Practical Guide to Ultrasound in Obstetrics and Gynecology

Contents
1. Basics of Ultrasound and Safety
Concerns 1
Sonal Panchal, Chaitanya Nagori
ƒ Safety of Diagnostic Ultrasound 2
ƒ Norms for Safe Use of Ultrasound in
11–14 Weeks Scan (WFUMB, ISUOG,
and American Institute of Ultrasound in
Medicine) 3
2. Know the Scanner and its Controls to
Optimize the Image 5
Sonal Panchal, Chaitanya Nagori
ƒ Equipment Settings 5
ƒ Optimizing the Image 5
ƒ Basic Understanding of Knobs and their
Settings 5
3. Doppler Basics for a Gynecologist 11
Sonal Panchal, Chaitanya Nagori
ƒ What is Doppler? 11
ƒ Color Doppler 11
ƒ Power Doppler 12
ƒ Spectral Doppler 13
ƒ Color/Power Doppler Settings 14
ƒ Settings for Pulsed
Wave Doppler 18
ƒ Setting the Speed of the Trace 21
ƒ Artifacts 22
ƒ Safety of Doppler 23
4. Ultrasound in First Trimester
Pregnancy 25
Sonal Panchal, Chaitanya Nagori
ƒ Confirmation of Pregnancy 26
ƒ Location of Gestational Sac 27
ƒ Early Detection of Multiple Gestations 31
ƒ Growth and Progress of Pregnancy 32
5. 11–14 Weeks Scan 40
Sonal Panchal, Chaitanya Nagori
ƒ Ultrasound as a Screening Modality 41
ƒ Neural Tube Anomalies 42
ƒ Facial Anomalies 44
ƒ Ocular Abnormalities 45
ƒ Cardiac Abnormalities 46
ƒ Abdominal Abnormalities 47
ƒ Skeletal Abnormalities 48
ƒ Miscellaneous Abnormalities 49
ƒ Chromosomal Markers 49
ƒ Noninvasive Prenatal Tests 62
6. Screening for Aneuploidy 69
Darshan Wadekar, Zalak Mehta
ƒ Markers of Aneuploidy 70
ƒ Biochemical Markers 83
ƒ Screening Policy for Aneuploidy 83
7. Second Trimester Scan 87
Sonal Panchal
ƒ Primary Essentials of Scanning 87
8. Placental Evaluation and
Trophoblastic Tumors 104
Sonal Panchal, Chaitanya Nagori
ƒ Abnormalities of Placenta and
Umbilical Cord 104
9. Role of Doppler in IUGR and
Pregnancy-induced Hypertension 125
Sonal Panchal, Chaitanya Nagori
ƒ Uteroplacental Vascular Anatomy 128
ƒ Technique of Doppler Assessment 130
ƒ Silent Period of Increased Resistance 132
ƒ Aortic Isthmus Flow 137
ƒ Umbilical Artery 139
ƒ Middle Cerebral Artery 139
ƒ Ductus Venosus 139
ƒ Obstetric Management Depending on
Doppler Findings 140
10. Role of Ultrasound in Medical
Disorders in Pregnancy 145
Darshan Wadekar, Zalak Mehta
ƒ Classification 145
ƒ Thyroid Disease and Pregnancy 145
ƒ Diabetes and Pregnancy 145
ƒ Gestational Diabetes Mellitus 161
ƒ Hypertension in Pregnancy 162
ƒ Seizure Disorders in Pregnancy 162
ƒ Cardiac Disease in Pregnancy 164
ƒ HIV Infection 164
ƒ Post-test Counseling of Seropositive
Women 165
ƒ Perinatal Infections 165
ƒ Sickle Cell Disease 165
ƒ Beta-thalassemia Disease 166
ƒ Management During Pregnancy 166
xiv Practical Guide to Ultrasound in Obstetrics and Gynecology: A Comprehensive Book
ƒ Genetic Evaluation 166
ƒ Systemic Lupus Erythematosus 166
11. Fetal Thoracic Abnormalities 171
Khurshid Alam, Rafat Jamal
ƒ Anatomy of Thoracic Cage 171
ƒ Bronchopulmonary Sequestration 174
ƒ Congenital Pulmonary Airway
Malformation 177
ƒ Congenital Diaphragmatic Hernia 184
ƒ Bronchogenic Cyst 192
ƒ Bronchial Atresia 194
ƒ Congenital High Airway Obstruction 195
ƒ Pleural Effusion 197
ƒ Pulmonary Hypoplasia 200
12. Abnormalities of Cardiovascular
System 206
Binodini M Chauhan
ƒ Embryology of the Human Heart 206
ƒ Timings 208
ƒ Technical Factors 208
ƒ Cardiac Examination 212
ƒ Specific Cardiac Abnormalities 220
ƒ Cardiac Examination in 1st Trimester 237
ƒ Indications for Early Fetal
Echocardiography 237
ƒ Benefits and Disadvantages of Early
Fetal Echocardiography 240
13. Fetal Urinary Tract Anomalies 242
KV Sridevi, Binodini M Chauhan
ƒ Ultrasound Imaging of Fetal Urinary
Tract 242
ƒ Renal Agenesis 245
ƒ Ectopic Kidney 248
ƒ Urinary Tract Dilatation 249
ƒ Fetal Pelviureteric Junction
Obstruction 252
ƒ Ureterovesical Junction Obstruction 252
ƒ Urethral Obstruction 254
ƒ Cystic Renal Disease 256
ƒ Autosomal Recessive Polycystic
Disease 257
ƒ Autosomal Dominant Polycystic Kidney
Disease 259
ƒ Glomerulocystic Kidney Disease 260
ƒ Nephronophthisis 260
ƒ Nonvisualized Urinary Bladder 261
ƒ Renal Anomalies with Syndromes 262
ƒ Vacterl Syndrome 264
14. Gastrointestinal Tract Abnormalities 267
Darshan Wadekar, Zalak Mehta
ƒ Gastrointestinal Tract 267
ƒ Normal Embryologic Development 267
ƒ Normal Sonographic Appearance 267
ƒ Abnormalities of Gastro intestinal
Tract 267
ƒ Gallbladder Duplication 272
15. Skeletal Dysplasia: Abnormalities of
Skeletal System 275
Binodini M Chauhan, Kairavi Desai
ƒ Ultrasound Evaluation 275
ƒ Nomenclature of the Bone Defects 276
ƒ Cause of 2nd Trimester Short Femur:
Intrauterine Growth Restriction and
Small for Gestational Age 278
ƒ Counseling for Short Femur in Second
Trimesters 279
ƒ Counseling for Short Femur in Third
Trimester 279
ƒ Assessment of Long Bones 279
ƒ Evaluation of Hands and Feet 280
ƒ Terminology 280
ƒ Thanatophoric Dysplasia 281
ƒ Achondrogenesis 282
ƒ Campomelic Dysplasia 284
ƒ Osteogenesis Imperfecta 284
ƒ Asphyxiating Thoracic Dystrophy
(Jeune’s Syndrome) 286
ƒ Achondroplasia 287
ƒ Tips to Differential Diagnosis
(Short Long Bones) 288
ƒ Diastrophic Dysplasia 288
ƒ Radial Ray Anomaly 289
ƒ Jarcho-Levin Syndrome/Spondylocostal
Dysplasia 290
ƒ Chondroectodermal Dysplasia 291
ƒ Hypophosphatasia 291
ƒ Short Rib Polydactyly Syndrome 292
ƒ Reduction Defects 292
ƒ Proximal Femoral Focal Deficiency 292
ƒ Femoral Hypoplasia-Unusual Facies
Syndrome 294
ƒ Split Hand and Split Foot Malformation
(Ectrodactyly) 294
ƒ Abnormalities of Joints 296
ƒ Sacral Dysgenesis/Caudal Regression
Syndrome 296
ƒ Skeletal Dysplasias (Shortcut to
Diagnosis) 298
ƒ Differential Diagnosis: Abnormalities of
Extremities 298
ƒ Differential Diagnosis of Joint
Abnormalities 298
16. Fetal Hydrops 300
KV Sridevi
ƒ Immune Hydrops 300
ƒ Pathophysiology 300