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Peter M. Doubilet - Atlas of Ultrasound in Obstetrics and Gynecology: A Multimedia Reference

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Atlas ofUltrasound in Obstetrics and Gynecology
A Multimedia Reference

SECOND EDITION

Peter M. Doubilet, MD, PhD

Professor of Radiology
Harvard Medical School
Senior Vice Chair of Radiology
Brigham and Womens Hospital
Boston, Massachusetts

Carol B. Benson, MD

Professor of Radiology
Harvard Medical School
Director of Ultrasound and Co-Director of High-Risk
Obstetrical Ultrasound
Brigham and Womens Hospital
Boston, Massachusetts

Acquisitions Editor Charles W Mitchell Product Manager Ryan Shaw Vendor - photo 1

Acquisitions Editor: Charles W. Mitchell
Product Manager: Ryan Shaw
Vendor Manager: Alicia Jackson
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2012 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business
Two Commerce Square
2001 Market Street
Philadelphia, PA 19103 USA
LWW.com

All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright.

Printed in China

Library of Congress Cataloging-in-Publication Data

Doubilet, Peter M.
Atlas of ultrasound in obstetrics and gynecology : a multimedia reference / Peter M. Doubilet, Carol B. Benson.2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-60831-778-3 (alk. paper)
1. Generative organs, FemaleUltrasonic imagingAtlases.
2. Ultrasonics in obstetricsAtlases. 3. FetusDiseases
DiagnosisAtlases. I. Benson, Carol B. II. Title.
[DNLM: 1. Ultrasonography, PrenatalAtlases. 2. Fetal
DiseasesultrasonographyAtlases. 3. Genital Diseases,
FemaleultrasonographyAtlases. WQ 17] RG107.5.U4D68 2011
618.107543dc22

2011008576

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner.

The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice.

To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300.

Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST.

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Online Video Icon

Figure legends with the website icon (Picture 2) have real-time ultrasound video clips in the corresponding figure on the online version of the Atlas.

Preface

Ultrasound emerged as a major tool in medical imaging in the 1970s, and it has been on a sustained trajectory of technological improvement ever since. As sonography has moved from static to real time, from black-and-white to shades of gray to color depiction of blood flow, and from unidimensional (A-mode) to two to three to four dimensional, its utility and range of applications have grown impressively.

Nowhere has the impact of ultrasound been more dramatic than in obstetrics and gynecology. The ability of sonography to detect fetal abnormalities prior to delivery, to diagnose gynecological diseases without surgery, and to direct minimally invasive therapy has revolutionized these fields of medicine.

All of these considerations led us to write the first edition of this Atlas, which was published in 2003. Since then, impressive advances in technology have prompted us to produce this second edition. Ultrasound image resolution has improved, allowing more accurate and confident diagnoses. The improvements have been especially dramatic in three-dimensional sonography, leading to considerably greater use of this technique in obstetrical and gynecological imaging. Because of these changes, the majority (over 90%) of the images and video clips in this second edition are new.

Another change since 2003 is increased access to high-speed Internet connections. So, instead of including with the book a compact disk (CD) to show real-time video clips, this second edition has a parallel version online. This will allow readers not only to see the video clips in motion, but also to access the full text and images wherever they have Internet access.

Ultrasound interpretation depends heavily on pattern recognition: identifying normal structures and establishing specific diagnoses from patterns of abnormal anatomy. As such, we anticipate that this Atlas will be useful in both clinical and educational settings. In the clinical arena, the Atlas can serve as a reference, to be pulled off the shelf when there is an abnormal sonographic finding for which the diagnosis is unclear. On the educational front, the Atlas can serve as a learning and study tool, as it offers up-to-date images and clips covering a wide range of obstetrical and gynecological entities. We hope that the Atlas, in both its book and online formats, is a useful addition to the growing body of ultrasound literature.

Acknowledgments

We are grateful to our colleagues and co-workers in the Brigham and Womens Hospital Radiology Department Ultrasound Section, as well as the joint Radiology-Obstetrics High-Risk Obstetrical Ultrasound Unit. Their expertise and hard work has made our institution a center of excellence in ultrasound.

SECTION I
Obstetrical Ultrasound
CHAPTER
First Trimester
1.1. Normal Pregnancy Prior to 6 Weeks of Gestation
Description and Clinical Features

Fertilization occurs at approximately 14 days after the beginning of the last menstrual period (LMP). Within 34 days, the zygote (fertilized egg) has traveled along the fallopian tube and reached the uterus, and, via cell division, has grown to a sphere of 1215 cells. Over the same time period, the endometrium becomes thicker and richer in blood vessels, ready to support the developing pregnancy. This change in the endometrium occurs because of stimulation from the hormone beta-human chorionic gonadotropin (-HCG), which is produced by the corpus luteum, the remnant of the ovarian follicle that released the ovum before fertilization. The altered endometrium is called the decidua. By 56 days after fertilization, the collection of cells (now called a blastocyst) implants into the decidua. At about 2 weeks after fertilization, close to the expected time of the next menses, a blood or urine pregnancy test (which checks for the presence of -HCG in these fluids) first becomes positive.

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