In the educational efforts of the 112 branches of the Ian Donald School, there is clearly a need for a textbook to complement and supplement lectures and didactic sessions. The first, second and the third textbooks were successful in this endeavor, but with the explosion of knowledge, it was clear that an expanded and updated fourth edition would be invaluable. The current edition of our textbook illustrates the latest developments including silhouette ultrasound and four-dimensional ultrasound which have been pioneered by our school. For the sake of simplicity, our book is divided into three sections. Section one deals with a variety of topics that lay the foundation for the rest of the book. Section two addresses the myriad subtopics in obstetric ultrasound that optimize the care of pregnant women and fetal patients. The last section addresses the essential role that ultrasound plays in the many dimensions of clinical gynecology.