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Ultrasound in Obstetrics and Gynaecology

Ultrasound in Obstetrics and Gynaecology. Dr Bhanu Deval MBBS MS MRCOG PgC Obs and Gynae Ultrasound. Obstetric Ultraound. Indications-First Trimester Bleeding Pain Previous ectopic Hyperemesis Previous molar pregnancy Bad obstetric history. Intrauterine Pregnancy.

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Ultrasound in Obstetrics and Gynaecology

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  1. Ultrasound in Obstetrics and Gynaecology Dr Bhanu Deval MBBS MS MRCOG PgCObs and Gynae Ultrasound

  2. Obstetric Ultraound Indications-First Trimester • Bleeding • Pain • Previous ectopic • Hyperemesis • Previous molar pregnancy • Bad obstetric history

  3. Intrauterine Pregnancy

  4. Complete Miscarriage

  5. Incomplete Miscarriage

  6. Missed Miscarriage

  7. Ectopic Pregnancy

  8. Indications Second Trimester • NT Scan • Chorionicity • Cervical length surveillance • Previous extreme pre term delivery <28weeks • Previous cone biopsies/multiple LLETZ • Multiple pregnancy • Known uterine anomaly • Morphology scan • Fetal Echocardiogram • Previous baby with congenital cardiac anomaly • Diabetic women • Epilepsy-medicated • Women with known cardiac anomaly

  9. Indications Third Trimester: • Growth Scans with UA/MCA dopplers • Presentation • Post Dates-AFI

  10. Indications Growth Scans Pregnancy related: • Multiple pregnancy-DCDA from 28weeks onwards • Multiple pregnancy-MCDA from 24 weeks onwards • PET • Reduced SFH • Known IUGR • APH-Placenta praevia, abruption • Recurrent APH of unknown cause • GDM Pre existing: • Obstetric History: SB, Previous IUGR, Previous abruption • Smoking/substance abuse • Pre existing medical conditions-Thrombophilias, APLS, SLE, autoimmune conditions, renal disease, hypertension, severe asthma, thyroid disorders • BMI>35

  11. Indications Post partum/post miscarriage Abnormal bleeding/Secondary PPH • RPOCs • Endometritis • Molar pregnancy • Placental site trophoblastic tumours • AV malformations

  12. Gynaecological Ultrasound Indications: Menorrhagia+/-dysmenorrhoea Oligomenorrhoea/Amenorrhoea Pelvic pain Pelvic mass Subfertility Post menopausal bleeding Misplaced Mirena/IUCD

  13. Menorrhagia • Fibroids • Endometrial polyps • DUB Menorrhagia with Dysmenorrhoea • Adenomyosis/endometriosis • PID

  14. Oligomenorrhoea/Amenorrhoea Primary • Uterine agenesis- RMK syndrome • Imperforate hymen • Mullerian abnormalities- Vaginal septum +/- other uterine abnormalities • Gonadal dysgenesis(Turner’s): Streak ovaries • GnRHa deficiency: Kallmann’s Syndrome

  15. Oligomenorrhoea/Amenorrhoea Secondary Hypothalamic/hypopituitary • Anorexia/Bulimia • Stress • Pituitary tumours • Sheehan’s syndrome • Thyroid dysfunction Ovarian: • PCOS • POF Uterine: Asherman’s Syndrome

  16. Pelvic pain • Adenomyosis/endometriosis-Ovarian endometriomas • PID • Ovarian cyst accidents-Haemorrhage/rupture/torsion Simple cysts do not cause pelvic pain!

  17. Pelvic Mass • Fibroid • Ovarian cysts • Pre menopausal-simple/complex • Post menopausal-simple/complex

  18. Subfertility Ovaries: • Ovarian reserve-AFC, AMH • PCOS • Endometrioma • Peri ovarian adhesions/fixity • Ovarian blood flow • Access Adnexal: • Hydrosalpinx-PID • Peri tubal/intra peritoneal adhesions Uterine: 3D scan • Submucous fibroid/endometrial polyps • Adenomysosis-EMZ disruption, POD fixity Unexplained

  19. Decline in Ovarian Reserve – using AFC and AMH Antral Follicle Count Anti Mullerian Hormone

  20. PMB • Atrophic endometrium • Endometrial Hyperplasia/Polyps • Endometrial CA • Ovarian cysts • Clinical examination –CST.

  21. Ultrasound in Obstetrics and Gynaecology • When? • What?

  22. Thank You!! 

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