妇产科疾病的超声诊断ENGLISH课件

妇产科疾病的超声诊断妇产科疾病的超声诊断-ENGLISH2024/8/1妇产科疾病的超声诊断ENGLISH妇产科疾病的超声诊断-ENGLISH2023/7/27妇产科1Sangreal-uterusTHE DAWINCI CODE妇产科疾病的超声诊断ENGLISHSangreal-uterusTHE DAWI2 Pelvic CavityPosterior:Occupied by rectum,colon,and ileumAnterior:bladder,ureters,ovaries,fallopian tubes,uterus,and vaginaNORMAL ANATOMY妇产科疾病的超声诊断ENGLISH Pelvic CavityNORMAL ANATOMY妇3Pre-inspection:Moderate bladder filling 妇产科疾病的超声诊断ENGLISHPre-inspection:Moderate bladd4UterusHollow,pear-shaped organDivided into fundus,body,and cervixUsually anteflexed and antevertedCovered with peritoneum except anteriorly below the os where peritoneum is reflected onto bladderSupported by levator ani muscles and pelvic fasciaRound ligament keeps uterus in position妇产科疾病的超声诊断ENGLISHUterusHollow,pear-shaped orga5Uterine sizePrepubertal:3 cm long by 0.5 to 1.0 cm wideMenarcheal:8 cm long by 4 cm widePostmenopausal:3.5 to 5.5 cm long by 1 to 2 cm wideNormal size:23(thick)45(width)78 cm(length)妇产科疾病的超声诊断ENGLISHUterine sizePrepubertal:3 cm6Uterine longitudinal diameter Uterine wide diameter Uterus before and after the Trail 妇产科疾病的超声诊断ENGLISHUterine longitudinal diameter 7length 78cmbefore and after the Trail 23cmwidth 45cm妇产科疾病的超声诊断ENGLISHlength 78cmbefore and after t8Uterine PositionMidline anteversion:most common;degree of anteversion is bladder distention dependentRight or left:normal variant in absence of pelvic massesRetroverted:entire organ displaced posteriorlyRetroflexed:body displaced with respect to cervix妇产科疾病的超声诊断ENGLISHUterine PositionMidline anteve9Ultrasonography of normal uterusUterine serosa layer:Linear high-echo;clear,smooth;Myometrium:Homogeneous middle-echo;Endometria:The middle line of high echo,around the weak echo.It is well known that the endometrium changes dynamically in response to cyclic hormonal flux.妇产科疾病的超声诊断ENGLISHUltrasonography of normal uter10Uterine serosa layer Myometrium Endometria Normal uterusNormal uterustransabdominal ultrasonographytransabdominal ultrasonography妇产科疾病的超声诊断ENGLISHUterine serosa layer Myometriu11Transvaginal sagittal view of the uterus.The Transvaginal sagittal view of the uterus.The rounded fundus is shown toward the left of the rounded fundus is shown toward the left of the image with the endometrial stripe rumming through image with the endometrial stripe rumming through the middle of the uterine cavity.the middle of the uterine cavity.MyometriumEndometriaUterine serosa layer妇产科疾病的超声诊断ENGLISHTransvaginal sagittal view of 12Fallopian Tube（输卵管）Infundibulum:funnel-shaped lateral tube that projects beyond the broad ligament to overlie the ovariesAmpulla:sidest part of the tube where fertilization occursIsthmus:hardest part;lies just lateral to the uterusLength:12 cm;supplied by ovarion arteries and veins妇产科疾病的超声诊断ENGLISHFallopian Tube（输卵管）Infundibulu13Ovary（卵 巢）Almond shapedAttached to back of the broad ligament by mesovarium;sometimes called suspensory ligament of the ovaryLies in ovarian fossaFossa is bounded by external iliac vessels,ureter,and obturator nerveReceives blood from ovarian arteryBlood drained by ovarian vein into inferior vena cava on right;on left by ovarian vein into lert renal vein妇产科疾病的超声诊断ENGLISHOvary（卵 巢）Almond shaped妇产科疾病的14Sonography of the normal ovaryAn ovoid homogeneous echodensity;follicular cysts are often present.The best sonographic marker for the ovary is identification of a follicular cyst,which has the classic appearance of being thin walled and anechoic with through-transmission posteriorly.妇产科疾病的超声诊断ENGLISHSonography of the normal ovary15Transabdominal sagittal image shows the Transabdominal sagittal image shows the left ovary posterior to the urinary bladderleft ovary posterior to the urinary bladder妇产科疾病的超声诊断ENGLISHTransabdominal sagittal image 16Transvaginal sagittal image of the ovaryTransvaginal sagittal image of the ovaryovarian follicle妇产科疾病的超声诊断ENGLISHTransvaginal sagittal image of17Follicular wall flow妇产科疾病的超声诊断ENGLISHFollicular wall flow妇产科疾病的超声诊断18Common Diseases of Obstetrics and GynecologyGynecology：Leiomyoma；Carcinoma;；Ovarian Tumors;Inflammatory mass;etc.Obstetrics：NaturalNatural pregnancy；Abnormal pregnancy;etc.妇产科疾病的超声诊断ENGLISHCommon Diseases of Obstetrics 19The uterus Leiomyoma/Hysteromyoma妇产科疾病的超声诊断ENGLISHThe uterus Leiomyoma/Hystero20Characteristics of LeiomyomasMost common pelvic tumorSmooth muscle cell compositionFibrosis occurs after atrophic of degenerative changesDegeneration occurs when fibroids outstrip their blood supply;calcificationMay be pedunculatedClinical:enlarged uterus,profuse and prolonged bleeding,pain妇产科疾病的超声诊断ENGLISHCharacteristics of LeiomyomasM21Uterine Locations of leiomyomasSubmucosal Erode into endomertial cavity heavy bleeding;infertilityIntramuralMay enlarge to cause pressure on adjacent organs;infertilitySubserosalMay enlarge to cause pressure on adjacent organs 妇产科疾病的超声诊断ENGLISHUterine Locations of leiomyoma22Subserous myomaBroad ligamentmyomaCervical myomaintramurous myomaSubmucous myoma妇产科疾病的超声诊断ENGLISHSubserous Broad ligamentCervic23Ultrasonic performanceTwo-dimensional：Increased uterine body or Form disorders；Spherical hypoechoic area in the uterine body，Rear echo attenuation；With calcification or Cystic change,etc；Signs of oppression；Color Doppler：Tumor around with the blood flow signal in the shape of ring or semi-circular ring；Doppler spectrum：Medium resistance index，RI 0.60.1。妇产科疾病的超声诊断ENGLISHUltrasonic performanceTwo-dime24intramurous myoma妇产科疾病的超声诊断ENGLISHintramurous myoma妇产科疾病的超声诊断ENG25Subserous myomaintramurous myoma妇产科疾病的超声诊断ENGLISHSubserous myomaintramurous myo26Subserous myoma妇产科疾病的超声诊断ENGLISHSubserous myoma妇产科疾病的超声诊断ENGLI27Cervical myoma妇产科疾病的超声诊断ENGLISHCervical myoma妇产科疾病的超声诊断ENGLIS28Abundant tumor blood flowAbundant tumor blood flowMUTUT妇产科疾病的超声诊断ENGLISHAbundant tumor blood flowMUT妇产29RI 0.61妇产科疾病的超声诊断ENGLISHRI 0.61妇产科疾病的超声诊断ENGLISH30Submucous myoma with calcification妇产科疾病的超声诊断ENGLISHSubmucous妇产科疾病的超声诊断ENGLISH31Teratoma Dermoid Tummors（卵巢良性囊性畸胎瘤/皮样囊肿)Pathology：derives from germ cell，the most common ovarian neoplasm,constituting 20%of ovarian tumors.up to 20%are bilateral.About 80%occur in women of childbearing age.妇产科疾病的超声诊断ENGLISHTeratoma Dermoid Tummors（卵巢32Size ranges from small to 40 cmUnliateral,round to oval massContains faty,sebaceous material,hair,cartilage,bone,teethClinical:asymptomatic to abdominal pain,enlargement and pressure;pedunculated,subject to torsionSonography:Cystic/complex/solid mass,echogenic components;acoustic shadowing妇产科疾病的超声诊断ENGLISHSize ranges from small to 40 c33Special Ultrasound Findings:1.A cystic mass:with an echogenic mural nodule2.A paste sign：particulate liptinite3.A fluff of hair sign4.A fat-fluid level sign：with fluid level in the cyst,fat above,fluid below.5.A complex mass妇产科疾病的超声诊断ENGLISHSpecial Ultrasound Findings:1.34cystic teratoma cystic teratoma of ovaryof ovaryA cystic massPaste signFluff of hair sign妇产科疾病的超声诊断ENGLISHcystic teratoma A cystic massP35Paste signFat-fluid level signA complex mass妇产科疾病的超声诊断ENGLISHPaste signFat-fluid level sign36A 8 years old girl,cutting off a three kilograms benign teratoma妇产科疾病的超声诊断ENGLISHA 8 years old girl,cutting of37The role of Ultrasound in Obstetrics妇产科疾病的超声诊断ENGLISHThe role of Ultrasound in Obst38TRIMESTERSFirst trimester =0 to 12 weeks of gestationSecond trimester =13 to 26 weeks of gestationThird trimester =27 to 42 weeks of getsationPostterm pregnancy=42 weeks of gestation妇产科疾病的超声诊断ENGLISHTRIMESTERSFirst trimester 39Indications for First-Trimester SonographyConfirm presence of intrauterine pregnancyEvaluate for suspected ectopic pregnancyDefine cause of vaginal bleedingDetermine gestational ageConfirm suspected multiple gestationsAid in invasive proceduresEvaluate pelvic massesDetect uterine abnormalities妇产科疾病的超声诊断ENGLISHIndications for First-Trimeste40Natural pregnancyNatural pregnancy妇产科疾病的超声诊断ENGLISHNatural pregnancy妇产科疾病的超声诊断ENG41Nonage pregnancy(First-Trimester)Definition：Pregnancy before 12 weekend.妇产科疾病的超声诊断ENGLISHNonage pregnancy(First-Trime425 weeks pregnant Gestational sac；6-7 weeks pregnant Germ;7-8 Weeks Primitive heart tube pulse；8-11 weeks Yolk sac;9 weeks Embryonic,placenta.The Normal First Trimester妇产科疾病的超声诊断ENGLISH5 weeks pregnant The Normal F43Sonographic Features of a Normal Gestational SacShape:round of ovalPosition:fundal or middle portion of uterus;a center position relative to endometriumContour:smoothWall:echogenic;3 mm of more in thickness妇产科疾病的超声诊断ENGLISHSonographic Features of a Norm44Internal landmarks:yalk sac present when gestational sac is larger than 10 mm;embryo present when gestational sac is larger than 18 mmGrowth:1 mm per day(range:0.7 mm to 1.5 mm per day)妇产科疾病的超声诊断ENGLISHInternal landmarks:yalk sac p454-5 weeks pregnant4-5 weeks pregnant In the gestational sac we can see a In the gestational sac we can see a embryo point,the earliest embryo.embryo point,the earliest embryo.妇产科疾病的超声诊断ENGLISH4-5 weeks pregnant妇产科疾病的超声诊断EN467 weeks pregnant7 weeks pregnant Fetus was about 4 mmFetus was about 4 mm，we can see we can see apparent heart throb,and small limb bud.apparent heart throb,and small limb bud.妇产科疾病的超声诊断ENGLISH7 weeks pregnant妇产科疾病的超声诊断ENGL478 weeks pregnant8 weeks pregnant Three-dimensional ultrasound show its beginning Three-dimensional ultrasound show its beginning of the shape of a humanof the shape of a human.妇产科疾病的超声诊断ENGLISH8 weeks pregnant妇产科疾病的超声诊断ENGL48Umbilical bordEmbryonic headEmbryonic abdomen妇产科疾病的超声诊断ENGLISHUmbilical bordEmbryonic headEm49Yolk sacEmbronic headAmniotic sac妇产科疾病的超声诊断ENGLISHYolk sacEmbronic headAmniotic 509 weeks pregnant9 weeks pregnant Known as a fetalKnown as a fetal，Development of the Development of the various parts of the fetus,tends to improvevarious parts of the fetus,tends to improve.妇产科疾病的超声诊断ENGLISH9 weeks pregnant妇产科疾病的超声诊断ENGL5112 weeks pregnant12 weeks pregnantThe spine is identifiable,as the two bead-like high The spine is identifiable,as the two bead-like high echo.Ears,limbs,bones can be shown and echo.Ears,limbs,bones can be shown and measurement.measurement.妇产科疾病的超声诊断ENGLISH12 weeks pregnant妇产科疾病的超声诊断ENG52Ultrasound of the Second and Third Trimesters妇产科疾病的超声诊断ENGLISHUltrasound of the Second and T53Indications for Second-and Third-Trimester Estimate gestational age for patients with uncertain datesEvaluate uterine size and clinical date discrepanciesEvaluate fetal growthEstimate fetal weightDetermine fetal presentationEvaluate fetal life妇产科疾病的超声诊断ENGLISHIndications for Second-and T54 provide adjunct to amniocentesis,percutaneous umbilical blood sampling procedure,or cerclage placementEvaluate uterine abnormalityEvaluate abnoumal maternal serum alpha-fetoprotein valuesEvaluate abnormal amniotic fluidEvaluate placenta Etc.妇产科疾病的超声诊断ENGLISH provide adjunct to amniocente55The Second-and Third-Trimester(Metaphase and terminal prengancy)Metaphase and terminal prengancy)Mid-Mid-pregnancy:pregnancy:13-27 13-27 weeks pregnancy.weeks pregnancy.Late-Late-pregnancy:pregnancy:More More than 28 weeks of than 28 weeks of pregnancypregnancy.妇产科疾病的超声诊断ENGLISHThe Second-and Third-Trimest56Scanning TechniquesSurvey uterus Observe cardiac activityDetermine position and number of the fetus and placentaAssess amniotic fluidLook for uterine of placental masses and fetal anomalies妇产科疾病的超声诊断ENGLISHScanning TechniquesSurvey uter57Check contents1、Fetal head：BPD biparietal diameter;2、Fetal abdomen:AC abdomen circumference;3、Fetal limb：FL femur length;4、Others：Placenta,Fetal heart rate,Amniotic fluid,etc.妇产科疾病的超声诊断ENGLISHCheck contents妇产科疾病的超声诊断ENGLIS581、Fetal headMeasuring the Biparietal Diameter(BPD)Obitain biparietal diameter of the fetal head at the transverse level of the midbrain:falx,cavum septi pellucidi,and thalamic nucleiMake sure the head is symmetric and ovalMeasure from outer to inner margins of the skullIn the third trimester,the BPD is not as accurate in predicting fetal age 妇产科疾病的超声诊断ENGLISH1、Fetal headMeasuring the Bi59 Fetal head,after 12 weekend Fetal head,after 12 weekend pregnantpregnant妇产科疾病的超声诊断ENGLISH Fetal head,after 12 we60 Fetal side profile,we Fetal side profile,we can observe its forehead,can observe its forehead,nose,lip,and chin,etc.nose,lip,and chin,etc.妇产科疾病的超声诊断ENGLISH Fetal side profile,we 612、Fetal abdomenThe hepatobiliary system:liver,port venous systerm,hepatic veins and arteries,gallbladder,and bile ductsThe gastrointestinal system:the esophagus,stomach,small and large intestines(colon)妇产科疾病的超声诊断ENGLISH2、Fetal abdomenThe hepatobilia62The urinary system:kidneys,adrenal glands,ureters,bladder.The fetal abdomen circumference（AC)is the most widely measured 妇产科疾病的超声诊断ENGLISHThe urinary system:kidneys,63Measuring the Abdominal Circumference(AC)The AC should be taken from a round transverse image with the umbilical portion of the left portal vein midline within the liverThe outer margin of the abdominal wall should be measuredThe abdominal wall measurement is the least accurate妇产科疾病的超声诊断ENGLISHMeasuring the Abdominal Circum64The fetal liverThe fetal livergallbladderstomachport venousspinegallbladderstomach妇产科疾病的超声诊断ENGLISHThe fetal livergallbladderstom653、Fetal limbsThe upper limbs:the ulna the radius the humerusThe lower limbs:the femur/the thigh bone the fibula the tibia The femur is the most widely measured long bone（FL femur length ）妇产科疾病的超声诊断ENGLISH3、Fetal limbsThe upper limbs:66Femur measurementHyperechonic linear structure represents the ossified portion of the femoual diaphysis and corresponds to femoral length measurement from the greater trochanter to the femoral condylesThe mormal femur has a straight laeral border and a curved medial borderFemur length may be used with the same accuracy as BPD to predict gestational ageFemur length may indicate skeletal dysplasias or intrauterine growth restriction妇产科疾病的超声诊断ENGLISHFemur measurementHyperechonic 67Long section of the upper limbsThe radiusThe ulnaThe humerus 妇产科疾病的超声诊断ENGLISHLong section of the upper limb68Femur/thigh boneFibula/perone Tibia/shin bone Long section of the lower limbs 妇产科疾病的超声诊断ENGLISHFemur/thigh boneFibula/perone694、The placenta（胎盘）The major fole of the placenta is to permit the exchange of oxygenated maternal blood(rich in oxgen and nutrients)with deoxygenated fetal blood.The thickness of the placenta varies with gestational age,with a minimum diameter of 15 mm in fetuses greater than 23 weeks.The size of the placenta rarely exceeds 50 mm in the normal fetus.妇产科疾病的超声诊断ENGLISH4、The placenta（胎盘）The major f70Anterior placenta at 21 weeks of gastationThe placentaUmbilical bordAmniotic fluidThe fetal妇产科疾病的超声诊断ENGLISHAnterior placenta at 21 weeks71 posterior placenta at 29 weeks of gestationcalcification 妇产科疾病的超声诊断ENGLISH posterior placenta at 29 week72Anterior placenta at 39 weeks of gastationAnterior placenta at 39 weeks of gastation妇产科疾病的超声诊断ENGLISHAnterior placenta at 39 weeks73Calm little faceCalm little faceEating toe Eating toe Eating fingersEating fingers妇产科疾病的超声诊断ENGLISHCalm little faceEating toe Eat74CryingCryingPouttingPoutting妇产科疾病的超声诊断ENGLISHCryingPoutting妇产科疾病的超声诊断ENGLIS75Fetal with umbilical Fetal with umbilical cord around the neckcord around the neckFetal with cleft lipFetal with cleft lip妇产科疾病的超声诊断ENGLISHFetal with umbilical cord arou76smailingsmailing妇产科疾病的超声诊断ENGLISHsmailing妇产科疾病的超声诊断ENGLISH77Bao bao,Bei bei 100 days old!妇产科疾病的超声诊断ENGLISHBao bao,Bei bei 100 days old!妇78Bao bao,Bei bei 1 years birthday!妇产科疾病的超声诊断ENGLISHBao bao,Bei bei 1 years birth79演讲完毕，谢谢听讲!再见，see you again3rew3rew2024/8/1妇产科疾病的超声诊断ENGLISH演讲完毕，谢谢听讲!再见，see you again3rew80