Impaired Ultrasonographic Cervical Assessment After Voiding A Randomized Controlled Trial
ABSTRACT : To estimate whether the timing of bladder emptying affects focal myometrial contraction development and image adequacy.
: Women at 14 0/7-32 0/7 weeks of gestation undergoing a transvaginal ultrasound examination from January 1, 2012, to September 1, 2012, were eligible for this blinded randomized controlled trial. Participants were randomly assigned to undergo transvaginal imaging immediately after urination (within 5 minutes) or to defer the imaging by at least 15 minutes. The primary outcome was focal myometrial contraction development as determined by two independent blinded reviews of the images. Secondary outcomes included image adequacy and the diagnosis of placenta previa. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated using repeated-measures log binomial regression.
: Two hundred twenty-one women provided 335 randomized encounters for analysis. Women in the deferred scan group were 30% less likely to experience a focal myometrial contraction (28.1% compared with 40.5%, RR 0.70, 95% CI 0.52-0.93) and 41% less likely to have inadequate images (18.6% compared with 31.5%, RR 0.59, 95% CI 0.40-0.86). The two groups were equally likely to be diagnosed with placenta previa (P=.13). However, participants in the deferred scan group were 76% less likely to have images demonstrating a placenta previa and focal myometrial contraction (3.0% compared with 12.5%, RR 0.24, 95% CI 0.09-0.62) than participants in the immediate scan group. Eight women would need to defer imaging for 15 minutes from bladder voiding to prevent one focal myometrial contraction of the lower uterine segment or inadequate imaging.
: A brief interval (at least 15 minutes) between voiding and transvaginal cervical evaluation is associated with decreased risk for focal myometrial contractions and improved imaging.
: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01513395.
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ABSTRACT: Objectives-To evaluate intraobserver variability of fibroid sonographic measurements and apply this factor to fibroid growth assessment. Methods-Study participants were African American women aged 23 to 34 years who had never had a diagnosis of uterine fibroids. All participants underwent transvaginal sonography to screen for the presence of previously undiagnosed fibroids (>= 0.5 cm in diameter). The diameters of up to 6 fibroids were measured in 3 perpendicular planes at 3 separate times during the examinations by experienced sonographers. Intraobserver variability as measured by the coefficient of variation (CV) for fibroid diameter and volume was calculated for each fibroid, and factors associated with the CV were assessed by regression models. The impact of variability on growth assessment was determined. Results-Ninety-six of 300 women screened were found to have at least 1 fibroid, yielding a total of 174 fibroids for this analysis. The mean CV for the 3 measurements of fibroid maximum diameter was 5.9%. The mean CV for fibroid volume was 12.7%. Fibroid size contributed significantly to intraobserver variability (P = .04), with greater variability for smaller fibroids. Fibroid type (submucosal, intramural, or subserosal) was not important. Fibroids from the same woman tended to have similar measurement variability when assessed for volume but not for maximum diameter. Calculations showed that when following up fibroids, as much as a 20% increase in diameter could be due to measurement error, not "true growth." Conclusions-A small fibroid must have a greater change in size than a large fibroid to conclude that it is growing, but even for small fibroids an increase in diameter of greater than 20% is likely to indicate true growth, not measurement variability.Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 07/2014; 33(7):1217-24. DOI:10.7863/ultra.33.7.1217 · 1.53 Impact Factor