1 / 31

OB GYNE ULTRASOUND concepts & its clinical correlation

OB GYNE ULTRASOUND concepts & its clinical correlation. Jan Charmaine Almonte-Saret M.D., FPOGS, FPSUOG. FIRST TRIMESTER ULTRASOUND. equal or less than 13 weeks Indications and advantages: confirmation of intrauterine pregnancy/ early pregnancy failure best estimation of G.A.

nia
Download Presentation

OB GYNE ULTRASOUND concepts & its clinical correlation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. OB GYNE ULTRASOUND concepts & its clinical correlation Jan Charmaine Almonte-Saret M.D., FPOGS, FPSUOG

  2. FIRST TRIMESTER ULTRASOUND equal or less than 13 weeks Indications and advantages: • confirmation of intrauterine pregnancy/ early pregnancy failure • best estimation of G.A. • Evaluation of vaginal bleeding • Evaluation of ectopic pregnancy • Confirmation of multiple pregnancy • Evaluation of pelvic, ovarian or uterine pathology

  3. FIRST TRIMESTER ULTRASOUND GUIDELINES FOR DATING PREGNANCY

  4. FIRST TRIMESTER ULTRASOUND NUCHAL TRANSLUCENCY • 11 to 14 wks • =/> 3 mm • Screening for fetal chromosomal abnormalities • screening for trisomy 21

  5. SECOND & THIRD TRIMESTER NON-BIOMETRIC PARAMETERS • Uncertain of menstrual dates • Measurement disparity in late trimester • Narrow down error in estimation gestational age TRANSCEREBELLAR DIAMETER (TCD) - Numerically equivalent to the number of weeks of gestation

  6. SECOND & THIRD TRIMESTER NON-BIOMETRIC PARAMETERS COLONIC GRADE • >/= 16 weeks- grade 1, anechoic lumen • at 26 weeks & more- grade 2- lumen appears more echoic • >/= 36 weeks- grade 3, lumen becomes brigther

  7. SECOND & THIRD TRIMESTER DISTAL FEMORAL EPIPHYSES (DFE) • at least 32-33 weeks PROXIMAL TIBIAL EPIPHYSES (PTE) • Seen at 35 weeks PROXIMAL HUMERAL EPIPHYSES (PHE) • at 38 weeks or more • reliable predictor of term gestation

  8. SECOND & THIRD TRIMESTER SIGNIFICANCE OF THE RATIOS • Cephalic Index (CI)- • BPD/OFD X 100 (74-83) • > 83- brachycephaly –may suggest a genetic abnormality • < 74 – dolichocephaly – seen with oilgohydramnios & breech presentation

  9. SECOND & THIRD TRIMESTER • FL/AC RATIO –evaluating skeletal dysplasia - < 0.16 suggestive of a lethal type • HC/ AC RATIO- determines growth lag; high ratio –implies fetal malnutrition/IUGR • FL/BPD RATIO- can be used as one of the screening parameters for Down’s syndrome ( short femur & normal BPD= high ratio)

  10. BIOPHYSICAL PROFILE • Gold standard for antepartum fetal surveillance WHEN TO REQUEST? -Antepartum testing started @ 26-28 weeks if with maternal complications -@ 32-34 weeks for high risk patients

  11. BIOPHYSICAL PROFILE HOW FREQUENT? • Repeated weekly • Most authors suggest 2x/week BPS &NST for: 1. IDDM 2. GDM with previous stillborn 3. IUGR 4. Post term pregnancy 5. Preeclampsia

  12. BIOPHYSICAL PROFILE What are the signs of fetal hypoxia? Chronic Hypoxia (compensated) 1. Oligohydramnios 2. Asymmetric (head-sparing) IUGR Acute Hypoxia (non-compensated) 1. Abnormal fetal heart rate changes • Non-reactive NST • (+) CST MODIFIED BPS -uses 2 parameters, NST ( acute marker of fetal compromise) & AFV (chronic marker)

  13. BIOPHYSICAL PROFILE Nueral Control of Fetal Biophysical Activities

  14. BIOPHYSICAL PROFILE Note: In pregnancy complicated by IUGR, DOPPLER VELOCIMETRY studies will enhance the perfomance of BPS – changes in Doppler findings occur 4 days prior to the deterioration of BPS

  15. DOPPLER VELOCIMETRY A sonologic procedure to assess maternal and fetal vascular resistance (vasoconstricted/vasodilated)  the state of fetal perfusion.

  16. DOPPLER VELOCIMETRY To whom should we request it for? 1. Diabetes 2. Maternal HPN 3. Autoimmune Diseases - SLE, APAS, Collagen vascular disease 4. Anemia 5. Post term Pregnancy 6. Unexplained Recurrent Pregnancy losses 7. Discordant multifetal pregnancy 8. IUGR

  17. DOPPLER VELOCIMETRY UTERINE ARTERY WHAT ARE THE ABNORMAL RESULTS? • Presence of notching • Increase indices (SD, RI, PI) AND IT’S SIGNIFICANCE? • Increase in the utero-placental resistance (vasoconstriction) • Higher chance of pregnancy complications

  18. DOPPLER VELOCIMETRY UMBILICAL ARTERY vasoconstriction increase intraplacental resistance elevated indices decreased fetal perfusion fetal hypoxia then IUGR

  19. DOPPLER VELOCIMETRY ABSENT END DIASTOLIC FLOW (AEDF) • highest risk to develop adverse perinatal outcome • the mean duration from AEDF to onset of fetal distress is 6-8 days

  20. DOPPLER VELOCIMETRY REVERSED END DIASTOLIC FLOW (REDF) • most extreme form of intraplacental vascular resistance • diagnosis to distress interval 4.2 +/- 1.4 days with perinatal moratality rate of 50%

  21. DOPPLER VELOCIMETRY MIDDLE CEREBRAL ARTERY What is an abnormal result? DECREASED INDICES- brain sparing reflex Remember: fetal hypoxia induces compensatory reflex preferential blood flow to the brain (MCA dilatation=decreased indices) while vasoconstriction in the less vital organs

  22. DOPPLER VELOCIMETRY NOTE: A sudden restoration of MCA indices to normal or higher or increasing indices from a serial decreasing pattern is omninous= failure of the fetal cerebral vessels to vasodilate = acute fetal brain injury

  23. ROLE OF COLOR DOPPLER IN THE DIAGNOSIS OF PLACENTA ACRRETA Patients who are at high risk to develop abnormally adherent placenta includes: • Multiparity • Hx of previous CS • Hx of previous curettage • Placenta previa implanted anteriorly in the LUS

  24. ROLE OF COLOR DOPPLER IN THE DIAGNOSIS OF PLACENTA ACRRETA • Unusually intense blood flow within the sonolucent space beneath the placenta • Hypervascularization within the placenta and non placental tissues • Turbulence of flow in areas where placentas appears to have lost parenchyma and within placenta lacunae

  25. CONGENITAL ANOMALY SCAN Should be done routinely in a 20-24 weeks gestation • Lowers perinatal mortality • Lethal malformations-corrected early or appropriate timing of delivery to allow surgical intervention; if not amenable to surgery, early counseling

  26. GYNECOLOGIC ULTRASOUND ADVANTAGES OF TVS OVER TAS • Patient discomfort • Clearer images • Eliciting pain and tenderness • Earlier diagnosis of pelvic pathology • Good for obese patients and with abdominal scars

  27. GYNECOLOGIC ULTRASOUND DISADVANTAGES OF TVS OVER TAS • Discomfort & pain to pxs with intact hymen and postmenopausal • Large pelvic masses • Refusal of the procedure

  28. GYNECOLOGIC ULTRASOUND

  29. HYSTEROSALPINGOSONOGRAPHY • Evaluates tubal patency • primary investigative tool for infertility When it is performed? First part of the menstrual cycle (Day 10-12)

  30. HYSTEROSALPINGOSONOGRAPHY • advantage of eliminating the risk of X-ray exposure & hypersensitivity to radiographic contrast media • Evaluation of endometrial pathology • Evaluation of ovaries for follicular growth • Evaluation of pelvic organs & structures for lessions and masses

  31. THANK YOU

More Related