For many years, the main use of ultrasound in the first trimester of pregnancy was to confirm viability and to establish gestational age. Indeed, the crown-rump length measurement in the first trimester remains the most accurate method to estimate the gestational age even today. However, improvements in ultrasound equipment and improvement in our understanding of normal and abnormal fetal development allows us now to perform a much more complete first trimester fetal evaluation. This pertains not only to the diagnosis of fetal anomalies but also to screening for fetal defects. The combination of the nuchal translucency measurement and maternal serum biochemistries (free β-hCG and PAPP-A) has been shown to be an extremely efficient way to screen for fetal aneuploidy. The addition of other first trimester markers such as the nasal bone evaluation, frontomaxillary facial angle measurement, and Doppler evaluation of blood flow across the tricuspid valve and through the ductus venosus improves the screening performance even further by increasing the detection rates and decreasing the false positive rates. Several of the first trimester markers also are useful in screening for cardiac defects. Furthermore, significant nuchal translucency thickening has been associated with a variety of genetic and nongenetic syndromes. A recently described first trimester marker called the intracerebral translucency appears to hold great promise in screening for open spine defects. Finally, it appears that a first trimester evaluation (uterine artery Doppler and the measurement of certain biochemical markers in the maternal serum) significantly improves the assessment of the risk of preeclampsia.

Preeclampsia and fetal growth restriction are major causes of perinatal mortality and morbidity. Several studies have shown that a generalized endothelial dysfunction is associated with these complications. Clinical trials have shown that pregnant women who demonstrate high resistance in uteroplacental blood flow are at higher risk for preeclampsia. Uterine artery Doppler studies both in the second and the first trimester can predict pregnancies at increased risk of the complications of impaired placentation. The sensitivity for predicting severe preeclampsia ranges between 80 and 90% for a false positive rate of 5 to 7%. Uterine artery Doppler screening at 20 to 24 weeks’ gestation is superior to first trimester screening, and appears to fulfill the requirements for a worthwhile screening test. Further research is needed to better assess the value of various combinations of uterine artery Doppler and maternal serum markers, for the prediction of adverse pregnancy outcome.

Conventionally, prenatal diagnosis is achieved by an invasive procedure followed by DNA analysis or hematological study. With experienced hand and a good ultrasound machine, a noninvasive approach consisting of serial two-dimensional ultrasound examinations of cardiothoracic ratio and placenta thickness can effectively reduce the need for invasive testing in the majority of unaffected pregnancies. Although middle cerebral artery peak systolic velocity (MCAPSV) is a well-established sonographic marker for predicting fetal anemia due to Rhesus isoimmunization, it is not clear whether MCAPSV is useful in the prediction of affected pregnancies. Preliminary studies have been performed to investigate the use of 3D ultrasound in the prediction of pregnancies affected by homozygous α⁰-thalassemia. It seems that 3D is not superior to 2D ultrasound prediction of affected pregnancies.

Three-dimensional (3D) and real-time three-dimensional (4D) technology, 3D power Doppler and high frequency transducers are being increasingly used in gynecological ultrasound. This treatise discusses practical aspects of these techniques and audits the utility and advantages of these indications in guiding and improving patient outcomes. Current literature places these techniques as a method of choice to image morbid pelvic anatomy and pathophysiology.

Magnetic resonance-guided focused ultrasound (MRgFUS) is a new treatment modality in treating uterine fibroid. It is noninvasive and can be done as out-patient procedure. It is the least invasive treatment option other than medical treatment. Early reports have demonstrated feasibility and safety. It is efficacious in symptom improve and fibroid volume reduction. This article reviews the principle, patient selection and treatment. Results from early trial and our center are summarized.

The advent of ultrasound and more recently three-dimensional ultrasound enables evaluation of functional anatomy of women's pelvic floor disorders. The observations in women's pelvic floor ultrasound showed that it is a promising modality not only in research but also clinical applications for the management of women's pelvic floor disorders in the future.

Laparoscopic ultrasound is initially developed to facilitate surgery for hepatobiliary and pancreatic cancers. With the advancement of laparoscopic surgery, laparoscopic ultrasound has been incorporated into laparoscopic surgery in order to combat against the limitation of laparoscopic surgery. In the management of gynecological malignancy, its role is mainly on the assessment of lymph nodes.

This article reviews the merits of three-dimensional (3D) ultrasound and thereby establishes its clinical and research role in reproductive medicine. Its main clinical applications include the assessment for uterine anomalies and intrauterine pathology, especially, if combined with the procedure of saline infusion into the uterine cavity. Moreover, 3D color Doppler sonography is an exciting research tool for the evaluation of endometrial receptivity, ovarian reserve, and polycystic ovaries.

Ultrasonography of the endometrium is a noninvasive way to evaluate the chance of successful implantation during in vitro fertilization treatment. Ultrasound parameters of endometrial receptivity include endometrial thickness, endometrial pattern, endometrial volume, Doppler studies of uterine vessels and the endometrium. Endometrial thickness, pattern and volume are not predictive of pregnancy. A good blood supply towards the endometrium is usually considered to be an essential requirement for implantation. Doppler study of uterine arteries does not reflect the actual blood flow to the endometrium. Endometrial and subendometrial vascularity can be more objectively measured with three-dimensional power Doppler ultrasound. However, the role of endometrial and subendometrial vascularity in predicting pregnancy of in vitro fertilization treatment remains controversial.

Cerebral palsy (CP) is the most common motor disability in childhood. It affects 2 to 2.5 children in 1000 live-births, with 20 to 30 fold increased prevalence in preterm infants. Despite of progress in perinatal care, the prevalence of cerebral palsy did not change in the last 50 years. New knowledge about etiological factors, such as inflammation, elevated level of cytokines, vascular strokes and genetic factors shift the origin of cerebral palsy mostly into antenatal period, making intrapartal damage responsible for less than 10% of cases. CP is becoming increasingly the subject of interdisciplinary research. Fetal neurosonography with a growing number of studies promises better understanding of the normal functional maturation of the human brain which may lead to effective prevention and treatment of cerebral palsy. Advances in 4D ultrasound resulted in development of KANET as tool for detection of abnormal fetal behavior.

The incidence of placenta accreta/percreta should rise steadily over the next century as the frequency of cesarean sections and advanced maternal age, both independent risk factors, increases. Patients who are at risk should be identified. The diagnosis of placenta previa accreta/percreta is possible by using gray-scale sonography, conventional color Doppler imaging and MRI through studying the relation of placenta to the uterine wall and nearby pelvic structures.

The potentially new modality of 3D and 3D color power Doppler ultrasound has it's value as a tool to achieve significantly increased diagnostic accuracy in the prediction of massive hemorrhage by assessing the extent, location and quantification of abnormal uteroplacental neovascularization. Hence, 3D ultrasound has the potential for providing additional information over conventional 2D ultrasound studies in the diagnosis of placenta previa percreta.

The diagnosis and anticipation of the problem achieve the best results for the obstetrician and the patient.