1. Ultrasound in Obstetrics and Gynaecology
Dr Bhanu Deval
MBBS MS MRCOG
PgC Obs 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: 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

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 with Dysmenorrhoea
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 Anti Mullerian Hormone
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!! 