Ultrasound examination in obstetrics and gynecology
- Thomas D Shipp, MD, RDMS
Thomas D Shipp, MD, RDMS
- Associate Professor of Obstetrics, Gynecology, and Reproductive Biology
- Harvard Medical School
- Section Editors
- Susan M Ramin, MD
Susan M Ramin, MD
- Section Editor — Obstetrics
- The American Board of Obstetrics and Gynecology (ABOG)
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
The term "ultrasound" refers to sound waves of a frequency greater than that which the human ear can appreciate, namely frequencies greater than 20,000 cycles per second or Hertz (Hz). To obtain images of the pregnant or nonpregnant pelvis, frequencies of 2 to 10 million Hertz (2 to 10 megahertz [MHz]) are typically required.
Real-time imaging is the most common sonographic technique used in obstetrics and gynecology. Multiple individual B-mode gray-scale images are obtained and rapidly displayed in succession, thereby creating a video of the area of interest over time that can be used to evaluate its structure and some aspects of its function. Real-time ultrasound is especially useful for imaging mobile subjects, such as the fetus or heart, and for quickly viewing an organ from different orientations.
The physical principles of ultrasound imaging are discussed separately. (See "Basic principles and safety of diagnostic ultrasound in obstetrics and gynecology".)
BASIC PROCEDURE AND EQUIPMENT
Sonography, like surgery, is an operator-dependent technology. A high level of competence can only be achieved by supervised experience with a large variety of normal and abnormal examinations.
Preprocedure issues — The sonographer should know the reason for the ultrasound examination and results of other evaluations related to the patient's problem. All of this information is critical for targeting specific structures, choosing whether to use a transvaginal and/or transabdominal technique, and deciding whether additional studies may be helpful (eg, saline infusion sonohysterography, Doppler velocimetry).
- Benacerraf BR, Shipp TD, Bromley B. Is a full bladder still necessary for pelvic sonography? J Ultrasound Med 2000; 19:237.
- Reddy UM, Abuhamad AZ, Levine D, et al. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol 2014; 123:1070.
- Tempkin BB. Ultrasound Scanning: Principles and Protocols, 2nd ed, WB Saunders Co, Philadelphia 1999.
- American Institute of Ultrasound in Medicine website. Official Statements, Cleaning and Preparing Endocavity Ultrasound Transducers Between Patients. Approved June 4, 2003.
- Brant WE. Ultrasound: The core curriculum, Lippencott, Williams & Wilkins, New York 2001.
- Whittingham TA. New and future developments in ultrasonic imaging. Br J Radiol 1997; 70 Spec No:S119.
- Desser TS, Jeffrey RB. Tissue harmonic imaging techniques: physical principles and clinical applications. Semin Ultrasound CT MR 2001; 22:1.
- Roberts WE. Practical and financial considerations that affect selection and purchase of ultrasound equipment. Obstet Gynecol Clin North Am 1998; 25:663.
- American Institute of Ultrasound in Medicine, Standards AIUM Practice Guideline for the performance of the antepartum obstetrical ultrasound examinations. American Institute of Ultrasound in Medicine, Laurel, MD 2007.
- American Institute of Ultrasound in Medicine, Guidelines for performance of the ultrasound examination of the female pelvis. American Institute of Ultrasound in Medicine, Laurel, MD 2004.
- Benacerraf BR, Shipp TD, Bromley B. How sonographic tomography will change the face of obstetric sonography: a pilot study. J Ultrasound Med 2005; 24:371.
- Benacerraf BR, Shipp TD, Bromley B. Improving the efficiency of gynecologic sonography with 3-dimensional volumes: a pilot study. J Ultrasound Med 2006; 25:165.
- Benacerraf BR, Shipp TD, Bromley B. Three-dimensional US of the fetus: volume imaging. Radiology 2006; 238:988.
- Rizzo G, Abuhamad AZ, Benacerraf BR, et al. Collaborative study on 3-dimensional sonography for the prenatal diagnosis of central nervous system defects. J Ultrasound Med 2011; 30:1003.
- Bermejo C, Martínez Ten P, Cantarero R, et al. Three-dimensional ultrasound in the diagnosis of Müllerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound Obstet Gynecol 2010; 35:593.
- Benacerraf BR, Shipp TD, Bromley B. Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding. Ultrasound Obstet Gynecol 2009; 34:110.
- Williams EA, Iriye BK, O'Keefe D. White Paper - Telemedicine in the MFM setting. Association for Maternal Fetal Medicine Management 2014. http://new.amfmm.com/Portals/0/Documents/Telemedicine-In-The-MFM-Setting.pdf (Accessed on October 01, 2014).
- Reddy UM, Abuhamad A, Saade GR. Fetal imaging. Semin Perinatol 2013; 37:289.
- Practice Bulletin No. 175: Ultrasound in Pregnancy. Obstet Gynecol 2016; 128:e241.
- Salomon LJ, Alfirevic Z, Berghella V, et al. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2011; 37:116.
- Wax J, Minkoff H, Johnson A, et al. Consensus report on the detailed fetal anatomic ultrasound examination: indications, components, and qualifications. J Ultrasound Med 2014; 33:189.
- Glanc P, Bhosale PR, Harris RD, Kang S, Pandharipande PV, Salazar GM, Shipp TD, Simpson L, Sussman BL, Wall DJ, Zelop CM, Javitt MC, Expert Panel on Women's Imaging. ACR Appropriateness Criteria® assessment of gravid cervix [online publication]. Reston (VA): American College of Radiology (ACR); 2014.
- AIUM Practice Guideline for the Performance of Pelvic Ultrasound Examinations. American Institute of Ultrasound in Medicine. Laurel, MD 2009.
- Timor-Tritsch IE, Monteagudo A. Scanning techniques in obstetrics and gynecology. Clin Obstet Gynecol 1996; 39:167.
- Goldstein SR, Horii SC, Snyder JR, et al. Estimation of nongravid uterine volume based on a nomogram of gravid uterine volume: its value in gynecologic uterine abnormalities. Obstet Gynecol 1988; 72:86.
- Kung FT, Chang SY. The relationship between ultrasonic volume and actual weight of pathologic uterus. Gynecol Obstet Invest 1996; 42:35.
- Merz E, Miric-Tesanic D, Bahlmann F, et al. Sonographic size of uterus and ovaries in pre- and postmenopausal women. Ultrasound Obstet Gynecol 1996; 7:38.
- Benacerraf BR, Shipp TD, Lyons JG, Bromley B. Width of the normal uterine cavity in premenopausal women and effect of parity. Obstet Gynecol 2010; 116:305.
- ACOG Committee Opinion, The role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding. Number 440. The American College of Obstetricians and Gynecologists, Washington, DC 2009.
- Dietz HP. Pelvic floor ultrasound: a review. Am J Obstet Gynecol 2010; 202:321.
- American Institute of Ultrasound in Medicine, Training guidelines for physicians who evaluate and interpret diagnostic ultrasound examinations. American Institute of Ultrasound in Medicine, Laurel, MD 2000.
- Baker JP, Coffin CT. The importance of an ergonomic workstation to practicing sonographers. J Ultrasound Med 2013; 32:1363.
- Salomon LJ, Alfirevic Z, Bilardo CM, et al. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2013; 41:102.
- Leung KY, Poon CF, Teotico AR, et al. Recommendations on routine mid-trimester anomaly scan. J Obstet Gynaecol Res 2015; 41:653.
- BASIC PROCEDURE AND EQUIPMENT
- Preprocedure issues
- - Obesity
- Patient position
- Transducers and probes
- Manual settings
- Scanning and documentation
- ADVANCED TECHNIQUES
- Three-dimensional sonography
- Four-dimensional sonography
- Doppler ultrasound
- OBSTETRICAL SONOGRAPHY
- Basic examination
- Limited examination
- Detailed examination
- Transabdominal examination
- Transvaginal examination
- Nonmedical use
- GYNECOLOGIC SONOGRAPHY
- Pelvic floor sonography
- HUMAN FACTORS AND ERGONOMICS
- GUIDELINES FROM NATIONAL ORGANIZATIONS
- SUMMARY AND RECOMMENDATIONS