resenLed 8y Maysa llLrla 41101149 1nL kCLL CI UL1kASCNCGkAn IN MANAGLMLN1 CI 1nkLA1LNLD A8Ck1ICN nLroducLlon 1he commonesL early pregnancy compllcaLlon of sponLaneous mlscarrlage occurs ln approxlmaLely 1320 of all pregnancles as recorded by hosplLal eplsode sLaLlsLlcs 1he acLual flgure from communlLy based assessmenL may be up Lo 30 as many cases remaln unreporLed Lo hosplLal 1 1he greaL ma[orlLy occur early before 12 weeks gesLaLlon whlle mld LrlmesLer loss beLween 12 and 24 weeks occurs less frequenLly and consLlLuLes of all pregnancy ouLcomes nLroducLlon ulLrasound dlagnosls aL presenLaLlon was compared wlLh flnal cllnlcal dlagnosls ln consecuLlve pregnanL women who presenLed Lo an emergency deparLmenL wlLh vaglnal bleedlng or abdomlnal paln 1he senslLlvlLy speclflclLy predlcLlve value and overall dlagnosLlc accuracy of ulLrasound were calculaLed ulLrasound ulLrasound ls cycllc sound pressure wlLh a frequency greaLer Lhan Lhe upper llmlL of human hearlng 1he producLlon of ulLrasound ls used ln many dlfferenL flelds Lyplcally Lo peneLraLe a medlum and measure Lhe reflecLlon slgnaLure or supply focused energy 1he mosL well known appllcaLlon of ulLrasound ls lLs use ln sonography Lo produce plcLures of feLuses ln Lhe human womb ulLrasound A common use of ulLrasound ls ln range flndlng Lhls use ls also called SCnA8 (sound navlgaLlon and ranglng) 1hls works slmllarly Lo 8AuA8 (radlo deLecLlon and ranglng) An ulLrasonlc pulse ls generaLed ln a parLlcular dlrecLlon f Lhere ls an ob[ecL ln Lhe paLh of Lhls pulse parL or all of Lhe pulse wlll be reflecLed back Lo Lhe LransmlLLer as an echo and can be deLecLed Lhrough Lhe recelver paLh ulLrasound Dopp|er U|trasound 2D 3D and 4D U|trasound 1ransvag|na| Scans 3-D ultrasound images The parts of an uItrasound machine U|trasound |n regnancy CbsLeLrlc ulLrasound ls prlmarlly used Lo ulagnosls and conflrmaLlon of early pregnancy uaLe Lhe pregnancy (gesLaLlonal age) Conflrm feLal vlablllLy ueLermlne locaLlon of feLus lnLrauLerlne vs ecLoplc Check Lhe locaLlon of Lhe placenLa ln relaLlon Lo Lhe cervlx Check for Lhe number of feLuses (mulLlple pregnancy) Check for ma[or physlcal abnormallLles Assess feLal growLh (for evldence of lnLrauLerlne growLh resLrlcLlon (uC8)) Check for feLal movemenL and hearLbeaL 1he hearLbeaL of Lhe feLus can be observed clearly as llLLle as 6 weeks lnLo Lhe pregnanL ueLermlne Lhe sex of Lhe baby Safety Diagnostic ultrasound is one oI the saIest means available Ior obtaining the necessary inIormation about your unborn baby (or babies). While many tests are continually conducted by manuIacturers and the U.S. government, results in the past have indicated no adverse side eIIects. Unlike X-rays, ionizing irradiation is not present and embryotoxic eIIects associated with such irradiation should not be relevant. The use oI high intensity ultrasound is associated with the eIIects oI "cavitation" and "heating" which can be present with prolonged insonation in laboratory situations. Occupational exposure to ultrasound in excess oI 120 dB may lead to hearing loss. Exposure in excess oI 155 dB may produce heating eIIects that are harmIul to the human body, and it has been calculated that exposures above 180 dB may lead to death. Abottloo Abottloo ls Lhe LermlnaLlon of pregnancy before Lhe feLus develops sufflclenLly Lo survlve 8y convenLlon aborLlon ls usually deflned as pregnancy LermlnaLlon prlor Lo 20 weeks gesLaLlon or less Lhan 300g blrLhwelghL Abottloo 5pootooeoos Abottloo 1 LhreaLened 2 lnevlLable 3 compleLe or lncompleLe 4 mlssed and 3 recurrenL aborLlon
1hreaLened AborLlon A bloody vaglnal dlscharge or bleedlng appears Lhrough a closed cervlcal os durlng Lhe flrsL half of pregnancy Cccurrlng commonly vaglnal spoLLlng or heavler bleedlng durlng early gesLaLlon may perslsL for days or weeks and may affecL one ouL of four or flve pregnanL women 1hreaLened aborLlon may progress Lo sponLaneous lncompleLe or compleLe aborLlon 1he 8ole of ulLrasound ln AborLlon 1he rouLlne use of ulLrasound ln Lhe lnvesLlgaLlon and dlagnosls of early pregnancy problems has also led Lo lmprovemenLs ln Lhe managemenL of early pregnancy loss ulLrasound plays a ma[or role ln maLernal reassurance where feLal cardlac acLlvlLy ls seen and ls plvoLal ln Lhe assessmenL of early pregnancy compllcaLlons such as vaglnal bleedlng ulfferenLlal ulagnosls Ectopic Pregnancy The results of the ultrasound revealed that there was an empty uterus, but there was a living fetus located posterior to the uterus. n the black arrow indicates the fetal head, while the white arrow indicates the position of the uterus. hydatidiform mole Complete hydatidiform mole has a classic sonographic appearance of a solid collection of echoes with numerous anechoic spaces (snowstorm appearance). n partial moles, the placenta is enlarged and contains areas of multiple, diffuse anechoic lesions. Lhough ulLrasound may be a valuable ald ln Lhe dlagnosls of bleedlng ln early pregnancy and may save Lhe paLlenL a long sLay ln hosplLal and unnecessary surgery feLal deaLh should never be dlagnosed wlLhouL Lhe conflrmaLlon of a second scan and wlLhouL havlng made cerLaln LhaL Lhe bladder ls adequaLely fllled 1he ManagemenL of AborLlon 1he dlagnosls of early pregnancy loss was based on cllnlcal hlsLory and examlnaLlon poslLlve urlnary hCC and ulLrasound flndlngs Surg|ca| evacuat|on f surglcal evacuaLlon ls Lo be used sucLlon cureLLage ls Lhe meLhod of cholce as Lhls ls assoclaLed wlLh fewer compllcaLlons Med|ca| Management Lxpectant Management 1he ManagemenL of AborLlon Lxpectant Management Expectant management oIten results in absorption oI retained tissue with little associated bleeding. For those women managed in general practice expectant management has long been the treatment oI choice. Med|ca| Management 1he LreaLmenL opLlon should Lake lnLo accounL Lhe paLlenL's sympLoms Lype of mlscarrlage volume of reLalned Llssue and paLlenL cholce 1hreaLened AborLlon SUMMAk Spontaneous abortion, which is the loss oI a pregnancy without outside intervention beIore 20 weeks` gestation, aIIects up to 20 percent oI recognized pregnancies. Spontaneous abortion can be subdivided into threatened abortion, inevitable abortion, incomplete abortion, missed abortion, septic abortion, complete abortion, and recurrent spontaneous abortion. Ultrasonography is helpIul in the diagnosis oI spontaneous abortion, but other testing may be needed iI an ectopic pregnancy cannot be ruled out. The role oI ultrasound in the management oI threatened abortion 1. Threatened abortion was diagnosed iI Ietal heart movement was identiIied. 2. Ultrasound in Clinically Diagnosed Threatened Abortion When this was not shown or iI the Ieatures detailed by Donald et al. were present missed abortion was diagnosed. II echoes were seen in the line oI the endometrial cavity incomplete abortion was diagnosed. When such echoes were absent or when the cavity showed as a straight line complete abortion was diagnosed. 3. Subsequent management was based entirely on the patient's clinical progress, and, apart Irom one hydatidiIorm mole, the ultrasonic Iindings were ignored. 4. Ultrasound in Preoperative Evaluation. 5. Ultrasound to determine pharmacological treatment kLIILkLNCLS Szabo I, Szilagyi A. Management of threatened abortion. Source : Department oI Obstetrics and Gynecology, University Medical School oI Pecs, Hungary. (available on http.//www.ncbi.nlm.gov.pub) Sairam. S., Khare. M., Michailidis. G., Thilaganathan. Dr B., %he role of ultrasound in the expectant management of early pregnancy loss., 2002., Ultrasound in Obstetrics & GynecologyVolume 17, Issue 6, pages 506509, June 2001( available on http://onlinelibrary.wiley.com) Craig P. GRIEBEL, MD, JOHN Halvorsen, MD, THOMAS B. GOLEMON, MD, dan Anthony A. HARI, MD., Mnagement of Spontaneous Abortion. 2005. University oI Illinois College oI Medicine di Peoria, Peoria, Illinois Am Fam Physician 2005 1 Oktober,. 72 (7) :1243-1250. Tzeren, Aydin (2000). uman Body Dynamics. Classical Mechanics and uman Movement. Springer. pp. 610. Pooh, K. Ritsuko; K. Asim. Donald School Journal of Ultrasound in Obstetrics and Gynecology. Recent Advances in 3D Assessment oI Various Fetal Anomalies. 2009;3(3):1-23. Turner, G.M.; P. Twining. Clinical Radiology Jolume 47. The Skeletal proIile in the diagnosis oI Ietal abnormalities. 1993; 389-395. Pilu; Nicolaides; Ximenes ; Jeanty. andbook of Fetal Abnormalities. Central Nervous System. 2000. Pilu, Gianluigi. 2006. %hree Dimensional Ultrasound of Craniofacial Anomalies. ( available on- line with updates at www.gehealthcare.com ). Overton, Timothy G.; Edmonds, D. Keith. Dewhurst,s %extbook of Obstetric & Gynaecology 7 th Edition. Antenatal Care. 2007; 6: 43. Cunningham F.G., Leveno K.J., Bloom S.L., etc. 2007.Ultrasonography and Doppler. illiams Obstetrics. USA : The McGraw-Hill Companies. Chapter 16. T H A N K Y O U