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Obstetrics & Gynecology 1990;75:110-113
© 1990 by The American College of Obstetricians and Gynecologists
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Ultrasound for Diagnosing and Preventing Malplacement of Intrauterine Tandems

C O GRANAI, MD, F. DOHERTY, MD, P. ALLEE, MD, H G BALL, MD, H. MADOC-JONES, MD and S L CURRY, MD

From the Division of Gynecologic Oncology, Department of Gynecology, Massachusetts General Hospital, and the Departments of Ultrasound, Radiation Oncology, and Obstetrics and Gynecology, New England Medical Center Hospitals, Boston, Massachusetts

Abstract

Postoperative B-mode ultrasound was used to evaluate final tandem position in 50 consecutive placements (28 patients). In 34% (17 of 50), the tandem was found to be suboptimally positioned; in 24% (12 of 50), it penetrated the myometrium; and in 10% (five of 50), it frankly perforated the uterus. The uterine fundus was the region most commonly perforated, and the anterior myometrium was the site most frequently penetrated. In all cases in which postoperative ultrasound showed malpositioning, the clinical and radiographic assessment indicated proper intracavitary placement. Ultrasound affected clinical management in 42% (21 of 50) of the placements involving 61% (17 of 28) of the patients. To improve tandem placement, we used intraoperative realtime ultrasound to guide 73 consecutive surgical insertions. Ultrasound clearly visualized the procedure, allowing tandems to be positioned with confidence even in the most difficult cases. The immediate feedback from intraoperative ultrasound eliminated malplacements and thus the need for a second anesthesia to reposition the tandem.






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Copyright © 1990 by the American College of Obstetricians and Gynecologists.