The document provides guidelines from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) for performing first trimester fetal ultrasound scans between 6-13 weeks gestation. It outlines recommendations for assessing viability, measuring the embryo/fetus, determining gestational age, evaluating fetal anatomy, and documenting the examination. Key recommendations include using transvaginal ultrasound when possible, measuring the crown-rump length to determine gestational age, and assessing the head, neck, spine and basic anatomy while acknowledging limitations in visualization of some structures so early.
This document discusses ultrasound examination in pregnancy. It provides information on using ultrasound for diagnostic and screening purposes in different trimesters. In the first trimester, ultrasound can be used to date the pregnancy, detect fetal anomalies, confirm intrauterine pregnancy, and detect ectopic pregnancies or nuchal lucency. Structures like the gestational sac, yolk sac, fetal pole, and heartbeat can be visualized on ultrasound as the pregnancy progresses in the first trimester. Crown rump length is an accurate method for measuring and dating the fetus early in the first trimester.
Imaging in obstetrics & gynaecology (part 1- Gynaecological scans in benign c...drmcbansal
Ultrasonography is a type of medical imaging that uses high-frequency sound waves to visualize structures within the body. It is a non-invasive technique that provides real-time images and does not use radiation. Common applications of ultrasound in gynecology include evaluating the uterus, ovaries, and fallopian tubes. A transvaginal probe is often used to obtain detailed images of the pelvic organs. Normal ultrasound appearances of the ovaries include scattered antral follicles that develop during the menstrual cycle. Ovulation is identified by a decrease in size of the dominant follicle. The corpus luteum that forms after ovulation can be seen as a cyst or echogenic area on ultrasound.
This document discusses screening for chromosomal defects like Trisomy 21 during pregnancy using ultrasound measurements of fetal nuchal translucency thickness between 11-13+6 weeks. It describes how increased nuchal translucency is associated with chromosomal abnormalities and various markers that can be assessed during the first trimester ultrasound like absent nasal bone, abnormal ductus venosus flow, and certain fetal measurements. The document provides guidelines for managing pregnancies based on nuchal translucency measurements and discusses offering invasive diagnostic tests for higher risk pregnancies.
This document discusses color Doppler ultrasound in the evaluation of intrauterine growth restriction (IUGR). It provides details on:
1. Changes seen in the fetal circulation in IUGR, including increased placental resistance seen on umbilical artery Doppler leading to absent or reversed end diastolic flow in severe cases.
2. Brain sparing effect seen on middle cerebral artery Doppler in IUGR fetuses, shown as increased diastolic flow.
3. Changes in the ductus venosus Doppler waveform seen in IUGR, from decreased forward flow to eventual reversal, indicating worsening fetal hypoxia and myocardial dysfunction.
The document discusses the use of MRI in assessing female pelvic organs and genitourinary conditions. MRI provides detailed images of the uterus, ovaries, and surrounding tissues. It can accurately diagnose adenomyosis, uterine anomalies, and characterize fibroids and ovarian cysts. MRI is also useful for staging cervical, endometrial, and ovarian cancers by identifying the extent of tumor invasion and spread to nearby organs or lymph nodes. Due to its safety during pregnancy, MRI can also evaluate obstetric complications and differentiate between benign and malignant tumors that may complicate pregnancy.
Ultrasound is essential for evaluating pelvic pain and vaginal bleeding in women of childbearing age. It can identify many potential causes of these presentations including pregnancy location, ectopic pregnancies, retained products of conception, and complications of pregnancy. Transvaginal ultrasound in particular provides high resolution imaging of the pelvis and adnexal structures to accurately diagnose conditions. Doppler ultrasound further aids evaluation by identifying blood flow patterns.
The document discusses the approach to evaluating ovarian masses through imaging. It describes how ovarian masses can be categorized and that epithelial tumors are the most common type of malignant ovarian tumor. The evaluation involves considering patient factors like age and mass characteristics on ultrasound like size, wall thickness, and presence of septations or solid areas. Scoring systems can help characterize masses as benign or malignant, though some remain indeterminate. MRI may help in these cases by identifying tissue types and infiltrative features suggestive of malignancy. The goal is to determine if the mass is ovarian in origin and the degree of suspicion for malignancy to guide clinical management.
This document discusses ultrasound examination in pregnancy. It provides information on using ultrasound for diagnostic and screening purposes in different trimesters. In the first trimester, ultrasound can be used to date the pregnancy, detect fetal anomalies, confirm intrauterine pregnancy, and detect ectopic pregnancies or nuchal lucency. Structures like the gestational sac, yolk sac, fetal pole, and heartbeat can be visualized on ultrasound as the pregnancy progresses in the first trimester. Crown rump length is an accurate method for measuring and dating the fetus early in the first trimester.
Imaging in obstetrics & gynaecology (part 1- Gynaecological scans in benign c...drmcbansal
Ultrasonography is a type of medical imaging that uses high-frequency sound waves to visualize structures within the body. It is a non-invasive technique that provides real-time images and does not use radiation. Common applications of ultrasound in gynecology include evaluating the uterus, ovaries, and fallopian tubes. A transvaginal probe is often used to obtain detailed images of the pelvic organs. Normal ultrasound appearances of the ovaries include scattered antral follicles that develop during the menstrual cycle. Ovulation is identified by a decrease in size of the dominant follicle. The corpus luteum that forms after ovulation can be seen as a cyst or echogenic area on ultrasound.
This document discusses screening for chromosomal defects like Trisomy 21 during pregnancy using ultrasound measurements of fetal nuchal translucency thickness between 11-13+6 weeks. It describes how increased nuchal translucency is associated with chromosomal abnormalities and various markers that can be assessed during the first trimester ultrasound like absent nasal bone, abnormal ductus venosus flow, and certain fetal measurements. The document provides guidelines for managing pregnancies based on nuchal translucency measurements and discusses offering invasive diagnostic tests for higher risk pregnancies.
This document discusses color Doppler ultrasound in the evaluation of intrauterine growth restriction (IUGR). It provides details on:
1. Changes seen in the fetal circulation in IUGR, including increased placental resistance seen on umbilical artery Doppler leading to absent or reversed end diastolic flow in severe cases.
2. Brain sparing effect seen on middle cerebral artery Doppler in IUGR fetuses, shown as increased diastolic flow.
3. Changes in the ductus venosus Doppler waveform seen in IUGR, from decreased forward flow to eventual reversal, indicating worsening fetal hypoxia and myocardial dysfunction.
The document discusses the use of MRI in assessing female pelvic organs and genitourinary conditions. MRI provides detailed images of the uterus, ovaries, and surrounding tissues. It can accurately diagnose adenomyosis, uterine anomalies, and characterize fibroids and ovarian cysts. MRI is also useful for staging cervical, endometrial, and ovarian cancers by identifying the extent of tumor invasion and spread to nearby organs or lymph nodes. Due to its safety during pregnancy, MRI can also evaluate obstetric complications and differentiate between benign and malignant tumors that may complicate pregnancy.
Ultrasound is essential for evaluating pelvic pain and vaginal bleeding in women of childbearing age. It can identify many potential causes of these presentations including pregnancy location, ectopic pregnancies, retained products of conception, and complications of pregnancy. Transvaginal ultrasound in particular provides high resolution imaging of the pelvis and adnexal structures to accurately diagnose conditions. Doppler ultrasound further aids evaluation by identifying blood flow patterns.
The document discusses the approach to evaluating ovarian masses through imaging. It describes how ovarian masses can be categorized and that epithelial tumors are the most common type of malignant ovarian tumor. The evaluation involves considering patient factors like age and mass characteristics on ultrasound like size, wall thickness, and presence of septations or solid areas. Scoring systems can help characterize masses as benign or malignant, though some remain indeterminate. MRI may help in these cases by identifying tissue types and infiltrative features suggestive of malignancy. The goal is to determine if the mass is ovarian in origin and the degree of suspicion for malignancy to guide clinical management.
Doppler ultrasound can be used in obstetrics and gynecology in several ways. It allows assessment of blood flow in various fetal and maternal vessels. In pregnancy, Doppler is commonly used to evaluate blood flow in the umbilical artery, middle cerebral artery, uterine arteries, ductus venosus and other vessels. Abnormal flow patterns in these vessels can indicate fetal growth restriction, hypoxia, or the risk of conditions like preeclampsia. Doppler provides important information about fetal well-being and helps manage high-risk pregnancies.
In this presentation we will discuss role of Doppler US in Infertility, fertilization and assisted fertilization.
we will discuss the favorable and unfavorable RI and PI.
We will discuss role of doppler us in various gynecological malignancies.
In this presentation we will discuss
First trimester US especially TVS is an integral part for confirmation of intrauterine pregnancy and to rule out ectopic pregnancy.
First trimester US helps us in suggesting conceptus viability.
First trimester US especially TVS is very efficient in approaching and evaluating the cause of vaginal bleeding.
Ultrasound is useful in the first trimester for evaluating bleeding, pain, gestational sac location and development. A gestational sac is normally visible by 4 weeks ultrasound. The yolk sac appears by 5 weeks and the embryo with cardiac activity by 6 weeks. Abnormal findings include lack of growth, irregular sac shape, large yolk sac size. Doppler can assess blood flow. Ectopic pregnancies can be detected by visualizing an embryo outside the uterus combined with serum hCG levels. Multiple pregnancies are determined by membrane thickness and number of yolk sacs.
Doppler ultrasound uses sound waves to evaluate blood flow and was first used in 1977 to study umbilical artery flow. It measures the Doppler shift in echoes from moving blood cells to determine flow velocity. Fetal vessels commonly assessed include the umbilical artery, which provides information on placental perfusion, and the middle cerebral artery, which indicates fetal oxygenation status. Doppler ultrasound can detect signs of fetal hypoxia like increased end-diastolic flow in the MCA, and meta-analyses found it reduces perinatal deaths and inductions when used for monitoring high-risk pregnancies.
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
This document provides information on transvaginal ultrasound (TVS) in the first trimester. It discusses the advantages of TVS including better image resolution from the shorter probe-target distance. Common indications for first trimester ultrasound are listed, along with normal ultrasound findings from 4-10 weeks of gestation. Guidelines for estimating gestational age using crown-rump length are provided. Diagnostic signs of early pregnancy failure and molar pregnancy are outlined. Biometric measurements used in obstetric ultrasounds after 13 weeks are also noted.
The document discusses Doppler ultrasound findings for a 25-year-old pregnant female with uncontrolled hypertension. Key findings include oligohydramnios, elevated head circumference to abdominal circumference ratio, and abnormal Doppler readings of the umbilical artery, middle cerebral artery, and ductus venosus indicating fetal hypoxia and intrauterine growth restriction. The summary provides an overview of the patient details and significant ultrasound findings reported in the document.
This document discusses umbilical and uterine artery Doppler ultrasound. It notes that umbilical artery Doppler is useful for predicting abnormal fetal outcomes, with a resistance index above 0.72 outside normal limits after 26 weeks. Absent or reversed end diastolic flow in the umbilical artery indicates fetal distress and need for monitoring or delivery. Uterine artery Doppler has limited use in predicting fetal growth restriction but can suggest maternal versus fetal causes. An abnormal uterine Doppler with decreased diastolic flow or persistence of a diastolic notch after 24 weeks can help predict preeclampsia. Fortnightly umbilical artery Doppler scans are recommended when growth is not maintained or abdominal circumference is below the third percentile.
This document provides an overview of imaging modalities used to evaluate ovarian tumors. It discusses the epidemiology, relevant anatomy, and types of ovarian tumors seen on ultrasound, CT, MRI, and PET/CT. The major epithelial tumors described are serous cystadenocarcinoma, mucinous cystadenocarcinoma, endometrioid carcinoma, and clear cell carcinoma. It also reviews sex cord-stromal tumors, germ cell tumors including teratomas and dysgerminoma, and the patterns of ovarian cancer spread. Imaging findings for each tumor type are presented to aid in differential diagnosis.
This document discusses various imaging methods used in gynecology, including ultrasound, CT, MRI, conventional radiology, and angiography. Ultrasound is the first-choice diagnostic tool for conditions like abnormal uterine bleeding, adnexal masses, infertility, and pelvic pain. CT and MRI are used for more detailed examination of ovarian tumors, endometriosis, and tumors. Conventional radiology examines calcifications, gas distribution, and skeleton. Angiography is rarely used to study abnormal pelvic vessels. In obstetrics, ultrasound is preferred for assessing pregnancy, fetal biometry, and screening due to lacking radiation exposure.
ROLE OF ULTRASOUND IN MULTIFETAL GESTATION - WHAT AN OBSTETRICIAN SHOULD KNOW ?Bharti Gahtori
Ultrasound plays an indispensable role in managing multifetal gestations. It is crucial for determining chorionicity and zygosity early in the first trimester, as this predicts complications. Ultrasound can also assess nuchal translucency, screen for anomalies, monitor growth and detect complications like twin-twin transfusion syndrome that are more common in monochorionic twins. Serial ultrasound examinations are important for detailed evaluation of the placenta, umbilical cords, fetal growth and well-being in order to guide management and improve outcomes in these high risk pregnancies.
This document discusses Doppler ultrasound principles and techniques. It begins by explaining the basic principles of how Doppler ultrasound measures blood flow velocity. It describes continuous wave and pulsed wave Doppler, and factors that affect Doppler measurements like ultrasound frequency, beam-to-flow angle, and aliasing. It also summarizes different ultrasound flow modes like color flow imaging, spectral Doppler, and power Doppler, when each is used, and how they complement each other.
1) Early pregnancy ultrasound is used to evaluate normal and abnormal early pregnancies through assessing gestational sac location, structure, viability, dating and number. It can also screen for fetal abnormalities and assist with procedures.
2) Sonographic signs of normal early pregnancy include identifying the gestational sac, yolk sac, embryo/fetus and presence of cardiac activity. Dating is based on mean sac diameter from 5-9 weeks and crown-rump length from 6-12 weeks.
3) Abnormal findings include failed early pregnancy, pregnancy of uncertain viability, pregnancy of unknown location, ectopic pregnancy, molar pregnancy, and retained products of conception. Precise diagnosis requires correlating ultrasound findings with hCG
This document outlines key aspects of a third trimester ultrasound exam, including assessing fetal cardiac activity, position, size, anatomy, amniotic fluid, placental location, and adnexa. It describes how to measure the biparietal diameter, head circumference, abdominal circumference, and femur length. Head circumference is a more reliable measurement than biparietal diameter if the fetus is breech or transverse. Abdominal circumference best estimates fetal weight. Amniotic fluid is assessed subjectively and using the amniotic fluid index. Placenta previa risks include previous c-sections and smoking. Tips for imaging obese patients include filling the bladder, using the umbilicus or other areas as windows, and trans
MRI uses magnetism, radio waves, and computers to create images of areas inside the body. It involves four basic steps: (1) placing the patient in a magnetic field, (2) transmitting radio frequency pulses, (3) receiving signals from the patient, and (4) transforming the signals into images using computer processing. MRI provides superior soft tissue resolution compared to ultrasound and allows for multiplanar imaging. It is useful for evaluating various fetal and maternal conditions like brain abnormalities, tumors, placental issues, and complications in multiple pregnancies. While a valuable tool, MRI also has some limitations including high cost, inability to be used in early pregnancy or if metallic implants are present, and longer scan times than ultrasound.
Retained products of conception dr.mohamed SolimanMohamed Soliman
1. Retained products of conception (RPOC) refers to incomplete evacuation of placental or trophoblastic tissue in the endometrial cavity after abortion, delivery, or cesarean section.
2. Ultrasound is first-line for diagnosis and may show an echogenic endometrial mass with low-resistance, high-velocity blood flow. Thickened endometrium (>10mm) or intrauterine fluid also suggest RPOC.
3. Differential diagnosis includes uterine atony, blood clots, or arteriovenous malformation. Presentation involves delayed bleeding or endometritis. Expectant management is appropriate for minimal vascularity; medication or surgery is
This document discusses techniques for diagnosing endometriosis, including current and new methods. It provides details on:
1) Primary locations of endometriosis, their prevalence, clinical features, and differential diagnosis according to studies. Common locations include the ovaries and retrocervical region.
2) Four basic sonographic steps for examining patients with suspected deep infiltrating endometriosis, including evaluating transvaginal tenderness and mobility and assessing the "sliding sign".
3) Studies showing substantial agreement between observers using transvaginal sonography to diagnose endometriosis in various pelvic locations, with high accuracy for the rectosigmoid colon.
This document discusses prenatal screening and diagnosis of Down syndrome. It describes various screening tests that can be done during the first and second trimester, including nuchal translucency screening between 11-13 weeks gestation and biochemical screening involving markers like beta-hCG and PAPP-A. Combining results from ultrasound markers like nuchal translucency with biochemical markers provides the most accurate risk assessment. A small percentage of high-risk cases may warrant diagnostic testing like amniocentesis or CVS. The document also discusses factors that can impact marker levels and outlines reporting recommendations.
This document discusses techniques and markers for first trimester screening for chromosomal defects. It provides information on screening for defects like Trisomy 21 and 18 through assessment of nuchal translucency, fetal heart rate, serum biochemistry, and new ultrasound markers such as nasal bone, facial angle, ductus venosus flow, and tricuspid flow. It also describes techniques for performing the scans and measurements and interpreting the various markers to determine risk of chromosomal abnormalities.
Doppler ultrasound can be used in obstetrics and gynecology in several ways. It allows assessment of blood flow in various fetal and maternal vessels. In pregnancy, Doppler is commonly used to evaluate blood flow in the umbilical artery, middle cerebral artery, uterine arteries, ductus venosus and other vessels. Abnormal flow patterns in these vessels can indicate fetal growth restriction, hypoxia, or the risk of conditions like preeclampsia. Doppler provides important information about fetal well-being and helps manage high-risk pregnancies.
In this presentation we will discuss role of Doppler US in Infertility, fertilization and assisted fertilization.
we will discuss the favorable and unfavorable RI and PI.
We will discuss role of doppler us in various gynecological malignancies.
In this presentation we will discuss
First trimester US especially TVS is an integral part for confirmation of intrauterine pregnancy and to rule out ectopic pregnancy.
First trimester US helps us in suggesting conceptus viability.
First trimester US especially TVS is very efficient in approaching and evaluating the cause of vaginal bleeding.
Ultrasound is useful in the first trimester for evaluating bleeding, pain, gestational sac location and development. A gestational sac is normally visible by 4 weeks ultrasound. The yolk sac appears by 5 weeks and the embryo with cardiac activity by 6 weeks. Abnormal findings include lack of growth, irregular sac shape, large yolk sac size. Doppler can assess blood flow. Ectopic pregnancies can be detected by visualizing an embryo outside the uterus combined with serum hCG levels. Multiple pregnancies are determined by membrane thickness and number of yolk sacs.
Doppler ultrasound uses sound waves to evaluate blood flow and was first used in 1977 to study umbilical artery flow. It measures the Doppler shift in echoes from moving blood cells to determine flow velocity. Fetal vessels commonly assessed include the umbilical artery, which provides information on placental perfusion, and the middle cerebral artery, which indicates fetal oxygenation status. Doppler ultrasound can detect signs of fetal hypoxia like increased end-diastolic flow in the MCA, and meta-analyses found it reduces perinatal deaths and inductions when used for monitoring high-risk pregnancies.
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
This document provides information on transvaginal ultrasound (TVS) in the first trimester. It discusses the advantages of TVS including better image resolution from the shorter probe-target distance. Common indications for first trimester ultrasound are listed, along with normal ultrasound findings from 4-10 weeks of gestation. Guidelines for estimating gestational age using crown-rump length are provided. Diagnostic signs of early pregnancy failure and molar pregnancy are outlined. Biometric measurements used in obstetric ultrasounds after 13 weeks are also noted.
The document discusses Doppler ultrasound findings for a 25-year-old pregnant female with uncontrolled hypertension. Key findings include oligohydramnios, elevated head circumference to abdominal circumference ratio, and abnormal Doppler readings of the umbilical artery, middle cerebral artery, and ductus venosus indicating fetal hypoxia and intrauterine growth restriction. The summary provides an overview of the patient details and significant ultrasound findings reported in the document.
This document discusses umbilical and uterine artery Doppler ultrasound. It notes that umbilical artery Doppler is useful for predicting abnormal fetal outcomes, with a resistance index above 0.72 outside normal limits after 26 weeks. Absent or reversed end diastolic flow in the umbilical artery indicates fetal distress and need for monitoring or delivery. Uterine artery Doppler has limited use in predicting fetal growth restriction but can suggest maternal versus fetal causes. An abnormal uterine Doppler with decreased diastolic flow or persistence of a diastolic notch after 24 weeks can help predict preeclampsia. Fortnightly umbilical artery Doppler scans are recommended when growth is not maintained or abdominal circumference is below the third percentile.
This document provides an overview of imaging modalities used to evaluate ovarian tumors. It discusses the epidemiology, relevant anatomy, and types of ovarian tumors seen on ultrasound, CT, MRI, and PET/CT. The major epithelial tumors described are serous cystadenocarcinoma, mucinous cystadenocarcinoma, endometrioid carcinoma, and clear cell carcinoma. It also reviews sex cord-stromal tumors, germ cell tumors including teratomas and dysgerminoma, and the patterns of ovarian cancer spread. Imaging findings for each tumor type are presented to aid in differential diagnosis.
This document discusses various imaging methods used in gynecology, including ultrasound, CT, MRI, conventional radiology, and angiography. Ultrasound is the first-choice diagnostic tool for conditions like abnormal uterine bleeding, adnexal masses, infertility, and pelvic pain. CT and MRI are used for more detailed examination of ovarian tumors, endometriosis, and tumors. Conventional radiology examines calcifications, gas distribution, and skeleton. Angiography is rarely used to study abnormal pelvic vessels. In obstetrics, ultrasound is preferred for assessing pregnancy, fetal biometry, and screening due to lacking radiation exposure.
ROLE OF ULTRASOUND IN MULTIFETAL GESTATION - WHAT AN OBSTETRICIAN SHOULD KNOW ?Bharti Gahtori
Ultrasound plays an indispensable role in managing multifetal gestations. It is crucial for determining chorionicity and zygosity early in the first trimester, as this predicts complications. Ultrasound can also assess nuchal translucency, screen for anomalies, monitor growth and detect complications like twin-twin transfusion syndrome that are more common in monochorionic twins. Serial ultrasound examinations are important for detailed evaluation of the placenta, umbilical cords, fetal growth and well-being in order to guide management and improve outcomes in these high risk pregnancies.
This document discusses Doppler ultrasound principles and techniques. It begins by explaining the basic principles of how Doppler ultrasound measures blood flow velocity. It describes continuous wave and pulsed wave Doppler, and factors that affect Doppler measurements like ultrasound frequency, beam-to-flow angle, and aliasing. It also summarizes different ultrasound flow modes like color flow imaging, spectral Doppler, and power Doppler, when each is used, and how they complement each other.
1) Early pregnancy ultrasound is used to evaluate normal and abnormal early pregnancies through assessing gestational sac location, structure, viability, dating and number. It can also screen for fetal abnormalities and assist with procedures.
2) Sonographic signs of normal early pregnancy include identifying the gestational sac, yolk sac, embryo/fetus and presence of cardiac activity. Dating is based on mean sac diameter from 5-9 weeks and crown-rump length from 6-12 weeks.
3) Abnormal findings include failed early pregnancy, pregnancy of uncertain viability, pregnancy of unknown location, ectopic pregnancy, molar pregnancy, and retained products of conception. Precise diagnosis requires correlating ultrasound findings with hCG
This document outlines key aspects of a third trimester ultrasound exam, including assessing fetal cardiac activity, position, size, anatomy, amniotic fluid, placental location, and adnexa. It describes how to measure the biparietal diameter, head circumference, abdominal circumference, and femur length. Head circumference is a more reliable measurement than biparietal diameter if the fetus is breech or transverse. Abdominal circumference best estimates fetal weight. Amniotic fluid is assessed subjectively and using the amniotic fluid index. Placenta previa risks include previous c-sections and smoking. Tips for imaging obese patients include filling the bladder, using the umbilicus or other areas as windows, and trans
MRI uses magnetism, radio waves, and computers to create images of areas inside the body. It involves four basic steps: (1) placing the patient in a magnetic field, (2) transmitting radio frequency pulses, (3) receiving signals from the patient, and (4) transforming the signals into images using computer processing. MRI provides superior soft tissue resolution compared to ultrasound and allows for multiplanar imaging. It is useful for evaluating various fetal and maternal conditions like brain abnormalities, tumors, placental issues, and complications in multiple pregnancies. While a valuable tool, MRI also has some limitations including high cost, inability to be used in early pregnancy or if metallic implants are present, and longer scan times than ultrasound.
Retained products of conception dr.mohamed SolimanMohamed Soliman
1. Retained products of conception (RPOC) refers to incomplete evacuation of placental or trophoblastic tissue in the endometrial cavity after abortion, delivery, or cesarean section.
2. Ultrasound is first-line for diagnosis and may show an echogenic endometrial mass with low-resistance, high-velocity blood flow. Thickened endometrium (>10mm) or intrauterine fluid also suggest RPOC.
3. Differential diagnosis includes uterine atony, blood clots, or arteriovenous malformation. Presentation involves delayed bleeding or endometritis. Expectant management is appropriate for minimal vascularity; medication or surgery is
This document discusses techniques for diagnosing endometriosis, including current and new methods. It provides details on:
1) Primary locations of endometriosis, their prevalence, clinical features, and differential diagnosis according to studies. Common locations include the ovaries and retrocervical region.
2) Four basic sonographic steps for examining patients with suspected deep infiltrating endometriosis, including evaluating transvaginal tenderness and mobility and assessing the "sliding sign".
3) Studies showing substantial agreement between observers using transvaginal sonography to diagnose endometriosis in various pelvic locations, with high accuracy for the rectosigmoid colon.
This document discusses prenatal screening and diagnosis of Down syndrome. It describes various screening tests that can be done during the first and second trimester, including nuchal translucency screening between 11-13 weeks gestation and biochemical screening involving markers like beta-hCG and PAPP-A. Combining results from ultrasound markers like nuchal translucency with biochemical markers provides the most accurate risk assessment. A small percentage of high-risk cases may warrant diagnostic testing like amniocentesis or CVS. The document also discusses factors that can impact marker levels and outlines reporting recommendations.
This document discusses techniques and markers for first trimester screening for chromosomal defects. It provides information on screening for defects like Trisomy 21 and 18 through assessment of nuchal translucency, fetal heart rate, serum biochemistry, and new ultrasound markers such as nasal bone, facial angle, ductus venosus flow, and tricuspid flow. It also describes techniques for performing the scans and measurements and interpreting the various markers to determine risk of chromosomal abnormalities.
Focused approach to antenatal care - First trimester screeningBharti Gahtori
This document discusses focused antenatal care and first trimester screening. It describes the essential elements of antenatal care including targeted assessments based on individual risk factors. First trimester screening aims to detect conditions like aneuploidy through measuring the nuchal translucency, analyzing maternal serum markers, and assessing fetal heart rate between 11-13 weeks of gestation. Screening tests are evaluated based on their sensitivity, specificity, and rates of false positives and negatives.
Nuchal translucency screening is an ultrasound performed in the first trimester of pregnancy to measure the thickness of fluid behind the baby's neck. A normal measurement indicates a lower risk of chromosomal abnormalities, while an abnormal measurement adjusts the age-related risk higher. Additional tests of the mother's blood can further adjust the pregnancy risk level.
Prenatal diagnosis is testing for diseases or conditions in a fetus before it is born. The aim is to detect birth defects such as Neural tube defects, Down syndrome, chromosomal abnormalities and genetic diseases. Common methods of prenatal diagnosis include invasive methods like amniocentesis, chorionic villus sampling, and cordocentesis as well as non-invasive methods like ultrasonography. Prenatal diagnosis provides information to help couples prepare for the birth of an affected baby and enables pregnancy termination as an option. Problems can include failure to obtain a sample or ambiguous chromosome results.
This document provides information about the California Prenatal Screening Program (CPSP), including different screening options and the use and significance of nuchal translucency (NT) measurements and maternal serum analyte levels. It describes how an increased NT measurement is associated with genetic and anatomical birth defects and how the CPSP screening becomes more sensitive at detecting anomalies like Down syndrome when NT is combined with serum analyte tests. Abnormal NT and analyte levels may warrant additional ultrasounds and follow up to monitor risks of conditions like preeclampsia and intrauterine growth restriction.
This document discusses screening in the late 1st trimester (11-13 weeks) of pregnancy. It presents several rare fetal abnormalities detected during nuchal translucency scans over a two year period, including cystic hygroma, acrania, neural tube defects, encephalocele, holoprosencephaly, omphalocele, kyphoscoliosis, sirenomelia, and megacystis. The take home message is that a detailed transvaginal examination and 3D/4D scan along with the nuchal scan can detect additional abnormalities in the late 1st trimester, such as cleft lip/palate, hypoplastic left heart, and atriovent
This document discusses first trimester ultrasound screening between 11-14 weeks of pregnancy. It describes how nuchal translucency measurement and additional tests can detect chromosomal abnormalities like Down syndrome in the fetus. Nuchal translucency measures fluid behind the fetal neck and increases the risk of abnormalities. Additional markers like the presence of the nasal bone and maternal blood tests further improve detection rates. An optimal first trimester screening uses multiple factors to screen with a sensitivity of up to 95%.
This document discusses various techniques for prenatal screening and diagnosis of fetal abnormalities. It describes nuchal translucency screening as a non-invasive tool that is highly sensitive in detecting markers of chromosomal anomalies. It also discusses additional sonographic markers like echogenic foci, shortened long bones, and the measurement of nuchal skin folds to further assess risk. Overall, the document emphasizes the value of ultrasound screening in the first trimester for its ability to provide tangible information to patients and guide decisions about invasive diagnostic procedures.
The document provides guidelines from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) for performing routine mid-trimester fetal ultrasound scans between 18-22 weeks of pregnancy. It recommends that all pregnant women should be offered the scan to detect fetal anomalies and complications. The scan should assess fetal growth and anatomy, and be performed by an individual with specialized training using standardized ultrasound equipment and documentation. While many malformations can be identified, some may be missed even with best practices.
Level II ultrasound aims to assess fetal anatomy and identify structural abnormalities. It involves a detailed scan of the fetal head, chest, abdomen, and limbs between 18-22 weeks. Key steps include measuring fetal biometry, examining the brain, heart, kidneys, and bones. Abnormalities like organ defects, skeletal dysplasias, and soft markers for genetic conditions are evaluated. Advanced techniques like 3D and 4D ultrasound help depict facial anomalies and aid diagnosis. A thorough Level II scan provides crucial information about fetal well-being and development.
This document provides an overview of prenatal screening and diagnosis of neural tube defects and Down syndrome. It discusses the incidence, risk factors, screening tests, and diagnostic evaluation for neural tube defects including ultrasound, maternal serum AFP testing, amniocentesis, and fetal MRI. Prenatal screening tests for aneuploidies like Down syndrome are also covered, including first trimester ultrasound, maternal serum markers, and integrated screening. Prevention through folic acid supplementation and pregnancy management options are summarized.
Prenatal diagnosis provides couples at risk of genetic disorders with informed choices. Non-invasive tests like maternal serum screening and ultrasound can detect abnormalities, while invasive tests like amniocentesis and chorionic villus sampling allow for chromosome analysis but carry small risks of miscarriage. Advanced maternal age is the most common indication for testing. Prenatal diagnosis aims to detect issues prenatally in order to provide counseling, reduce anxiety, and potentially enable prenatal treatment in the future through gene therapy.
The document discusses screening and diagnosis of chromosomal defects in pregnancies. It notes that:
- Screening can be done by assessing maternal age, fetal nuchal translucency thickness on ultrasound, and maternal serum markers. This can identify 75-90% of chromosomal defects like trisomy 21.
- Invasive diagnosis requires procedures like chorionic villus sampling or amniocentesis, which carry a small risk of miscarriage. These should only be done by trained practitioners.
- New methods continue to be developed to improve non-invasive screening, but so far examination of fetal cells in maternal blood is mainly useful for risk assessment rather than diagnosis. Assessment of cell-free fetal DNA
This document summarizes several fetal anomalies seen on ultrasound:
1) Alobar holoprosencephaly is a rare brain malformation where the brain hemispheres fail to separate, resulting in a single ventricle and absence of midline structures. Associated craniofacial abnormalities may include cyclopia.
2) Omphalocele is a congenital abdominal wall defect where intestines or other contents herniate outside the abdomen and are covered by a membrane at the umbilical cord insertion site.
3) Sacrococcygeal chordoma is a rare tumor originating from embryonic remnants in the coccyx, appearing on ultrasound as a soft tissue mass destroying local bone.
4) Twin
Neural tube defects are congenital malformations that occur due to defects during neural tube formation in early embryonic development. They can be open, where neural tissue is exposed, or closed, where neural tissue is confined but covered by dysplastic skin. Ultrasound and MRI are used for prenatal diagnosis and show findings characteristic of specific defects like anencephaly, encephalocele, myelomeningocele, or craniorachischisis. Management involves prenatal counseling and postnatal surgical intervention if needed.
1) The progression of sonographic findings in early first trimester pregnancies follows a predictable pattern, with the gestational sac appearing at 5 weeks, yolk sac at 5.5 weeks, embryo with heartbeat at 6 weeks, and amnion at 7 weeks.
2) A single hCG measurement cannot reliably distinguish a normal intrauterine pregnancy from a failed one or ectopic pregnancy when no pregnancy is visible on ultrasound.
3) Any round or oval fluid collection in the uterus should be interpreted as a gestational sac, and treatments that could damage the pregnancy should be avoided.
This document discusses maternal serum screening, which analyzes various biomarkers in a pregnant woman's blood to assess risk for fetal abnormalities. It began in the 1970s with alpha-fetoprotein screening for neural tube defects. Additional markers like human chorionic gonadotropin and unconjugated estriol were later added, improving detection rates for Down syndrome. Today's standard screening incorporates these "triple markers" along with inhibin A in a "quad screen". Newer tests analyze markers in the first trimester like pregnancy-associated plasma protein A and nuchal translucency ultrasound to provide very early screening. Positive screens may warrant diagnostic testing via amniocentesis or ultrasound.
This document discusses various "food signs" in radiology where imaging findings resemble different foods. It provides examples of signs named after fruits like the apple core sign in colon cancer and berry aneurysms. Other signs are named after vegetables, meats, pastas, desserts and dishes. Examples described include the banana sign in neural tube defects, sausage digit in psoriatic arthropathy, and eggshell calcification in lymph nodes. Recognition of these memorable signs aids diagnosis and differential diagnosis. While sometimes fanciful, they improve pattern recognition and radiological interpretation.
Guía ISUOG: Ecografía del primer trimestreTony Terrones
This document provides guidelines for performing first trimester fetal ultrasounds from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). It recommends that routine first trimester ultrasounds should be performed between 11-13+6 weeks gestation to confirm viability, accurately date the pregnancy, determine fetal number, and assess gross anatomy. Ultrasounds should be performed by trained practitioners using appropriate equipment and following standardized examination and documentation procedures. Measurements such as crown-rump length are recommended to accurately assess gestational age. Safety considerations and limitations of first trimester ultrasounds are also discussed.
This document provides guidelines for performing obstetric ultrasound examinations at various stages of pregnancy. It discusses indications, imaging parameters, and documentation requirements for first trimester, standard second/third trimester, limited, and specialized ultrasound exams. Key aspects include evaluating gestational sac features in the first trimester, assessing fetal anatomy and biometric measurements in later exams, and documenting important findings such as placental location and amniotic fluid levels. Adherence to these guidelines helps maximize detection of fetal abnormalities.
Guía ISUOG sobre ecografía del segundo trimestreTony Terrones
This document provides guidelines for performing a routine mid-trimester fetal ultrasound scan between 18-22 weeks of gestation. The purpose of the scan is to assess fetal growth and anatomy, detect congenital anomalies, and determine gestational age. Key aspects that are recommended include using ultrasound equipment with appropriate capabilities, documenting standardized measurements and images, and having healthcare practitioners with specialized training perform the scans. Deviations from the guidelines should be documented, and cases requiring a more detailed scan should be referred to an appropriate specialist.
This technical report summarizes the student's experience during their industrial work experience scheme (SIWES) at the Ekiti State Teaching Hospital in Nigeria. The report describes the use of obstetric ultrasound, including the equipment, procedures, importance and limitations. Obstetric ultrasound uses sound waves to examine the fetus and uterus during pregnancy, allowing clinicians to monitor fetal growth and check for abnormalities without radiation exposure. The student concludes that ultrasound is a standard prenatal screening tool and recommends extending the duration of future SIWES programs to improve training opportunities for students.
Ultrasonographic Cervical Length Measurement at 10-14- and 20-24-weeks’ Gesta...AI Publications
Preterm labor is a regular occurrence in pregnancy; an estimated 15 million babies are born prematurely each year, with the number increasing. This was a prospective study of pregnant women who came to the Maternity Teaching Hospital in Erbil, Kurdistan Province, Iraq, for an outpatient clinic. On a manageable sample of 150 singleton pregnancies. In this study, one hundred fifty singleton asymptomatic pregnancies encountered the inclusion criteria during the study period, 69 primi gravid, 81 multi gravid. The correlation between the cervical length at 20–24 weeks and preterm delivery was moderately poor (r =0.715), and this correlation was highly significant (P < 0.001). In another word, a better correlation was found between preterm delivery and cervical length at 20–24 weeks than at 10–14 weeks in the prediction of preterm delivery. This study also points towards the importance of serial ultrasound scans to detect those who are at higher risk. There was no statistically significant effect of age, parity. Finally, the findings revealed that trans vaginal ultrasound is more accurate at 20-24weeks than 10-14weeks gestation for prediction of preterm labor, it can be used routinely to prevent preterm birth.
Focused reproductive endocrinology and infertility (2019) guidelineVõ Tá Sơn
Focused reproductive endocrinology and infertility (2019) image library, guideline,
Hình ảnh học siêu âm trong nội tiết sinh sản và vô sinh,
AIUM 2019,
Bs Võ Tá Sơn,
Guía ISUOG sobre ecografía en embarazo gemelarTony Terrones
This document provides guidelines from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) on the role of ultrasound in twin pregnancies. It recommends that twin pregnancies be dated using the larger crown-rump length between 11-13 weeks of gestation. It also recommends determining chorionicity and amnionicity before 14 weeks using membrane thickness and placental mass number. Uncomplicated dichorionic twins should have scans at 11-14 weeks, 20-22 weeks, and every 4 weeks thereafter, while uncomplicated monochorionic twins should have scans every 2 weeks after 16 weeks to monitor for twin-to-twin transfusion syndrome and other complications.
Ultrasound in early pregnancy is used to assess:
1. Normal aspects such as gestational sac size and viability by detecting a heartbeat.
2. Abnormalities including ectopic pregnancies, molar pregnancies, and hemorrhages.
3. Dating the pregnancy accurately in the first trimester by measuring the mean sac diameter or crown-rump length.
4. Detecting multiple pregnancies and diagnosing chorionicity and zygosity.
5. Screening for fetal abnormalities such as thickened nuchal translucency which is used to detect Down syndrome.
The document provides guidelines for performing a routine mid-trimester fetal ultrasound scan between 18-22 weeks gestation. It outlines the purpose, who should perform the scan, and what should be evaluated which includes fetal anatomy, growth, and well-being. Key recommendations include using standardized measurements and imaging protocols, producing a report for the referring provider, and minimizing fetal exposure during the scan. The guidelines aim to optimize outcomes for both mother and fetus through an accurate and safe examination.
Gestational age is a key piece of data used by healthcare providers to determine the timing of various screening tests and assessments of the fetus and mother throughout pregnancy. Gestational age may be assessed at any time during pregnancy, and several modes of assessment exist, each requiring different equipment or skills and with varying degrees of accuracy. Obtaining more accurate estimates of gestational age through better diagnostic approaches may initiate more prompt medical management of a pregnant patient.
Prenatal diagnosis has advanced significantly from early techniques like amniocentesis. Now, non-invasive prenatal testing using cell-free fetal DNA from maternal blood can screen for common chromosomal abnormalities with over 99% sensitivity. Ultrasound is routinely used during pregnancy to check fetal anatomy and growth. Biochemical markers in maternal blood can assess risks for issues like Down syndrome, assess placental health through hormones like HCG, and monitor fetal well-being. Invasive techniques like amniocentesis and chorionic villus sampling allow for direct genetic testing of fetal cells.
This document discusses the role and components of first trimester ultrasounds. It begins by providing background on the history and development of ultrasound technology. It then describes the mechanics of ultrasounds and their safety. The document outlines the standard exam components including gestational sac, yolk sac, fetal pole, cardiac activity and crown rump length. It discusses the uses of first trimester ultrasounds such as dating the pregnancy and screening for abnormalities. The document also covers topics like failed pregnancies, abortion, invasive procedures, ectopic pregnancies, molar pregnancies, nuchal translucency screening, and various fetal abnormalities.
High-risk approach with screening and assessmentAnamika Ramawat
High risk pregnancies require screening and assessment to identify risks and provide extra care. Around 20-30% of pregnancies are considered high risk due to factors that could adversely affect the pregnancy outcome for the mother or baby. Assessment involves evaluating the health history and risk factors, while screening identifies apparently healthy people who may be at increased risk. Various diagnostic tests can then be used to further evaluate any risks found during screening. These include noninvasive tests like ultrasound, CTG, NST and CST as well as invasive tests like CVS and amniocentesis. Proper screening, assessment and diagnosis of high risk pregnancies allows for improved monitoring and outcomes.
Obstetrical Ultrasound Examination and Biochemical Markers as Contemporary To...Rustem Celami
- Obstetrical ultrasound examination and biochemical markers are contemporary tools used in Albania to assess fetal anomalies.
- Nuchal translucency measurements over 3mm and abnormal biochemical markers indicate an increased risk of structural fetal abnormalities.
- Abnormalities like increased nuchal translucency and cystic hygroma can be detected during first trimester ultrasound screening.
Ultrasound is a widely used and safe imaging technique in obstetrics and gynecology. In obstetrics, it can diagnose pregnancies as early as 4-5 weeks and assess fetal growth and anatomy. It is used to detect fetal abnormalities, placental location, and amniotic fluid levels. Doppler ultrasound assesses fetal well-being. In gynecology, ultrasound evaluates ovarian reserve, pelvic masses, endometrial thickness, and guides invasive procedures. Other imaging techniques like MRI and CT provide additional anatomical details in certain conditions while x-rays are used to assess specific organ systems. Overall, ultrasound is a primary tool for evaluating the female reproductive system in both non-pregnant and pregnant patients.
Cervical length for preterm birth prevention Aboubakr ELNASHARAboubakr Elnashar
This document discusses cervical length screening during pregnancy to prevent preterm birth. It begins by explaining that a short cervical length is a strong predictor of preterm birth, especially for women with a prior preterm birth history. Transvaginal ultrasound is described as the gold standard for accurately measuring cervical length. The document then provides steps for proper cervical length measurement and recommends assessing length between 16-24 weeks of gestation. It outlines cervical length screening guidelines for women with a prior preterm birth, which is to screen every 1-2 weeks from 16-24 weeks. The document discusses debate around universal cervical length screening and notes insufficient evidence for screening in some high-risk situations.
Cervical incompetence is premature dilation of the cervix during pregnancy before labor begins. It affects 0.1-2% of pregnancies and causes around 15% of preterm births between 16-28 weeks. While the cause is often unknown, it can be due to congenital weaknesses, prior trauma, or connective tissue disorders. Diagnosis relies on history of preterm births and physical findings like dilation of the cervix when not pregnant. Cervical cerclage placement is the standard treatment and involves surgically stitching the cervix closed to prevent premature dilation. The document discusses various cerclage techniques and their appropriate uses.
This document provides guidelines for performing obstetric ultrasounds, including indications, imaging parameters, and types of examinations. It recommends using real-time ultrasound with transducers of 3-5 MHz for standard second and third trimester exams to evaluate fetal anatomy, growth, and well-being. First trimester ultrasounds should use transvaginal or transabdominal ultrasound to assess gestational age, viability, and risk of aneuploidy by measuring the nuchal translucency. Limited and specialized ultrasounds are also described for targeted evaluations.
Similar to Isuog practice guidelines performance of first trimester fetal ultrasound scan (20)
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
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Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
2. The International Society of
Ultrasound in Obstetrics and
Gynecology (ISUOG) is a scientific
organization that encourages safe
clinical practice and high-quality
teaching and research related to
diagnostic imaging in women’s
healthcare.
The ISUOG Clinical Standards
Committee(CSC) has a remit to develop
Practice Guidelines and Consensus
Statements that provide healthcare
practitioners with a consensus-based
3. INTRODUCTION
Routine ultrasound examination is an established part of
antenatal care if resources are available and access
possible.
It is commonly performed in the second trimester ,
Although routine scanning is offered increasingly during the
first trimester, particularly in high-resource settings.
Ongoing technological advancements, including high-
frequency transvaginal scanning, have allowed the
resolution of ultrasound imaging in the first trimester to
evolve to a level at which early fetal development can be
assessed and monitored in detail.
4. AIM of ISUOG first trimester guidelines
to provide guidance for healthcare practitioners
performing, or planning to perform,
routine or indicated first-trimester fetal
ultrasound scans.
5. ‘First trimester’ here refers to a stage of pregnancy
starting from the time at which viability can be
confirmed (i.e. presence of a gestational sac in the
uterine cavity with an embryo demonstrating cardiac
activity) up to 13 weeks + 6 days of gestation.
Ultrasound scans performed after this gestational age
are not considered in these Guidelines.
in these Guidelines the term ‘embryo’ is used before 10
weeks and ‘fetus’ thereafter, (to reflect the fact that after
10 weeks of gestation organogenesis is essentially
complete and further development involves
predominantly fetal growth and organ maturation)
6. GENERAL CONSIDERATIONS
What is the purpose of a first-trimester
fetal ultrasound scan?
In early pregnancy, it is important to
Confirm viability,
Establish gestational age accurately,
Determine the number of fetuses in the
presence of a multiple pregnancy,
To assess chorionicity and amnionicity.
7. Towards the end of the first trimester, the scan also
offers an opportunity to detect gross fetal abnormalities
and, in health systems that offer first-trimester
aneuploidy screening, measure the nuchal translucency
thickness (NT).
In general, the main goal of a fetal ultrasound scan is to
provide accurate information which will facilitate the
delivery of optimized antenatal care with the best
possible outcomes for mother and fetus.
8. When should a first-trimester fetal ultrasound scan be
performed?
There is no reason to offer routine ultrasound simply to
confirm an ongoing early pregnancy in the absence of any
clinical concerns, pathological symptoms or specific
indications.
It is advisable to offer the first ultrasound scan when
gestational age is thought to be between 11 and 13+6
weeks’ gestation
if requested, evaluate fetal gross anatomy and risk of
aneuploidy.
Before starting the examination, a healthcare provider
should counsel the woman/couple regarding the potential
benefits and limitations of the first-trimester ultrasound
scan.(GOOD PRACTICE POINT)
9. Who should perform the first-trimester
fetal ultrasound scan?
Individuals who perform obstetric scans
routinely should have specialized training that is
appropriate to the practice of diagnostic
ultrasound for pregnant women. (GOOD
PRACTICE POINT)
10. To achieve optimal results from routine ultrasound
examinations it is suggested that scans should be
performed by individuals who fulfill the following
criteria:
1. Have completed training in the use of diagnostic
ultrasonography and related safety issues;
2. Participate in continuing medical education activities;
3. Have established appropriate care pathways for
suspicious or abnormal findings;
4. Participate in established quality assurance
11. What ultrasonographic equipment should be
used?
It is recommended to use equipment with at least the
following capabilities:
Real-time, gray-scale, two-dimensional (2D) ultrasound
Transabdominal and transvaginal ultrasound
transducers
Adjustable acoustic power output controls with output
display standards;
Freeze frame and zoom capabilities;
Electronic calipers;
Capacity to print/store images;
12. How should the scan be documented?
An examination report should be produced as
an electronic and/or paper document
Such a document should be stored locally and,
in accordance with local protocol, made
available to the woman and referring healthcare
provider. (GOOD PRACTICE POINT)
13. Is prenatal ultrasonography safe during the
first trimester?
Fetal exposure times should be minimized, using the
shortest scan times and lowest possible power output
needed to obtain diagnostic information using the
ALARA (As Low As Reasonably Achievable)
principle. (GOOD PRACTICE POINT)
Many international professional bodies, including
ISUOG, have reached a consensus that the use of B
mode and M-mode prenatal ultrasonography, due to
its limited acoustic output, appears to be safe for all
stages of pregnancy
14. Doppler ultrasound is safe or not?
Doppler ultrasound is, however, associated with
greater energy output and therefore more
potential bioeffects, especially when applied to
a small region of interest
Doppler examinations should only be used in
the first trimester, if clinically indicated.
(More details are available in the ISUOG Safety Statement)
15. What if the examination cannot be performed in
accordance with these Guidelines?
These Guidelines represent an international benchmark for
the first-trimester fetal ultrasound scan, but consideration
must be given to local circumstances and medical
practices.
If the examination cannot be completed in accordance with
these Guidelines, it is advisable to document the reasons
for this.
In most circumstances, it will be appropriate to repeat the
scan, or to refer to another healthcare practitioner. This
should be done as soon as possible, to minimize
unnecessary patient anxiety and any associated delay in
achieving the desired goals of the initial examination.
(GOOD PRACTICE POINT)
16. What should be done in case of multiple
pregnancies?
Determination of chorionicity and amnionicity is
important for care, testing and management of multifetal
pregnancies.
Chorionicity should be determined in early pregnancy,
when characterization is most reliable.
Once this is accomplished, further antenatal care,
including the timing and frequency of ultrasound
examinations, should be planned according to the
available health resources and local guidelines. (GOOD
PRACTICE POINT)
17. 1. Assessment of ‘Viability’ / early
pregnancy
2. Early pregnancy measurements
3. First-trimester fetal measurements
4. Assessment of gestational age
5. Assessment of fetal anatomy
GUIDELINES FOR EXAMINATION
18. 1. Assessment of viability / early
pregnancy
In this Guideline, ‘age’ is expressed as menstrual or
gestational age, which is 14 days more than
conceptional age.
Embryonic development visualized by ultrasound closely
agrees with the ‘developmental time schedule’ of human
embryos described in the Carnegie staging system.
The embryo is typically around 1–2 mm long when first
detectable by ultrasound and increases in length by
approximately 1 mm per day.
The cephalic and caudal ends are indistinguishable until
53 days (around 12 mm), when the diamond-shaped
rhombencephal cavity (future fourth ventricle) becomes
19. Defining ‘VIABILITY’
The term ‘viability’ implies the ability to live
independently outside the uterus and, strictly speaking,
cannot be applied to embryonic and early fetal life.
However Fetal viability, from an ultrasound perspective,
is the term used to confirm the presence of an embryo
with cardiac activity at the time of examination.
Cardiac activity is often evident when the embryo
measures 2 mm or more.
20. The presence of an intrauterine gestational sac clearly
signifies that the pregnancy is intrauterine, but the
criteria for the definition of a gestational sac are
unclear.
The use of terms such as an ‘apparently empty’ sac, the
‘double-decidual ring’ or even ‘pseudosac’ do not
accurately confirm or refute the presence of an
intrauterine pregnancy.
In an asymptomatic patient, it is advisable to wait until
the embryo becomes visible within the intrauterine sac
as this confirms that the ‘sac’ is indeed a gestational
21. 2. Early pregnancy measurements
The mean gestational sac diameter (MSD) has been
described in the first trimester from 35 days from the last
menstrual period onwards.
The MSD is the average of the three orthogonal
measurements of the fluid-filled space within the
gestational sac.
in the presence of the embryo, the crown–rump length
(CRL) provides a more accurate estimation of
gestational age than MSD. (MDSD values show greater
variability of age prediction).
22. 3. First-trimester fetal measurements
Which measurements should be performed in
the first trimester?
CRL measurements can be carried out
transabdominally or transvaginally.
A midline sagittal section of the whole embryo or fetus
should be obtained, ideally with the embryo or fetus
oriented horizontally on the screen.
An image should be magnified sufficiently to fill most of
the width of the ultrasound screen, so that the
measurement line between crown and rump is at about
90◦ to the ultrasound beam
23. Electronic linear calipers should be used to measure
the fetus in a neutral position (i.e. neither flexed nor
hyperextended).
The end points of crown and rump should be defined
clearly.
Care must be taken to avoid inclusion of structures
such as the yolk sac.
In order to ensure that the fetus is not flexed, amniotic
fluid should be visible between the fetal chin and chest.
25. However, this may be difficult to achieve at earlier
gestations (around 6–9 weeks) when the embryo is
typically hyperflexed.
In this situation, the actual measurement represents the
neck–rump length, but it is still termed the CRL.
In very early gestations it is not usually possible to
distinguish between the cephalic and caudal ends and
a greatest length measurement is taken instead.
The biparietal diameter (BPD) and head circumference
(HC) are measured on the largest true symmetrical
axial view of the fetal head, which should not be
distorted by adjacent structures or transducer pressure.
26. At about 10 weeks’ gestation, structures such as the
midline third ventricle, interhemispheric fissure and
choroid plexuses should be visible.
Towards 13 weeks, the thalamus and 3rd ventricle
provide good landmarks.
Correct axial orientation is confirmed by including in the
image both anterior horns and low occipital lobes of the
cerebral ventricles, whilst keeping the plane above the
cerebellum.
For BPD measurement, Both outer-to-inner (leading
edge) and outer-to-outer measurements are to be use.
28. Other measurements
Nomograms are available for abdominal
circumference (AC), femur length(FL) and most
fetal organs, but there is no reason to measure
these structures as part of the routine first-
trimester scan.
29. 4. Assessment of gestational age
Pregnant women should be offered an early ultrasound
scan between 10+0 and 13+6 weeks to establish
accurate gestational age. (Grade A recommendation)
Ultrasound assessment of embryonic/fetal age (dating)
uses the following assumptions:
gestational (menstrual age) represents post-conception
age+14 days;
embryonic and fetal size correspond to post-conception
(post fertilization) age;
structures measured are normal;
30. measurement technique conforms to the reference
normogram;
measurements are reliable (both within and between
observers);
the ultrasound equipment is calibrated correctly.
Accurate dating is essential for appropriate follow-up of
pregnancies and has been the primary indication for
routine ultrasound in the first trimester.
It provides valuable information for the optimal
assessment of fetal day of conception, to within 5 days
either way in 95% of cases
31. At very early gestations, when the fetus is relatively
small, measurement errors will have a more significant
effect on gestational age assessment; the optimal time
for assessment appears, therefore, to be somewhere
between 8 and 13+6 weeks. (GOOD PRACTICE
POINT).
At 11 to 13+6 weeks, the CRL and BPD are the two
most commonly measured parameters for pregnancy
dating.
It is recommended that CRL measurement should be
used to determine gestational age unless it is above 84
mm;
After this stage, HC can be used, as it becomes slightly
32. 5. Assessment of fetal anatomy
The second-trimester ‘18–22-week’ scan remains
the standard of care for fetal anatomical evaluation
in both low-risk and high-risk pregnancies.
First-trimester evaluation of fetal anatomy and
detection of anomalies was introduced in the late
1980s and early 1990s with the advent of effective
transvaginal probes.
The introduction of NT aneuploidy screening in the
11 to 13+6-week window has rekindled an interest
in early anatomy scanning.
33. Reported advantages include,
o early reassurance to at-risk mother early
o detection and exclusion of many major
anomaliess,
o earlier genetic diagnosis and
o easier pregnancy termination if appropriate.
34. Limitations include
o need for trained and experienced personnel,
o uncertain cost/benefit ratio and
o late development of some anatomical structures and
pathologies (e.g. corpus callosum, hypoplastic left
heart),
(which make early detection impossible and can
lead to difficulties in counselling due to the uncertain
clinical significance of some findings.)
35. Head
Cranial bone ossification should be visible by 11
completed weeks.
It is helpful to look specifically for bone ossification in
the axial and coronal planes.
No bony defects (distortion or disruption) of the skull
should be present.
The cerebral region at 11 to 13+6 weeks is dominated
by lateral ventricles that appear large and are filled with
the echogenic choroid plexuses in their posterior two
thirds (Figure 2b).
36. Normal choroid plexuses (C) and midline falx
and interhemispheric fissure (arrows). Lateral
walls of anterior horns are indicated by
(arrowheads)
37. The hemispheres should appear symmetrical and
separated by a clearly visible interhemispheric fissure and
falx.
The brain mantle is very thin and best appreciated
anteriorly, lining the large fluid-filled ventricles, an
appearance which should not be mistaken for
hydrocephalus.
At this early age, some cerebral structures (e.g. corpus
callosum, cerebellum) are not sufficiently developed to
allow accurate assessment.
At 11 to 13+6 weeks, an attempt can be made to visualize
the eyes with their lenses, interorbital distances, nose, the
nasal bone and mandible as well as the integrity of the
mouth and lips
41. Neck
Attention should be paid to proper alignment of
the neck with the trunk and identification of
other fluid collections such as hygromas and
jugular lymph sacs.
Sonographic assessment of NT is part of the
screening for chromosomal anomalies.
42. Spine
Longitudinal and axial views should be obtained to
show normal vertebral alignment and integrity, and an
attempt should be made to show intact overlying skin.
However, in the absence of obvious anomaly, failure to
examine the spine at this time should not prompt further
examination earlier than the mid-trimester scan.
Particular attention should be paid to the normal
appearance of the spine when BPD<5th centile
43. Fetal spine. Intact skin (short thick arrow) is
visible posterior to the vertebrae from neck to
sacrum in a true median view.
44. Thorax
The chest normally contains lungs of
homogeneous echogenicity on ultrasound,
without evidence of pleural effusions or cystic or
solid masses.
Diaphragmatic continuity should be evaluated,
noting normal intra-abdominal position of
stomach and liver.
45. Heart
The normal position of the heart on the left side
of the chest (levocardia) should be documented.
More detailed sonographic assessment of
cardiac anatomy has been demonstrated to be
feasible at 11 to 13+6 weeks., but this is not part
of routine assessment.
For safety reasons, use of Doppler is not
indicated during routine scanning.
46. Axial section of the fetal thorax at the level of
the four-chamber view of the heart, with the
cardiac apex pointing to the left (L)
47. Abdominal content
At 11 to 13+6 weeks, the stomach and bladder are the
only hypoechoic fluid structures in the abdomen.
The position of the stomach on the left side of the
abdomen together with levocardia helps confirm normal
situs visceralis.
The fetal kidneys should be noted in their expected
paraspinal location as bean-shaped slightly echogenic
structures with typical hypoechoic central renal pelvis
By 12 weeks of gestation, the fetal bladder should be
visible as a median hypoechoic round structure in the
lower abdomen.
48. Axial view of abdomen at level at which abdominal
circumference is measured (dashed line), showing
stomach (S) and umbilical vein (UV).
49. Coronal view of abdomen showing kidneys with
central hypoechoic renal pelvis (K, arrows),
stomach (S) and diaphragm (Diaph, lines).
50. Abdominal wall
The normal insertion of the umbilical cord
should be documented after 12 weeks.
The physiological umbilical hernia is present up
to 11 weeks and should be differentiated from
omphalocele and gastroschisis
52. Limbs
The presence of each bony segment of the
upper and lower limbs and presence and
normal orientation of the two hands and feet
should be noted at the 11 to 13+6-week
ultrasound scan.
The terminal phalanges of the hands may be
visible at 11 weeks, especially with transvaginal
scanning.
54. Normal leg showing normal orientation of
foot with respect to lower leg. Also visible are
kidney (K) and stomach (S).
55. Genitalia
The evaluation of genitalia and gender is based
upon the orientation of the genital tubercle in
the mid-sagittal plane,
(but is not sufficiently accurate to be used for
clinical purposes.
56. Umbilical cord
The number of cord vessels, cord insertion at the
umbilicus and presence of cord cysts should be noted.
Brief evaluation of the paravesical region with color or
power Doppler can be helpful in confirming the
presence of two umbilical arteries,
(but this is not part of the routine assessment.)
57. Role of three-dimensional (3D) and 4D
ultrasound
Three-dimensional (3D) and 4D ultrasound are
not currently used for routine first-trimester fetal
anatomical evaluation, as their resolution is not
yet as good as that of 2D ultrasound.
In expert hands, these methods may be helpful
in evaluation of abnormalities, especially those
of surface anatomy.
58. 6. Chromosomal anomaly assessment
Most experts recommend that NT should be measured
between 11 and 13+6 weeks, corresponding to a CRL
measurement of between 45 and 84 mm.
This gestational age window is chosen because NT as
a screening test performs optimally and fetal size allows
diagnosis of major fetal abnormalities
Screening performance is further improved by the
addition of othermarkers, including biochemical
measurement of free beta or total human chorionic
gonadotropin (hCG) and pregnancy-associated plasma
protein-A (PAPP-A).
59. In appropriate circumstances, personnel with
appropriate training and certification may sought for:
• additional aneuploidy markers,
• including nasal bone,
• tricuspid regurgitation,
• ductal regurgitation
• and others.
60. How to measure NT
NT measurements used for screening should only be
done by trained and certified operators.
NT can be measured by a transabdominal or
transvaginal route.
The fetus should be in a neutral position, a sagittal
section should be obtained and the image should be
magnified in order to include only the fetal head and
upper thorax.
Furthermore, the amniotic membrane should be
identified separately from the fetus.
61. The median view of the fetal face is defined by
o the presence of the echogenic tip of the nose and
rectangular shape of the palate anteriorly,
o the translucent diencephalon in the center and
o the nuchal membrane posteriorly.
If the section is not exactly median, the tip of the nose
will not be visualized and the orthogonal osseous
extension at the frontal end of the maxilla will appear.
The ultrasound machine should allow measurement
precision of 0.1 mm.
62. Calipers should be placed correctly (on-on) to measure
NT as the maximum distance between the nuchal
membrane and the edge of the soft tissue overlying the
cervical spine.
If more than one measurement meeting all the criteria is
obtained, the maximum one should be recorded and
used for risk assessment.
Multiple pregnancy requires special considerations,
taking into account chorionicity.
65. How to train and control for the quality of NT
measurement
A reliable and reproducible measurement of NT
requires appropriate training.
A rigorous audit of operator performance & constructive
feedback from assessors has been established in many
countries and should be considered essential for all
practitioners who participate in NT-based screening
programs. (GOOD PRACTICE POINT)
66. Aims of the nuchal scan
To date the pregnancy accurately
To diagnose multiple pregnancy
To diagnose major fetal abnormalities
To diagnose early miscarriage
To assess the risks of Down's syndrome and other
chromosomal abnormalities
67. 7. Other intra- and extrauterine structures
The echostructure of the placenta should be evaluated.
Clearly abnormal findings, such as masses, single or
multiple cystic spaces or large subchorionic fluid
collection (>5 cm), should be noted and followed up.
Position of the placenta in relation to the cervix is of less
importance at this stage of pregnancy since most
‘migrate’ away from the internal cervical os.
Placenta previa should not be reported at this stage.
68. Special attention should be given to patients with a prior
Cesarean section, who may be predisposed to scar
pregnancy or placenta accreta, with significant
complications.
In these patients, the area between the bladder and the
uterine isthmus at the site of the Caesarean section
scar should be scrutinized.
In suspected cases, consideration should be given to
prompt specialist referral for further evaluation and
management.
PRIOR CESAREAN SECTION
69. Other findings to be seen
Gynecological pathology, both benign and malignant,
may be detected during any first-trimester scan
Abnormalities of uterine shape, such as uterine septa
and bicornuate uteri, should be described.
The adnexa should be surveyed for abnormalities and
masses.
Editor's Notes
as this provides an opportunity to achieve the aims outlined above, i.e. confirm
viability, establish gestational age accurately, determine
the number of viable fetuses and
In embryology, Carnegie stages are a standardized system of 23 stages used to provide a unified developmental chronology of the vertebrate embryo.
but is not evident in around 5–10% of viable embryos measuring between 2 and 4 mm
2nd point explanation - Ultimately, the decision is a subjective one and is, therefore, influenced by the experience of the person performing the ultrasound examination.
Nomograms for both crown–rump length (CRL) and MSD are available, but, in the presence of the embryo, the CRL provides a more accurate estimation of gestational age because MSD values
show greater variability of age prediction35,36.
Note neutral position of neck.
caliper placement should follow the technique used to produce the selected nomogram.
Biparietal diameter (BPD) measurement (calipers).
Note true axial view through head and central position of third ventricle and midline structures (T indicates third ventricle and thalamus).
Head circumference would also be measured in this plane.
Many authors have published nomograms for these variables.
Measurements can be made transabdominally or transvaginally.
Singleton nomograms remain valid and can be applied in the case of multiple pregnancy
relight (a fire).
"Josh set about rekindling the stove“
revive (something lost or lapsed).
verb rekindle when you're trying to get something started again
Note that choroid plexuses extend from the medial to the lateral border of the posterior horn.
Lateral walls of anterior horns are indicated by arrowheads.
However, in absence of obvious anomaly, failure to examine the fetal face at this time should not prompt further examination earlier than the mid-trimester scan.
N nasal bone
(which will be discussed below)
Note vertebral bodies show ossification, but neural arches, which are still cartilaginous, are isoechoic or hypoechoic.
In cervical region (long arrow) the vertebral bodies have not yet ossified and the cartilaginous anlage is hypoechoic; this is normal
Note atria and ventricles are symmetrical on either side of the septum (arrow).
Lung fields are of homogeneous echogenicity and symmetrical.
Aorta is just to left side of spine (S).
thus providing women who are carrying an affected fetus with the option of an early termination of pregnancy
To diagnose multiple pregnancy. Approximately 2% of natural conceptions and 10% of assisted conceptions result in multiple pregnancy. Ultrasound scanning can determine if both babies are developing normally and if the babies share the same placenta which can lead to problems in the pregnancy. In such cases it would be advisable to monitor the pregnancy more closely.