Uses of 4D Ultrasound scan

In short: Four-dimensional ultrasound has many uses in diagnosis. The most important is following the pregnancy and the baby’s wellbeing at every stage: in the first trimester it checks the number of embryos, the dating of the pregnancy, the baby’s heartbeat and whether the pregnancy is outside the uterus. This article lists its main uses.

Four dimensional ultrasound has widespread applications in diagnosis, the most important ones are:

• 1- Follow up of pregnancy and fetal wellbeing throughout the different stages of pregnancy:

First trimester:

• Check the number of embryos.
• Threatened abortion.
• Dating of pregnancy.
• Fetal heart.
• If there is ectopic pregnancy (pregnancy outside the uterus).
• Completion of skull bones.
• Completion of vertebral columns and if there is any problem like neural tube defects or meningocele.
• Screening for Down syndrome (nuchal translucency measurement at 11–14 weeks, combined with blood tests).
• The baby’s sex can sometimes be suggested at the end of the first trimester, but this is not reliable until the mid-pregnancy scan.
• Check upper and lower limbs and facial features.

Second and third trimester:

• Examine the head and brain in a detailed manner.
• Check if there are associated anomalies of the internal organs like, heart, brain, lungs, kidneys, stomach, esophagus, bladder and liver.
• Check the chest, thoracic cage and abdomen. - Identify structural (congenital) anomalies and signs that may suggest a chromosomal problem, which can then be confirmed by genetic testing such as amniocentesis.
• Fetal growth, development and synchronization of its movement.
• Check placental location and associated problems such as, infarctions, insufficiency, identify umbilical cord insertion, thrombosis and coherence in the case of multiple pregnancies, if we use Doppler ultrasound.
• To study the amount of amniotic fluid around the fetus, blood supply to fetal organs and blood flow in the umbilical cord.
• To have a clear idea of fetal features, attitude and surrounding environment.
• Identify risk factors for preterm labor.

Fourth dimensional ultrasound:

Adds useful detail to the standard 2D scan, especially for surface anomalies such as cleft lip, the face, limbs and spine, and in some cases the skeleton and internal organs; the main anomaly scan is still based on 2D ultrasound.

In addition to the joyful feeling the parents would have by looking at their baby, which has a major role in strengthening the child - parent relationship. It will also help them to accept and handle anomalies (if present). This will minimize post partum psychological stress.

This test needs only 20 - 40 minutes. It is safe and does not need any preparation, except for setting an appointment.

• 2- Diagnosis of women’s infertility and gynecological problems:

A- Ovaries:

• Accurate estimation of ovarian size.
• Follicular measurements (number and accurate size).
• Diagnosis of PCOs.
• Follicular tracing and to identify ovarian hyperstimulation.
• Cyst aspiration and oocyte retrieval, which is done by monitoring needle insertion and piercing through the ultrasound screen.
• Assessing ovarian masses and estimating whether they look benign or suspicious for cancer (a final diagnosis needs surgery and tissue examination).

B- Fallopian tube:

• Differentiate between hydrosalpinx (fluid accumulation inside the tube), and ovarian cysts.
• Check whether the tubes are open (patency) using a contrast test (HyCoSy).

C- Uterine status diagnosis:

• Positive evaluation of endometrial shape, thickness and accurate size.
• Diagnose uterine anomalies by taking complete sections of the uterus.
• Identifying uterine factors interfering with pregnancy like endometrial polyps, fibroids or tumors.

Achieve the purpose of HSG and checking fallopian tubes by (Hycosy), using saline mixed with air or a foam contrast (HyCoSy/HyFoSy), injecting it into the uterus and following its path. This procedure will avoid the patient being exposed to X-ray, allergic reactions to the dye and anesthesia. It is done at the clinic, it is quick, and it usually causes only mild, period-like cramping.

3- In family planning:

• Check the position of IUD.
• Check if the woman’s body is suitable for an IUD: an IUD should not be inserted if there is pregnancy, a uterine anomaly or fibroid that distorts the cavity, certain tumors of the uterus or cervix, or a current pelvic infection. A previous ectopic pregnancy or miscarriage does not prevent using an IUD.

4- Diagnose cancerous tumors:

Four dimensional ultrasound can accurately visualize internal organs and understand the complicated relation between anatomical organs, measuring their accurate size and area, especially if there are irregularities. All this helps the doctor detect tumors and judge whether they look benign or suspicious, especially in the breast, testes, uterus, ovary and cervix; a definite diagnosis of cancer still needs a biopsy or surgery. Using Doppler ultrasound can clarify the degree of blood supply.

5- Breast examination and diagnosing masses or tubers.

6- Treatment of male infertility:

• Examining the testes and check if there is varicocele or hydrocele.
• Check the prostate gland.

This device is also helpful in other medical fields such as, urinary tract, kidneys, internal medicine, heart, respiratory system, brain, neurological system and even in ophthalmology.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist