Pitfalls in sonographic imaging of the incompetent uterine cervix.

Artifacts interfering with sonographic imaging of the uterine cervix in pregnancy are described. Increasing the amount of fluid in the urinary bladder closes the cervix and alters the configuration of the lower uterine segment, while increased intra-uterine pressure results in reciprocal changes. Angulation of the transducer and manual pressure thereon distort sonographic findings. It is concluded that, contrary to recent reports in the literature, sonography cannot reliably demonstrate changes in cervical compliance during pregnancy. Vaginal examination remains the ultimate diagnostic modality for the diagnosis of the incompetent cervix, while sonography may be used as an adjunct only.

Prenatal sonographic diagnosis of Hirschsprung's disease.

The prenatal sonographic presentation of Hirschsprung's disease is described. This report strongly suggests that bowel distention in Hirschsprung's disease may begin in the late third trimester of intrauterine life. The importance of early diagnosis and treatment cannot be overemphasized. Sonography may greatly contribute to the early diagnosis of Hirschsprung's disease.

Sonographic imaging of intrauterine adhesions.

Hysterosalpingography and hysteroscopy are the diagnostic modalities most commonly used to evaluate and follow intrauterine adhesions (Asherman syndrome). Three patients with intrauterine adhesions are presented. These adhesions were visualized with sonography and appeared as dense intrauterine lines. These lines disappeared after hysteroscopic lysis of the adhesions. The present results indicate that sonography may alert the clinician to the presence of intrauterine adhesions.

Direct diagnosis of unruptured ectopic pregnancy by real-time ultrasonography.

Real-time sonography was used in a prospective study of 32 patients as the sole diagnostic parameter for ectopic pregnancy. The minimal finding for diagnosis was an identifiable gestational sac with a circular pattern of echoes. Neither the presence or absence of an intrauterine sac nor the knowledge of either a positive or negative pregnancy test was used in the diagnosis. Among the 32 study patients, the diagnosis of ectopic pregnancy was made by sonography in nine (28.4%). Follow-up surgery confirmed the diagnosis in eight (89%). Among 23 patients with negative findings on sonography, only one was found on follow-up to have an ectopic pregnancy, for a 96% diagnostic accuracy for the negative group. Thus, of 32 patients with the potential diagnosis of ectopic pregnancy, 30 (94%) were correctly diagnosed using real-time sonography alone.