Q&A with leading OB/GYN ultrasound expert Jacques Abramowicz, MD
Ultrasound use in obstetrics and gynecology has only been around since the 1950s. Now, physicians rely on this type of imaging to identify both common and complex gynecological issues and conditions associated with pregnancy. We spoke with one of the world's leading ultrasound experts, Jacques Abramowicz, MD, to answer questions about the importance of medical ultrasound. Abramowicz is UChicago Medicine's maternal-fetal medicine director of ultrasound services and sees patients ages 12 and up.
What is an ultrasound, exactly?
Medical ultrasound uses very high-frequency sound waves to provide an image of soft tissues in the body.
What are some common misconceptions you hear from patients about their ultrasound?
Particularly in pregnancy, the biggest misconception is that once we say we didn’t *see* anything wrong, nothing is wrong with the baby. It means that what we *saw* is okay — we cannot see absolutely everything. And there are certain tiny defects, particularly of the heart, that cannot be detected by prenatal ultrasound. The heart is the size of a dime or quarter in a term baby, so earlier in pregnancy, it’s even smaller and, thus, it is more difficult to see issues and conditions, if they exist.
What types of ultrasounds are used in OB/GYN?
We use 2D, 3D, 4D, color Doppler and spectral Doppler. Each provides a different type of image.
2D is what is most commonly utilized. 3D ultrasounds are computer reconstructions of the various images that were obtained with 2D, and they give us a volume of the organ we’re looking at that we can then manipulate in different directions that the 2D doesn’t allow us to see as clearly. 2D is one slice of the picture, whereas 3D shows the whole volume of the organ.
When do you need to use 3D and other types of ultrasounds?
We don’t need to use 3D all the time if we get a clear image of what we’re looking at.
For instance, in gynecology, if we don’t know where an IUD (intrauterine device) is located, 2D would give us a general idea but not an exact location. 3D reconstruction allows us to see the whole volume of the uterus, so we could more precisely locate the IUD. Another example would be a tumor in the lower pelvis — sometimes it’s a little difficult to verify if it’s uterine or ovarian. In these cases, 3D allows us to better evaluate the relations between various organs.
4D is real time 3D with movement, which means we see the anatomy in 3D, except it cannot perform reconstruction like 3D can. We can identify, for instance, a problem like a cleft lip. It is excellent to examine the surface of the body. But if we need to look at internal organs, it is more difficult with 4D, because we would have to freeze the image to spot issues better.
When do you need to use Doppler imaging?
We use spectral Doppler imaging to examine blood flow in certain blood vessels in terms of how fast the blood flows and how much resistance there is to the flow in the organs we are looking at.
Color Doppler helps us visualize the vessels, because the computer adds color to anything that moves — so blood moving in blood vessels is clearly depicted with colored images.
What are some of the various uses of ultrasounds in obstetrics and gynecology?
We do ovarian cancer screenings and examine people with gynecological problems like pelvic pain, abnormal bleeding, suspected fibroids and many other issues.
In general, we use abdominal ultrasound, which is when we have a probe on the abdomen. We also use vaginal ultrasound (also called transvaginal or endovaginal) when the probe is inserted into the vagina, essentially to get closer to the organs of interest (for instance, the uterus, pregnant or not and the ovaries). The higher the frequency of an ultrasound, the better the image. But, higher frequency means a shallower visibility of the area being viewed. So, if we want a good image of the uterus and ovaries, we will use vaginal probe rather than an abdominal one.
In OB, there are a lot of indications including pregnancy dating that we perform very early in pregnancy, which is the best time to date the pregnancy. Dating pregnancy means determining the gestational age and date of delivery. Not all the patients we see know when they became pregnant, so that can be extremely useful to follow the growth of the fetus and determine when the fetus should be delivered. In the first trimester (around 11 to 12 weeks), we will check the back of the neck thickness (called nuchal translucency or NT), which is a screening test for issues in general.
We usually will do an anatomy scan around 18 to 20 weeks, where we look at the various fetal organs. This is when we can need to use 3D, for instance — to look at the fetal face, to rule out cleft palate, look at the spine with 3D to look at various angles, no spinal issues.
In the third trimester we perform biophysical profile, which means looking at fetal breathing and body movements as well as assessing the amount of amniotic fluid around the baby. This gives us an idea of the fetal health status.
We also offer second opinions for patients who have questions about diagnoses they received elsewhere.
Can parents come just to get an image of their baby for fun?
We do not approve of souvenir ultrasound or entertainment ultrasound. There are stores in certain malls where you can have a 3D ultrasound, but we (along with the American Medical Association and other groups) don't approve of that. It's a medical procedure that should be used as such, with a clear indication.
We will give 3D pictures to the parents when it’s within the frame of medical ultrasound. We will give a couple of pictures if the baby is in the right position and if there is enough fluid around the baby. It’s not as simple as taking a photo on your phone.
Are there risks associated with ultrasound?
Although ultrasound is considered safe, it is a form of energy that has the potential to heat and displace tissues. We know that heat has the potential to cause birth defects, as it has been clearly shown in tests with animals. While it's easy to control the amount of energy generated by the machine, about 70 percent of the general population of people who perform ultrasound, do not know about this. Our ultrasound practice is accredited by AIUM (The American Institute of Ultrasound in Medicine). This involves a voluntary peer review process that determines if nationally recognized standards in the performance and interpretation of diagnostic ultrasound examinations are met or exceeded.
Jacques Abramowicz, MD
Jacques Abramowicz, MD, is an expert in the use of ultrasound for prenatal diagnosis of fetal anomalies and screening for early detection of ovarian cancer.Read more about Dr. Abramowicz
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