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Obstetric Ultrasound Scanning Technique Harry Gee (teaching materials provided by David Cole, Lecturer at City University, Birmingham)
2 nd & 3 rd Trimester Scans Identify fetus –Orientation –Fetal heart beat Placental site Biometry –Bi-Parietal Diameter (BPD) –Head Circumference (HC) –Abdominal Circumference (AC), –Femur length (FL) Liquor Estimation
2 nd & 3 rd Trimester Scans Place probe longitudinal on lower abdomen superior to symphysis pubis Slide probe superiorly using sweeping movements to locate fetus
2 nd & 3 rd Trimester Scans Slide probe superiorly - sweeping side to side up to uterine fundus.
FH + Orientation
Fetal Orientation Lie –longitudinal –Transverse –Oblique Presentation –cephalic –breech
Breech legs extended
Placental localisation Full bladder Midline sagittal section Placental position anterior or posterior Low placenta - measure distance between lower edge and internal os *
Major placenta praevia
Minor placenta praevia
Liquor volume Subjective assessment Maximum deepest pool (MPD) Amniotic fluid index
Subjective Assessment Normal liquor volume
Maximum deepest pool Deepest pool in cm Do not include cord or fetal limbs
Amniotic Fluid Index Sum of the deepest pools in each of four quadrants
Oligohydramnios MPD < 3 cm up to 36 weeks MPD < 2 cm 36 weeks - term
Polyhydramnios MPD > 8 cm
Fetal Biometry Biparietal diameter BPD Head circumference HC Abdominal circumference AC Femur length FL
BPD Measurement ROCK
Biparietal diameter BPD
BPD Errors Few (best inter-observer error) Oblique section (increases measurement) Not at BPD (decreases measurement)
Head Circumference Trans-ventricular Plane choroid plexus posterior horn falx cerebri CSP anterior horn
Measurement Criteria BPD & HC Landmarks: CSP, Falx, thalami Alignment: symmetrical –midline no orbits, no cerebellum Calipers: BPD widest distance 90 o midline. HC bony perimeter of skull
Abdominal Circumference Long Axis of fetus (Spine) Fetal trunk parallel to transducer Rotate transducer at right angles Move up and down until landmarks identified. Repeat to consistency
Abdominal Circumference UV stomach spine Ao
AC Sources of Error Oblique Section (Salami Effect) Too high Too low Abdominal compression (oligo- hydramnios) Fetal Breathing
FL Measurement Identify femur close to fetal bladder/pelvis.
FL Measurement Slide probe so that femur is central
FL Measurement Rotate probe to obtain full length image of femur.
Source of Error Oblique image (shortens measurement)
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