BOOK
LIC - Obstetric & Gynaecological Ultrasound Ebk
Trish Chudleigh | Alison Smith | Sonia Cumming
(2016)
Additional Information
Book Details
Abstract
This established text covers the full range of obstetric ultrasound examinations that a sonographer would be expected to perform in a general hospital or secondary referral setting, and is the only text that combines the practicalities of learning how to perform these examinations with the information needed to carry them out in a clinical setting. It encourages students to think about their practice and provides the sonographer with the necessary tools to provide a 'gold standard' service.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Obstetric & Gynaecological Ultrasound | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Table Of Contents | vii | ||
| Contributor | ix | ||
| Foreword | xi | ||
| Preface | xiii | ||
| Acknowledgements | xv | ||
| 1 The principles of ultrasound, Doppler ultrasound and instrumentation | 1 | ||
| Contents | 1 | ||
| 2D Ultrasound | 1 | ||
| Wave Properties | 1 | ||
| The Pulse-Echo Principle | 2 | ||
| 2D Scanning | 3 | ||
| Time Gain Compensation | 4 | ||
| Generation, Detection and Diffraction | 5 | ||
| Interactions of Ultrasound with Tissue | 7 | ||
| Frame Rate | 9 | ||
| Focusing | 10 | ||
| Harmonic Imaging | 11 | ||
| Artefacts | 12 | ||
| 3D Imaging | 13 | ||
| Doppler Ultrasound | 14 | ||
| The Doppler Principle | 14 | ||
| The Doppler Frequency Spectrum | 16 | ||
| The Vessel Wall Filter | 18 | ||
| Doppler Flowmeters | 18 | ||
| The Continuous Wave Flowmeter | 18 | ||
| Display options | 19 | ||
| Pulsed Doppler Flowmeters | 19 | ||
| The sample volume | 20 | ||
| Limitations of pulsed Doppler | 20 | ||
| Sampling limitations | 20 | ||
| Range–velocity limitations | 21 | ||
| Real-Time Spectrum Analysis | 21 | ||
| Doppler Indices | 22 | ||
| Frequency Calculations | 23 | ||
| Velocity Calculations | 23 | ||
| Volume Flow Calculations | 23 | ||
| Colour Flow Doppler Ultrasound | 23 | ||
| Power Doppler | 25 | ||
| Safety | 25 | ||
| Further reading | 27 | ||
| 2 Preparing to scan | 29 | ||
| Contents | 29 | ||
| The Components of the Ultrasound Machine | 29 | ||
| The Probe | 30 | ||
| Left/Right Invert Control | 31 | ||
| Ultrasound Frequency | 33 | ||
| The Control Panel | 33 | ||
| Power Output | 33 | ||
| Thermal Index and Mechanical Index | 33 | ||
| Frequency | 34 | ||
| Depth and Zoom | 34 | ||
| Read Zoom | 35 | ||
| Write Zoom | 35 | ||
| Focus | 35 | ||
| Dynamic Range | 35 | ||
| Gain | 36 | ||
| Time Gain Compensation | 36 | ||
| The Resulting Image Including Presets | 36 | ||
| Freeze Control | 38 | ||
| Cine-loop | 38 | ||
| On-Screen Measurement | 38 | ||
| The Monitor | 38 | ||
| Recording Systems | 38 | ||
| The Ergonomics of Safe Scanning | 39 | ||
| Preparing Yourself for the Scan | 40 | ||
| Preparing the Woman for the Scan | 41 | ||
| Selecting the More Appropriate Route | 41 | ||
| Patient Identification | 41 | ||
| Preparing The Probe | 43 | ||
| Coupling Medium | 43 | ||
| Protection | 43 | ||
| The Triple Sheets Technique | 44 | ||
| Preparing for A Transvaginal Scan | 44 | ||
| Preparing for A Transabdominal Scan | 45 | ||
| Aftercare | 45 | ||
| Further reading | 46 | ||
| 3 Starting to scan using the transabdominal route | 47 | ||
| Contents | 47 | ||
| Preparing to Scan | 47 | ||
| The Woman | 48 | ||
| Preparing the Probe | 48 | ||
| Protection | 48 | ||
| The Scanning Technique | 48 | ||
| Orientation | 48 | ||
| The Probe Movements | 50 | ||
| Sliding (Fig. 3.2A) | 50 | ||
| Rotating (Fig. 3.2B) | 50 | ||
| Angling (Fig. 3.2C) | 52 | ||
| Dipping (Fig. 3.2D) | 52 | ||
| The Uterine Survey and Assessing Fetal Number | 52 | ||
| Fetal Lie, Presentation, Attitude and Position | 53 | ||
| Identifying the Fetal Position | 53 | ||
| Lie and Presentation | 53 | ||
| Finding the Longitudinal Axis of the Fetus and Confirming a Live Fetus | 53 | ||
| Difficulties in Finding the Longitudinal Axis of the Fetus | 55 | ||
| Fetal position | 55 | ||
| Excessive fetal movement | 55 | ||
| Demonstrating the Live Fetus to the Woman | 55 | ||
| Cephalic or Breech Presentation | 57 | ||
| Transverse Lie | 57 | ||
| Oblique Lie | 57 | ||
| Fetal Attitude – Prone, Supine or Decubitus | 57 | ||
| Midsagittal and Coronal Sections | 59 | ||
| The Midsagittal Prone Position | 59 | ||
| The Midsagittal Supine Position | 60 | ||
| Decubitus Position | 60 | ||
| Moving from a Coronal Section to a Midsagittal Section | 60 | ||
| Following the Longitudinal Lie of the Fetus | 61 | ||
| Assessing Fetal Situs | 61 | ||
| 4 Starting to scan using the transvaginal route | 63 | ||
| Contents | 63 | ||
| Explaining the Procedure | 63 | ||
| Getting Started | 64 | ||
| Getting Into Position | 64 | ||
| Preparing and Positioning the Woman | 64 | ||
| Preparing the Probe | 65 | ||
| The Scanning Technique | 66 | ||
| Orientation | 66 | ||
| The Importance of Orientation | 67 | ||
| Putting It into Practice | 67 | ||
| Probe Movements | 69 | ||
| Sliding | 69 | ||
| Panning | 70 | ||
| Angling | 70 | ||
| Rotating | 71 | ||
| Finding the Uterus | 71 | ||
| Finding the Ovaries | 72 | ||
| The Iliac Vessels Technique | 72 | ||
| Slide and Pan Technique | 73 | ||
| Problems in Imaging the Uterus and Ovaries | 74 | ||
| Adiposity | 74 | ||
| Bowel Gas | 74 | ||
| Fibroids | 74 | ||
| Bowel Loops | 74 | ||
| Blood Vessels | 74 | ||
| Clinical Information | 75 | ||
| Further reading | 75 | ||
| 5 Assessing the early intrauterine pregnancy | 77 | ||
| Contents | 77 | ||
| Assessing the Length of the Pregnancy | 77 | ||
| Early Embryological Development and Terminology | 78 | ||
| Using Embryological Age | 78 | ||
| Using the LMP | 79 | ||
| Using a Gestation Calculator Wheel | 79 | ||
| Using the Computer Database | 79 | ||
| Using Assisted Conception Dates | 79 | ||
| Using the Date of Egg Collection | 80 | ||
| Method 1 | 80 | ||
| Method 2 | 80 | ||
| Using the Date of Embryo Transfer | 80 | ||
| Using the Date of Embryo Transfer in a Frozen Cycle | 80 | ||
| Age of the Woman or Donor at the Time of Egg Collection | 80 | ||
| Assigning the EDD | 81 | ||
| Estimating the Length of Pregnancy | 81 | ||
| The Positive Pregnancy Test | 81 | ||
| Ultrasound Parameters | 82 | ||
| Assessment of Early Pregnancy | 82 | ||
| The Transvaginal Method | 83 | ||
| Examining the Uterus | 83 | ||
| Thickened Endometrium | 83 | ||
| The Intrauterine Gestation Sac | 83 | ||
| The Very Early Gestation Sac (4–5 Weeks) | 85 | ||
| The Pseudosac (Fluid Within the Cavity) | 85 | ||
| Implantation Bleed | 85 | ||
| Finding and Measuring the Gestation Sac | 86 | ||
| Calculation of Mean Gestation Sac Diameter | 87 | ||
| Threshold Values for Mean Gestation Sac Diameter | 87 | ||
| The Yolk Sac | 87 | ||
| The Embryo | 89 | ||
| CRL Definition | 89 | ||
| CRL Measurement | 90 | ||
| Ongoing Pregnancy, Heart Pulsations, CRL Threshold, Miscarriage Risk | 91 | ||
| Physiological Herniation of the Gut at 8–10 Weeks | 91 | ||
| Twin Pregnancies | 92 | ||
| Ovaries and Adnexae | 92 | ||
| Anechoic Corpus Luteum | 93 | ||
| Haemorrhagic Corpus Luteum | 93 | ||
| Collapsed Corpus Luteum | 93 | ||
| The Ovaries Following In Vitro Fertilization | 94 | ||
| The Transabdominal Method | 94 | ||
| Examining the Uterus | 95 | ||
| Problems | 95 | ||
| Finding the Gestation Sac | 96 | ||
| Ovaries and Adnexae | 96 | ||
| Writing the Report | 97 | ||
| Further reading | 98 | ||
| 6 Problems of early pregnancy | 99 | ||
| Contents | 99 | ||
| Terminology | 100 | ||
| Historical Terminology | 100 | ||
| Current Terminology | 100 | ||
| Selection of Women for Scanning in Early Pregnancy | 100 | ||
| Length of Pregnancy | 100 | ||
| Serum hCG | 101 | ||
| Pregnancy Test | 101 | ||
| Clinical Question | 101 | ||
| Asymptomatic Women | 101 | ||
| Scanning the Symptomatic Early Pregnancy | 102 | ||
| Subchorionic Haematoma | 102 | ||
| Pregnancy of Unknown Viability | 103 | ||
| Identifying a PUV | 103 | ||
| Follow-up Scan and Diagnosis | 104 | ||
| Writing the Initial Report for PUV | 104 | ||
| Writing the Follow-up Report for PUV | 105 | ||
| Miscarriage | 105 | ||
| Ultrasound Diagnosis of Miscarriage | 105 | ||
| What You Should Look for, Measure and Include in Your Report for Miscarriage | 105 | ||
| Miscarriage, Early Embryonic Demise | 106 | ||
| Writing the Report for Miscarriage, Early Embryonic Demise | 107 | ||
| Miscarriage, Early Fetal Demise | 107 | ||
| Writing the report for Miscarriage, Early Fetal Demise | 107 | ||
| Incomplete Miscarriage | 108 | ||
| Products of conception | 108 | ||
| Writing the report for products of conception | 109 | ||
| Retained products of conception | 109 | ||
| Writing the report for retained products of conception | 109 | ||
| Complete Miscarriage | 109 | ||
| Management of miscarriage | 110 | ||
| Surgical management | 110 | ||
| Medical management | 110 | ||
| Expectant management | 110 | ||
| Pregnancies of Unknown Location | 111 | ||
| Management of PUL | 111 | ||
| Writing the Report for a PUL | 112 | ||
| Ectopic Pregnancy | 112 | ||
| Ultrasound Findings of Ectopic Pregnancy (Tubal) | 112 | ||
| Assessing the endometrium and uterine cavity | 113 | ||
| Assessing the ovaries | 114 | ||
| Assessing the adnexae | 114 | ||
| Assessing the ectopic pregnancy | 114 | ||
| Assessing the Pouch of Douglas | 115 | ||
| Management of ectopic pregnancy | 115 | ||
| What should be included in the report for ectopic pregnancy | 116 | ||
| Management of Ectopic Pregnancy | 116 | ||
| Expectant management | 116 | ||
| Medical management | 116 | ||
| Surgical management | 117 | ||
| Interstitial Ectopic | 117 | ||
| Cervical Pregnancy | 117 | ||
| Caesarean Scar Pregnancy | 118 | ||
| Ovarian Pregnancy | 118 | ||
| Abdominal Pregnancy | 118 | ||
| Heterotopic Pregnancy | 119 | ||
| Trophoblastic Disease | 119 | ||
| Complete Hydatidiform Mole | 119 | ||
| Partial Hydatidiform Mole | 119 | ||
| Invasive Mole | 120 | ||
| Pregnancy and an Intrauterine Contraceptive Device | 120 | ||
| Uterine Fibroids | 120 | ||
| Ovarian Problems in Early Pregnancy | 121 | ||
| Ovarian Cysts in Pregnancy | 121 | ||
| Difficult-to-Assess Ovarian Cysts | 121 | ||
| Further reading | 122 | ||
| 7 Dating and screening the pregnancy between 10 and 14 weeks | 123 | ||
| Contents | 123 | ||
| The Value of an Accurate EDD | 125 | ||
| Ultrasound Parameters | 125 | ||
| Crown Rump Length | 125 | ||
| The Correct Section | 125 | ||
| Neutral Position | 126 | ||
| Degree of Curvature of the Lower Spine | 127 | ||
| Identifying the End Points | 127 | ||
| Finding the Maximum Length | 127 | ||
| Measuring the CRL | 127 | ||
| Reporting the CRL Measurement to One Decimal Place | 128 | ||
| Problems | 128 | ||
| Head Circumference and Biparietal Diameter | 129 | ||
| The Correct Section at 12–14 Weeks | 129 | ||
| Measuring the HC | 130 | ||
| Measuring the BPD | 130 | ||
| Problems with HC and BPD Measurements | 130 | ||
| Size Charts and Dating Charts | 131 | ||
| Size Charts | 131 | ||
| Dating Charts and Look-Up Tables | 131 | ||
| Using the Correct Data Set Correctly | 131 | ||
| The Impact of Differing Equations for Pregnancy Dating | 132 | ||
| Crown Rump Length | 132 | ||
| Head Circumference | 132 | ||
| Biparietal Diameter | 132 | ||
| Dealing with the Differences in Gestational Age Equivalents | 133 | ||
| Estimation of Gestational Age in a Spontaneously Conceived Twin Pregnancy | 133 | ||
| Estimation of Gestational Age in an Assisted Conception Pregnancy | 133 | ||
| Screening for Down’s Syndrome and Edwards’ and Patau’s Syndromes in the First Trimester | 134 | ||
| Down’s Syndrome | 134 | ||
| Edwards’ Syndrome | 134 | ||
| Patau’s Syndrome | 134 | ||
| Combined Screening | 135 | ||
| Triploidy | 136 | ||
| Age-Related, Background and Adjusted Risks | 136 | ||
| Threshold Risk and Terminology | 136 | ||
| Screening for Down’s Syndrome Using NT | 137 | ||
| Getting the Correct Section for Measuring the NT | 137 | ||
| Getting the Correct Section in Practice | 139 | ||
| When Obtaining a Correct Section Is Not Possible | 139 | ||
| When Obtaining a Correct Section Is Not Possible in the Larger Woman | 139 | ||
| Calliper Placement | 140 | ||
| Measuring the NT | 141 | ||
| The Impact of NT on Risk | 141 | ||
| The Implications of NT Above the 95th Centile | 143 | ||
| The Impact of the CRL Measurement on Combined Screening Risk Assessment | 144 | ||
| Clinical Management of the Screen Positive Result | 145 | ||
| Information Required for Accurate Risk Assessment From Combined Screening | 147 | ||
| Maternal Weight | 147 | ||
| Ethnicity | 147 | ||
| Smoking | 147 | ||
| Other factors | 147 | ||
| Aftercare | 147 | ||
| When Measuring an Accurate CRL Is Not Possible | 148 | ||
| Examining the Fetus for Structural Abnormalities | 149 | ||
| Acrania/Exencephaly/Anencephaly | 150 | ||
| Alobar Holoprosencephaly | 151 | ||
| Cystic Hygroma | 151 | ||
| Omphalocele | 151 | ||
| Gastroschisis | 152 | ||
| Megacystis | 152 | ||
| Absent Limb(s) | 153 | ||
| Stomach | 154 | ||
| Heart | 154 | ||
| Scan Menus | 154 | ||
| The ‘Dating Menu’ | 154 | ||
| Managing the Woman Who Declines Screening for Down’s, Edwards’ and Patau’s Syndromes | 154 | ||
| The ‘Combined Screening Menu’ | 155 | ||
| An ‘Anatomical Survey Menu’ | 155 | ||
| Amniotic Fluid and the Placenta | 156 | ||
| Amniotic Fluid Volume | 156 | ||
| Placental Site | 156 | ||
| Reporting the Findings of the Dating Scan and of the Combined Screening Scan | 156 | ||
| Further reading | 157 | ||
| 8 First steps in examining the second trimester pregnancy | 159 | ||
| Contents | 159 | ||
| Approaching the Second Trimester Scan | 160 | ||
| Screening Standards | 161 | ||
| Routine Anomaly Screening | 162 | ||
| Confirming Situs Solitus | 164 | ||
| Measuring the HC and BPD | 164 | ||
| Lateral Ventricles/Chitty Section for HC and BPD | 165 | ||
| Finding the Correct Section for HC and BPD | 165 | ||
| Measuring the HC | 166 | ||
| Measuring the BPD | 167 | ||
| ‘Outer-to-inner’ measurement | 167 | ||
| ‘Outer-to-outer’ measurement | 167 | ||
| BPD measurements in breech and transverse presentations | 167 | ||
| Problems in Obtaining the Correct Sections for HC and BPD | 168 | ||
| Incorrect angle | 168 | ||
| Incorrect rotation | 168 | ||
| Incorrect level | 168 | ||
| Midline not horizontal | 168 | ||
| OA/OP position | 168 | ||
| The Ventricles | 170 | ||
| The Posterior Horn of the Lateral Ventricle/Atrium | 170 | ||
| Measurement of the Posterior Horn of the Lateral Ventricle | 170 | ||
| The Anterior Horn of the Lateral Ventricle | 172 | ||
| Measurement of the Anterior Horn of the Lateral Ventricle | 172 | ||
| Current practice | 173 | ||
| Evaluating the Skull Shape From the Lateral Ventricles View | 173 | ||
| Evaluating the Intracranial Anatomy From the Lateral Ventricles View | 173 | ||
| The Clinical Impact of Correctly Evaluating the Chitty HC Section | 174 | ||
| The Thalami View/Hadlock Section | 174 | ||
| Finding the Thalami View | 174 | ||
| The Suboccipito-Bregmatic Section | 175 | ||
| Finding the Suboccipito-Bregmatic Plane | 175 | ||
| The Cerebellum | 175 | ||
| Measuring the TCD | 175 | ||
| The Cisterna Magna | 176 | ||
| The Nuchal Fold | 176 | ||
| The Clinical Impact of Correctly Evaluating the Suboccipito-Bregmatic Section | 176 | ||
| Measuring the AC | 177 | ||
| Finding the AC | 177 | ||
| Measurement of the AC | 177 | ||
| Problems in Obtaining the Correct Section for AC | 178 | ||
| Directly Anterior Fetal Spine | 178 | ||
| Noncircular Outline | 178 | ||
| Long Length of UV | 179 | ||
| Evaluating the Fetal Anatomy From the AC Section | 179 | ||
| The Clinical Impact of Correctly Evaluating the AC Section | 179 | ||
| Measuring the FL | 179 | ||
| Finding the FL | 180 | ||
| Measurement of the FL | 180 | ||
| Problems in Obtaining the Correct Section for FL | 181 | ||
| Fetal Movements | 181 | ||
| One or Both End Points Are Difficult to Define | 181 | ||
| The Upper Femur Appears Straight While the Lower Femur Appears Bowed | 181 | ||
| Gestational Age Equivalents of the HC and FL Disagree | 181 | ||
| Evaluating the Femur Length View | 181 | ||
| Evaluating the Anatomy between the AC and FL Sections | 181 | ||
| The Clinical Impact of Correctly Evaluating the FL Section | 182 | ||
| Observation of the Fetus for Body and Limb Movements | 182 | ||
| Evaluation of Amniotic Fluid Volume | 182 | ||
| Visual Assessment | 183 | ||
| Oligohydramnios/Anhydramnios | 183 | ||
| Polyhydramnios | 183 | ||
| Localization of the Position of the Placenta Relative to the Internal Os | 184 | ||
| Problems of Placental Localisation | 186 | ||
| Overdistension of the Maternal Bladder | 186 | ||
| Braxton Hicks Contractions | 186 | ||
| Assessment of Fetal Biometry | 186 | ||
| Dating the Pregnancy | 187 | ||
| Dating a Twin Pregnancy | 188 | ||
| Reporting the Scan Findings | 188 | ||
| Reporting the Findings When the EDD Has Already Been Accurately Assigned | 188 | ||
| Reporting the Findings When the Gestational Age and the EDD are to be Assigned | 188 | ||
| Screening for Down’s Syndrome with the Quadruple Test | 189 | ||
| Maternal Weight | 190 | ||
| Ethnicity | 190 | ||
| Smoking Status | 190 | ||
| Method of Conception | 190 | ||
| Insulin-Dependent Diabetes Mellitus | 190 | ||
| Screening for Edwards’ and Patau’s Syndromes With the Quadruple Test | 191 | ||
| Further reading | 191 | ||
| 9 Assessing the fetal head, brain, neck and face | 193 | ||
| Contents | 193 | ||
| The Shape of the Skull | 194 | ||
| Dolicocephaly and Brachycephaly | 194 | ||
| Lemon-Shaped Skull | 194 | ||
| Strawberry-Shaped Skull | 195 | ||
| Clover-Leaf-Shaped Skull | 195 | ||
| Practical Management of an Abnormally Shaped Skull | 195 | ||
| The Integrity of the Skull Bones | 196 | ||
| Acrania, Exencephaly and Anencephaly | 196 | ||
| Encephalocele | 197 | ||
| The Echogenicity of the Bones of the Skull and of the Brain | 198 | ||
| Hypomineralization of the Skull | 198 | ||
| Increased Echogenicity of the Brain | 198 | ||
| The Size of the Head | 199 | ||
| Microcephaly | 199 | ||
| Head Size and Spina Bifida | 200 | ||
| The H/A Ratio | 200 | ||
| The Appearances of the Intracranial Anatomy | 200 | ||
| The Cerebral Falx and the Midline | 200 | ||
| The Cavum Septum Pellucidum | 200 | ||
| Absent Cavum Septum Pellucidum | 201 | ||
| The Thalamus/Thalami | 201 | ||
| The Sylvian Fissure/Insula | 201 | ||
| The Ventricular System | 202 | ||
| The Lateral Ventricles | 202 | ||
| The Third Ventricle | 203 | ||
| The Fourth Ventricle (See Later in Text) | 203 | ||
| Ventriculomegaly/Hydrocephalus | 203 | ||
| The Choroid Plexus | 204 | ||
| Choroid Plexus Cysts | 204 | ||
| Porencephalic Cyst | 205 | ||
| Hydranencephaly | 206 | ||
| Holoprosencephaly | 206 | ||
| The Corpus Callosum | 206 | ||
| Agenesis of the Corpus Callosum | 206 | ||
| Arachnoid Cyst | 207 | ||
| The Appearances of the Posterior Fossa | 208 | ||
| The Cerebellum | 208 | ||
| Abnormal Size | 208 | ||
| Abnormal Shape: The Banana Sign | 208 | ||
| Arnold Chiari malformation | 209 | ||
| Agenesis of the cerebellar vermis | 209 | ||
| The Fourth Ventricle | 210 | ||
| The Cisterna Magna | 210 | ||
| Dandy-Walker complex | 210 | ||
| Blake’s pouch cyst | 211 | ||
| The Nuchal Fold | 211 | ||
| Increased Nuchal Fold/Skin Fold Thickness | 211 | ||
| The Appearances of the Neck | 212 | ||
| Cystic Hygroma | 212 | ||
| Neck Mass | 212 | ||
| The Appearances of the Fetal Face | 214 | ||
| Development of the Face | 214 | ||
| Obtaining a Coronal View of the Face | 214 | ||
| The Orbits and Eyes | 215 | ||
| The Nose and Upper Lip | 215 | ||
| The Alveolar Ridge or Alveolus | 216 | ||
| The Palate | 216 | ||
| Facial Clefting | 216 | ||
| Cleft lip | 217 | ||
| Clefting of the alveolus | 218 | ||
| The premaxilla | 218 | ||
| Midline cleft | 218 | ||
| The Profile | 218 | ||
| The Forehead | 219 | ||
| Flat Forehead | 219 | ||
| The Nose | 220 | ||
| Nasal Bone | 220 | ||
| Proboscis | 220 | ||
| The Chin | 221 | ||
| Micrognathia | 221 | ||
| The Tongue | 221 | ||
| Macroglossia | 221 | ||
| Further reading | 221 | ||
| 10 Assessing the chest and heart | 223 | ||
| Contents | 223 | ||
| The Chest and Ribs | 223 | ||
| The Chest | 223 | ||
| Champagne Cork Chest | 224 | ||
| The Ribs | 224 | ||
| Rib Fractures | 224 | ||
| Differential Diagnosis of Chest Masses | 225 | ||
| The Diaphragm | 225 | ||
| Congenital Diaphragmatic Hernia | 225 | ||
| The Lungs | 226 | ||
| Hydrops Fetalis | 227 | ||
| Pleural Effusion | 227 | ||
| Pericardial Effusion | 227 | ||
| Congenital Lung Lesions | 227 | ||
| Bronchopulmonary Sequestration | 227 | ||
| Cystic Pulmonary Airways Malformation | 228 | ||
| Tracheal Occlusion | 229 | ||
| The Fetal Circulation | 229 | ||
| The Foramen Ovale | 231 | ||
| The Ductus Arteriosus | 231 | ||
| The Ductus Venosus | 231 | ||
| The Umbilical Vessels | 231 | ||
| Changes at Delivery | 232 | ||
| The Fetal Heart | 233 | ||
| Colour Doppler Settings | 233 | ||
| M Mode | 235 | ||
| Aim of the Examination | 235 | ||
| The Four Chamber View | 235 | ||
| Situs Solitus | 237 | ||
| Situs abnormalities | 238 | ||
| Left atrial isomerism | 238 | ||
| Right atrial isomerism | 238 | ||
| Size of the Heart | 238 | ||
| Enlarged heart | 239 | ||
| The Apex of the Heart | 239 | ||
| Dextrocardia | 239 | ||
| Angle of the Cardiac Axis | 239 | ||
| Abnormal axis | 239 | ||
| The Atria | 240 | ||
| The Foramen Ovale | 240 | ||
| The Atrial Septum | 240 | ||
| Atrial septal defect | 240 | ||
| The Ventricles | 241 | ||
| Difference in size of the ventricles | 241 | ||
| Enlarged ventricle | 241 | ||
| Small ventricle | 241 | ||
| The Moderator Band | 242 | ||
| Moderator band in the ‘wrong’ ventricle | 242 | ||
| The Left Ventricle | 242 | ||
| The AV Valves | 242 | ||
| The tricuspid valve | 242 | ||
| The mitral valve | 242 | ||
| The Crux of the Heart | 243 | ||
| AVSD | 243 | ||
| The Ventricular Septum | 243 | ||
| The Left Outflow Tract View | 245 | ||
| The 3vt View | 247 | ||
| The Right Outflow Tract View | 247 | ||
| The Cross over of the Great Vessels | 249 | ||
| The 3vv | 249 | ||
| Other Cardiac Abnormalities | 251 | ||
| Aortic Stenosis | 251 | ||
| Critical Aortic Stenosis | 251 | ||
| Pulmonary Stenosis | 251 | ||
| Hypoplastic Left Heart Syndrome | 251 | ||
| Pulmonary Atresia | 252 | ||
| Ventricular Septal Defect | 253 | ||
| Overriding Aorta | 253 | ||
| Conotruncal Abnormalities/Truncus Arteriosus | 254 | ||
| Tetralogy of Fallot | 254 | ||
| TGA | 254 | ||
| Corrected Transposition | 255 | ||
| Double Outlet Right Ventricle | 255 | ||
| Coarctation | 255 | ||
| Right Aortic Arch (V Sign) | 255 | ||
| Right Aortic Arch (U Sign) | 255 | ||
| Double Aortic Arch | 257 | ||
| Additional Views of the Heart | 257 | ||
| The Ductal Arch View | 257 | ||
| The Aortic Arch View | 257 | ||
| Fetal Heart Rate and Rhythm | 258 | ||
| Further reading | 259 | ||
| 11 Assessing the abdomen | 261 | ||
| Contents | 261 | ||
| Abdominal Size | 262 | ||
| The Gall Bladder | 262 | ||
| Absent Gall Bladder | 262 | ||
| The Liver | 263 | ||
| The Spleen | 263 | ||
| The Stomach | 263 | ||
| Right Sided Stomach | 264 | ||
| Absent or Small Stomach | 264 | ||
| Oesophageal Atresia and Tracheo-oesophageal Fistula | 264 | ||
| VATER and VACTERL | 264 | ||
| ‘Double Bubble’ | 265 | ||
| The Bowel | 265 | ||
| Bright or Echogenic Bowel | 265 | ||
| Bowel Obstruction | 267 | ||
| ‘Double Bubble’ or Duodenal Atresia | 267 | ||
| Lower Bowel Atresia or Obstruction | 268 | ||
| The Anterior Abdominal Wall | 268 | ||
| Physiological Herniation of the Bowel | 268 | ||
| The Umbilical Cord | 268 | ||
| Two-Vessel Cord or Single Umbilical Artery | 269 | ||
| The Cord Insertion | 270 | ||
| Chest Wall and Abdominal Wall Defects | 271 | ||
| Ectopia Cordis | 271 | ||
| Bladder Extrophy or Ectopia Vesicae | 271 | ||
| Omphalocele | 271 | ||
| Gastroschisis | 272 | ||
| The Kidneys | 273 | ||
| Transverse Section of the Kidney | 273 | ||
| Sagittal Section of the Kidney | 273 | ||
| Coronal Section of the Kidney | 274 | ||
| Measurement of the Kidneys | 275 | ||
| The Renal Pelvis and Ureter | 275 | ||
| Measurement of the Renal Pelvis | 276 | ||
| Duplex Kidney | 276 | ||
| The Bladder | 277 | ||
| Ureterocele | 277 | ||
| Urinary Tract Abnormalities | 278 | ||
| Renal Agenesis | 278 | ||
| Congenital Cystic Disease of the Kidney | 278 | ||
| Classifications | 278 | ||
| Infantile Polycystic Kidney Disease | 279 | ||
| Multicystic Dysplastic Kidney Disease | 280 | ||
| Renal Dysplasia | 280 | ||
| Adult Polycystic Kidney Disease | 281 | ||
| Meckel–Gruber Syndrome | 281 | ||
| Renal Cysts | 281 | ||
| Obstructive Uropathy | 281 | ||
| Urethral Obstruction | 282 | ||
| Renal Pelvic Dilation | 282 | ||
| Abdominal Cysts | 283 | ||
| Fetal Hydrops or Hydrops Fetalis | 284 | ||
| The Genitalia | 285 | ||
| Further reading | 286 | ||
| 12 Ultrasound assessment of the spine and limbs | 287 | ||
| Contents | 287 | ||
| The Spine | 288 | ||
| Sagittal View of the Spine | 288 | ||
| Coronal View of the Spine | 289 | ||
| Transverse View of the Spine | 290 | ||
| Neural Tube Defects | 290 | ||
| Alpha-Fetoprotein | 291 | ||
| Spina Bifida | 291 | ||
| The ‘Lemon’ and ‘Banana’ Signs | 292 | ||
| Other Abnormalities Associated with the Spine | 294 | ||
| Sacral Agenesis (Caudal Regression Syndrome) | 294 | ||
| Sacrococcygeal Teratoma | 294 | ||
| Hemivertebra, Scoliosis, Lordosis and Kyphosis | 294 | ||
| The Limbs | 295 | ||
| The Humerus | 296 | ||
| The Radius and Ulna | 296 | ||
| The Hands | 296 | ||
| Abnormalities of the Hands | 297 | ||
| Fixed flexion of the hands | 297 | ||
| Polydactyly | 297 | ||
| Syndactyly | 297 | ||
| Clinodactyly | 298 | ||
| Overlapping fingers | 298 | ||
| The Femur | 298 | ||
| The Tibia and Fibula | 298 | ||
| The Feet | 299 | ||
| Abnormalities of the Foot | 300 | ||
| Talipes | 300 | ||
| Rocker bottom foot | 300 | ||
| Sandal gap | 300 | ||
| Polydactyly | 301 | ||
| Skeletal Dysplasia | 301 | ||
| Abnormal Length | 301 | ||
| Bowing | 302 | ||
| Defective Mineralization | 303 | ||
| Fractures | 303 | ||
| Additional Features | 303 | ||
| Frontal Bossing | 303 | ||
| Nasal Bridge | 303 | ||
| Characteristic Features | 304 | ||
| Thanatophoric Dysplasia | 304 | ||
| Osteogenesis Imperfecta | 304 | ||
| Achondrogenesis | 304 | ||
| Asphyxiating Thoracic Dystrophy | 304 | ||
| Ellis–Van Creveld Syndrome | 304 | ||
| Diastrophic Dysplasia | 304 | ||
| Achondroplasia | 304 | ||
| Modes of Inheritance | 304 | ||
| 13 Assessing fetal growth, amniotic fluid, fetal and uterine artery Dopplers | 307 | ||
| Contents | 307 | ||
| Defining Growth and Growth Velocity | 307 | ||
| Assessing Fetal Growth | 308 | ||
| Defining Normal Growth | 309 | ||
| Estimating Fetal Weight | 311 | ||
| Customized Growth Charts | 311 | ||
| SGA and IUGR | 312 | ||
| Small for Gestational Age | 312 | ||
| Intrauterine Growth Restriction | 312 | ||
| Maternal causes of growth restriction | 313 | ||
| Placental causes of growth restriction | 313 | ||
| Reduced uteroplacental perfusion | 313 | ||
| Reduced fetoplacental perfusion | 313 | ||
| Identifying the High-Risk Population | 313 | ||
| The Head/Abdomen Ratio | 313 | ||
| Ultrasound Features of Intrauterine Growth Restriction | 313 | ||
| Symmetrical intrauterine growth restriction | 314 | ||
| The constitutionally small fetus | 314 | ||
| The pathologically small fetus | 314 | ||
| Asymmetrical growth restriction | 315 | ||
| Large for Dates | 315 | ||
| Fetal Biophysical Profile | 316 | ||
| Amniotic Fluid | 320 | ||
| Assessment of amniotic fluid volume | 320 | ||
| Subjective Assessment | 320 | ||
| Single Deepest Pool | 320 | ||
| Amniotic Fluid Index | 321 | ||
| Deepest Vertical Pool or AFI? | 322 | ||
| Oligohydramnios/Anhydramnios | 322 | ||
| 14 Placental and cervical imaging | 345 | ||
| Contents | 345 | ||
| Development of the Placenta | 345 | ||
| Normal placental appearances | 346 | ||
| Localizing the Placenta at 18–22 Weeks | 346 | ||
| Placenta Praevia | 349 | ||
| Classification | 349 | ||
| The Clinical Problem | 349 | ||
| the Relationship between the Placental Edge and the Internal Os | 349 | ||
| When to Scan in the Third Trimester | 350 | ||
| Reporting Placental Site at 32 and 36 Weeks | 351 | ||
| At 32 Weeks | 351 | ||
| At 36 Weeks | 352 | ||
| Variations in Placental Morphology | 352 | ||
| Placental Lakes | 352 | ||
| Succenturiate Lobe | 353 | ||
| Amniotic Band | 353 | ||
| Morbidly Adherent Placenta/Placenta Accreta | 354 | ||
| Chorioangioma | 354 | ||
| Placental Grading | 355 | ||
| Placental Abruption | 356 | ||
| Cord Insertion Into the Placenta | 356 | ||
| Velamentous Cord Insertion | 357 | ||
| Marginal Cord Insertion | 358 | ||
| Vasa Praevia | 358 | ||
| The cervix | 358 | ||
| Assessment and Measurement of Cervical Length | 358 | ||
| Cervical Funnelling | 361 | ||
| Further reading | 361 | ||
| 15 Multiple pregnancy | 363 | ||
| Contents | 363 | ||
| Placentation of the Singleton Pregnancy | 364 | ||
| Zygosity | 364 | ||
| Dizygotic Twins | 364 | ||
| DZ Twinning Rates | 366 | ||
| Monozygotic Twins | 366 | ||
| The Three Types of MZ Twins | 366 | ||
| DCDA Monozygotic Twins | 366 | ||
| MCDA Monozygotic Twins | 367 | ||
| MCMA Monozygotic Twins | 367 | ||
| Conjoined twins | 367 | ||
| MZ Twinning Rates | 368 | ||
| The Implications of Twinning | 368 | ||
| Risks of Chromosomal Defects | 368 | ||
| DZ Twins | 368 | ||
| MZ Twins | 368 | ||
| DC Twins | 368 | ||
| Establishing Chorionicity and Amnionicity | 369 | ||
| Diagnosing the Early Twin Pregnancy | 369 | ||
| Problems | 371 | ||
| Determining chorionicity | 371 | ||
| Triploidy Screening in a Twin Pregnancy | 373 | ||
| Combined Screening | 373 | ||
| Measuring NT in a Twin Pregnancy | 374 | ||
| The Twin Pregnancy With One Live Fetus and One Empty Sac | 374 | ||
| The Twin Pregnancy With One Live Fetus and One Dead Fetus | 374 | ||
| Quadruple Test Screening | 374 | ||
| Quadruple Testing in an MC Twin Pair | 374 | ||
| Quadruple Testing in a DC Twin Pair | 375 | ||
| Ultrasound Labelling of Twins | 375 | ||
| The Implications of Monochorionic Twinning | 375 | ||
| Twin to Twin Transfusion Syndrome | 376 | ||
| The Intertwin Membrane | 376 | ||
| Twin Reversed Arterial Perfusion | 378 | ||
| Your Role in the Scanning of MCDA Twin Pregnancies | 378 | ||
| Normal Ultrasound Findings in MCDA Twin Pregnancies | 379 | ||
| Diagnosis and Assessment of Chorionicity of Twins after 14 Weeks | 379 | ||
| The 18–22 Week Scan in a Twin Pregnancy | 379 | ||
| Structural Abnormalities in a Twin Pregnancy | 379 | ||
| Assessment of Fetal Growth in a Twin Pregnancy | 380 | ||
| Measuring Amniotic Fluid in a Twin Pregnancy | 380 | ||
| Intertwin Growth Discrepancy | 380 | ||
| Pitfalls | 380 | ||
| Further reading | 380 | ||
| 16 Scanning the non pregnant pelvis | 381 | ||
| Contents | 381 | ||
| The Uterus and Cervix | 382 | ||
| Anatomy | 382 | ||
| Ultrasound Appearances | 382 | ||
| Caesarean Section Scar | 383 | ||
| Measuring the Uterus | 384 | ||
| Longitudinal Diameter | 384 | ||
| AP Diameter | 385 | ||
| Transverse Diameter | 385 | ||
| Assessment of the Endometrium | 385 | ||
| Measuring Endometrial Thickness | 386 | ||
| Subjective Assessment of the Endometrium | 386 | ||
| The Postmenopausal Uterus | 387 | ||
| The Perimenopausal Uterus | 388 | ||
| Congenital Uterine Anomalies | 388 | ||
| Interpretation of a 3D Volume | 389 | ||
| The Adnexae | 391 | ||
| The Ovaries | 391 | ||
| Ultrasound Appearances | 391 | ||
| Measuring Ovarian Size and Volume | 391 | ||
| Longitudinal Diameter | 391 | ||
| AP Diameter | 392 | ||
| Transverse Diameter | 392 | ||
| Paraovarian cysts | 393 | ||
| The Fallopian Tubes | 393 | ||
| The Pouch of Douglas | 393 | ||
| Writing the Report | 394 | ||
| Further reading | 394 | ||
| 17 The menstrual cycle, the menopause and the effects of exogenous hormones | 395 | ||
| Contents | 395 | ||
| The Menstrual Cycle | 395 | ||
| The Endometrium | 396 | ||
| Days 1–5 | 396 | ||
| The Endometrium | 397 | ||
| The Ovary | 397 | ||
| Days 6–12 | 398 | ||
| The Endometrium | 398 | ||
| 18 Uterine and ovarian anomalies | 409 | ||
| Contents | 409 | ||
| Uterine Fibroids | 409 | ||
| Incidence | 410 | ||
| Symptoms | 410 | ||
| Ultrasound Appearances | 410 | ||
| Location | 410 | ||
| Submucosal | 411 | ||
| Subserosal | 412 | ||
| Intramural | 412 | ||
| Pedunculated | 412 | ||
| Degeneration | 412 | ||
| Lipoleiomyoma | 413 | ||
| Leiomyosarcoma | 413 | ||
| Ultrasound Examination | 413 | ||
| Mapping and Reporting of Fibroids | 415 | ||
| Example report A | 415 | ||
| Example report B | 415 | ||
| Mapping and Reporting Difficulties | 415 | ||
| Clinical Management | 416 | ||
| Adenomyosis and Adenomyoma | 416 | ||
| Ultrasound Appearances | 417 | ||
| Adenomyosis | 417 | ||
| Adenomyoma | 417 | ||
| Haematometra, Haematocolpos and Haematosalpinx | 418 | ||
| Ultrasound Appearances | 418 | ||
| Endometrial Polyp | 419 | ||
| Ultrasound Appearances | 419 | ||
| Endometrial Hyperplasia | 420 | ||
| 19 Characterization of adnexal cysts, differential diagnoses of the pelvis and report writing | 429 | ||
| Contents | 429 | ||
| The Adnexae | 429 | ||
| Defining an Adnexal Cyst | 429 | ||
| The Purpose of Your Ultrasound Examination | 430 | ||
| How To Establish the Origin of an Adnexal Cyst | 431 | ||
| Paraovarian Cyst | 431 | ||
| Hydrosalpinx | 431 | ||
| Pedunculated Fibroid | 432 | ||
| Fibroma | 432 | ||
| Granulosa Cell Tumour | 432 | ||
| Tubo-Ovarian Abscess | 432 | ||
| Peritoneal Pseudocyst | 433 | ||
| Measurement of an Adnexal Cyst | 433 | ||
| IOTA Classification | 434 | ||
| Type | 434 | ||
| Unilocular Cyst | 434 | ||
| Unilocular Solid Cyst | 435 | ||
| Multilocular Cyst | 435 | ||
| Multilocular Solid Cyst | 435 | ||
| Solid Cyst | 436 | ||
| Internal Content | 436 | ||
| Contour | 437 | ||
| Vascularity | 437 | ||
| Free fluid | 437 | ||
| Characterization for Malignancy Risk | 439 | ||
| Assessing the Malignancy Risk | 439 | ||
| Ovarian Crescent Sign | 439 | ||
| Diagnostic Algorithms | 439 | ||
| Risk of Malignancy Index | 439 | ||
| Ultrasound score (U) as for Menstrual status (M) | 440 | ||
| Menstrual status (M) | 440 | ||
| Ovarian tumour marker (CA) | 440 | ||
| The Simple Rules Algorithm | 440 | ||
| The simple rules in practice | 441 | ||
| Case 1 – mucinous cystadenoma (Fig. 19.11) | 441 | ||
| Case 2 – fibroma (Fig. 19.3) | 441 | ||
| Case 3 – metastatic ovarian carcinoma (Fig. 19.16A and B) | 441 | ||
| Writing the Report for Adnexal Cysts | 442 | ||
| Further reading | 442 | ||
| 20 Professional issues | 443 | ||
| Contents | 443 | ||
| The Referrer of the Ultrasound Examination | 443 | ||
| Managing the Examination | 444 | ||
| Discussing the Findings | 444 | ||
| Arranging Follow-up | 446 | ||
| The Ultrasound Report | 446 | ||
| The Sonographer’s Responsibilities | 447 | ||
| Departmental Protocol | 447 | ||
| Working with a Student | 447 | ||
| Medicolegal Issues | 448 | ||
| The Manager’s Responsibilities | 448 | ||
| Audit of Findings | 449 | ||
| Further reading | 449 | ||
| Appendices | 451 | ||
| Appendix 1 Orientation and fetal lie | 453 | ||
| Appendix 2 Equation and look-up table for estimating gestational age (GA) from the crown rump length (CRL) as recommended by current national guidelines | 457 | ||
| Appendix 3 Head circumference (HC) dating table and equation | 459 | ||
| Appendix 4 Biparietal diameter (BPD) dating table (‘outer to inner’) | 461 | ||
| Appendix 5 The 11 conditions screened for, together with their current expected detection rates, within the national screening programme | 463 | ||
| Appendix 6 Equation, head circumference (HC) size chart and HC size table | 465 | ||
| Appendix 7 Biparietal diameter (BPD) size chart (‘outer to inner’) | 467 | ||
| Appendix 8 Equation, abdominal circumference (AC) size chart and AC size table | 469 | ||
| Appendix 9 Equation and dating table for estimating gestational age (GA) from the femur length (FL) | 471 | ||
| Appendix 10 Equation, femur length (FL) size chart and FL size table | 473 | ||
| Appendix 11 Markers of chromosomal abnormality | 475 | ||
| Index | 477 | ||
| A | 477 | ||
| B | 478 | ||
| C | 479 | ||
| D | 480 | ||
| E | 481 | ||
| F | 482 | ||
| G | 484 | ||
| H | 484 | ||
| I | 485 | ||
| J | 486 | ||
| K | 486 | ||
| L | 486 | ||
| M | 487 | ||
| N | 488 | ||
| O | 488 | ||
| P | 489 | ||
| Q | 491 | ||
| R | 491 | ||
| S | 491 | ||
| T | 493 | ||
| U | 494 | ||
| V | 495 | ||
| W | 496 | ||
| X | 496 | ||
| Y | 496 | ||
| Z | 496 |