Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 3 , ISSUE 3 ( July-September, 2009 ) > List of Articles

REVIEW ARTICLE

Primary Care in Obstetrics and Gynecology — A Place for Advanced Ultrasound?

Ulrich Honemeyer

Keywords : Adnexal mass,power Doppler,transvaginal ultrasound,saline infusion sonohysterography,obstetric ultrasound screening,primary care

Citation Information : Honemeyer U. Primary Care in Obstetrics and Gynecology — A Place for Advanced Ultrasound?. Donald School J Ultrasound Obstet Gynecol 2009; 3 (3):61-74.

DOI: 10.5005/jp-journals-10009-1022

License: CC BY-NC 4.0

Published Online: 01-09-2009

Copyright Statement:  Copyright © 2009; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

The evaluation of adnexal masses based on transvaginal sonography (TVS) and when their size is too big- transabdominal US can be facilitated and refined by using color Doppler (CD), power Doppler (PD), and pulsed Doppler(PW), including three-dimensional ultrasound (3D US). With these modes, we obtain information about vascularity and flow indices, and their distribution within a mass. Considering the fact that neoangiogenesis is a main feature of malignancy, this is essential information. Thus, we are able to assume the benign or malignant character of an adnexal mass, make the right choice of additional imaging or biochemical tests, and then channel the treatment appropriately. This is subsequently demonstrated for simple cyst, hemorrhagic cysts, endometrioma, dermoid, serous papillary cystoma, ectopic pregnancy, and ovarian carcinoma.

Abnormal uterine bleeding (AUB) is a common problem in primary care. Compared to transabdominal approach, TVS improves the detection rate of underlying uterine pathology. In conditions like endometrial hyperplasia, polyps, submucous leiomyoma, and endometrial cancer, CD, PD, PW and contrast enhanced transvaginal ultrasound may optimize sonographic evaluation. Saline infusion sonohysterography (SISH) in out patient department (OPD) is an alternative to invasive diagnostic hysteroscopy in patients with AUB.

Care for maternal and fetal well-being during pregnancy is a main task in OPD. The assessment of fetal pathology is almost entirely based on Ultrasound. Several illustrations of fetal anomalies detected during 1st trimester and 2nd trimester screening, of abnormal findings in feto-maternal Doppler ultrasound, and fetal pathology demonstrated in 3D/4D ultrasound mode, conclude this review of advanced ultrasound in primary care.


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  1. Management of adnexal mass. Evidence technology assessment AHRQ Publication No. 06- E0040,130. Rockville MD: Agency for healthcare research and quality, Feb 2006.
  2. Ultrasonography, CT and MRI imaging for ovarian Cancer. Eur J Radiol 2007;62:328.
  3. Transvaginal sonographic characterization of ovarian disease: Evaluation of a new scoring system to predict ovarian malignancy. Obstet Gynecol 1991;78:70-76.
  4. Gynecol Oncol 2000;76:28-32.
  5. Transvaginal sonographic appearance of hemorrhagic ovarian cysts and their spontaneous regression. Int J Gynaecol Obstet 1994;44:47.
  6. Ovarian sonography. In: Donald School Textbook of Ultrasound in Obstetrics and Gynecology, 2nd edition. Jaypee Brothers: New Delhi, 2008.
  7. Preoperative evaluation of cystic teratoma: What does color Doppler add? J Clin Ultrasound 1997;25-309.
  8. Tumor angiogenesis: Therapeutic implications. N Engl J Med Nov 1971;18;285(21):1182-86.
  9. Tumor vascularisation, Dopler measurements and chaos: What to do? Ultrasound Obstet Gynecol 1995;5:209-10.
  10. C. luteum morphology and vascularisation assessed by Transvaginal 2 dimensonal and 3 dimensional ultrasound. Donald School Journal of Ultrasound in Obstetrics and Gynecology. April-June 2007;1(2):42-49.
  11. Transvaginal color Doppler and pelvic tumor neo-angiogenesis: Lessons learned and future challenges. Ultrasound Obstet Gynecol 1995;6:145-59.
  12. Comparative evaluation of blood vessels in serous tumors of the ovaries by color Doppler mapping and morphometry. Bull Exp Biol Med 2002,133:188-91.
  13. Contrast-enhanced three-dimensional power Doppler sonography for differentiation of adnexal masses. Obstet Gynecol 2000;96:452-58.
  14. The detection of stage 1 ovarian cancer by three- dimensional sonography and power Doppler. Gynecol Oncol 2003;90:258-64.
  15. 3D-PD imaging of ovarian pathologyadvantages and limitation of the method: How can we standardize the results? Donald School Journal of Ultrasound in Obstetrics and Gynecology Jan-March 2009;3(1):48-54.
  16. Tumor in the lower pelvis as imaged by vaginal sonography Gynaecol Oncol 1990;37:224-29.
  17. Classification of ovarian lesions with high frequency transvaginal sonography J Clin Ultrasound 1990;18:359.
  18. 3 dimensional ultrasonography and power Doppler in ovarian cancer screening of asymptomatik peri- and postmenopausal women. Croat Med J 2005;46:757-64.
  19. Ectopic pregnancy; In: Donald School Textbook of Ultrasound in Obstetrics and Gynecology, 2nd edition. Jaypee Brothers: New Delhi 2008;230-43.
  20. Ectopic pregnancy: Tansvaginal color Doppler flow in questionable adnexa. J Ultrasound Med 1991;10:695-99.
  21. Pathological findings of the postmenopausal endometrium. In: Osmers R, Kurjak A, eds. Ultrasound and the uterus. Carnforth, New York: Panthenon Publishing 1995;31-44.
  22. 426: The role of transvaginal ultrasonography in the evaluation of postenopausal bleeding. Obstet Gynecol 2009;113:462.
  23. Evaluation of the woman with postmenopausal bleeding: Society of Radiologists in Ultrasound-Sponsored Consensus Conference statement. J Ultrasound Med 2001;20:1025.
  24. Endometrial assessment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding. Am J Obstet Gynecol 1990;163:119.
  25. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding- A Nordic Multicenter Study. Am J Obstet Gynecol 1995;172:1488.
  26. Vaginosonography for early detection of endometrial carcinoma. Lancet 1990;1:1569-71.
  27. Clinical usefulness of endometrial screening by ultrasound in asymptomatic postmenopausal women. Maturitas 2004;48:421-24.
  28. Ultrasound in the postmenopause. Donald School textbook of ultrasound in Obstetrics and Gynecology. Jaypee Brothers: New Delhi 2008;Chapter 62:933.
  29. Transvagial sonography, saline contrast sono-hysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium > 5 mm. Ultrasound Obstet. Gynecol. 2001;18:157-62.
  30. Endometrial carcinoma in postmenopausal women:evaluation by transvaginal Color Doppler. Am J Obstet Gynecol 1993;169:1597-603.
  31. Detection of benign endometrial masses by endometrial stripe measurement in premenopausal women. Obstet Gynecol 2004;104:120.
  32. Saline infusion sonohysterography in endometrial cancer: Assessment of malignant cells dissemination risk. Acta Obstet Scand 2000;79:321.
  33. Three-dimensional ultrasound and power- Doppler in assessment of uterine and ovarian angiogenesis: A prospective study. Croatian Medical J 1999;8(1):1-5.
  34. Histopathologic features and risk factors for benignity, hyperplasia, and cancer in endometrial polyps. Am J Obstet Gynecol 2003;188:927.
  35. Genomic changes in endometrial polyps associated with tamoxifen show no evidence for its action as an external carcinogen. Cancer res 1998;58:2278.
  36. Four cytogenetic subgroups can be identified in endometrial polyps. Cancer res 1995;55:1565.
  37. Clinicopath findings in endometrial polyps. Obstet Gynecol 1988;71:77.
  38. Endometrial polyps and their implication in the pregnancy rate of patients undergoing intrauterine inseminaton. A prospective randomized study. Human Reprod 2005;20:1632.
  39. A prospective study to evaluate the efficacy of two-and threedimensional sonohysterography of women with intrauterine lesion. Fertil Steril 2003;79:1222.
  40. Estimating the date of confinement: ultrasonographic biometry versus certain menstrual dates. Am J Obstet Gynecol 1996;174:278.
  41. Performing a fetal anatomy scan at the time of 1st trim screening. Obstet Gynecol 2009;113:402.
  42. The 18-23 week scan. Diploma in fetal medicine and ISUOG educational series 2002.
  43. Fetal anomalies in a controlled one-stage ultrasound screening trial. A report from the Helsinki Ultrasound Trial. Perinat. Med 1994;22:279.
  44. A randomized trial of prenatal ultrasonographic screening: Impact on the detection, management and outcome of anomalous fetuses. The RADIUS Study Group. Am J Obstet Gynecol 1994;171:392.
  45. The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study. Am J Obstet Gynecol 1999;181:446.
  46. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 2001;103:1269.
  47. Detection of Transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation 1999;99:916.
  48. An attempt to introduce neurological test for fetus based on 3D and 4D sonography. Donald School Journal of Ultrasound in Obstetrics and Gynecology Oct-Dec 2008;2(4):29-44.
  49. Doppler in obstetrics. Diploma in fetal medicine and ISUOG educational series 2002.
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