A Practical Guide to Real-Time Office Sonography in Obstetrics and Gynecology
A Practical Guide to Real-Time Office Sonography in Obstetrics and Gynecology Robert V. Giglia, R. T., R.D.M.S. Kara L. Mayden, R. T., R.D.M.S. and Norbert Gleicher, M.D. Rush Medical College and Mount Sinai Hospital and Medical Center of Chicago Chicago, Illinois With the collaboration of Haim Elrad, M.D., and Jan Friberg, M.D., Ph.D. PLENUM MEDICAL BOOK COMPANY New York and London
Library of Congress Cataloging in Publication Data Giglia, Robert V. A practical guide to real-time office sonography in obstetrics and gynecology. Includes bibliographies and index. 1. Ultrasonics in obstetrics. 2. Generative organs, Female - Diseases - Diagnosis. 3. Diagnosis, Ultrasonic. I. Mayden, Kara L. II. Gleicher, Norbert. III. Title. [DNLM: 1. Genital Diseases, Female-diagnosis. 2. Pregnancy Complications-diagnosis. 3. Prenatal Diagnosis-methods. 4. Ultrasonic Diagnosis. WQ 209 G459p) RG527.5.U48G54 1986 618 85-12033 ISBN-13: 978-0-306-41865-5 e-isbn-13: 978-1-4615-8348-6 001: 10.1007/978-1-4615-8348-6 1986 Plenum Publishing Corporation Softcover reprint of the hardcover 1 st ed ition 1986 233 Spring Street, New York, N. Y. 10013 Plenum Medical Book Company is an imprint of Plenum Publishing Corporation All righ ts reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher
This book is dedicated to my parents, whose support and love made this book and my career possible. Robert V. Giglia I dedicate this book to my father and mother, who have inspired, guided, and encouraged me in my personal and professional evolution. Kara L. Mayden To my family. Norbert Gleicher
Contents Introduction... ix Chapter 1 Indications for Sonography... 1 Chapter 2 ACOG/AIUM Recommendations... 3 Chapter 3 Principles of Real-Time Sonography... 7 PART I. REAL-TIME SONOGRAPHY IN OBSTETRICS Chapter 4 Normal Fetal Anatomy... 13 Chapter 5 Cord and Placenta... 41 Chapter 6 Amniocentesis... 51 Chapter 7 Gestational Dating... 55 Chapter 8 Fetal Growth and Weight Estimation... 75 Chapter 9 Diabetes Mellitus... 93 Chapter 10 Erythroblastosis Fetalis and Other Immune Sensitizations of the Fetus... 97 Chapter 11 Nonimmunologic Hydrops... 101 Chapter 12 Multiple Pregnancies... 105 Chapter 13 First Trimester Bleeding... 113 Chapter 14 Ectopic Pregnancy... 119 Chapter 15 Molar Pregnancy... 123 Chapter 16 Second and Third Trimester Bleeding... 127 Chapter 17 Abnormal Fetal Anatomy: Level II Sonography... 133 vii
PART II. REAL-TIME SONOGRAPHY IN GYNECOLOGY Chapter 18 Principles of Gynecologic Sonography... 165 Chapter 19 Normal Pelvic Anatomy... 169 Chapter 20 Follicular Sonography... 185 Chapter 21 Abnormal Pelvic Anatomy... 199 Chapter 22 Nongynecologic Pelvic Sonography... 213 Chapter 23 Ascites... 217 Index... 221 viii CONTENTS
Introduction Real-time ultrasonography has entered office practice in obstetrics and gynecology. With increasing numbers of sonography systems entering the ambulatory office setting, obstetric sonography at a routine level (level I) has largely been the targeted area. Recent developments in gynecologic real-time sonography have, however, significantly enlarged the sphere of applicability of sonographic equipment in an office setting. The very rapid growth of follicular sonography in infertility assessment and management has made real-time sonography of increasing importance to the gynecologic practitioner. In office settings like the authors', gynecologic office sonography represents close to 50% of all ordered sonography. This handbook of office sonography in obstetrics and gynecology was conceived to reflect these changes in practice patterns. This volume is not meant to replace standard sonography texts for the full-time sonographer but is instead directed toward the practicing obstetrician/gynecologist who uses real-time sonography in the office setting within the framework of daily practice. Technical comments were therefore restricted to a minimum, with practical advice and photographic examples taking their place. Most of the sonographic real-time images were retrieved from the authors' own files. However, some were obtained through the generosity of friends and colleagues, for which we would like to extend acknowledgment and appreciation. Similar appreciation is extended to Dr. Haim Elrad and Dr. Jari Friberg, who also participated in the editorial process; to Sheila Martin, who performed superbly as our editorial assistant, a most difficult responsibility; and to Hilary Evans, our editor at Plenum Publishing Corporation. Robert V. Giglia Kara L. Mayden Norbert Gleicher ix
A Practical Guide to Real-Time Office Sonography in Obstetrics and Gynecology