Accuracy of Gray‑scale and Three‑dimensional Power Doppler Ultrasound Parameters in the Diagnosis of Morbidly Adherent Placenta

Background: Morbidly adherent placenta (MAP) is usually associated with excess blood loss, bladder injuries, and hysterectomies.Aim: This study was designed to evaluate the accuracy of grayscale and three-dimensional (3D) power Doppler ultrasound parameters in the diagnosis of MAP. Subjects and Methods: Fifty pregnant women ≥28 weeks’ gestation with suspected MAP were included randomly in this prospective study. Two-dimensional (2D) transabdominal gray-scale ultrasound and 3D power Doppler scans were done for studied women to confirm placental location and findings suggestive of MAP. Intraoperative findings and histopathology results of removed uteri in the cases were managed by hysterectomies compared to preoperative sonographic findings using Student’s t-test and Mann–Whitney U-test for quantitative data, Chi-square test for qualitative data to detect the accuracy of 2D transabdominal gray-scale ultrasound and 3D power Doppler parameters in the diagnosis of MAP. Results: Best 2D gray scale ultrasound parameters for the detection of emergency hysterectomies in the studied cases were disruption of uterine serosa– bladder interface (81.8% sensitivity) and exophytic mass invading bladder (94.9% specificity, 66.7% positive predictive value (PPV), and 84.1% negative predictive value [NPV]). Best 3D power Doppler parameters for the detection of emergency hysterectomies in the studied cases were disruption of uterine serosa–bladder interface (90.9% sensitivity, 68.8% specificity, and 47% PPV) and crowded vessels over peripheral subplacental zone (93.2% NPV). Conclusion: 3D power Doppler is a useful complementary tool to 2D gray-scale ultrasound for antenatal diagnosis of MAP. Crowded vessels over peripheral sub-placental zone and disruption of uterine serosa–bladder interface were the best 3D power Doppler parameters for the detection of difficult placental separation, considerable intraoperative blood loss, and emergency hysterectomies in the studied cases.KEY WORDS: Three‑dimensional power Doppler, gray-scale, morbidly adherent placent

AmnioQuick® Duo+ for diagnosis of premature fetal membranes rupture

Background: Failure to identify women with premature fetal membranes rupture associated with infectious morbidities. Evaluation of the accuracy of AmnioQuick® Duo+ in diagnosing premature fetal membranes rupture compared to conventional diagnostic tests was the aim of this study.Methods: 220 pregnant women ≥37 and <39 weeks` gestation studied and classified into two groups; study group (premature fetal membranes rupture) and control group (no premature fetal membranes rupture). Participants examined by trans-abdominal ultrasound (TAS) and vaginal speculum to visualize amnion leaking and for collection of samples for fern, nitrazine and AmnioQuick® Duo+ tests on admission. A final diagnosis whether the studied women had PROM or not at the initial presentation made after delivery.Results: Sensitivity and specificity of the AmnioQuick® Duo+ to diagnose PROM was 93.6% and 86.4%; respectively compared with 72.7% and 80.9%; respectively for fern test and 76.4% and 83.6%; respectively for nitrazine test. Positive predictive value, negative predictive value and accuracy of AmnioQuick® Duo+ to detect PROM were 87.3%, 93.1% and 90%; respectively compared with 79.2%, 74.8% and 76.8%; respectively for fern test and 82.4%, 77.97% and 80%; respectively for nitrazine test. AmnioQuick® Duo+ test had higher accuracy to detect premature fetal membranes rupture compared to conventional diagnostic tests.Conclusions: AmnioQuick® Duo+ is accurate bedside immunoassay test, better than the individual conventional diagnostic tests and can used as complementary test to improve the management of women with women premature fetal membranes rupture

Titrated Misoprostol Versus Dinoprostone for Labor Induction

Background: Misoprostol is as effective as dinoprostone for labor induction with low cost and temperature stability.Aim: This study designed to compare titrated misoprostol regarding its safety and efficacy with dinoprostone for induction of labor.Subjects and Methods: Women with a single pregnancy, above 37 weeks’ gestation, cephalic presentation, modified Bishop’s score &lt;8, and not in labor with reassuring fetal heart rate, admitted for labor induction enrolled in this randomized controlled study. Studied women were randomized into; Group I: received oral misoprostol titrated in sterile water (200 μg tablet was dissolved in 200 ml sterile water [1 μg/ml]), starting dose of 20 μg misoprostol required, given every 2 h, and stopped if adequate contractions obtained and Group II: received vaginal dinoprostone tablet maximum two doses followed by augmentation of labor by oxytocin ± amniotomy if there is no uterine contractions after two doses of dinoprostone. In Group I, if the contractions were inadequate after two doses of oral titrated misoprostol (20 μg [20 ml]), the starting dose increased to 40 μg (40 ml), escalating the dose from 5 to 10 ml (45–50 μg), and 20 ml (60 μg) maximum ± amniotomy. If the uterine contractions were adequate, the next dose of misoprostol or dinoprostone was omitted. Statistical analysis done using Student’s t‑test for quantitative data and Chi‑square test for qualitative data.Results: Induction‑to‑delivery time was significantly longer in misoprostol than dinoprostone group (975 vs. 670 min, respectively), (P = 0.01). About 20.2% (21/104) of women in misoprostol group did not deliver vaginally within 24 h compared to 7.4% (8/108) in dinoprostone group (significant difference, P = 0.01). Augmentation of labor was significantly high in dinoprostone (37.96% [41/108]) compared to misoprostol group (10.6% [11/104]) (P &lt; 0.01).Conclusion: Titrated misoprostol for induction of labor seems to be associated with significantly longer induction‑to‑delivery time, low incidence of vaginal birth within 24 h, and less need for augmentation of labor compared to vaginal dinoprostone.KEY WORDS: Dinoprostone, labor induction, titrated misoprosto