| Chapter Page 1. The Application of Ultrasound to Obstetrics, 1 Gynecology and Reproductive Technologies For Nurses and Nurse Midwives Guidelines for the Incorporating Ultrasound into Practice Indications for Diagnostic Ultrasound in Obstetrics Professional Organization Guidelines Documentation and Retrieval Ultrasound for Non-Diagnostic Purposes Competency and Cost Conclusions Educational Resources References 2. The Physics and Instrumentation of Ultrasound 15 Definition Ultrasound Physics Transducers Ultrasound Machine Scan Planes Artifacts Doppler Effect Bioeffects Documentation Care of the Equipment Ultrasound for Non-Diagnostic Purposes Conclusion References 3. Documentation and Communication in Ultrasound 25 Documentation Supervision Communication Legal Case Review Ethical Issues 4. Imaging the Female Reproductive System 35 Gynecologic and Reproductive Ultrasound Anatomy of the Female Pelvis Urinary Bladder Pelvic Musculature Pelvic Vasculature Uterus Cervix and Vagina Fallopian Tubes Bowel Ovaries Normal Menstrual Cycle Uterine Changes Doppler and Color Flow Imaging Conclusions References 5. Ultrasound Evaluation of Gynecologic Pain and 65 Dysfunctional Uterine Bleeding: The Basic Scan Uterine Evaluation The Endometrium The Adnexa Follicular Cysts Corpus Luteum Cysts Complex Cysts Fallopian Tubes References 6. Ultrasound in the First Trimester of Pregnancy 81 Indications for 1st Trimester Ultrasound Ultrasonography of Early Pregnancy Fetal Structural Anomalies Nuchal Translucency Membranes, Yolk Sac, and Umbilical Cord Adnexa and Uterus Sonography of Early Pregnancy Failure Conclusion References 7. Ultrasound Evaluation of the Fetus: The Standard Scan 99 Indications for 2nd and 3rd Trimester Ultrasound Fetal Biometry Biparietal Diameter Head Circumference Femur Length Abdominal Circumference Estimated Fetal Weight and Age Fetal Survey Other Views and Measurements Maternal Cervical Length References 8. Ultrasound Evaluation of the Second and Third Trimester 121 Bleeding Placental Previa Vasa Previa Placenta Accreta Placental Abruption Placental Lakes Retained Placenta Color Doppler Conclusion References 9. Ultrasound Evaluation of the Maternal Abdomen: 133 The Standard Scan Liver Gallbladder Kidney Pancreas Spleen Appendix References 10. Ultrasound Evaluation of Fetal Well-Being 151 Methods of Antepartum Evaluation Antepartum Evaluation with Ultrasound Biophysical Profile Other Indications for Amniotic Fluid Assessment The Nurse’s Role in Fetal Assessment with Ultrasound Conclusions References Appendices 163 A: Predicted Menstrual Age with Biparietal Diameter (BPP) B: Predicted Menstrual Age with Head Circumference (HC) C: Predicted Menstrual Age with Femur Length (FL) D: Predicted Menstrual Age with Abdominal Circumference (AC) E: Percentile Values for Abdominal Circumference (AC) F: Estimated Fetal Weight with BPP and AC G: Estimated Fetal Weight with AC and FL H: Estimated Birth Weight for Males I: Estimated Birth Weight for Females Glossary To order, click here |
| PREFACE FOR 2010 EDITION: The technology of sonography has grown rapidly; the equipment is relatively easy to use and its application is pertinent in nearly all medical specialties. When an ultrasound examination is performed by a radiologist or sonographer, the examination consists of predetermined parameters which must be evaluated. However, when the clinical situation does not allow for a complete examination, parameters have been set for the non-radiologist or non-sonographer to perform what has been previously called a limited ultrasound. However, more recently the American Institute of Ultrasound in Medicine (AIUM) and the American College of Obstetricians and Gynecologists (ACOG) changed the categories of ultrasound, and in doing so, some procedures in the limited ultrasound category now fall under more than one category. As a result of these changes in terminology, in 2010 the Association for Women’s Health, Obstetrics, and Neonatal Nursing (AWHONN) published new professional guidelines to reflect these changes. Therefore, at this point in time, the term “limited” is no longer used to describe the types of ultrasound examinations that nurses may perform. In place of that, simply the phrase “ultrasound for nurses” has been developed. As a result, this new edition of the book formerly entitled “Limited Sonography in Obstetric and Gynecologic Triage” has been retitled and updated to include all aspects of sonography that may be performed by nurses in the areas of obstetrics, gynecology, and reproductive medicine. All categories are further defined in Chapter 1 of this new edition. Educational programs to prepare professional sonographers exist in both collegiate and hospital settings. Currently most obstetricians and gynecologists learn sonography during residency training. However, sonography is not a part of nursing education curriculum, although it is now more frequently offered in advanced nursing practice programs, as well as nurse midwifery programs. Some practitioners in these categories learn “on the job.” Unfortunately, in many areas the clinical application has preceded appropriate educational training and competency validation programs. This is still true during the writing of this edition. Many nurses who work in obstetrics and gynecology in-patient and out-patient settings are accepting the responsibility for performing sonography. Nurses working in out-patient assisted reproduction programs are measuring follicles and early gestational sacs. Labor and delivery nurses frequently use the ultrasound machine to verify presenting part during labor or to locate the fetal heart. Some postpartum nurses utilize ultrasound to examine the bladder for residual urine. The majority of these nurses have the basic knowledge of maternal and fetal physiology to be able to perform such assessments and receive on-site clinical instruction and supervision. It also is clear that nurse practitioners and nurse midwives have the prerequisite knowledge of pelvic anatomy and physiology necessary for acquiring ultrasound skills. Women’s health care practitioners are logical candidates for incorporating ultrasound skills into their practice. But all facets of ultrasound examinations should be done with specific formal educational and clinical practice in order to achieve competency and maintain quality of care. This book, Ultrasound for Nurses: Obstetrics, Gynecologic, and Reproductive Technologies was designed with these didactic and clinical goals in mind. Chapter 1 further describes and defines the categories of ultrasound and prerequisite training based on the pertinent professional organization guidelines. So that practitioners (nurses, nurse practitioners, nurse midwives, and physicians) can obtain the best-quality images, the principles of ultrasound as well as the proper use of the equipment are presented in Chapter 2. Also included is a review of female pelvic anatomy presented with a comparison of the specific sonographic images. This should help one transfer anatomic landmarks and structures into sonographic images. Along with the performance of ultrasound goes the ethical and legal accountability between practitioner and patient. This information is also covered and cannot be taken lightly. The remaining chapters discuss specific physiologic and pathologic conditions for which an ultrasound examination may be performed, including not only obstetric, gynecologic, and assisted reproductive technologies, but also general maternal abdominal problems that may present during a pregnancy. The book concludes with appendices, including a glossary of terms and fetal growth charts. Many growth charts exist, many of which are part of the ultrasound machine software packages. Those shown were chosen by the individual authors and represent various practice situations and regions of the country. Finally, it is hoped that this book can aid in education and competency validation, as well as in incorporating the practice of ultrasound more safely and securely into the practice of women’s health care. Cydney Afriat Menihan CNM, MSN, RDMS January 2010 |
