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1、妇产科疾病的超声诊断妇产科疾病的超声诊断2011Sangreal-uterusTHE DAWINCI CODEUterine PositionlMidline anteversion: most common; degree of anteversion is bladder distention dependentlRight or left: normal variant in absence of pelvic masseslRetroverted: entire organ displaced posteriorlylRetroflexed: body displaced with r
2、espect to cervixUltrasonography of normal uteruslUterine serosa layer: Linear high-echo ;clear, smooth;l Myometrium: Homogeneous middle-echo ;lEndometria: The middle line of high echo , around the weak echo . It is well known that the endometrium changes dynamically in response to cyclic hormonal fl
3、ux.Uterine serosa layer Myometrium Endometria Normal uterusNormal uterustransabdominal ultrasonographytransabdominal ultrasonographyTransvaginal sagittal view of the uterus. The Transvaginal sagittal view of the uterus. The rounded fundus is shown toward the left of the rounded fundus is shown towar
4、d the left of the image with the endometrial stripe rumming through image with the endometrial stripe rumming through the middle of the uterine cavity.the middle of the uterine cavity.MyometriumEndometriaUterine serosa layerFallopian Tube（输卵管）lInfundibulum: funnel-shaped lateral tube that projects b
5、eyond the broad ligament to overlie the ovarieslAmpulla: sidest part of the tube where fertilization occurslIsthmus: hardest part; lies just lateral to the uteruslLength: 12 cm; supplied by ovarion arteries and veinsOvary（卵 巢）l Almond shapedlAttached to back of the broad ligament by mesovarium; some
6、times called suspensory ligament of the ovarylLies in ovarian fossalFossa is bounded by external iliac vessels, ureter, and obturator nervelReceives blood from ovarian arterylBlood drained by ovarian vein into inferior vena cava on right; on left by ovarian vein into lert renal veinSonography of the
7、 normal ovarylAn ovoid homogeneous echodensity; follicular cysts are often present.lThe best sonographic marker for the ovary is identification of a follicular cyst, which has the classic appearance of being thin walled and anechoic with through-transmission posteriorly.Transabdominal sagittal image
8、 shows the Transabdominal sagittal image shows the left ovary posterior to the urinary bladderleft ovary posterior to the urinary bladderTransvaginal sagittal image of the ovaryTransvaginal sagittal image of the ovaryovarian follicleFollicular wall flowCommon Diseases of Obstetrics and GynecologyGyn
9、ecology ：Leiomyoma ；Carcinoma ;；Ovarian Tumors; Inflammatory mass ;etc.Obstetrics： NaturalNatural pregnancy ； Abnormal pregnancy; etc.TheuterusLeiomyoma /HysteromyomaCharacteristicsofLeiomyomaslMost common pelvic tumorlSmooth muscle cell compositionlFibrosis occurs after atrophic of degenerative cha
10、ngeslDegeneration occurs when fibroids outstrip their blood supply; calcificationlMay be pedunculatedlClinical: enlarged uterus, profuse and prolonged bleeding, painUterineLocationsofleiomyomasSubmucosal Erode into endomertial cavity heavy bleeding; infertilityIntramuralMay enlarge to cause pressure
11、 on adjacent organs; infertilitySubserosalMay enlarge to cause pressure on adjacent organs Subserous myomaBroad ligamentmyomaCervical myomaintramurous myomaSubmucous myomaUltrasonicperformancelTwo-dimensional：Increased uterine body or Form disorders； Spherical hypoechoic area in the uterine body ，Re
12、ar echo attenuation； With calcification or Cystic change, etc；Signs of oppression；lColor Doppler：Tumor around with the blood flow signal in the shape of ring or semi-circular ring ；lDoppler spectrum：Medium resistance index，RI 0.60.1。intramurous myomaSubserous myomaintramurous myomaSubserous myomaCer
13、vical myomaAbundant tumor blood flowAbundant tumor blood flowMUTUTRI 0.61Submucous myoma with calcificationTeratoma DermoidTummors（卵巢良性囊性畸胎瘤/皮样囊肿)lPathology ：derives from germ cell，the most common ovarian neoplasm, constituting 20% of ovarian tumors. up to 20% are bilateral. About 80% occur in women
14、 of childbearing age. lSize ranges from small to 40 cmlUnliateral,round to oval masslContains faty,sebaceous material, hair, cartilage, bone, teethlClinical: asymptomatic to abdominal pain, enlargement and pressure; pedunculated, subject to torsionlSonography: Cystic/ complex/solid mass, echogenic c
15、omponents; acoustic shadowingSpecialUltrasoundFindings:1. A cystic mass: with an echogenic mural nodule2. A paste sign：particulate liptinite3. A fluff of hair sign4. A fat-fluid level sign：with fluid level in the cyst, fat above, fluid below.5. A complex masscystic teratoma cystic teratoma of ovaryo
16、f ovaryA cystic massPaste signFluff of hair signPaste signFat-fluid level signA complex massA 8 years old girl, cutting off a three kilograms benign teratomaThe role of Ultrasound in ObstetricsTRIMESTERSlFirst trimester = 0 to 12 weeks of gestationlSecond trimester = 13 to 26 weeks of gestationlThir
17、d trimester = 27 to 42 weeks of getsationlPostterm pregnancy = 42 weeks of gestationIndications for First-Trimester SonographylConfirm presence of intrauterine pregnancylEvaluate for suspected ectopic pregnancylDefine cause of vaginal bleedinglDetermine gestational agelConfirm suspected multiple ges
18、tationslAid in invasive procedureslEvaluate pelvic masseslDetect uterine abnormalitiesNatural pregnancyNatural pregnancyNonagepregnancy(First-Trimester) Definition ：Pregnancy before 12 weekend.5 weeks pregnant Gestational sac； 6-7 weeks pregnant Germ;7-8 Weeks Primitive heart tube pulse；8-11 weeks Y
19、olk sac; 9 weeks Embryonic, placenta.The Normal First TrimesterSonographic Features of a Normal Gestational SaclShape: round of ovallPosition: fundal or middle portion of uterus; a center position relative to endometriumlContour: smoothlWall: echogenic; 3 mm of more in thicknesslInternal landmarks:
20、yalk sac present when gestational sac is larger than 10 mm; embryo present when gestational sac is larger than 18 mmlGrowth: 1 mm per day (range: 0.7 mm to 1.5 mm per day)4-5 weeks pregnant4-5 weeks pregnant In the g In the gestational sac we can see a estational sac we can see a embryo point, the e
21、arliest embryo. embryo point, the earliest embryo. 7 weeks pregnant7 weeks pregnant Fetus was about 4 mmFetus was about 4 mm，we can see we can see apparent heart throb, and sapparent heart throb, and small limb bud .mall limb bud .8 weeks pregnant8 weeks pregnant Three-dimensional ultrasound show it
22、s beginning Three-dimensional ultrasound show its beginning of the shape of a humanof the shape of a human. .Umbilical bordEmbryonic headEmbryonic abdomenYolk sacEmbronic headAmniotic sac9 weeks pregnant9 weeks pregnant Known as a fetalKnown as a fetal，Development of the Development of the various p
23、arts of the fetus, tends to improvevarious parts of the fetus, tends to improve. .12 weeks pregnant12 weeks pregnantThe spine is identifiable , as the two bead-like high The spine is identifiable , as the two bead-like high echo. Ears, limbs, bones can be shown and echo. Ears, limbs, bones can be sh
24、own and measurement. measurement. Ultrasound of the Second and Third TrimestersIndications for Second- and Third-Trimesterl Estimate gestational age for patients with uncertain dateslEvaluate uterine size and clinical date discrepancieslEvaluate fetal growthlEstimate fetal weightlDetermine fetal pre
25、sentationlEvaluate fetal lifel provide adjunct to amniocentesis, percutaneous umbilical blood sampling procedure, or cerclage placementlEvaluate uterine abnormalitylEvaluate abnoumal maternal serum alpha-fetoprotein valueslEvaluate abnormal amniotic fluidlEvaluate placenta Etc.The Second- and Third-
26、Trimester( Metaphase and terminal prengancy) Metaphase and terminal prengancy)Mid-Mid-pregnancy:pregnancy:13-27 13-27 weeks pregnancy.weeks pregnancy.Late-Late-pregnancy:pregnancy:More More than 28 weeks of than 28 weeks of pregnancypregnancy. .Scanning TechniqueslSurvey uterus lObserve cardiac acti
27、vitylDetermine position and number of the fetus and placentalAssess amniotic fluidlLook for uterine of placental masses and fetal anomaliesCheck contentsl1、Fetal head ：BPD biparietal diameter;l2、Fetal abdomen: AC abdomen circumference;l3、Fetal limb： FL femur length ;l4、Others：Placenta, Fetal heart r
28、ate, Amniotic fluid, etc.1 、 Fetal headMeasuring the Biparietal Diameter(BPD)lObitain biparietal diameter of the fetal head at the transverse level of the midbrain: falx, cavum septi pellucidi, and thalamic nucleilMake sure the head is symmetric and ovallMeasure from outer to inner margins of the sk
29、ulllIn the third trimester, the BPD is not as accurate in predicting fetal age Fetal head, after 12 weekend Fetal head, after 12 weekend pregnantpregnant Fetal side profile, we Fetal side profile, we can observe its forehead, can observe its forehead, nose ,lip, and chin, etc.nose ,lip, and chin, et
30、c.2、FetalabdomenlThe hepatobiliary system: liver, port venous systerm, hepatic veins and arteries, gallbladder, and bile ductslThe gastrointestinal system: the esophagus, stomach, small and large intestines(colon)lThe urinary system: kidneys, adrenal glands, ureters, bladder.The fetal abdomen circum
31、ference（AC) is the most widely measured Measuring the Abdominal Circumference(AC)lThe AC should be taken from a round transverse image with the umbilical portion of the left portal vein midline within the liverlThe outer margin of the abdominal wall should be measuredlThe abdominal wall measurement
32、is the least accurateThefetalliverThefetallivergallbladderstomachport venousspinegallbladderstomach3、FetallimbslThe upper limbs: the ulna the radius the humeruslThe lower limbs: the femur/the thigh bone the fibula the tibia lThe femur is the most widely measured long bone （FL femur length ）Femur mea
33、surementlHyperechonic linear structure represents the ossified portion of the femoual diaphysis and corresponds to femoral length measurement from the greater trochanter to the femoral condyleslThe mormal femur has a straight laeral border and a curved medial borderlFemur length may be used with the
34、 same accuracy as BPD to predict gestational agelFemur length may indicate skeletal dysplasias or intrauterine growth restrictionLong section of the upper limbsThe radiusThe ulnaThe humerus Femur/thigh boneFibula /perone Tibia/shin bone Longsectionofthe lowerlimbs 4、 The placenta（胎盘）lThe major fole
35、of the placenta is to permit the exchange of oxygenated maternal blood(rich in oxgen and nutrients) with deoxygenated fetal blood.lThe thickness of the placenta varies with gestational age,with a minimum diameter of 15 mm in fetuses greater than 23 weeks. The size of the placenta rarely exceeds 50 m
36、m in the normal fetus.Anterior placenta at 21 weeks of gastationThe placentaUmbilical bordAmniotic fluidThe fetal posterior placenta at 29 weeks of gestationcalcification Anterior placenta at 39 weeks of gastationAnterior placenta at 39 weeks of gastationCalm little faceCalm little faceEating toe Eating toe Eating fingersEating fingersCryingCryingPouttingPouttingFetal with umbilical Fetal with umbilical cord around the neckcord around the neckFetal with cleft lipFetal with cleft lipsmailingsmailing结束语结束语谢谢大家聆听！谢谢大家聆听！81
