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eFigure 37–25. Adult trematodes. Clonorchi sinensis adults are flattened and measure approximately 10–25 mm long by 3–5 mm wide. Like other flukes, they are hermaphroditic, with a single ovary situated anterior to two branches testes. Adults reside in the biliary passages of the liver of the definitive host. A: Adult of C sinensis. B: Adult of C sinensis stained with carmine. Clearly visible in this image are the oral sucker (OS), pharynx (PH), ceca (CE), acetabulum, or ventral sucker (AC), uterus (UT), vitellaria (VT) and testes (TE). (From Global Health, Division of Parasitic Diseases and Malaria, CDC.) A photo and a diagram of adult trematodes.

Current Medical Diagnosis & Treatment 2024 > Clonorchiasis & Opisthorchiasis

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eFigure 37–25. Adult trematodes. Clonorchi sinensis adults are flattened and measure approximately 10–25 mm long by 3–5 mm wide. Like other flukes, they are hermaphroditic, with a single ovary situated anterior to two branches testes. Adults reside in the biliary passages of the liver of the definitive host. A: Adult of C sinensis. B: Adult of C sinensis stained with carmine. Clearly visible in this image are the oral sucker (OS), pharynx (PH), ceca (CE), acetabulum, or ventral sucker (AC), uterus (UT), vitellaria (VT) and testes (TE). (From Global Health, Division of Parasitic Diseases and Malaria, CDC.) A photo and a diagram of adult trematodes.

Current Medical Diagnosis & Treatment 2024 > Clonorchiasis & Opisthorchiasis

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eFigure 20–3. Myoma. Longitudinal sonogram of the pelvis demonstrating an enlarged myomatous uterus. A large anterior uterine myoma (M) can be seen displacing the endometrial cavity (arrows) posteriorly. (Used, with permission, from Peter W. Callen, MD.) A longitudinal sonogram shows a myoma in the endometrial cavity of the uterus.

Current Medical Diagnosis & Treatment 2024 > Abnormal Uterine Bleeding in Women of Reproductive Age

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eFigure 20–7. Anterior vaginal prolapse, known as cystocele. (Reproduced, with permission, from DeCherney AH, Nathan L, Laufer N, Roman S. Current Diagnosis & Treatment: Obstetrics & Gynecology, 12th edition. McGraw-Hill, 2019.) A diagram depicts the surgical opening of the abdomen below the umbilicus. A circular mass projects from the vagina into the open, triangular uterus.

Current Medical Diagnosis & Treatment 2024 > Pelvic Organ Prolapse

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eFigure 20–9. Enterocele and prolapsed uterus, sagittal view. (Reproduced, with permission, from DeCherney AH, Nathan L, Laufer N, Roman S. Current Diagnosis & Treatment: Obstetrics & Gynecology, 12th edition. McGraw-Hill, 2019.) A diagram of the sagittal section of the lower abdomen shows the distal part of the small bowel projecting down into the uterus. The uterus is compressed and it descends into the vagina. The bladder on the anterior side is also compressed from the top down.

Current Medical Diagnosis & Treatment 2024 > Pelvic Organ Prolapse

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eFigure 20–11. Insertion of Hodge type pessary if bimanual replacement of uterus is not successful. (Reproduced, with permission, from DeCherney AH, Nathan L, Laufer N, Roman S. Current Diagnosis & Treatment: Obstetrics & Gynecology, 12th edition. McGraw-Hill, 2019.) Three diagrams show the steps in the insertion of a Hodge type pessary.

Current Medical Diagnosis & Treatment 2024 > Pelvic Organ Prolapse

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eFigure 20–17. Pelvic inflammatory disease with a characteristic pyosalpinx (Fallopian tube filled, even distended, with pus), most commonly caused by infection with chlamydia and/or gonorrhea. A. Transvaginal sonogram shows a pyosalpinx and both ovaries as part of a tubo-ovarian complex. TUBE, Fallopian tube, RT OV, right ovary, LT OV, left ovary; B. CT image shows a tortuous pyosalpinx (arrow) adjacent to the uterus. Ut, uterus. (Reproduced, with permission, from Hoffman BL, Schorge JO, Halvorson LM, Hamid CA, Corton MM, Schaffer JI. Williams Gynecology, 4th edition. McGraw-Hill, 2020.) A sonogram and a radiograph reveal fallopian tube enlargement.

Current Medical Diagnosis & Treatment 2024 > Pelvic Inflammatory Disease (Salpingitis, Endometritis)

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eFigure 20–19. Cervical changes in women exposed to diethylstilbestrol (DES) in utero. A: Circular sulcus. B: Central depression and ectopy (covered by columnar epithelium.) C: Portio vaginalis and ectopy. D: Anterior cervical protuberance (rough). E: Anterior cervical protuberance (smooth). (Reproduced, with permission, from DeCherney AH, Nathan L, Laufer N, Roman S. Current Diagnosis & Treatment: Obstetrics & Gynecology, 12th edition. McGraw-Hill, 2019.) An image shows circular fissues in the cervix. An image shows depression of the cervix, with tissues pushed out from the center. An image shows a bump on the uterine neck covered by columnar epithelium. An image shows a rough cervical protuberance. An image shows a smooth cervical protuberance.

Current Medical Diagnosis & Treatment 2024 > Effects of Exposure to Diethylstilbestrol in Utero

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eFigure 20–19. Cervical changes in women exposed to diethylstilbestrol (DES) in utero. A: Circular sulcus. B: Central depression and ectopy (covered by columnar epithelium.) C: Portio vaginalis and ectopy. D: Anterior cervical protuberance (rough). E: Anterior cervical protuberance (smooth). (Reproduced, with permission, from DeCherney AH, Nathan L, Laufer N, Roman S. Current Diagnosis & Treatment: Obstetrics & Gynecology, 12th edition. McGraw-Hill, 2019.) An image shows circular fissues in the cervix. An image shows depression of the cervix, with tissues pushed out from the center. An image shows a bump on the uterine neck covered by columnar epithelium. An image shows a rough cervical protuberance. An image shows a smooth cervical protuberance.

Current Medical Diagnosis & Treatment 2024 > Effects of Exposure to Diethylstilbestrol in Utero

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eFigure 20–19. Cervical changes in women exposed to diethylstilbestrol (DES) in utero. A: Circular sulcus. B: Central depression and ectopy (covered by columnar epithelium.) C: Portio vaginalis and ectopy. D: Anterior cervical protuberance (rough). E: Anterior cervical protuberance (smooth). (Reproduced, with permission, from DeCherney AH, Nathan L, Laufer N, Roman S. Current Diagnosis & Treatment: Obstetrics & Gynecology, 12th edition. McGraw-Hill, 2019.) An image shows circular fissues in the cervix. An image shows depression of the cervix, with tissues pushed out from the center. An image shows a bump on the uterine neck covered by columnar epithelium. An image shows a rough cervical protuberance. An image shows a smooth cervical protuberance.

Current Medical Diagnosis & Treatment 2024 > Effects of Exposure to Diethylstilbestrol in Utero

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eFigure 20–19. Cervical changes in women exposed to diethylstilbestrol (DES) in utero. A: Circular sulcus. B: Central depression and ectopy (covered by columnar epithelium.) C: Portio vaginalis and ectopy. D: Anterior cervical protuberance (rough). E: Anterior cervical protuberance (smooth). (Reproduced, with permission, from DeCherney AH, Nathan L, Laufer N, Roman S. Current Diagnosis & Treatment: Obstetrics & Gynecology, 12th edition. McGraw-Hill, 2019.) An image shows circular fissues in the cervix. An image shows depression of the cervix, with tissues pushed out from the center. An image shows a bump on the uterine neck covered by columnar epithelium. An image shows a rough cervical protuberance. An image shows a smooth cervical protuberance.

Current Medical Diagnosis & Treatment 2024 > Effects of Exposure to Diethylstilbestrol in Utero

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eFigure 20–19. Cervical changes in women exposed to diethylstilbestrol (DES) in utero. A: Circular sulcus. B: Central depression and ectopy (covered by columnar epithelium.) C: Portio vaginalis and ectopy. D: Anterior cervical protuberance (rough). E: Anterior cervical protuberance (smooth). (Reproduced, with permission, from DeCherney AH, Nathan L, Laufer N, Roman S. Current Diagnosis & Treatment: Obstetrics & Gynecology, 12th edition. McGraw-Hill, 2019.) An image shows circular fissues in the cervix. An image shows depression of the cervix, with tissues pushed out from the center. An image shows a bump on the uterine neck covered by columnar epithelium. An image shows a rough cervical protuberance. An image shows a smooth cervical protuberance.

Current Medical Diagnosis & Treatment 2024 > Effects of Exposure to Diethylstilbestrol in Utero

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eFigure 20–20. Endometrial carcinoma. A: Longitudinal sonogram from a patient with vaginal bleeding. A large soft-tissue mass (arrows) is identified within the uterus. This tissue has the appearance of endometrium but is nonspecific and could represent hyperplasia, polyps, or carcinoma. B: Endovaginal sonogram from the same patient. Prominent soft tissue is seen in the expected location of the endometrium (arrows). At biopsy this proved to be endometrial carcinoma. (Used, with permission, from Peter W. Callen, MD.) A longitudinal sonogram shows a large soft-tissue mass located within the uterus. An endovaginal sonogram shows a large soft tissue located within the utereus.

Current Medical Diagnosis & Treatment 2024 > Carcinoma of the Endometrium

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eFigure 20–20. Endometrial carcinoma. A: Longitudinal sonogram from a patient with vaginal bleeding. A large soft-tissue mass (arrows) is identified within the uterus. This tissue has the appearance of endometrium but is nonspecific and could represent hyperplasia, polyps, or carcinoma. B: Endovaginal sonogram from the same patient. Prominent soft tissue is seen in the expected location of the endometrium (arrows). At biopsy this proved to be endometrial carcinoma. (Used, with permission, from Peter W. Callen, MD.) A longitudinal sonogram shows a large soft-tissue mass located within the uterus. An endovaginal sonogram shows a large soft tissue located within the utereus.

Current Medical Diagnosis & Treatment 2024 > Carcinoma of the Endometrium

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eFigure 21–1. Biometric measurements in a fetus. A: The biparietal diameter is measured on an axial image through the fetal head at the level of the hypoechoic thalamui (asterisks) and the cavum septum pellucidum (arrows). Head circumference is measured on the same plane of imaging as the biparietal diameter. B: Femur length. C: Abdominal circumference is measured in a transverse plane through the abdomen at the level of the stomach (S) and right portal vein of the liver (arrows); spine is seen at 3 o'clock. The ultrasound age is usually an average of the four measurements—biparietal diameter, head circumference, abdominal circumference, and femur length—and is reported in menstrual weeks. The result is compared with the patient's reported first day of her last normal menstrual period. (Reproduced, with permission, from Fetal Imaging. In: Cunningham F, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, Spong CY (editors). Williams Obstetrics, 25th ed. McGraw Hill; 2018.) Three sonograms show the biometric measurements of a fetus inside the uterus.

Current Medical Diagnosis & Treatment 2024 > Essentials of Prenatal Care

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eFigure 21–2. Various sites and frequency of ectopic pregnancies. (Reproduced, with permission, from Ectopic Pregnancy. In: Hoffman BL, Schorge JO, Halvorson LM, Hamid CA, Corton MM, Schaffer JI (editors). Williams Gynecology, 4th ed. McGraw Hill; 2020.) A diagram of the uterus, fallopian tube, and ovary shows the common sites of ectopic implantation.

Current Medical Diagnosis & Treatment 2024 > Ectopic Pregnancy

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eFigure 21–5. Sonogram of hydatidiform moles. With complete hydatidiform moles, the classic "snowstorm" appearance is created by the multiple placental vesicles. The mole completely fills this uterine cavity, and calipers measure the intrauterine contents. (Reproduced, with permission, from Gestational Trophoblastic Disease. In: Hoffman BL, Schorge JO, Halvorson LM, Hamid CA, Corton MM, Schaffer JI (editors). Williams Gynecology, 4th ed. McGraw Hill; 2020.) A sonogram of the uterus shows a large oval gray area with several small black spots near the top of the field.

Current Medical Diagnosis & Treatment 2024 > Gestational Trophoblastic Disease (Hydatidiform Mole & Choriocarcinoma)

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eFigure 21–6. Placenta previa. A. In this transvaginal image at 34 weeks' gestation, the anterior placenta completely covers the internal cervical os outlined by arrows. B. This transvaginal image at 34 weeks' gestation depicts a posterior placenta (arrow) that just reaches the level of the internal cervical os. (Reproduced, with permission, from Obstetrical Hemorrhage. In: Cunningham F, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, Spong CY (editors). Williams Obstetrics, 25th ed. McGraw Hill; 2018.) A sonogram of the uterus shows the black border of the placenta extending partially over the internal cervical wall on the right of the field, indicated by arrows.

Current Medical Diagnosis & Treatment 2024 > Third-Trimester Bleeding

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eFigure 21–7. Placental abruption. Shown to left is a total placental abruption with concealed hemorrhage. To the right is a partial abruption with blood and clots dissecting between membranes and decidua to the internal cervical os and then externally into the vagina. (Reproduced, with permission, from Obstetrical Hemorrhage. In: Cunningham F, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, Spong CY (editors). Williams Obstetrics, 25th ed. McGraw Hill; 2018.) A diagram depicts a uterus with placenta previa.

Current Medical Diagnosis & Treatment 2024 > Third-Trimester Bleeding

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