Abnormal liquor volume and mode of delivery

Introductions: Sonographic assessment of four quadrant measurement of amniotic fluid index (AFI) is an integral part of antenatal evaluation of pregnancies, especially in the third trimester. Decreased (oligohydramnios, AFI 0-9.9 cm) or increased (polyhydramnios >25 cm) increases the risk of intrauterine growth retardation, birth asphyxia and induction or operative interference. The aim of this study was to analyse abnormal liquor volume and mode of delivery. Methods: This retrospective cross-sectional study analysed the cases of abnormal liquor volume in term pregnancies during 2013-2016 at Patan Hospital. Patient's files were traced from medical record section. We analysed the abnormal liquor volume based on amniotic fluid index (AFI) and the mode of deliveries. Results: Among 15,272 term pregnancies scanned, 130 had abnormal AFI, 128 oligohydramnios and 2 polyhydramnios. Out of 128 oligohydramnios, 40 (30.8%) were severe, 54 (41.5%) moderate and 34 (26.2%) mild. Two cases had polyhydramnios. The emergency lower uterine segment caesarean sections (emLSCS) were performed in 99 (76.1%) oligohydramnios. Conclusions: This study suggests that oligohydramnios measured by AFI at term pregnancy required more emLSCS. Keywords: amniotic fluid index, oligohydramnios, polyhydramnios, emergency caesarean sections, spontaneous vaginal deliverie

Congenital anomalies in antenatal ultrasound scan at a tertiary care teaching hospital

Introductions: Early detection of congenital fetal anomalies by ultrasonography (USG) helps to identify the severity and termination of pregnancy in severe cases. Anomalies cause significant perinatal morbidity and mortality. Aim of this study was to analyse real-time USG detection of prenatal anomalies. Methods: This was a cross-sectional descriptive study of fetal anomalies detected during 2nd and 3rd trimester antenatal USG scan done from 2011 to 2015, in Patan Hospital. Age of mother, parity, gestational age when anomalies detected and, anomalies of previous child, use of folic acid were analysed. Descriptive analysis was done. Results: There were 35,571 deliveries in four years period with 134 (0.37%) congenital anomalies, 99 (79.2%) detected during antenatal USG during 2nd and 3rd trimester. Among 99 anomalies, 29 (29.29%) were detected before 22 weeks. Central nervous system (CNS) anomalies were 47, gastrointestinal 23, renal 12, skin and fetal compartment 8 and rest were less common. Young mothers of less than 30 years were 109 (81.34%) and primi were 85 (63.4%). Conclusions: Antenatal ultrasound can detect fetal anomalies in 2nd and 3rdtrimester with higher frequencies belonging to the central nervous system followed by gastrointestinal tract anomalies and renal. Keywords: congenital anomalies, gestational age, prenatal ultrasound sca

Correlation of ultrasound imaging with histopathological findings in gestational trophoblastic disease

Introduction:  Gestational trophoblastic diseases (GTD) include a spectrum of pregnancy-related diseases caused by abnormal proliferation of the placenta .  The main aim of this study to study the Correlation of ultrasound imaging with histopathological findings in gestational trophoblastic disease. Method: This is the retrospective study consisting of 155 sonographically diagnosed cases of GTD collected for three years 2016-2019. These patients were evaluated by transabdominal sonography. All these patients underwent Evacuation of product of conception (POC) and samples were subsequently sent for histopathological examination Their histopathological reports were followed up. The Correlation between USG and histopathological findings in GTD was studied. Result :  Among these 155 sonographically diagnosed cases of GTD 141 (91.0%) were  histologically confirmed GTD,  14 (9.0%) were  non-molar miscarriages on histological examination. In 141 cases of histologically confirmed GTD, 110 (71.0 %) were partial mole, 15 (9.7%) complete mole, 12 (7.7%) invasive mole and 3 (1.9 %) persistent mole, 1(0.6%) was choriocarcinoma. Conclusion :  The diagnostic accuracy of ultrasound to be 90% in the diagnosis of GTD, increasing its reliability. Thus ultrasound seems to be an initial modality of choice in the workup of every woman suspected of having GTD

Sonographic and histopathological findings in ovarian dermoid cyst

Introductions: Ovarian dermoid cyst occurs most commonly in reproductive age group. It consists all three layers of germ cells, in variable composition resulting in wide spectrum of USG findings. This study aimed to find the association between sonographic and histopathological findings of dermoid cyst. Methods: This was a retrospective study consisting of 55 cases of complex ovarian cysts with features of dermoid cyst, during two years 2013-2015. The diagnostic accuracies of trans-abdominal sonography findings were compared with post-operative histopathology reports. Results: Among 55 cases of complex ovarian cyst with sonographic features of dermoid, histopathology was benign in 52 (94.5%) and malignant in 3 (5.5%). In 52 benign cysts, 25 (48.0%) were teratoma and 27 (51.9%) were other benign masses. Conclusions: The accuracy of ultrasound was 95% in the diagnosis of ovarian cyst and is the modality of choice for initial workup of ovarian mass. Keywords: complex ovarian mass, dermoid cyst, histopathology, sonograph

Echogenic liquor at term pregnancy on ultrasonography is not always meconium

Introductions: The presence of echogenic amniotic fluid at term pregnancy on sonography is uncommon. Finding of meconium in the amniotic fluid by ultrasound is used to predict mode of delivery of fetus, fetal wellbeing and risk of intrauterine fetal demise. We aim to observe the clinical significance of echogenic liquor at term pregnancy.Methods: This was a retrospective study of 102 cases of echogenic liquor at gestation age between 36 and 41 weeks (term pregnancy) during five years 2010 to 2015. Amniotic fluid index (AFI) was calculated. Fluid was observed for presence of vernix caseosa or meconium stain during spontaneous and artificial rupture of membrane. The APGAR score of baby was taken twice at 5 and 10 minutes.Results: Among the 102 patients with echogenic amniotic fluid at term, 83 (81.4%) were vernix and 19 (18.6%) had meconium stain. Low APGAR scores were found in 5 (0.9%) and normal score in 97 (95.1%) indicating good fetal outcome. Among these cases, 89 (87.3%) had normal AFI and 13 (12.7%) had decreased liquor.Conclusions: There were no association between echogenic liquor and meconium stain, AFI or APGAR score of the baby in term pregnancy.Keywords: AFI, echogenic liquor, fetal outcome, prenatal ultrasound, term pregnancy, vernix or meconiu

Renal ultrasound and voiding cystourethrogram in children with recurrent urinary tract infection

Introductions: Urinary tract infection (UTI) is common in children and vesicoureteric reflux (VUR) is a risk factor for the UTI. Renal ultrasound, voiding cystourethrogram (VCUG) and nuclear renal scanning are used to confirm VUR. Recent studies show that ultrasound has a low sensitivity and specificity for VUR. Aim of the study was to assess the findings of renal ultrasound and VCUG in recurrent urinary tract infection and presence of VUR. Methods: This cross-sectional study retrospectively reviewed 208 cases of children with recurrent UTI who had ultrasound and VCUG in at Patan Hospital during 2010 to 2015. Sensitivity and specificity of both tests were analysed. Amount of contrast required for VCUG with or without VUR was analysed. Results: Among the 209 patients with recurrent UTI, 51 (24.51%) had VUR and 157 (75.48%) were normal. In ultrasound, 196 cases (94.2%) were normal, 11 cases (5.3%) had mild hydronephrosis and 1 (0.5%) had moderate hydronephrosis. VUR cases needed more amount of contrast medium than normal patients while performing VCUG. Conclusions: Ultrasound alone is not diagnostic of VUR and VCUG is required to confirm diagnosis. Mire amount of contrast volume is required in VUR cases than no VUR. Keywords: recurrent UTI in children, renal ultrasound, voiding cystourethrogram VCUG, vesicoureteral reflux VU

CT KUB evaluation of suspected urolithiasis: CT KUB in suspected urolithiasis

Introduction: Non-contrasted computed tomography scan for kidney, ureter, and bladder (CT KUB) for the diagnosis of urolithiasis is important for accurate diagnosis, followup, and management. Unlike USG, CT KUB has more diagnostic yield in urolithiasis and other incidental findings. This study aims to evaluate the use of the CT KUB in suspected urolithiasis, which is presented with severe flank pain. Method: A retrospective observational study was carried out in the Department of Radiology and Imaging, Patan Hospital, Nepal. The CT KUB reports of patients with suspected urolithiasis from a period of 3 years from Jan 2017 to Jan 2020 were analyzed for evidence of urolithiasis and secondary signs of obstruction as ‘diagnostic’ of CT KUB. Other incidental radiological findings were further analysed and categorized into urinary and extra-urinary. Ethical approval was obtained. The association between USG and CT KUB was analysed using the Chi-square test, with a p value of 0.05 considered statistically significant. Result: A total of 414 CT KUB reports were analysed, 230(55.6%) males, 314 patients had USG before CT KUB. Considering CT KUB as a gold standard for the diagnosis of urolithiasis, the accuracy of ultrasound was found to be 85.03%, and sensitivity is 94.09% and specificity of 27.9%. Conclusion:  The majority of the patients included in the study had ultrasound done before CT KUB. The sensitivity of ultrasound was significant considering CT KUB as a gold standard in the diagnosis of urolithaisis. Keywords: Urolithiasis, CT KUB, incidental findings, USG sca