Basic Imaging
Principles in Obstetrics
Dr T Musila Mutala
Lecturer
Department of Diagnostic Imaging and
Radiation Medicine
• University of Nairobi
Objectives
Look at the imaging indications for trimesters 1, 2 &3.
Discuss the principles of ultrasound as mainstay of imaging in
obstetrics.
Highlight the applicability of ultrasound imaging with examples
Mention briefly other imaging modalities applicable in obstetrics –
Plain X-ray, CT scan and MRI for other specific indications
Why ultrasound?
Non-ionizing radiation
Widely available
Relatively cheap
Main limitation – operator dependence
Ultrasound
Uses high frequency sound
waves
Sonography
• Use of coupling gel – reduce air
interface between transducer
and skin surface: air is bad
transmitter of sonographic waves
• Patient must have just a full
bladder to allow visualization of
essential pelvic anatomy
Sonography – Approaches
Transabdominal Transvaginal – higher frequency
Early
pregnancy
• First trimester – up to 14
weeks.
Early Intrauterine Pregnancy Timelines
Double deciduous sign (4.5-5 weeks)
Gestational sac, yolk sac and fetal pole at 6 weeks
• Crown-rump length (CRL)
measurement – dating of the
pregnancy. First trimester
ultrasonic dating is the most
accurate
Cardiac activity in early pregnancy: this can be seen before a fetal pole is well shown but must be normally
demonstrated when fetal pole has a crown-rump length (CRL) of at least 7 mm.
Early IUP
• Embryo, amniotic
membrane demonstrated
(6.7-7.0 weeks)
Early IUP
• Mean sac diameter (MSD)
can also be used to date
early pregnancy when fetal
pole is not visualized
Early IUP
Multiple gestation
FAILED EARLY PREGNANCY
FAILED EARLY
PREGNANCY
Blighted ovum –
anembryonic
pregnancy
FAILED EARLY
PREGNANCY
Embryonic demise
– fetal pole, no
cardiac activity
Failed early pregnancy – inevitable abortion
Opening cervical canal
No cardiac activity
Finally cervical canal widely dilates
Subchorionic hemorrhage
Ectopic pregnancy
Empty uterine cavity Ectopic pregnancy within the left adnexa
?
Cervical ectopic pregnancy
• Adnexal double deciduous sign with increased vascularity on color Doppler in a patient who had positive
clinical and biochemical pregnancy, presenting with acute lower abdominal pain
Ruptured (slow leaking) ectopic pregnancy – hemorrhage
within the POD.
• Fluid within the hepatorenal
(Morrison’s) space.
Gestational trophoblastic disease
Complete hydaditiform mole
Late first trimester ultrasound image
Nuchal translucency and nasal bone assessment for aneuploidy screening
2ND AND 3RD TRIMESTER
Standard fetal
anatomy
examination:
“Anomaly”
scan- best done
at around 18/40
Report
• Fetal number
• Cardiac activity and heart rate
• Physical activity (body movements)
• All the subsets of the essential elements as per the ACR-
Anomaly scan •
ACOG-AIUM-SRU practice parameters
Biometric profile (estimated fetal gestational age and
weight)
• Placental position
• Cord vessels – number
• Amniotic fluid
• Cervical length and os situation.
Twin gestation
• Two heads demonstrated next
to each other
• Heart 4 chamber view
Fetal head
• Cleft lip on 3-D ultrasound
• Cystic hygroma
Abdomen and cord • Three-vessel cord
insertion:
• Placenta and amniotic fluid
• Fetal spine
• Cervical assessment
Biometric profile
Specialized (Focused, targeted) examination
Answers specific questions: e.g.
1. Confirmation of anomalies picked on standard examination
2. Assessment of cervical incompetence and intervention thereof
3. Suspected IUGR
4. APH- assessment of placenta
5. Suspected fetal death
6. Predelivery fetal position
• Cervical incompetence:
shortened cervical length
and funneling of the
internal os
Placenta previa completely covering the entire
cervical os: Grade IV.
Severe oligohydramnios
Polyhydramnios
Other modalities
• Plain X-ray
• Computed tomography (CT)
• MRI
Plain x-ray -ELP
Low-dose computed tomography (LDCT)
pelvimetry
Magnetic Resonance Imaging (MRI)
Problem solving
Non-ionizing radiation
Relatively expensive
Not widely available
Specific implants may contraindicate its use.
Hydrops fetalis
MRI Ultrasound
• Chiari III on fetal MRI
Not to forget….
• A pregnant mother can develop any other health-related condition
just like the general population.
• This may necessitate the need for imaging
• Under such conditions, As Low As Reasonably Achievable (ALARA)
principle must be applied. Benefits must outweigh risks before
radiation exposure.
