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Donald School Basic Textbook of Ultrasound in Obstetrics and Gynecology
Badreldeen Ahmed, Abdallah Adra, Zehra Nese Kavak
1:
Physical Bases of Medical Ultrasound
Introduction
The Sound Wave
Piezoelectric Crystal is the Source and the Detector of Ultrasound
Attenuation of the Sound Wave
Reflection and Transmission
Doppler Effect
Echosonography
Resolution of the Echo Method
Mode of Signal Presentation
A-mode
B-mode
M-mode or M-scan
Imaging by Doppler Effect
Three-dimensional Imaging
Biological Effects of Ultrasound
2:
Techniques, Instrumentation and Safety
Techniques and Instrumentation
Diagnostic Ultrasound Systems
Structural Imaging Systems
Pulse Reflection Method in the Basic A-mode
Contact Compound Scan B-mode Ultrasound
Electronic Scan Real-time B-mode Ultrasound
Improved Resolution of Real-time B-mode Ultrasound
B-flow
Gray Level Histogram Width (GLHW) Tissue Characterization
Usefulness of Electronic Scan Real-time B-mode
Three Dimensional (3D) Ultrasound
Four Dimensional (4D) Ultrasound
Doppler Ultrasound Systems
CW Doppler Ultrasound
Fetal Heart Detector
Fetal Heart Valve Action Analysis
Ultrasound Fetal Monitor
CW Doppler Flow Velocity Waveform
PW Doppler Ultrasound
Pulsed Doppler Flow Velocity Wave
Color Doppler Flow Mapping
Power Doppler Flow Mapping
Safety of Diagnostic Ultrasound
Ultrasound Intensity of Doppler Ultrasound
The Effect of Heating on Mammal Fetuses
Non-hazardous Exposure Time of the Fetus to the Heart
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
Mechanical Effects of Diagnostic Ultrasound
Conclusion
3:
Early Normal and Abnormal Pregnancy
Introduction
Earliest Ultrasound Detection and HCG
Timing of Early Pregnancy5,16,19–21
First-trimester Ultrasound: Normal Landmarks (Figures 3.1 to 3.23)
Fourth Week
Fifth Week
Sixth Week
Seventh Week
Eighth Week
Ninth Week
Tenth Week
Eleventh Week
Twelfth Week
Abnormal Ultrasound Findings in Early Pregnancy4, 22,24,25,28–34 (Figures 3.24 to 3.36)
Fetal Sex Determination by Ultrasound at First Trimester35,36 (Figure 3.37)
First Trimester Nuchal Translucency Examination37–39 (Figure 3.38)
Early Fetal Echocardiography40 (Figures 3.39 and 3.40)
Multiple Pregnancy and the Chorionicity Determination at the First Trimester6–8,18,24,27 (Figures 3.41 and 3.42)
Conclusion
4:
Basic Biometry
Introduction
Ultrasound in Assessment of Gestational Age
Crown-Rump Length (CRL)
Biparietal Diameter
Abdominal Circumference
Femur Length
5:
Sonographic Determination of 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
Conclusions
6:
Cervical Incompetence: Ultrasonic Evaluation
Introduction
Diagnosis
Pregestational Diagnosis
Gestational Diagnosis
Ultrasonic Evaluation of Uterine Cervix
Technique
The Cervix in Women with Symptoms of Preterm Labor
The Cervix in High-Risk Asymptomatic Women
The Cervix in Low-Risk Population
The Cervix in Multiple Pregnancies
The Cervix in Preterm Premature Rupture of Membranes
Interventions for Cervical Incompetence Based on Ultrasonographic Findings
Conclusions
7:
Fetal Growth
Ultrasound Fetal Biometry
Intrauterine Growth Restriction (IUGR)
Macrosomia
Conclusion
8:
The Placenta
Introduction
Normal Placenta
Developmental Changes
Placental Abnormalities
Placenta Previa
Placenta Creta
Placental Abruption
Placental Lakes
Placental Masses
Conclusion
9:
Sonographic Assessment of the Umbilical Cord
Introduction
The Umbilical Cord Development
The Umbilical Cord Anatomy
Umbilical Cord Length
Umbilical Cord Thickness and Wharton's Jelly
The Number of Umbilical Cord Vessels
Vessels Luminal Diameters and Discordant in Size Umbilical Arteries
The Umbilical Cord Coiling
Other Umbilical Cord Abnormalities
Umbilical Vein Aneurysm
Umbilical Cord Lesions
Summary
10:
Twins
Introduction
Types of Twins-Incidence
Monozygotic Twins
Dizygotic Twins
Placentation
Perinatal and Maternal Morbidity and Mortality
Maternal Physiology
Diagnosis of Multiple Gestation
Differential Diagnosis
Detection of Chorionicity and Amnionicity
Prenatal Diagnosis
Risk of Aneuploidy
Indications for Prenatal Diagnosis
First Trimester Screening
Sonography
Maternal Serum Biochemistry
Invasive Diagnostic Procedures
Amniocentesis
Chorionic Villus Sampling (CVS)
Fetal Blood Sampling (FBS)
Special Problems in Multiple Pregnancies
Discordant Growth/IUGR
Management Options
Twin to Twin Transfusion Syndrome (TTTS)
Placental Anatomy
Pathophysiology
Sonographic Features of TTTS
Staging and Prognosis of TTTS
Treatment of TTTS
Serial Amnioreduction
Amniotic Septostomy
Laser Therapy
Laser versus SAR
Monochorionic Monoamniotic Twins (MCMA)
Twin Reversed Arterial Perfusion (TRAP) Sequence/Acardiac Twins
Conjoined Twins
Intrauterine Demise of one Fetus
11:
Normal Fetal Anatomy
Introduction
Ultrasound in the First Trimester
Initial Visit
11 to 14 Week Scan
The Second Trimester Ultrasound Exam
Head and Brain
Face and Neck
Spine
Chest
The Fetal Skeletal System
Abdomen and Pelvis
Scanning in the Third Trimester
Conclusion
12:
Fetal Abnormalities
Introduction
Central Nervous System (CNS) Abnormalities17–21
Neck and Face Abnormalities8,9,21,22
Abnormalities of the Chest5,8,10,16,23–25
Cystic Adenomatoid Malformation of the Lung (CCAM)
Diaphragmatic Hernia
Esophageal Atresia
Pleural Effusion (fetal hydrothorax)
Pulmonary Sequestration
Cardiovascular System Malformations5,8,10,11,16,26
The Genitourinary System5,8,10,11,16,27–29
Hydronephrosis
Posterior Urethral Valves (PUV)
Renal Agenesis
Exstrophy of the Bladder
Cloacal Exstrophy
Autosomal Recessive Polycystic Kidney Disease (Infantile Polycystic Kidney Disease)
Multicystic Dysplastic Kidney
Neuroblastoma
Ureterocele
Sirenomelia
Gastrointestinal System Abnormalities5,8,10,11,16,30,31
Gastroschisis
Omphalocele
Meconium Ileus
Meconium Cyst or Meconium Peritonitis
Small Bowel Atresia or Stenosis
Duodenal Atresia
Skeletal Abnormalities5,8,10,11,16,32,33
Achondroplasia
Artrogryposis
Campomelic Dysplasia
Diastrophic Dysplasia
Osteogenesis Imperfecta
Thanatophoric Dysplasia
13:
Abnormalities which should not be Missed by Ultrasound
Introduction
Sonographic Evaluation of Fetal Anatomy
Transvaginal Ultrasound
Absence of a Normally Present Structure
Presence of an Additional Structure
Herniation Through Structural Defects
Dilatation Behind an Obstruction
Abnormal Fetal Biometry
Absent or Abnormal Fetal Motion
Ultrasound Detection of Chromosomal Abnormalities
14:
Fetal Central Nervous System
Introduction
Normal Visualization of Early CNS Development
Basic Anatomical Knowledge of the Brain
Transvaginal 3D Sonographic Assessment of Fetal CNS
Congenital CNS Abnormalities
Nural Tube Defects
Ventriculomegaly and Hydrocephalus
Simple Hydrocephalus
Dysgenetic Hydrocephalus
Secondary Hydrocephalus
Holoprosencephaly
Chiari Malformation
Dandy-Walker Malformation
15:
Ultrasound and Prenatal Diagnosis
Amniocentesis
Indications
Timing
Procedure
Risk
Cytogenetic Analysis Using Amniotic Fluid Cells
Chorionic Villus Sampling (CVS)
Timing
Indications
Contraindications
Procedure
Transabdominal or Transcervical
Complication
Cytogenic Studies using Chorionic Villi
Cordocentesis (Percutaneous Umbilical Blood Sampling (PUBS))
Indications
Timing
Procedure
Complication
Prenatal Diagnosis Procedures in Twin Pregnancy
Amniocentesis in Twins
CVS in Twins
Acknowledgements
16:
Ethics and Law in Congenital Defects
Introduction
General Ethical Principles
Principle of Beneficence
Principle of Autonomy
Principle of Justice
Basic Legal Principles
Specific Legal:Ethical Principles in Prenatal Diagnosis
Chronology of Ethical and Legal Dilemmas
Disclosing the Information
Establishing the Indication
Performing the Technique
Communicating the Diagnosis
Decision Making following Diagnosis
Obstetrical Conduct following Prenatal Diagnosis of a Congenital Defect
Response According to the Type of Defect
Conclusion
17:
Fetal Echocardiography
Introduction
Development of Fetal Echocardiography
To Screen or not to Screen for Fetal CHD
Whom to Screen: Low-risk or High-risk Population
Who should Screen: General Gynecologists or Pediatric Cardiologists?
How to Screen?
When to Screen: The First or the Second Trimester
What after the Prenatal Diagnosis of Fetal Cardiac Lesion
New Imaging Techniques for the Evaluation of Fetal Heart
Conclusion
18:
Obstetrical Doppler
Introduction
Fetal Chronic Hypoxemia
Clinical Use of Obstetrical Doppler
Umbilical Arteries
Fetal Vessels
Arteries
Venous System
Uterine Arteries
Clinical Use
Conclusions
CTG
FBP
Summary
19:
Basic Principles of 3D and 4D Sonography
Introduction
3D and 4D Imaging
Starting a 3D and 4D Mode
3D and 4D Rendering
Surface Rendering or Gray Scale Rendering
Transparent Mode
Minimum Mode
Maximum Mode
Volume Contrast Imaging (VCI)
STIC, Spatio-Temporal Image Correlation, Fetal Cardio
Removing overlaying structures
Advantages and Possibilities of 4D and 3D Imaging
Applications and Advantages of 4D Ultrasound
Obstetrics
STIC and Fetal Cardio
Gynecology
Breast and Small Parts
Urology
Internal Medicine
Pediatrics
Data Review and Networking
Conclusion
20:
Screening by Ultrasound in Pregnancy
Introduction
Screening for Aneuploidies
Screening in the First Trimester
Screening in the Second Trimester
Echogenic Intracardiac Focus (EIF)
Nuchal Fold
Choroid Plexus Cyst (CPC)
Fetal Echogenic Bowel
Mild Ventriculomegaly
Mild Pyelectasis
Other Sonographic Markers
Scoring Index
Screening for Fetal Malformations
Screening for Pre-eclampsia
Screening for Pre-eclampsia with Uterine Arteries Doppler Velocimetry
Screening for Preterm Delivery
Technique
Screening in High-Risk Asymptomatic Women
Screening in Low-risk Population
Screening in Multiple Pregnancies
21:
Ultrasound in Human Reproduction
Introduction
Ultrasound and Folliculogenesis
Clinically Important Morphological Aspects of Folliculogenesis
Sonographic Studies of Follicle Growth and Ovulation
US Indices Relevant for Monitoring of Follicle Growth
Ultrasound and Ovulation
Sonographic Indices of Ovulation
Ultrasound as The Tool for Monitoring and Prediction of Success of IVF Cycles
Ultrasound Monitoring in Stimulated Cycles
Ultrasound Monitoring in Natural Cycles
Ultrasound as the only Monitoring Tool for Assisted Reproduction
The Role of Ultrasonographic Evaluation of Endometrium in ART
Conclusion
22:
Uterus
Basic Anatomy
Ultrasound Imaging
Uterine Perfusion
Menstrual Cycle and Postmenopausal Changes
Uterine Abnormalities
Uterine Myomas, Uterine Fibroids, Leiomyomas
Leiomyosarcoma
Endometrial Polyps
Endometrial Hyperplasia
Endometritis
Asherman's Syndrome
Endometrial Carcinoma
23:
Sonographic Evaluation of Benign Pelvic Masses
Introduction
Adnexal Masses
Functional Ovarian Cysts
Follicular Cysts
Corpus Luteum Cysts
Theca Lutein Cysts
Ovarian Hyperstimulation Syndrome
Endometrioma
Benign Ovarian Neoplasms
Cystadenomas
Brenner Tumor
Dermoid Cysts
Pelvic Inflammatory Disease
Ectopic Pregnancy
Other Less Common Cystic Masses
Torsed Ovary
Solid Pelvic Masses
Ovarian Masses
Other Solid Masses
Uterine Fibroid
Types of Fibroids
Magnetic Resonance Guided Focused Ultrasound
Ultrasound Guided Fibroid Sclerosation
Summary
24:
Fallopian Tube
Ultrasound Visualization
Abnormalities of the Fallopian Tube
Ultrasonographic Findings
Acute PID
Chronic PID
Ectopic Pregnancy
The Role of Biochemical Markers in Ectopic Pregnancy
The Role of Ultrasound in the Diagnosis of Ectopic Pregnancy
Benign Tumors of the Fallopian Tube
Malignant Tumors of the Fallopian Tube
Ultrasonographic Findings
25:
The Basic Assessment of Normal and Abnormal Ovaries
Introduction
Origin and Size
Internal Architecture
Associated Lesions
Differentiation of Pelvic Masses by Ultrasound
Cystic Masses
Physiologic Ovarian Cysts
Hydrosalpinx / Tubo-ovarian Complex or Abscess
Endometriosis
Paraovarian Cysts
Complex Masses
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
INDEX
TOC
Index
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