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Reproductive health awareness among educated young adult females in Egypt: A pre youth revolution survey. The purpose of this document is to present evidence regarding methodology, indications, benefits, and risks of obstetric ultrasonography in specific clinical situations. Although there is no reliable evidence of physical harm to human fetuses from diagnostic ultrasound imaging, public health experts, clinicians, and industry representatives agree that casual use of ultrasonography, especially during pregnancy, should be avoided. In an attempt to answer these concerns over the safety of ultrasound, studies are initiated to determine if there is an association between diagnostic ultrasound imaging in utero and chromosomal abnormalities, altered fetal growth, learning disabilities, or even malignancy. The American College of Obstetricians and Gynecologists uses the terms "standard," "limited," and "specialized" to describe various types of ultrasound examinations performed during the second or third trimesters. Limited Examination: A limited examination is performed when a specific question requires investigation.
Specialized Examination: A detailed or targeted anatomic examination is performed when an anomaly is suspected on the basis of history, biochemical abnormalities or clinical evaluation, or suspicious results from either the limited or standard ultrasound examination. The primary goal of ultrasound evaluation in the first trimester is to determine whether the pregnancy is intrauterine and whether the embryo is living. There is no question that, with a careful examination, the true number of embryos can be accurately determined in the first trimester. Although evaluating the number of fetuses may be difficult during early pregnancy, it should be extremely easy and accurate in the second- and third-trimesters. A second-trimester specialized ultrasound examination may be targeted to detect fetal aneuploidy. Ultrasound Assessment of Cervical Length: Preterm birth is the main cause of perinatal morbidity and mortality.
Cervical ultrasonography has yet no appreciable clinical usefulness in low-risk populations because of its poor positive predictive value and the absence of preventive therapy. The American Institute of Ultrasound in Medicine (AIUM) advocates the responsible use of diagnostic ultrasound. Ultrasound examination is an accurate method of determining gestational age, fetal number, viability, and placental location. Manual of Obstetrics and Gynecology Nursing reviews the the clinical evaluation and management of obstetrical and gynecological problems. Woodlands OBGYN Associates is the leading obstetrics and gynecology practice for women in The Woodlands, Texas area. Woodlands OBGYN Associates invites you to join our growing family of patients and to experience an atmosphere where you are truly our priority. Our doctors develop a professional medical relationship with our patients over long periods of time. Our staff also develops professional relationships with our patients through obstetrics and gynecology nursing care and through services provided through our lab, medical assistants, technological and business office services. Our medical practice provides extensive and complete care for women in all areas of gynecology and obstetrics. Beyond the immediate and general information on our website, we want to speak to your specific and personal circumstances or concerns and to answer any questions you may have. This phenomenal, new technology has been developed to offer a safe aesthetic alternative to traditional and potentially skin-damaging tattoo removal techniques like acid removal, dermabrasion and even excision.
From an experienced medical perspective, Woodlands OBGYN Associates can help in areas regarding beauty, nutrition and weight. We are experts in the most current obstetrics and gynecology technology, including the da Vinci Robot, which is one of the most innovative surgical technologies ever developed. This tool greatly improves your surgeon’s visibility and ability to manipulate tissue during complex operations. Originally this was done through open surgery, where a large incision was made to allow the surgeon access. Whilst robotic surgery is still laparoscopic, it is robot-assisted in that a computer controls the surgical instruments whilst the surgeon observes and instructs the computer from the same room. Once home, you’ll need to keep the incision areas dry and you may have sutures which will need removing. A complete recovery can be expected from a few weeks to a few months, depending on the individual.
Enter your email address to subscribe to this blog and receive notifications of new posts by email. Assisted conception techniques are associated with a significantly higher rate of ectopic pregnancies. Although the almost universal enthusiasm for this modality is exciting, it has raised a new series of questions and problems. Sections of the document addressing physician qualifications and responsibilities, documentation, quality control, infection control and patient education are the recommendations of Women's Health and Education Center (WHEC).
It has been shown, for example that 90% of infants with congenital anomalies are born to women with no risk factors.
The most common transducers, which are the "work horses" of the ultrasound laboratory, are a linear array, a sector transducer (3 to 7 MHz) for abdominal transducers, or vaginal transducers, with frequency ranging from 5 to 10 MHz are used.
Viewed in this light, exposing the fetus to ultrasonography with no anticipation of medical benefit is not justified (3). Two of the most often cited long-term studies evaluating the effect of ultrasound on the fetus are the work of Stark et al and Salvensen et al. Although the standard and limited examinations are defined by their components, the specialized examination is defined by the indications for the examination, that is, the circumstances that suggest a more thorough ultrasound examination is needed (5). It includes an evaluation of fetal presentation, amniotic fluid volume, cardiac activity, placental position, fetal biometry, and an anatomic survey. In an emergency, for example, a limited examination can be performed to evaluate heart activity in a bleeding patient.
Other specialized examinations might include fetal Doppler, biophysical profile, fetal echocardiography, or additional biometric studies.
With present day equipment, particularly transvaginal transducers, both of these tasks should be readily accomplished at very early stages of gestation. Amnionicity and chorionicity should be documented for all multiple pregnancies when possible. For multiple pregnancies, additional information should be documented: chorionicity, amnionicity, comparison of fetal sizes, estimation of amniotic fluid volume (increased, decreased, or normal) on each side of the membrane, and fetal genitalia (when visualized). This type of examination has been offered in some centers for the past several years and is aimed at the detection of a range of minor anatomic features associated with an increased risk of fetal aneuploidy.
A short cervical length on transvaginal ultrasonography has been shown to be one of the best predictors of spontaneous preterm birth.
Gestational age at which transvaginal ultrasound cervical length is measured significantly affects the calculation of risk of spontaneous preterm birth.
The AIUM strongly discourages the non-medical purposes (eg, solely to create "keepsake" photographs or videos) for psychosocial or entertainment purposes. Even though centers that perform non-medical ultrasonography and create "keepsake" photographs and videos of the fetus may offer disclaimers about the limitations of their product, customers may interpret an aesthetically pleasing image or entertaining video as evidence of fetal health and appropriate development.
Since 1992, we’ve provided exceptional healthcare to women of all ages and have delivered thousands of babies in our community.


We get to know our patients well so that they feel at home in discussing subjects that may otherwise be uncomfortable to discuss. In addition, we focus on wellness, beauty and your general health, so our website is designed to be a continual resource for you in many aspects of your life. We want you to be aware that health, beauty, nutrition and weight loss or maintenance do not exist in isolation. In addition to great removal results, PicoSure removes tattoos not only with better results and improved recovery than traditional methods, but with fewer treatments than traditional lasers. All the ink (or pigment) is shattered into insignificant particles that are dust-like and are then easily absorbed and eliminated through the body’s natural processes.
PicoSure laser treatments give you clearer skin without injury to surrounding skin, which is why it is the first and only pico-second aesthetic laser in the world that has been approved by the FDA. The medically safe PicoSure laser removal is only performed by an expert licensed physician at Woodlands OBGYN Associates. Call to schedule a consultation today.
These areas are all tied together in a woman’s body and to her lifestyle and we can help address and improve areas of concern. Operations in the past required large incisions as well as long hospital stays and long recovery times. It is the surgical removal of the uterus which may be required due to non-cancerous tumors called fibroids, ovarian or cervical cancer, long-term pain in the pelvic region, and due to the pain and discomfort of heavy periods. However, due to medical advances, the procedure became laparoscopic, done through small incisions. It has now been nearly 5 decades since sonography was first used to evaluate the obstetric patient. However, several studies conducted between 1985 and 1994 found routine ultrasound screening yielded no consistent impact on perinatal mortality or morbidity.
The higher-frequency transducers are most useful in achieving high-resolution scans, and the lower-frequency transducers are useful in those circumstances in which increased penetration of the sound beam is necessary.
Stark et al studied 425 children at birth and between 7 and 12 years of age who were exposed to diagnostic ultrasound in utero. First-trimester obstetric ultrasonography is distinct from these and is discussed separately.
This evaluation also would be appropriate for verifying fetal presentation in a laboring patient; however, in most cases, a limited examination is appropriate only when the patient has had a prior complete examination. Specialized examinations are performed by an operator with experience and expertise in such ultrasonography who determines the components of the examination on a case-by-case basis.
When multiple gestations are missed using ultrasound assessment, it is usually from a less than optimal first trimester examination. Advanced maternal age or an abnormal first- or second-trimester multiple marker screen indicating and increased risk for Down syndrome are among the indications for a specialized ultrasound examination. Screening for a short cervical length has been studied in several populations, including asymptomatic women with singleton gestations at either low or high risk for preterm birth, multiple gestations, and symptomatic women with either preterm labor or preterm premature rupture of the membranes. The spontaneous preterm birth risk increases as the length of the cervix declines and as the gestational age decreases.
The use of either two-dimensional (2D) or three-dimensional (3D) ultrasound to only view the fetus, obtain a picture of the fetus or determine the fetal gender without a medical indication is inappropriate and contrary to responsible medical practice. Ultrasonography performed for psychosocial or entertainment purposes may be limited by the extent and duration of the examination, the training of those acquiring the images, and the quality control in place at the ultrasound facility.
We specialize in women’s reproductive and health issues, including infertility treatment, diet, nutrition, hormone replacement therapy, laser skin resurfacing and laser tattoo removal. The da Vinci robotic surgery is done with less pain, small incisions, minimal hospital stays and a shorter recovery time.
After surgery, some pain is to be expected, but medication will be given to keep this to a minimum. Cervical ectopic pregnancies are very rare, accounting for less than 1% of all ectopic pregnancies3.
Through the education process of the healthcare providers will help alleviate errors in diagnosis. In the screened population, the detection rate for congenital anomalies ranged from 16% to 85%.
Variations of transducer technology include convex linear transducers and multi-frequency probes. Birth-weight, Apgar scores, and neurologic and cognitive testing revealed no biologically significant differences between exposed and unexposed children. Fetal anatomy, may be assessed adequately by ultrasonography after approximately 16-20 weeks of gestation. It is for these reasons that some investigators prefer that if one ultrasound examination is to be done concentrating on fetal number, it should be done in the early to middle second trimester of pregnancy. The use of the ultrasound markers developed in high-prevalence patient populations in screening for Down syndrome in a low-risk population in the second trimester currently is premature. In a study of 188 women with histories of a prior preterm delivery who underwent serial endovaginal sonography between 22-24 weeks of gestation, Durnwald and colleagues found that, of the women with cervixes shorter than 25 mm, 36% delivered before 35 weeks (7). These spontaneous preterm birth risks are important for counseling and management for women with various degrees of short cervical length at different gestational age (9). Although there are no confirmed biological effects on patients caused by exposures from present diagnostic ultrasound instruments, the possibility exists that such biological effects may be identified in the future.
Westmoreland are committed to providing our patients with the best care possible and meeting your specific medical needs. Once you are drinking properly, your IV will be removed; and once you are passing gas then you can start eating again. You must avoid any heavy lifting for a couple of weeks, and refrain from sexual intercourse for six weeks. Case Report Day 0 Case Report A 41-year old Caucasian woman attended for a routine scan at 6 weeks’ gestation following a single euploid embryo transfer as part of in-vitro fertilisation (IVF) treatment. At its inception it was difficult to convince clinicians as to the usefulness of this new diagnostic modality.
A subsequent secondary analysis of these studies concluded that routine screening was cost-effective.
Food and Drug Administration views the promotion sale, or lease of ultrasound equipment for making "keepsake" fetal videos are and unapproved use of a medical device; use of ultrasonography without a physician's order may be a violation of state or local law or regulations regarding the use of a prescription medical device. Salvensen et al found no difference in dyslexia between ultrasound-exposed and control groups.
It may be possible to document normal structures before this time, although some structures can be difficult to visualize because of fetal size, position, movement, abdominal scars, and increased maternal wall thickness.
Another study of 69 women with prior preterm delivery and serial endovaginal sonography every 2 weeks between 16 and 30 weeks of gestation showed that women at less than 20 weeks with cervical length less than the 10th percentile (22 mm) or funneling of internal os had an increased risk of recurrent preterm birth, with 33% delivering within 2 weeks, 66% delivering within 4 weeks, and 100% delivering before 35 weeks. Thus ultrasound should be used in a prudent manner to provide medical benefit to the patient (10). Abnormalities may be detected in settings that are not prepared to discuss and provide follow-up for concerning findings. Now, it is not unusual for a patient to have one or even several ultrasound examinations during her pregnancy.


Before an ultrasound examination is performed, patients should be counseled about the limitations of ultrasonography for diagnosis.
Using a mathematical model to evaluate further the published results, other researchers concluded that routine screening at tertiary centers would be cost-effective, but screening in non-tertiary centers resulted in a net loss (1).
Two measurements of acoustic output are displayed on-screen with contemporary ultrasound equipment. At the present time, based on available studies, there is little evidence to indicate ultrasonography as causing abnormalities in the human fetus.
A second- or third-trimester ultrasound examination may pose technical limitations for an anatomic evaluation because of imaging artifacts from acoustic shadowing. Without the ready availability of appropriate prenatal health care professionals, customers at sites for non-medical ultrasonography may be left without necessary support, information, and follow-up for concerning findings. It is important to start moving around as soon as possible to aid your recovery and prevent complications. Her general and abdominal examination was unremarkable and she was haemodynamically stable.
The appeal of ultrasound examination is that it is a non-invasive, safe procedure that has a high degree of patient acceptance and can yield a wealth of information. In some countries, as many as 90% to 100% of women seeking obstetric care will have at least one ultrasound examination during pregnancy. The thermal index is an estimate of possible tissue temperature increase that may be caused by ultrasound absorption. The major biologic effects of ultrasonography are believed to be thermal (a rise in temperature) and cavitation (production and collapse of gas-filled bubbles). When this occurs, the report of the ultrasound examination should document the nature of this technical limitation. The cul-de-sac should be evaluated by ultrasonography for the presence or absence of fluid. Obstetric ultrasonography is most appropriately obtained as part of an integrated system for delivering prenatal care. The optimal timing for a single ultrasound examination in the absence of specific indications for a first-trimester examination is at 16-20 weeks of gestation. A transvaginal ultrasound scan revealed a viable monochorionic diamniotic twin pregnancy implanted in the cervical canal with evidence of fetal heart activity. If ultrasound evaluation is relatively safe and non-invasive and has the potential for yielding important diagnostic information, then why not use this modality in every pregnant patient?
The mechanical index is a measure of the interaction of ultrasonography with microscopic gas bubbles that are present in all tissues. Although it has been shown that a rise in temperature of less than 1o C may occur during diagnostic ultrasound evaluation, this is unlikely to have any clinical impact in humans. Serial ultrasonograms to determine the rate of growth should be obtained approximately every 2-4 weeks.
The mechanical index incorporates cavitations with other possible non-thermal effects of ultrasonography. Likewise, cavitation (which requires the preexistence of stable gas-filled nuclei) may occur in humans.
When the thermal index and mechanical index are adjusted by the user to values of less than unity, the likelihood of tissue effect is very low (2). In the past 5 years, there has been concern raised over the use of pulsed Doppler imaging when applied to the developing embryo.
Most machines allow adjustment of output and will instantly recalculate and display the new thermal index and mechanical index. Spectral or pulsed Doppler imaging uses high-amplitude transmit pulses due to the fact that the signal reflected from blood is small.
Appropriate documentation of an obstetric or gynecologic ultrasound examination is essential to both direct clinical care and quality assurance. She was counselled regarding the risks of this pregnancy and therefore consented to treatment and had mifepristone (orally 200mg) and systemic Methotrexate (80mg IM). Most manufacturers now offer machines capable of 3-dimensional surface rendering of fetal anatomy, and some offer near real-time 3-dimensional imaging. All of those factors when taken together mean that spectral Doppler has a high likelihood of producing a bioeffect in tissue. Ideally, quality control is accomplished through careful recordkeeping of obstetric ultrasound examination results, reliable archival of reports and images, and clinical correlation with clinical outcomes.
Although the potential for embryonic effects from Doppler imaging exists, there is little evidence that ultrasound is teratogenic. Any practice active in obstetric ultrasonography should maintain such records and make every effort to correlate imaging results with ultimate clinical outcome data. Day 9 An ultrasound performed revealed 2 yolk sacs and 2 embryos with no fetal heartbeats seen. Day 12-42 Outpatient monitoring of the patient with serial serum ?HCG and transvaginal ultrasound (see Figures 1c, 1d and 2). Day 46 The patient was again counselled on Day 46 regarding the persistent yolk sacs and embryos and the potential risks involved and therefore, consented for surgical management. Day 50 The patient underwent suction evacuation of the ectopic pregnancy under general anaesthetic. She sustained blood loss of approximately 600ml during the procedure and was treated with syntocin and carboprost. However, haemostasis could only be achieved following tamponade in the cervical canal with a Foley’s catheter. She was treated with prophylactic intravenous antibiotics (Co-Amoxiclav and Metronidazole). 3 month follow-up (Day 143) The patient was seen in the Outpatient Department and reported a good post-operative recovery. She recommenced spontaneous menstruation 26 days after the procedure and continued to have 24-day cycles after that. She is currently 26 weeks’ pregnant with dichorionic diamniotic twins, through a successful cycle of IVF.
Discussion & Conclusion This case is an example of a complication of in-vitro fertilisation. This case also illustrates the importance of serial ?HCG measurements and serial TV scanning in our management.
We felt that conservative management of this cervical ectopic pregnancy was reasonable and that rendering the pregnancy non-viable by using systemic Methotrexate before curettage would decrease the likelihood of complications, especially major haemorrhage, which could potentially lead to hysterectomy.



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