Step by Step® Interventional Ultrasound in Obstetrics and Gynecology Jaideep Malhotra, Nidhi Gupta, Narendra Malhotra, Neharika Malhotra, Kuldeep Singh
Page numbers followed by f refer to figure
Abortion 22, 25
Abruptio placentae 76
Acardiac twin 96
Adenomyosis 14
Admission-discharge and treatment chart 181
Adnexal cyst aspiration 146
Adnexal cystic masses 100
treatment of 115
ultrasound-guided puncture of 115
Alpha-fetoprotein 6, 18, 90, 166
Alzheimer's disease 21
Amniocentesis 8f, 27, 31, 38, 40, 50, 77, 78, 81, 93
consent for 170
early 41, 80
freehand technique for 39f, 40f
Amniodrainage 95
Amniofilteration 81
Amniotic cavity 82
amniocentesis for diagnosis of microbial invasion of 82
microbial invasion of 83
Amniotic fluid 83
aspiration 80
culture 83
gram stain 83
leakage 41, 81
loss 46
microphage derived cytokines 83
WBC count 83
Analgesia 8
Anesthesia 8, 34, 102
general 56
local 46, 56
record 186
regional 56
Anesthetic drugs 54
Anesthetic techniques 55
Antibiotic 103
Antisperm antibodies 164
Asherman's syndrome 140f
Aspiration pump 103
ASRM classification 109f
Assisted reproduction 28
techniques for 155
Benign masses, puncture of 115
Benzodiazepine 57
Biopsy guide 4f
and needle, abdominal probes with 3f
Bladder neck, descent of 111
Bleeding 38, 75, 137
Bloody taps 41, 81
Bolus transfusion 47
Cancer, endometrial 14
Cardiovascular system 53
Case proforma sheet
husband 182
wife 183
culture 69
ectopic pregnancy 128
polyp 75
Cervix 29
Chorion frondosum 69
Chorionic hematoma 69
Chorionic villus sampling 6, 18, 27, 31, 34, 50, 69, 70f, 75, 94, 166
Chorionicity, diagnosis of 93
Clomiphene 84
Coelocentesis 38, 38f, 39f, 65, 66, 67f
Coelomic aspiration 65
Coelomic fluid 65
Contraception, permanent 28
Contralateral lung, drainage of 64
Cord blood sampling 31, 42, 50
Cordocentesis 42, 45f, 64f
routes for 44f
Cornual pregnancy 127
diagnosis of 127
Corpus luteum, measurement of 14
Culdocentesis 122
Cyst 15
aspirated material, cytological examination of 103
pulmonary 47
puncture under ultrasound guidance 102f, 119f
Cytogenetic diagnosis 40
consent for acceptance of 178
semen 179
Double needle technique 74
Down's syndrome 21, 23
Ectopic pregnancy 28, 107f, 108f, 124f
interstitial 127
laparoscopic management of 107f
local injection in 108f, 125f
management of 105, 107f, 121, 123
nonsurgical management of 121
pretreatment scores 163
treatment of 122
donation, consent for acceptance of 180
reduction 86
transfer 151f
Endocoelomic cavity 65
Endometrial thickness, measurement of 14
Endometrioma 104f
Endometriosis 15, 164
Endometrium 14
Endoscopic cord ligation 97
ESGE classification 110f
Ethoxysclerol 103
Extraembryonic celom 70f
Fallopian tube 28
abnormalities of 14
Fetal abdomen 46
anemia 46
ascites 47
biometry 13
biopsy 31
bladder aspiration 64
sampling 27, 95
transfusion 31
disorder, diagnosis of 170
immobility 57
injury 41, 81
invasive therapy 47
loss 41, 46, 81
lung maturity 40
counseling in 17
ultrasound-guided  techniques in 59
muscle, biopsy of 32f
portal vein 46
equipment for 51f
procedure of 87f
routes of 86f
research 25
respiratory complication 41
shunts 31, 47
biopsy of 32f
instruments for biopsy  of 33f
needles for biopsy of 33f
thrombocytopenia 42, 46
Fetomaternal transfusion 41, 81
Fetus, medical treatment of 40
Fibroids 14, 27
First trimester screening 6, 18, 166f
Follicles, measurement of 14
Follicular development, monitoring of 15
Free-hand technique 39f, 40f, 59
Gastrointestinal tract 54
Genetic counseling 16, 69
Genetic screening questionnaire 168
Gestational age 163
Gestational sac 66f
ectopic 125
Glomerular filteration 54
Glucose concentration I 83
Ground glass appearance 104f
Gynecological complications 14
Gynecological ultrasound 14
Gynecology 12
Doppler in 15
procedures 98
Hemoperitoneum 163
High risk pregnancy evaluation form 165
Hydrocephalus puncture 48f
Hydrosalpinx 14, 163
drainage of 101f
Hypercarbia 58
Hypercholesterolemia, familial 21
Hyperplasia, endometrial 14
Hyperstimulation syndrome, diagnosis of 15
Hyperventilation 57
Hypocarbia 57
Immunodeficiencies, correction of 46
In vitro fertilization
indications for 164
proforma 184
treatment for 174
Incompetent cervix 137
Infection 41, 46, 75, 137
Inferior vena caval compression 54
Infertility 15
and oncology 15
immunological 164
long standing unexplained 164
procedures 138
International Federation of Gynecologists and Obstetricians Committee  Report 86
International procedures, preoperative preparations for 163
Interventional ultrasound 17, 26
anesthesia for 53
techniques, negligence in performance of 24
tricks of 31
Intra-amniotic infection 40
Intra-amniotic injection, rapid diagnosis of 83
Intra-amniotic pressure 49
assessment 50f
Intracavitory tissue 27
Intraovarian insemination 151
Intraperitoneal fetal blood transfusions 64
Intrauterine contraceptive device 26
extraction of 15
Intrauterine exchange 47
Intrauterine fetal transfusion 46
Intrauterine pressure assessment 49
Invasive obstetric procedures 34
Invasive procedures 15, 31, 59
Isoimmunization 40, 81
Jansen Anderson cannula 148
Laparoscopic electro ovarian surface cauterization 152
Laparoscopic ovarian cystectomy 104f
Laparoscopic puncture 153f
Macaca fasicularis 41
Malignant tumors, puncture of 118
Meconium staining 41
Metabolic defects 40
Methotrexate 28, 124, 129
Midtrimester amniocentesis technique 78
Minor uterine surgery 27
Minute alveolar ventilation 54
Multifetal reduction 84
Multiple gestation 22
amniocentesis in 81
Myometrium 152f
Narcotics 57
intraoperative 57
Needle, placement of 39f, 43f
Neisseria gonorrhoeae 69
Nitrous oxide 57
Nonimmune hydrops evaluation 42
Noninvasive prenatal screening 6, 18, 166f
Obstetric procedures 30
Obstructive uropathy 47
Oligoasthenospermia 164
consent for acceptance of 178
donation 176
consent for 176
pick up 148f
retrieval 15, 148f
Open neural tube defects 6, 18, 166
Operative technique 130
Ovarian carcinoma 15
Ovarian cyst 103f, 104f
aspiration of 15
injection of 15
puncture 103f, 146
Ovarian stimulation 155
Ovary 14, 15
abnormal 104f
Ovulation induction 85, 155
pick-up 4f, 146
recovery 155
retrieval 146
abdominal 163
lower abdominal 125
Parasitic infections 42
Pelvic abscesses, drainage of 15
Pelvic anatomy, normal 14
Pelvic masses 105
differential diagnosis of 15
Perinatal fetal assessment 46
Peritoneal fluid, assessment of 14
Periurethral aspiration 157
Placenta 46
Placental anastomosis, laser coagulation of 96
Pleural effusion 47
Polycystic ovaries
diagnosis of 15
drilling 154f
Polyhydramnios 97
drainage of 40
Polyp 14, 27, 140f
Postpartum uterine evaluation 27
Postpuncture convalescent period
signs of 125
symptoms of 125
Post-voiding residual volume 111
Pouch of Douglas 150
Pregnancy 96
early 12
loss 38, 75
causes of 90
multifetal 51f
multiple 85, 86
physiological changes of 53
Prenatal diagnosis 21, 24, 93
Prenatal genetic screening 166
Prenatal screening 18f, 19f
Preterm labor 75
Principal in vitro fertilization consent form 174
Progesterone 163
Puncture procedures 122
Quadruplet pregnancy 52f
Real time ultrasonography 77
Red blood cell alloimmunization 42
Respiratory function 54
Rh isoimmunization 41
Ring of fire sign 107f
Rocket fetal catheter 49
Sagittal ultrasound section 134f, 135f
infusion sonography 27
sonohysterography 139f
Salpingocentesis 124
Sampling devices 71
Sampling techniques 73
Sclerosing agents, injection of 103
Selecting puncture site 78
Semen intrafallopian tube insemination 150
Septa and lateral metroplasty, hysteroscopic correction of 108
Septate uterus 137
sonographic picture of 131f
Shunt, types of 48, 49
Single needle insertion technique 74, 94
Sonohysterography 27, 140f
Sonohysterosalpingography 144f
Sonosalpingography 15, 142
3D power Doppler 146f
color bruit indicating spill 143f
color flow 28
Spina bifida 21, 23
Stress incontinence surgery and ultrasound 113
abdominal 28
laparoscopic 28
Synechia 137
Terramycin 103
Thoracoamniotic shunting 64
Transabdominal chorionic villus sampling 72f
Transabdominal needle 71
Transabdominal ovum recovery 156
Transabdominal sampling 74
Transcervical catheter 71
Transcervical chorionic villus sampling 72f
Transcervical embryo transfer 159
Transcervical metroplasty 108, 137
Transcervical sampling 73
Transducers, selection of 79
Transvaginal ovum recovery 157
Transvaginal probe with biopsy guide and needle 98f, 99f
Transvaginal sonographic puncture procedures 121
Transverse ultrasound section 133f
Triplet pregnancy, ultrasound picture of 84f
Tubal cannulation 148
Tubal ectopic pregnancy, diagnosis of 124
Tubal evaluation 142
Tube 14
3D ultrasound evaluation of 101f
Twin pregnancies 93
Twin-reversed arterial perfusion
evaluation 46
sequence 97
syndrome 31
Twin-twin transfusion syndrome 46, 52, 95
Typical adnexal ring or bagel sign 124
Ultrasonography 6, 18, 26, 166
Ultrasound 53
physics of 31
cannulation 149f
embryo transfer 151
PCO puncture 152
prenatal diagnostic procedures 27
procedures, technique for 61f
contraindications of 116
indications of 116
transcervical metroplasty 130
Umbilical cord
catheterization of 44f
free loop of 42f, 43f, 46
Umbilical fetal abdomen attachment 46
Umbilical placental attachment 46
Urinary bladder study 112f, 113f
Urodochocentesis 64
Urogynecology 111
Uterine cavity 26, 152f
evaluation 138
polyp in 140f
Uterine movement 14
Uterine position 14
Uterine relaxation 57
Uterine septa
sectioning of 130
transcervical section of 130
Uterine shape 14
Uterine size 14
Uterine wall, thickness of 135f
Uterus 14
arcuate 137
congenital anomalies of 108
inflate Foley's bulb in 143f
Vaginal probes 3f
Vanishing twin 89
Vascular injury 152f
Villi 37f
Viral infections 42
Chapter Notes

Save Clear

Second Edition
Editor-in-Chief Narendra Malhotra MD FICMCH FICOG FRCOG FICS FMAS FIAP President, INSARG, Past President, FOGSI/IFUMB/ISPAT/ISAR Vice President, WAPM/SAFOG Managing Director, Global Rainbow Health Care & MNMH(P) Ltd Agra, Uttar Pradesh, India Professor, Sarajevo School of Science and Technology, Croatia Associate Editors Nidhi Gupta MS FICMCH FICOG Past President, Agra Obstetrical & Gynecological Society Professor, Department of Obstetrics and Gynecology SN Medical College, Agra, Uttar Pradesh, India Neharika Malhotra MD (Gold Medalist) DRM (Germany) FICMCH Fellow ICOG (Rep Med) ICOG (USG) Joint Secretary, FOGSI, Chair YTP Committee, FOGSI Director and Consultant, Global Rainbow IVF & MNMH(P) Ltd Agra, Uttar Pradesh, India Jaideep Malhotra MD FICMCH FICOG FRCOG FRCPI FMAS President, SAFOM/ISPAT Past President, IMS/ISAR/FOGSI/ASPIRE Managing Director, ART—Global Rainbow IVF & MNMH(P) Ltd Agra, Uttar Pradesh, India Kuldeep Singh MBBS FAUI FICMCH Consultant Ultrasonologist Dr Kuldeep's Ultrasound and Color Doppler Clinic New Delhi, India
Jaypee Brothers Medical Publishers (P) Ltd
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23-B
Ansari Road, Daryaganj
New Delhi 110 002, India
Landline: +91-11-23272143, +91-11-23272703
+91-11-23282021, +91-11-23245672
Corporate Office
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Overseas Office
J.P. Medical Ltd
83 Victoria Street, London
Phone: +44 20 3170 8910
Fax: +44 (0)20 3008 6180
© 2021, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale.
Inquiries for bulk sales may be solicited at:
Step by Step® Interventional Ultrasound in Obstetrics and Gynecology
First Edition: 2004
Second Edition: 2021
Printed at
Preface to the Second Edition
“Use sound to see better
Turn on the color to improve your image
Shift to the 3rd and 4th dimension
Heal with sound”
Ultrasound today is the mainstay in the field of obstetrics and gynecology.
Introduction of interventional procedures in obstetrics and gynecology has now made it possible to make histopathological diagnosis.
After the huge success of the first edition of this book we have come out with the second edition with addition of commonly used interventional procedures.
The procedures have been simplified step by step for the practitioners to learn and practice in their patients.
Narendra Malhotra
Nidhi Gupta
Neharika Malhotra
Jaideep Malhotra
Kuldeep Singh
Preface to the First Edition
Ultrasound today is the mainstay investigation in the field of obstetrics and gynecology. It is now quick, easy, reproducible and inexpensive to make an anatomical diagnosis in obstetrics and gynecology. The addition of color gives us an insight to the physiology of the area/organ/fetus being scanned and 3D and 4D have added a new anatomical plane and dimension.
Introduction of interventional procedures to obstetrics and gynecological ultrasound has now made it possible for us to help in making a histopathological diagnosis.
This step by step book aims at introducing the reader and familiarizing the reader to interventional sonography in Obstetrics and Gynecology.
It is mandatory by the Indian PNDT law to register your machine and clinic to perform interventional genetic diagnostic procedures.
Kuldeep Singh
Narendra Malhotra
Our heartiest thanks to our parents, elders, teachers, spouses, siblings, our sons, daughters and our friends who have helped us step by step at every step of our ambitious project of step by step series.
We were introduced to interventional sonography by Ananda Kumar (Singapore), Rajat Goswamy (UK), Asim Kurjak and Sanja Kupesic (Croatia), Prof Alfred Kratrochwil (Austria), Ashok Khurana, Ambarish Dalal, Pratap Kumar, Bhupendra Ahuja, Dr PK Shah, Jatin P Shah and Pranay Shah and many others who taught us small tricks of the trade at each step of our life.
We are indebted to Prof Struat Campbell and Prof Asim Kurjak for teaching us imaging and grateful to Ian Donald School, India and INSUOG.
Special thanks to Dr Rahul Gupta and Nitin Agarwal of Rainbow 4D imaging center for all the images.
Narendra Malhotra