Endosonography in Obstetrics and Gynecology

ISBN-13: 9783642741135 / Angielski / Miękka / 2011 / 187 str.

Gerhard Bernaschek; Josef Deutinger; Alfred Kratochwil

Opis

More than 25 years ago, when ultrasound diagnostic methods were first intro duced into gynecology and obstetrics, few of the pioneers of these techniques sus pected what importance sonographic diagnosis was destined to assume. It was soon recognized that the organs of the lesser pelvis could be visualized to much greater advantage by inserting probes into the natural bodily orifices than by abdominal sonography. Full exploitation of the physical properties of ultra sound had to wait, as so often in the history of sonography, for technological ad vances. Endosonography in the form available to us today combines the advantages of endoscopy and sonography. The next light-reflecting surface, once the limit of en doscopy, represents no barrier to ultrasound. A whole range of both diagnostic and therapeutic procedures can be sonographically guided. Blood flow in vessels lying deep in the lesser pelvis can now be measured by means of vaginal duplex sonography."

Spis treści

History of Endosonography.- References.- Safety Aspects of Endosonography.- 1 Biologic Effects of Ultrasound.- 1.1 Thermal Effects.- 1.2 Cavitation.- 1.3 Chromosome Damage.- 1.4 Sister Chromatid Exchange Rate.- 1.5 Epidemiologic Studies.- 1.6 Carcinogenesis.- 1.7 Statistical Considerations.- 1.8 Summary.- 2 Sterilization of Vaginal Probes.- References.- Advantages and Disadvantages of Endosonography.- 1 Advantages.- 2 Disadvantages.- Scanner Types.- 1 Linear-Array Scanners.- 2 Curved-Array Scanners.- 3 Sector Scanners.- Scan Planes.- 1 Definition of Scan Directions.- 2 Definition of Scan Planes.- Orientation of Scan Planes.- Reference.- Endosonographic Procedures.- 1 Vaginosonography.- 2 Hysterosonography.- 3 Rectosonography.- 4 Cystosonography.- References.- Normal Early Pregnancy.- 1 Chorionic Cavity.- 1.1 General.- 1.2 Vaginosonography.- 1.3 Recognition of Pseudogestational Sac.- 1.4 Correlation Between Chorionic Cavity and ß-hCG.- 1.4.1 Earliest Detection with Vaginosonography.- 1.4.2 Discriminatory Limit.- 2 Yolk Sac.- 2.1 General.- 2.2 Vaginosonography.- 3 Embryo.- 3.1 General.- 3.2 Vaginosonography.- 4 Cardiac Activity.- 4.1 General.- 4.2 Vaginosonography.- 5 Amniotic Cavity.- 5.1 General.- 5.2 Vaginosonography.- 6 Other Biometrie Data in the First Trimester.- 6.1 Biparietal Diameter.- 6.2 Trunk Diameter.- 6.3 Umbilical Cord and Placenta.- 7 Multiple Pregnancy.- 8 Summary.- References.- Disorders of Early Pregnancy.- 1 General.- 2 Threatened Abortion.- 3 Blighted Ovum.- 4 Missed Abortion.- 5 Incomplete Abortion.- 6 Hydatidiform Mole.- 7 Ectopic Pregnancy.- 7.1 General.- 7.2 Exclusion of Intrauterine Pregnancy.- 7.2.1 Recognition of a Pseudogestational Sac.- 7.2.2 Discriminatory Limit.- 7.3 Demonstration of an Intact Ectopic Pregnancy in the Adnexal Region.- 7.4 Nonspecific Masses in the Adnexal Region.- 7.5 Free Fluid in the Abdomen.- 7.6 Uncommon Sites of Ectopic Pregnancy.- 7.7 Summary.- References.- Vaginosonographic Examination of the Fetus.- 1 General.- 2 Indications.- 2.1 Examination of the Fetus in the First Half of Pregnancy.- 2.1.1 Biometry.- 2.1.2 Visualization of Fetal Organs.- 2.1.3 Screening for Anomalies.- 2.1.4 Anhydramnios.- 2.1.5 Sex Determination.- 2.1.6 2.2 Examination of the Fetus in the Second Half of Pregnancy.- 2.2.1 Examination of the Presenting Part.- 2.2.2 Vaginal Pulsed Doppler Examination of Fetal Arteries.- References.- Evaluation of the Cervix.- 1 General.- 2 Vaginosonography.- References.- Placenta Previa.- 1 General.- 2 Vaginosonography.- 3 Summary.- References.- Vaginosonographic Pelvimetry.- 1 General.- 2 Technique and Preliminary Results.- 3 Summary.- References.- Endosonography of the Uterus.- 1 Normal Anatomy.- 1.1 Size.- 1.2 Version and Flexion.- 2 Congenital Anomalies.- 3 Diagnosis of Myomas.- References.- Endosonography of the Ovaries.- 1 The Normal Ovary.- 2 Ovarian Cysts.- 2.1 Corpus Luteum Cysts.- 2.2 Dermoid Cysts.- 2.3 Endometriotic Cysts.- 2.4 Multiloculated Cysts.- 2.5 Ovarian Carcinoma.- 3 Inflammatory Adnexal Changes.- References.- Postoperative Endosonography.- References.- Intrauterine Contraceptive Devices.- 1 General.- 2 Vaginosonography.- References.- Endosonographic Diagnosis of Carcinoma.- 1 Cervical Carcinoma.- 1.1 General.- 1.2 Staging.- 1.2.1 Rectosonography Vs Vaginosonography.- 1.2.2 Intracervical Extent of Disease.- 1.2.3 Vaginal Infiltration.- 1.2.4 Parametrial Infiltration.- 1.2.5 Infiltration of the Bladder Wall and Rectum.- 1.2.6 Comparison of CT, MRI, and Endosonography.- 1.3 Follow-up of Inoperable Cervical Carcinoma.- 2 Corpus Carcinoma.- 2.1 General.- 2.2 Early Detection.- 2.3 Staging.- 2.3.1 Hysterosonography.- 2.3.1.1 Carcinoma Confined to the Endometrium.- 2.3.1.2 Myometrial Invasion.- 2.3.1.3 Extension to the Cervix.- 2.3.2 Vaginosonography.- 2.4 Summary.- 3 Ovarian Carcinoma.- 3.1 General.- 3.2 Early Detection.- 4 Vaginal Carcinoma.- 5 Diagnosis of Recurrent Carcinoma.- 5.1 General.- 5.2 Detection of Recurrence.- References.- Diagnostic Evaluation of Urinary Incontinence.- 1 General.- 2 Vaginosonography and Rectosonography.- 3 Perineal and Introital Sonography.- References.- Infertility.- 1 General.- 2 Evaluation of the Menstrual Cycle.- 2.1 General.- 2.2 Visualization and Measurement of the Follicles.- 2.3 Corpus Luteum.- 2.4 Cyclic Endometrial Changes.- 2.5 Correlation of Folliculometry with Hormonal Parameters.- 2.6 Doppler Measurements of Blood Vessels in the Lesser Pelvis.- 3 Endocrine Disorders.- 3.1 Corpus Luteum Insufficiency.- 3.2 LUF Syndrome.- 3.3 PCO Syndrome.- 4 In Vitro Fertilization.- 4.1 General.- 4.2 Stimulation Therapy.- 4.3 Determining the Time of Ovulation.- 4.4 Inadequate Stimulation Therapy.- 4.4.1 Hyperstimulation.- 4.4.2 Insufficient Stimulation.- 4.5 Follicular Aspiration.- 4.5.1 Laparotomy and Laparoscopy.- 4.5.2 Ultrasound-Guided Aspiration Methods.- 4.5.3 Vaginal Follicular Aspiration Guided by Vaginosonography.- 4.6 Embryo Transfer.- 5 Summary.- References.- Endosonographically Guided Punctures.- 1 General.- 2 Technical Aspects.- 2.1 Scanner Types.- 2.2 Freehand Needle Technique.- 2.3 Needle Guides.- 2.4 Preparation of the Patient.- 3 Indications.- 3.1 Follicular Aspiration.- 3.1.1 General.- 3.1.2 Vaginal Follicular Aspiration Guided by Vaginosonography.- 3.2 Aspiration of Cysts.- 3.2.1 Cyst Wall Biopsy.- 3.2.2 Sclerotherapy.- 3.2.3 Abscess Drainage.- 3.3 Puncture of Tubal Pregnancy.- 3.4 Selective Embryocide.- 3.4.1 General.- 3.4.2 Ultrasound-Guided Embryocide.- 3.5 Fine-Needle Aspiration Biopsy.- 3.6 Chorionic Biopsy.- 3.6.1 General.- 3.6.2 Chorionic Biopsy Using a Vaginal Scanner.- 3.7 Vaginal Decompression of Hydrocephalus.- References.- Vaginal Doppler Techniques.- 1 Basic Principles of Doppler Ultrasound.- 2 Vaginal Probes.- 2.1 Continuous Wave Doppler.- 2.2 Pulsed Doppler.- 2.3 Doppler Waveforms.- 3 Vaginal Pulsed Doppler Techniques.- 3.1 Examination Procedure.- 3.2 Advantages of Vaginal Doppler.- 4 Clinical Applications.- 4.1 The Uterine Artery.- 4.1.1 Normal Pregnancy.- 4.1.2 Complicated Pregnancy.- 4.2 Fetal Vessels.- 4.2.1 Early Pregnancy.- 4.2.2 The Fetal Internal Carotid Artery.- 4.3 Uterine Artery Flow in Cervical Carcinoma.- 4.4 Infertility.- 4.4.1 Failure of Implantation After Embryo Transfer.- 4.4.2 The Ovarian and Iliac Arteries in Stimulated Cycles.- 5 Clinical Significance of Vaginal Pulsed Doppler Blood Flow Studies.- References.- Subject Index 183.

O autorze

Pioneers in the use of endosonography in obgyn provide a practical manual on all areas of application (transvaginal, cervical, rectal, vesical).