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

2.  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

3. 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

4. FETAL AGE PROTOCOL 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. 1 st Trimester

5. FETAL AGE PROTOCOL 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. 1 st Trimester

6. FETAL COMPLETE PROTOCOL (2 nd & 3 rd Trimesters) Images to be taken: HEAD 1.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.

7. FETAL COMPLETE PROTOCOL 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. (2 nd & 3 rd Trimesters)

8. FETAL COMPLETE PROTOCOL (2 nd & 3 rd 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.

9. FETAL COMPLETE PROTOCOL (2 nd & 3 rd 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.

10. FETAL COMPLETE PROTOCOL (2 nd & 3 rd 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.

11. FETAL COMPLETE PROTOCOL (2 nd & 3 rd 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.

12. Fetal Presentation:  Longitudinal lie cephalic:  Longitudinal lie in breech presentation:

13. Fetal Presentation:  Transverse lie head maternal left  Transverse lie maternal right

14. 2 nd trimester for a normal Fetus: Head

15. 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

16. 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 4 th ventricle folding of the Rhombencephalon

17. Normal Anatomy of the Fetal Head:  Normal Fetal Left Ear  Normal Fetal Hair

18.  3D View of the face Normal 2 nd trimester Fetal 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.

19.  Lips Normal Fetal anatomy of the Face Fat Pad of the Cheek

20. Orbits

21. Normal Fetal Anatomy of the Heart/Chest:  Fetal Lung  Diaphragm

22. Fetal Anatomy of the Heart/chest:  Fetal heart

23. Normal Anatomy of the Fetal Abdomen:

25. Adrenal glands

26. liver

27. Normal Fetal Anatomy: Umbilical Cord  Umbilical Cord insertion site  Umbilical Cord

28. Umbilical cord:

29. Fetal Bladder & Kidneys  Fetal Kidney Fetal Adrenal Gland Medullary Pyramid Of the kidney

30. Normal Fetal Bladder

31. Pelvic: is it a boy or a girl ??  Male Genitalia

32. spine

33. Extremities  Distal Diaphysis of femur with  Distal epiphysis with

34. Extremities Creases of the hand Fetal foot at 16weeks Fetal Hand

36.  harryhholdorf@gail.com The End