fetal imaging

Question 1

what is the anatomy of the uterus?

Answer 1

hollow muscular organ

7.5cm in length in the non-pregnant woman and consists of: a main portion (body), with an elongated lower part (neck), the opening (os), the upper rounded portion of the uterus is the fungus.
at each extremity of the fallopian tubes join the uterus.

the uterus is supported in the pelvic cavity by:
the broad ligaments, round ligament, cardinal ligaments and rectouterine and veslcouterine folds or ligaments..

Question 2

why is a trans vaginal USS used?

Answer 2

A transvaginal ultrasound is usually performed to view the endometrium or the lining of the uterus, including its thickness, and the ovaries.

Transvaginal ultrasound also affords a good way to evaluate the muscular walls of the uterus, called the myometrium.

Question 3

what does sonohysterography allow for?

what can you detect with one

Answer 3

Sonohysterography allows for a more in-depth investigation of the uterine cavity. These exams are typically performed to detect:
uterine anomalies uterine scars endometrial polyps fibroids
cancer, especially in patients with abnormal uterine bleeding
Some physicians also use sonohysterography for patients with infertility.

Question 4

what are the benefits of USS?

Answer 4

Benefits.
Ultrasound
Ultrasound is the preferred imaging modality for the diagnosis and monitoring of pregnant women and their unborn babies.
Ultrasound provides real-time imaging, making it a good tool for guiding minimally invasive procedures such as needle biopsies and needle aspiration.
Pelvic ultrasound can help to identify and evaluate a variety of urinary and reproductive system disorders in both sexes without even the minimal risks associated with x-ray exposure.

Question 5

what would you image for infertility?

Answer 5

Cervix
Uterine cavity
Fallopian tubes
ovaries

Question 6

how is a hysterosalpinography carried out?

Answer 6

Catheter inserted into the uterine cavity

Contrast injected into the cavity under pressure

Contrast track along the fallopian tubes

X Ray image obtained

Question 7

why do we image pregnancy?

Answer 7

for safety

to pick things up and safety for mother and baby

Question 8

when do we image pregnancy?

Answer 8

• Early scan if clinical reason
• 12 week dating scan
• 20 week anomaly scan
• Additional scans depending on clinical need

Question 9

what do you look for on the 12 week scan?

Answer 9

nucheal translucency?
Heart beat to assess viability
Crown rump length to date the pregnancy
Number of fetuses

Question 10

what do you look for on the 20 week scan?

Answer 10

To detect any abnormality
– Detailed whole body scan
To assess the nature of the abnormality
– Viable or not
To assess the extent of the abnormality
– Referral to fetal maternal specialist 
Assess placenta and its location

Question 11

what additional investigations may you do?

Answer 11

– Blood test
– Amniocentesis
– Further ultrasound
– Magnetic resonance imaging

Question 12

what is the risk of amniocentesis?

Answer 12

increased risk of miscarriage.

Question 13

when and why are MRI used?

Answer 13

• No radiation unlike CT and X-Ray
• Thought to be safe
• Only for clinical need
• Not in first trimester
• Only following tertiary referral ultrasound opinion
• Limited availability in the UK
• Sheffield centre of excellence

Question 14

problems with MRI?

Answer 14

• Expensive
• Limited availability
• Limited experience
• Still developing
• Not routine on NHS
• Images easier for parents to understand
• claustrophobia
• Movement problems
• 20 slices in 20 seconds
• 30-40 mins in scanner, longer if twins
• Better definition of brain and soft tissues • Worse for limbs, heart, movement

Question 15

why do an MRI?

Answer 15

• Insufficient information from Ultrasound
– Additional test and additional stress
• Information to plan delivery
• Information for post delivery care
• Information for future pregnancies. • Second opinion, different modality