1. Session #9 Step 12: Ultrasound

2. Step 12: Ultrasound Indication for testing: Positive Pregnancy Test (ONLY)‏ Confirm the viability of pregnancy.  visualize your baby’s heartbeat within the uterus.  31% of all pregnancies are not viable. (it could be miscarriage, ectopic pregnancy, or multiple other reasons why the pregnancy hormone would be in the urine). Confirming how far along she is related to her last menstrual period (LMP). Explain what you anticipate before the exam. © CompassCare Pregnancy Services

3. Step 12: Ultrasound Ultrasound Routine “Glamor Shot” Measurements:  Heart Rate  Gestational age measurement (GS and/or CRL)‏  Mid Line: TRV and LNG views Adnexa (same for both right and left)‏  RT ADN: TRV and LNG  LT ADN: TRV and LNG  Label and measure ovaries/corpus luteum if seen © CompassCare Pregnancy Services

4. Step 12: Ultrasound Importance of pt being alone: Allows her to “feel” and express a reaction to what she sees Offers privacy if needing to do vaginal ultrasound Information of ultrasound (dates, etc) may add to situation © CompassCare Pregnancy Services

5. ----+ 3-4 wks More clarity ++++ 12 wks arms & legs moving, jaw lines, fingers and toes ++++ 11 wks face ++++ 9-10 wks arms, legs ++++ 8-9 wks --+++ 6-7 wks --?++ 5-6 wks ---?+ 4-5 wks Development (visualized)‏ MovementsFetal Heart Motion Yolk Sac (YS)‏ Gestational Sac (GS)‏ Gestational Age Step 12: Ultrasound © CompassCare Pregnancy Services

6. Step 12: Ultrasound First Trimester Symptoms: Frequent urination  Size of uterus v bladder capacity Nausea and vomiting  Estimated gestational age, typically subsides around 12 weeks © CompassCare Pregnancy Services

7. Step 12: Ultrasound Scope of Information Provided: © CompassCare Pregnancy Services Ultrasound Exam Results See What You Expect to See Didn’t See What You Expect to See Confirm Viability Can not Confirm Viability (Before 6 Weeks)‏ Can not Confirm Viability (After 6 Weeks)‏

8. Step 12: Ultrasound See What You Expect To See: See What You Expect to See Confirm Viability Can’t Confirm Viability So, You’re Pregnant Brochure Reschedule for Repeat Ultrasound Refer to physician for Prenatal Care © CompassCare Pregnancy Services

9. Step 12: Ultrasound Saw What you Expect to See See What You Expect to See Confirm Viability Can’t Confirm Viability Give Miscarriage/ Ectopic Pregnancy Brochure Reschedule for repeat ultrasound one week Refer her to physician © CompassCare Pregnancy Services

10. Step 12: Ultrasound Didn’t See What You Expect to See © CompassCare Pregnancy Services Didn’t See What You Expect to See Can’t Confirm Viability Symptoms  EDNo Symptoms Call Patient’s OB For Plan If no OB,  ED

11. Step 12: Ultrasound What this exam does not include: Sex of the baby Diagnosis of pregnancy from an RN or Sonographer Diagnosis/Opinion of what is wrong if you do not see what you expect to see (to the pt.)‏ © CompassCare Pregnancy Services