The Role of Ultrasound in Obstetric and Gynaecology Max Brinsmead PhD FRANZCOG May 2006
Potential uses for ultrasound in obstetrics 1 : <ul><li>Locate the pregnancy – exclude ectopic </li></ul><ul><li>Assess vi...
Potential uses for ultrasound in obstetrics 2 : <ul><li>Second trimester dating (+/- 10 days) </li></ul><ul><ul><ul><li>Bi...
Potential uses for ultrasound in obstetrics 3 : <ul><li>Assessment of fetal welfare </li></ul><ul><ul><ul><li>Amniotic flu...
Proven uses for ultrasound in pregnancy : <ul><li>Dating the gestation </li></ul><ul><ul><ul><li>30% of women cannot provi...
Unproven uses for ultrasound in pregnancy : <ul><li>Screening for Aneuploidy </li></ul><ul><ul><ul><li>Cost effectiveness ...
Harmful Effects of ultrasound in pregnancy : <ul><li>It is not ionising radiation </li></ul><ul><li>However, thermal effec...
Potential uses for ultrasound in gynaecology 1 : <ul><li>Assessment of adnexal pelvic masses </li></ul><ul><ul><ul><li>Com...
Potential uses for ultrasound in gynaecology 2 : <ul><li>IUCD and Implanon location </li></ul><ul><li>Treatment of ovarian...
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Ultrasound

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Ultrasound

  1. 1. The Role of Ultrasound in Obstetric and Gynaecology Max Brinsmead PhD FRANZCOG May 2006
  2. 2. Potential uses for ultrasound in obstetrics 1 : <ul><li>Locate the pregnancy – exclude ectopic </li></ul><ul><li>Assess viability – assessment of threatened miscarriage </li></ul><ul><li>Determining gestation & dates </li></ul><ul><ul><ul><li>Crown rump length </li></ul></ul></ul><ul><li>Diagnosis of twins – the importance of zygosity </li></ul><ul><li>Assessment of other pelvic masses </li></ul><ul><ul><ul><li>e.g. fibroids, functional ovarian cysts & neoplasms </li></ul></ul></ul><ul><li>Screening for abnormalities first trimester </li></ul><ul><ul><ul><li>Nuchal fold measure, anencephaly etc. </li></ul></ul></ul><ul><li>Assisting CVS and amniocentesis </li></ul><ul><li>Diagnosis of molar pregnancy </li></ul>
  3. 3. Potential uses for ultrasound in obstetrics 2 : <ul><li>Second trimester dating (+/- 10 days) </li></ul><ul><ul><ul><li>Biparietal diameter, head & abdominal circumference, femur length </li></ul></ul></ul><ul><li>Screening for abnormalities </li></ul><ul><ul><ul><li>e.g. spina bifida, cardiac, renal </li></ul></ul></ul><ul><li>Screening for placenta previa </li></ul><ul><li>Cervical length monitoring </li></ul><ul><ul><ul><li>>30 mm before 18w & >25 mm before 28 w = low risk of pre term delivery </li></ul></ul></ul><ul><li>Assessment of APH </li></ul><ul><li>Assessment of fetal growth </li></ul><ul><ul><ul><li>Asymmetrical and symmetrical </li></ul></ul></ul><ul><li>Evaluation of polyhydramnios and hydrops </li></ul>
  4. 4. Potential uses for ultrasound in obstetrics 3 : <ul><li>Assessment of fetal welfare </li></ul><ul><ul><ul><li>Amniotic fluid index or deepest pool </li></ul></ul></ul><ul><ul><ul><li>Fetal breathing </li></ul></ul></ul><ul><ul><ul><li>Fetal movements and tone (the Biophysical Profile) </li></ul></ul></ul><ul><li>Doppler flow studies </li></ul><ul><ul><ul><li>In umbilical arteries </li></ul></ul></ul><ul><ul><ul><li>Fetal middle cerebral artery </li></ul></ul></ul><ul><ul><ul><li>Uterine arteries </li></ul></ul></ul><ul><li>Diagnosis and management of malpresentation </li></ul><ul><ul><ul><li>Breech and unstable or transverse lie </li></ul></ul></ul><ul><li>Directing intrauterine interventions </li></ul><ul><ul><ul><li>e.g. transfusion for hydrops, catheter for urethral stricture </li></ul></ul></ul><ul><li>Placental grading (of doubtful value) </li></ul><ul><li>Assessment of the postpartum uterus </li></ul>
  5. 5. Proven uses for ultrasound in pregnancy : <ul><li>Dating the gestation </li></ul><ul><ul><ul><li>30% of women cannot provide a LMP </li></ul></ul></ul><ul><ul><ul><li>Another 25% have a LMP that is >2w different from USS dates </li></ul></ul></ul><ul><ul><ul><li>When dates are known aneuploidy screening is accurate and errors of delivery are avoided, fewer inductions for post dates etc. </li></ul></ul></ul><ul><li>Identification of multiple pregnancy </li></ul><ul><ul><ul><li>Twins have a perinatal mortality that is 2-4x singletons </li></ul></ul></ul><ul><ul><ul><li>Monitoring for discordant growth with Doppler reduces risk </li></ul></ul></ul><ul><li>Identification of breech in the third trimester </li></ul><ul><ul><ul><li>ECV reduces the rate of Caesarean section </li></ul></ul></ul><ul><li>Few RCTs of routine ultrasound have shown any effect on overall perinatal mortality and morbidity </li></ul>
  6. 6. Unproven uses for ultrasound in pregnancy : <ul><li>Screening for Aneuploidy </li></ul><ul><ul><ul><li>Cost effectiveness of universal screening debated </li></ul></ul></ul><ul><ul><ul><li>Ethical issues and patient choice involved </li></ul></ul></ul><ul><li>Screening for structural malformations </li></ul><ul><ul><ul><li>Sensitivity is 13 – 50% depending on expertise & equipment </li></ul></ul></ul><ul><ul><ul><li>And only half of these before 20 w gestation </li></ul></ul></ul><ul><ul><ul><li>False positives occur </li></ul></ul></ul><ul><li>Screening for IUGR in the 3 rd trimester </li></ul><ul><ul><ul><li>Sensitivity is 80-90% </li></ul></ul></ul><ul><ul><ul><li>But the positive predictive value of neonatal morbidity is only 25-50% </li></ul></ul></ul><ul><ul><ul><li>The rest have constitutional smallness </li></ul></ul></ul>
  7. 7. Harmful Effects of ultrasound in pregnancy : <ul><li>It is not ionising radiation </li></ul><ul><li>However, thermal effects and cavitation can occur in tissues exposed to high power ultrasound </li></ul><ul><li>One RCT of repeated routine ultrasound with Dopplers in the 3 rd trimester found a small but significant decrease in birth weight in the exposed cohort </li></ul>
  8. 8. Potential uses for ultrasound in gynaecology 1 : <ul><li>Assessment of adnexal pelvic masses </li></ul><ul><ul><ul><li>Compound B scan </li></ul></ul></ul><ul><ul><ul><li>Doppler vessel studies </li></ul></ul></ul><ul><li>Diagnosis of polycystic ovaries </li></ul><ul><li>Investigation of postmenopausal bleeding </li></ul><ul><ul><ul><li>Imaging and measure of endometrial thickness </li></ul></ul></ul><ul><li>Investigation of menorrhagia </li></ul><ul><ul><ul><li>Fibroids and adenomyosis </li></ul></ul></ul><ul><li>Monitoring of follicle number and growth for IVF </li></ul><ul><li>Egg recovery for IVF and ICSI </li></ul><ul><li>Evaluation of pelvic pain </li></ul><ul><ul><ul><li>A limited role </li></ul></ul></ul><ul><li>Screening for ovarian cancer </li></ul><ul><ul><ul><li>Too many false positives </li></ul></ul></ul>
  9. 9. Potential uses for ultrasound in gynaecology 2 : <ul><li>IUCD and Implanon location </li></ul><ul><li>Treatment of ovarian cysts (aspiration) and ectopic pregnancy (methotrexate) </li></ul><ul><li>Saline hysterography for delineation of the uterine cavity </li></ul><ul><li>Tubal patency studies in infertility </li></ul><ul><li>Evaluation of primary amenorrhoea </li></ul>

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