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The Role of Ultrasound in Obstetric and Gynaecology. Max Brinsmead PhD FRANZCOG May 2006. Potential uses for ultrasound in obstetrics 1 :. Locate the pregnancy – exclude ectopic Assess viability – assessment of threatened miscarriage Determining gestation & dates Crown rump length

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the role of ultrasound in obstetric and gynaecology

The Role of Ultrasound in Obstetric and Gynaecology

Max Brinsmead PhD FRANZCOG

May 2006

potential uses for ultrasound in obstetrics 1
Potential uses for ultrasound in obstetrics 1:
  • Locate the pregnancy – exclude ectopic
  • Assess viability – assessment of threatened miscarriage
  • Determining gestation & dates
      • Crown rump length
  • Diagnosis of twins – the importance of zygosity
  • Assessment of other pelvic masses
      • e.g. fibroids, functional ovarian cysts & neoplasms
  • Screening for abnormalities first trimester
      • Nuchal fold measure, anencephaly etc.
  • Assisting CVS and amniocentesis
  • Diagnosis of molar pregnancy
potential uses for ultrasound in obstetrics 2
Potential uses for ultrasound in obstetrics 2:
  • Second trimester dating (+/- 10 days)
      • Biparietal diameter, head & abdominal circumference, femur length
  • Screening for abnormalities
      • e.g. spina bifida, cardiac, renal
  • Screening for placenta previa
  • Cervical length monitoring
      • >30 mm before 18w & >25 mm before 28 w = low risk of pre term delivery
  • Assessment of APH
  • Assessment of fetal growth
      • Asymmetrical and symmetrical
  • Evaluation of polyhydramnios and hydrops
potential uses for ultrasound in obstetrics 3
Potential uses for ultrasound in obstetrics 3:
  • Assessment of fetal welfare
      • Amniotic fluid index or deepest pool
      • Fetal breathing
      • Fetal movements and tone (the Biophysical Profile)
  • Doppler flow studies
      • In umbilical arteries
      • Fetal middle cerebral artery
      • Uterine arteries
  • Diagnosis and management of malpresentation
      • Breech and unstable or transverse lie
  • Directing intrauterine interventions
      • e.g. transfusion for hydrops, catheter for urethral stricture
  • Placental grading (of doubtful value)
  • Assessment of the postpartum uterus
proven uses for ultrasound in pregnancy
Proven uses for ultrasound in pregnancy:
  • Dating the gestation
      • 30% of women cannot provide a LMP
      • Another 25% have a LMP that is >2w different from USS dates
      • When dates are known aneuploidy screening is accurate and errors of delivery are avoided, fewer inductions for post dates etc.
  • Identification of multiple pregnancy
      • Twins have a perinatal mortality that is 2-4x singletons
      • Monitoring for discordant growth with Doppler reduces risk
  • Identification of breech in the third trimester
      • ECV reduces the rate of Caesarean section
  • Few RCTs of routine ultrasound have shown any effect on overall perinatal mortality and morbidity
unproven uses for ultrasound in pregnancy
Unproven uses for ultrasound in pregnancy:
  • Screening for Aneuploidy
      • Cost effectiveness of universal screening debated
      • Ethical issues and patient choice involved
  • Screening for structural malformations
      • Sensitivity is 13 – 50% depending on expertise & equipment
      • And only half of these before 20 w gestation
      • False positives occur
  • Screening for IUGR in the 3rd trimester
      • Sensitivity is 80-90%
      • But the positive predictive value of neonatal morbidity is only 25-50%
      • The rest have constitutional smallness
harmful effects of ultrasound in pregnancy
Harmful Effects of ultrasound in pregnancy:
  • It is not ionising radiation
  • However, thermal effects and cavitation can occur in tissues exposed to high power ultrasound
  • One RCT of repeated routine ultrasound with Dopplers in the 3rd trimester found a small but significant decrease in birth weight in the exposed cohort
potential uses for ultrasound in gynaecology 1
Potential uses for ultrasound in gynaecology 1:
  • Assessment of adnexal pelvic masses
      • Compound B scan
      • Doppler vessel studies
  • Diagnosis of polycystic ovaries
  • Investigation of postmenopausal bleeding
      • Imaging and measure of endometrial thickness
  • Investigation of menorrhagia
      • Fibroids and adenomyosis
  • Monitoring of follicle number and growth for IVF
  • Egg recovery for IVF and ICSI
  • Evaluation of pelvic pain
      • A limited role
  • Screening for ovarian cancer
      • Too many false positives
potential uses for ultrasound in gynaecology 2
Potential uses for ultrasound in gynaecology 2:
  • IUCD and Implanon location
  • Treatment of ovarian cysts (aspiration) and ectopic pregnancy (methotrexate)
  • Saline hysterography for delineation of the uterine cavity
  • Tubal patency studies in infertility
  • Evaluation of primary amenorrhoea