Objective: To identify the present skill level of obstetric ultrasound, to set quality standards and to make recommendations in terms of obstetrics ultrasound service improvement. Methods: An audit was carried out in five provinces in Sri Lanka. At the beginning of the ultrasound workshops, attendees were requested to participate in this audit. Optimum ultrasound machine settings and biometry standards were defined at the beginning. Measures were taken to recruit a cross section of the obstetric service providers including postgraduate trainees and senior house officers (SHOO). They were asked to perform an ultrasound scan and obtain standard images. These images were assessed onsite and documented in structured data sheet. The level of competency was analyzed according to the pre-defined standards. A structured ultrasound training programs have been carried out to improve the existing knowledge and skills of the participants. In order to simulate their own scan environment and habits, participants were assessed without their knowledge in the second phase of this audit. Results: Overall skills in controlling machine settings were very poor. Almost all the participants did not manage to set the machine competently. Postgraduates were slightly better in obtaining correct landmarks for fetal biometry. It is encouraging to note that most of the postgraduates were able to improve their machine setting skills in subsequent audit. First trimester crown-rump length is the least improved fetal biometry in second phase. Conclusion: At present background skills of obstetric ultrasound are substandard and it can be improved by dedicated training. Systematic

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BackgroundRecent rapid advances in assisted reproductive health technologies enables couples with subfertility to conceive through various intervention. Majority of treatment modalities target the female partner. However it is important to identify and treat male factor subfertility right at the outset. We report a case of isolated follicle stimulating hormone deficiency resulting in azoospermia and primary subfertility.Case presentationA 28 year otherwise healthy male presented with primary subfertility with a healthy female counterpart. He was found to have non obstructive azoospermia with low seminal fluid volume. He had normal external genitalia and potency with increased libido. Further evaluation revealed an isolated deficiency of follicle stimulating hormone with elevated testosterone levels. His luteinizing hormone and prolactin levels were normal. Contrast enhanced CT scan of chest, abdomen and pelvis and MRI scan of the pituitary fossa were normal too.ConclusionIn the era of modern reproductive technology it is important to further evaluate males with non-obstructive azoospermia to detect underlying gonadotropin deficiency.

Objective: To compare the measurements and the client-preferences of transabdominal scan (TAS) and transvaginal scan (TVS) in assessing cervical length.Method: A validation study with a cross sectional component on patient-preferences was conducted among 568 pregnant women with a period-of-amenorrhoea between 11+0 to 22+6 weeks. Pre-and post-void TAS and a post-void TVS measurements were taken. Receiver Operating Characteristics (ROC) curves were generated to assess the detection of short cervix using pre and post void TAS at different lengths of the cervix. Results:The mean (SD) age of the participants was 28.4 (5.7) years with a mean gestation age of 14+1 weeks. The mean (SD) cervical lengths detected by the pre-void TAS, post-void TAS and TVS were 32.2 (5.8) mm, 28.9 (5.8) mm and 34.4 (5.3) mm respectively. Factors with significant association with a higher TVS cervical length were; increasing age (p<0.001), higher gravidity (p<0.001), higher parity (p<0.001) and higher number of vaginal deliveries (p<0.001). The TAS and TVS measurements significantly correlated with each other (p<0.001).Post-void TAS could not obtain measurement in 49.47% of attempts. The shortest cervical length can be detected by pre-void TAS was 26mm with a ideal cut-off of 33 mm. For post-void TAS the shortest length was 28 mm with an ideal cut-off of 28.16mm. Majority preferred TAS over TVS. Conclusion:Pre-void TAS can predict a cervical length of 26mm or less with 87.5% sensitivity whereas the shortest length predicted by post-void is relatively longer. Nearly in half, a valid post-void TAS could not be recorded. Client preference was more favourable for TAS.

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