Ultrasonography in pregnancy

A mode
B mode
M mode
real time
TVS
TAS

1. ULTRASONOGRAPHY IN PREGNANCY SHARON TREESA ANTONY FIRST YEAR M.SC NURSING GOVT.COLLEGE OF NU

2. MODALITIES A mode B mode M mode Real time

3. FIRST TRIMESTER

4. Purposes Dating: 6 weeks: TVS Number Viability Location Anomalies : anencephaly

5. Gestational sac visible from 5 weeks Small embryo visible from 6 weeks Fetus : 7 weeks fetal pulsation CRL Fetal activity After 10 weeks :BPD,FERMUR, HUMERUS & ABDOMEN

6. TRANS VAGINAL SCANNING Best for earliest dating Gestational sac visible at 5 weeks TRANS ABDOMINAL SCANNING sac visible at 6 weeks Fetal pole at 7 weeks Cardiac activity visible from 7.5 weeks

7. Gestational age up to 12 weeks In weeks CRL- 5mm In days CRL+ 42 OR mean sac diameter + 30

8. Ultra sound markers of fetal anomalies Nuchal translucency > 3mm ( trisomy 21, 18,13) 2 gestational sac Absent double decidual sac sign/presence of fluid in pouch of Douglas Snow storm appearance : hydatidiform mole

9. SECOND TRIMESTER

10. Benefits Viability Dating : head circumference Multiple pregnancy& congenital anomalies Placenta localisation Biophysical scoring Fetal biometry Adjunct to amniocentesis/ cordocentesis

11. Fetal growth Hadlock formula for fetal weight (1.4787+0.001837(BPD)2+0.0458(AC)+ 0.158(FL)-0.03343 (AC*FL)

12. Gestational age Most accurate : 14- 20 weeks HC/ AC /FL/BPD Single most sensitive : AC

13. Fetal anatomic survey Neural tube defects Cranial abnormalities Obliteration of Cisterna magna Banana sign Lemon sign Absence of calvarium More BPD/HC& Ventriculomegaly

14. BANANA SIGN

15. Spina bifida Cleft lip/ palate Stomach bubble seen from 20 weeks Hydrops fetalis Hydatidiform mole Fetal heart

16. Fetal Gender Identification Placental thickness Distance between placental edge & internal os Multiple pregnancy: twin peak or lambda sign Placenta accreta Placental maturity

17. Umbilical cord Insertion ( velamentous , vasaprevia ) Single umbilical artery

18. Amniotic fluid index: 5- 24cm

19. Doppler Uterine artery Umbilical artery Umbilical vein Middle cerebral artery S/D Ratio Biophysical profile

20. THIRD TRIMESTER

21. Anomalies : duodenal atresia , achondroplasia , microcephaly Fetal weight estimation Growth profile

22. Nurse’s Role TRANS VAGINAL Lithotomy Drape Condom/ transducer sheath filled with coupling gel Lubricate Transducer cleaned with disinfectant

23. Trans abdominal Full bladder Supine Drape towel roll

24. THANK YOU