Ultrasound Diagnosis in Obstetrics and Gynecology

1 Physics and Instrumentation in Diagnostic Ultrasound.- 1.1 Propagating Properties of Ultrasound.- 1.2 Grey-Scale Sonography.- 1.2.1 Acoustic Impedance Mismatch.- 1.2.2 Attennuation by Tissue.- 1.3 Transducer Beam Pattern.- 1.3.1 Geometry of Reflecting Interfaces.- 1.3.2 Principle of Grey-Scale Sonography.- 1.4 Quality of Image and Frame Rate.- 1.5 Real-Time Scanning.- 1.6 Simple and Compound Scanning.- 1.7 Contact and Water-Path Coupling.- 1.8 Current Instrumentation.- 1.8.1 Articulated Arm Manual Contact Scanner.- 1.8.2 Linear Array Scanner.- 1.8.3 Mechanical Sector Scanner.- 1.8.4 Water-Path Scanner.- 1.9 Future Developments.- References.- 2 Safety of Diagnostic Ultrasound.- 2.1 Primary Effects.- 2.1.1 Heat Production.- 2.1.2 Pseudocavitation and Microstreaming.- 2.1.3 Chemical Effects.- 2.2 Biologic Effects.- 2.2.1 Tissue Lesions and Ultrastructural Changes in Cells.- 2.2.2 Teratogenicity.- 2.2.3 Mutagenicity.- 2.2.4 Comutagenicity.- 2.2.5 Other Effects.- 2.3 The Problem of Safe Levels.- 2.4 Concluding Remarks.- References.- 3 Examination of the Female Pelvis.- 3.1 General.- 3.1.1 Selection of Equipment.- 3.1.2 Examination Procedure.- 3.1.3 Findings.- References.- 3.2 Pelvimetry.- References.- 4 Pregnancy (First Trimester).- 4.1 Normal Development.- 4.1.1 Definition of Terms, Basic Embryology.- 4.1.2 Earliest Detection of Intrauterine Pregnancy.- 4.1.3 Five Weeks: Morphology and Biometry of the Gestational Sac.- 4.1.4 Six Weeks: Embryonic Structures, Viability.- 4.1.5 Seven Weeks.- 4.1.6 Eight Weeks: Yolk Sac.- 4.1.7 Nine to Eleven Weeks: Biometry, Embryo fetal Structures.- References.- 4.2 Abnormalities in the First Trimester.- 4.2.1 Blighted Ovum.- 4.2.2 Missed Abortion.- 4.2.3 Hydatidiform Mole.- 4.3 Ectopic Pregnancy.- 4.3.1 Detection of an Intact Intrauterine Pregnancy.- 4.3.2 Demonstration of an Intact Ectopic Pregnancy in the Cul-de-Sac or Adnexal Region.- 4.3.3 Complex Adnexal Masses.- 4.3.4 Fluid in the Abdomen or Cul-de-Sac.- 4.3.5 Principal Sources of Misdiagnosis in Patients with a Positive Pregnancy Test, No Visible Gestational Sac, and Suspected Ectopic Pregnancy.- References.- 4.4 Tumors Associated with Pregnancy.- References.- 4.5 The Kidney in Pregnancy.- References.- 5 Multiple Pregnancy.- References.- 6 Amniocentesis.- References.- 7 Normal Fetal Anatomy in the Second and Third Trimesters.- 7.1 Examination Procedure.- 7.1.1 Face.- 7.1.2 Brain.- 7.1.3 Spine.- 7.1.4 Thorax.- 7.1.5 Abdomen.- 7.1.6 Urogenital Tract.- 7.1.7 Genitalia.- 7.1.8 Extremities.- References.- 7.2 Ultrasound Biometry in the Second and Third Trimester.- 7.2.1 Introduction.- 7.2.2 Ultrasound Cephalometry.- 7.2.3 Fetal Trunk Measurements.- 7.2.4 Measurement of the Fetal Extremities.- References.- 7.3 Diagnosis of Intrauterine Growth Retardation.- 7.3.1 Diagnostic Criteria, Possible Screening Methods.- 7.3.2 Technique and Accuracy of Measurement.- References.- 7.4 Estimation of Fetal Weight.- References.- 7.5 Critical Reading of the Biometry Literature.- 7.5.1 Importance of a Critical Approach.- 7.5.2 Why Fetal Biometry.- 7.5.3 How are Normal Values Derived.- 7.5.4 Selection of the Patients.- 7.5.5 Type of Studies: Cross-Sectional or Longitudinal.- 7.5.6 Sample Size.- 7.5.7 Study Design.- 7.5.8 Curve Fitting.- 7.5.9 What is the Basic Idea of Regression Analysis?.- 7.5.10 Linear Regression Analysis.- 7.5.11 Polynomial Regression Analysis.- 7.5.12 The Coefficients of Correlation and of Determination.- 7.5.13 The F Test.- 7.5.14 Prediction from Equations.- 7.5.15 How to Compute the Confidence Limits.- 7.5.16 Summary.- References.- 7.6 Estimation of Gestational Age.- 7.6.1 Definitions.- 7.6.2 Parameters Proposed for Estimation of Gestational Age.- 7.6.3 Selection of Appropriate Table.- 7.6.4 What to Do When Different Parameters Provide Different Estimates.- 7.6.5 How to Report the Results.- 7.6.6 The Use of Computers for the Reporting of Obstetrical Examinations.- References.- 7.7 Normal Growth of Fetal Parameters.- 7.7.1 Crown-Rump Length.- 7.7.2 Cranial Parameters.- 7.7.3 Thoracic and Abdominal Organs.- 7.7.4 Long Bones.- 7.7.5 Estimated Fetal Weight.- References.- 8 Fetal Malformations.- 8.1 Signs Suggesting the Presence of a Malformation.- References.- 8.2 Neural Tube Defects.- 8.2.1 Anencephaly.- 8.2.2 Spina Bifida.- 8.2.3 Encephalocele.- References.- 8.3 Malformations of the Brain.- 8.3.1 Hydrocephalus.- 8.3.2 Microcephaly.- References.- 8.4 Malformations Involving the Abdomen and Gastrointestinal Tract.- 8.4.1 Abdominal Wall Defects.- 8.4.2 Intraabdominal Structural Abnormalities.- References.- 8.5 Malformations of the Urogenital Tract.- 8.5.1 Potter’s Syndrome (Renal Agenesis).- 8.5.2 Cystic Kidneys (Potter Type I).- 8.5.3 Cystic Kidneys (Potter Type II).- 8.5.4 Cystic Kidneys (Potter Type III).- 8.5.5 Urinary Tract Obstruction.- References.- 8.6 Skeletal Malformations.- 8.6.1 Radial Aplasia.- 8.6.2 Malformations Incompatible with Postnatal Viability.- References.- 8.7 Tumors.- 8.7.1 Teratomas.- 8.7.2 Pulmonary Tumors.- References.- 8.8 Heart Defects and Cardiovascular Diseases.- 8.8.1 Cardiovascular Disease.- 8.8.2 Heart Disease.- References.- 8.9 Ultrasound Evaluation of Patients at Risk of Fetal Anomalies.- 8.9.1 High-Risk Group 1: Family History of Malformations.- 8.9.2 High-Risk Group 2: Exposure to Exogenous, Potentially Teratogenic Agents in Early Pregnancy.- 8.9.3 High-Risk Group 3: Maternal Diabetes Mellitus.- 8.9.4 High-Risk Group 4: Elevation of Serum or Amniotic Fluid AFP.- References.- 9 Rhesus Incompatibility and Nonimmunologic Hydrops Fetalis.- 9.1 Rh Incompatibility.- 9.1.1 Definition and Pathogenetic Principle.- 9.1.2 Diagnosis and Management.- References.- 9.2 Nonimmunologic Hydrops Fetalis.- 9.2.1 Etiology and Pathogenesis.- 9.2.2 Diagnosis and Treatment.- References.- 10 Phenotype and Rare Syndromes.- References.- 11 The Placenta.- 11.1 Sonographic Placental Development.- 11.2 Localization of the Placenta.- 11.3 Evaluation of Placental Growth.- 11.3.1 Placental Thickness.- 11.3.2 Placental Attachment Area, Surface Area, and Volume.- 11.4 Ultrasound Structure of the Placenta.- References.- 12 The Cervix.- References.- 13 Postpartum Ultrasound.- References.- 14 Ultrasound Screening.- 14.1 The Multistage Concept.- 14.2 Ultrasound Anatomy.- 14.3 Diagnosis of Fetal Malformations.- 14.4 Determination of Gestational Age, Growth Monitoring, and Weight Assessment.- 14.4.1 Gestational Age.- 14.4.2 Growth Monitoring and Weight Assessment.- References.- 14.5 Patterns of Fetal Activity and Their Relevance for the Assessment of Fetal Wellbeing.- 14.5.1 Patterns of Fetal Activity in Normal Pregnancy.- 14.5.2 Patterns of Fetal Activity in Complicated Pregnancy.- 14.5.3 Summary.- References.- 14.6 The Psychological Impact of Ultrasound Scanning in Pregnancy.- References.- 14.7 Conclusions.- 15 Sonographic Aspects of the Menstrual Cycle.- 15.1 Endometrium, Follicles, Blood Vessels.- 15.1.1 Endometrial Changes.- 15.1.2 Follicular Growth.- 15.1.3 Intrafollicular Structures.- 15.1.4 Bloodvessels.- References.- 15.2 Applications of Ultrasound in Endocrinology.- 15.2.1 Monitoring of Gonadotropin Therapy.- 15.2.2 Monitoring of Clomiphene Citrate Therapy.- 15.2.3 Oocyte Collection for In Vitro Fertilization.- 15.2.4 Timing the Postcoital Test.- 15.2.5 Luteal Phase Defects.- References.- 16 Pathology of the Genital Tract.- 16.1 Capabilities and Limitations of Sonographic Diagnosis.- References.- 16.2 Applications of Ultrasound in Oncology.- References.- 17 Intrauterine Contraceptive Devices.- References.- 18 Diagnosis of Breast Disease.- 18.1 Normal Structures.- 18.2 Pathologic Structures.- 18.2.1 Duct Ectasia.- 18.2.2 Cysts.- 18.2.3 Acoustic Shadowing.- 18.2.4 Fibroadenomas.- 18.2.5 Carcinomas.- 18.2.6 Mastopathies.- 18.2.7 Mastitis.- 18.2.8 Implants.- 18.2.9 Gynecomastia.- 18.3 Real-Time Scans.- 18.4 Conclusions.- References.- 19 Appendix.- A Simple Reporting Program for Obstetrical Ultrasound.