This document provides information on Dr. Rupal N Shah, an experienced gynecologist and IVF consultant in Surat, India. It discusses her qualifications and experience in advanced infertility treatment, endoscopic surgeries, and her roles teaching and publishing on health topics. The rest of the document focuses on summarizing Dr. Shah's presentation on the uses of ultrasonography in infertility, including evaluating ovarian reserve, follicular development, polycystic ovary syndrome, ovarian cysts, uterine anomalies, and endometrial thickness.
Obstetric ultrasound uses sound waves to produce pictures of a baby (embryo or fetus) within a pregnant woman, as well as the mother's uterus and ovaries. It does not use ionizing radiation, has no known harmful effects, and is the preferred method for monitoring pregnant women and their unborn babies.
In this presentation we will focus on aetiological factors that cause infirtility. Our focus is on US depiction of these aetiological factors to help physician in the management of infirtility.
We have nothing to do with direct radiological intervention in the management of infirtility in this presentation.
ultrasonography in obstetrics, usg in obstetrics, ultrasound in obstetrics, doppler in obstetrics, usg doppler in obstetrics, signs in ultrasound, anomaly scan, pregnancy scan, ultrasound in pregnancy,
Obstetrical Ultrasound• Introduced in the late 1950’s ultrasonography is a safe, non- invasive, accurate and cost-effective means to investigate the fetus• Computer generated system that uses sound waves integrated through real time scanners placed in contact with a gel medium to the maternal abdomen• The information from different reflections are reconstructed to provide a continuous picture of the moving fetus on the monitor screen
my key note address at AICOG 2013.....for all who missed this one and on request of many who were present and wanted a copy...... if you copy these please do but please acknowledge.....
In this presentation we will discuss role of Doppler US in Infertility, fertilization and assisted fertilization.
we will discuss the favorable and unfavorable RI and PI.
We will discuss role of doppler us in various gynecological malignancies.
Obstetric ultrasound uses sound waves to produce pictures of a baby (embryo or fetus) within a pregnant woman, as well as the mother's uterus and ovaries. It does not use ionizing radiation, has no known harmful effects, and is the preferred method for monitoring pregnant women and their unborn babies.
In this presentation we will focus on aetiological factors that cause infirtility. Our focus is on US depiction of these aetiological factors to help physician in the management of infirtility.
We have nothing to do with direct radiological intervention in the management of infirtility in this presentation.
ultrasonography in obstetrics, usg in obstetrics, ultrasound in obstetrics, doppler in obstetrics, usg doppler in obstetrics, signs in ultrasound, anomaly scan, pregnancy scan, ultrasound in pregnancy,
Obstetrical Ultrasound• Introduced in the late 1950’s ultrasonography is a safe, non- invasive, accurate and cost-effective means to investigate the fetus• Computer generated system that uses sound waves integrated through real time scanners placed in contact with a gel medium to the maternal abdomen• The information from different reflections are reconstructed to provide a continuous picture of the moving fetus on the monitor screen
my key note address at AICOG 2013.....for all who missed this one and on request of many who were present and wanted a copy...... if you copy these please do but please acknowledge.....
In this presentation we will discuss role of Doppler US in Infertility, fertilization and assisted fertilization.
we will discuss the favorable and unfavorable RI and PI.
We will discuss role of doppler us in various gynecological malignancies.
Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life.
This Note is Prepared by A OBGYN resident @ SPHMMC, Addis Ababa, Ethiopia (March 2019)
For further notes, you can join us on our Telegram group @obgynsphmmc2019
Tel: +251920257863
Cervical incompetence is the inability for the cervix to retain an intra-uterine pregnancy till term as a result of structural and functional defects of the cervix
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Ultrasound in infertility
1. • The young, enthusiastic and energetic chief
consultant at Rupal Hospital For Women,
Surat, India for last 18 years
• Medical director and IVF consultant at
Blossom IVF Centre,Surat,India
• Diploma in Reproductive Medicine from Kiel,
Germany
• Intense training in Advanced infertility
treatment at numerous workshops and
conferences in USA and Europe.
• Invited as a faculty in various state,national and
international conferences.
• Specialized in all kind of gynec endoscopic
surgeries.
• Promotes health awareness by conducting
Seminars and writing articles and specialty
related books
• In addition of being techno-savvy person, she
loves making friends, and keenly interested in
music and Guajarati literature. She is actively
associated with the leading cultural club of
Surat-Tarbatar.
Dr Rupal N Shah
M.D.(OBGYN)
Diploma in Reproductive Medicine
(Germany)
6/21/2015 1Rupal Hospital For Women
2. Ultrasound in Infertility
Dr Rupal N Shah
M.D.:D.G.O
Diploma in Reproductive Medicine(Germany)
Blossom IVF Centre,
Rupal Hospital For Women
Surat
3. Sonography in Infertility
• Transvaginal Sonography is one of the indispensable
investigations as far as infertility patient is
concerned.
• It is the primary examination parallel to clinical
assessment as it gives more information than any
other single test and is noninvasive.
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4. Ultrasonography in infertility
1. Workup for infertility
2. Assisted reproduction technique
3. Early pregnancy scanning
4. Male Infertility
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6. Ultrasound evaluation of Ovarian Reserve
• Antral Follicle count
The number of visible ovarian follicles(2-8 mm)
on cycle day 2-3
• Ovarian Volume
limited value compared with antral follicle count
for detection of diminished ovarian reserve.
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7. Antral Follicle Count
• 12 / more immature follicles ( 2 -
8mm)
• AFC Less than 5 -Poor responder
• Total number of antral follicles achieved
the best predictive value for favourable
IVF outcome, followed by Ovarian
stromal FI, total ovarian stromal area &
total ovarian volume Kupesic S et al,
Hum Reprod 2002; 17(4):950-55
6/21/2015 7Rupal Hospital For Women
9. Prediction of ovulation
• Dominant Follicle >
14mm
• Grows 2-3 mm/day.
• Ovulation 18-24 mm.
• Sonolucent halo 24 hours
prior to ovulation.
• Cumulus like shadow.
In the hands of experienced operators, ultrasound alone suffices
for cycle monitoring, with no necessity for additional hormonal
estimations.
Golan et al, Shoham et al and Tan SL et al
10. 16mm Cumulus oophorus 3/4th vascularity
• Ovulation 16-24 mm.
• Vascularity - 3/4th of the follicle
• On the day of HCG – If cumulus like echoes is not seen in all
three planes in the follicle , it is less likely to be mature
fertilizable oocyte.
6/21/2015 10Rupal Hospital For Women
11. Luteinized Unruptured Follicle-LUF
• Persistent follicle
with thick walls.
• Progressive loss of
cystic appearance.
• Thick echogenic
endometrium.
• No fluid in POD.
13. ESHRE/ASRM consensus revised
definition of PCOS ( 2003)
Two of the following three criteria and
exclusion of other etiologies:
1. Oligo and/or anovulation
2. Hyperandrogenism
3. Polycystic ovaries on TVS
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14. Ultrasound diagnosis of PCO is one of
the key features for diagnosis of
PCOD.
• This is done by a transvaginal scan done on day 2 – 3 of
the cycle
• 12 follicles of 2-9 mm in diameter in at least one ovary or
• Peripheral cystic pattern(Neckless pattern) or generalized
cystic pattern
• Increased ovarian volume (>10 cm3)
6/21/2015 14Rupal Hospital For Women
15. Sono AVC
• Recently Sono AVC has also been
tried to measure the number of
antral follicles
• Adv: Can separate follicular number
of 2 -6 mm and 6 – 9 mm follicles
and prevents recounting of follicles
• Disadv: requires post processing.
VOCAL
Volume calculation by Computer
6/21/2015 15Rupal Hospital For Women
16. Ovarian Cysts
• Corpus luteum – hemorrhagic cyst –
LUF
• Endometrioma
• Dermoid cysts
• Serous and mucinous cystadenomas
• Endometrioid tumours
• fibroma
6/21/2015 16Rupal Hospital For Women
17. But it is more convenient to divide these
lesions according to morphology
• Nonseptated clear cysts
• Cysts with internal echoes
6/21/2015 17Rupal Hospital For Women
19. Cysts with internal echoes
• thick, echogenic wall
• internal echogenecity
Corpus luteum Heamorrhagic Endometrioma
6/21/2015 19Rupal Hospital For Women
20. Heamorrhagic cyst
• The commonest
appearance is a fishnet
appearance
• Changes echogenicity over
time due to fibrinolysis of
a clot
• Scanty and high resistance
blood flow
21. Endometrioma
• Bilateral in 1/3 cases
• Thick shaggy walls
• With or without septae,
• internal echogenicity with
ground glass appearance
• Pain on pressure with the
probe
• Sometimes ‘kissing
ovaries”
• Vascularity may vary
between lesions.
6/21/2015 21Rupal Hospital For Women
22. Dermoids
• Thick wall, echogenic material
in lumen
• Fluid fluid level
• Hyperechoic lines and
dots due to hair.
• Hyperechic/calcified echoes
due to teeth and bones
• Avascular
24. Volume USG, 3D and 4D USG has a
major role to play in the diagnosis of
uterine anomalies :
Virtual hysteroscopy
Sensitivity of the Volume USG
for the detection of congenital uterine
abnormalites is > 98%.
6/21/2015 24Rupal Hospital For Women
26. Failure of one /more mullerian duct to develop
or to canalize-rudimentary horn
Unicornuate uterus:
• Uterus is not in midline
• normal shape in long section
• one cornual projection
• only one uterine artery
• 3D:Banana shaped uterine cavity
Rudimentary horn :
on other side as hypoechoic shadow
6/21/2015 26Rupal Hospital For Women
27. Failure to fuse/abnormal fusion
• Uterus didelphys-double uterus
• Bicornuate uterus
6/21/2015 27Rupal Hospital For Women
28. Failure to fuse/abnormal fusion
Uterus Didelphys
• Two separate uteri and cervix
• Uteri are Seen in midline or on
lateral pelvic wall as two well
developed uterine structure
• On transverse section ,both
uterine horns make a figure of
eight.
6/21/2015 Rupal Hospital For Women 28
29. Failure to fuse/abnormal fusion
Bicornuate Uterus
• Two separate uterine bodies and a
single cervix
• On transverse section widened
fundus and division of endometrial
cavity towards fundus
Volume US:
• Fundus shows dimple
• Distance between the line joining
the endometrial tips and the fundal
dimple is less than 5 mm
6/21/2015 Rupal Hospital For Women 29
30. Failure of resorption of midline
septum-Septate or arcuate uterus
Septate uterus
• Flat or convex external
contour
• Acute angle between
endometrial cavities
• Distance between line
joining the tips of endo
cavity to the deepest point
between the two cavities-
>10 mm
Arcuate uterus
• Convex external contour
• Obtuse angle between
cavities
• Distance between line
joining the tips of endo
cavity to the deepest point
between the two cavities
<10 mm
•6/21/2015 Rupal Hospital For Women 30
31. Which is arcuate and which is
subseptate?
<90°>90°
Obtuse: arcuate Acute: subseptate
32. Septate uterus has highest implications on
pregnancy…
Infertility
Frequency of ectopic 27.34% as compared to 13.3%
otherwise.
First trimester abortions : 28 – 45%
Second trimester abortions : 5%
Premature deliveries
dystocia
6/21/2015 32Rupal Hospital For Women
33. Bicornuate V/S Septate uterus
Bicornuate
• Fundus-dimple
• <5 mm uterine wall above
the line joining tips of 2
uterine cavity
• Angle between 2 cavities
>90 *
• Medial margins of endo
cavity -Convex
Septate
• Fundus-No dimple
• >5 mm uterine wall above
the line joining tips of 2
uterine cavity
• Angle between 2 cavities
<90*
• Medial margins of endo
cavity -streight
6/21/2015 Rupal Hospital For Women 33
37. Synechiae
Hyperechoic bands
traversing through the
endometrial cavity
In thick synechiea 3D US
can be used for exact
assessment
of restriction of
endometrial cavity.
6/21/2015 37Rupal Hospital For Women
38. Polyps
• non-specific endometrial
thickening or focal masses within
the endometrium
• May appear as just diffusely
thickened endometrium,without
visualisation of descrete
mass(Mimicks endometrial
hyperplasia)
• A feeding vessel may be seen
extending to polyp on colour
doppler imaging
6/21/2015 38Rupal Hospital For Women
41. Intramural/Subserous Fibroids
• Well-defined,hypoechoic,
homogeneous ,rounded lesions with
peripheral hypoechoic rim.
• Enlargement of the uterus and
distortion of the contour
• Sometimes heterogenicity due to
degeneration or calcification
• On power doppler :Peripheral
vascularity
6/21/2015 41Rupal Hospital For Women
42. Adenomyosis
• Altered hyper and hypoechoic
zones-swiss cheese appearance.
• Generalized involving the whole
uterus or localized to one
portion(adenomyoma)
• Power doppler:penetrating
vascularity
44. TVS for endometrial grading
Endometrial thickness and endometrial pattern
are useful prognostic parameters for successful
pregnancy.
• 8-13 mm -Favorable
• <6 and >15 mm – Problematic
6/21/2015 44Rupal Hospital For Women
45. C
B
A
TVS for endometrial grading
The coexistance of a
thinner
endometrium(<7mm)
and no-triple line
pattern reflects poor
receptivity of the
endometrium and low
clinical pregnancy rate.
Triple line endometrium
6/21/2015 45Rupal Hospital For Women
47. Zone 1 - Myometrium
surrounding the
endometrium.
Zone 2 - Hyperechoic
endometrial edge
Zone 3- Internal endometrial
hypoechoic zone.
Zone 4 - Endometrial cavity
2
3 4
Endometrial vascularity zones
Applebaum scoring
48. Absent subendometrial and
intraendometrial vascularization on the
day of hCG, appears to be a useful
predictor of failure of implantation in IVF,
irrespective of morphological
appearance.
6/21/2015 48Rupal Hospital For Women
49. When pregnancy is achieved in absence of
endometrial and subendometrial flow on the
day of embryo transfer, more than half of
these pregnancies will finish as
spontaneous miscarriage.
Chein LW, et al, Assessment of uterine receptivity by the
endometrial-subendometrial blood flow distribution pattern in
women undergoing IVF-ET. Fertil Steril 2002; 78:245-51
6/21/2015 49Rupal Hospital For Women
50. Hydrosalpinx
Fusiform cystic lesion
Cog wheel sign
Incomplete septae
Cyst wall thicker than 5mm in
almost all acute inflammations and
app.3 % of chronic lesions
6/21/2015 50Rupal Hospital For Women
51. Assisted reproduction technique
• Monitoring of ovarian response
• Oocyte retrieval / embryo transfer under
ultrasound guidance
• Prediction of ovarian response and
pregnancy
6/21/2015 51Rupal Hospital For Women
54. Tubal patency-Sonosalpingography
Advantages
OPD procedure, less time
consuming, cost
effective,NoninvasiveNo
anasthesia,No radiation, no
iodinated contrast,Reproducible
and reliable for assessment of
tubal patency
6/21/2015 Rupal Hospital For Women 54
55. Tubal patency-Sonosalpingography
Disadvantages
• Tubal spasm
• Hydrosalpinx gives tubal flow – false
positive for patency
• Technical competence required
• Site of block can not be located exactly
• Intratubal pathology cannot be detected
• Peritubal adhesions and tubal motility
can not be assessed
• Findings are subjective.
6/21/2015 55Rupal Hospital For Women
56. USG in Male Infertility
Male factors are primary cause of infertility
in 20-30% of couples and a contributing
factor in another 20-25% of patients.
A systemic and logical evaluation of the
infertile male by USG helps to distinguish
between correctable and noncorrectable
abnormalities
57. USG in male infertility
• Scrotal Ultrasound and doppler
-Vericocele
-Epididymal abnormalities,undecended testes
• Transrectal Ultrasound
-Imaging of prostate,seminal vesicles and vas
deference
-Obstructive azoospermia(OA)
• Penile Ultrasound
-evaluates physical causes of erectile dysfunction.
6/21/2015 57Rupal Hospital For Women