placenta: A systematic review of scoring systems and primary data analysis

Introduction: Accurate discrimination between placenta accreta spectrum (PAS) and scar dehiscence with underlying non‐adherent placenta is challenging both on prenatal ultrasound and intraoperatively. This can lead to overdiagnosis of PAS and unnecessarily aggressive management of scar dehiscence which increases the risk of morbidity. Several scoring systems have been published which combine clinical and ultrasound information to help diagnose PAS in women at high risk. This research aims to provide insights into the reliability and utility of existing accreta scoring systems in differentiating these two closely related but different conditions to contribute to improved clinical decision making and patient outcomes. Material and Methods: A literature search was performed in four electronic databases. The references of relevant articles were also assessed. The articles were then evaluated according to the predefined inclusion criteria. Primary data for testing each scoring system were obtained retrospectively from two hospitals with specialized PAS services. Each scoring system was used to evaluate the predicted outcome of each case. Results: The literature review yielded 15 articles. Of these, eight did not have a clearly described diagnostic criteria for accreta, hence were excluded. Of the remaining seven studies, one was excluded due to unorthodox diagnostic criteria and two were excluded as they differed from the other systems hindering comparison. Four scoring systems were therefore tested with the primary data. All the scoring systems demonstrated higher scores for high‐grade PAS compared to scar dehiscence (p < 0.001) with an excellent Area Under the receiver operator characteristic Curve ranging from 0.82 (95% CI 0.71–0.92) to 0.87 (95% CI 0.79–0.96) in differentiating between these two conditions. However, no statistically significant differences were noted between the low‐grade PAS and scar dehiscence on all scoring systems. Conclusions: Most published scoring systems have no clearly defined diagnostic criteria. Scoring systems can differentiate between scar dehiscence with underlying non‐adherent placenta from high‐grade PAS with excellent diagnostic accuracy, but not for low‐grade PAS. Hence, relying solely on these scoring systems may lead to errors in estimating the risk or extent of the condition which hinders preoperative planning

Chest radiography patterns of COVID-19 pneumonia in Kumasi, Ghana

Objectives: To document the pattern of chest radiographic findings in coronavirus disease 2019 (COVID-19) patients with moderate to severe disease. Design: Retrospective cross-sectional study. Setting: The study site was Komfo Anokye Teaching Hospital (KATH) located at Bantama in Kumasi, the capital town of the Ashanti Region. It is the second largest hospital in the country and the major referral site for Ashanti region and the northern part of the country. The hospital hosts a highly infectious isolation unit (HIIU) for COVID19 patients with moderate to severe infections and receives referred cases from the region and within the hospital. Participants: The study involved 27 patients admitted to the HIIU at KATH with COVID-19 infection who underwent chest X-ray as part of their investigations. Results: The study enrolled 12 males and 15 females. The common comorbidities were hypertension and diabetes. Chest x-ray findings in most of the patients (81.5%) revealed ground-glass opacities while a few of them (18.5%) had lung consolidations without ground-glass opacities. For those with ground-glass opacities, eight (29.6%) had superimposed consolidation. All the participants had positive chest x-ray findings. Conclusion: The chest x-ray findings in the 27 COVID-19 positive patients with moderate to severe disease on admission at the KATH HIIU enrolled in this study showed significant pulmonary abnormalities. The predominant pulmonary abnormalities were bilateral peripheral ground-glass opacities with the lower lung zones being mostly affected

Three-dimensional volume rendering ultrasound for assessing placenta accreta spectrum severity and discriminating it from simple scar dehiscence

BACKGROUND Prenatal ultrasound discrimination between placenta accreta spectrum and scar dehiscence with underlying nonadherent placenta is challenging both prenatally and intraoperatively, which often leads to overtreatment. In addition, accurate prenatal prediction of surgical difficulty and morbidity in placenta accreta spectrum is difficult, which precludes appropriate multidisciplinary planning. The advent of advanced 3-dimensional volume rendering and contrast enhancement techniques in modern ultrasound systems provides a comprehensive prenatal assessment, revealing details that are not discernible in traditional 2-dimensional imaging. OBJECTIVE This study aimed to evaluate the use of 3-dimensional volume rendering ultrasound techniques in determining the severity of placenta accreta spectrum and distinguishing between placenta accreta spectrum and scar dehiscence with underlying nonadherent placenta. STUDY DESIGN A prospective, cohort study was conducted between July 2022 and July 2023 in the fetal medicine unit of Dr Soetomo Academic General Hospital, Surabaya, Indonesia. All pregnant individuals with anterior low-lying placenta or placenta previa with a previous caesarean section who were referred with suspicion of placenta accreta spectrum were consented and screened using the standardised 2-dimensional and Doppler ultrasound imaging. Additional 3-dimensional volumes were obtained from the sagittal section of the uterus with a filled urinary bladder. These were analyzed by rotating the region of interest to be perpendicular to the uterovesical interface. The primary outcomes were the clinical and histologic severity in the cases of placenta accreta spectrum and correct diagnosis of dehiscence with nonadherent placenta underneath. The strength of association between ultrasound and clinical outcomes was determined. Multivariate logistic regression analyses and diagnostic testing of accuracy were used to analyze the data. RESULTS A total of 70 patients (56 with placenta accreta spectrum and 14 with scar dehiscence) were included in the analysis. Multivariate logistic regression of all 2-dimensional and 3-dimensional signs revealed the 3-dimensional loss of clear zone (P<.001) and the presence of bridging vessels on 2-dimensional Doppler ultrasound (P=.027) as excellent predictors in differentiating scar dehiscence and placenta accreta spectrum. The 3-dimensional loss of clear zone demonstrated a high diagnostic accuracy with an area under the curve of 0.911 (95% confidence interval, 0.819–1.002), with a sensitivity of 89.3% (95% confidence interval, 78.1–95.97%) and specificity of 92.9% (95% confidence interval, 66.1–99.8%). The presence of bridging vessels on 2-dimensional Doppler demonstrated an area under the curve of 0.848 (95% confidence interval, 0.714–0.982) with a sensitivity of 91.1% (95% confidence interval, 80.4–97.0%) and specificity of 78.6% (95% confidence interval, 49.2–95.3%). A subgroup analysis among the placenta accreta spectrum group revealed that the presence of a 3-dimensional disrupted bladder serosa with obliteration of the vesicouterine space was associated with vesicouterine adherence (P<.001)

A simple guide to ultrasound screening for placenta accreta spectrum for improving detection and optimizing management in resource limited settings

Publisher Copyright: © 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.Placenta accreta spectrum is a pregnancy complication associated with severe morbidity and maternal mortality especially when not suspected antenatally and appropriate management instigated. Women in resource-limited settings are more likely to face adverse outcomes due to logistic, technical, and resource inadequacies. Accurate prenatal imaging is an important step in ensuring good outcomes because it allows adequate preparation and an appropriate management approach. This article provides a simple three-step approach aimed at guiding clinicians and sonographers with minimal experience in placental accreta spectrum through risk stratification and basic prenatal screening for this condition both with and without Doppler ultrasound.Peer reviewe

Three-dimensional volume rendering ultrasound for assessing placenta accreta spectrum severity and discriminating it from simple scar dehiscence

BACKGROUND: Prenatal ultrasound discrimination between placenta accreta spectrum and scar dehiscence with underlying nonadherent placenta is challenging both prenatally and intraoperatively, which often leads to overtreatment. In addition, accurate prenatal prediction of surgical difficulty and morbidity in placenta accreta spectrum is difficult, which precludes appropriate multidisciplinary planning. The advent of advanced 3-dimensional volume rendering and contrast enhancement techniques in modern ultrasound systems provides a comprehensive prenatal assessment, revealing details that are not discernible in traditional 2-dimensional imaging.OBJECTIVE: This study aimed to evaluate the use of 3-dimensional volume rendering ultrasound techniques in determining the severity of placenta accreta spectrum and distinguishing between placenta accreta spectrum and scar dehiscence with underlying nonadherent placenta. STUDY DESIGN: A prospective, cohort study was conducted between July 2022 and July 2023 in the fetal medicine unit of Dr Soetomo Academic General Hospital, Surabaya, Indonesia. All pregnant individuals with anterior low-lying placenta or placenta previa with a previous caesarean section who were referred with suspicion of placenta accreta spectrum were consented and screened using the standardised 2-dimensional and Doppler ultrasound imaging. Additional 3-dimensional volumes were obtained from the sagittal section of the uterus with a filled urinary bladder. These were analyzed by rotating the region of interest to be perpendicular to the uterovesical interface. The primary outcomes were the clinical and histologic severity in the cases of placenta accreta spectrum and correct diagnosis of dehiscence with nonadherent placenta underneath. The strength of association between ultrasound and clinical outcomes was determined. Multivariate logistic regression analyses and diagnostic testing of accuracy were used to analyze the data.RESULTS:A total of 70 patients (56 with placenta accreta spectrum and 14 with scar dehiscence) were included in the analysis. Multivariate logistic regression of all 2-dimensional and 3-dimensional signs revealed the 3-dimensional loss of clear zone (P&lt;.001) and the presence of bridging vessels on 2-dimensional Doppler ultrasound (P=.027) as excellent predictors in differentiating scar dehiscence and placenta accreta spectrum. The 3-dimensional loss of clear zone demonstrated a high diagnostic accuracy with an area under the curve of 0.911 (95% confidence interval, 0.819–1.002), with a sensitivity of 89.3% (95% confidence interval, 78.1–95.97%) and specificity of 92.9% (95% confidence interval, 66.1–99.8%). The presence of bridging vessels on 2-dimensional Doppler demonstrated an area under the curve of 0.848 (95% confidence interval, 0.714–0.982) with a sensitivity of 91.1% (95% confidence interval, 80.4–97.0%) and specificity of 78.6% (95% confidence interval, 49.2–95.3%). A subgroup analysis among the placenta accreta spectrum group revealed that the presence of a 3-dimensional disrupted bladder serosa with obliteration of the vesicouterine space was associated with vesicouterine adherence (P&lt;.001). CONCLUSION: Three-dimensional volume rendering ultrasound is a promising tool for effective discrimination between scar dehiscence with underlying nonadherent placenta and placenta accreta spectrum. It also shows potential in predicting the clinical severity with urinary bladder involvement in cases of placenta accreta spectrum.</p

Three-dimensional volume rendering ultrasound for assessing placenta accreta spectrum severity and discriminating it from simple scar dehiscence

BACKGROUND: Prenatal ultrasound discrimination between placenta accreta spectrum and scar dehiscence with underlying nonadherent placenta is challenging both prenatally and intraoperatively, which often leads to overtreatment. In addition, accurate prenatal prediction of surgical difficulty and morbidity in placenta accreta spectrum is difficult, which precludes appropriate multidisciplinary planning. The advent of advanced 3-dimensional volume rendering and contrast enhancement techniques in modern ultrasound systems provides a comprehensive prenatal assessment, revealing details that are not discernible in traditional 2-dimensional imaging.OBJECTIVE: This study aimed to evaluate the use of 3-dimensional volume rendering ultrasound techniques in determining the severity of placenta accreta spectrum and distinguishing between placenta accreta spectrum and scar dehiscence with underlying nonadherent placenta. STUDY DESIGN: A prospective, cohort study was conducted between July 2022 and July 2023 in the fetal medicine unit of Dr Soetomo Academic General Hospital, Surabaya, Indonesia. All pregnant individuals with anterior low-lying placenta or placenta previa with a previous caesarean section who were referred with suspicion of placenta accreta spectrum were consented and screened using the standardised 2-dimensional and Doppler ultrasound imaging. Additional 3-dimensional volumes were obtained from the sagittal section of the uterus with a filled urinary bladder. These were analyzed by rotating the region of interest to be perpendicular to the uterovesical interface. The primary outcomes were the clinical and histologic severity in the cases of placenta accreta spectrum and correct diagnosis of dehiscence with nonadherent placenta underneath. The strength of association between ultrasound and clinical outcomes was determined. Multivariate logistic regression analyses and diagnostic testing of accuracy were used to analyze the data.RESULTS:A total of 70 patients (56 with placenta accreta spectrum and 14 with scar dehiscence) were included in the analysis. Multivariate logistic regression of all 2-dimensional and 3-dimensional signs revealed the 3-dimensional loss of clear zone (P&lt;.001) and the presence of bridging vessels on 2-dimensional Doppler ultrasound (P=.027) as excellent predictors in differentiating scar dehiscence and placenta accreta spectrum. The 3-dimensional loss of clear zone demonstrated a high diagnostic accuracy with an area under the curve of 0.911 (95% confidence interval, 0.819–1.002), with a sensitivity of 89.3% (95% confidence interval, 78.1–95.97%) and specificity of 92.9% (95% confidence interval, 66.1–99.8%). The presence of bridging vessels on 2-dimensional Doppler demonstrated an area under the curve of 0.848 (95% confidence interval, 0.714–0.982) with a sensitivity of 91.1% (95% confidence interval, 80.4–97.0%) and specificity of 78.6% (95% confidence interval, 49.2–95.3%). A subgroup analysis among the placenta accreta spectrum group revealed that the presence of a 3-dimensional disrupted bladder serosa with obliteration of the vesicouterine space was associated with vesicouterine adherence (P&lt;.001). CONCLUSION: Three-dimensional volume rendering ultrasound is a promising tool for effective discrimination between scar dehiscence with underlying nonadherent placenta and placenta accreta spectrum. It also shows potential in predicting the clinical severity with urinary bladder involvement in cases of placenta accreta spectrum.</p