Foetal Anomaly 3D / 4D Ultrasound

"To all who have known doubt, perplexity and fear as I have known them,

To all who have made mistakes as I have,

To all who humility increases with their knowledge of the most fascinating subject, this book is dedicated. "

(Professor Ian Donald in his book, Practical Obstetrics Problems)

Ultrasound scanning was invented in 1957 by Ian Donald and Tom Brown. Since then the technology progressed from the b-mode contact scanning to real time scanning developed in 1965 by Walter Krause and Richard Soldner. One of ultrasound first uses in 1966 was to assist in performing amniocentesis. Ever since then, the progressive improvement in the technology made ultrasound scanning an accepted and established technique, now utilized to help clinicians in almost all disciplines of Medicine. The use of ultrasound is now almost replacing the traditional practical skills of Obstetrics & Midwifery and one does not expect any obstetrician & gynaecologist to be able to practice properly without some skills in ultrasound scan use.

The availability of the technology of the scanning machine, scan recording and reporting computerized software still needs the interpretation of the imaging results by an appropriately trained individual. Even obtaining an image depends very much on the skill of the operator and not just the technology.

At the British Clinic, Dr. Samia Saafan and Professor Darweesh were privileged to have met and attended Professor Ian Donald lectures in the 1970’s and recall his story with obstetrics ultrasound as he thought of the foetus as a little submarine inside the uterus swimming in the fluid, that was when he saw the technology of the submarine scanning in the ocean at the submarine base in Glasgow!! That was only the start!! And rest is history…

Dr. Samia Saafan was trained by the assistant of Professor Ian Donald in 1970’s , Dr. Usama Abdulla of the University of Liverpool and continued to maintain the technological skills with the advance in such technology.

Ultrasound Scanning Program

Ante-Natal

 At Booking (before 10 weeks)

• Confirm pregnancy
• Exclude ectopic pregnancy
• Exclude Hydatiditiform mole (H-mole)
• Early measures of crown rump length (CRL) give most accurate date with ± 3-4 days

11-14 weeks

• Pre term labour screening, measuring cervix
• Nuchal transluscency (NT), foetal nose
• Doppler ultrasound : Resistant Index (R.I.), Pulsatility Index (P.I.) and Mean Vascular Cerebral Artery Velocity

18-21 weeks

Foetal Morphology/Anomaly scan

(http://fetalanomaly.screening.nhs.uk)

Skull, head, neck (skin  fold) (nuchal fold), brain (cavium septum pellucidum, ventricular atrium, cerebellum), face, lip, chest, heart (four chambers view, outflow tracts), lungs, abdomen, stomach and that intrahepatic section of the umbilical vein, abdominal wall, bowel, renal pelvis, bladder, spine, vertebrae, skin covering, limbs, femur, feet (metatarsals rt & lt), arms (metacarpals rt & lt) , uterine cavity, amniotic fluid, placental localization, penetration, thickness, blood flow, cystic formations, etc.

21-24 weeks

• Ultrasound scanning to monitor growth and liquor
• Doppler ultrasound : R.I., P.I., etc.
• Placental localization, volume, penetration, thickness, blood flow, etc.

This is then repeated at regular intervals to monitor progress throughout the pregnancy and to exclude placental aging, insufficiency and abnormal penetration.

Ultrasound in Gynaecology

• Monitoring of ovulation by measuring follicular development and growth.
• Measuring uterine artery RI, PI and mean velocity prior to giving HCG injection to trigger ovulation.
• Measuring endometrial thickness to decide the optimal time for triggering ovulation and optimizing implantation.
• Diagnosing uterine myomas, polyp or other lesions.
• Localization of IUCD.
• Diagnosing ovarian cysts, tumor or any adenexal pathology.
• Diagnosing tubal pathology, like hydrosalphinx, etc.
• Assessing tubal patency.
• Vaginal ultrasound guided oocytes (egg) collection for IVF & ICSI procedures.
• Vaginal ultrasound guided aspiration of ovarian cysts.

APPROVAL MOH BW02763

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