Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5809_Библиотеки_им_академика_М_И_Перельмана.pdf
24 Ectopic Pregnancy
387
Fig. 24.6 (a) Transvaginal
ultrasound of an ovarian
corpus luteum cyst. (b)
Transvaginal ultrasound:
color Doppler imaging of
an ovarian corpus luteum
cyst
a
b
Such early diagnosis can spare maternal mortality at the expense of fetal mortality, with a perinatal mortality rate of 40–95% [33].
Cesarean Scar Ectopic Pregnancy
Although previously rare, the incidence of pregnancy implantation within the scar of a prior
cesarean is increasing due to the increasing number of cesarean deliveries. The natural history of
such a condition is unknown, but uterine scar
rupture and hemorrhage, even in the rst trimes-
ter, seem likely if the pregnancy is allowed to
continue, with possible serious maternal morbidity and the possible need for hysterectomy and
loss of subsequent fertility. Early diagnosis of
such implantation is made only with a high level
of suspicion: early ultrasound in a woman with a
prior cesarean delivery (Fig.24.7).
Endometrial and myometrial disruption or
scarring can predispose to abnormal pregnancy
implantation. Trophoblast adherence or invasion
is enhanced when the scant decidualization of the
lower uterine segment is impaired further by previous myometrial disruption. Implantation of a
388
a
D. L. Fylstra
b
Fig. 24.7 (a) Transvaginal ultrasound: midline sagittal image with gestation in the anatomical location of a prior cesar-
ean scar. (b) Transvaginal ultrasound: 3D rendering of cesarean scar ectopic
pregnancy within the uterine scar of a prior cesarean delivery is different from an intrauterine
pregnancy with placenta accreta. Cesarean scar
implantation is a gestation completely surrounded by the myometrium and the brous tis-
sue of the scar and separated from the endometrial
cavity or fallopian tube (see Fig. 24.7). The
mechanism that most probably explains scar
implantation, like intramural implantation, is
invasion of the myometrium through a micro-
24 Ectopic Pregnancy
389
scopic tract. Like intramural pregnancy, such a
tract is believed to develop from the trauma of
previous uterine surgery, such as curettage, cesarean delivery, myomectomy, metroplasty, hysteroscopy, and even manual removal of the placenta
[34–36]. The time interval between such trauma
and a subsequent pregnancy may impact upon
implantation events. Some of the reported cases
were diagnosed and treated within a few months
of a prior cesarean delivery suggesting that
incomplete healing of the uterine scar may contribute to scar implantation [37, 38].
Early diagnosis with ultrasound can offer
treatment options capable of avoiding uterine
rupture and hemorrhage and, thereby, preserve
the uterus. The differential diagnosis between
spontaneous abortion in progress, cervicoisthmic pregnancy, and implantation within a
cesarean scar can be difcult. Strict ultrasound
imaging criteria must be used to assess the diagnosis of cesarean scar pregnancy. Sagittal midline transvaginal ultrasound should reveal an
empty uterine cavity, an empty cervical canal,
development of the gestational sac in the anterior
part of the uterine isthmus, and an absence of
healthy myometrium between the bladder and the
gestational sac, this last criterion allowing differentiation from cervico-isthmic implantation [39].
Although cesarean scar pregnancy is an
uncommon occurrence, only with a high index of
suspicion and the use of early endovaginal sonography can the diagnosis be made early enough to
prevent rupture leading to signicant maternal
morbidity and loss of future fertility. Clinical history and endovaginal ultrasound can aid in differentiating cesarean scar pregnancy from
incomplete abortion and cervico-isthmic pregnancy. Precise localization of the early pregnancy
by transvaginal ultrasound should be encouraged
in all patients with threatening gestational pathology. A sagittal ultrasound view along the long
axis of the uterus, through the gestational sac, can
localize precisely a cesarean scar implantation
(see Fig.24.7).
There are two types of cesarean scar ectopic
implantations: one extending toward the serosal
uterine surface and bladder (exophytic) and one
extending toward the endometrial cavity (endo-
phytic). Such locations dictate treatment
options [40].
Interstitial Ectopic Pregnancy
Two to 3% of ectopics are implanted within the
interstitial portion of the fallopian tube, that portion of the tube that transitions from the endometrial cavity to the tubal isthmus through a wall of
the myometrium [11]. The interstitial, or cornual,
portion of the fallopian tube is tortuous, 0.7mm
in diameter, and 1–2cm in length [41]. This is a
relatively thick segment of fallopian tube with a
greater capability to expand before rupture than
more distal portions of the fallopian tube [42].
Since implantation within this portion of the fallopian is still “within the tube,” it is associated
with the same commonly recognized risk factors
for tubal ectopic pregnancy. No single factor
clearly differentiates women with an interstitial
pregnancy from those with isthmic or ampullary
ectopic pregnancies.
Transvaginal ultrasound is the primary method
for diagnosing interstitial implantation
(Fig. 24.8). However, many early ultrasounds
show that these pregnancies are surrounded by
the myometrium and can be mistaken for normally implanted pregnancies. Three-dimensional
ultrasound ndings that are highly suggestive of
interstitial implantation are the identication on a
coronal view of an echogenic line between the
gestational sac and the endometrial cavity, “the
interstitial line sign,” an empty uterine cavity
with a gestational sac eccentrically located outside the endometrial cavity with a thin mantle of
surrounding myometrium less than 5 mm in
thickness [43]. Collectively, these ultrasound
ndings are 88–93% specic but with a sensitivity of only 40% [44, 45]. Coronal images generated by 3D sonography are helpful in identifying
these features (see Fig.24.8) [46].
Interstitial ectopic pregnancies are frequently
mislabeled as “cornual ectopics.” Cornual pregnancy refers to a pregnancy within the horn of a
bicornuate uterus, communicating or noncommunicating, and the clinical outcome of this
implantation varies greatly and depends upon
390
Fig. 24.8 (a)
Transvaginal ultrasound:
transverse view across
uterine fundus
demonstrating an
asymmetrically
implanted gestation,
concern for interstitial
ectopic. (b) Transvaginal
ultrasound: 3D
rendering conrming
interstitial pregnancy
implantation. Open
arrows point to
gestational sac
D. L. Fylstra
a
b
the size and expansile capacity of the affected
horn [46].
Angular pregnancies are implanted in one of
the lateral angles of the uterine cavity, medial to
the uterotubal junction, and must be distinguished from interstitial implantations. Angular
pregnancies lead to an asymmetric enlargement
of the uterus (Fig.24.9). What distinguishes an
interstitial ectopic pregnancy from an angular
pregnancy is that the laparoscopic appearance
of the bulge of an interstitial pregnancy is lateral
to the round ligament, whereas the bulge of an
angular pregnancy is medial to the round ligament, displacing the round ligament laterally.
Over one third of angular pregnancies end in
early abortion, but for those that continue pelvic
pain, persistent vaginal bleeding, placental
retention during the third stage of labor, and
rarely uterine rupture can be expected
complications.
24 Ectopic Pregnancy
Fig. 24.9 Transvaginal ultrasound: angular pregnancy
391
Ectopic After Hysterectomy
Seventy-two cases of ectopic pregnancy after
hysterectomy have been reported in the world’s
literature and are rarely suspected before surgical
intervention [47]. Over half of such pregnancies
have been “early presentations,” this occurring
because an unrecognized, preclinical pregnancy
existed at the time of hysterectomy: a preimplanted fertilized ovum was in transit and
conned to the fallopian tube, or sperm was present within the fallopian when the hysterectomy
was performed during a peri-ovulatory period,
allowing postoperative fertilization and tubal
implantation. An immediate pre-hysterectomy
pregnancy test would not be expected to be positive under such circumstances. “Late presentation” ectopics have occurred after all types of
hysterectomy and as remote as 12years after the
hysterectomy. These post-hysterectomy ectopic
pregnancies occur with retention of one or both
ovaries with the presence of a vaginal-tubal or
vaginal-peritoneal stula allowing vaginally
implanted sperm access to ovulated ova.
Because the symptoms of ectopic pregnancy
can be mimicked by common immediate complications after hysterectomy, such as protracted
abdominal pain, pelvic hematoma formation,
vaginal cuff infection, and vaginal bleeding,
ectopic pregnancy is rarely expected in most
post-hysterectomy cases until additional imaging
or repeat operation conrms the diagnosis.
Summary
Ectopic pregnancy occurs in one out of every 50
pregnancies. Early transvaginal ultrasound can
locate most, if not all, early pregnancies and
should be performed on every early pregnancy
with symptoms of gestational pathology or a high
likelihood of ectopic pregnancy based on gynecologic history. With suspected gestational
pathology, early vaginal sonography should be
performed regardless of hCG level. The late diagnosis of an ectopic pregnancy increases the risk
for loss of fertility and for maternal morbidity
and mortality. Many non-tubal ectopic locations
392
D. L. Fylstra
can be diagnosed with early transvaginal sonography and then with successful medical management. The pregnancy of unknown location, when
diagnosed early and conrmed to be extrauterine,
can, likewise, be managed conservatively and
successfully. Medical management fails more
commonly with more advanced, living ectopic
pregnancies, which may occur with non-tubal
ectopic pregnancies, requiring surgical intervention [48]. Therefore, it is extremely prudent to
diagnose gestational pathology early with transvaginal sonography.
References
1. Centers for Disease Control and Prevention (CDC).
Ectopic pregnancy – United States, 1990–1992.
MMWR Morb Mortal Wkly Rep. 1995;44:46–8.
2. Ankum WM, Mol BWJ, Van der Veen F, Bodduyt
PM. Risk factors for ectopic pregnancy: a metaanalysis. Fertil Steril. 1996;65:1093–9.
3. Peterson HB, Xia Z, Hughes JM, Wilcox LS, Tylor LR,
Trussell J.The risk of ectopic pregnancy after tubal
sterilization: US Collaborative Review of Sterilization
Working Group. N Engl J Med. 1997;336:762–7.
4. Borgatta L, Murphy M, Chuangb C, Beardsley L,
Burnhill MS. Pregnancies diagnosed during depoprovera use. Contraception. 2002;66:169–72.
5. Furlong LA.Ectopic pregnancy risk when conception
fails: a review. J Reprod Med. 2002;47:881–5.
6. Kadar N, Bohrer M, Kemmann E, Shelden R.The discriminatory human chorionic gonadotropin zone for
endovaginal sonography: a prospective, randomized
study. Fertil Steril. 1994;61:1016–20.
7. Spandorfer SD, Barnhart KT. Endometrial stripe
thickness as a predictor of ectopic pregnancy. Fertil
Steril. 1996;66:474–7.
8. Ankum WM, Van der Veen F, Hamerlynck JVTH,
Lammes FB. What to do when human chorionic
gonadotropin levels are below the discriminatory
zone. J Reprod Med. 1995;40:525–8.
9. Barnhart KT, Sammel MD, Rinaudo PF, Zhou L,
Hummel AC, Guo W. Symptomatic patients with
an early viable intrauterine pregnancy: HCG curves
redened. Obstet Gynecol. 2004;104:50–5.
10. Kadar N, Caldwell BV, Romero R. A method of
screening for ectopic pregnancy and its indications.
Obstet Gynecol. 1981;52:162–6.
11. Bouyer J, Coste J, Fernandez H, Pouly JL, JobSpira N. Site of ectopic pregnancy: a 10 year
population- based study of 1800 cases. Hum Reprod.
2002;17:3224–30.
12. Ushakov FB, Elchalal U, Aceman PJ, Schenker
JG. Cervical pregnancy: past and future. Obstet
Gynecol Surv. 1997;52:45–59.
13. Dicker D, Feldberg D, Samuel N, Goldman
JA.Etiology of cervical pregnancy: association with
abortion, pelvic pathology, IUDs, and Asherman’s
syndrome. J Reprod Med. 1985;30:25–7.
14. Ginsburg ES, Frates MC, Rein MS, Fox JH, Hornstein
MD, Friedman AJ.Early diagnosis and treatment of
cervical pregnancy in an invitro fertilization program.
Fertil Steril. 1994;61:966–9.
15. Shinagawa S, Nagayama M. Cervical pregnancy as
a possible sequela of induced abortion. Am J Obstet
Gynecol. 1969;105:282–4.
16. Thomas RL, Gingold BR, Gallagher MW. Cervical
pregnancy: a report of two cases. J Reprod Med.
1991;36:459–62.
17. Fylstra DL. Cervical pregnancy: 13 cases treated
with suction curettage and balloon tamponade. Am J
Obstet Gynecol. 2014;210:581.e1–5.
18. Raskin MM. Diagnosis of cervical pregnancy by
ultrasound: a case report. Am J Obstet Gynecol.
1978;130:234–5.
19. Timor-Tritsch IE, Monteagurdo A, Mandeville EO,
Peisner DB, Anaya GP, Pirronw EC. Successful
management of a viable cervical pregnancy by local
injection of methotrexate guided by transvaginal ultrasonography. Am J Obstet Gynecol. 1994;170:737–9.
20. Grimes HG, Nosal RA, Gallagher JC. Ovarian
pregnancy: a series of 24 cases. Obstet Gynecol.
1983;61:174–80.
21. Kraemer B, Kraemer E, Guengoer E, Juhasz-Boess
I, Solomayer EF, Wallwiener D, etal. Ovarian ectopic pregnancy: diagnosis, treatment, correlation to
Carnegie stage 16 and review based on a clinical case.
Fertil Steril. 2009;92:392.e13–5.
22. Sandvei R, Ulstein M.History and nding of ectopic pregnancies in women with and without an
IUD.Contracept Deliv Syst. 1980;1:131–8.
23. Spiegelberg O. Zur Casuistik der
Ovariaschwangerschaft. Arch Gynekol. 1873;13:73.
24. Shaw SW, Hsu JJ, Chueh HY, Han CM, Chen FC,
Chang YL, etal. Management of primary abdominal
pregnancy: twelve years of experience in a medical
centre. Acta Obstet Gynecol. 2007;86:1058–62.
25. Clark JFJ, Guy RS. Abdominal pregnancy. Am J
Obstet Gynecol. 1996;96:511–20.
26. Studdiford WE.Primary peritoneal pregnancy. Am J
Obstet Gynecol. 1942;44:487–91.
27. Anderson PM, Opfer EK, Busch JM, Megann EF.An
early abdominal wall ectopic pregnancy successfully treated with ultrasound guided intralesional
methotrexate: a care report. Obstet Gynecol Int.
2009;2009:247252.
28. Chui AK, Lo KW, Choi PC, Sung MC, Lau
JW. Primary hepatic pregnancy. Aust N Z J Surg.
2001;71:260–1.
29. Nama V, Gyampoh B, Karoski M, McRea R, Opemuyi
I. Secondary abdominal appendicular ectopic pregnancy. J Minim Invasive Gynecol. 2007;14:516–7.
30. Shippey SH, Bhoola SM, Royek AB, Long
ME. Diagnosis and management of hepatic ectopic
pregnancy. Obstet Gynecol. 2007;109:544–6.
24 Ectopic Pregnancy
393
31. Thompson RJ, Hawe MJ.A rare pathological trinity:
an appendiceal ectopic pregnancy, acute appendicitis,
and a carcinoid tumor. Ir J Med Sci. 2011;180:579–
80. Epub 2009 Feb 6 (epub ahead of print).
32. Yagil Y, Beck-Razi N, Amit A, Kerner H, Gaitini
D.Splenic pregnancy: the role of abdominal imaging.
J Ultrasound Med. 2007;26:1629–32.
33. Martin JN, Sessums JK, Martin RW, Proyer JA,
Morrison JC.Abdominal pregnancy: current concepts
of management. Obstet Gynecol. 1988;71:549–62.
34. Fait G, Goyert G, Sundareson A, Pickens A Jr.
Intramural pregnancy with fetal survival: case history
and discussion of etiologic factors. Obstet Gynecol.
1987;70:472–4.
35. McGowan L. Intramural pregnancy. JAMA.
1965;192:637–8.
36. Miller DA, Chollet JA, Goodwin TM. Clinical risk
factors for placenta previa-placenta accreta. Am J
Obstet Gynecol. 1997;177:210–4.
37. Huang KH, Lee CL, Wang CJ, Soong YK, Lee
KF.Pregnancy in a previous cesarean section scar: case
report. Changgeng Yi Xue Za Zhi. 1998;21:323–7.
38. Marcus S, Cheng E, Goff B.Extrauterine pregnancy
resulting from early uterine rupture. Obstet Gynecol.
1999;94:804–5.
39. Godin PA, Bassil S, Donnez J.An ectopic pregnancy
developing in a previous cesarean section scar. Fertil
Steril. 1997;67:398–400.
40. Gonzalez N, Tulandi T. Cesarean scar pregnancy:
a systemic review. J Minim Invasive Gynecol.
2017;24(5):731–8.
41. Tulandi T, Al-Jaroudi D. Interstitial pregnancy: results generated from the 92. Society of
Reproductive Surgeons Registry. Obstet Gynecol.
2004;103:47–50.
42. Lau S, Tulandi T.Conservative medical and surgical
management of interstitial ectopic pregnancy. Fertil
Steril. 1999;72:207–15.
43. Moawad NS, Mahajan ST, Moniz MH, Taylor
SE, Hurd WW. Current diagnosis and treatment
of interstitial pregnancy. Am J Obstet Gynecol.
2010;202:15–29.
44. Ackerman TE, Levi CS, Dashefsky SM, Holt SC,
Lindsay DJ. Interstitial line: sonographic nding in
interstitial (cornual) ectopic pregnancy. Radiology.
1993;189:83–7.
45. Timor-Tritsch IE, Monteagudo A, Matera C,
Veit CR. Sonographic evolution of cornual pregnancy treated without surgery. Obstet Gynecol.
1992;79:1044–9.
46. Rastogi R, Meena GL, Rastogi N, Rastogi
V. Interstitial ectopic pregnancy: A rare and difcult
clinicosonographic diagnosis. J Hum Reprod Sci.
2008;1:81–2.
47. Fylstra DL.Ectopic pregnancy after hysterectomy: a
review and insight into etiology and prevention. Fertil
Steril. 2010;94:431–5.
48. American College of Obstetricians and Gynecologists.
ACOG Practice Bulletin. Number 94. Medical management of ectopic pregnancy. Obstet Gynecol.
2009;111:1479–85.
Index
A
Abdominal myomectomies, 147, 148
Abdominal pregnancy, 386, 387
Abnormal uterine bleeding (AUB), 156
Absorption, 4
Acoustic intensity, 4
Acoustic window, 26
Acquired uterine abnormalities, SHG, 202, 203
Adenomyosis, 145
Adhesiolysis, 308
Adnexal masses, 259
American Association of Gynecologic Laparoscopists
(AAGL), 156
American Fertility Society (AFS), 194
classication, 127
American Institute for Ultrasound in Medicine
(AIUM), 114
American Society of Reproductive Medicine (ASRM)
classication, 122
Amnionicity, in twin pregnancies, 378
A-mode, 24
Androgen Excess Society, 92
Angiogenesis, 43
Angle correction, 101
Angular pregnancies, 390, 391
Antepartum and postpartum bleeding, 125
Anteroexed uterus, 116
Anti-Mullerian hormone (AMH), 32, 76, 93, 94, 194
ovarian reserve, 86
Antral follicle count (AFC), 32, 51, 66, 68, 93,
300–302, 322
ovarian reserve, 76–78, 85, 86
Antral follicles, 321
Arcuate uterus, 124, 128
Asherman’s syndrome (AS), 34, 181, 182, 184, 188–191,
194, 308, 358
As low as reasonably achievable (ALARA) principle, 13
ASRM classication, 126
Assisted reproductive technologies (ART), 155, 183
procedures, 305
2D ultrasound, follicle monitoring, 273
endometrial proliferation, uterine cavity and
monitoring of, 279–281
follicular size and volume, 278
follicular phase monitoring, 273, 274
mature oocytes, retrieval of, 278, 279
methods, 274, 275
normal folliculogenesis, 274
with power Doppler, 281
self-monitoring, 281
Standard Ultrasound Monitoring Program,
275–278
vs. 3D, 281
triggering ovulation, criteria used for, 278
ultrasound, in male infertility, 229
Autism spectrum disorder (ASD), 12
Auto-crosslinked hyaluronic acid (ACP) gel, 192, 193
B
Baseline scan, 239
Bicornuate uterus, 128, 352
Bioeffects, 3
Blood-ow and Doppler imaging, tubal patency
evaluation, 246, 247
Blunt adhesiolysis, 189
B-mode, 5, 12, 13, 25
grey-scale image, 25
C
Capacitance index (CI), 101
Cavitation, 6
Cerebral neocortex, 10
Cervical incompetence, 125
Cervical polyps, 159, 171, 172, 350
Cervical pregnancy, 384–386
Cervical synechiae, 348, 350
Cervix, 117, 118
antiestrogenic effects on, 264, 265
Cesarean scar ectopic pregnancy, 387–389
Chinese PCOS population, 99
Chlamydia antibody titre (CAT), 240
Chorionic villi, 11
Chorionicity, in twin pregnancies, 378
Chromopertubation, 240, 241
Chronic endometritis, 364
Clinical touch transfer technique (CTET), 336
© Springer Nature Switzerland AG 2019
L. A. Stadtmauer, I. Tur-Kaspa (eds.), Ultrasound Imaging in Reproductive Medicine,
https://doi.org/10.1007/978-3-030-16699-1
395
396
Index
Clomiphene citrate (CC), 263, 264
ovulation induction,ultrasound, 268, 269
Clomiphene citrate therapy, treatment schema and
monitoring of, 265, 266
C-mode, 25
Colour and power Doppler ultrasound, 44
Congenital bilateral absence of the vas deferens
(CBAVD), 221
Congenital uterine anomalies
arcuate uterus, 124
clinical presentation of, 124, 125
embryologic development, 121, 122
imaging of
HSG, 125, 126
pelvic MRI, 126
surgical intervention, 125
3DUS and MRI, 125–129
2DUS, 126
urinary tract anomalies, 130
Müllerian anomalies, 123
prevalence rates, 121
reproductive outcomes, 130, 131
septate uterus, 124
SHG, 201, 202
surgical intervention, 131, 132
three-dimensional ultrasound criteria, 127
ultrasound criteria, 128
unicornuate uterus, 123
uterus didelphys, 124
Continuous-wave (CW), 7
Continuous wave Doppler, 26
Controlled ovarian hyperstimulation
(COH) for, 167
Controlled ovarian stimulation (COS),
30, 35, 273
Conventional two-dimensional (2D) ultrasound, 21
Cornual ectopics, 389
Cornual polyps, 158
Corpus luteum cyst, 278
Cowden syndrome, 170
Crown-rump length (CRL), 371, 372
Cryptorchidism, 222, 223
Cushing’s syndrome, 91
Cystic epididymal mass, 219
Cystic polyp, 156
Cysts, TRUS, 227
D
Dermoid cyst, 81
D-galactose, 47
Diethylstilbestrol (DES), 122
Dilatation and curettage (D&C), 193
Dominant follicle, 250
Doppler equipment, 7
Doppler mode, 5
Doppler technology, 278
Doppler US, 25
Dose-area product (DAP), 241
Dwell time, 5, 6
Dye test, 240, 241
E
Early follicular phase (EFP), 252
Early growing follicles, 94
Early pregnancy ultrasound, 369
embryonal landmarks and temporal
appearance, 370
EHR, 373
embryo and CRL, 371, 372
gestational sac, 370
yolk sac, 370, 371
placental location, diagnosis of, 374, 375
pregnancy dating, 373, 374
pregnancy location, 369
pregnancy viability, 376, 377
twin pregnancies, chorionicity and amnionicity
in, 378
Echogenic mass, 162
Echovist®, 245
Ectopic pregnancy, 381
abdominal pregnancy, 386, 387
after hysterectomy, 391
cervical pregnancy, 384, 386
Cesarean scar ectopic pregnancy, 387–389
endometrial echo, transvaginal ultrasound
measurement of, 384
hCG, discriminatory zone, 381
interstitial ectopic pregnancy, 389, 390
intrauterine pregnancy with transvaginal
ultrasound, 381
intrauterine pregnancy, transvaginal ultrasound
identication of, 384
ovarian pregnancy, 386
yoke sac, 383
Ejaculatory duct obstruction, TRUS, 228
Embryo transfer (ET), ultrasound guidance in,
313–315, 335
abdominal US, 339, 340
clinical touch ET vs. transabdominal US-guided ET,
336, 337
pre-ET vaginal US, 336
RCTs and meta-analyses, 336
saline 3D US, 336
training in, 339, 340
transvaginal vs. transabdominal US guidance for,
337–339
vaginal US-guided transmyometrial needle
placement, 338
Embryonal heart rate (EHR), 373
End-diastolic velocity (EDV), 101
Endocervical polyps, 171, 348
Endometrial cavity, 381, 389
infertility, 351, 352
Endometrial echo, transvaginal ultrasound measurement
of, 384
Endometrial function test® (EFT®), 359
Endometrial hyperplasia (EH), 184
Endometrial microbiome, 363, 364
Endometrial patterns, 312
Endometrial polyps, 157, 169, 348, 353
Endometrial proliferation, uterine cavity and monitoring
of, 279–281
Index
397
Endometrial receptivity, 357
assessment, 364
endometrial assessment approaches, 358, 359
endometrial microbiome, 363, 364
ERA laboratory and data analysis procedure, ow
chart of, 360
ERA predictor set and classication parameters,
principal component analysis, 361
methods, 357
non-receptive, 362
receptive, 360
transcriptomic assessment of, 359, 360
trilaminar endometrium, 358
window of implantation and, 361
WOI varies, 357
Endometrial thickness, 312
Endometrial tunneling, 174
Endometrioma, 81
Endometrioma ultrasound, 259
Endometriosis, 125
Endometrium, 116, 117
antiestrogenic effects on, 264, 265
Endoplasmic reticulum (ER), 195
Endovaginal scanning, 9
Epididymal injury, 223
Epididymis, 217
E-tegrity, 359
European Society of Human Reproduction and
Embryology (ESHRE), 34
F
Fallopian tubes, 239, 242
VHSG, 353
Female reproductive aging, 75
Female reproductive tract, see Virtual
hysterosalpingography
Fetal central nervous system (CNS), 10
FIGO type 3 intramural broids, 140
First trimester ultrasound, 369, 372, 377
Flow index (FI), 47, 69, 70, 101
Focal depth, 5
Follicular output rate (FORT), 302
Folliculogenesis, 51
Four-dimensional image techniques, 28
Free androgen index (FAI), 99
G
General Electric (GE), 26
GE medical systems, 30
Genital tuberculosis, 182
Genitourinary ultrasonography, 213, 214
Gestational sac (GS), 370, 381, 383
Gonadotrophin stimulation, 43
Gonadotropin releasing hormone agonists and antagonists
(GnRHa), 145
Gonadotropin therapy, 326
Gonadotropins, ultrasound, follicle monitoring for, 266
monitoring of therapy, 266, 267
patients selection, 266
H
Harmonic response, 245
Hellman’s method, 370
Hematometra, 308, 309
Hemoconcentration, 328
Hemorrhagic cyst, 81
Hitachi, 26
Human amniotic mesenchymal stromal cells (hAMSCs),
195
Human chorionic gonadotrophin (hCG), 381
Human menopausal gonadotropins (hMG)
clomiphene citrate, 268
ovulation induction,ultrasound, 268, 269
Hydrosalpinges, 239
Hydrosalpinx, 261, 354
Hydrosalpinx aspiration, 310
Hypercoagulability, 328
Hyperstimulation syndrome, 99
Hyperthermia, 10
Hypovascular bromuscular septum, 130
Hypoxia, 51
Hysterectomy, ectopic pregnancy after, 391
Hysterosalpingo-contrast-sonography (HyCoSy), 206
tubal patency evaluation, 241–243
Hysterosalpingography (HSG), 125, 183
tubal patency evaluation, 241
Hysteroscopic adhesiolysis, 188, 189
Hysteroscopic metroplasty, 132
Hysteroscopic myomectomy, 146, 147
Hysteroscopy, 306
SHG vs., 206, 207
I
In vitro fertilization (IVF), 95, 273
In vitro fertilization-embryo transfer (IVF-ET), 43
In vitro models, 7
Increasing frame rate, 5
Inertial cavitation, 6
Infertility, 280
endometrial cavity, pathology of, 351, 352
reproductive medicine cervical pathology in,
349–351
Injectable GnRH agonists, 146
International Federation of Gynecology and Obstetrics
(FIGO), 138, 140
Interstitial ectopic pregnancy, 389, 390
Interstitial line sign, 389
Intradecidual sign, 382
Intraendometrial power Doppler area (EDPA), 44
Intrafollicular echoes, 252
Intratesticular cysts, 223
Intrauterine adhesions (IUA)
AMH, 194, 195
causes, 182
cyclical hormonal therapy, 195
diagnosis, 183
E2-HP hydrogel, 195
effects, 183
uid barriers, 192
hAMSC transplantation, 195