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History, pelvic examination findings and mobility of ovaries as a sonographic marker to detect pelvic adhesions with fixed ovaries
Author(s) -
Marasinghe Jeevan Prasanga,
Senanayake Hemantha,
Saravanabhava Namasivayam,
Arambepola Carukshi,
Condous George,
Greenwood Peter
Publication year - 2014
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.12234
Subject(s) - medicine , pelvic pain , endometriosis , pelvic examination , gynecology , laparoscopy , pelvis , ovary , physical examination , radiology
Aim To compare the performance of history and examination findings combined with transvaginal ultrasound ( TVS ) ‘soft marker’ evaluation of ovarian mobility for the prediction of fixed ovaries secondary to endometriosis at laparoscopy. Methods This was a prospective observational study performed at the U niversity G ynecology unit, N ational H ospital of C olombo S ri L anka. Women who were scheduled for laparoscopic assessment of their pelvis to investigate subfertility or chronic pelvic pain were enrolled. All women underwent history evaluation for dysmenorrhea and dyspareunia, vaginal examination and detailed presurgical TVS . TVS was used to assess ‘soft marker’ of ovarian mobility. ‘Fixed’ ovaries on ultrasound were defined as one or other of the ovaries being fixed or adherent to the internal iliac artery or pelvic sidewall laterally or to the uterus medially. These findings were compared with ‘fixed’ ovaries confirmed at laparoscopy. Results A total of 106 patients were analyzed. Mean age was 33.3 years (standard deviation, 5.1). Sensitivity, specificity, positive and negative predictive values of each of the screening methods against laparoscopy in detecting endometriosis were as follows: dyspareunia, 45.9%, 76.8%, 51.5% and 72.6%; dysmenorrhea, 75.7%, 69.6%, 57.1% and 84.2%; positive vaginal examination, 73%, 88.4%, 77.1% and 85.9%; fixed ovaries with TVS , 78.4%, 94.2%, 87.9% and 89%; and a combination of history, examination findings and detection of fixed ovaries in TVS , 91.9%, 60.9%, 55.7% and 93.3%, respectively. Conclusion A combination of clinical and TVS ‐based ‘soft marker’ of ovarian mobility provides a valid method for identifying fixed ovaries secondary to endometriosis.