José Antonio García-Mejido1,2, Zenaida Ramos-Vega3, Alberto Armijo-Sánchez4, Ana Fernández-Palacín5, Rocío García-Jimenez4, José Antonio Sainz4,6. 1. Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain. jagmejido@hotmail.com. 2. Department of Obstetrics and Gynecology, University of Seville, Seville, Spain. jagmejido@hotmail.com. 3. Department of Obstetrics and Gynecology, Nuestra Señora de la Merced Hospital, Seville, Spain. 4. Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain. 5. Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain. 6. Department of Obstetrics and Gynecology, University of Seville, Seville, Spain.
Abstract
INTRODUCTION AND HYPOTHESIS: The objective was to identify the best parameter (pubis-cervix measurement, pubis-uterine fundus measurement or pubis-pouch of Douglas measurement) on transperineal ultrasound, based on the difference between measurements taken at rest and with the Valsalva maneuver, for presurgical differential diagnosis between uterine prolapse (UP) and cervical elongation (CE) without UP. METHODS: A prospective observational study of 60 consecutively recruited patients who underwent corrective surgery of the middle compartment (UP or CE without UP). A transperineal ultrasound was performed, and the descent of the pelvic organ was measured in relation to the posteroinferior margin of the pubis in the midsagittal plane, referencing the uterine fundus, pouch of Douglas and the cervix at rest and with the Valsalva test. RESULTS: Receiver operating characteristic (ROC) curves were constructed for the three evaluated measures, based on the difference between rest and Valsalva, for the diagnosis of UP. For the pubis-cervix distance, an area under the curve (AUC) of 0.59 was obtained; for the pubis-uterine fundus distance, the AUC was 0.81; and for the pubis-pouch of Douglas distance, the AUC was 0.69. Based on the best AUC (the difference in the pubis-uterine fundus distance at rest and with the Valsalva maneuver), a cut-off point of 15 mm was established for the diagnosis of UP (sensitivity: 75%; specificity: 95%; positive predictive value: 86%; and negative predictive value: 89%). CONCLUSION: A difference of ≥15 mm in the pubis-uterine fundus distance at rest and with the Valsalva maneuver is useful for differentiating UP from CE without UP by ultrasound.
INTRODUCTION AND HYPOTHESIS: The objective was to identify the best parameter (pubis-cervix measurement, pubis-uterine fundus measurement or pubis-pouch of Douglas measurement) on transperineal ultrasound, based on the difference between measurements taken at rest and with the Valsalva maneuver, for presurgical differential diagnosis between uterine prolapse (UP) and cervical elongation (CE) without UP. METHODS: A prospective observational study of 60 consecutively recruited patients who underwent corrective surgery of the middle compartment (UP or CE without UP). A transperineal ultrasound was performed, and the descent of the pelvic organ was measured in relation to the posteroinferior margin of the pubis in the midsagittal plane, referencing the uterine fundus, pouch of Douglas and the cervix at rest and with the Valsalva test. RESULTS: Receiver operating characteristic (ROC) curves were constructed for the three evaluated measures, based on the difference between rest and Valsalva, for the diagnosis of UP. For the pubis-cervix distance, an area under the curve (AUC) of 0.59 was obtained; for the pubis-uterine fundus distance, the AUC was 0.81; and for the pubis-pouch of Douglas distance, the AUC was 0.69. Based on the best AUC (the difference in the pubis-uterine fundus distance at rest and with the Valsalva maneuver), a cut-off point of 15 mm was established for the diagnosis of UP (sensitivity: 75%; specificity: 95%; positive predictive value: 86%; and negative predictive value: 89%). CONCLUSION: A difference of ≥15 mm in the pubis-uterine fundus distance at rest and with the Valsalva maneuver is useful for differentiating UP from CE without UP by ultrasound.
Authors: José Antonio García-Mejido; Enrique González-Diaz; Ismael Ortega; Carlota Borrero; Ana Fernández-Palacín; José Antonio Sainz-Bueno Journal: Quant Imaging Med Surg Date: 2022-02
Authors: José Antonio García-Mejido; Zenaida Ramos-Vega; Ana Fernández-Palacín; Carlota Borrero; Maribel Valdivia; Irene Pelayo-Delgado; José Antonio Sainz-Bueno Journal: Tomography Date: 2022-07-01
Authors: José Antonio García-Mejido; Zenaida Ramos Vega; Alberto Armijo Sánchez; Ana Fernández-Palacín; Carlota Borrero Fernández; José Antonio Sainz Bueno Journal: Int Urogynecol J Date: 2021-10-07 Impact factor: 1.932