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OBSTETRIC ULTRASOUND

TECHNIQUES
FETAL AGE ESTIMATION

Sequence
Introduction to Obstetric Ultrasound
Technology
Common Uses
Types of USG
Indications of Ultrasound Examination
Application of Ultrasound in Trimesters
Fetal Age Estimation
Conclusion
Q & A session
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Introduction to Obstetric Ultrasound


Use of ultrasound scans in pregnancy
Introduced in late 1950s
Provision of good information about the fetus
and its environment
Determining early intervention or conservative
management
Safe, non-invasive, accurate, and cost-effective
investigation in fetus
Important role in care of pregnant women
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Ultrasound Technology
Principle of SONAR, used by bats and ships
Generation of high-frequency sound waves through
a transducer
Pulsed sound waves penetrate till structures of
different tissues densities is reached
Reflected energy to the transducer is amplified and
displayed on a screen
Detection of breathing, cardiac actions and vessel
pulsations through real-time ultrasonography
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Transducer

Received pulse

Transmitted pulse

Object

Common Uses of Obstetric USG


Obstetrical ultrasound is a useful clinical test to:
Establish the presence of a living embryo/fetus
Estimate the age of the pregnancy
Diagnose congenital abnormalities of the fetus
Evaluate the position of the fetus
Evaluate the position of the placenta

Common Uses of Obstetric USG

cont

Determine if there are multiple pregnancies


Determine the amount of amniotic fluid around the
baby
Check for opening or shortening of the cervix or
mouth of the womb
Assess fetal growth
Assess fetal well-being
Suspected hydatidiform mole
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Common Uses of Obstetric USG

cont

Suspected fetal death


Suspected uterine abnormality
UCD localization
Ovarian follicle development surveillance
Biophysical profile after 28 weeks of gestation
Observation of intra-partum events
Suspected poly- or oligohydramnios
Suspected abruptio placenta
Adjunct to external version from breech to vertex
presentation
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Types of Ultrasonography
Trans Abdominal Ultrasonography (TAS)
Trans Vaginal Ultrasonography (TVS)
Doppler Ultrasound
Tissue Harmonic Imaging (THI)
Three-dimensional Ultrasound (3-D USG)

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Trans Abdominal Ultrasound (TAS)


Major technique for imaging in 2nd and 3rd trimester
Patient to have full bladder because
Pushes the uterus out of the pelvis
Provides an acoustic window
Displaces pelvic bowel loop superiorly

Real-time ultrasound equipment includes:


Sector transducers, when access is limited
Linear curved array transducers, for less distortion
and greater field of view
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Trans Vaginal Ultrasound (TVS)


Method of choice for
Monitoring infertility disorders
Diagnosis of ectopic pregnancy
Differentiation of normal and abnormal 1st
trimester pregnancy
Diagnosis of congenital anomalies in 2nd trimester

Patient to have empty bladder because


Uterus will be pushed posteriorly out of the field
of view of the transducer
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Trans Vaginal Ultrasound (TVS)

cont

Specially designed high frequency transducers


Higher resolution images
Favorable for obese patients or in early stage of
pregnancy
Limitations include
Reduced beam penetration
More invasive nature of the technique
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Doppler Ultrasonography
Most widely employed for detection of:
Fetal cardiac pulsation
Pulsation in various fetal blood vessels

Doppler waveform for useful information about


intra-uterine growth retardation
Use remains controversial due to increased power

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Tissue Harmonic Imaging (THI)


Processing of lower amplitude, higher frequency
waveforms accompanying fundamental frequency
Lesser clutter and scatter
Better visualization of fetal structure

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Three-dimensional USG (3-D)


3-Dimensional cleaner image of the scanning
Transducer captures series of images
3-D processing done by Computer
Significant improvement in identifying
Cleft lips
Spina bifida
Polydactyl
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Application of Ultrasound in Trimesters


First Trimester
Commonly performed at 9-12 weeks

2nd and 3rd Trimester


Commonly performed at 18-20 weeks

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Obstetric USG in 1st Trimester


Identification of Gestational sac and Embryo

First trimester fetus and yolk sac

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Obstetric USG in 1st Trimester

cont

Recording the presence or absence of fetal life

Embryo 4 weeks

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Obstetric USG in 1st Trimester

cont

Identification and documenting the fetal number

Two gestational sacs,


each containing a yolk sac

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Obstetric USG in 1st Trimester

cont

Evaluation of Uterus and Adnexal structures

Uterus and cervical plug

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Obstetric USG in 1st Trimester

cont

Measurement of Nuchal Translucency

Nuchal
Translucency

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Triplet with sub-chorionic bleeding

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Twin pregnancy
28 mm CRL in 10 weeks

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Obstetric USG in 2nd and 3rd Trimester


Fetal life, number and presentation
Amount of amniotic fluid

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Obstetric USG in 2nd and 3rd Trimester cont


Record Placental localization
Establishment of fetal age and growth by fetal
biometry including

Bi-parietal Diameter
Head Circumference
Femur Length
Abdominal Circumference

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Obstetric USG in 2nd and 3rd Trimester cont


Evaluation of the uterus and adnexal structures
Evaluation of fetal anatomic structures :
Cerebellum and Cerebral ventricles
Spine
Stomach-bowel, abdominal wall at the area of the
umbilical cord insertion
Bladder and kidney
All four Limbs
Four chamber view of the heart
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Fetal Cardiac Structure

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Fetal Age Estimation


Assessment of gestational age is fundamental to
obstetric care
Ultrasound is a reliable method for establishing
the length of pregnancy

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Fetal Age Estimation in 1st Trimester


Identification of Gestational sac
Correlation of MSD and CRL with menstrual age

Visualizing of Embryo by TVS and TAS


Estimation of gestational age by crown-rump length

Nuchal Translucency assessment in 1st trimester

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Fetal Age Estimation in 2nd & 3rd Trimester


Bi-parietal diameter measurement
Around 09 weeks until end of pregnancy

Head Circumference measurement


Gestational age prediction when abnormal skull shape
Measured on same plane as Bi-parietal diameter

Abdominal Circumference measurement


Measurement similar to head circumference
Less accurate for establishing gestational age
Perpendicular plane to the long axis of fetus
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Fetal Age Estimation in 2nd & 3rd Trimester


Bi-parietal diameter and head circumference measurements

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Bi-parietal Diameter

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Fetal Age Estimation in 2nd & 3rd Trimester


Femur measurement
Only long bone measured routinely
Fetal age assessment when head cannot be utilized
for Bi-parietal diameter

Multiple Fetal growth parameters


Single parameter increases variability in predicting
fetal age in 3rd trimester
Variability reduction through parameter combination
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Conclusion
Fetal age estimation is fundamental to obstetric
care
Ultrasound is a reliable method for establishing
the length of pregnancy and in this way can
improve obstetric care

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Thank You

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Q&A

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