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Donald School Textbook of Ultrasound in Obstetics and Gynecology
Asim Kurjak, Frank A Chervenak
SECTION 1: GENERAL ASPECTS
CHAPTER 1:
Twenty-five Years' History of Ian Donald Inter-University School of Medical Ultrasound
THE FIRST IAN DONALD SCHOOL IN 1982
REFERENCE
DIRECTORS OF IAN DONALD INTERUNIVERSITY SCHOOL OF MEDICAL ULTRASOUND
ASIM KURJAK
Education
Present Position
Publications
Awards, Honors and Achievements
Scientific Interest
FRANK A CHERVENAK
Education
Present Position
Research Interests
Awards, Honors, Achievements
CO-DIRECTORS OF IAN DONALD INTER-UNIVERSITY SCHOOL OF MEDICAL ULTRASOUND
JOSE M CARRERA
KAZUO MAEDA
GIAMPAOLO MANDRUZZATO
WOLFGANG HOLZGREVE
Education
Present Position
Publications
Editor
President
Prizes/Honors
GRANTS
CROATIAN BRANCH DIRECTOR SANJA KUPESIC, MD, PhD
SANJA KUPESIC, Professor
Position
Education
Activities
Awards/Honors
Publications
Research Interests
CROATIAN BRANCH DIRECTOR, RATKO MATIJEVIC, MD, PhD
RATKO MATIJEVIC
Education
Present Position and Activities
Editor
Scientific Interests
Publications
Ian Donald Inter-University School Courses in Croatian Branch
ITALIAN BRANCH DIRECTOR, VINCENZO D'ADDARIO
VINCENZO D'ADDARIO, Professor
Education
Present Position
Research Interests
Publications
EARLY COURSES WERE ORGANIZED BY GIAMPAOLO MANDRUZZATO IN 1992 AND 1993
GIAMPAOLO MANDRUZZATO
Education
Present Position
Publications
Awards, Honors and Achievements
Ian Donald School Courses In Trieste
Ian Donald School Courses in Bari
Ian Donald School 2003 and Ian Donald School 2005
SPANISH BRANCH DIRECTOR, JOSÉ MARIA CARRERA
JOSÉ M CARRERA, Professor
Education
Present Position
Publications
Awards, Honors and Achievements
Ian Donald School Courses in Spain
Comments for each course
Subscriptions to the Yellow Journal (The Ultrasound Review of Obstetrics and Gynecology)
Critical Opinions about the School
TURKISH BRANCH DIRECTOR, CIHAT ŞEN
CIHAT ŞEN
Education
Present Position
Publications
Awards, Honors and Achievements
Ian Donald School Courses in Turkish Branch
JAPANESE BRANCH DIRECTOR, KAZUO MAEDA, MD, PhD
KAZUO MAEDA
Education
Present Position
Research Interest
Publications
Awards, Honors and Achievements
JAPANESE BRANCH SECRETARY GENERAL, RITSUKO K POOH, MD, PhD
RITSUKO KIMATA POOH
Education
Present Position
Research Interests
Awards, Honors and Achievements
History of the Ian Donald Inter-University School of Medical Ultrasound in Japanese Branch
Some Details of each Courses
Coming Ian Donald Schools
Response to the Queries of Director Asim Kurjak
JORDAN BRANCH DIRECTOR, MAHER G SARRAF
MAHER G. SARAAF, Professor
Education
Present Position
Publications and Presentations
IAN DONALD SCHOOL OF ULTRASOUND MIDDLE EAST BRANCH
GREEK BRANCH DIRECTOR, ARIS J ANTSAKLIS
ARIS J ANTSAKLIS, Professor
Education
Present Position
Achievements
Research Interests
Publications
Ian Donald School Courses in Greek Branch
INDIAN BRANCH DIRECTOR, NARENDRA MALHOTRA, MD, FICOG, FICMCH
NARENDRA MALHOTRA, Professor
Present Position
Research Interests
Publications
Awards and Honors
Jaideep Malhotra, MD, FICOG, FICMCH
Present Position
Publications
Research Interests
Awards and Honors
Ian Donald School Courses in India
HUNGARIAN BRANCH DIRECTOR, ZOLTÁN PAPP, MD, PhD, DSC, FACOG (HON.)
ZOLTÁN PAPP, Professor
Present Position
Education
Present Position
Research Interests
Hungarian Branch of the Ian Donald School
RUSSIAN BRANCH DIRECTOR, ANTON V MIKHAILOV
ANTON V MIKHAILOV
Education
Present Position
Research Interests
Awards and Achievements
Publications
Ian Donald School Courses in Russia
ARGENTINEAN BRANCH DIRECTOR, LILIANA S VOTO, MD, PhD
LILIANA S VOTO, Professor
Education
Present Position
Research Interests
Publications
Awards and Honors
Ian Donald School Courses in Argentina
SERBIA AND MONTENEGRO BRANCH DIRECTOR, ALEKSANDAR LJUBIC
ALEKSANDAR LJUBIC, Professor
Present Position
Publication
Serbia and Montenegro Branch
URUGUAYAN BRANCH DIRECTOR, ANNA BIANCHI
ANNA BIANCHI, Professor
Education
Present Position
Research Interest
Ian Donald School in Uruguayan Branch
SLOVENIAN BRANCH DIRECTOR, VELJKO VLASAVLJEVIC
VELJKO VLAISAVLJEVIC, Professor
Education
Present Position
Research Interests
Publications
Ian Donald School Courses in Slovenia
ROMANIAN BRANCH DIRECTOR, FLORIN VASILE STAMATIAN, MD, PhD
FLORIN VASILE STAMATIAN, Professor
Education
Present Position
Publications
CO-DIRECTOR, RADU VLÃDÃREANU, MD, PhD
RADU VLÃDÃREANU, Professor
Education
Present Position
Research Interest
Awards/Honors/Publications
Ian Donald School Courses in Romania
QATAR BRANCH DIRECTOR, BADRELDEEN IBRAHIM AHMED, MBCHB, MD, MFFP, MRCOG, CCST
BADRELDEEN IBRAHIM AHMED
Education and Qualification
Present Position
Previous Appointments
Regional and National Responsibilities
Awards
Membership
Publications
Ian Donald School Courses in Qatar
Qatar Ian Donald School Program
BOSNIA AND HERZEGOVINA BRANCH, DIRECTOR: ZLATAN FATUSIC
ZLATAN FATUSIC, MD, PhD
Education
Present Position
Publications
CHINESE BRANCH DIRECTOR, TAO DUAN, MD
TAO DUAN, Professor
Education
Experience
Present Position
Academic Positions
Ian Donald School Courses in China
INDONESIAN BRANCH DIRECTOR, GULARDI HANIFA WIKNJOSASTRO, MD
GULARDI H WIKNJOSASTRO, Professor
HAWAIIAN BRANCH DIRECTOR, IVICA ZALUD, MD, PhD, FACOG
IVICA ZALUD, Professor
Education
Certification
Present Position
Academic Position
Awards
Other Activities
Publication
Ian Donald School Courses in Hawaiian Branch
SAUDI ARABIAN BRANCH DIRECTOR, SAMEER ABDULLAH MD
SAMEER ABDULLAH
Education
Present Position
Publications
Ian Donald School Courses in Saudi Arabia
GEORGIAN BRANCH DIRECTOR, ALEXANDER PAPITASHVILI, MD
ALEXANDER PAPITASHVILI, Professor
Education
Present Position
Publications
Awards and Honors
Memberships
Ian Donald School Courses in Georgia
UKRAINIAN BRANCH CO-DIRECTOR, YURIY P VDOVICHENKO, MD
YURIY P VDOVICHENKO, Professor
Education
Present Position
Research Interest
Publications
UKRAINIAN BRANCH CO-DIRECTOR, ANDREW V TKACHENKO, MD
ANDREW V TKACHENKO, Professor
Present Position
Education
Research Interest
Publications
UKRAINIAN BRANCH SECRETARY GENERAL, DR DMITRY S LEDIN, MD
DMITRY S LEDIN
Present Position
Education
Research Interest
Publications
Ian Donald School Courses in Ukrainian Branch
CZECH BRANCH DIRECTOR, ISHRAQ DHAIFALAH, MD, PhD
ISHRAQ DHAIFALAH
Education/Qualifications
Certification
Short Attachments
Present Position
Medical Registrations and Memberships
Clinical Skills, Techniques and Experience
Ian Donald School in Czech
PERU BRANCH DIRECTOR, ALFREDO GUZMAN, MD, MPH
ALFREDO GUZMAN
Present Position
Education
Professional Expertise
Publications
Membership
Other Activities
Languages
Ian Donald School Courses in Peru
BANGLADESH BRANCH DIRECTOR, MA BASHED
MA BASHED
OMAN BRANCH DIRECTOR, SAADIA SULTAN AL RIYAMI
SAADIA SULTAN AL RIYAMI
Present Position
EGYPTIAN BRANCH DIRECTOR, ALAA EBRASHY, MD
ALAA EBRASHY, Professor
Qualifications
Present Position
Workshop Organizer and Instructor
Conference Attendance as Invited Speaker
Publications
IAN DONALD SCHOOL JOURNAL
EDITORIAL: WHY A NEW JOURNAL?
Asim Kurjak and Frank A Chervenak
IAN DONALD SCHOOL TEXTBOOKS
VIDEOTAPES AND HANDBOOK COLLECTIONS
References (Figures above)
Acknowledgement
CHAPTER 2:
Understanding Technology— Key to Correct Diagnostics
THE NATURE OF ULTRASOUND
Ultrasound Waves and Their Interaction with Tissues
THE ULTRASOUND SCANNER
The Time Gain Compensation (TGC)
Ultrasound Beam from a Piezoelectric Transducer
Focusing
Scanner Probes
PRACTICAL ASPECTS
Use of the Probes
Resolution
Measurement
Artifacts
Puncture Guiding with Ultrasound
Physical Principles of the Doppler Effect and its Application in Medicine
The Doppler Effect
Doppler Indices
INSTRUMENTATION FOR DOPPLER MEASUREMENTS
Flow vs Velocity
Two Dimensional Flow Measurements
2D Color Doppler Display
Power Doppler Ultrasound
BASIC LIMITATIONS OF DOPPLER EXAMINATIONS
Accuracy
Precision
Artifacts
Aliasing
ACKNOWLEDGEMENT
CHAPTER 3:
Safety of Ultrasound in Obstetrics and Gynecology
INTRODUCTION
DIAGNOSTIC ULTRASOUND INSTRUMENTS AND ULTRASOUND INTENSITY
ULTRASOUND INTENSITY OF DOPPLER ULTRASOUND
THE EFFECT OF HEATING ON MAMMAL FETUSES
NON-HAZARDOUS EXPOSURE TIME OF THE FETUS TO THE HEAT
STRATEGY FOR THE SAFETY OF DIAGNOSTIC ULTRASOUND EQUIPMENTS
Prevention of Thermal Damage due to Ultrasound Exposure
Two Modes in Ultrasonic Exposure Duration
Prospective Setting of Exposure Time Before Examination
Other Thermal Issues
The Safety of 3D Ultrasound
The Safety of 4D Ultrasound
MECHANICAL EFFECTS OF DIAGNOSTIC ULTRASOUND
CONCLUSION
CHAPTER 4:
Development of 3D Ultrasound
INTRODUCTION
What Can 3D Ultrasound Do?
TECHNICAL ASPECTS OF 3D ULTRASOUND
Acquisition of 3D Data
Construction of a 3D Data Set
Volume Visualization
Section Reconstruction
Surface Rendering
Volume Rendering
Realtime Ultrasonic Beam Tracing
Defocusing Method
PRACTICAL TIPS
3D Scanning
Region of Interest
Threshold
Electrical Scalpel
CONCLUSION
CHAPTER 5:
Artifacts, Pitfalls and Normal Variants
DOPPLER ULTRASOUND ARTIFACTS
Aliasing
Range Ambiguity
Temporal Ambiguity
Angle of Insonation
Doppler Mirror Artifact
CONCLUSION
CHAPTER 6:
Screening by Ultrasound in Obstetrics
INTRODUCTION
SCREENING
SCREENING BY ULTRASOUND IN OBSTETRICS
Obstetric Ultrasound as a Screening Test
Clinical Conditions for which a Screening can be Advisable
Premature Birth
IUGR
Post-term
Clinical Conditions
Management of Very Preterm Labor
Recognition of IUGR
Precise Identification of Post-term Pregnancies
CONCLUSION
CHAPTER 7:
Routine Use of Obstetric Ultrasound
INTRODUCTION
BASIC ULTRASOUND1
SAFETY
GUIDELINES FOR USE OF OBSTETRIC ULTRASOUND
RANDOMIZED CONTROLLED TRIALS OF ROUTINE ULTRASOUND
CRITIQUE OF RADIUS TRIAL
Applicability of Results
Outcomes Emphasized
Ultrasound Quality
Cost Analysis
META-ANALYSES OF RANDOMIZED CONTROLLED TRIALS
DIAGNOSTIC ABILITY OF ROUTINE ULTRASOUND
FIRST TRIMESTER ULTRASONOGRAPHY
ETHICAL DIMENSIONS
Beneficence
Autonomy
CONCLUSION
CHAPTER 8:
Medical-legal Issues in Obstetric and Gynecologic Ultrasound
MEDICAL NEGLIGENCE
GUIDELINES
INSTRUMENTATION AND SAFETY
DOCUMENTATION
INDICATIONS
EXAMINATION CONTENT
QUALITY CONTROL
LITIGATION RELATED TO ULTRASOUND
NON-MEDICAL USE OF ULTRASONOGRAPHY
CONCLUSION
CHAPTER 9:
Ultrasound in Developing Countries
MATERNAL MORTALITY AND MORBIDITY
Global Overview
Causes of Maternal Mortality
Ultrasound Features in Early Pregnancy
PERINATAL MORTALITY AND MORBIDITY
CAUSES OF PERINATAL MORTALITY
PRIME CAUSES OF PERINATAL MORTALITY IN INDIA
FROM 06 to 09 WEEKS
FROM 10 to 14 WEEKS
FROM 18 to 22 WEEKS
FROM 35 to 40 WEEKS
CONGENITAL MALFORMATION
ANTEPARTUM FETAL DEATH
Uteroplacental Circulation
Fetoplacental Circulation
DOPPLER SAMPLING SITES IN THE FETUS
Umbilical Artery
Middle Cerebral Artery
Ductus Venosus
Descending Aorta
The 11 to 14 Weeks Scan
CONCLUSION
SECTION 2: OBSTETRICS
CHAPTER 10:
Development of the Human Embryo
INTRODUCTION
GESTATIONAL AGE
PREIMPLANTATION PERIOD: FIRST WEEK OF DEVELOPMENT
Fertilization
Cleavage and Morula Formation (Fig. 10.1)
Early Blastocyst (Carnegie Stage 3)
IMPLANTATION: SECOND WEEK OF DEVELOPMENT
Lacunar or Previllous Stage
Bilaminar Embryonic Disk
GASTRULATION: THIRD WEEK OF DEVELOPMENT
Primitive Streak
Notochord
ECTODERM DIFFERENTIATION: NEURULATION
Primary Neurulation
Secondary Neurulation
Neural Crest
Mesoderm Differentiation
Somites
ENDODERM DIFFERENTIATION
VASCULOGENESIS AND FORMATION OF THE EARLY CIRCULATORY SYSTEM
Vasculogenesis
Development of Heart Primordia
Embryonic Circulation
MOLECULAR BASIS OF DEVELOPMENT
Genes Involved in the Neural Tube Differentiation
CHAPTER 11:
Ultrasound Evaluation during the First Trimester of Normal Pregnancy
INTRODUCTION
THE EMBRYONIC PERIOD AND THE FETAL LIFE
WEEKS 1–2
The First Half of the Menstrual Cycle: Preovulatory and Periovulatory Phase
Menstrual Phase
Proliferative Phase
Ovulation
Endometrium
WEEKS 3–4: CONCEPTUS
Embryonic events
ULTRASOUND FINDINGS
WEEK 5
Embryonic Events
Start of the 5th Week
Ultrasound Findings
Gestational Sac
There are two β-hCG levels
Yolk Sac
WEEKS 6 to 10: EMBRYONIC PERIOD
Embryonic Events
Musculoskeletal System
CV System
GI system
Ultrasound Findings
Embryo, Amnion and Cardiac Activity
Musculoskeletal System
Brain
Gastrointestinal System (Physiologic Midgut Herniation)
Doppler
WEEK 11 AND AFTER
ACKNOWLEDGMENTS
CHAPTER 12:
Sonographic Determination of Gestational Age
IMPORTANCE OF ACCURATE GESTATIONAL AGE ASSESSMENT
ASSESSING GESTATIONAL AGE USING LMP
CLINICAL METHODS FOR DETERMINING GESTATIONAL AGE
ULTRASOUND ASSESSMENT OF GESTATIONAL AGE
First Trimester Ultrasound
Second Trimester Ultrasound
Ultrasound Parameters
Third Trimester Ultrasound
Multifetal Pregnancies
Choosing a Due Date
Ultrasound Pitfalls
CONCLUSION
CHAPTER 13:
Ultrasound Markers of Chromosomal Anomalies in First Trimester
INTRODUCTION
FETAL GROWTH
HEART RATE
FETAL STRUCTURAL MALFORMATIONS
NUCHAL TRANSLUCENCY
MEGACYSTIS
ABSENT NASAL BONE
UMBILICAL CORD DIAMETER
UMBILICAL ARTERY PULSATILITY INDEX
DUCTUS VENOSUS VELOCIMETRY
TRICUSPID REGURGITATION
DOPPLER ASSESSMENT OF MITRAL VALVE
CHAPTER 14:
Ultrasound Markers of Chromosomal Abnormalities
INTRODUCTION
Sequential Screening
Background Risk
CYTOGENETICS AND PHENOTYPE
Autosomal Trisomies
Trisomy 21
Trisomy 18
Trisomy 13
Sex Chromosome Abnormalities
Turner's Syndrome (45,X)
Triploidy
FIRST TRIMESTER ULTRASOUND FEATURES
Fetal Nuchal Translucency
Measurement Technique
Cystic Hygroma
Nasal Bone
Fetal Heart Rate
Crown-rump Length (CRL)
Doppler Parameters
Umbilical Artery
Umbilical Vein
Ductus Venosus
Tricuspid Regurgitation
Maxillary Length
Single Umbilical Artery
Megacystis
SECOND TRIMESTER ULTRASOUND FEATURES
Central Nervous System
Strawberry-shaped Head
Brachycephaly
Microcephaly
Choroid Plexus Cysts (CPC)
Agenesis of Corpus Callosum
Dandy-Walker Malformation
Holoprosencephaly
Ventriculomegaly
The Face and Neck
Cleft Lip/Palate
Eye Abnormalities
Micrognathia
Macroglossia
Nasal Bone Hypoplasia
Small Ears
Cystic Hygroma
Nuchal Edema
The Thorax
Congenital Diaphragmatic Hernia (CDH)
Cardiac Malformations
Hydrothorax and Ascites
The Abdomen
Omphalocele
Gastroschisis
Duodenal Atresia
Echogenic Bowel
Genitourinary Anomalies
Skeletal Abnormalities
Short Femur/Humerus
Other Skeletal Abnormalities
Widened Pelvic Angle
Umbilical Cord Cysts
SONOGRAPHIC FEATURES OF SELECTEDSYNDROMES
Trisomy 21
Risk Assessment
Trisomy 18
Trisomy 13
Triploidy
Turner's Syndrome
CONCLUSION
CHAPTER 15:
Ultrasound Evaluation of Abnormal Early Pregnancy
INTRODUCTION
EARLY PREGNANCY FAILURE AND VAGINAL BLEEDING
Threatened Abortion (Abnormal Vaginal Bleeding)
Incomplete and Complete Spontaneous Abortion
MISSED ABORTION
BLIGHTED OVUM (ANEMBRYONIC PREGNANCY)
INTRAUTERINE HEMATOMAS
ECTOPIC PREGNANCY
EARLY PREGNANCY LOSS
Gestational Sac
Yolk Sac
Crown-rump Length (CRL)
Embryonic Heart Rate
Amnion Evaluation
OBJECTS IN FIRST TRIMESTER SCREENING FOR CHROMOSOMOPATHIES
Nuchal Translucency
Ductus Venosus and Heart Failure
Umbilical Artery Assessment
Nasal Bone
Heart Analysis
Umbilical Cord Diameter
COMBINED STRATEGIES FOR ANEUPLOIDY SCREENING
CONCLUSION
CHAPTER 16:
Ectopic Pregnancy
INTRODUCTION
THE ROLE OF BIOCHEMICAL MARKERS IN ECTOPIC PREGNANCY
THE ROLE OF ULTRASOUND IN THE DIAGNOSIS OF ECTOPIC PREGNANCY
Transabdominal Ultrasound
Transvaginal Ultrasound
Color Doppler Ultrasound
3D Ultrasound in the Assessment of Tubal Ectopic Pregnancy
OTHER SITES OF IMPLANTATION
Interstitial Pregnancy
Cervical Pregnancy
Ovarian Pregnancy
Intra-abdominal Pregnancy
THERAPY
CONCLUSION
CHAPTER 17:
Trophoblastic Disease
INTRODUCTION
CLASSIFICATION, DEVELOPMENT AND PATHOLOGY
Complete Hydatidiform Mole
Partial Hydatidiform Mole
Invasive Hydatidiform Mole
Choriocarcinoma
Placental Site Trophoblastic Tumor
Persistent Trophoblastic Disease
SYMPTOMS OF GESTATIONAL TROPHOBLASTIC DISEASE
Complete Hydatidiform Mole
Partial Hydatidiform Mole
Invasive Hydatidiform Mole
Choriocarcinoma
DIAGNOSIS OF GESTATIONAL TROPHOBLASTIC DISEASE
Complete Hydatidiform Mole
Partial Hydatidiform Mole
Invasive Hydatidiform Mole
Gestational Choriocarcinoma
Nongestational Choriocarcinoma
Persistent Trophoblastic Disease (PTD)
Placental Site Trophoblastic Tumor (PSTT)
THERAPY OF TROPHOBLASTIC DISEASES
Complete Hydatidiform Mole
Partial Hydatidiform Mole
Postmolar Monitoring
Choriocarcinoma
The role of ultrasound in the Chemotherapy of Choriocarcinoma
Pulsed Doppler for the Early Detection of Sensitivity to Chemotherapy
Nongestational Choriocarcinoma
Persistent Trophoblastic Disease
Invasive Mole
PSTT
Other Reported Treatment
CONCLUSION
CHAPTER 18:
Fetal Anatomical Survey during Second Trimester Screening Examination
INTRODUCTION
HEAD AND BRAIN
SPINE
CHEST
ABDOMEN
LIMBS
GUIDELINES
Head
Chest
Abdomen
Spine
Limbs
CHAPTER 19:
Fetal Growth and Biometry
INTRODUCTION
BODY PARTS
INDIVIDUAL GROWTH ASSESSMENT
FETAL ORGAN MEASUREMENTS
Brain (Fig. 19.1)
Cerebellum (Fig. 19.3)
Heart (Fig. 19.4)
Lung (Fig. 19.6)
Liver (Fig. 19.7)
Spleen (Fig. 19.9)
Kidney (Fig. 19.10)
Adrenal Gland (Fig. 19.12)
Organ Vasculature Using 3D Power Doppler Ultrasound
SUMMARY
CHAPTER 20:
Ultrasound and Doppler Diagnosis of Intrauterine Growth Restriction
INTRODUCTION
DEFINITIONS
CLASSIFICATION
INCIDENCE
SCREENING
DIAGNOSIS
Anamnesis
Fundal Height Measurement
Ultrasound Diagnosis
Pregnancy Dating
Biometric Evaluation
Assessing Growth
Three-dimensional Fetal Growth Assessment
DIAGNOSIS OF THE TYPE OF SGA
Abnormal-SGA
IUGR versus Normal-SGA
STUDY OF FETAL DETERIORATION
Chronic Tests
Umbilical Artery
Middle Cerebral Artery
Amniotic Fluid
Acute Markers
Precordial Veins (Ductus Venosus, Inferior Vena Cava and Umbilical Vein)
Fetal Heart Rate
Biophysical Profile
OBSTETRIC MANAGEMENT
CHAPTER 21:
Fetal Central Nervous System
TRANSVAGINAL NEUROSONOGRAPHYN
BASIC ANATOMICAL KNOWLEDGE OF THE BRAIN
TRANSVAGINAL 3D SONOGRAPHIC ASSESSMENT OF FETAL CNS
NORMAL FETAL CENTRAL NERVOUS SYSTEM IMAGING
VENTRICULOMEGALY AND HYDROCEPHALUS
Variety of Mild Ventriculomegaly with AW 10 to 15 mm
Moderate to Severe Ventriculomegaly with AW>15 mm
Simple Hydrocephalus
Dysgenetic Hydrocephalus
Secondary Hydrocephalus
CONGENITAL CNS ANOMALIES
Cranium Bifidum
Spina Bifida
Chiari Malformation
Holoprosencephaly
Agenesis of the Corpus Callosum
Absent Septum Pellucidum, Septo-optic Dysplasia
Migration Disorder
Lissencephaly
Schizencephaly
Dandy-Walker Malformation, Dandy-Walker Variant, Megacisterna Magna
Arachnoid Cyst, Interhemispheric Cyst
Craniosynostosis
Vein of Galen Aneurysm
Choroid Plexus Cysts
Acquired Brain Abnormalities in Utero
Brain Tumors
Subependymal Pseudocysts
Porencephaly
Hydranencephaly
Intracranial Hemorrhage
Fetal Periventricular Leukomalacia (PVL)
Microcephaly
FUTURE ASPECT
CHAPTER 22:
Ultrasound Examination of the Fetal Thorax
THE THORAX
DIAPHRAGMATIC HERNIA
HYPERECHOGENIC LUNG
Diagnostic Procedures
Findings 28
CONGENITAL CYSTIC ADENOMATOID MALFORMATION
SEQUESTRATION OF THE LUNGS
PLEURAL EFFUSIONS
CHAPTER 23:
Three- and Four-dimensional Evaluation of the Fetal Heart
INTRODUCTION
IMPACT OF CONGENITAL HEART DISEASES: EPIDEMIOLOGY AND POPULATION AT RISK
PRENATAL DIAGNOSIS OF CONGENITAL HEART DISEASES: CURRENT SITUATION
Screening Techniques
Standard Fetal Cardiac Examination Protocol
Suggestions to Improve Detection Rate of Congenital Heart Defects
HISTORY OF FETAL ECHOCARDIOGRAPHY
Realtime Ultrasound
Time Motion (M-mode)
Pulsed or Continuous Wave Doppler
Color Doppler
Power Doppler
Tissue Doppler Echocardiography
Three-Dimensional Imaging
Spatio-temporal Image Correlation
Telemedicine
NEW PERSPECTIVES IN THREE- AND FOUR-DIMENSIONAL FETAL ECHOCARDIOGRAPHY
Fetal Cardiac Screening
Feasibility to Obtain Greater Number of Cardiac Views
Improvement of Basic Cardiac Views in Unfavorable Fetal Positions
Evaluation of Fetal Cardiac Function
Dynamic Three-dimensional Color Doppler Ultrasound
Doppler-gated Three-dimensional Fetal Echocardiography
Realtime Three-dimensional Echocardiography
Three-dimensional Power Doppler Ultrasound
Three-dimensional Multiplanar Time-motion Ultrasound
Spatio-temporal Image Correlation
New Reconstructive Approaches
Virtual Echocardiography by Internet Link
CLINICAL APPLICATION OF 3/4D IN FETAL CARDIOVASCULAR SYSTEM
Peripheral Vascular System in 3D
Umbilical Cord and Placenta
Intra-abdominal Vessels
Renal Vessels
Intracerebral Vessels
Lung Vessels
Fetal Tumors or Aberrant Vessels
Fetal Heart in 3D and 4D
SPATIO-TEMPORAL IMAGING CORRELATION: A NEW APPROACH TO THREE- AND FOUR-DIMENSIONAL EVALUATION OF THE FETAL HEART
Technical Bases
Acquisition
Post-processing
Visualization
Advantages
Improved Temporal Resolution
Dynamic Evaluation of the Four-chamber View
Evaluation of the Outflow Tracts
Multiplanar Dynamic Display and Navigation
Reconstruction of a Three-dimensional Rendered Image
Online Acquisition (Patient in the Room)
Offline Analysis
Timing
New Anatomical Planes
New Promising Technology
Applications in Telemedicine (TELESTIC)
Limitations
Specific Limitations of Two-dimensional Technology
Specific Limitations of Three-dimensional Technology
Specific Limitations of Color Doppler Technology
Specific Limitations of STIC Technology
Current Applications and New Perspectives
Clinical Application in Unselected Population and also in Population at Risk
Systematization of the Multiplanar Technique
Reproducibility Study
Assessment of the Diagnosis Ability Referred to Heart Diseases
Specific Applications in the Prenatal Diagnosis of Congenital Heart Diseases
Estimation of Volumes and Masses in Animal Experimental Models
Algorithms for the Automated Obtaining of the Standard Anatomical Slices from the Stored Volume
Application of this Technology in the Telemedicine Field (TELE-STIC)
New Diagnostic Algorithms (Minimum Projection Mode, Inversed Mode, B-flow).
First Spanish Study in Spatio-temporal Image Correlation (STIC) Technology
Introduction
Objective
Methods and Material
Results
Conclusion
Methodology
Results
Comment
CHAPTER 24:
Malformation of the Gastrointestinal System
INTRODUCTION
ANTERIOR ABDOMINAL WALL DEFECTS
Omphalocele
Body Stalk Anomaly
DIAPHRAGMATIC DEFECTS
BOWEL DISORDERS
Esophageal Atresia
Duodenal Atresia or Stenosis
Bowel Obstruction
Meconium Peritonitis
Echogenic Bowel
NON-BOWEL CYSTIC MASSES
Choledocal Cysts
Mesenteric and Omental Cyst
Hepatic Masses
CHAPTER 25:
Fetal Genitourinary Tract: Prenatal Diagnosis and Assessment of Nephrouropathies
NEPHROUROPATHIES: PRENATAL DIAGNOSES AND ASSESSMENT
PATHOLOGY OF PARENCHYMATOUSSUBSTRATES
Islets in Primordial Tubules, Fibrous Layers Cartilaginous Metaplasia, Fetal Pathology (Malformative or Genetic)2 (Fig. 25.2)
Type I Cystic Kidney
Type II Cystic Kidney
Type III Cystic Kidney
Type IV Cystic Kidney
RENAL DYSPLASIA: INFORMATIVE ECHOGRAPHIC RECORDS
Possible Echographic Profiles Resulting from Renal Dysplasia
Bilateral Agenesia (Genuine Potter's Syndrome)
Unilateral Agenesia
Hypoplasia
Simple Cyst (Fig. 25.15)
Multicystic (Uni or bilateral types)8 (Fig. 25.16)
Polycystic (Fig. 25.17)
DILATION OF EXCRETORY CONDUCTS: PATHOLOGY OF THE EXCRETOR SUBSTRATE
Calicial Dilation1
Ureter Dilation
Static Forms
Dynamic Forms
Pathology of the Renal Parenchyma
Etiologic Factors
INTRAUTERINE TREATMENTS FOR OBSTRUCTIVE NEPHROUROPATHIES
Biometric Parameters (Graph 25.1)
Dynamic Parameters
Biochemical Parameters
FURTHER ASPECTS RELATED TO RENAL FUNCTIONALITY
Renal Glomerular Filtration (RGF)
Tubular Dynamics of Sodium and Chlorine
Tubular Dynamics of Potassium
Tubular Dynamics of Calcium
Tubular Dynamics of Phosphorus
Tubular Dynamics of Uric Acid
Acid-base Balance
Tubular Dynamics of Glucose
Urinary Concentration Capacity
CHAPTER 26:
The Fetal Musculoskeletal System
NORMAL ULTRASOUND APPEARANCE
NORMAL US APPEARANCE OF FETAL SKELETON
Osteochondrodysplasias
Thanatophoric Dysplasia (Figs 26.16 to 26.29)
Osteogenesis Imperfecta (Figs. 26.30 to 26.43)
Achondroplasia (Figs 26.44 to 26.50)
Achondrogenesis (Figs 26.51 to 26.56)
Campomelic Dysplasia (Figs 26.57 to 26.63)
Spondylothoracic Dysplasia (Jarcho-Levin Syndrome) (Figs 26.64 to 26.67)
Athelosteogenesis (Figs 26.68 to 26.70)
Other Osteochondrodysplasias (Figs 26.71 to 26.77)
Reductional Defects
Terminal Defects (Figs 26.78 and 26.79)
Phocomelias (Figs 26.95 to 26.98)
Proximal Femoral Focal Deficiency (PFFD)
Split-hand and Split-foot Syndrome (SHFM)
Hand and Foot Malpositions
Malpositioned Hands (Figs 26.110 and 26.111)
Malpositioned Feet (Figs 26.112 to 26.120)
Polydactyly (Figs 26.121 to 26.128)
Hemivertebrae
Fetal Akinesia Deformation Sequence (Figs 26.131 to 26.137)
Other Skeletal Defects
Patellar Anterior Luxation (Figs 26.138 to 26.140)
CHAPTER 27:
The Umbilical Cord: Sonographic Assessment
UMBILICAL CORD AREA
UMBILICAL CORD DIAMETER IN THE FIRST TRIMESTER
UMBILICAL CORD COILING
DISCORDANT UMBILICAL ARTERIES
SINGLE UMBILICAL ARTERY (SUA)
UMBILICAL CORD TUMORS
CHAPTER 28:
3D Power Doppler in the Study of Fetal and Maternal Angiogenesis and Vasculogenesis
INTRODUCTION
VISUALIZATION OF NORMAL FETAL STRUCTURAL DEVELOPMENT
Early Pregnancy
Five Weeks
Six Weeks
Seven Weeks
Eight Weeks
Nine to Ten Weeks
Eleven Weeks
Twelve Weeks
Late Gestation
Placental Circulation
Umbilical Circulation
Fetal Circulation
CLINICAL RECOMMENDATION FOR 3D COLOR AND POWER DOPPLER USAGES
Umbilical Cord and Placenta
Intra-abdominal Vessels
Renal Vessels
Intracerebral Vessels
Lung Vessels
Fetal Tumors or Aberrant Vessels
3D POWER DOPPLER IN THE DIAGNOSIS AND ASSESSMENT OF GESTATIONAL TROPHOBLASTIC DISEASE
Total Hydatidiform Mole
Partial Hydatidiform Mole
Invasive Hydatidiform Mole
Gestational Choriocarcinoma
Nongestational Choriocarcinoma
Persistent Trophoblastic Disease (PTD)
Placental Site Trophoblastic Tumor (PSTT)
CONCLUSION
CHAPTER 29:
The Placenta
INTRODUCTION
PLACENTAL THICKNESS, SHAPE AND VOLUME
NORMAL PLACENTAL LESIONS
Subchorionic Fibrin Deposition
Intervillous Thrombosis
Perivillous Fibrin Deposition
Maternal Blood Lakes
Placental Infarcts
Placental Calcifications
ABNORMAL PLACENTAL LESIONS
Tumors (Primary and Secondary)
Abscess
Retroplacental Space
Retroplacental Hematomas
Placental Abruption
Subamniotic Hematoma
Placenta Previa
Placenta Accreta
Placenta and Multiple Pregnancy
Placental Vessels
CHAPTER 30:
Ultrasound-based Diagnosis of Cervical Insufficiency and Evidence to Support the Intervention
INTRODUCTION
CERVICAL INSUFFICIENCY: THE DIAGNOSIS
CERCLAGE AND CERVICAL INSUFFICIENCY
CHAPTER 31:
Ultrasound Evaluation of the Multifetal Gestation
INTRODUCTION
EARLY ASSESSMENT OF MULTIFETAL GESTATIONS
EMBRYOLOGY AND CLINICAL CHARACTERISTICS OF MULTIFETAL GESTATIONS
DETERMINATION OF AMNIONICITY AND CHORIONICITY
ASSESSMENT OF AMNIOTIC FLUID VOLUME
ULTRASONIC EVALUATION OF FETAL GROWTH IN MULTIFETAL GESTATIONS
TWIN -TWIN TRANSFUSION SYNDROME
ANOMALIES IN MULTIPLE GESTATIONS
CHAPTER 32:
The Performance of US Screening of Congenital Anomalies
INTRODUCTION
PREVENTION OF FETAL MALFORMATIONS
SONOGRAPHIC SCREENING OF CONGENITAL ABNORMALITIES
FACTORS THAT INFLUENCE THE RESULTS
Origin of the Data / Examiners’ Experience
Inclusion or Exclusion Criteria
Prevalence of CAs in the Population Screened
Features of the Audit
Postnatal Identification of CAs
Numbers of Scans and their Timing
CLINICAL USE OF THE SONOGRAPHIC SCREENING OF CAs
SONOGRAPHIC SCREENING TRIALS OF CONGENITAL MALFORMATIONS
CHAPTER 33:
Nonimmune Hydrops Fetalis
DEFINITION
CLASSIFICATION
INCIDENCE
ETIOLOGY AND PATHOPHYSIOLOGY
Hematologic Causes
Cardiovascular Causes
Infectious Causes
Renal Disorders
Gastrointestinal Disorders
Chromosomal Abnormalities
Metabolic Disorders
Pulmonary Causes
DIAGNOSIS
PROGNOSIS
CHAPTER 34:
Ultrasound in the Management of the Alloimmunized Pregnancy
INTRODUCTION
HISTORY
DIAGNOSIS
Noninvasive Diagnosis
MANAGEMENT
Alloimmune Thrombocytopenia
SUMMARY
CHAPTER 35:
Post-termination Fetopathology
INTRODUCTION
A few important terms
FETAL INFECTIONS: TORCH
NEURAL TUBE DEFECT (NTD)
Anencephaly
Spina Bifida
Iniencephaly
Meckel's Syndrome
COMMON CHROMOSOME ABNORMALITIES
Trisomy 13
Trisomy 18
Trisomy 21
Monosomy X
Triploidy
DiGeorge Syndrome
THE PATHOLOGY BACKGROUND OF THE MOST FREQUENT ULTRASONOGRAPHIC FINDINGS
Oligohydramnios and Related Malformations
Hydrops
Cystic Lesion in the Chest
Multiple Pterygium Syndrome/Fetal Akinesia
Abnormal Intracranial Anatomy
TUMORS
OSTEOCHONDRODYSPLASIAS
CHAPTER 36:
Doppler Sonography in Obstetrics
INTRODUCTION
THE SAFETY OF DOPPLER ULTRASOUND IN OBSTETRICS
DEPENDENCY OF DOPPLER FLOW VELOCITY WAVEFORMS ON GESTATIONAL AGE
INDICES
Using Nomograms in Practice
CHANGES IN DOPPLER SONOGRAPHIC RESULTS DURING THE COURSE OF PREGNANCY AND COMPLICATED PREGNANCIES
Umbilical Artery (UA)
Intrauterine Growth Restriction
Chromosomal Abnormalities
Impact on Perinatal Consequences
Neonatal Intraventricular Hemorrhage
Neuromotoric Outcome
Intrapartum Studies
Umbilical Artery Doppler Ultrasound in Unselected Patients
Multiple Gestation
The Biophysical Profile and Multivessel Doppler Ultrasound in IUGR
Fetal Descending Aorta (FDA)
Middle Cerebral Artery (MCA)
Prediction of Fetal Hemoglobin in Red Cell Alloimmunization
FETAL VENOUS CIRCULATION
Umbilical Vein (UV)
Inferior Vena Cava
Ductus Venosus (DV)
Timing of Delivery in Pregnancies Complicated with IUGR
UTEROPLACENTAL PERFUSION
Prediction of Complicated Pregnancies with Uteroplacental Doppler Velocimetry
SUMMARY
CHAPTER 37:
Doppler Study of Fetal Arterial Circulation
INTRODUCTION
ARTERIAL VESSELS
Hemodynamic Changes
UMBILICAL ARTERIES (UA)
Technique
Clinical Significance and Use
CEREBRAL ARTERIES (CA)
Technique
Clinical Significance
AORTA (AO)
Technique
Clinical Significance
CONCLUSION
CHAPTER 38:
Doppler Study of Fetal Venous System
INTRODUCTION
EMBRYOLOGY OF THE FETAL VENOUS SYSTEM
ANATOMY OF THE FETAL VENOUS SYSTEM
PHYSIOLOGY OF THE FETAL VENOUS SYSTEM
NORMAL DOPPLER FINDINGS
STRUCTURAL ANOMALIES OF THE FETAL VENOUS SYSTEM
VENOUS SYSTEM DOPPLER AND FETAL DISEASES
CONCLUSION
CHAPTER 39:
Postpartum Ultrasound
INTRODUCTION
NORMAL PUERPERIUM
Doppler Ultrasound during the Puerperium
RETAINED PLACENTAL TISSUE
POSTPARTUM ENDOMETRITIS
CESAREAN SECTION
CONGENITAL UTERINE MALFORMATIONS
POSTPARTUM URINARY RETENTION
CONCLUSION
CHAPTER 40:
Three-dimensional Sonoembryology
INTRODUCTION
MODERN EMBRYOLOGY BY MAGNETIC RESONANCE MICROSCOPY AND COMPUTER GRAPHICS
NORMAL EMBRYO VISUALIZATION BY THREE-DIMENSIONAL SONOEMBRYOLOGY
FETAL ABNORMALITIES IN EARLY GESTATION
Yolk Sac
Nuchal Translucency (NT)
Cystic Hygroma
Facial Abnormality
Limb Abnormality
Chest Abnormality
Abnormality of Abdominal Wall
Urinary Tract Abnormality
Vertebral Abnormality
CONCLUSION
ACKNOWLEDGMENTS
CHAPTER 41:
3D Ultrasound in the Visualization of Fetal Anatomy in the Three Trimesters of Pregnancy
INTRODUCTION
THE FIRST TRIMESTER OF PREGNANCY
From Conception to Weeks 10
An Ultrasound View of the First Trimester of Pregnancy
Pre-embryonic Period
Embryonic Period
Fetal Period
Embryo-fetal Pathology Detectable by Ultrasound in the First Trimester
Signs Predictive of Aneuploidy and Structural Embryo-fetal Alterations in the First Trimester (Soft Markers)
Transitory Signs
Persistent Signs
THE SECOND AND THIRD TRIMESTERS
Head
Chest
Abdomen
Neural Tube and Limbs
Genitals
Umbilical Cord
Motor Activity and Facial Expression
Brain Function
Behavior, Senses and Response to Stimulation in the Second and Third Trimesters
ACKNOWLEDGMENT
CHAPTER 42:
Three-dimensional Visualization of Fetal Malformations
INTRODUCTION
CURRENT STATUS
FETAL HEAD
CRANIOFACIAL MALFORMATIONS
ECHOGRAPHICAL CLASSIFICATION
FRONTAL TUMORS
3D Ultrasound
PROBOSCIS
Classification of the Anomalies of the Facies
NASAL BONE
EAR MALFORMATIONS
MANDIBLE
Developmental Anomalies
EYE ANOMALIES
NECK ANOMALIES
Nuchal Translucency
2D and 3D Measurements of Nuchal Translucency
INIENCEPHALY
MALFORMATIONS OF THE MEDULLARY CANAL
TERATOMAS
CONJOINED TWINS
FETUS ACARDIUS (TRAP SYNDROME)
ABDOMINAL WALL DEFECTS
FETAL LIMB ABNORMALITIES
POSITIONAL ANOMALIES AND CONTRACTURES
KIDNEY MALFORMATIONS
UMBILICAL CORD ANOMALIES
INTRODUCTION
FIRST TRIMESTER
Fetal Markers
Vascular Markers
Adnexal Markers
SECOND AND THIRD TRIMESTERS
Superficial Malformations
Internal Malformations
Inversion Mode Display
FETAL BEHAVIOR
Fetal Behavior Study: Role of 3D and 4D Ultrasound
Previous Observation of Fetal Activity
Study of Fetus Reaction to Stimuli
Study of Fetus Customs (Habituation)
Fetal Neurological Study
FETAL BEHAVIOR IN STRUCTURAL ANOMALIES AND IN FETUSES WITH SUSPICION OF FETAL WELLBEING LOSS
Correlation between Images of Abnormal Behavior in Uterus and Brain Function Damage
The Fetal learning as a new pattern to control the CNS development of the fetus
INVASIVE TECHNIQUES IN THE STUDY OF MALFORMATIONS WITH 3D
CHAPTER 43:
Fetal Behavior: Ontogenesis and Transition to Neonate
FETAL BEHAVIOR
THE ONTOGENESIS OF HUMAN FETAL BEHAVIOR
Intrinsic Emergence and Development of Human Fetal Behavior
Eye Movement and its Ultradian/circadian Rhythm
Possible REM/NREM Sleep in the Human Fetus
Can we define REM/NREM Sleep in Utero?
Fetal Behavioral Parameters Related to Extrinsic Factors
Fetal Learning and the Examination of Fetal Learning
Fetal Habituation Using the Startle Reflex
Fetal Habituation Using the Orienting Reflex
Clinical Application: Can We Diagnose or Screen Fetal Brain Dysfunction Using Behavioral Parameters?
TRANSITION IN FETAL BEHAVIOR DURING PERINATAL PERIOD
Micturition
Transition in the Relationship between Micturition and EM around Birth
What Causes Rapid Alteration during the Perinatal Period?
SUMMARY
CHAPTER 44:
Application of 4D in Perinatology
INTRODUCTION
CLINICAL RECOMMENDATIONS FOR 3D AND 4D USAGES
Fetal Face
Nasal Bone
Fetal Ears
Fetal Central Nervous System (CNS)
Fetal Cranial Sutures, Thorax, Ribs, and Lungs
Fetal Spine
Fetal Extremities and Skeletal Abnormalities
Fetal Heart
Placenta
VISUAL DEPICTION FOR REASSURANCE OR DEMONSTRATION OF AN ABNORMALITY FOR CONSULTING CLINICIANS AND PATIENTS
Extent of Anomalies Such as Cystic Hygroma
Multiple Gestations
Umbilical Cord
RECENT RESEARCH ON 3D AND 4D SONOGRAPHY
Maternal Fetal Bonding
Diagnosis and Follow-up of Fetal Vascular Anomalies
Volumetric Measurements of Fetal Organs
4D US Guidance for Invasive Obstetric Procedures
4D US IN THE ASSESSMENT OF FETAL BEHAVIOR
Introduction
Structural Development of the CNS
Ultrasound Assessment of Fetal Neuroanatomy in the Early Pregnancy
Functional Development of the CNS and the Origin of Fetal Behavior
First Trimester
Ultrasound Assessment of Embryonic and Fetal Behavior in the First Trimester of Gestation
Second and Third Trimesters
Ultrasound Assessment of Fetal Behavior in the Second and Third Trimesters
Development of Specialized Movements
Development of Fetal Sensory System
Fetal Vestibular and Auditory System
Fetal Vision
Fetal Pain
Fetal Taste, Appetite and Satiety
Development of Dipsogenic Mechanisms
Cyclic Behavior and Development of Circadian Rhythm
NORMAL STANDARDS FOR FETAL EUROBEHAVIORAL DEVELOPMENTS : LONGITUDINAL QUANTIFICATION BY 4D SONOGRAPHY
Quality of GMs studied by 4D Ultrasound
Assessment of Fetal Behavior by 4D US in Abnormal Fetuses
Continuity of GMs from Prenatal to Postnatal Life
IMPORTANT FACTS ABOUT CEREBRAL PALSY: OBSTETRICAL POINT OF VIEW
The Diagnosis of CP from Obstetrical Point of View
Is prenatal diagnosis of neurologically disabled fetus possible?
CONCLUSION
CHAPTER 45:
Normal Fetal Behavior Assessed by 4D Sonography
INTRODUCTION
WHAT IS FETAL BEHAVIOR?
WHY IS IT IMPORTANT TO EVALUATE FETAL BEHAVIOR?
2D US AND 4D US IN EVALUATING FETAL BEHAVIOR
The Technique
Limitations
IS IT DIFFICULT TO STUDY FETAL BEHAVIOR?
WHAT ARE THE MOVEMENT PATTERNS MOST FREQUENTLY ANALYZED IN FETUSES DURING THE FIRST TRIMESTER?
WHAT ARE THE FACIAL EXPRESSIONS AND MOVEMENTS PATTERNS MOST FREQUENTLY ANALYZED IN FETUSES DURING THE SECOND AND THE THIRD TRIMESTER (FIGS 45.6 TO 45.16)
Facial expressions17,31,35,36
Hand and head movements17,35,36
Definitions
Facial Expressions
Fetal Movement Patterns
FETAL BEHAVIOR DURING THE FIRST-HALF OF A NORMAL PREGNANCY
FETAL BEHAVIOR DURING THE SECOND HALF OF A NORMAL PREGNANCY
CONCLUSION
ACKNOWLEDGMENT
CHAPTER 46:
Ultrasound-guided Fetal Invasive Procedures
INTRODUCTION
TECHNIQUE GENERALIZATION
LIVER BIOPSY
Technique
Indications
Ornitil Transcarbamylase Deficiencies (OTCs)
Primary Hyperoxaliuria (PH)
Carbamoyl Phosphate Synthetase Deficiency
Complications
FETAL PUNCTURE IN THE EVALUATION OF RENAL STATUS
SKIN BIOPSY
Technique
Indications
Complementary Requirements
Complications
MUSCLE BIOPSY
Technique
CHAPTER 47:
Chorionic Villus Sampling
INTRODUCTION
TECHNICAL ASPECTS
COMPLICATIONS
Pregnancy Loss, Safety
Multiple Pregnancy
Placental Confined Mosaicism
ACCEPTANCE
CONCLUSION
CHAPTER 48:
Amniocentesis and Fetal Blood Sampling for Prenatal Diagnosis
INTRODUCTION
AMNIOCENTESIS
Introduction
Indications
Timing
Technique
Complications
Early Amniocentesis
FETAL BLOOD SAMPLING AND TISSUE BIOPSY
Cordocentesis
Complications
Fetal Tissue Sampling
EMBRYOSCOPY-FETOSCOPY CLINICAL APPLICATION
Introduction
Transabdominal Fetoscopy
Transcervical Embryoscopy
Transabdominal Embryoscopy
Potential Applications
Fetal Therapy
CHAPTER 49:
Invasive Genetic Studies in Multiple Pregnancy
INCIDENCE
The Risk of Aneuploidy in Multiple Gestations
Indications for Prenatal Diagnosis
Invasive Procedures for Prenatal Diagnosis
The Greek Experience
CHAPTER 50:
MRI: How to Use it during Pregnancy?
INTRODUCTION
SAFETY OF MRI
INDICATION AND PROCEDURES FOR MRI DURING PREGNANCY
Pelvimetry
Maternal Tumors
Fetal Anomalies
Placenta
Umbilical Cord
CONCLUSION
SECTION 3: GYNECOLOGY
CHAPTER 51:
Normal Gynecological Anatomy (Uterus, Tubes, Ovaries)
INTRODUCTION
UTERUS
Position
Size, Shape and Echo Texture
New-born and Prepuberty
Adult
Proliferative Phase
Secretory Phase
Menstrual Phase
Postmenopausal State
Subendometrial Myometrial Waves
Cervix
Vagina
FALLOPIAN TUBE
OVARIES
Position
Size, Shape, and Echo Texture
Ovarian Cycle
Follicular Phase
Ovulation
Luteal Phase
Newborn
Childhood
Adolescence and Adulthood
Perimenopausal and Postmenopausal State
CHAPTER 52:
Uterine Lesions: Advances in Ultrasound Diagnosis
INTRODUCTION
NORMAL UTERUS
ENDOMETRIAL POLYPS
INTRAUTERINE SYNECHIAE (ADHESIONS)
ADENOMYOSIS
ENDOMETRIAL HYPERPLASIA
ENDOMETRIAL CARCINOMA
LEIOMYOMA
LEIOMYOSARCOMA
CONCLUSION
CHAPTER 53:
Ultrasound and Uterine Fibroid
DEFINITION
Incidence
ETIOLOGY AND PATHOPHYSIOLOGY
POSSIBLE CAUSES OF FIBROIDS
LOCALIZATION
Types of Fibroids
SYMPTOMS
DIAGNOSIS
TREATMENT
SURGICAL TREATMENTS
Uterine Fibroid Embolization
Magnetic Resonance-guided Focused Ultrasound
Ultrasound-guided fibroid sclerosation
CHAPTER 54:
Ovarian Sonography
INTRODUCTION
SONOGRAPHIC PARAMETERS
Origin and Size
Internal Architecture
Associated Lesions
SONOGRAPHIC DIFFERENTIAL DIAGNOSIS OF PELVIC MASSES
Cystic Masses
Physiologic Ovarian Cysts
Hydrosalpinx/Tubo-ovarian Complex or Abscess
Endometriosis
Paraovarian Cysts
Complex Mass
Ovarian Dermoid Cysts
Ovarian Tumors Originating from the Surface Epithelium
Solid Masses
Fibroma
EVALUATION OF AN OVARIAN MASS
Morphologic Assessment
Doppler Parameters
PERSISTENT VS REGRESSING MASSES
TRANSVAGINAL SONOGRAPHY IN OVARIAN CANCER SCREENING
CHAPTER 55:
Three-dimensional Static Ultrasound and 3D Power Doppler in Gynecologic Pelvic Tumors
INTRODUCTION
ENDOMETRIAL CANCER
UTERINE LEIOMYOMAS AND SARCOMAS
CERVICAL CANCER
ADNEXAL TUMORS
OTHER APPLICATIONS
CHAPTER 56:
ART Procedure and Ultrasound Only Monitoring Protocols
INTRODUCTION
IMPORTANT ECHOGRAPHIC INFORMATION FOR MONITORING OF IVF CYCLE
Growth of Preovulatory Follicle
Monitoring of Individual Follicles
Correlation of Follicle Growth with Estradiol Levels
Prognostic Value of Follicle Growth Pattern
Diameter of Follicles and hCG Administration
ULTRASOUND AND DIFFERENT STIMULATION PROTOCOLS
Programming of the Cycle
Ultrasound in Monitoring of Administration of Gonadotropins
Ultrasound and Monitoring Protocol with Agonist
Ultrasound and Administration of Antagonist
Ultrasound and Natural Cycle for IVF
ULTRASOUND AS THE ONLY METHOD FOR MONITORING OF IVF CYCLE
ULTRASONOGRAPHIC ASSESSMENT OF PERIFOLLICULAR BLOOD FLOW
ENDOMETRIAL CHANGES IN SPONTANEOUS CYCLE
ULTRASOUND AND ENDOMETRIUM IN IVF PROGRAMS
CHAPTER 57:
Fallopian Tube
INTRODUCTION
PELVIC INFLAMMATORY DISEASE
Ultrasound Findings
Color Doppler Findings
Three-dimensional Ultrasound
BENIGN TUMORS OF THE FALLOPIAN TUBE
MALIGNANT TUMORS OF THE FALLOPIAN TUBE
Ultrasound Findings
Color Doppler findings
Three-dimensional Ultrasound
CONCLUSION
CHAPTER 58:
Sonographic Imaging in Infertility
INTRODUCTION
UTERINE CAUSES OF INFERTILITY
Perfusion in Infertile Patients
Endometrial Thickness, Endometrial Volume and Vascularity
Congenital Anomalies
Endometrial Polyp
Submucous Leiomyomas
Adenomyosis
Endometritis
Asherman's Syndrome
OVARIAN CAUSES OF INFERTILITY
POLYCYSTIC OVARIAN SYNDROME
Luteinized Unruptured Follicle Syndrome
Luteal Phase Defect
TUBAL CAUSES OF INFERTILITY
CONCLUSION
CHAPTER 59:
Ultrasound Markers of Implantation
INTRODUCTION
ULTRASOUND IMPLANTATION MARKERS
Endometrial Thickness and Volume
Endometrial Pattern
Uterine Doppler
2D and 3D Endometrial Doppler
CHAPTER 60:
Hysterosonosalpingography: Normal and Abnormal Findings
INTRODUCTION
HISTORICAL DEVELOPMENT OF THE ULTRASONIC ASSESSMENT OF THE FALLOPIAN TUBE
ULTRASOUND CONTRAST AGENTS
TECHNIQUE OF HY-CO-SY
Requirements
Procedure
GRAY-SCALE HY-CO-SY (B-MODE)
PULSED DOPPLER ANALYSIS OF TUBAL PATENCY
COLOR DOPPLER HYSTEROSONOSALPINGOGRAPHY
REVIEW OF THE LITERATURE
THREE-DIMENSIONAL HYSTEROSONOSALPINGOGRAPHY
CONCLUSION
CHAPTER 61:
Guided Procedures Using Transvaginal Sonography
INTRODUCTION
TRANSVAGINAL PUNCTURE PROCEDURES
Transvaginal Oocyte Retrieval
Ovarian Cyst Aspiration
Drainage of Pelvic Abscesses
Multiembryo Reduction
Diagnostic Culdocentesis
Obstetrical Procedures
Chorionic Villous Sampling
Early Amniocentesis
Conservative Management of Ectopic Pregnancy
Other Applications
CONCLUSION
CHAPTER 62:
Ultrasound in the Postmenopause
INTRODUCTION
CHALLENGES OF THE POSTMENOPAUSE
INSTRUMENTATION
SCANNING IN THE POSTMENOPAUSE
POSTMENOPAUSAL OVARY
Visualization
Morphology and Biometry
Ovarian Malignancy in the Postmenopause
Postmenopausal Palpable Ovary Syndrome (PMPO)
Unilocular (Simple) Ovarian Cysts in the Postmenopause
Color Doppler Velocimetry of the Postmenopausal Ovary
POSTMENOPAUSAL UTERUS
Morphology
Biometry
Uterus under HRT
Color Doppler Velocimetry in the Postmenopausal Uterus
Myomas and Malignant Potential after the Menopause
Leiomyomas under HRT
POSTMENOPAUSAL ENDOMETRIUM
Visualization and Morphology
Postmenopausal Endometrial Thickness
Suspect Postmenopausal Endometrium
Postmenopausal Bleeding and Transvaginal Sonography (Transvaginal Sonography Versus Dilatation and Curettage)
Postmenopausal Intrauterine Fluid Collection
Color Doppler Velocimetry and Postmenopausal Endometrium
The Endometrium under HRT
CHAPTER 63:
Sonographic Evaluation of Gynecologic and Obstetric Causes of Acute Pelvic Pain
INTRODUCTION
GYNECOLOGIC ETIOLOGIES OF ACUTE PELVIC PAIN
Acute Pelvic Pain with Negative Pregnancy Tests
Pelvic Inflammatory Disease
Hemorrhagic Ovarian Cysts
Degenerating Leiomyomas
Adnexal Torsion
Endometriosis
Pelvic Congestion Syndrome
Ovarian Vein Thrombosis
Acute Pelvic Pain with Positive Pregnancy Tests
Normal Intrauterine Pregnancy
Spontaneous Abortion
Ectopic Pregnancy
Corpus Luteum Cysts
Leiomyoma
Uterine Dehiscence and Rupture
Placental Abruption
CONCLUSION
CHAPTER 64:
Ultrasound in Urogynecology
INTRODUCTION
CLINICAL CONSIDERATIONS
INVESTIGATIONS
TECHNICAL CONCEPTS, NORMS AND ANATOMICAL CONSIDERATIONS
ULTRASOUND FINDINGS IN UROGYNECOLOGICAL CONDITIONS
CONCLUSION
CHAPTER 65:
Ultrasound of the Breast
INTRODUCTION
EQUIPMENT REQUIREMENTS FOR BREAST ULTRASOUND
EXAMINATION TECHNIQUE
NORMAL BREAST ANATOMY AND SONOGRAPHIC ANATOMY
BREAST LESIONS AND ULTRASONOGRAPHY
BI-Rads Classification
Background Echotexture of the Breast
Sonographic Analysis of Focal Breast Lesions (Masses)
Posterior Acoustic Features
Surrounding Tissue
Calcifications
Special Cases
BENIGN BREAST LESIONS
Malignant Breast Lesions
Classification of Invasive Breast Cancers
Invasive Carcinoma
ULTRASOUND-GUIDED PROCEDURES
Fine needle Aspiration Cytology, Fine needle Core Biopsy and Vacuum-assisted Mammotome Biopsy
Wire Localizations
DOPPLER IMAGING AND 3D-IMAGING IN BREAST EVALUATION
BREAST ULTRASOUND AFTER RADIATION THERAPY AND AFTER OPERATIVE PROCEDURES
ULTRASOUND IN THE SCREENING ALGORITHM
INDEX
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