Miranda, Marilena (2013) L’impatto delle nuove tecnologie ecografiche nella Medicina Materno-Fetale ed in Ginecologia. [Tesi di dottorato]

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The history of ultrasound as a diagnostic imaging technique belongs to the second half of the twentieth century, but its earlier beginnings may be traced back to the first description of the properties of sound and ultrasound. Ultrasound was utilized in the obstetric and gynaecologic practice for therapeutic purposes before the potential for diagnosis was considered. Recent studies have evaluated the role of cervical length measured by transvaginal ultrasonography in predicting preterm birth in asymptomatic low-risk women as well as in those presenting with threatened preterm labor (symptomatic high risk women). Women with autoimmune diseases are at risk of having pregnancies complicated by congenital heart block. Development of heart block in the fetus occurs during gestational week 18-24, and is related to the presence of Ro/SSA-autoantibodies in the maternal circulation. However, to discover the block at an early stage or while it is developing, weekly fetal echocardiographic assessment of the fetal heart needs to be performed in these fetuses at risk. In particular, a novel Doppler method was assessed to measure fetal P-R interval by means of a double-gated Doppler sample volume in anti-SSA/Ro positive women at 24-26 weeks of gestation. Over the past decade advances in Radiological Technology with subsequent introduction of imaging modalities changed the gynaecologic evaluation of female pelvis. Gynaecologic ultrasound was first used by Donald Etal in 1958 in diagnosis of abdominal masses and increased experience resulted in wide spread use of this technique as a diagnostic and surgical tool in gynaecologic practice. In the past, the uterus only could be clinically evaluated by means of a physical examination. Several methods have been introduced for gynecological evaluation. Undoubtedly, ultrasound is the method that has brought the greatest contribution as non-invasive method for evaluation of the uterus and its attachments, initially as a 6 two-dimensional (2D) modality with an abdominal approach , and later with a transvaginal approach . Most recently, ultrasonography has been added of the three-dimensional (3D) processing in both modalities — the multiplanar and the volumetric ones. New diagnostic methods have been introduced, and ultrasound has consolidated its position as an invaluable tool to complement the clinical rationale. Its role in the evaluation of uterine malformations is already defined and will be more and more consolidated with the utilization of the 3D technique. Therefore, a differential and accurate diagnosis of ―double uterus or endometrial cavity‖ is possible with this technique. Malignant neoplasms of the myometrium are infrequent but with high malignancy, constituting 0.5-1% of all cancers of the female genital tract and 2-6% of the uterus. The use of transvaginal ultrasound has deeply changed the imaging of the physiological and pathological myometrium since the use of high frequency probes placed closer to the target organ. The integrated use of color Doppler and pulsed Doppler provided the opportunity to study uterine hemodynamics improving the information obtained by two-dimensional ultrasound.

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