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X
- •Preface
- •Contributors’ Addresses
- •Contents
- •Abbreviations
- •Basic Concepts
- •History
- •Oscillation, Sound Wave
- •Reflection and Refraction
- •Scattering
- •Interference
- •Diffraction
- •Absorption
- •Generating the Image
- •Pulse-Echo Procedure
- •Time Gain Compensation
- •A-Mode
- •B-Mode
- •M-Mode
- •The Sound Field
- •Resolution
- •Focusing
- •Scanning Procedures
- •Principle of Operation
- •Linear Array Scanner
- •Curved or Convex Array Scanner
- •Sector Scanner
- •Phased Array Scanner
- •Mechanical Sector Scanners
- •Rotary Principle
- •Wobbler Principle
- •Annular Phased Array Transducer
- •Ultrasound Artifacts
- •Distal Acoustic Shadowing
- •Dorsal Sound Amplification
- •Disadvantages of Mechanical Scanners
- •The Generation of Ultrasound
- •Physical Effects
- •Margin Shadow
- •Side Lobe
- •Slice Thickness Artifact
- •Repetition Artifact
- •Doppler Sonography
- •Fundamentals of Doppler Sonography
- •Geometrical Distortion
- •Continuous Wave Doppler Systems
- •Pulsed Wave Doppler systems
- •Alias Phenomenon in Pulsed Doppler
- •Baseline Shift
- •Wall Filter
- •Color-Coded Doppler Sonography
- •Amplitude-Coded Flow Display
- •Safety Aspects
- •Thermal Effects
- •Mechanical Effects
- •Important Definitions
- •Acoustic Output
- •Acoustic Power
- •Intensity
- •Intensity Special Peak Time Average
- •Risks of Individual Ultrasound Procedures
- •B-Mode
- •M-Mode
- •CW Doppler
- •PW Doppler
- •Color-Coded Doppler Sonography
- •Summary
- •Important Instrument Settings
- •Selecting the Most Suitable Transducer
- •B-Mode Settings
- •Depth of Penetration
- •Gain
- •Focusing
- •Setting the Doppler Parameters
- •Sample Volume
- •PRF and Baseline Shift
- •Scaling the Time Axis
- •Wall Filter
- •Orientation of the Tracings of Spectra
- •Color-Coded Doppler
- •Size of the Color Window
- •Color Gain
- •2 Indices for the Evaluation of Doppler Sonograms
- •Introduction
- •Quantitative Measurements
- •Qualitative Measurements
- •Angle Problems
- •Wall Filter
- •Indices Used to Evaluate Two-Dimensional Doppler Sonograms
- •Indices of Velocity
- •Indices of Acceleration
- •Path Length Index
- •Temporal Indices
- •Relative Flow Index
- •Optical Classification
- •Clinical Procedure
- •Vascular Supply of the Uteroplacentofetal Unit
- •Uteroplacental Blood Supply
- •Fetoplacental Blood Supply
- •Fetal Blood Supply
- •Reference Curves
- •Index Quotients
- •Summary
- •Suggestions for Obstetric Practice
- •Methods of Examining Specific Vessels
- •Displaying the Maternal Vessels
- •Displaying the Peripheral Fetal Vessels
- •Examining the Central Fetal Vessels
- •4 Blood Flow Analysis During Pregnancy
- •Uteroplacental Vessels
- •Reference Values
- •Physiological Flow Changes
- •Fetoplacental Vessels
- •Umbilical Vessels
- •Reference Values
- •Abnormal Flow Changes
- •Medications
- •Physiological Flow Changes
- •Pathological Flow Changes
- •Morphological Changes
- •Umbilical Vein
- •Reference Values
- •Physiological and Pathological Flow Alterations
- •Fetal Vessels
- •Aorta
- •Evaluation Criteria
- •Reference Values
- •Physiological Flow Changes
- •Arteries Supplying the Brain
- •Reference Values
- •Physiological Flow Changes
- •Renal Arteries
- •Evaluation Criteria
- •Reference Values
- •Ductus Arteriosus
- •Inferior Vena Cava
- •Evaluation Criteria
- •Reference Values
- •Physiological Flow Changes
- •Pathological Flow Changes
- •Ductus Venosus Arantii
- •Hepatic Veins
- •Effect of Therapeutic Measures
- •Prostaglandins
- •Antihypertensives
- •β-blockers
- •Calcium Antagonists
- •Epidural Anesthesia
- •5 Documentation
- •Sample Documentation Records
- •Correct Display of Vessels with Normal Instrument Settings
- •Role of the Angle in the Doppler Examination
- •Possible Sources of Error in Doppler Ultrasound Examinations of Maternal and Fetal Vessels
- •Displaying the Uterine Artery
- •Displaying the Umbilical Artery
- •Displaying the Fetal Aorta
- •Displaying the Middle Cerebral Artery
- •Complete Series of Doppler Ultrasound Examinations, Including Displays of Maternal Uterine and Fetal Peripheral and Central Vessels
- •Basic Concepts: References
- •Blood Flow Analysis During Pregnancy
- •Obstetric Applications of Doppler Ultrasound
- •The Significance of Transvaginal Sonography and Serum hCG
- •Characteristic Sonographic Findings in Ectopic Pregnancy
- •Differential Diagnosis
- •Transvaginal Color Doppler Ultrasound
- •Diagnostic Validity
- •Effectiveness of the Procedure
- •Errors
- •Critical Evaluation
- •Summary
- •8 Indications for Obstetric Ultrasound
- •IUGR and Biological Measurement
- •Basic Principles
- •Some Specific Measurements
- •Skull
- •Abdomen
- •Extremities
- •Cerebellum
- •Procedure when Biological Measurements are Abnormal
- •Growth Restriction
- •Suspected IUGR
- •PIH/Preeclampsia/Eclampsia
- •Status Post Dysmature Delivery/Intrauterine Death
- •Status Post Preeclampsia/Eclampsia
- •Abnormalities in the Recorded Fetal Heart Rate
- •Reasonable Suspicion of Fetal Anomalies or Fetal Disease
- •Multiple Pregnancy with Discordant Growth
- •Suspicion of Cardiac Anomaly or Heart Disease
- •Other Indications
- •First Trimester
- •Third Trimester
- •Second Trimester
- •Validity of a Test
- •Validation of Indices
- •Screening Population
- •Screening for Suspected Fetoplacental Perfusion Disorders and/or IUGR
- •Summary
- •Pathological Changes in Preeclampsia
- •Evaluating the Risk of Preeclampsia in the First and Second Trimesters—Examining the Uteroplacental Arteries
- •Doppler Ultrasound Findings
- •Evidence for or Exclusion of Fetal Risk—Evaluating the Fetal or Fetoplacental Vessels
- •Doppler Sonographic Findings
- •Doppler Sonographic Findings
- •Redistribution of Blood (Brain Sparing)
- •Summary
- •11 Doppler Ultrasound in the Diagnosis of Fetal Anomalies
- •Anomalies in the Region of the Head and Neck
- •Anomalies of the Lung and Diaphragm
- •Fetal Cardiac Malformations
- •Malformations of the Gastrointestinal Tract and the Abdominal Wall
- •Anomalies of the Urogenital System
- •Coccygeal Teratomata
- •Placenta
- •Hydrops Fetalis
- •Anhydramnios
- •Malformations of the Umbilical Cord
- •Doppler Ultrasound Diagnosis of Malformations in Early Pregnancy
- •12 Multiple Pregnancy and Doppler Ultrasound
- •Studies Using Doppler Ultrasound for Multiple Pregnancies
- •Theoretical Considerations Related to the Above Studies
- •Special Considerations for the Use of Doppler Ultrasound in Twin Pregnancies
- •Acardius Acranius, TRAP
- •Crossed Cord Around the Neck
- •Velamentous Insertion and Vasa Previa
- •Hydramnios-Oligohydramnios
- •Summary
- •NonInvasive Procedures for Suspected Fetal Anemia
- •Ultrasonic Imaging
- •Doppler Ultrasound
- •14 Umbilical Cord Complications and Doppler Ultrasound
- •Doppler Ultrasound Findings when Umbilical Cord Complications Affect Hemodynamics
- •Obstetric Applications of Doppler Ultrasound: References
- •Multiple Pregnancy and Doppler Ultrasound
- •15 Doppler Ultrasound and the Cardiotocogram
- •Comparing Tests
- •Comparing Tests to Predict Neonatal Acidosis
- •Information Lead Time Using Doppler Ultrasound
- •Clinical Significance of Doppler Ultrasound
- •16 Doppler Ultrasound Findings Near Term
- •Physiological Findings in the Late Stages of Pregnancy
- •Aorta: Quantitative Analysis
- •Aorta: Qualitative Analysis
- •Cerebral Arteries
- •Common Carotid Artery
- •Middle Cerebral Artery
- •Renal Arteries
- •Changes at Term and Postterm
- •Femoral Arteries
- •The “Term Effect”
- •The Circulatory Balance
- •Clinical Conclusions
- •Doppler Ultrasound during Labor?
- •Summary
- •Studies of Diagnostic Significance
- •Uteroplacental Arteries
- •Umbilical Arteries and Other Fetal Vessels
- •Umbilical Arteries and Fetal Aorta
- •The Umbilical Vein in Arterial Diastolic Block or Reverse Flow
- •Cerebral Arteries and Redistribution of the Circulation
- •Studies of Clinical Significance
- •Uteroplacental Arteries
- •Umbilical Arteries
- •Analysis of Individual Clinical Doppler Studies
- •Cumulative Metaanalysis
- •Conclusions
- •Diastolic Reverse Flow
- •Multiple Pregnancy
- •Summary
- •18 Doppler Sonography of the Fetal Venous Circulation
- •Anatomy
- •Physiology
- •The Right Path from the Inferior Vena Cava to the Right Atrium
- •Ultrasound Display and Doppler Sonography of the Venous System
- •Results of the Doppler Studies
- •Summary
- •1—Fetal Growth Restriction
- •2—Extreme Fetal Growth Restriction Due to Endarteritis Obliterans
- •3—Exclusion of Potter Syndrome
- •4—Closely Coordinated Preventive Care for High-Risk Patients
- •5—Patient with Antiphospholipid-Antibody Syndrome
- •6—Marked Fetal Growth Restriction
- •7—Twin Pregnancy with Twin-to-Twin Transfusion Syndrome
- •20 Doppler Ultrasound in Gynecology
- •Tumor Angiogenesis
- •Essential Considerations for Clinical Practice
- •Examination Procedure and Instrumentation for Ultrasound Diagnosis of the Pelvis
- •Evaluation
- •Ovarian Diagnosis
- •Conventional Ultrasound Examination of the Ovary: Procedure and Results
- •Normal Findings in the Doppler Ultrasound Examination of the Ovaries
- •Doppler Ultrasound and Myomas
- •Essential Considerations for Clinical Practice
- •Endometrial Diagnosis
- •Essential Considerations for Clinical Practice
- •Application of Ultrasound in Diagnosis of the Uterine Tube
- •Display of the Tube by Contrast Sonography
- •Comparison to Other Procedures
- •Supplementation by Doppler
- •22 Diagnostic Sonography of Blood Flow in Breast Tumors
- •Biological Background
- •Instrumentation
- •Continuous Wave Doppler
- •Pulsed Wave Doppler
- •Color-Coded PW Doppler
- •Angio Color, Angio Mode, Power Doppler
- •Introduction of Ultrasound Contrast Media
- •Color-Coded Doppler Ultrasound in the Differential Diagnosis of Breast Tumors
- •Advanced Topics in Obstetrics and Gynecological Doppler Ultrasound: References
- •Doppler Ultrasound and the Cardiotocogram
- •Doppler Ultrasound Findings Near Term
- •Diagnostic and Clinical Significance of Doppler Ultrasound in Obstetrics
- •Doppler Ultrasound in Gynecology
- •Diagnosis of the Uterine Tube by Transvaginal Ultrasound
- •Index


IIIIII


Doppler Ultrasound in Gynecology
and Obstetrics
Christof Sohn, M.D.
Professor
Department of Obstetrics/Gynecology
Hanover University Clinic
Hanover, Germany
Hans-Joachim Voigt, M.D.
Professor
Director Gynecological Hospital
Westpfalz Klinikum GmbH
Kaiserslautern, Germany
Klaus Vetter, M.D.
Professor
Obstetric Clinic
Vivantes Medical Center Neukoelln
Berlin, Germany
Translated by Oliver French, M.D.
With contributions by
P.M. Baier, A. Baudendistel, H. Frey, F. Geka, M. Gonser, C. Hofstaetter, Ö. Kilavuz,
A. Scharf, C. Sohn, K. Vetter, H.-J. Voigt
466 illustrations
32 tables
Thieme
Stuttgart · New York

Library of Congress Cataloging-in-Publication Data
is available from the publisher.
This book is an authorized translation of the German
edition published and copyrighted 1999 by Georg
Thieme Verlag, Stuttgart, Germany.Title of the German
edition: Kursbuch Dopplersonographie in Gynäkologie
und Geburtshilfe
Translator: Oliver French M.D., Ithaca NY, USA
Important Note: Medicine is an ever-changing science
undergoing continual development. Research and
clinical experience are continually expanding our
knowledge, in particular our knowledge of proper
treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have
made every effort to ensure that such references are in
accordance with the state of knowledge at the time
of production of the book.
Nevertheless, this does not involve, imply, or express
any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms
of applications stated in the book. Every user is re-
quested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary
in consultation with a physician or specialist, whether
the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from
the statements made in the present book. Such examination is particularly important with drugs that are
either rarely used or have been newly released on the
market. Every dosage schedule or every form of application used is entirely at the user’s own risk and responsibility. The authors and publishers request every
user to report to the publishers any discrepancies or
inaccuracies noticed.
IV
© 2004 Georg Thieme Verlag,
Rüdigerstrasse 14, D-70469 Stuttgart, Germany
http://www.thieme.de
Thieme New York, 333 Seventh Avenue,
New York, NY 10001, USA
http:///www.thieme.com
Cover design: Martina Berge, Erbach-Ernsbach
Typesetting by primustype R. Hurler GmbH,
D-73274 Notzingen,
Typeset on Textline/HerculesPro
Printed in Germany by Grammlich, Pliezhausen
ISBN 3-13-135591-3 (GTV)
ISBN 1-58890-261-7 (TNY) 12345
Some of the product names, patents, and registereddesigns referred to in this book are in fact registered
trademarks or proprietary names even though specific
reference to this fact is not always made in the text.
Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.
This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher’s consent, is
illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing, preparation of microfilms, and electronic data processing and storage.

Preface
Doppler ultrasound is the most successful clinical innovation introduced into obstetrics and gynecology in
the last few years. This functional biophysical technique has extended the limits of the specialty. It is
now possible to record and analyze the hemodynamics of the blood supply of individual organs in gynecology and the fetoplacental unit in obstetrics. Thanks
to cardiotocography and Doppler ultrasound, the
black box of pregnancy now presents some quite sizeable illuminated peepholes. They are the basis for
part of the considerable progress in prenatal and perinatal medicine.
In contrast to other methods the diagnostic and
clinical value of Doppler ultrasound was demonstrated
before its widespread acceptance. It is the method of
choice for determining the sufficiency of the uteroplacental and fetoplacental circulations and for answering questions regarding the fetal response to
various changes in its environment, such as the blood
supply. In most cases differential analysis of the state
of both arterial and venous circulation, combined with
echocardiography, provides a reasonably accurate realtime image of the condition of the fetus, and allows
suitable specific therapeutic measures to be undertaken.
Each of the editors has been repeatedly asked to provide an up-to-date book on Doppler ultrasound. In
view of the increasingly complex nature of the subject
they focused on Doppler ultrasound in obstetrics and
gynecology, and in collaboration with other authors
wrote this book to assist readers in their everyday
practice.
It is inevitable that in such a dynamic field the new
matter presented here will be called into question or
overtaken within a short time by new research. We
would like to encourage our readers not to spare us
from constructive criticism, for only in that waycan we
make progress in caring for the women and children
entrusted to us.
We would like to thank Thieme Verlag, especially Dr.
M. Becker, for their productive collaboration, and our
co-workers and families for their patience.
Hanover/Kaiserslautern/Berlin Christof Sohn
Autumn 2003 Hans-Joachim Voigt
Klaus Vetter
V

Contributors’ Addresses
Peter M. Baier, M.D.
Center for Gynecology and Obstetrics
University Medical Center
Hanover, Germany
Anja Baudendistel, M.D.
Center for Gynecology and Obstetrics
University Medical Center
Frankfurt, Germany
Holger Frey
ECOSCAN GmbH
Wiesbaden, Germany
Fani Geka, M.D.
Center for Gynecology and Obstetrics
University Medical Center
Frankfurt, Germany
Markus Gonser, M.D.
University Gynecology and Obstetrics
Medical Center
Tübingen, Germany
C. Hofstaetter, M.D.
Department of Prenatal Diagnostics and Therapy
Center for Gynecology and Obstetrics
Bonn University Hospital
Bonn, Germany
O. A. Oemer Kilavuz
Department of Obstetrics
Berlin, Germany
A. Scharf, M.D.
Center for Gynecology and Obstetrics
University Medical Center
Hanover, Germany
VI

Contents
Basic Concepts
1 Physical and Technical Fundamentals of Ultrasound and Doppler Ultrasound
H. Frey
History ....................................... 3
Oscillation, Sound Wave ...................... 3
The Generation of Ultrasound ................ 4
Physical Effects ............................... 5
Reflection and Refraction ...................... 5
Scattering .................................... 6
Interference .................................. 6
Diffraction .................................... 6
Absorption .................................... 6
Generating the Image ........................ 7
Pulse-Echo Procedure ......................... 7
Time Gain Compensation ...................... 7
A-Mode ...................................... 7
B-Mode ....................................... 8
M-Mode ...................................... 8
The Sound Field .............................. 9
Resolution .................................... 9
Focusing ...................................... 9
Scanning Procedures ......................... 10
Principle of Operation ......................... 10
Linear Array Scanner .......................... 11
Curved or Convex Array Scanner ............... 11
Sector Scanner ................................ 11
Phased Array Scanner ......................... 11
Mechanical Sector Scanners .................... 12
Rotary Principle ............................. 12
Wobbler Principle ........................... 13
Annular Phased Array Transducer ............ 13
Ultrasound Artifacts .......................... 13
Distal Acoustic Shadowing ..................... 13
Dorsal Sound Amplification .................... 13
Disadvantages of Mechanical Scanners ....... 13
Margin Shadow ............................... 14
Side Lobe ..................................... 14
Slice Thickness Artifact ........................ 14
Repetition Artifact ............................ 14
Doppler Sonography .......................... 15
Fundamentals of Doppler Sonography ......... 15
Geometrical Distortion ........................ 15
Continuous Wave Doppler Systems ............ 17
Pulsed Wave Doppler systems ................. 17
Alias Phenomenon in Pulsed Doppler ........... 18
Baseline Shift ................................. 18
Wall Filter .................................... 19
Color-Coded Doppler Sonography .............. 19
Amplitude-Coded Flow Display ................ 19
Safety Aspects ................................ 20
Thermal Effects ............................... 20
Mechanical Effects ............................ 20
Important Definitions ......................... 21
Acoustic Output ............................. 21
Acoustic Power ............................. 21
Intensity .................................... 21
Intensity Special Peak Time Average ......... 21
Risks of Individual Ultrasound Procedures ..... 21
B-Mode ..................................... 21
M-Mode .................................... 21
CW Doppler ................................ 21
PW Doppler ................................ 21
Color-Coded Doppler Sonography ............ 21
Summary ..................................... 21
Important Instrument Settings ............... 22
Selecting the Most Suitable Transducer ......... 22
B-Mode Settings .............................. 22
Depth of Penetration ....................... 22
Gain ........................................ 22
Focusing .................................... 22
Setting the Doppler Parameters ................ 22
Sample Volume ............................. 22
PRF and Baseline Shift ....................... 22
Scaling the Time Axis ....................... 22
Wall Filter .................................. 22
Orientation of the Tracings of Spectra ........ 22
Color-Coded Doppler .......................... 23
Size of the Color Window .................... 23
PRF......................................... 23
Color Gain .................................. 23
VII

Contents
2 Indices for the Evaluation of Doppler Sonograms
K. Vetter, M. Gonser, H.-J. Voigt
Introduction ................................. 25
Quantitative Measurements .................... 25
Qualitative Measurements ..................... 25
Angle Problems ............................... 25
Wall Filter .................................... 26
Indices Used to Evaluate Two-Dimensional
Doppler Sonograms .......................... 26
Indices of Velocity ............................. 26
Indices of Acceleration ........................ 28
Path Length Index ............................. 29
Temporal Indices ............................. 29
Relative Flow Index ........................... 30
Optical Classification ......................... 32
Clinical Procedure ............................ 33
Reference Curves ............................. 34
Index Quotients .............................. 37
Summary .................................... 39
Suggestions for Obstetric Practice .............. 39
3 Vascular Supply of the Uteroplacentofetal Unit and Techniques
for the Examination of Individual Vessels
C. Sohn
Vascular Supply of the Uteroplacentofetal
Unit .......................................... 41
Uteroplacental Blood Supply ................... 41
Fetoplacental Blood Supply .................... 42
Fetal Blood Supply ............................ 42
Methods of Examining Specific Vessels ....... 44
Displaying the Maternal Vessels ................ 44
Examining the Uterine Arteries in the
Second Trimester ........................... 44
Examining the Uterine Arteries in the
Third Trimester ............................. 47
Displaying the Peripheral Fetal Vessels ......... 47
Examining the Umbilical Artery .............. 47
Examining the Aorta in the Second
and Third Trimesters ........................ 48
Examining the Central Fetal Vessels ............ 50
Examining the MCA ......................... 50
Examining the Carotid Artery ................ 51
VIII
4 Blood Flow Analysis During Pregnancy
K. Vetter, M. Gonser
Uteroplacental Vessels ........................ 53
Reference Values ............................ 54
Physiological Flow Changes .................. 54
Fetoplacental Vessels ......................... 55
Umbilical Vessels ............................. 55
Reference Values ............................ 55
Abnormal Flow Changes ..................... 55
Medications ................................ 55
Physiological Flow Changes .................. 56
Pathological Flow Changes ................... 56
Morphological Changes ...................... 56
Umbilical Vein ................................ 58
Reference Values ............................ 58
Physiological and Pathological
Flow Alterations ............................ 58
Fetal Vessels ................................. 59
Aorta ......................................... 59
Evaluation Criteria .......................... 59
Reference Values ............................ 59
Physiological Flow Changes .................. 60
Arteries Supplying the Brain ................... 60
Reference Values ............................ 61
Physiological Flow Changes .................. 61
Renal Arteries ................................. 61
Evaluation Criteria .......................... 62
Reference Values ............................ 62
Ductus Arteriosus ............................. 62
Inferior Vena Cava ............................ 62
Evaluation Criteria .......................... 62
Reference Values ............................ 62
Physiological Flow Changes .................. 62
Pathological Flow Changes ................... 62
Ductus Venosus Arantii ........................ 62
Hepatic Veins ................................. 63
Effect of Therapeutic Measures ............... 63
Prostaglandins ................................ 63
Antihypertensives ............................. 63
β-blockers .................................. 64
Calcium Antagonists ......................... 64
Epidural Anesthesia ........................... 64

5 Documentation
C. Sohn
Sample Documentation Records .............. 66
6 Common Errors in the Doppler Ultrasound Display of Uterine Blood Flow
and Fetal Vessels
F. Geka, C. Sohn
Contents
Correct Display of Vessels with Normal
Instrument Settings .......................... 69
Role of the Angle in the Doppler Examination .69
Possible Sources of Error in Doppler
Ultrasound Examinations of Maternal
and Fetal Vessels ............................. 71
Displaying the Uterine Artery .................. 71
Displaying the Umbilical Artery ................ 73
Displaying the Fetal Aorta ..................... 74
Displaying the Middle Cerebral Artery .......... 76
Complete Series of Doppler Ultrasound
Examinations, Including Displays of Maternal
Uterine and Fetal Peripheral and Central
Vessels ....................................... 77
Basic Concepts: References ................... 80
Physical and Technical Fundamentals
of Ultrasound and Doppler Ultrasound ....... 80
Indices for the Evaluation of Doppler
Sonograms ................................. 80
Blood Flow Analysis During Pregnancy ....... 80
Obstetric Applications of Doppler Ultrasound
7 The Role of Doppler Ultrasound in the Diagnosis of Ectopic Pregnancy
H.-J. Voigt
The Significance of Transvaginal Sonography
and Serum hCG ............................... 85
Characteristic Sonographic Findings in
Ectopic Pregnancy ............................ 85
Differential Diagnosis ........................ 85
Transvaginal Color Doppler Ultrasound ....... 86
Diagnostic Validity ............................ 86
Effectiveness of the Procedure ................. 86
Errors ........................................ 87
Critical Evaluation ............................. 89
Summary .................................... 89
8 Indications for Obstetric Ultrasound
C. Sohn
IUGR and Biological Measurement ............ 92
Basic Principles ............................... 92
Some Specific Measurements .................. 92
Skull ....................................... 92
Abdomen ................................... 92
Extremities ................................. 93
Cerebellum ................................. 93
Procedure when Biological Measurements are
Abnormal ..................................... 93
Growth Restriction ............................ 94
Suspected IUGR ............................... 94
PIH/Preeclampsia/Eclampsia .................. 96
Status Post Dysmature Delivery/Intrauterine
Death ........................................ 96
Status Post Preeclampsia/Eclampsia .......... 97
IX
Abnormalities in the Recorded Fetal Heart
Rate .......................................... 97
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