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Study of Yolk Sac Abnormalities in the First Trimester Using Ultrasonography دراسه تشوهات كيس الصفار في الثلث االول من الحمل بإستخدام الموجات فوق الصوتية

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Study of Yolk Sac Abnormalities in the First Trimester Using Ultrasonography دراسه تشوهات كيس الصفار في الثلث االول من الحمل بإستخدام الموجات فوق الصوتية Sudan University Of Science And Technology College Of Graduate Studies Study of Yolk Sac Abnormalities in the First Trimester Using Ultrasonography دراسه تشوهات كيس الصفار في الثلث اﻻول من الحمل بإستخدام الموجات فوق الصوتية (A Thesis Submitted For Partial Fulfillment Of The Requirements Of M.Sc Degree In Medical Diagnostic Ultrasound) Presented by: Dalia Hashim Ahmed Mahjoub Supervisor: Dr. Muna Ahmed Mohamed 2019 Dedication I dedicate this work to: My parents whom support me and sought to blessed comfort and happiness, they gave everything to push me in a way of success and pray for me. My brother and sister whom we love. My colleagues and everyone who help me at any time in my life. With my love and appreciation I Acknowledgement I wish to thank my committee members who were more than generous with their expertise and precious time. A special thanks to Dr. MUNA, my committee chairman for his countless hours of reflecting, reading, encouraging, and most of all patience throughout the entire process. I would like to acknowledge and thank my university division for allowing me to conduct my research and providing any assistance requested. II Abstract This study was conducted in Khartoum state Sudan, in the ultrasound departments of khartoum north teaching hospital, Alskeikh Mohammed Ali Fadol and new omdurman hospital. The problem of the study was difficulty of sonographic detection of yolk sac abnormalities, and lack of interest for evaluation by sonographer and sonologist. The aim of the study was to estimate the role of ultrasound in the diagnosis of yolk sac abnormalities, the complication associated with it, and the usefulness in prediction of pregnancy outcome. This was observational analytical study carried out during the period from January to July 2014. The data was collected from 100 pregnant women during first trimester of pregnancy, classified and analyzed by using SPSS (statistical package for social science). The analysis of the results showed that all yolk sac abnormalities were diagnosed by ultrasound with absence yolk sac (46%), large yolk sac (29%), irregular yolk sac, (6%) Small yolk sac (5%), calcified yolk sac (13%), echogenic yolk sac (1%), and there was no patients with persistent yolk sac. The complications were bighted ovum (46%) and missed miscarriage (37%). Which affect middle aged women (20 – 30 years) (52%), multigravid (60%), paraII (31%), with no history of chronic disease (95%), and can be detected by transabdominal (41%) or endovaginal probe (59%) with transvaginal technique was more accurate.The most yolk sac abnormalities associated with complication were absence, large, and irregular yolk sac which predict poor pregnancy outcome. Other Small, calcified, echogenic, and persistent yolk sac abnormalities cannot predict poor pregnancy outcome and most commonly associated with normal pregnancy.The study recommended that all pregnant women during first trimester of pregnancy should do obstetric ultrasound and yolk sac should be evaluated carefully for any abnormalities. III مستخلص الدراسة أجريت هذه لدرالةذف ذا يلداذف لدمر ذ - لدسذ ال، ذا أاسذا لدا جذاق ذ و لد ذ ساف ىاسلخذطو لدمر ذ ى ذر يمسلخذطو لدخذام م اذر فذا مذت يمسلخذطو أ اامذا، لدشريذرا مخذسفف لدرالةذف هذا ذن ىف لدسخذ ذ سخذ هاق لدساس لدا ا ىادا جاق و لد ساف ي ر لهلاا سقناا يلخ ذاياا لدا جذاق ذ و لد ذ ساف ىلقاذات سخذ هاق لدسذاس لدا ذذاا هذذر ت لدرالةذذف دلقاذذات ايا لدا جذذاق ذذ و لد ذذ ساف ذذا سخذذماح االدذذت ا ي ذذفف لداذذ لد اذذر اناذذف لداما طاق لدارس طه ىها يللدسلطاا منها ا لدلن ؤ ىنلاشف لد اتا يها االةف ا ريف س فافاف لجريت ذا لدطلذرم مذ ايسا ر إدذو مذاا .2019 جانذت لد اانذاق مذ 211 لمذرأم ذا لدطلذرم للدذ دو مذ لد اذت ذنطت ياففذت ى ةذلناا لدل فاذذت للد ذذايا لدرزمذف لحد ذاياف دنفذت لحدشلاذا ا يياذ ت لدنلذايل ىذي، ةذت االدذت ا ي ذفف لداذ لد اذر اناذف شم ت ىادا جاق و لد ساف يةا، غااب لدساس لدا ا 24%)ا ي فف م ة ارم )12 %)ا ي فف م شاذم )4 %)ا ي ذذفف مذذ ذذ ارم )5 %)سسفذذس ا ي ذذفف لداذذ )21 %)ا ي ذذفف مذذ ى ذذري الخفذذا )2 %)يدذذت سسذذ هنذذا االدذذت ى ي ذذفف لداذذ لدرلياذذفا لدامذذا طاق لدارس طذذف ىلخذذ هاق لدسذذاس لدا ذذا ةانذذت لد يمذذف لدطااغذذف )24٪)ي لحدشهاض لداطلقر 13 %(.يلدلا سؤثر فو لدنساء ا منل لدنار لدلا ةانت دهت لةثر م ثﻻثه لرلق اات ةذاىقف 41%(يةانذذت نلذذايل لد اذذت اناذذف داذذرسا )12%(يدذذاس دهذذت سذذاايم مذذ لداذذرض لداذذ م )25 %) يسذذت لدسخذذ ىادا جاق و لد ساف ريق جرلا لد ط )22%( ي ريق لدا جاق و لد ساف لداه فاف )52% مذ ل، لدا جاق و لد ساف لداه فاف أةثر اافا أةثر ااﻻق ا ي فف لدا لد ار اناف لدلا إاس طت ىاما طاق ةانت غااب ا ي ذفف لداذ ا ي ذفف مذ ة اذرم ي ا ي فف م شاذم لدلا ياس ل، سسلمر ا لدلن ؤ ىنلاشف ةائه دف اتا لما ا ي فف لدا لد ارم ا ي فف لدا لدالسفسف ا ي ذفف مذ ى ذري الخفذا مذ االدذت ا ي ذفف لداذ لد اذر اناف ل سسلطا لدل و ىنلاشف اات ةا يف يمرس طف ىاد ات لدط اناا أي ت لدرالةف ىي، ةت لدنساء لد لمت أثناء لدطلرم لأد دو م لد ات يشب أ، يممذن دط ذح م جذاق ذ و ذ ساف دف ات يا ي فف لدا يشب أ، سقات ىننايف ا لد اﻻق غار لدط انافا IV Table of contents No Contents Page No I Dedication Acknowledgements II Abstract(English) III Abstract (Arabic) IV Table of contents V List of tables VII List of figures VIII List of abbreviation IX Chapter One: Introduction 1.1 Introduction 1 1.2 Problem of the study 3 1.3 Objectives 3 1.4 Overview of the study 4 Chapter Two: Literature Review 2.1 Anatomy 5 2.2 Physiology 7 2.3 Pathology 8 2.4 Previous study 13 Chapter Three: Materials and Methodology 3-1 Materials 16 3-1-1 Subjects 16 3-1-2 Machines used 16 3-2 Method 16 3-2-1 Study Design 16 3-2-2 Area of the Study 16 3-2-3 Duration of Study 17 3-2-4 Study Population 17 3-2-5 Sample 17 3-2-6 Study Variables 17 3-2-7 Data Collection 17 3-2-8 Data Analysis 17 3-2-9 Method and technique 17 VI Data Storage 3-2-10 18 Ethical Consideration 3-2-11 19 Chapter four: Results Results 20 Chapter Five: Discussion, Conclusion, and Recommendation 5.1 Discussion 29 5.2 Conclusion 32 5.3 Recommendations 33 References Appendix VII List of Tables The table Table title Page Table (4-1) Distribution of patients with yolk sac abnormalities 20 according to the age. Table (4-2) Distribution of patients with yolk sac abnormalities 21 according to gravity. Table (4-3) Distribution of patients with yolk sac abnormalities 22 according to parity. Table (4-4) Distribution of patients with yolk sac abnormalities 23 according to history of chronic disease. Table (4-5) Distribution of patients with yolk sac abnormalities 24 according to the type of scanning. Table (4-6) Distribution of patients with yolk sac abnormalities 25 according to the gestational age. Table (4-7) Distribution of patients according to yolk sac 26 abnormalities. Table (4-8) Distribution of patients according to the complication 27 associated with yolk sac abnormalities. Table (4-9) Relationship between yolk sac abnormalities and 28 complication associated with it. VII List of figures The figure Title Page Figure (2-1) Formation of secondary yolk sac 6 Figure (2-2) Absence of a yolk sac 8 Figure (2-3) Large yolk sac 9 Figure (2-4) Small yolk sac 10 Figure (2-5) Calcified yolk sac 10 Figure (2-6) Echogenic yolk sac 11 Figure (2-7) Irregular yolk sac 12 Figure (2-8) Persistent yolk sac 12 Figure (4-1) Distribution of patients with yolk sac 20 abnormalities according to the age. Figure (4-2) Distribution of patients with yolk sac 21 abnormalities according to gravity. Figure (4-3) Distribution of patients with yolk sac abnormalities according to parity. 22 Figure (4-4) Distribution of patients with yolk sac abnormalities according to history of chronic disease. 23 Figure (4-5) Distribution of patients with yolk sac abnormalities according to the type of scanning. 24 Graph (4-6) Distribution of patients with yolk sac abnormalities according to the gestational age. 25 Graph (4-7) Distribution of patients according to yolk sac abnormalities. 26 Graph (4-8) Distribution of patients according to the complication associated with yolk sac 27 abnormalities. Graph (4-9) Relationship between yolk sac abnormalities 28 and complication associated with it. VIII List of abbreviation CD Color Doppler Ultrasound EVS Endovaginal Sonography G Number of gravity GA Gestational Age GS Gestational Sac LMP Last Menstrual Period MGSD Mean Gestational Sac Diameter MHZ Megahertz MSD Mean Sac Diameter MYSD Mean Yolk Sac Diameter P Number of parity PD Power Doppler Ultrasound SPSS Statistical Package For Social Sciences TAS Transabdominal Sonography TVS Transvaginal Sonography US Ultrasound YS yolk sac 3D Three Dimentional Ultrasound 4D Four Dimentional Ultrasound IX Chapter One Chapter One Introduction 1-1 Introduction: Ultrasound is considered as high developed technology of sound properties during the last 20 years to demonstrate and diagnosis of variant diseases such as yolk sac abnormalities. Conventional 2D ultrasound imaging is the standard modality in most Obstetric and Gynecological applications however the addition of various Doppler technologies provides an excellent adjunctive tool for sonographic diagnosis in many Obstetric and Gynecological patients, the two commonly applied techniques are transabdominal (TAS) and endovaginal (EVS) sonography (Devin and Dean, 2005).
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