Normal Pelvic Anatomy.

This article reviews normal pelvic anatomic findings during ultrasound and discusses how to obtain and measure these images. Representative images of normal pelvic anatomy, with select videos, are included to assist in understanding the presented concepts and normal anatomic images.

Coding and Legal Issues in Obstetric and Gynecologic Ultrasound.

This article addresses coding and liability related to obstetric and gynecologic ultrasound examinations. The coding section includes an overview of general concepts, highlighting the differences between coding in hospital-owned facilities and provider-owned clinics. It also addresses the importance of correct International Classification of Diseases, 10th edition, coding, emphasizing the use of the most specific applicable codes. This section discusses proper coding and applicable parameters for early pregnancy and gynecologic ultrasound examination. The liability section addresses common errors leading to litigation in obstetric and gynecologic ultrasound practice. Examples are given demonstrating how such errors lead to liability actions.

What Is New in Medical-Legal Issues in Obstetrics and Gynecology?: Best Articles From the Past 2 Years.

This month we focus on current research in medical-legal issues in obstetrics and gynecology. Dr. Shwayder discusses four recent publications, which are concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in Box 1 on this page, along with direct links to the abstracts.

Cystic adenomatoid tumor of the uterus.

We present a case of a cystic adenomatoid tumor in a 40-year-old woman. The tumor was an intramural multicystic mass, histologically similar to a multicystic mesothelioma. Cystic adenomatoid tumors of the uterus are extremely rare. They present with a wide differential diagnosis in radiology. The tumors are known to be benign and awareness of this rare entity is the key to its diagnosis for a pathologist.

Current methods of tubal patency assessment.

OBJECTIVE: To evaluate the scientific literature on current methods of uterine cavity and tubal patency assessment. DESIGN: Review of literature and appraisal of relevant articles using MEDLINE, OVID, EMBASE, and Cochrane on-line databases. RESULT(S): Current pelvic imaging subfertility investigations are compared with the gold standard laparoscopy. The technical aspects, associated risks, potential advantages, and weighted utility of each screening study are discussed. A comprehensive analysis of the clinical evidence regarding the safety, tolerance, and accuracy of hysterosalpingo-contrast sonography compared with alternative screening studies and/or laparoscopy is reviewed. CONCLUSION(S): Increasing evidence supports the more recently described hysterosalpingo-contrast sonography procedure as an acceptable screening study for the subfertile patient with the potential advantage that it is a comprehensive evaluation, methodologically simple, cost effective, and time efficient.

Pelvic pain, adnexal masses, and ultrasound.

Pelvic pain, acute or chronic, accounts for more than 10% of referrals to gynecologists. Pain accounts for more than 40% of gynecologic diagnostic laparoscopies. Predicting operative findings is critical in planning surgical interventions, as well as preoperative and postoperative medical therapy. Ultrasound is useful in preoperative evaluation and in predicting surgical findings. This section reviews the use of various ultrasound modalities in evaluating adnexal masses and associated pelvic pain. Morphologic assessment with two-dimensional (2-D) ultrasound is the foundation for adnexal evaluation. The ultrasound morphology of common ovarian and adnexal masses is reviewed. The application and reliability of Doppler assessment is also reviewed. New advances, such as three-dimensional (3-D) sonography, 3-D vascular assessment, and contrast imaging, augment diagnostic accuracy. These advances may find future application in the clinical evaluation of patients. This section reviews the application of 2-D morphology, Doppler analysis, 3-D morphology, rendering and vascular assessment, and the use of contrast agents in the ultrasound evaluation of patients with adnexal masses and pelvic pain.

Liability in high-risk obstetrics.

This article outlines the major causes of malpractice suits, focusing on those in obstetrical practice and reviewing the prime areas in antepartum and intrapartum care. Understanding the basic elements of medical malpractice allows a provider to better understand the nature of a suit for medical negligence. While the threat of a medical malpractice is ever present in obstetrics, practicing contemporary, evidence-based medicine with compassion and excellent communication is the best way to avoid alleged negligence.