Gynaecological Ultrasound in Clinical Practice: Ultrasound Imaging in the Management of Gynaecological Conditions (Royal College of Obstetricians and Gynaecologists Advanced Skills)

247 Pages·2009·5.151 MB·English

by  Davor Jurkovic (editor), Lil Valentin (editor), Sanjay Vyas (editor)

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The use of ultrasound imaging in gynaecology goes well
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beyond simple picture recognition. A skilful gynaecological
Gynaecological
sonographer will bring together scan findings and the clinical
scenario to enhance patient care. This leads to targeted
investigations and, just as importantly, to strategies for non-
Ultrasound in
intervention. This book covers all aspects of the use of
ultrasound and also includes chapters on clinical gynaecology,
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to assist in making the best possible use of the technology. l V Clinical Practice
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Just as one could never imagine a cardiologist without a na
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stethoscope, it is hard to imagine a gynaecologist without an an r Jdite
ultrasound scanner. This book will be a reference source for all d ud
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gynaecologists to aid their clinical practice. aoy
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RCOG Press
Royal College of Obstetricians and Gynaecologists
27 Sussex Place,
Regent’s Park, Edited by
London Davor Jurkovic, Lil Valentin
NW1 4RG
www.rcog.org.uk and Sanjay Vyas
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18.5mm
Gynaecological Ultrasound in Clinical Practice

Gynaecological Ultrasound
in Clinical Practice
Ultrasound imaging in the management
of gynaecological conditions
Edited by Davor Jurkovic, Lil Valentin and Sanjay Vyas
© 2009 Royal College of Obstetricians A machine-readable catalogue record

and Gynaecologists for this publication is available from the

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First published 2009 listings.html]

All rights reserved. No part of this Published by the RCOG Press at the

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transmitted in any form or by any means, Gynaecologists

without the prior written permission 27 Sussex Place, Regent’s Park

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Drugs and their doses are mentioned
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isbn 978-1-904752-29-5
Contents
About the authors vii
Abbreviations ix
Preface xi
1 U ltrasound imaging in gynaecological practice 1
A manda J O’Leary, Harsit R Tejura and Sanjay Vyas
2 Normal pelvic anatomy 7
Lil Valentin and Sturla Eik-Nes
3 The uterus 17
Rehan Salim and Davor Jurkovic
4 P ostmenopausal bleeding: presentation and investigation 29
Christopher Lee and Davor Jurkovic
5 H RT, contraceptives and other drugs affecting
the endometrium 43
Louise Melson and Timothy Hillard
6 D iagnosis and management of adnexal masses 55
Lil Valentin
7 U ltrasound assessment of women with pelvic pain 67
Lil Valentin
8 U ltrasound of non-gynaecological pelvic lesions 77
Michael John Weston
9 U ltrasound imaging in reproductive medicine 91
Povilas Sladkevicius
10 U ltrasound imaging of the lower urinary tract and
uterovaginal prolapse 107
Charlotte Chaliha and Vikram Khullar
11 U ltrasound and diagnosis of obstetric anal sphincter injuries 121
Abdul H Sultan and Ranee Thakar
12 O rganisation of the early pregnancy unit 133
Emma Sawyer and Davor Jurkovic
13 Sonoembryology: ultrasound examination of early pregnancy 143
Harm-Gerd Karl Blaas and Sturla Eik-Nes
14 Diagnosis and management of miscarriage 159
Johanna Trinder and Sanjay Vyas
15 Tubal ectopic pregnancy 179
Davor Jurkovic
16 Non-tubal ectopic pregnancies 193
Joseph Yazbek and Davor Jurkovic
17 Ovarian cysts in pregnancy 211
J oseph Yazbek, Christopher Lee and Davor Jurkovic
Index 229
vii
About the authors
Harm-Gerd Karl Blaas
National Centre for Fetal Medicine, Department of Obstetrics and
Gynaecology, University Hospital of Trondheim, Norway
Charlotte Chaliha MRCOG
Consultant Obstetrician and Gynaecologist, Royal London Hospital,
Whitechapel, London, UK
Sturla Eik-Nes MD PhD
Professor, National Centre for Fetal Medicine, St Olav’s Hospital,
University of Trondheim, Norway
Timothy Hillard DM FRCOG
Consultant Gynaecologist, Department of Obstetrics and Gynaecology,
St Mary’s Maternity Unit, Poole Hospital, Poole, UK
Davor Jurkovic MD FRCOG
Consultant Gynaecologist, Department of Obstetrics and Gynaecology,
University College Hospital, London, UK
Vikram Khullar MRCOG
Consultant Obstetrician and Gynaecologist, Department of Obstetrics
and Gynaecology, St Mary’s Hospital, London, UK
Christopher Lee MRCOG
Research Fellow, Early Pregnancy and Gynaecology Assessment Unit,
King’s College Hospital, London, UK
Louise Melson MRCOG
Specialist Registrar, Department of Obstetrics and Gynaecology,
St Mary’s Maternity Unit, Poole Hospital, Poole, UK
Amanda J O’Leary MRCOG
Specialist Registrar, Llandough Hospital, Penarth, Wales, UK
Rehan Salim MD MRCOG
Consultant Gynaecologist, Department of Obstetrics and Gynaecology,
University College Hospital, London, UK
viii
Emma Sawyer MB BS
Research Fellow, Early Pregnancy and Gynaecology Assessment Unit,
King’s College Hospital, London, UK
Povilas Sladkevicius MD PhD
Consultant, Department of Obstetrics and Gynecology, Malmö
University Hospital, Lund University, Malmö, Sweden
Abdul H Sultan MD FRCOG
Consultant Obstetrician and Gynaecologist, Department of Obstetrics
and Gynaecology, Mayday University Hospital, Croydon, Surrey, UK
Harsit R Tejura MRCOG
Specialist Registrar, Neville Hall Hospital, Abergavenny, Wales, UK
Ranee Thakar MD MRCOG
Consultant Obstetrician and Urogynaecologist, Department of
Obstetrics and Gynaecology, Mayday University Hospital, Croydon,
Surrey, UK
Johanna Trinder MRCOG
Consultant Obstetrician, Department of Obstetrics and Gynaecology,
St Michael’s Hospital, Bristol, UK
Lil Valentin MD PhD
Professor of Obstetrics and Gynaecology, Lund University, University
Hospital, Malmö, Sweden
Sanjay Vyas MD FRCOG
Consultant Obstetrician and Gynaecologist, Southmead Hospital,
Bristol, UK
Michael John Weston MRCP FRCR
Consultant, Department of Ultrasound, St James’ University Hospital,
Leeds, UK
Joseph Yazbek MB BS
Research Fellow, Early Pregnancy and Gynaecology Assessment Unit,
King’s College Hospital, London, UK
ix
Abbreviations
A&E accident and emergency

AP anterior–posterior

BPD biparietal diameter

CI confidence interval

CNS central nervous system

CO2 carbon dioxide

COMS cerebro-oculomuscular syndrome

CRL crown–rump length

CSM Committee on Safety of Medicines

CT computed tomography

D&C dilatation and curettage

DPMA depot medroxyprogesterone acetate

EED early embryonic demise

ERPC evacuation of retained products of conception

ET endometrial thickness

FSH follicle-stimulating hormone

GnRH gonadotrophin-releasing hormone

hCG human chorionic gonadotrophin

HRT hormone replacement therapy

HSG hysterosalpingography

HyCoSy hystero-contrast sonography
Hz hertz
IUCD intrauterine contraceptive devices

IUI intrauterine insemination

IVF in vitro fertilisation

LBWC limb–body wall complex
LH luteinising hormone

LMP last menstrual period

MHz megahertz

MRI magnetic resonance imaging

MSD mean gestational sac diameter
MVA manual vacuum aspiration
OHSS ovarian hyperstimulation syndrome
OIES omphalocele, exstrophy, imperforate anus, spinal defects
OR odds ratio
PCOS polycystic ovary syndrome
PMB post-menopausal bleeding
RCOG Royal College of Obstetricians and Gynaecologists