No abstract

Uterine perforation is a potential complication of intrauterine procedures that can be associated with vascular or visceral injury. We report the case of a 35‐year‐old woman diagnosed with omentum incarceration, secondary to a uterine perforation, during a dilatation and curettage. This rare complication was successfully managed by release of incarcerated omentum hysteroscopically. Sealing of uterine wall defect was achieved by administration of intravenous uterotonic drugs, thus, avoiding a major surgery. In conclusion, this is a novel approach to a case of uterine omental incarceration. To date, there are few cases reported in the literature and only one of them was managed by hysteroscopy. Hysteroscopy alone or combined hysteroscopic and laparoscopic approach when needed, should be attempted in such cases as it is safe and minimally invasive.

Objectives Detection of small for gestational age (SGA) fetuses in a third trimester ultrasound could be affected by variation in sonographer performance. Methods Retrospective analysis of all singleton, non‐anomalous ultrasound examinations between 35+0‐36+6 weeks gestation, in a single institution where a universal 36‐week scan is offered. Screen positive was defined as estimated fetal weight (EFW) <10th centile; SGA was birthweight <10th centile. Individual sonographers' distributions of head circumference (HC), abdominal circumference (AC) and femur length (FL) were used to assess sonographers' screen positive rate (SPR), detection rate (DR) and true positive rate (TPR). Univariate and multivariate regression analysis was performed to assess the association between the sonographers' mean and SD (SD) for HC, AC, FL and their SPR, DR and TPR. Results There were 27 sonographers performing more than 50 examinations per year, a total of 5691 scans. The mean incidence of SGA was 10.0%. For an overall SPR of 9.4%, the overall DR was 43.8% (95% CI: 39.6% ‐ 48.1%) and the overall TPR was 46.5% (95% CI: 42.9% ‐ 50.2%). Higher AC scatter (SD difference up to 11.6 mm) was associated with higher SPR (P = 0.001). Lower mean FL (difference up to 3.6 mm) was associated with higher SPR (P = 0.003) and higher DR (P = 0.002). As a result, DR varied amongst different sonographers between 14.3% and 85.7% and TPR varied between 8.3% and 100.0%. Conclusions Monitoring of individual AC and FL distributions is a simple and effective tool for institutional quality assurance.