Ultrasound in Obstetrics and Gynaecology Dr Bhanu Deval

Ultrasound in Obstetrics and Gynaecology Dr Bhanu Deval MBBS MS MRCOG Pg. C Obs and Gynae Ultrasound

Obstetric Ultraound Indications-First Trimester ØBleeding ØPain ØPrevious ectopic ØHyperemesis ØPrevious molar pregnancy ØBad obstetric history

Intrauterine Pregnancy

Complete Miscarriage

Incomplete Miscarriage

Missed Miscarriage

Ectopic Pregnancy

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

Indications Third Trimester: ØGrowth Scans with UA/MCA dopplers ØPresentation ØPost Dates-AFI

Indications Growth Scans Pregnancy related: Ø Ø Ø Ø Multiple pregnancy-DCDA from 28 weeks 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: Ø Obstetric History: SB, Previous IUGR, Previous abruption Ø Smoking/substance abuse Ø Pre existing medical conditions-Thrombophilias, APLS, SLE, autoimmune conditions, renal disease, hypertension, severe asthma, thyroid disorders Ø BMI>35

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

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

Menorrhagia ØFibroids ØEndometrial polyps ØDUB Menorrhagia with Dysmenorrhoea ØAdenomyosis/endometriosis ØPID

Oligomenorrhoea/Amenorrhoea Primary ØUterine agenesis- RMK syndrome ØImperforate hymen ØMullerian abnormalities- Vaginal septum +/- other uterine abnormalities ØGonadal dysgenesis(Turner’s): Streak ovaries ØGn. RHa deficiency: Kallmann’s Syndrome

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

Pelvic pain ØAdenomyosis/endometriosis-Ovarian endometriomas ØPID ØOvarian cyst accidents-Haemorrhage/rupture/torsion Simple cysts do not cause pelvic pain!

Pelvic Mass ØFibroid ØOvarian cysts Ø Pre menopausal-simple/complex Ø Post menopausal-simple/complex

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

Decline in Ovarian Reserve – using AFC and AMH 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!!