Ultrasound in Obstetrics and Gynaecology

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Presentation transcript:

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

Complete Miscarriage

Incomplete Miscarriage

Missed Miscarriage

Ectopic Pregnancy

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

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

Indications Growth Scans Pregnancy related: Pre existing: 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

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

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

Menorrhagia with Dysmenorrhoea Fibroids Endometrial polyps DUB Menorrhagia with Dysmenorrhoea Adenomyosis/endometriosis PID

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

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

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

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

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

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

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

Ultrasound in Obstetrics and Gynaecology When? What?

Thank You!! 