Ultrasound is used in many different fields. Ultrasonic devices are used to detect objects and measure distances. Ultrasound imaging or sonography is often used in medicine.

1. Presenting
Mr. jagdish sambad
Msc.nursing-M.S.N

2. INTRODUCTION

3. DEFINITION
“ The ultrasound is a sound wave beyond the
audible range of frequency greater than 2Mhz.”
Commonly used frequency range:
 abdominal transducers 3-5Mhz
 vaginal transducers 5-7Mhz

4. TRANSABDOMINAL SONOGRAPHY (TAS)
TRANSVAGINAL SONOGRAPHY (TVS)
TRANSVAGINAL COLOUR DOPPLER
SONOGRAPHY

5. TRANSABDOMINAL SONOGRAPHY (TAS)
 2.5 -3.5Mhz frequency
 Full bladder (to displace the bowel out of
pelvis,otherwise the gas in the bowel
acts as a complete barrier)
Uses:-
In case of large masses eg:fibroid or
ovarian tumour

6. TRANSVAGINAL SONOGRAPHY
(TVS)
 Probe is placed close to the target organ
 No need of the full bladder
 Frequency range 5-8Mh
 Detailed evaluation of pelvic organ possible
(10cm field)
Drawbacks are due to narrow vagina in
virgins,post menopausal women or post radiation
,vaginal stenosis

7. TRANSVAGINAL COLOUR
DOPPLER SONOGRAPHY
It provides information about blood flow
to the organs

8. INDICATION OF OBESTRICS
USG
 FETAL INDICATIONS
 UETOPLACENTAL INDICATION
 MATERNAL INDICATIONS

9. FETAL INDICATIONS
 Diagnosis of pregnancy
 Diagnosis of multiple pregnancy
 Diagnosis of IUFD
 Diagnosis of Ectopic pregnancy
 Assessment of gestational age
 Assessment of growth (IUGR)
 Assessment of presentation (breech)

10.  Localization of placenta(placenta praevia)
 Diagnosis of abruption placenta
 Diagnosis of uterine malformation
 Assessment of liquor volume
(polyhydramnios,oligohdramnios)
 Diagnosis of cervical incompetence
UETOPLACENTAL INDICATION

11. MATERNAL INDICATIONS
 Pelvic mass diagnosis
 Amniocentesis
 Intrauterine fetal therapy (transfusion)

12. FIRST TRIMESTER
ULTRASONOGRAPHY
 DATING OF PREGNANCY
 MULTIPLE PREGNANCY
 ANEMBRYONIC PREGNANCY
 ECTOPIC PREGNANCY

13. DATING OF PREGNANCY:
 Measurement of crown rump length (CRL) in the first
trimester
 CRL (mm)+ 6.5 = gestational age in weeks
 After 12 weeks accuracy of CRL decreases due to
progressive curvature of fetus.
MULTIPLE PREGNANCY
Identification of gestational sacs indicated twin
birth in 52-63% of cases
ANEMBRYONIC PREGNANCY
There is absence of fetal pole in a gestational sac
with the diameter of 3cm or more
ECTOPIC PREGNANCY
TVS can detect 90% of tubal ectopic pregnancy

14. MID TRIMESTER USG:
BENEFITS
 Viability of fetus
 Pregnancy dating
 Detection of multiple pregnancy
 Detection of congenital abnormalities
 Placental localization
 Monitoring of high risk pregnancy

15. 1. FETAL GROWTH
Normal fetal weight should be between 10 & 90%
Wt <10% - small for gestational age
Wt >90% - large for gestational age.
2. GESTATIONALAGE ASSESSMENT
· 20% of pregnant women uncertain about LMP
· Most accurate assessment- 14-20 wks.
3. FETALANATOMY AND COMMON
ANOMOLIES·
CNS, CVS, GI, Genitourinary, Musculoskeletal,
Pulmonary, Thoracic, Lymphatics.
Survey of placenta and amniotic fluid are also done

16. 4. NEURAL TUBE DEFECT
· Spinal bifida
· Anencephaly
5. CRANIALABNORMALITIES
· Anencephaly
· Hydrocephaly
· Enchephalocele
6. FETAL HEART view of heart chambers and evaluation of outflow
tracts are done i.e. to screen congenital heart diseases
7. OMPHALOCELE
8. HYDROPS FETALIS
9. HYADATIFORM MOLE
10. PLACENTAAND UMBLICAL CORD
· Thickness >45mm is considered as abnormal
11. PLACENTA OF MULTIFETAL PREGNANCY

17. THIRD SIMESTER USG
All the information of second
trimester sonography can be obtained in
the third trimester

18. USES OF USG IN GYNAECOLOGY
1) USE IN INFERTILITY WORK-UP
• Folliculometry & endometrial thickness are done using TVS
• Mature follicle should measure between 18-20mm in
diameter
• USG can provide presumptive evidence of ovulation
2) Ectopic pregnancy can be detected on TVS as a TUBAL
RING seperate from the ovary in patient with empty uterine
cavity
3) PELVIC MASS
• Pelvic mass can be evaluated as regard to its location &
consistency .eg fibroid uterus ,ovarian mass ,endometrioma
4) ONCOLOGY
• TV-CDS can asses vascularity of the mass
• Low flow impedance with high flow velocity raises the
suspiction of malignant tumor

19. 5) EDOMETRIAL DISEASE
 Women with unexplained uterine bleeding are
better studied with TVS
 Endometrial thickness <5mm is considered
atrophic
6) SONOHYSTEROGRAPHY
 Instillation of saline in uterine cavity & study
with TVS
 Submucous fibroid or polyps are better
diagnosed
7) SONOHYSTEROSALPINGOGRAPHY
 Normal saline is pushed within the uterine
cavity with pediatric Foleys catheter
 Then catheter balloon is inflated at the level of
cervix to prevent fluid leakage
 Then USG of uterus & fallopian tube done

20. 8) SONOGRAPHICALLY GUIDED PROCEDURES
 A needle is attached to the shaft of the
vaginal probe
 TVS can guide the needle in safe pathway
Purpose
Aspiration
Biopsy
9) TRANSRECTAL
 It is used where TVS cannot be used due to
vaginal narrowing

21. BIBLIOGRAPHY
 TEXTBOOK OF OBSTETRICS’ , D . C.DUTTA 6 EDITION
, PUBLISHED BY CHINTAMANI DAKOLKATA,PAGE NO
416-418
 C.S. DOWN , TEXT BOOK OF
OBSTERICS,&NEONATOLOGY,15TH EDITION PUBLISHED
BY SMT. ARTI DAWN, PAGE NO 512-514.
 MYLES,TEXT BOOK OF MIDWIVES,12TH EDITION
PUBLISHED BY MARY LAW, PAGE NO 613-614.
 MUDALIAR & MEON’S TEXTBOOK OF OBSTETRICS &
GYNAECOLOGY, PUBLISHED BY ORIENT LONGMAN ,
PAGE NO 628-630.
 WWW.ELCEISER.ORG/ GYENECOLOGY/20% /.ASPX.