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Protocol
Protocol will vary with patient age and fetal position
The goal of the exam is to image each structure in the protocol
The protocol is divided up into sections
It is highly recommended that you complete each image in the applicable section
before moving to the next section when possible.
Fetal Measurements
nd
2
and 3rd Trimester OB Protocol
Structure/
Scan
Label
Placenta Comp
Heart and
Rate,
Uterine
Cervix, Ovaries,
Adnexa,
Fetal Head
Face
Structures
Order
PlaneImagesLandmarks
Identified
Placenta,
and Fluid
Trans
BPD
Cavum
septum pellucidum, IHF, Thalami
Organ/
Scan
Label
Landmarks
Identified
Axial
and Parietal
bones
Structur
Scan
Label
Landmarks
Identified
Fetal
Order
Plane
Measurement technique
e/
Plane
CHP
Measureme Fetal
IHFPlace calipers on the outside of the
Order
nts
Head
closetPlexus
parietal
bone ventricle
to the inside of the
Choroid
within
Begin
at
move
out of
o farthest
Trycervix,
to get
both superiorly
in one image,
if uterine
not do
parietal
bone
Fetal
Coronal
fundus
HC
Cavum
septum(in
pellucidum,
IHF, Thalami
Head
separately
axial plane)
NO IMAGEo Identify the fetus within the uterus
and Parietal bones
TX
SCAN
o Identify number of fetuses
Fetal
VENTRICLES
IHF
Measurement technique
o Identify fetal lie
THROUGH
o Place calipers outside to outside of the
Head
(indicate
Ventricles
o Determine the right and left sides of the
parietal bones
Transaxia
RT & LT)
fetus
Uterus/
o
Open the calipers with an ellipse that
TXl
HEART RATE Fetal heart and chest
Fetus
surrounds the fetal skull
o IHF
Enlarge image of heart and document
CEREBELLU
IHF,
Cerebral Peduncles, Cerebellum,
VENTRICLES Ventricle
heart rate with M-mode or Spectral
M
Cisterna Magna,
and Nuchal Fold
(indicate
Measurement
Technique
Doppler
Measurement
technique
o Posterior ventricle
RT RATE
& LT) Fetal
TX
HEART
heart and chest
o Place
calipers
on the outsidetoofmedial
the
Measure
internally
o Enlarge
image
of heart lateral
and document
lateral
wall to the outside of the
at glomus
heart
rate with a cine-loop
opposite lateral wall
Uterine
Sagitt
CERVIX ML
Vaginal Canal
CISTERNA
IHF,
Fetal
Face
FACE
OrbitsCerebral Peduncles, Cerebellum,
Cervix
al
Cervix
MAGNA
Cisterna Magna, and Nuchal Fold
Face
Coronal
Mandible
Amniotic Sac
Measurement technique
Sagitt
CERVIX ML
Vaginal
Canalcalipers at the level of the mid
o Place
LENS
Orbits
al
Cervix posterior wall of the cerebellum to the
Echogenic lens (can be in transaxial
Amniotic
Sac of occipital bone
inside
plane)
Measure
Cervical
Length
NUCHAL
IHF, Cerebral Peduncles,
Cerebellum,
o
External
os
to
internal os
FOLD
Cisterna Magna, and Nuchal Fold
NOSE AND
Nostrils
Sagitt
FETAL LIE
Document
presenting
fetal structure
Measurement
technique
LIPS
Upper
lip
al
Cervix
o Place calipers at the level of the mid
o Indicate Breech or Vertex in annotation
posterior
wallextended
of the cerebellum
Face
PROFILE
Forehead,
nose,
chin andfrom
neck
Sagitt ADNEXA SAG RT Adnexa include ovary if possible
the outside of occiptal bone to outside
Midline
al
RT
skin line
Adnexa
Sagittal
Sagitt ADNEXA SAG LT Adnexa include ovary if possible
Abdom
AC
Umbilical vein/portal vein junction
al
LT
en TX
3 points of the spine
Sagitt
PLACENTA
Placenta closest to Cervix
Symmetrical ribs
al
SAG INF
Retroplacental complex
Measurement technique
Sagitt
PLACENTA
Placenta Mid- include cord insertion
o Place calipers on outside of skin line
Placenta
al
SAG MID
Retroplacental complex
directly behind spine and in front of
Sagitt
PLACENTA
Placenta- superior portion
abdomen.
al
SAG SUP
Retroplacental
o Open complex
calipers to form an ellipse
Amniotic Sagitt
Q1
Measure largest
pocket
clearthe
of fetal
around vertical
abdomen
including
skin
Fluid
al
components
linefrom Anterior to Posterior
Index
Sagitt
Q2 FL
Measure
vertical
pocket
clear
of fetal
Long
Femurlargest
bone with
distal
or end
shadowing
(volume)
al Bone
components
from technique
Anterior to Posterior
Measurement
Q1+Q2+ Sagitt
Q3
Measure
largest
vertical
pocket
of fetal
o Place calipers from
endclear
to end
on the
Q3+Q4=
al
components
from
Anterior
to Posterior
femur
-Do
not include
epiphysis point
AFI
o largest
Calipersvertical
shouldpocket
dissectclear
the middle
Measure
of fetalof
the from
boneAnterior to Posterior
components
*Structur
Sagitt
Long
HL
Humerus bone with distal or end
es seen
al Bone
Q4
shadowing
HMP:\Protocols\OBGYN Protocols\2nd Trimester
Protocol.docx
in each
Measurement technique
pocket
o Place calipers from end to end on the
will vary
Organ/
Order
Thorax/
Abdomen
Stomach
Sagittal
DIAPHRAG
M LT
Transver
se
STOMACH
Transver
se
Kidneys
Sagittal
KIDNEYS
RK SAG
LT lung
Diaphragm
Stomach
Stomach
Transverse spine
Transverse spine
Right kidney
Left kidney
Sagittal
Umbilical
Cord
LK SAG
Transver
se
CI
Transver
se
CORD
Bladder/
Cord
Transver
se
Bladder
Transver
se
Iliac wings
Bladder
Color Doppler around bladder
BLADDER
Iliac wings
Bladder
GENDER
3VC
Male
o Scrotum and penis
Transver Protocols\2nd Trimester Protocol.docx
HMP:\Protocols\OBGYN
Female
Gender
(identify
se
o Labia
male or
female)
Scan
Plane
Label
Landmarks Identified
CSP SAG
Sagittal
TSP SAG
Sagittal
LSP SAG
Transvers
e
Transvers
e
Transvers
e
Longitudi
nal
Longitudi
nal
Longitudi
nal
Longitudi
nal
Longitudi
nal
CSP TX
TSP TX
LS-SP TX
RT HUMERUS
RT
ULNA/RADIUS
RT HAND
LT HUMERUS
LT
ULNA/RADIUS
LT HAND
RT FEMUR
RT TIB/FIB
Coronal
RT FOOT
Foot
Toes
Longitudi
nal
LT FEMUR
Sagittal
Spine
Upper
Extremity
Lower
Extremity
Longitudi
nal
Longitudi
nal
Longitudi
nal
LT TIB/FIB
Knee, tibia, fibula and ankle
Longitudi
o FRONTAL View
nal
HMP:\Protocols\OBGYN Protocols\2nd
Trimester Protocol.docx
LT FOOT
Foot
Coronal
Toes
Fetal Heart
Fetal heart images will vary from site to site. All students are responsible for
completing a sweep through the heart to determine situs, connection and
recognize views
Organ/Orde
r
Subcostal
4 Chamber
View
Apical
4 Chamber
View
Superior
Vena Cava
& Inferior
Vena Cava
Left
Ventricular
Outflow
Tract
Aortic Arch
Right
Ventricular
Outflow
Tract
Right
Ventricular
Outflow
Tract
Ductus
Arteriosus
Scan
Plane
Transverse
fetal chest
(IVS
horizontal)
Transverse
fetal chest
(IVS
Vertical)
Long axis
Sagittal
fetal chest
Long Axis
Transverse
fetal chest
Sagittal
Fetal
Chest
Long Axis
Transverse
Fetal
Chest
Short Axis
Transverse
Fetal
Chest
Sagittal
Fetal
Label
Landmarks Identified
SVC/IVC
LVOT
Left ventricle
Aortic valve
Aortic root
Proximal aorta
3 branches-innominate, left common
carotid artery & left subclavian
Thoracic aorta
Right ventricle
Pulmonary valve
Pulmonary trunk
RT ventricle
Pulmonary valve
RT pulmonary artery
LT pulmonary artery
Aorta
Aortic valve
Pulmonary trunk
Ductus arteriosus
4CH
SUBCOST
AL
4CH
APICAL
AA
RVOT
RVOT
SHORT
DA
Arch
3 Vessel
View
Chest
Transverse
Fetal
Chest
AO
SVC
DA
Area of
Interest
Divide the
uterus into 4
quadrants
and measure
the largest
vertical
pocket of
amniotic fluid
in each
quadrant
Plane
Sagittal
Measureme
nt
Greater than
20cm
abnormal
Less than
5cmabnormal
*measuremen
t may vary
per site
Amniotic Fluid
Largest Vertical
Pocket
Single
Sagittal
Greater than
10cmAbnormal
Less than
2cmAbnormal
*measuremen
t may vary
per site
Cerebellum
Posterior
Fossa of the
Brain
Sagittal
Nuchal Fold
Skin
thickness on
the posterior
head
Coronal
Equal to
gestational
age
Normal
-less than
6mm up to 24
weeks
gestation
Comments
Patient should be supine
With the probe in the
sagittal position, locate
the largest pocket of
amniotic fluid clear of all
fetal parts
Measure the fluid pocket
from anterior to posterior
(at least 1cm)
Document this
measurement for each
quadrant of the uterus.
Add the measurements
for a total
Measurement of the
largest single vertical
pocket of fluid in the
uterus
Commonly used for twin
pregnancies
Anechoic
Coronal
Normal
Same plane as
Space in the
-less than 10
cerebellum measurement
Posterior
mm
Fossa
HMP:\Protocols\OBGYN Protocols\2nd Trimester Protocol.docx
Cisterna Magna
Kidney Length
Lateral
Ventricles
Coronal
Less than 10
mm
Area of
Interest
Document
umbilical
artery blood
flow with Color
Doppler and
Spectral
Analysis in a
free loop of the
umbilical cord
Plane
Longitudi
nal
Normal
Measurement
S/D= less than
3 after 30 week
Comments
RI-less than .7
after 30 weeks
Umbilical
Vein
Middle
Cerebral
Artery
Document
umbilical
artery blood
flow with Color
Doppler and
Spectral
Analysis in a
free loop of the
umbilical cord
Lateral
branches of
the circle of
Willis
Longitudi
nal
Coronal
2nd-3rd
trimester=
Continuous
forward flow
with increasing
mean velocities
until 37 weeks
PI=
Greater than
1.45 before
term
Less than 1 by
term
after 32 weeks)
Ductus
Venosus
Shunt between
the umbilical
vein and
inferior vena
cava
Transvers
e
Abdomen
Peak velocity=
50 cm/sec
Laboratory Values
Qualitative hCG-urine pregnancy test, results positive or negative
Quantitative hCG- blood pregnancy test, results indicate possible age of pregnancy
Alpha Fetoprotein (AFP)-blood test for detection of certain abnormalities at 15-20 weeks
High indicates open neural tube defect
Low indicates Down syndrome
Abnormal in cases of wrong dates, fetal demise or twins
Triple Screen or Quad Screen-combination of blood test including AFP, unconjugated
estriol (uE3), hCG, and Inhibin A (Quad screen)
Used to detect chromosome abnormalities
Pathology
Gray scale sagittal and transverse images including images with 3 measurements
(length, width and height)
Color Doppler image document the presence of blood flow
Spectral Doppler image document type and velocity of blood flow