THIRD EDITION
Editors Asim Kurjak MD PhD
Professor and Chairman Department of Obstetrics and Gynecology Medical School University of Zagreb Sveti Duh Hospital
Zagreb, Croatia
Frank A Chervenak MD PhD
Professor and Chairman Department of Obstetrics and Gynecology The New York Weill Hospital-Cornell Medical Center
New York, USA
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Donald School Textbook of Ultrasound in Obstetrics and Gynecology
© 2011, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2004
Second Edition: 2008
Third Edition: 2011
9789350252598
Typeset at JPBMP typesetting unit
Printed in India
7CONTRIBUTORS
- Badreldeen Ahmed
- Head
- Feto-Maternal Unit
- Department of Obstetrics and Gynecology
- Women's Hospital
- Hamad Medical Corporation
- Doha, State of Qatar
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology
- University Clinic of Navarra
- School of Medicine University of Navarra
- Pamplona, Spain
- Cristian Andrei
- Department of Obstetrics and Gynecology
- Elias University Hospital
- Carol Davila University of Medicine
- Bucharest, Romania
- Aris Antsaklis
- Head
- 1st Department of Obstetrics and Gynaecology
- “Alexandra” Maternity Hospital
- University of Athens
- Medical School
- Athens, Greece
- Silvia Arevalo
- Fetal Medicine Unit
- Hospital Vall d'Hebron
- Barcelona, Spain
- Guillermo Azumendi Pérez
- Clinica Gutenberg
- Malaga, Spain
- Kazunori Baba
- Center for Maternal, Fetal and Neonatal Medicine
- Saitama Medical Center, Saitama Medical University
- Saitama, Japan
- María J Barco
- Gynecologic Centre “Bolonia”
- Zaragoza, Spain
- Jill Beithon
- Ultrasound Services Sanford Health
- Fargo, ND, USA
- Isaac Blickstein
- Department of Obstetrics and Gynecology
- Kaplan Medical Center Rehovot, and Hadassah-Hebrew University
- School of Medicine
- Jerusalem, Israel
- Tatjana Bozanovic
- School of Medicine
- Belgrade University, and Institute for Obstetrics and Gynecology
- Clinical Center of Serbia
- Belgrade, Serbia
- Lluis Cabero
- Department of Obstetrics and Gynecology
- Hospital Vall d'Hebron
- Barcelona
- Spain
- José M Carrera
- Senior Member
- Department of Obstetric and Gynaecology
- University Institute Dexeus
- Autonomous University of Barcelona
- Barcelona, Spain
- Elena Carreras
- Fetal Medicine Unit
- Obstetrics and Gynecology Department
- Hospital Vall d'Hebron
- Barcelona, Spain
- Romina Castagno
- Hospital Vall d'Hebron
- Barcelona, Spain
- Gabriele Centini
- Prenatal Diagnosis Unit
- University of Siena
- Siena, Italy
- Giovanni Centini
- Prenatal Diagnosis Unit
- University of Siena
- Siena, Italy
- Aleksandar Cetkovic
- Clinical Center of Serbia
- Belgrade, Serbia
- Stephen T Chasen
- Weill Medical College of Cornell University, New York, USA
- Frank A Chervenak
- Chairman
- Department of Obstetrics and Gynecology
- Joan and Sanford I Weill Medical College of Cornell University
- The New York Presbyterian Hospital, New York, USA
- Judith L Chervenak
- New York University School of Medicine
- New York, USA
- Carmina Comas Gabriel
- Fetal Medicine Unit
- Department of Obstetrics and Gynecology
- University Institute Dexeus
- Barcelona, Spain
- Antonella Cromi
- Department of Obstetrics and Gynecology
- Vincenzo D'Addario
- Department of Obstetrics and Gynecology, University of Bari
- Bari, Italy
- Luca Di Cagno
- Fetal Medicine Unit
- Department of Obstetrics and Gynecology, University of Bari
- Bari, Italy
- Edoardo Di Naro
- III Obstetrics and Gynecology Unit
- University Medical School of Bari
- Bari, Italy
- Marko Dosen
- Department of Reproductive Medicine and Gynecologic Endocrinology
- University Clinical Center Maribor
- Maribor, Slovenia
- Alaa Ebrashy
- Director
- Fetal Medicine Unit
- Kasr El Aini Hospital
- Faculty of Medicine
- Cairo University
- Cairo, Egypt
- A Kubilay Ertan
- Head
- Department of Obstetrics and Gynecology Hospital of Leverkusen
- Leverkusen,
- Germany
- Francesc Figueras
- Service of Fetal Medicine
- Clinical Institute of Gynecology
- Obstetrics and Neonatology
- University of Barcelona
- Barcelona,
- Spain
- Biserka Funduk Kurjak
- Department of Obstetrics and Gynecology Medical School
- University of Zagreb
- Zagreb, Croatia
- Alessandra Giocolano
- Department of Obstetrics and Gynecology
- III Obstetrics and Gynecology Unit
- University Medical School of Bari
- Bari, Italy
- Teresa Higueras
- Fetal Medicine Unit
- Hospital Vall d'Hebron
- Barcelona
- Spain
- Ulrich Honemeyer
- Head
- Department of Obstetrics and Gynecology
- Welcare Hospital
- Dubai, UAE
- Jon Hyett
- Head
- High Risk Obstetrics
- RPA Women and Babies
- Royal Prince Alfred Hospital
- Central Clinical School
- University of Sydney
- Sydney, Australia
- Shigenori Iwagaki
- Department of Maternal and Fetal Medicine
- National Hospital Organization
- Nagara Medical Center
- Nagara Gifu, Japan
- Robin B Kalish
- Division of Maternal-Fetal Medicine
- Department of Obstetrics and Gynecology
- Weill Medical College of Cornell
- University, New York, USA
- Ichiro Kawabata
- Department of Maternal and Fetal Medicine
- National Hospital Organization
- Nagara Medical Center
- Nagara Gifu, Japan
- Ashok Khurana
- The Ultrasound Lab
- New Delhi, India
- Sanja Kupesic Plavsic
- Department of Medical Education
- Paul L Foster School of Medicine
- Texas Tech University
- El Paso, Texas, USA
- Asim Kurjak
- Department of Obstetrics and Gynecology Medical School
- University of Zagreb
- Zagreb, Croatia
- Mario Lituania
- Centro di Fisiopatologia
- Preconcezionale e Prenatale.
- Ospedali Galliera Genova
- Genova, Italy
- Aleksandar Ljubic
- School of Medicine
- University of Belgrade, and Institute for Obstetrics and Gynecology
- Clinical Center of Serbia
- Belgrade, Serbia
- Kazuo Maeda
- Department of Obstetrics and Gynecology (Professor Emeritus)
- Tottori University Medical School
- Yonago, Japan
- Jaideep Malhotra
- Malhotra Nursing and Maternity Home (P) Ltd
- Agra, India
- Narendra Malhotra
- Malhotra Nursing and Maternity Home (P) Ltd
- Agra, India
- Neharika Malhotra
- Malhotra Nursing and Maternity Home (P) Ltd
- Agra, India
- Alexandra Matias
- Department of Obstetrics and Gynecology
- Porto Medical Faculty of Medicine
- Hospital of S João
- Eva Meler
- Department of Obstetrics and Gynaecology
- University Institute Dexeus
- Autonomus University of Barcelona, Barcelona, Spain
- Luis T Mercé
- CENEGO (National Center of Gynecology and Obstetrics US) and Assisted Reproduction Unit
- International Ruber Hospital
- Madrid, Spain
- Eberhard Merz
- Chairman
- Department of Obstetrics and Gynecology
- Krankenhaus Nordwest
- Frankfurt/Main, Germany
- Srboljub Milicevic
- Institute for Obstetrics and Gynecology
- Clinical Center of Serbia
- Belgrade, Serbia
- Berivoj Miskovic
- Head Department of Obstetrics and Gynecology
- Clinical Hospital Sveti Duh
- Zagreb, Croatia
- Giovanni Monni
- Head
- Department of Obstetrics and Gynecology
- Prenatal and Preimplantation
- Genetic Diagnosis
- Microcitemico Hospital
- Cagliari, Sardinia, Italy
- Nuno Montenegro
- Porto Medical Faculty of Medicine
- Department of Obstetrics and Gynecology, Hospital of S João
- Porto, Portugal
- Ajlana Mulic-Lutvica
- Department of Women's and Children's Health
- Obstetrics and Gynaecology Uppsala University
- Uppsala, Sweden
- Zehra Nese Kavak
- Director
- Fetal Medicine Unit
- Department of Obstetrics and Gynecology
- Marmara University Teaching and Research Hospital, Pendik
- Istanbul, Turkey
- Agnieszka Nocun
- Gynecology and Oncology Clinic
- University Hospital in Krakow
- Krakow, Poland
- Aleksandra Novakov
- School of Medicine
- University of Novi Sad
- Clinical Center of Vojvodina
- Novi Sad, Serbia
- Zoltán Papp
- Maternity Private Clinic
- Semmelweis University
- Budapest, Hungary
- George A Partsinevelos
- 1st Department of Obstetrics and Gynaecology
- University of Athens
- Medical School
- Athens, Greece
- Bhargavi Patham
- Department of Medical Education
- Paul L Foster School of Medicine Texas Tech University
- El Paso, Texas, USA
- Vincenzo Pinto
- Department of Obstetrics and Gynecology
- University of Bari
- Bari, Italy
- Armando Pintucci
- Department of Obstetrics and Gynecology
- University of Bari
- Bari, Italy
- Branko M Plavsic
- Department of Radiology
- Paul L Foster School of Medicine
- Texas Tech University
- El Paso, Texas, USA
- Ritsuko K Pooh
- Director CRIFM Clinical Research Institute of Fetal Medicine PMC
- Osaka, Japan
- KyongHon Pooh
- Department of Neurosurgery
- Kagawa National Children's Hospital, Zentsuji,
- Japan
- Maja Predojevic
- Department of Physiology
- Medical School University of Zagreb
- Zagreb, Croatia
- Luigi Raio
- Department of Obstetrics and Gynecology, University of Bern
- Bern, Switzerland
- Jai Prakash Rao
- Malhotra Nursing and Maternity Home (P) Ltd
- Agra, India
- Frederico Rocha
- Division of Maternal Fetal Medicine
- Department of OB/GYN and Women's Health
- John A Burns School of Medicine University of Hawaii
- Honolulu, Hawaii,
- USA
- Carlota Rodó
- Fetal Medicine Unit
- Hospital Vall d'Hebron
- Barcelona, Spain
- Lucia Rosignoli
- Prenatal Diagnosis Unit
- P Palagi Hospital
- Florence, Italy
- Cristina A Rossi
- Fetal Medicine Unit
- Department of Obstetrics and Gynecology, University of Bari
- Aida Salihagic Kadic
- Department of Physiology, and Croatian Institute for Brain Research Medical School
- University of Zagreb
- Zagreb, Croatia
- Cihat Şen
- Chairman Department of Perinatology
- Cerrahpasa Medical School University of Istanbul
- Istanbul, Turkey
- Geeta Sharma
- Weill Medical College of Cornell University
- New York, USA
- Kohei Shiota
- Department of Anatomy and Developmental Biology and Congenital Anomaly Research Center
- Kyoto University Graduate School of Medicine
- Kyoto, Japan
- Daniel W Skupski
- Director
- Maternal-Fetal Medicine
- Associate Chairman Department of Obstetrics and Gynecology
- The New York Hospital of Queens
- Flushing, New York, USA
- Jiri Sonek
- Department of Obstetrics and Gynecology
- Wright State University
- President Fetal Medicine Foundation of the United States of America
- Dayton, Ohio, USA
- Yuichiro Takahashi
- Department of Maternal and Fetal Medicine
- National Hospital Organization
- Nagara Medical Center
- Nagara Gifu, Japan
- András Tankó
- Department of Obstetrics and Gynecology
- County Hospital
- Kecskemét, Hungary
- H Alper Tanriverdi
- Head
- Maternal-Fetal Medicine Unit
- Department of Obstetrics and Gynecology
- Adnan Menderes University Faculty of Medicine
- Aydin, Turkey
- Sakshi Tomar
- Malhotra Nursing and Maternity Home (P) Ltd
- Agra, India
- Nuria Toran
- Department of Pediatric Pathology
- Hospital Vall d'Hebron
- Barcelona
- Spain
- Zoltán Tóth
- Department of Obstetrics and Gynecology
- Debrecen University
- Debrecen, Hungary
- Boris Ujevic
- Department of Obstetrics and Gynecology
- Clinical Hospital Sveti Duh
- Zagreb, Croatia
- Martina Ujevic
- Polyclinic “Vili”
- Zagreb, Croatia
- Gino Varga
- Polyclinic “Nemetova”
- Zagreb, Croatia
- Oliver Vasilj
- Department of Obstetrics and Gynecology
- Clinical Hospital Sveti Duh
- Zagreb, Croatia
- Radu Vladareanu
- Chairman
- Department of Obstetrics and Gynecology
- Elias University Hospital
- Carol Davila University of Medicine
- Bucharest, Romania
- Veljko Vlaisavljevic
- Department of Reproductive
- Medicine and Gynecologic Endocrinology
- University Clinical Center Maribor
- Maribor, Slovenia
- Marcin Wiechec
- Obstetrics and Perinatology Clinic
- University Hospital in Krakow
- Krakow, Poland
- Tevfik Yoldemir
- Department of Obstetrics and Gynecology
- Marmara University Teaching and Research Hospital, Pendik
- Istanbul, Turkey
- Nadah B Zafar
- Department of Medical Education
- Paul L Foster School of Medicine
- Texas Tech University
- El Paso, Texas, USA
- Ivica Zalud
- Chief,
- Division of Maternal Fetal Medicine
- Department of OB/GYN and Women's Health
- John A Burns School of Medicine University of Hawaii
- Honolulu, Hawaii, USA
- Mona Zvanca
- Department of Obstetrics and Gynecology
- Elias University Hospital
- Carol Davila University of Medicine
- Bucharest, Romania
The Ian Donald International School of Ultrasound bears testament to globalization in its most successful and worthwhile form. The school was founded in Dubrovnik in 1981; in the preface of the first edition in 2004 we were proud to announce that the School had grown to 8 branches. Since then, the growth has been meteoric and now consists of 55 branches in almost every corner of the globe. The reason for this success has been the tireless and selfless efforts of the world's leading authorities in ultrasound who are willing to dedicate their valuable time without reimbursement to teach sonologists and sonographers throughout the world. Our teachers put national, religious, political, and other parochial considerations aside as they strive to improve the care of all women and fetal patients. Politicians in the countries represented by our School have much to learn from the purity of spirit that exists throughout our international family. We believe that Ian Donald is smiling down from heaven at the School that bears his name.
In the educational efforts of the 55 branches of the Ian Donald School, there is clearly a need for a textbook to complement and supplement lectures and didactic sessions. The first and second textbooks were successful in this endeavor, but with the explosion of knowledge, it was clear that an expanded and updated third edition would be invaluable. For the sake of simplicity, our book is divided into three sections. Section One deals with a variety of topics that lay the foundation for the rest of the book. Section Two addresses the myriad subtopics in obstetric ultrasound that optimize the care of pregnant women and fetal patients. The last section addresses the essential role that ultrasound plays in the many dimensions of clinical gynecology.
A special word of thanks to Jadranka, our tireless secretary for her hundreds of dedicated hours of quality work.
We are grateful to many course directors and lecturers of the Ian Donald School who have enabled its growth and have selflessly contributed to this volume. In order to maximize the reach of this textbook by minimizing its price, all contributors have waived any honorarium or royalty. Their dedication to the dream of globalized quality ultrasound has enabled its reality.
Asim Kurjak
13PREFACE TO THE FIRST EDITION
Ultrasound is the backbone of modern obstetric and gynecology practice. For those of us old enough to remember the dark ages of clinical practice prior to ultrasound, this is not an overstatement. Younger physicians may find it hard to imagine the clinical realities of doctors who delivered undiagnosed twins presenting at delivery, who performed unnecessary surgeries for the clinical suspicion of a pelvic mass that was not present, and who consoled anguished parents when an anomalous infant was born unexpectedly. Recent technological breakthroughs in diagnostic ultrasound, including the advent of color Doppler, power Doppler, three-dimensional and fourdimensional imaging, have led ultrasound to surpass the expectations of Ian Donald, its visionary father.
The Ian Donald School was founded in 1981 and is devoted to international education and research cooperation concerning all aspects of diagnostic ultrasound. The first chapter was founded in Dubrovnik at that time and has now expanded to 7 additional national branches.
To facilitate the educational efforts of the Ian Donald School we believed a textbook would be of value. The text is divided into three parts general aspects, obstetrics, and gynecology. All contributors are either present or former teachers in the 8 branches of the Ian Donald School. We believe this comprehensive text with state-of-the-art images will be of value for both new learners and experienced practitioners.
We are grateful to all of the teachers in the School and especially to all of the contributors to this textbook for their tireless efforts to enhance the quality of ultrasound practice throughout the world.
Asim Kurjak
Frank A Chervenak