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Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
Obstetric ultrasound
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Obstetric ultrasound

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  • 1. OBSTETRIC ULTRASOUND TECHNIQUES FETAL AGE ESTIMATION 1
  • 2. 2
  • 3. 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 3
  • 4. 4
  • 5. 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 5
  • 6. 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 6
  • 7. Transducer Received pulse Transmitted pulse Object
  • 8. 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 8
  • 9. 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 9
  • 10. 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 10
  • 11. Types of Ultrasonography • Trans Abdominal Ultrasonography (TAS) • Trans Vaginal Ultrasonography (TVS) • Doppler Ultrasound • Tissue Harmonic Imaging (THI) • Three-dimensional Ultrasound (3-D USG) 11
  • 12. 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 12
  • 13. 13
  • 14. 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 14
  • 15. 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 15
  • 16. 16
  • 17. 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 17
  • 18. 18
  • 19. Tissue Harmonic Imaging (THI) • Processing of lower amplitude, higher frequency waveforms accompanying fundamental frequency • Lesser clutter and scatter • Better visualization of fetal structure 19
  • 20. 20
  • 21. 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 21
  • 22. 22
  • 23. Application of Ultrasound in Trimesters • First Trimester – Commonly performed at 9-12 weeks • 2nd and 3rd Trimester – Commonly performed at 18-20 weeks 23
  • 24. Obstetric USG in 1st Trimester • Identification of Gestational sac and Embryo First trimester fetus and yolk sac 24
  • 25. Obstetric USG in 1st Trimester cont • Recording the presence or absence of fetal life Embryo 4 weeks 25
  • 26. Obstetric USG in 1st Trimester cont • Identification and documenting the fetal number Two gestational sacs, each containing a yolk sac 26
  • 27. Obstetric USG in 1st Trimester cont • Evaluation of Uterus and Adnexal structures Uterus and cervical plug 27
  • 28. Obstetric USG in 1st Trimester cont • Measurement of Nuchal Translucency Nuchal Translucency 28
  • 29. Triplet with sub-chorionic bleeding 29
  • 30. 30
  • 31. Twin pregnancy 28 mm CRL in 10 weeks 31
  • 32. Obstetric USG in 2nd and 3rd Trimester • Fetal life, number and presentation • Amount of amniotic fluid 32
  • 33. 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 33
  • 34. 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 34
  • 35. Fetal Cardiac Structure 35
  • 36. Fetal Age Estimation • Assessment of gestational age is fundamental to obstetric care • Ultrasound is a reliable method for establishing the length of pregnancy 36
  • 37. 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 37
  • 38. 38
  • 39. 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 39
  • 40. Fetal Age Estimation in 2nd & 3rd Trimester Bi-parietal diameter and head circumference measurements 40
  • 41. Bi-parietal Diameter 41
  • 42. 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 42
  • 43. 43
  • 44. 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 44
  • 45. Thank You 45
  • 46. Q&A 46
  • 47. 47

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