Diagnostic Medical Sonography OBSTETRICS AND GYNECOLOGY Diagnostic Medical Sonography OBSTETRICS AND GYNECOLOGY Third Edition Susan Raatz Stephenson, MAEd, RDMS (OB)(AB)(BR), RVT, RT(R)(C), CIIP Sonographer Sandy, Utah Publisher: Julie K. Stegman Senior Product Manager: Heather Rybacki Product Manager: Kristin Royer Marketing Manager: Shauna Kelley Design Coordinator: Joan Wendt Art Director: Jennifer Clements Manufacturing Coordinator: Margie Orzech Production Services: Absolute Service, Inc. Copyright © 2012 by Lippincott Williams & Wilkins, a Wolters Kluwer business 351 West Camden Street Two Commerce Square Baltimore, MD 21201 2001 Market Street Philadelphia, PA 19103 Third Edition All rights reserved. This book is protected by copyright. No part of it may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in the book prepared by individuals as part of their offi cial duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China. Library of Congress Cataloging-in-Publication Data Diagnostic medical sonography. Obstetrics and gynecology. — 3rd ed. / edited by Susan Raatz Stephenson. p. ; cm. Obstetrics and gynecology Rev. ed. of: Obstetrics and gynecology / edited by Mimi C. Berman, Harris L. Cohen. 2nd ed. c1997. Includes bibliographical references and index. ISBN 978-1-60831-117-0 (alk. paper) I. Stephenson, Susan Raatz. II. Obstetrics and gynecology. III. Title: Obstetrics and gynecology. [DNLM: 1. Genital Diseases, Female–ultrasonography. 2. Fetal Diseases–ultrasonography. 3. Pregnancy Complications–ultrasonography. 4. Ultrasonography, Prenatal. WP 141] 618.1’07543–dc23 2011043624 Care has been taken to confi rm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express or implied, with respect to the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. 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Visit Lippincott Williams & Wilkins on the Internet at LWW.com Lippincott Williams & Wilkins customer ser- vice representatives are available from 8:30 AM to 6:00 PM, EST. 10 9 8 7 6 5 4 3 2 1 To the men in my life, none of whom wanted this dedication. Beginning with my father who nurtured the personality, to my brother with whom I compete, the son who has become a great person, the man I chose to spend my life with and has to put up with me, and fi nally, to my nephew who I look forward to getting to know better. Susan Raatz Stephenson And to students and professionals who will use this book: In my own journey to this point, there were many times when I wished the technology changes would slow down. Through the years, it became evident that the development and use of modes, such as Doppler and now Volume Imaging, require lifelong learning. My advice to you is to endeavor to understand the why and when we use the facets of sonography. Remember, “Curiosity is the very basis of education and if you tell me that curiosity killed the cat, I say only the cat died nobly.” —Arnold Edinborough A fi nal note from B.B. King, “The beautiful thing about learning is nobody can take it away from you.” Contents PART 1 (cid:129) GYNECOLOGIC SONOGRAPHY 1 Principles of Scanning Technique in Obstetric and Gynecologic Ultrasound .......1 Susan Raatz Stephenson 2 Embryonic Development of the Female Genital System ....................................21 Susan Raatz Stephenson 3 Congenital Anomalies of the Female Genital System .........................................31 Faith Hutson 4 The Female Cycle ................................................................................................51 Sue Benzonelli-Blanchard 5 Normal Anatomy of the Female Pelvis ................................................................81 Sanja Plavsic Kupesic (cid:129) Tricia Turner 6 Doppler Evaluation of the Pelvis .......................................................................137 Michelle Wilson 7 Pediatric Pelvis ...................................................................................................157 Jennifer Martin (cid:129) Linda Woolpert (cid:129) Susan Raatz Stephenson 8 Benign Disease of the Female Pelvis .................................................................175 Susan Raatz Stephenson 9 Malignant Disease of the Uterus and Cervix .....................................................213 Faith Hutson 10 Malignant Disease of the Ovary ........................................................................237 Danielle M. Bolger 11 Pelvic Infl ammatory Disease and Endometriosis ...............................................257 Allison A. Cowett 12 Assisted Reproductive Technologies (ART), Contraception, and Elective Abortion ........................................................................................277 Catheeja Ismail (cid:129) Molina Dayal PART 2 (cid:129) OBSTETRIC SONOGRAPHY 13 The Use of Ultrasound in the First Trimester .....................................................313 Paula Woletz 14 Sonographic Evaluation of First Trimester Complications.................................333 Paula Woletz 15 Sonographic Assessment of the Ectopic Pregnancy .........................................351 Amanda Auckland 16 Assessment of Fetal Age and Size in the Second and Third Trimester............................................................................................367 Susan Johnston vii viii CONTENTS 17 The Fetal Environment ......................................................................................393 Malka Stromer 18 Abnormalities of the Placenta and Umbilical Cord ...........................................423 Lisa M. Allen 19 Sonographic Assessment of the Fetal Neural Tube Structures .............................................................................461 Susan Raatz Stephenson (cid:129) Roa M. Qato 20 Ultrasound of the Normal Fetal Chest, Abdomen, and Pelvis .........................................................................................503 Robert G. Magner, Jr. (cid:129) Cheryl A. Vance 21 Ultrasound of the Abnormal Fetal Chest, Abdomen, and Pelvis .........................................................................................539 Gertrude Alfonsin Layton 22 Fetal Echocardiography .....................................................................................577 Marium Holland (cid:129) Joan M. Mastrobattista 23 Normal and Abnormal Fetal Limbs ...................................................................609 Molly Siemens 24 Doppler Ultrasound of the Normal Fetus ..........................................................629 Tonya N. Brathwaite 25 The Biophysical Profi le.......................................................................................645 Meredith O. Cruz (cid:129) Isabelle Wilkins 26 Multiple Gestations ...........................................................................................661 Julia A. Drose 27 Intrauterine Growth Restriction (IUGR)..............................................................683 Michelle Kominiarek 28 Patterns of Fetal Anomalies ..............................................................................713 John F. Trombly (cid:129) Susan Raatz Stephenson 29 Effects of Maternal Disease on Pregnancy ........................................................745 Tammy Stearns 30 The Postpartum Uterus......................................................................................767 Dea Shatterly 31 Interventional Ultrasound ..................................................................................775 Sanja Plavsic Kupesic 32 3-D and 4-D Imaging in Obstetrics and Gynecology ........................................801 Bridgette Lunsford Index ..................................................................................................................835
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