Download Ultrasound Scanning protocol for Obstetrics

Harry H. Holdorf PhD, MPA, RDMS, RVT, LRT(AS)
Getting Started:
KEYS TO A GOOD SCAN
 Selection and technique
 Having a modern unit Siemens, voluson, acuson
and others.
 Using the correct transducer
 curved linear approximately 3-7 MHZ. (Depends on
patient habitus)
Patient Prep
Before you begin the exam, the
following information must be
obtained:
 Gravidity
 Parity
 Fertility treatment
 Date of LMP
 Current pregnancy History
 Past pregnancy History
 Gynecological History
FETAL AGE
PROTOCOL
1st Trimester
IMAGES TO BE TAKEN :
1. Sagittal uterus: lower uterine segment and cervix
region.
2. Sagittal uterus: uterine body and fundus region.
3. Transverse: uterine lower body region.
4. Transverse: uterine body and fundus region.
5. Sagittal gestational sac.
6. Sagittal gestational sac: Measure Length and AP
diameter.
FETAL AGE
PROTOCOL
1st Trimester
CONTINUED
7. Transverse Gestational sac
8. Transverse Gestational sac: Measure Width.
9. Sagittal embryo: If no embryo, document yolk
sac if present.
10.Sagittal embryo: Measure CRL.
11. Sagittal right adnexa.
12.Sagittal left adnexa.
FETAL COMPLETE
PROTOCOL
(2nd & 3rd Trimesters)
Images to be taken:
HEAD
1. Transverse fetal head at the level of the thalmus and midbrain. Measure BDP.
2. Repeat scan the same plane as image #1. Measure BPD and
frontal occipital diameters. If high risk pregnancy is being
studied, measure the HC for use in calculation of a head-toabdominal circumference ratio.
3. Transverse fetal head at the level of the lateral ventricles,
demonstrating atria.
4. Same as image #3 with measurement of width of the atri
further from the transducer.
FETAL COMPLETE
PROTOCOL
(2nd & 3rd Trimesters)
HEAD CONTINUED
5. Transverse fetal head demonstrating posterior fossa
including cerebellum and cisterna magna.
5. Same as image #5 with measurement of the diameter of he
cisterna magna and the width of the cerebellum.
*NOTE*
If one or more previous studies have been performed, the GA
at the time of the current examination should be based on the
earliest examination that permits measurement of CRL, BPD,
etc.
FETAL COMPLETE
PROTOCOL
(2nd & 3rd Trimesters)
1. Transverse abdomen at the level of the liver just below the heart, demonstrating
the umbilical portion of the left portal vein to confirm a true transverse plane.
1. Same as image #1: measure two abdominal diameters perpendicular to each other
from skin surface to skin surface. If high risk pregnancy is being studied, measure
the AC for use in calculation of a head-to-abdominal circumference ratio.
1. Transverse view of the lower thorax demonstrating a 4 chamber view of the fetal
heart.
1. Repeat image #3 demonstrating the fetal stomach.
1. Transverse mid-abdomen to demonstrate both fetal kidneys.
1. Repeat image #5 at a slightly different level.
FETAL COMPLETE
PROTOCOL
(2nd & 3rd Trimesters)
1. Transverse mid-abdomen demonstrating abdominal cord insertion.
2. Transverse of umbilical cord to demonstrate number of vessels.
3. Transverse or sag pelvis to demonstrate urinary bladder.
4. Long axis of femur.
5. Long axis of femur with femur length.
6. The other femur.
7. Transverse cervical spine.
8. Transverse thoracic spine.
FETAL COMPLETE
PROTOCOL
(2nd & 3rd Trimesters)
9. Transverse lumbosacral spine.
10. Sagittal cervical spine.
11. Sagittal thoracic spine.
12. Sagittal lumbosacral spine.
*NOTE*
This protocol specifies sagittal views of the fetal spine. However due to fetal
lie, it may not be possible to obtain sagittal views. In these cases, carefully
examine the spine in whatever plane accessible and document representative
views along the entire length of the spine. In particular, concentrate on the
lumbosacral region.
FETAL COMPLETE
PROTOCOL
(2nd & 3rd Trimesters)
AFI & PLACENTA LIE
1.
Document largest pocket of fluid in the LUQ of the uterus.
2.
Document largest pocket of fluid in the RUQ of the uterus.
3.
Document largest pocket of fluid in the RLQ of the uterus.
4.
Document largest pocket of fluid in the LLQ of the uterus.
5.
Body of placenta close to or at the umbilical cord insertion.
6.
Sagittal lower uterine segment through internal OS and endocervical canal to
rule out placenta previa.
NOTE*
In certain cases due to fetal lie, it may not be possible to obtain sagittal views. In these cases,
carefully examine the spine in whatever plane accessible and document representative views
along the entire length of the spine. In particular, concentrate on the lumbosacral region.
Fetal Presentation:
 Longitudinal lie cephalic:
 Longitudinal lie in breech
presentation:
Fetal Presentation:
 Transverse lie head maternal left
 Transverse lie maternal right
2nd trimester for a normal Fetus:
Head
Normal Fetal Anatomy of the HEAD
Choroid Plexus
 The LATERAL VENTRICLES should
be less than 10mm in diameter
(best measured at the occipital
horn).
The CHOROID PLEXII should be
homogenous. Small, and
sometimes multiple, choroid
plexus cysts are a common.
HEAD Continued: CNS
CC, corpus callosum; CF, choroidal fissure; CM,
cisterna magna; CP, choroid plexus; CSP, cavum
septi pellucidi; LF, lateral fissure; OH, occipital
horn; PO, parietal operculum; TH, temporal horn;
TO, temporal operculum; VB, lateral ventricular
body; 4V, fourth ventricle.
Early 4th ventricle folding
of the
Rhombencephalon
Normal Anatomy of the Fetal Head:
 Normal Fetal Left Ear
 Normal Fetal Hair
Normal 2nd trimester Fetal
Face:
 3D View of the face
Image showing the fetal face , eyelid, cheek
Nose nostril, upper and lower lip
Profile w/ Mandible--
ensure the mandible is
appropriate size, nasal bone is
present and there is a normal
face/head shape.
Normal Fetal anatomy of the Face
 Lips
Fat Pad of the Cheek
Orbits
Normal Fetal Anatomy of the
Heart/Chest:
 Fetal Lung
 Diaphragm
Fetal Anatomy of the Heart/chest:
 Fetal heart
Normal Anatomy of the Fetal
Abdomen:
Adrenal glands
liver
Normal Fetal Anatomy: Umbilical
Cord
 Umbilical Cord insertion
site
 Umbilical Cord
Umbilical cord:
Fetal Bladder & Kidneys
 Fetal Kidney
Medullary Pyramid
Of the kidney
Fetal Adrenal Gland
Normal Fetal Bladder
Pelvic: is it a boy or a girl ??
 Male Genitalia
spine
Extremities
 Distal Diaphysis of femur
with
 Distal epiphysis with
Extremities
Creases of the hand
Fetal Hand
Fetal foot at 16weeks
The End
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