Comprehensive Obstetrics Ultrasound Scan Lecture. Indications for 1st , 2nd and 3rd Trimester Ultrasound scans. Pathological findings. Emergency obstetrics Ultrasound scan cases. Sample ultrasound scan report. Useful Radiology Training Resource for Paramedics and Medics

1. RADIOLOGY TRAINING RESOURCE FOR MEDICAL
IMAGING TECHNOLOGISTS/SONOGRAPHERS,
NURSES, MIDWIVES AND RELATED MEDICS
Module 7: Understanding Basics of
Obstetrics Ultrasound Scan
Course lecturer
Nchanji Nkeh Keneth
Radiologic Technologist/Sonographer
CSMRR: 001012016
+237 671459765
B.TECH/HPD in MDIRT
(St. LOUIS UNIHEBS, Univ Buea)
excellence660@gmail.com
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Nurses,MidwivesandMedics,NchanjiNkehKeneth
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2. PART 1
OVERVIEW OF ULTRASOUND (US)
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4. Presentation outline
 Overview of Ultrasonography
 Basic Terminologies used in Ultrasound
 Ultrasound scans of the Abdomen, pelvis,
Obstetrics, Testicles, Breast, Thyroid, Heart,
Blood vessels, Prostate
 Emergency Ultrasound (FAST Scan)
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5. Outcome
 At the end of this presentation, students
would have:
Learned about general ultrasound, basic
definitions, various body parts
Be able to recognize abnormal findings
based on reports from Sonographers
and correlate with clinical presentations
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6. Requirements of this module:
All Students are Urged to review their anatomy and
physiology lectures on:
• The digestive system
• Cardiovascular System
• Reproductive system
• Obstetrics and Gynecology
• And Pathological conditions
associated with these body systems
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7. Introduction
 Ultrasound is sound inaudible to the human
hearing
 All sound exhibit frequency energy and
only travel through a medium
 Ultrasonography ( also known as
Echography) is a medical Diagnostic
Imaging Modality, making use of
Ultrasound waves and an Ultrasound
Machine to obtain images of the human
body for diagnostic and therapeutic
purposes
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9. Intro Cont
 Ultrasound scan use began in the 1950s and
first rudimentary ultrasound scan was that
of pregnancy (obstetrics)
 The Science of Ultrasonography has been
evolving and today, Ultrasound exam of the
heart and blood vessels can be performed
 Ultrasound scan is the safest diagnostic
medical imaging modality for women and
children
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10.  Ultrasound scan services are widely
available even in local settings and are the
most frequently done with high chances of
misdiagnosis
 Ultrasound scan is Operator Dependent!!
 Proper training of Sonographers and
Sonologists and Assistant Sonographers are
indispensable for Safe Ultrasound Practice
 Errors in Ultrasound Diagnosis can be
devastating
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11. Sonogram of ectopic cervical
gestation
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15. Types of Ultrasound Scan
Exams
1. Obstetrics
2. Pelvic
3. Abdominal
Ultrasound
4. AbdominoPelvic
Ultrasound
5. Musculoskeletal
Ultrasound
6. Breast Ultrasound
7. Prostate Ultrasound
8.Transfontannel
ultrasound
9.Doppler Ultrasound
10.Echocardiography
11. Special Ultrasound
scan procedures in
Interventional
Radiology
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22. Ultrasound Terminologies Frequently seen in
Ultrasound reports
 Anechoic: this terms describes any area
looking dark (black ) on ultrasound. It
usually represents the collection of fluid
 Hypoechoic; Grey area seen on the
Ultrasound scan or on the film printed;
Denotes soft tissues and some times masses
and fluid collection
 Hyperechoic: Means a bright white area on
the scan. This represents areas of dense
structures like bones and calcifications
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23. Terms Con’t
 Isoechoic: Means two structures compared,
look the same
 Homogenous: Means the structure examined
looks uniform as should be as opposed to
heterogeneous presentation
 Ultrasound Report: This is a documentation
of the Ultrasound scan findings
 Indication of the US exam: This is the
justified medical reason requiring the
performing of the ultrasound scan
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24. General Benefits of
Ultrasound
 Safe and fast and quite affordable in
evaluating the welfare of a pregnancy
 Useful in detecting pelvic abnormalities esp
in women
 Useful in the assessment of Prostate Problems
like BPH
 Assessment of heart problems is equally done
on ultrasound
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25. Advantages of Ultrasound Scan Over Radiography and
other Medical Imaging Modalities
Easily accessible and cost of
exam relatively affordable
Fast to perform and
repetitive
No use of Ionising radiations
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26. Part 2
Understanding various
Types of Ultrasound Scan
Examinations
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27. Part 2a
Obstetrics
Ultrasound Scan
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29. Obstetrics US
 This is the ultrasound scan done to examine
pregnancy
 Obstetrics US is done in the various
trimesters of pregnancy
 Useful in detecting abnormalities with the
pregnancy
 Repetitive and cost effective and helps in the
proper management of the pregnancy
 Obst US is highly recommended in todays
ANC services
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35. FIRST TRIMESTER
OBSTETRICS ULTRASOUND
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36. 1st Trim Obst USS Exam
 This is US exam done within the first Three
Months of pregnancy
 This is the recommended standard for all
pregnant women
 Endovaginal Ultrasound scan technique is
gold standard for the proper examination of
the GS (Gestational Sac) and contents
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37. Using GS to estimate
Gestational Age (GA)
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39. Mean Sac Diameter
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40. Indications for 1st Trim Obst US
 1. to confirm pregnancy
 2. to rule out the location of the GS
 3. to estimate the age of pregnancy
 4. to rule out the cause of per vaginal
bleeding in Pregnancy
 5. to evaluate the cause of Lower abdominal
Pains
 6. to know the number of gestational sacs
 7. follow up evaluation of threatened
abortion
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42. Subchorionic haematoma
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44. Incomplete Abortion
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45. D and C Contents
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46. Incomplete Obst USS Request (left)
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47. Sample Ultrasound scan Report
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49. Positive PT with no GS in the
uterus
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50. Complete Molar gestation
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51. Myoma in Early Pregnancy
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Blighted Ovum

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54. Essential Aspects of the 1st Trim Obst US
Report
 Documentation of the Following:
 1. Gestational Sac
 2. Subchorionic collections
 3. presence of the Yolk sac
 4. presence of the embryo and signs of viability
 5. any uterine lesions
 6. adnexal findings
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55. Next lecture
Second Trimester Obstetrics
Ultrasound
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56. Second and Third Trimester
Obstetrics Ultrasound
(14-42 weeks )
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58. This is ultrasound scan exam done
from 13 weeks to 42 weeks of
gestation
Second Trimester begins from 12-
24 weeks and third trimester begins
from 25 weeks to 42 weeks of
gestation
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59. Indications for 2nd Trim Obst USS
 1.Routine Fetal evaluation
 2.Placenta development and position
 3.To rule out the cause of pv bleeding
 4. to estimate the age of the gestation
 5. to evaluate the structural development of
the fetus
 6. r/o the cause of LAP
 7. to confirm the viability of the fetus
 8. sex determination
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60. Fetal Structural Developments
 Fetal skull, limbs, neck , spine and thoraco
abdominal organs are assessed.
 Skull deformities could be seen
 Spinal defects
 Abdominal defcets
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61. Gestational Age (GA)
Estimation
 BPD: Biparietal Diameter
 AC: Abdominal Circumference
 HC: Head Circumference
 FL: Femur Length
 APBD: Anterior Posterior Body Diameter
These are biometric parameters used in
evaluating GA and Fetal Weight
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62. Amniotic Fluid Evaluation
 Normal Volume using the Maximum
Vertical Pocket Technique should range
between 3cm to 8cm in second Trimester.
 If the volume is less than 3cm, it is called
olygohydramnios and if more than 8cm, it is
termed polyhydramnios
 NB. Read on the Formation of Amniotic
Fluid and its Relevance in Obst.
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64. Fetal gender
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65. The case of twin gestation
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66. 2nd Trim Obst Abnormal Findings
fetal Demise
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67. Severe Polyhydramnios
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68. Placenta Previa
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69. Placenta Previa
Complete Placenta Previa
Low Lying Placenta Previa
Marginal Placenta Previa
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70. Incompetent Cervix
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71. Normal Cervix (L) vs abnormal
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72. Meningoceles
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73. 2nd Trim Obst Uss Report
 Report should comment on the Placenta
 Amniotic Fluid
 Status of the Cervix and Uterus
 The Fetus: Biometry and Fetal Structures
beside fetal weight and Heart activity
 Number of fetuses should be documented
and fetal gender if the patient desires
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74. Third Trimester Obst USS
 Indications
 1. routine fetal evaluation
 2. fetal Presentation evaluation
 3, Placenta assessment
 4. amniotic Fluid Volume and
echogenicity
 5. GA and due date in case of unknown
lmp and previous exams
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75. Remarks
 Placenta Grade and sonographic changes
should be noted
 Amniotic fluid volume and echogenicity
should be noted
 Manning Score (Physiologic Score) should
be noted
 Fetal activity should be noted
 Umbilical Cord entanglements should be
documented on
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76. Fetal Presentation
 Back cephalic is the Ideal Presentation for
normal delivery
 Breech, transverse and oblique positions could
be seen
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77. Breech Presentation
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78. Placenta Calcifications
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79. Essential Components of 3rd
Trim Obst Uss Report
 1. Fetal Presentation
 2.Heart rate (135b/m to 149b/m)
 3.Amniotic Fluid Volume (AFI or MVP
Measurements . Olygohydramnios or
polyhydramnios should be commented on
 4. Placenta Grade and calculi should be
commented
 5. Grade Score should be noted
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80. ANY QUESTIONS ?
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81. References
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82. References
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83. FUNDAMENTALS OF OBSTETRIC AND
GYNAECOLOGICAL ULTRASOUND
NURSING/MIDWIFERY L400 STUDENTS OF ST. LOUIS UNIHEBS
2015/2016 ACADEMIC YEAR
PART A
Brief Review Of Anatomy And Physiology Of The Female
Pelvic Organs
83
Nchanji NKEH KENETH
kennchanji@yahoo.com
Radiology Dept
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WITH MATERIALS FROM AIUM, UKAS, WHO MANUAL OF DIAGNOSTIC ULTRASOUND
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