TheRoleof

Ultrasound in
Obstetricand
Gynaecology

Max Brinsmead PhD FRANZCOG

May 2006
Potential usesfor ultrasoundin obstetrics1:
 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 usesfor ultrasoundin obstetrics2:
 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 usesfor ultrasoundin obstetrics3:
 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 usesfor ultrasoundin 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 usesfor ultrasoundin 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 3rd trimester
 Sensitivity is 80-90%
 But the positive predictive value of neonatal morbidity is only
25-50%
 The rest have constitutional smallness
Harmful Effectsof ultrasoundin 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 3rd trimester found a small but
significant decrease in birth weight in the exposed
cohort
Potential usesfor ultrasoundin 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 usesfor ultrasoundin 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