Faculty Bibliography

Recent technologic developments have made transvaginal ultrasound an important adjunct to gynecologic examination in both the office and the emergency room settings. Important advantages of using transvaginal ultrasonography to supplement bimanual examination are presented and discussed. Training and equipment issues, as well as medicolegal issues, are addressed

Transvaginal sonography allows early and accurate diagnosis of cornual pregnancy, as well as providing a means for puncture injection treatment of certain ectopic pregnancies. We describe four cases of cornual pregnancy managed nonsurgically and followed with transvaginal sonography for 47-64 weeks. Sonographic evidence of cornual pregnancy persisted throughout the period of follow-up, despite resumption of normal menstrual cyclicity. We conclude that some early live cornual pregnancies can be managed by puncture injection, and cornual pregnancies in which the embryo has died can be followed conservatively

A study was undertaken to evaluate the ability of the high-frequency transvaginal scanning method to consistently image first- and early second-trimester fetal structures, such as body contours, long bones, fingers, face, palate, feet, toes, and the four-chamber view. Ninety-seven low-risk pregnancies were scanned from 9 weeks to 14 menstrual weeks inclusive. Accurate dating was ascertained. The results showed that consistent detection of the respective structures was achieved at the following menstrual ages: sagittal contours at 9 weeks to 10 weeks, long bones at 10 weeks to 11 weeks, fingers at 12 weeks, face and palate at 12 weeks, feet and toes at 13 weeks, and the four-chamber view at 14 weeks. The organs and structures examined could be detected at 9 weeks to 14 weeks inclusive. An increasing number of structure were detected consistently with the increasing menstrual age. The study supports the possibility of searching for specific malformations at or after the menstrual ages mentioned, or performing a more comprehensive malformation evaluation after 13 weeks

OBJECTIVE: The objective of this study was to evaluate the feasibility and diagnostic value of the emergency room use of transvaginal ultrasonography operated by the obstetrics and gynecology residents. STUDY DESIGN: One hundred sixty-eight patients scanned in the emergency room constituted the study group and were compared with 61 patients for whom emergency room scanning was not available. Scanning and no-scanning days alternated for a 6-month period. The Student t test was used in the analysis. RESULTS: By comparing the two patient groups a statistically significant (p less than 0.0001) difference was seen in the time spent by the group of patients scanned in the emergency room (40 minutes) when compared with that of the patients for whom no emergency room scanning was available (215 minutes). The residents expressed high confidence in the scanning procedure. There were six misdiagnosed cases, three of them nonruptured ectopic gestations. However, none of these patients was discharged without adequate treatment. CONCLUSION: The study confirmed our hypothesis that obstetrics and gynecology residents can operate and should have available ultrasonography machines in the emergency departments to render quicker and better patient care

This article describes the sonographic appearance of the central nervous system (CNS) from about 6 weeks to term. Highlights of CNS development and the chronologic appearance of sonographically detected new structures throughout gestation are presented

With the advent of high-frequency transvaginal ultrasonography, new opportunities are presented to better define ovarian lesions. The goal of this study was to develop a scoring system using transvaginal sonographic characterization of pelvic/ovarian lesions. Our purpose was to maximize the discrimination between benign and malignant entities. Transvaginal sonographic pelvic images of 143 patients were correlated with surgical findings or histopathology. Of 281 ovaries, 108 had benign lesions (30 endometriomas, 24 teratomas, 21 simple cysts, and 33 other abnormalities) and 20 had malignancies. The scoring system devised was useful in distinguishing benign from malignant masses, with a specificity of 83%, sensitivity of 100%, and positive and negative predictive values of 37 and 100%, respectively. Further experience and refinements of this method of scoring should maximize the benefit of high-resolution transvaginal sonography of ovarian lesions

Transvaginal sonographic images of tubal pregnancies were correlated with the surgical findings in 191 patients having this condition. The sonographic appearance of the ectopic gestations was classified by the absence or presence of structures such as a 'tubal ring' containing the yolk sac, embryonic structures, heart activity, a sonolucent or irregularly echogenic gestational sac, dilated Fallopian tube with amorphous content, fluid in the pelvis and an empty uterus. The following classifications were made: Type Ia (n = 43) A well-defined 'tubal ring' and a beating heart with or without discrete embryonic or extra-embryonic structures.Type Ib (n = 48) A 'tubal ring' containing embryonic and/or extra-embryonic structures without heart beats. Type II (n = 64) An ill-defined or thin tubal wall containing sonolucent or an irregularly echogenic core but not embryonic or extra-embryonic structures. Type III (n = 28) Free pelvic fluid and an empty uterus in patients with positive serum beta-hCG levels. The outline of the tube cannot be visualized. Surgery revealed unruptured tubal pregnancies in 90 patients of the combined groups of Types Ia and Ib. In one additional patient, a tubal rupture was found. In the Type II patients, 26 tubal pregnancies with blood clots in the tube but no evidence of bleeding into the pelvis, and 38 tubal ruptures or abortions were diagnosed. All Type III patients had ruptured tubal pregnancies or bleeding tubal abortions. In eight patients (4.2%), the only sonographic finding was an empty uterus, and these cases were erroneously diagnosed as not having an ectopic pregnancy (false negatives). There were two false-positive cases in which a tubal ring was detected, and this was related to an hemorrhagic corpus luteum. When used for diagnosing tubal pregnancy, the transvaginal scanning technique (together with beta-hCG in Type III cases) carries a sensitivity of 95.8% and specificity of 99.9%. It is an invaluable tool in the diagnostic work-up and management of patients with suspected ectopic gestation