Ultrasound Scanning protocol for Obstetrics

Harry H. Holdorf PhD, MPA, RDMS, RVT, LRT(AS)

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)

Getting Started:KEYS TO A GOOD SCAN

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

Patient Prep

FETAL AGEPROTOCOL

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.

1st Trimester

FETAL AGEPROTOCOL

CONTINUED

7.Transverse Gestational sac8.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.

1st Trimester

FETAL COMPLETEPROTOCOL

(2nd & 3rd Trimesters)Images to be taken:

HEAD1. Transverse fetal head at the level of the

thalmus and mid-brain. 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-to-abdominal 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 COMPLETEPROTOCOL

HEAD CONTINUED

5. Transverse fetal head demonstrating posterior fossa including cerebellum and cisterna magna.

6. 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.

(2nd & 3rd Trimesters)

FETAL COMPLETEPROTOCOL

(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.

2. 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.

3. Transverse view of the lower thorax demonstrating a 4 chamber view of the fetal heart.

4. Repeat image #3 demonstrating the fetal stomach.

5. Transverse mid-abdomen to demonstrate both fetal kidneys.

6. Repeat image #5 at a slightly different level.

FETAL COMPLETEPROTOCOL

(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 COMPLETEPROTOCOL

(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 COMPLETEPROTOCOL

(2nd & 3rd Trimesters)

AFI & PLACENTA LIE1. 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

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.

Choroid Plexus

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

3D View of the face

Normal 2nd trimester FetalFace:

Image showing the fetal face , eyelid, cheekNose 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.

Lips

Normal Fetal anatomy of the Face

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

Fetal Adrenal Gland

Medullary PyramidOf the kidney

Normal Fetal Bladder

Pelvic: is it a boy or a girl ??

Male Genitalia

spine

Extremities

Distal Diaphysis of femur with

Distal epiphysis with

ExtremitiesCreases of the hand

Fetal foot at 16weeks

Fetal Hand

harryhholdorf@gail.com

The End