The Role of

Ultrasound in
Obstetric and
Gynaecology


Potential uses for ultrasound in obstetrics 1:
Locate the pregnancy exclude ectopic
Assess viability assessment of threatened miscarriage
Determining gestation & dates
Crown rump length
Diagnosis of twins the importance of zygosity
Assessment of other pelvic masses
e.g. fibroids, functional ovarian cysts & neoplasms
Screening for abnormalities first trimester
Nuchal fold measure, anencephaly etc.
Assisting CVS and amniocentesis
Diagnosis of molar pregnancy

Potential uses for ultrasound in obstetrics 2:
Second trimester dating (+/- 10 days)
Biparietal diameter, head & abdominal circumference, femur length
Screening for abnormalities
e.g. spina bifida, cardiac, renal
Screening for placenta previa
Cervical length monitoring
>30 mm before 18w & >25 mm before 28 w = low risk of pre term
delivery
Assessment of APH
Assessment of fetal growth
Asymmetrical and symmetrical
Evaluation of polyhydramnios and hydrops
Potential uses for ultrasound in obstetrics 3:
Assessment of fetal welfare
Amniotic fluid index or deepest pool
Fetal breathing
Fetal movements and tone (the Biophysical Profile)
Doppler flow studies
In umbilical arteries
Fetal middle cerebral artery
Uterine arteries
Diagnosis and management of malpresentation
Breech and unstable or transverse lie
Directing intrauterine interventions
e.g. transfusion for hydrops, catheter for urethral stricture
Placental grading (of doubtful value)
Assessment of the postpartum uterus
Proven uses for ultrasound in pregnancy:
Dating the gestation
30% of women cannot provide a LMP
Another 25% have a LMP that is >2w different from USS dates
When dates are known aneuploidy screening is accurate and
errors of delivery are avoided, fewer inductions for post dates etc.
Identification of multiple pregnancy
Twins have a perinatal mortality that is 2-4x singletons
Monitoring for discordant growth with Doppler reduces risk
Identification of breech in the third trimester
ECV reduces the rate of Caesarean section
Few RCTs of routine ultrasound have shown any effect
on overall perinatal mortality and morbidity
Unproven uses for ultrasound in pregnancy:
Screening for Aneuploidy
Cost effectiveness of universal screening debated
Ethical issues and patient choice involved
Screening for structural malformations
Sensitivity is 13 50% depending on expertise & equipment
And only half of these before 20 w gestation
False positives occur
Screening for IUGR in the 3
rd
trimester
Sensitivity is 80-90%
But the positive predictive value of neonatal morbidity is only 25-
50%
The rest have constitutional smallness
Harmful Effects of ultrasound in pregnancy:
It is not ionising radiation

However, thermal effects and cavitation can occur
in tissues exposed to high power ultrasound

One RCT of repeated routine ultrasound with
Dopplers in the 3
rd
trimester found a small but
significant decrease in birth weight in the exposed
cohort
Potential uses for ultrasound in gynaecology
1:
Assessment of adnexal pelvic masses
Compound B scan
Doppler vessel studies
Diagnosis of polycystic ovaries
Investigation of postmenopausal bleeding
Imaging and measure of endometrial thickness
Investigation of menorrhagia
Fibroids and adenomyosis
Monitoring of follicle number and growth for IVF
Egg recovery for IVF and ICSI
Evaluation of pelvic pain
A limited role
Screening for ovarian cancer
Too many false positives

Potential uses for ultrasound in gynaecology
2:
IUCD and Implanon location

Treatment of ovarian cysts (aspiration) and ectopic
pregnancy (methotrexate)

Saline hysterography for delineation of the uterine cavity

Tubal patency studies in infertility

Evaluation of primary amenorrhoea