Ultrasound report the black box of fetal status

Panel discussion

1. SONOGRAPHIC DATING AND STANDARD FETAL BIOMETRY REPORT -- THE BLACK BOX OF FETAL STATUS -- Free PowerPoint Templates PANEL DISCUSSION SFM CORBETT MEET, SEPTEMBER 2018 MODERATOR – DR BHARTI PANT GAHTORI MBBS MD ( MAMC) DELHI ADVANCE USG AND DOPPLER EXPERT

2. Free PowerPoint Templates DR ASHOK KHURANA SENIOR RADIOLOGIST & FETAL MEDICINE EXPERT DR VIVEK KASHYAP DR TLN PRAVEEN SENIOR RADIOLOGIST & FETAL MEDICINE EXPERT PANELISTS 1 2 3 SENIOR RADIOLOGIST & FETAL MEDICINE EXPERT

3. Free PowerPoint Templates DR CHANCHAL MD ,MRCOG MATERNAL FETAL MEDICINE SPECIALIST DR ANUPAMA RAVI DR SUMITA PRABHAKAR MD , OB-GYN & INFERTILITY (IVF) SPECIALIST PANELISTS 4 5 6 MD , OB-GYN & INFERTILITY (IVF) SPECIALIST

4. Free PowerPoint Templates “Knowledge has to be improved, challenged, and increased constantly, or it vanishes” So “If you have knowledge, let others light their candles in it.” I BELIEVE

5. Free PowerPoint Templates 1950 1960 1970 1980 1990 2000 + DR IAN DONALD USED IT FOR OBSTETRIC PURPOSE INTRODUCTION OF VAGINAL TRANSDUCER MECHANICAL SECTOR REAL TIME SCANNERS 3D/4D ULTRASOUND 3D ADVANCEMENT & ADVANCE TRANSDUCERS USG JOURNEY SO FAR ENDOVAGINAL TRANSDUCERCOLOUR DOPPLER IMAGING

6. Free PowerPoint Templates AT THE END OF THIS PANEL DISCUSSION LEARN WHICH USG TO ASK FOR ? AT WHAT GESTATION ? LEARN WHAT YOU GET FROM THE SCAN LEARN HOW TO INTERPRET ? LEARN WHAT TO REJECT ? LEARN HOW TO SHED OFF DEPENDENCE

7. QUESTION 1 QUES 1: How much importance an ultrasonologist should give to the patient information ,expected by the machine ? FOR ALL PANELISTS

8. WHAT TO KEEP IN MIND ……… Correct name, date of birth ( Age) Dating from LMP ( regularity/ type of conception ) Period of gestation Obstetric history ( GPAEL , chorionicity , BOH ) Indication for ultrasound Type of ultrasound R eferring doctor Medicolegal documentation

9. QUES 2 : DR ASHOK KHURANA SIR Is the first trimester viability scan (7-10wks) integral part of antenatal screening ? How informative and relevant is it ?

10. Correct dating Intrauterine / extrauterine pregnancy (most relevant in presence of symptoms, as per RCOG recommendations) Multiple pregnancy – establishing chorionicity In our context, if one has to choose one scan, it would be rather NT/NB scan than viability IMPORTANT POINTS TO KEEP IN MIND………..

11. QUES 3 : DR VIVEK KASHYAP SIR a)What are the routine measurements done during the viability scan ? b)How to assess normal and abnormal findings by this scan ?

12. Location Gestational sac Number of sacs Yolk sac CRL Fetal heart rate Intervening membrane in twins Adnexal pathology ROUTINE MEASUREMENTS

13. What abnormal findings can one assess by this scan ? Size-dates Discrepancy Early pregnancy failure Ectopic pregnancy Heterotopic pregnancy Caesarean scar pregnancy Gestational trophoblastic Disease

14. a ) What are the important parameters measured during NT-NB scan ? b) What are the FMF recommendations regarding measurements of these parameters ? QUES 4 : DR TLN PRAVEEN SIR

15. PARAMETERS ASSESSED DURING NT –NB SCAN CRL Nuchal Translucency Presence Of Nasal Bone Presence Of Intracranial Translucency Fetal Heart Rate Flow Across Tricuspid Valve Ductus Venosus Wave Form Uterine A dopplers

16. Magnification 60% 98% Image should occupy 60-98% of the screen

17. NUCHAL TRANSLUCENCY

18.   a)What is the best time to ask for second trimester scan ? b) What all information do we gather while doing this scan ? QUES 5 ) DR ANUPAMA FUTELA MAM

19. 18-22 weeks Keeping in mind the MTP act, 18-20 weeks more suitable

20. Biometry for Growth Other biometry of significance- Atrial width , cisterna magna , Nuchal fold thickness , NBL , Structural abnormalities Placenta Amniotic fluid Cervical length Uterine artery Dopplers

21. a) Optimal views in fetal anatomical survey – A myth or reality ? QUES 6) DR CHANCHAL

22. a) What is the importance of doing fetal biometry in the 18-22 weeks scan ? b) What do the measured parameters convey individually ? QUES 7) DR ASHOK KHURANA SIR

23. BPD HC AC FL TCD Atrial Width Cisterna Magna Nuchal Fold Thickness Nasal Bone Length COMMON BIOMETRIC PARAMETERS OTHER BIOMETRY

24. a)What are biometric ratios ? How are they assessed ? b) What is their relevance in present scenario QUES 8) DR SUMITA PRABHAKAR MAM

25. TCD /AC RATIO Other Ratios Ratio Used In Thorax (lung /head ratio)

26. a) Are fetal dopplers integral part of routine mid trimester scan and third trimester scan? b) What are the indications of conducting it and its interpretation? QUES 9) DR ANUPAMA FUTELA MAM

27. Uterine artery Doppler should be taken at midtrimester scan Too late for prevention But important for screening for PE/FGR and appropriate surveillance

28. a) How is the fetal environment assessed ? b) Does placental size / volume assessment play a role in high risk pregnancy ? QUES 10) DR VIVEK KASHYAP SIR

29. Amniotic fluid Placenta Umbilical cord Cervix

30. a) What are the components of the third trimester fetal well being scan ? b) What is the best time to recommend it ? Does the timing change according to patients clinical profile QUES 11 ) DR SUMITA PRABHAKAR MAM

31. Biometry Use of growth charts Dopplers – Umbilical and MCA Cerebroplacental ratio for diagnosis of late FGR

32. a) If we find that the Estimated fetal weight <10 th centile , at any gestational age, how to proceed ? QUES 12) : DR CHANCHAL

33. Wrong Dates SGA versus FGR Dopplers - AFI - Uteroplacental insufficiency UA > 95 centile Mean uterine A > 95 centile CPR >1 Fetal infection Chromosomal ab

34. Few controversies and where do they stand a) If soft markers present , how to proceed list b) Measuring scar thickness c) Mentioning loops of cord QUES 13) : DR TLN PRAVEEN SIR

35. ( Am J Perinatalogy 2015) No impact on obstetric or neonatal outcomes 15% 3rd trimester scan reduces to 4% by term

36. THANK YOU