Adobe Systems Ultrasound in obstetrics and gynecology Ultrasound in obstetrics and gynecology Romana Gerychová 2019/2020 1 Adobe Systems Ultrasound in obstetrics and gynecology 2 History ̶ 1920s – sonar for marine purposes ̶ 1944 – first therapeutic use of ultrasound (brain tissue disruption) ̶ UK, Australia, Germany, USA, Japan – leading countries ̶ 2D, 3D imaging, CFM – color mapping ̶ 21st century – quality, miniaturisation, intracavital application Adobe Systems Ultrasound in obstetrics and gynecology 3 US technology development Adobe Systems Ultrasound in obstetrics and gynecology 4 Ultrasound diagnostics advantages ̶ non-invasive method ̶ method based on mechanical energy (relatively safe) ̶ examination is carried by obgyn specialists themselves (direct link between clinical status and objective method results) Adobe Systems 5 Ultrasound diagnostics 2D imaginig ̶ base examination, gold standard 3D/4D imaging ̶ additional examination ̶ multiplanar image ̶ volume CT mode ̶ 3D power Doppler ̶ A plane image Fetal face Plane B fetal face Plane C A B C Plane Ultrasound in obstetrics and gynecology Adobe Systems Ultrasound in obstetrics and gynecology 6 Contemporary imaging techniques ̶CT −gynecology (diff.dg. abdominal cavity pathologies) −exclusion peri/postoperative complications (TEN) −oncogynecology (staging) Adobe Systems Ultrazvuk v gynekologii a porodnictví 7 Contemporary imaging techniques ̶MRI - gynecology - obstetrics - fetal anomalies - abnormal placentation - placental functional examination - fetal weight estimation - virtual fetal autopsy D:\Moje dokumenty\MRI\Obstetric MR Imaging -- Levine et al_ 211 (3) 609 -- Radiology_soubory\r99jn20g10b.gif C:\Documents and Settings\Roma\Plocha\ISUOG 2011 LA\špindl\obrazy\výběr\PA 1.JPG D:\Moje dokumenty\MRI\Obstetric MR Imaging -- Levine et al_ 211 (3) 609 -- Radiology_soubory\r99jn20g6b.gif Adobe Systems Ultrazvuk v gynekologii a porodnictví 8 Imaging techniques transabdominal (3,5-5 MHz) ̶ visualisation abdominal cavity (gynecology – formation bigger than small pelvis, obstetrics, pediatric gynecology) ̶ full bladder transvaginal (5-7,5 MHz) ̶ better visualisation (examination distance 8-10cm) ̶ empty bladder ̶ hymen, vaginal stricture - impossible Adobe Systems Ultrasound in obstetrics and gynecology 9 US in obstetrics and gynecology options, limits ̶equipment (probe type, frequency,…) ̶limitations - not influenced (e.g.obesity,…) - probably influenced (e.g.oligohydramnion, multiple pregnancy,..) - influenced (fetal movement, fetal position, empty bladder,…) Adobe Systems Ultrasound in obstetrics and gynecology 10 US - gynecology ̶congenital anomalies ̶dif.-dg amenorhoe ̶diff.-dg pelvic pain, inflammation, tumor ̶IUD visualisation ̶sterility treatment ̶uro/oncogynecology ̶peri/postoperative diagnostics Adobe Systems Ultrasound in obstetrics and gynecology 11 US - gynecology - uterus G:\VVV\gynekologie\sono HSG\IMG_20111029_36_1.jpg G:\gyn\foto\děloha1.JPG DUPLEX_7 DUPLEX_10 TWIN_1 G:\VVV\gynekologie\IUD\zakova_1.jpg Adobe Systems Ultrasound in obstetrics and gynecology 12 US - gynecology - uterus G:\VVV\gynekologie\heterotopicka grav\crlikova\IMG_20130313_1_4.jpg G:\gyn\endometrium\IMG_20110116_9_1.jpg F:\kucerova\KUCEROVA_0000.JPG G:\VVV\gynekologie\uterotomie\ceperova\IMG_20121213_2_3.jpg Adobe Systems Ultrasound in obstetrics and gynecology 13 Uterine anomalies - 3D/4D image F:\VVV\gynekologie\VVV deloha\arcuatus.jpg F:\VVV\gynekologie\VVV deloha\duplex .jpg uterus arcuatus uterus bicornis uterus duplex Adobe Systems Ultrasound in obstetrics and gynecology 14 US - gynecology - ovaries G:\gyn\sonoHSG\IMG_20110116_7_3.jpg G:\gyn\onko\IMG_20110118_8_1.jpg G:\gyn\cysta,CD\cysta (2).jpg G:\endometrisa\ENDOMETRIOSA.JPG G:\gyn\cysta,CD\IMG_20110116_1_3.jpg ̶ K:\UZ obrázky\borderline\UZ OBRAZKY_653.JPG Adobe Systems US - obstetrics - sonoembryology ̶ F:\pdg\5W_2.JPG 8 Ultrasound in obstetrics and gynecology 15 fetal development observation Adobe Systems Ultrasound in obstetrics and gynecology 16 US - obstetrics anomaly scan 3 – steps screening I. trimestr (11-14 wks) II. trimestr (20-22 wks) III. trimestr (30-32 wks) ̶ G:\certifikat\I.screening\IMG_20111110_3_3.jpg G:\certifikat\II.screening\rihova\IMG_20120816_4_2_4.jpg G:\VVV\prenat\VVV\rozstep\NTD\Arnold Chiari\IMG_20111108_1_6.jpg Adobe Systems Ultrasound in obstetrics and gynecology 17 I trimestr screening targets, specifics ̶screening for fetal anomalies ̶screening for fetal chromosomal anomalies ̶better visualisation ̶time for genetic counselling ̶safer termination of pregnancy ̶screening for pregnancy risk (e.g. preeclampsia, placental pathology) ̶ ̶ ̶ Adobe Systems Ultrasound in obstetrics and gynecology 18 I trimestr screening 11-14 wks (11+0 - 13+6) ̶pregnancy date ̶number of fetuses (amnionicity, chorionicity) ̶anomaly scan - direct (structural anomalies) - indirect (chromosomal anomalies) ̶ ̶ ̶ Adobe Systems Ultrasound in obstetrics and gynecology 19 I trimestr screening pregnancy date §birth date estimation §CRL measurement (crown-rump lenght) §estimating - birth term - timing next exams ̶ ̶ ̶ Adobe Systems Amnionicity/chorionicity ̶ G:\VVV\prenat\gemini\bi bi\bibi v myomatose.jpg G:\VVV\prenat\gemini\mo bi\IMG_20120311_3.jpg G:\VVV\prenat\gemini\mo mo\IMG_20120109_13_1.jpg G:\VVV\prenat\gemini\tri\stevankova_2.jpg G:\VVV\prenat\gemini\tri\tri bi\matustikova_6.jpg G:\VVV\prenat\gemini\mo mo\norma\IMG_20120301_5_2.jpg G:\VVV\prenat\gemini\mo mo\bradova\IMG_20131204_1_13.jpg G:\VVV\prenat\gemini\bi bi\bi bi 2_2.jpg Ultrasound in obstetrics and gynecology 20 Adobe Systems Ultrasound in obstetrics and gynecology 21 I trimestr screening anomaly scan ̶ morfologic anomalies ̶ chromosomal anomalies ̶ TRISOMIE 18_1 G:\VVV\prenat\VVV\uropoeticky trakt\obstrukce\megavesica\IMG_20120311_2_1.jpg ENCEPHALOCELE_6 Adobe Systems 22 Fetal chromosomal anomalies screening I ̶ nasal bone nuchal translucency intracranial translucency Ultrasound in obstetrics and gynecology markers Adobe Systems 23 Fetal chromosomal anomalies screening II nuchal translucency ˃ 3mm 75% fetal aneuploidy 30% fetal structural anomaly, genetic syndrome 1% normal fetus main marker of fetal abnormality Evans 1999, Nicolaides 2009, Pereira 2011, Kagan 2015, Grande 2015 Ultrasound in obstetrics and gynecology Adobe Systems Fetal chromosomal anomalies screening III Ultrasound in obstetrics and gynecology 24 -ductus venosus abnormal flow -tricuspide valve regurgitation - facial angle Adobe Systems 25 II trimestr screening 20-22 wks ̶fetal structural anomalies detection ̶fetal cardiac defect detection ̶placental dysfunction detection Ultrasound in obstetrics and gynecology Adobe Systems 26 III trimestr screening 30-32wks ̶anomaly scan ̶fetal growth ̶fetal position ̶placental position ̶birth plan Ultrasound in obstetrics and gynecology Adobe Systems Obstetrics vaginal US ̶ placental position ̶ cervical lenght ̶ lower uterine segment (CS scar, fibroma) ̶ vasa praevia ̶ fetal examination (I trimestr, head,..) D:\Moje dokumenty\VVV\vasa praevia\foto\Obrázek1.jpg Ultrasound in obstetrics and gynecology 27 ACCRETA_4 D:\Moje dokumenty\VVV\vasa praevia\foto\úpon pupečníku.jpg F:\přednášky\2017\jihlava\foto\IMG_20170427_5.jpg Doppler measurement a./v.umbilicalis a.cerebri media ductus venosus placental pathology - increasing placental resistence – decreasing diastolic flow (umbilical cord) – increasing diastolic flow in the fetal brain vessels – centralisation of bloodstream Ultrasound in obstetrics and gynecology 28 Adobe Systems Ultrasound – invasive prenatal dignostics − amniocentesis − chorionic villi sampling − umbilical cord puncture − abortion risk 0.8 - 1% − fetal genetic status examination − − § § Ultrasound in obstetrics and gynecology 29 Adobe Systems Fetal therapy - intrauterine transfusion -maternal red blood cells antibodies fetal hemolytic anemia -follow up - laboratory - antibody level - fetal RhD (cfDNA) - ultrasound - MCA Doppler flowmetry − therapy- intrauterine transfusion § § C:\Documents and Settings\Lubojacký\Plocha\jana\IMG_20120525_6.jpg D:\Moje dokumenty\porodnice\IUT\foto\IMG_20100507_1_3.jpg Ultrasound in obstetrics and gynecology 30 Adobe Systems Ultrasound in obstetrics and gynecology 31 Fetal therapy – vesico-amniotic shunting fetal obstructive uropathy Adobe Systems Ultrasound in obstetrics and gynecology 32 Fetal therapy - thoraco-amniotic shunting pleural effusion - indications for therapy - fetal hydrops - massive effusion (> ½ thoracic cavity volume) - rapid progression, polyhydramnion 22.t 23.t. 24.t 36.t Adobe Systems Fetal therapy - next indications - laser fetoscopy - twin-to-twin transfusion sy - sIUGR monochorionic twins - TRAP sequence - sacrococcygeal teratoma - diafragmatic hernia (endoscopic tracheal oclusion) - fetal aortal valvuloplasty § Ultrasound in obstetrics and gynecology 33 Adobe Systems Ultrasound in obstetrics and gynecology 34 Conclusion ̶ ultrasound - inherent helper of ob-gyn specialist ̶ theoretical knowledge, practical training ̶ regular quality audit ̶ ultrasound of specialist ̶ subspecialisation for postgradual trainee