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Counselor

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resenLed 8y
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UL1kASCNCGkAn IN
MANAGLMLN1 CI 1nkLA1LNLD
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nLroducLlon
1he commonesL early pregnancy
compllcaLlon of sponLaneous mlscarrlage
occurs ln approxlmaLely 1320 of all
pregnancles as recorded by hosplLal
eplsode sLaLlsLlcs 1he acLual flgure from
communlLy based assessmenL may be up
Lo 30 as many cases remaln unreporLed
Lo hosplLal 1 1he greaL ma[orlLy occur
early before 12 weeks gesLaLlon whlle mld
LrlmesLer loss beLween 12 and 24 weeks
occurs less frequenLly and consLlLuLes
of all pregnancy ouLcomes
nLroducLlon
ulLrasound dlagnosls aL presenLaLlon
was compared wlLh flnal cllnlcal
dlagnosls ln consecuLlve pregnanL
women who presenLed Lo an
emergency deparLmenL wlLh vaglnal
bleedlng or abdomlnal paln 1he
senslLlvlLy speclflclLy predlcLlve
value and overall dlagnosLlc
accuracy of ulLrasound were
calculaLed
ulLrasound
ulLrasound ls cycllc sound pressure wlLh a
frequency greaLer Lhan Lhe upper llmlL of human
hearlng
1he producLlon of ulLrasound ls used ln many
dlfferenL flelds Lyplcally Lo peneLraLe a medlum
and measure Lhe reflecLlon slgnaLure or supply
focused energy
1he mosL well known appllcaLlon of ulLrasound ls
lLs use ln sonography Lo produce plcLures of
feLuses ln Lhe human womb
ulLrasound
A common use of ulLrasound ls ln range flndlng
Lhls use ls also called SCnA8 (sound navlgaLlon
and ranglng) 1hls works slmllarly Lo 8AuA8
(radlo deLecLlon and ranglng) An ulLrasonlc pulse
ls generaLed ln a parLlcular dlrecLlon f Lhere ls an
ob[ecL ln Lhe paLh of Lhls pulse parL or all of Lhe
pulse wlll be reflecLed back Lo Lhe LransmlLLer as
an echo and can be deLecLed Lhrough Lhe recelver
paLh
ulLrasound
Dopp|er U|trasound
2D 3D and 4D U|trasound
1ransvag|na| Scans
3-D ultrasound images
The parts of an uItrasound machine
U|trasound |n regnancy
CbsLeLrlc ulLrasound ls prlmarlly used Lo
ulagnosls and conflrmaLlon of early pregnancy
uaLe Lhe pregnancy (gesLaLlonal age)
Conflrm feLal vlablllLy
ueLermlne locaLlon of feLus lnLrauLerlne vs ecLoplc
Check Lhe locaLlon of Lhe placenLa ln relaLlon Lo Lhe cervlx
Check for Lhe number of feLuses (mulLlple pregnancy)
Check for ma[or physlcal abnormallLles
Assess feLal growLh (for evldence of lnLrauLerlne growLh resLrlcLlon (uC8))
Check for feLal movemenL and hearLbeaL 1he hearLbeaL of Lhe feLus can
be observed clearly as llLLle as 6 weeks lnLo Lhe pregnanL
ueLermlne Lhe sex of Lhe baby
Safety
Diagnostic ultrasound is one oI the saIest means available Ior obtaining the
necessary inIormation about your unborn baby (or babies). While many
tests are continually conducted by manuIacturers and the U.S. government,
results in the past have indicated no adverse side eIIects.
Unlike X-rays, ionizing irradiation is not present and embryotoxic eIIects
associated with such irradiation should not be relevant. The use oI high
intensity ultrasound is associated with the eIIects oI "cavitation" and
"heating" which can be present with prolonged insonation in laboratory
situations.
Occupational exposure to ultrasound in excess oI 120 dB may lead to
hearing loss. Exposure in excess oI 155 dB may produce heating eIIects
that are harmIul to the human body, and it has been calculated that
exposures above 180 dB may lead to death.
Abottloo
Abottloo ls Lhe LermlnaLlon of pregnancy
before Lhe feLus develops sufflclenLly Lo
survlve 8y convenLlon aborLlon ls usually
deflned as pregnancy LermlnaLlon prlor Lo 20
weeks gesLaLlon or less Lhan 300g
blrLhwelghL
Abottloo
5pootooeoos Abottloo
1 LhreaLened
2 lnevlLable
3 compleLe or lncompleLe
4 mlssed and
3 recurrenL aborLlon

1hreaLened AborLlon
A bloody vaglnal dlscharge or bleedlng appears
Lhrough a closed cervlcal os durlng Lhe flrsL half
of pregnancy Cccurrlng commonly vaglnal
spoLLlng or heavler bleedlng durlng early
gesLaLlon may perslsL for days or weeks and may
affecL one ouL of four or flve pregnanL women
1hreaLened aborLlon may progress Lo
sponLaneous lncompleLe or compleLe aborLlon
1he 8ole of ulLrasound ln AborLlon
1he rouLlne use of ulLrasound ln Lhe
lnvesLlgaLlon and dlagnosls of early pregnancy
problems has also led Lo lmprovemenLs ln Lhe
managemenL of early pregnancy loss
ulLrasound plays a ma[or role ln maLernal
reassurance where feLal cardlac acLlvlLy ls
seen and ls plvoLal ln Lhe assessmenL of early
pregnancy compllcaLlons such as vaglnal
bleedlng
ulfferenLlal ulagnosls
Ectopic Pregnancy
The results of the ultrasound
revealed that there was an empty
uterus, but there was a living fetus
located posterior to the uterus. n the
black arrow indicates the fetal head,
while the white arrow indicates the
position of the uterus.
hydatidiform mole
Complete hydatidiform mole
has a classic sonographic
appearance of a solid collection
of echoes with numerous
anechoic spaces (snowstorm
appearance).
n partial moles, the placenta is
enlarged and contains areas of
multiple, diffuse anechoic
lesions.
Lhough ulLrasound may be a valuable ald ln
Lhe dlagnosls of bleedlng ln early pregnancy
and may save Lhe paLlenL a long sLay ln
hosplLal and unnecessary surgery feLal deaLh
should never be dlagnosed wlLhouL Lhe
conflrmaLlon of a second scan and wlLhouL
havlng made cerLaln LhaL Lhe bladder ls
adequaLely fllled
1he ManagemenL of AborLlon
1he dlagnosls of early pregnancy loss was
based on cllnlcal hlsLory and examlnaLlon
poslLlve urlnary hCC and ulLrasound flndlngs
Surg|ca| evacuat|on
f surglcal evacuaLlon ls Lo be used sucLlon
cureLLage ls Lhe meLhod of cholce as Lhls ls
assoclaLed wlLh fewer compllcaLlons
Med|ca| Management
Lxpectant Management
1he ManagemenL of AborLlon
Lxpectant Management
Expectant management oIten results in absorption
oI retained tissue with little associated bleeding.
For those women managed in general practice
expectant management has long been the treatment
oI choice.
Med|ca| Management
1he LreaLmenL opLlon should Lake lnLo accounL Lhe
paLlenL's sympLoms Lype of mlscarrlage volume
of reLalned Llssue and paLlenL cholce
1hreaLened AborLlon
SUMMAk
Spontaneous abortion, which is the loss oI a pregnancy without outside intervention beIore 20
weeks` gestation, aIIects up to 20 percent oI recognized pregnancies. Spontaneous abortion
can be subdivided into threatened abortion, inevitable abortion, incomplete abortion, missed
abortion, septic abortion, complete abortion, and recurrent spontaneous abortion.
Ultrasonography is helpIul in the diagnosis oI spontaneous abortion, but other testing may be
needed iI an ectopic pregnancy cannot be ruled out.
The role oI ultrasound in the management oI threatened abortion
1. Threatened abortion was diagnosed iI Ietal heart movement was identiIied.
2. Ultrasound in Clinically Diagnosed Threatened Abortion
When this was not shown or iI the Ieatures detailed by Donald et al. were present
missed abortion was diagnosed. II echoes were seen in the line oI the endometrial cavity
incomplete abortion was diagnosed. When such echoes were absent or when the cavity
showed as a straight line complete abortion was diagnosed.
3. Subsequent management was based entirely on the patient's clinical progress, and, apart
Irom one hydatidiIorm mole, the ultrasonic Iindings were ignored.
4. Ultrasound in Preoperative Evaluation.
5. Ultrasound to determine pharmacological treatment
kLIILkLNCLS
Szabo I, Szilagyi A. Management of threatened abortion. Source : Department oI Obstetrics and
Gynecology, University Medical School oI Pecs, Hungary. (available on http.//www.ncbi.nlm.gov.pub)
Sairam. S., Khare. M., Michailidis. G., Thilaganathan. Dr B., %he role of ultrasound in the expectant
management of early pregnancy loss., 2002., Ultrasound in Obstetrics & GynecologyVolume 17, Issue 6,
pages 506509, June 2001( available on http://onlinelibrary.wiley.com)
Craig P. GRIEBEL, MD, JOHN Halvorsen, MD, THOMAS B. GOLEMON, MD, dan Anthony A. HARI,
MD., Mnagement of Spontaneous Abortion. 2005. University oI Illinois College oI Medicine di Peoria,
Peoria, Illinois Am Fam Physician 2005 1 Oktober,. 72 (7) :1243-1250.
Tzeren, Aydin (2000). uman Body Dynamics. Classical Mechanics and uman Movement. Springer.
pp. 610.
Pooh, K. Ritsuko; K. Asim. Donald School Journal of Ultrasound in Obstetrics and Gynecology. Recent
Advances in 3D Assessment oI Various Fetal Anomalies. 2009;3(3):1-23.
Turner, G.M.; P. Twining. Clinical Radiology Jolume 47. The Skeletal proIile in the diagnosis oI Ietal
abnormalities. 1993; 389-395.
Pilu; Nicolaides; Ximenes ; Jeanty. andbook of Fetal Abnormalities. Central Nervous System. 2000.
Pilu, Gianluigi. 2006. %hree Dimensional Ultrasound of Craniofacial Anomalies. ( available on-
line with updates at www.gehealthcare.com ).
Overton, Timothy G.; Edmonds, D. Keith. Dewhurst,s %extbook of Obstetric & Gynaecology 7
th
Edition.
Antenatal Care. 2007; 6: 43.
Cunningham F.G., Leveno K.J., Bloom S.L., etc. 2007.Ultrasonography and Doppler. illiams Obstetrics.
USA : The McGraw-Hill Companies. Chapter 16.
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