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Ultrasound in Infertility & Gynecology: Text & Atlas
Chaitanya Nagori, Sonal Panchal
CHAPTER 1:
Transvaginal Scan
INTRODUCTION
TRANSVAGINAL SCAN
Method
Tips for Probe Insertion
Basic Probe Movements
Equipment Settings and Optimizing the Image
Scanning Angle
Scanning Depth
Probe Frequency
Setting the Focal Zone
Zoom
Gains
Probe Power
Contrast
Systematic Scan
DOPPLER TECHNIQUE
What is Doppler?
Types of Doppler
Color Doppler
Power Doppler
Pulsed Wave Doppler/Spectral Doppler (Figure 29)
Color and Power Doppler Settings
Spectral Doppler Settings
3D and 3D Power Doppler Techniques in Gynecology and Infertility
Acquiring the Volume: (Video 17)
Multiplanar Imaging
Rendering
CHAPTER 2:
Normal Uterus
SCANNING AND ORIENTATION OF IMAGE
ORIENTATION AND POSITION OF THE UTERUS
BASIC PROBE MOVEMENTS
i. The Endometrium
ii. The Myometrium
iii. The Cervix
MEASUREMENTS
REPORT OF THE ULTRASOUND OF UTERUS
CHAPTER 3:
Abnormal Uterus
INTRODUCTION
Congenital Uterine Abnormalities
Uterine Aplasia
Unicornuate Uterus
Uterus Didelphys
On Ultrasound
Bicornuate Uterus
Septate-Subseptate Uterus
US features: (Volume Ultrasound)
Size of Septum and Implications
Pitfalls in Ultrasound-based differential Diagnosis
Arcuate Uterus
Hypoplastic Uterus
T-shaped Uterus
Acquired Uterine Abnormalities
Fibroid
Volume Ultrasound
Adenomyosis
Endometrial Pathologies
Endometritis
Acute Endometritis
Endometrial Hyperplasia
Polyps
Synechiae
Method
Uterine Scar
CHAPTER 4:
Ultrasound of Adnexal lesions
ADNEXAL LESIONS
1. Ovarian Lesions
2. Tubal Lesions
3. Adnexal Lesions:
Ovarian Lesions
ULTRASOUND BASED CLASSIFICATION OF OVARIAN LESIONS
a. Nonseptated Clear Cysts
1. Follicular Cyst
2. Simple Cyst of the Ovary
b. Cysts with Septae but no Internal Echogenicities:
Multiple Follicles
Serous Cystadenoma
c. Cysts with Internal Echogenicities
On Doppler
d. Solid lesions
e. Complex Lesions with Cystic with Solid Areas
1. Dermoids
2. Struma Ovarii
3. Granulosa Cell Tumor
4. Epithelial Tumors
TUBAL LESIONS
Pelvic Inflammatory Disease (PID)
ECTOPIC PREGNANCIES
On Ultrasound
MISCELLANEOUS LESIONS
CHAPTER 5:
Tubal Evaluation by Ultrasound
INTRODUCTION
Investigations for Assessment of Tubal Status
Hysterosalpingography (HSG)
Method
Sonohysterosalpingography (Saline Infusion Sonography—(SIS)
TECHNIQUE
Reliability of the Procedure
MODIFICATIONS
A Using Pulse Doppler
B. Using Color Doppler
C. Combining Saline with Air
D Transvaginal Three-dimensional Saline SHSG
Hystero-Contrast-Salpingography (HyCoSy)
TECHNIQUE
Modifications of HyCoSy
Technique of 3D HyCoSy
CONCLUSION
CHAPTER 6:
Ultrasound Diagnosis of PCOS and Prediction of OHSS
INTRODUCTION
INCIDENCE
DIAGNOSIS
Ultrasound Diagnosis
Scanning Technique
Ultrasound Findings of Polycystic Ovarian Syndrome
Ovarian Volume
Antral Follicle Count
Arrangement of Follicles
Pathophysiology
Stromal Abundance
Correlation of Stromal Abundance to Hyperinsulinemia
Antral Follicles and Hormonal Implications
Stromal Vascularity
Controversies
CHAPTER 7:
Cyclical Changes in Ovaries and Follicular Tracking
INTRODUCTION
Cyclical Changes Occurring in the Ovaries
Follicle Tracking
Baseline scan
Technique for Baseline Scan of Ovaries
Preovulatory Scan: Follicular Assessment
B-mode features of a mature follicle
Doppler Features of a Mature Pre-hCG Follicle
Implications of Flow Parameters on Ovum Quality
Volume Ultrasound Parameters of Mature Pre-hCG Follicle
Secretory Scan
Luteinized Unruptured Follicle
Luteal Phase Defect
CONCLUSION
CHAPTER 8:
Cyclical Changes in Endometrium and Uterus
INTRODUCTION
B-Mode Features of Endometrium with Good Receptivity
Doppler Features of Receptive Endometrium
UTERINE ARTERY DOPPLER
3D and 3DPD Features of Good Endometrial Receptivity
UTERINE CONTRACTIONS
Secretory Scan
Luteinized Unruptured Follicle
Luteal Phase Defect
CONCLUSION
CHAPTER 9:
Transvaginal Assessment of the Cervix
CHAPTER 10:
Assessment of early pregnancy
AFTER THE GESTATIONAL SAC APPEARS
Confirmation of intrauterine pregnancy
Four Weeks
Five Weeks
Six Weeks
Seven Weeks
Eight Weeks
Nine Weeks
Ten Weeks
Eleven Weeks
Twelve Weeks
Evaluation of Abnormal Early Pregnancy
Pregnancy with Abnormal Prognosis
Due to Abnormal Growth Pattern
Fetal abnormality
Abnormal Location of Gestational Sac
Ovarian Ectopic (Figure 58)
Pregnancy with Uterine Abnormalities (Figures 60A to D)
Pregnancies with Tumors of Chorionic Tissue
Chorioangioma (Figure 61)
Vesicular Mole (Figure 62)
Early Detection of Multiple Gestation
CHAPTER 11:
Ultrasound Guided Procedures in Assisted Reproduction
OOCYTE RETRIEVAL
METHOD
Pre-procedure
Premedication and Anesthesia
Technique (Video 1)
COMPLICATIONS
Embryo Transfer (ET)
Technique (Figures 9A to E)
Variations in Embryo Transfer Technique
Ultrasound Guided Instead of Clinical Touch Method
Catheter Types
Transfer at the Point of Maximum Implantation (MIP)
Cyst Aspirations
PROCEDURE
Aspiration of Hydrosalpinx
Aspiration of Ascitic Fluid in OHSS (Video 4)
Fetal Reduction
Pre-procedure
KCL injection
Transvaginal Approach (Videos 5–7)
Risks of Procedure
INDEX
TOC
Index
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