Ultrasound of the placenta and umbilical cord: a review.

The placenta and umbilical cord play important roles in the development of the growing fetus. The placenta can be clearly identified by the 14th gestational week and should be evaluated during each obstetric ultrasound examination.This article reviews the formation of the placenta and its expected sonographic appearance throughout gestation along with its normal variants. Expected findings in a singleton pregnancy are primarily addressed. The next portion of the article covers placental abnormalities of clinical consequence, including anomalies of appearance, location, and function.The umbilical cord is also discussed, focusing on the relevance of the location of the umbilical cord's insertion into the placenta.

The role of abdominal radiography in the evaluation of the nontrauma emergency patient.

PURPOSE: To characterize the utility of abdominal radiography for nontrauma emergency patients in a single-institution setting. MATERIALS AND METHODS: Following approval from the Director of Professional Services, a retrospective review of radiography and of patient records was conducted for patients who presented to a nontrauma emergency department over a period of 6 months and who were imaged by using abdominal radiography. Only the first radiograph per patient was used for analysis. The interpretations were sorted as normal, nonspecific, or abnormal. The patients' medical records were reviewed to determine whether further imaging was performed (computed tomography, ultrasonography, or upper gastrointestinal imaging) and results were compared with abdominal radiography. Chart reviews were conducted to identify patients in whom abdominal radiography alone influenced treatment. RESULTS: In 874 patients, interpretation of abdominal radiography was normal in 34% (n = 300), nonspecific in 46% (n = 406), and abnormal in 19% (n = 168). Further imaging was performed for 50% (436) of all patients. Of 300 patients whose abdominal radiography results were normal, 42% (n = 125) had follow-up imaging; 72% (n = 90) of these showed abnormal, 78% (165 of 212) showed nonspecific, and 87% (86 of 99) showed abnormal findings. Of 438 patients who did not undergo follow-up imaging, 75% (n = 327) were discharged. For all indications other than catheter placement, abdominal radiography helped confirm the suspected diagnosis in 2%-8% of cases. In 37 (4%) of 874 patients, abdominal radiography was possibly helpful in changing patient treatment without a follow-up study. CONCLUSION: Abdominal radiography is often requested; however, its results contribute to patient treatment in a small percentage of cases. With the exception of catheter placement, if a patient requires investigation beyond clinical history, physical examination, and lab results, the emergency physician should be encouraged to request more definitive imaging.