History, pelvic examination findings and mobility of ovaries as a sonographic marker to detect pelvic adhesions with fixed ovaries

Jeevan P. Marasinghe, Jeevan Prasanga Marasinghe, Hemantha Senanayake, Namasivayam Saravanabhava, Carukshi Arambepola, George Condous, G. Condous, Peter Greenwood
Journal of Obstetrics and Gynaecology Research · 2013 · vol. 40(3) , pp. 785–790 · doi:10.1111/jog.12234 · PMID:24738122 · W1908401228
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This study found that combining patient history, pelvic examination findings, and transvaginal ultrasound assessment of ovarian mobility accurately identifies fixed ovaries in women with endometriosis.

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Abstract

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 University Gynecology unit, National Hospital of Colombo Sri Lanka. 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.

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Condition tags

endometriosischronic_pelvic_paindysmenorrheadyspareunia

MeSH descriptors

Adnexal Diseases Choristoma Ovary Tissue Adhesions Adnexal Diseases Adnexal Diseases Adult Biomarkers Choristoma Choristoma Endometriosis Endometriosis Female Humans Iliac Artery Infertility, Female Infertility, Female Middle Aged Ovary Pelvic Pain

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References (23)

Cited by (17)

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