Pelvic and obstetrics ultrasound radiology training lectures, nchanji nkeh keneth

RADIOLOGY TRAINING RESOURCE FOR MEDICAL
IMAGING TECHNOLOGISTS/SONOGRAPHERS,
NURSES, MIDWIVES AND RELATED MEDICS
Module :
Fundamentals Of Obstetric And
Gynaecological Ultrasound
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
MedicalImagingTrainingResourceForMedicalImagTech,
Nurses,MidwivesandMedics,NchanjiNkehKeneth
1
10/23/2020

FUNDAMENTALS OF OBSTETRIC AND
GYNAECOLOGICAL ULTRASOUND
NURSING/MIDWIFERY L400 STUDENTS OF ST. LOUIS UNIHEBS
2015/2016 ACADEMIC YEAR
PART C
Lecture 3
Ultrasound Scan of the Non-Gravid Uterus and Gravid
Uterus (Obstetrics)
2
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh
Keneth
WITH MATERIALS FROM AIUM, UKAS, WHO MANUAL OF DIAGNOSTIC ULTRASOUND

Pelvic ultrasound
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics ,
Nchanji Nkeh Keneth
3

Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji
Nkeh Keneth 4

Introduction
Pelvic ultrasound plays a very vital role
in gynecology
It is usually done in conjunction with
obstetric ultrasound
Thorough knowledge of the female
pelvic anatomy/ physiology is
paramount.
It concentrates primarily on the uterus,
ovaries, FT while scanning the adjacent
adnexae
Keneth 5

Patient preparation
It usually requires a full urinary bladder for
trans abdominal scan.
The patient may also need enema
cleansing of the large bowel
The full Ub serves as an acoustic window
for the uterus and other structures
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth 6

Medical Imaging Training Resource For
Medical Imag Tech, Nurses, Midwives
and Medics , Nchanji Nkeh Keneth 7

Indications for pelvic US/clinical features
The indications include but are not limited
to the following:
1. Follow up of a known disease
2. Pelvic pain
3. Abnormalities with menstruation
4. Lower abdominal tenderness,
5. Confirmation of PID
6. Suspected female reproductive tract
obstruction
Nchanji Nkeh Keneth 8

Step by step approach
1 The UTERUS
It is a pear-shape
muscular organ
Measures about 7.5cm
in length, 5cm in width
and about 2.5cm in
thickness
Please visit lecture 1 for
more details

Hysterectomy images

Uterus cont
The uterus is
surrounded by 8
ligaments
Some common
terms to describe
the uterus
position are:
Retroverted
Retroflexed
Anterveted
anteflexed

Sonographic characteristics
The uterus is seen as a homogeneous structure lying posterior to
the distended bladder. In the sagittal plane, the vagina is
identified as three parallel echogenic lines opening into the
cervix. The cervix is a slightly bulbous and smoothly
marginated opening into the body and fundus. The central
endometrial canal is represented as a hyperechoic line. On
occasion, the canal can be distended by fluid (blood or pus).
Intra-cavitary scanning provides superior detail of the uterine
tissue and better describes the following uterine changes that
occur in different phases of the menstrual cycle.

Uterine lining thickness at diff phases of the
menstrual cycle
Nkeh Keneth 14

Normal uterus variants and
abnormalities

Nkeh Keneth 16

Disorders of the uterus
Uterine fibroid
Leiomyoma are the most common benign neoplasms
of the uterus. They are found in 20 to 40 percent of
women over 30 to 35 yrs. of age. They are also
known as fibroids, myomas and fibroleiomyomas
because they are composed of varying amounts of
smooth muscle and stromal tissue. Leiomyomas are
usually multiple but do occur as solitary lesions in
less than 2 percent of patients.
Leiomyoma may be situated under the serosa
(subserous), within the myometrium (intramural or
interstitial) or under the mucosa or endometrium
(submucous or subendometrial). Intra mural
leiomyomas are the most common; sub mucosal are
the least frequent.
Keneth
17

They are most common in the body and fundus of
the uterus. In 3 percent of cases, a leiomyoma is
found in the uterine cervix; at times, a tumor may
occur in the broad ligament, where it mimics an
adnexal neoplasm.
Because they may grow under the influence of
oestrogen, leiomyomas may increase in size during
pregnancy and may become smaller following
menopause. They vary in size from a few cm to massive
tumors.

They may undergo malignant changes. A
leiomyosarcoma develops in a pre-existing
leiomyoma in approximately 0.2 percent of cases.
Enlargement of a fibroid in a postmenopausal
woman should raise the possibility of malignant
degeneration. It is important to remember that it is
usually impossible to definitely differentiate a benign
fibroid from a leiomyosarcoma either clinically or
sonographically.
Leiomyomas occasionally cause infertility by
deforming the isthmic portion of the fallopian tube
and obstructing the passage of the ovum.
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and
Medics , Nchanji Nkeh Keneth 19

Various types of fibroids based on their
location
20
and Medics , Nchanji Nkeh Keneth

Clinical findings/ sonographic appearance
Patients with leiomyomas
are usually
asymptomatic, though
they can present with
menstrual irregularities,
abdominal or pelvic pain,
pressure symptoms of the
urinary bladder and GIT,
palpable pelvic or
pelvoabdominal mass or
infertility or prolonged
labor.
Sonographically,
A hypoechoic mass is
usually seen
The size and shape of
the uterus varies
There may be
calcifications
Nkeh Keneth 21

Fibroids in pregnanacy

Nkeh Keneth 24

Disorders
2. POLYPS
They arise from the
endometrium,
echogenic and are
small in size.
Keneth 25

3.NEBOTHIAN cysts
Nabothian cysts are benign cystic
lesions of the endocervix that are
frequently multiple and range
from 2 to 3 mm in diameter. The
cervix of the uterus contains
glands lined by mucin secreting
cells. When the duct is obstructed
or stenosed because of
inflammation from chronic
cervicitis, retention of mucus
results in cystic dilation of the
gland and the development of a
Nabothian cyst.
The patient is
generally
asymptomatic. There
may be associated
signs and symptoms
of cervicitis such as
vaginal discharge,
dyspareunia, urinary
frequency, urgency or
metrorrhagia
Clinical findings

4. Cervical carcinoma
Carcinoma of the cervix is the most
common malignant gynecologic
neoplasm in women. It occurs
predominantly between 45 and 55 yrs of
age but can affect younger patients. The
exact etiology of carcinoma of the
cervix is uncertain. Lower
socioeconomic status, early sexual
exposure, herpes virus type 2 and
multiple sexual partners have been
considered as contributing factors.
28

Clinical findings
Although patients may be asymptomatic,
some present with abnormal uterine
bleeding, vaginal discharge, anorexia (loss
of appetite), anemia, weight loss, pelvic
pain, cervical ulceration,
dyspareunia(painful sexual intercourse)
etc.
Nkeh Keneth
29

Sonographic properties
Most commonly a
mass posterior to the
urinary bladder that is
usually hypoechoic,
but may be
inhomogeneous
Keneth 30

5.Female genital tract obstruction
An obstruction can occur
anywhere in the female
genital tract. Cause of
obstruction include
imperforate hymen, vaginal
membrane, vaginal cervical
stenosis or atresia, post
menopausal atrophy, vaginal
fibroma, radiotherapy for
carcinoma of the cervix.
Clinical findings
Pubertal age females
presenting with
amenorrhea, pelvic
pain, abdominal
distention, palpable
pelvic mass and urinary
tract obstruction.
Keneth 31

Sonographic features
Most commonly an ovoid or
pear-shaped sonolucent midline
mass with posterior acoustic
enhancement situated behind
the urinary bladder
Low-level internal echoes may
be scattered throughout the
mass or produce an echogenic-
anechoic level The uterus may
be displaced superiorly.
The lesion can be lobulated or
tubular if there is extension of
the hemorrhage into the cervix
and uterus.
Keneth 32

The fallopian tubes
The fallopian tubes are not usually visualized
sonographically because of their extremely small
diameter, however, a fallopian tube distended
with pus (pyosalpinx) or fluid (hydrosalpinx) can
be readily seen. Conventional trans abdominal
scanning demonstrates a distended tube as a
sonolucent cylindrical structure lying in a
transverse plane in the adnexal area. An
intracavitary probe often may even show it
folding on itself in the adnexal region.
33

Disorders
1.Hydrosalpinx
Hydrosalpinx
refers to the
dilatation of the
fallopian tube
with fluid; if
pus, then
pyosalpinx
34

The OVARIES and disorders
The bilateral ovaries are seen as oblong or
almond shaped structures lying in the adnexal
regions . They usually lie medial to the iliac
vessels and lateral to the ureters. The position of
each ovary is highly variable and may change
due to pregnancy, surgical procedures, or
displacement by adjacent structures. The
ovaries are well encapsulated and exhibit a
smooth medium echogenicity. They usually
contain thin walled sonolucent follicles that
generally are not more than 2.5 cm in diameter.

The size of
the ovary
reduces in
post
menopausal
women

Disorders
1.Follicular cysts
When a mature follicle
fails to involute or
ovulate, it ruptures and
closes off immediately,
resulting in retention of
the fluid and the
formation of a follicular
cyst.
Clinical features
Although most patients
are asymptomatic, some
present with pelvic pain
due to hemorrhage into
the cyst; rupture of the
cyst; or torsion of the
ovary containing the cyst.
Occasionally, abnormal
uterine bleeding or an
enlarged tender ovary
may develop.
Medics , Nchanji Nkeh Keneth 37

Most commonly
an anechoic
ovarian mass
with thin smooth
walls.
Image
Keneth 38

Hemorrhagic ovarian cyst
Keneth 39

Corpus luteum cyst

3. Polycystic ovarian disease
Polycystic ovarian disease (PCOD)
(Stein−leventhal syndrome) is a complex
endocrinologic disorder that causes
chronic anovulation.
It results from low levels of FSH and high
level of LH !!!!!
Usually bilateral
Keneth 41

PCOD
Nkeh Keneth 42

4.DERMOID cysts
They are benign tumors that arise from
germ cells of the ovary. Composed of
tissue originating from all three germ
cell layers (ectoderm (covers the body
of the embryo, it produces the epidermis
and the NS of the adult), endoderm( one
of the tissue layers of the embryo wh
eventually produces the GIT) and
mesoderm( eventually produces many
organs of the adult such as the brain,
muscles, will give rise to body
systems,etc), 43

Dermoids contain variable amounts of
fat, hair, skin and teeth. Although they
can occur at any age, the tumor most
often is found in the reproductive age
group (20 to 40 yrs of age).
Dermoids account for 10 to 15 percent
of all ovarian neoplasm (50 percent of
all ovarian neoplasm in children). They
are usually unilateral, but can be
bilateral in 25 percent of cases and
multiple in the same ovary.
Nkeh Keneth 44

Multiple nodules in the mass or
predominantly solid components in a
childhood tumor should suggest the
possibility of malignancy. Ascites, metastatic
liver disease, lympadenopathy,
hydronephrosis
and mesenteric as well as omental involvement
may be associated with malignant degeneration,
which develops in 2 to 4 percent of cases.

Sonographic appearance
It consists of a complex mass containing
fluid and hyperechoic solid tissue
associated with posterior acoustic
shadowing. The hyperechoic component
may result from sebum, hair and at times
from teeth, calcification or ossification.

Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an
acute or chronic process in which
infection spreads to the pelvis in
ascending fashion, most commonly via
the vagina but also by direct spread
from pelvic surgery, diverticulitis,
ruptured appendiceal abcess, post-
partum sepsis or the hematogenous
route. An intrauterine device may
predispose to the development of PID
at the time of insertion, (or re-
insertion), or if it perforates. 49

50
The three stages of PID are hyperemia,
frank salgingitis and tubo-ovarian
abscess. In the 1st stage, which is
characterized by mild hyperemia, free
effusion and exudates, the ultrasound
exam may be entirely normal. The 2nd
stage of salpingitis consists of
enlarged ovaries with no evidence of
abcess. In the 3rd stage, the enlarged
ovaries contain abcesses of varying
size, which may appear in the pouch of
douglas.

Clinical findings
Patients may remain
asymptomatic or
present with a foul-
smelling vaginal
discharge, fever,
pelvic discomfort, pain
or tenderness, a
palpable pelvic mass
or abnormal bleeding.
Endometrial
echoes may be
more
prominent than
normal
51

PID
note the prominent endometrial echoes in the images

5.Endometriosis
It is the presence of active functioning
endometrial tissue outside its normal site in
the lining of the uterine cavity. The
condition affects women in the child-bearing
age and can be diffuse or focal. The ovary is
the most frequent site of involvement, which
is usually bilateral. Other areas affected by
endometriosis include the pouch of
Douglas, round ligaments, urinary bladder,
broad ligament posterior surface of the
uterus, colon etc.
53

The exact etiology of endometriosis is
unknown. Postulated causes include;
Ectopic endometrial tissue is
transplanted on pelvic structures from
the uterus via the fallopian tubes by
retrograde menstrual blood flow.
Endometrial tissue is directly implanted
at the time of surgery or as a
combination of the above mechanisms.

Endometrioma or Endometriotic cyst of ovary or
Chocolate cyst of the ovary
Nkeh Keneth 55

Lecture 4
Obstetric
ultrasound
56

Introduction
lecture outline
Early development of the embryo/ fetus
First trimester Ultrasound
Maternal physiology and embryo
development
Identification of fetal landmarks and
sacs
Determination of gestational age
Nkeh Keneth 57

First trimester complications
Developmental pitfalls and
anomalies.
Second and third trimester
ultrasound
Placental development and
abnormalities
Multiple gestations
Twin gestations
Keneth 58

Rem:
OBSTETRICS IS THE BRANCH
OF MEDICAL SCIENCE THAT IS
CONCERNED WITH THE
HEALTH CARE OF WOMEN
DURING AND AFTER
PREGNANCY

Early development of the embryo and the
fetus
The first 27 days of gestation
(pre−embryonic period) includes
the fertilization period,
implantation of the blastocyst and
development of the yolk sac,
primitive streak, limb buds, and
the primordia of the liver,
pancreas, lungs, heart etc.
Keneth
60

The embryonic period begins at day
28 and continues until the end of the
7th week.
By this time, all the organs in the body
must have been formed and development
continues till the onset and end of the
fetal period
Nkeh Keneth 61

4 weeks gestation 5 weeks gestation
Keneth 62

6 weeks gestation
7 weeks gestation

During this early period of
development of the embryo,
transvaginal ultrasound I the best
method of imaging.
Gestational age within the first
trimester can be evaluated by
measuring the Crown Rump Length
(CRP).

The CRL is the distance
from the crown of the head
to the rump of the anal
region. This measurement
becomes inaccurate at the
onset of 8 weeks of gestation

Fetal structures routinely seen are
Fetal heart: The four chambered view is
identified, fetal heart motion is
documented and the fetal rate is
computed.
Fetal lungs.
BPD and head circumference are
measured for dating
Fetal brain and ventricle measurements
are obtained.
Keneth
66

Fetal structures routinely seen are
Fetal spine is documented in the
longitudinal plane at the cervical,
thoracic and lumbosacral levels.
Umbilical cord and cord insertion
site into the abdomen are
documented.
Fetal kidneys and bladder are
localized and documented.
67

Organs routinely scanned
The fetal diaphragm and adjacent thorax
and abdomen are documented in the
longitudinal plane.
Fetal limbs are identified and a
measurement of the femur length is
obtained.

Nkeh Keneth 69

Ultrasound Evaluation during
the First Trimester of
Pregnancy
Keneth 70

The first trimester is characterized
by the remarkable transformation
of a single cell into a human.
Transvaginal sonography is the
optimal way to image a patient
during the 1st trimester of
pregnancy
Keneth 71

Indications for first trimester
ultrasound
The need to identify the location and
number of gestational sacs.
The need to date the age of a
pregnancy
The need to determine whether an early
pregnancy has a normal appearance or
whether sonographic indicators are
present that predict failure and

Maternal symptoms such as pain and
bleeding.
The 1st trimester can be divided into pre-
and periovulation, conceptus, embryonic
and fetal phases of development
Nkeh Keneth 73

MATERNAL PHYSIOLOGY AND EMBRYO
DEVELOPMENT
During the 1st 2 wks of pre and
periovulation, cyclic changes occur within
both the ovaries and endometrium as a
result of the influence of pituitary
gonadotropic FSH and LH.
Keneth 74

A 28 day cycle
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
75

During the 3rd to 5th wks of the cycle (the
conceptus period), fertilization occurs, with
subsequent development of morula,
blastocyst and bilaminar and ultimately
trilaminar, or flat, embryo
76

The morula enters the uterine cavity on
day 18 or 19 of the cycle
During the 4th week, the blastocyst,
measuring 1mm in diameter, becomes
fully imbedded into myometrial tissue
Not surprisingly, during this process, as
trophoblastic tissue invades the
endometrium, vaginal bleeding may
occur and be confused clinically with an
atypical menstrual cycle 77

During the final wk of the conceptus stage
(5 wks GA), normal menstrual flow is
absent and the woman may suspect
pregnancy
The products of conception continue to
enlarge primarily as a result expansion of
the chorionic cavity, which attains a
diameter of 5mm

The gestational sac with the yolk sac at 6 weeks gestation is
normally seen.
11 to 12 weeks of gestation begins the fetal period and
continues till the end of the third trimester.
Primordial heart beat begins at 6 wks of gestation and the
Cardiovascular system develops rapidly
79

NORMAL SONOGRAPHIC ANATOMY
AND LAND MARKS
1. Identifying the gestational sac
This is the first definitive
sonographic finding confirming an
early intrauterine pregnancy.
It is perceived as a fluid collecting
sac surrounded completely by an
echogenic rim of tissue.
it measures about 2 to 3mm and
corresponds to 4 weeks 1-3 days GA

The rim of surrounding echogenic
tissue is the decidua layer
The fluid cavity is the chorionic cavity
which contains the chorionic fluid.
The MGSD (mean gestational sac
diameter) is usually determined and the
normal value is 5mm which
corresponds to 5 weeks of gestation
If the diameter is more than 20mm with
no yolk sac or embryo, it is a blighted
ovum
Keneth
81

The more the sac enlarges, it eventually joins with the
adjacent decidua layer to form the double sac layer
Double sac sign Blighted ovum
82

Sonographic sttres and land
marks con’t
2. Identifying the yolk sac
This is the first anatomic structure seen
within the GS at about 5.5 weeks of
gestation. It serves as the nutrient source
for the develop
Visualization of the YS confirms that an intrauterine
fluid collection represents an early IUP as opposed to a
pseudo sac associated with an ectopic pregnancy. The
YS can be used for dating purposes, and it serves as
an anatomic landmark for initially locating the
embryonic disk and early cardiac activity
83

Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics
, Nchanji Nkeh Keneth
84

DETERMINING
GESTATIONAL AGE
The best time to date a pregnancy is
during the 1st trimester, when biologic
variation is relatively minimal besides
less maternal influence on the
development of the embryo.
determining GA based on the LMP is
often risky as most women are
uncertain about their LMP

The first sttre that can
be measured is the
GS wherein the
MGSD is calculated
The YS is also measured to
date the pregnancy. YS with
cardiac activity corresponds to
5.5wks gestation
The crown rump length is the
most suitable measurement as
from 7-12weeks gestation
86

FIRST TRIMESTER
COMPLICATIONS
Approximately 15% of clinically recognized
pregnancies are spontaneously aborted.
Vaginal spotting or frank bleeding is very
common and is experienced by 25 % of
patients during the 1st few wks of
pregnancy.
In a setting of severe pain, uterine
contraction, and a dilated cervix,
the pregnancy is doomed to failure.

1) If the cervix is long and closed in a patient
with vaginal bleeding, the diagnosis is
threatened abortion.
2) Embryonic demise should apply when
there is clear evidence of a nonliving embryo
(i.e absent cardiac activity),
3)blighted ovum should be used to describe
an abnormal pregnancy with a gestational sac
greater than 22 mm.
Keneth 88

4) Absent Intrauterine Sac
If the uterus appears normal on
sonographic examination, or if the
endometrial echoes appear prominent and
no sac is visible, the differential diagnosis
includes absence of pregnancy, an early
IUP (normal or abnormal), or an ectopic
pregnancy. Assuming a positive PT, most
often the outcome is unfavorable
89

5. Detecting a Sac without an
Embryo or Yolk Sac
When ultrasound examination reveals a
sac without an embryo or yolk sac, the
diagnosis is limited to one of the three
entities: (1) a normal early IUP; (2) an
abnormal IUP; or (3) a pseudogestational
sac in a patient with an ectopic pregnancy.
In theory, an intrauterine sac can be
distinguished from a pseudosac because
the former is located within the decidua,
whereas the latter is within the uterine
cavity 90

6. INTRAUTERINE BLOOD
As implantation occurs, these collections
result from the erosive effects of the
chorion frondosom as it penetrates into the
decidua basalis
91

7. ABORTION
This refers to the premature loss of the
products of conception
it can be induced or can occur
spontaneously
7a) Incomplete abortion
Incomplete expulsion of the products of
conception. The placenta and fetal
membranes are usually retained in the uterus

7a) sonogram of incomplete
abortion
Keneth 93

7b) Complete Abortion. Complete
expulsion of the products of conception from
the uterus.
7c) Threatened abortion
The fetus is alive but there is vaginal
bleeding and a closed cervical os. It is a
common complication that may occur in
approx. 25% of clinically apparent
pregnancies.
Keneth 94

7d) Inevitable Abortion. Gestational sac
(with embryo/fetus) in the process of
expulsion. The cervix is often dilated with
vaginal bleeding and cramps
95

8) Incompetent cervix
It refers to a premature dilataion of the
endocervical canal prior to the onset of
labor. This condition generally occurs in the 2nd
trimester without any vaginal bleeding or labor
pain. It may recur with subsequent pregnancies.
The exact etiology of an incompetent cervix is
unknown. One possible cause is the weakness
of the sphincter mechanism due to an excessive
amount of smooth muscle. Predisposing factors
include trauma to the cervix (D/C), congenital
normal variations, etc.

DETECTING FETAL ANOMALIES
Congenital fetal malformations can be the result
of genetic or chromosomal, environmental, or
combined factors. In more than 50% of cases,
the origin is unknown; however most are due to
chromosomal aberrations. Environmental
causes, or teratogens, are responsible for 10%
of anomalies. Very early exposures (up to 5 wks
GA) typically have an all-or-none result: the
embryo will either die or be unaffected.
Exposure during organogenesis (5 to 10 wks
GA) often affects organ development and results
in severe congenital anomalies.

98

Medical Imaging Training Resource
For Medical Imag Tech, Nurses,
Midwives and Medics , Nchanji Nkeh
Keneth 99

Exposure during the fetal phase of
development has a variable result.
Although many congenital anomalies
cannot be diagnosed with confidence until
the 2nd trimester, gross abnormalities
such as large encephaloceles,
holoprosencephaly, and conjoints twins,
although rare, can now be detected late in
the 1st trimester
Keneth 100

Some
DEVELOPMENTAL
PITFALLS

1. Rhombencephalon As the
embryo develops, several
normal anatomic structures
undergo developmental
changes that can be
misinterpreted as abnormal.
One potentially cystic space,
readily visible in the posterior
cranium between 7 and 9 wks
GA, is the developing
rhombencephalon

NUCHAL TRANSLUCENCY
An important part of the late 1st trimester
sonogram is evaluation of the thickness of
the posterior nuchal translucency, a thin
membrane found along the posterior neck
of most embryos beginning at approx 10
wks. An anteroposterior measurement of
≥3 mm, measured from the membrane to
the skin surface, is abnormal (fig.).
103

Normal (0.15 cm) Thickened (5 cm
Medics , Nchanji Nkeh Keneth
104

105
SECOND AND THIRD
TRIMESTERS OF
PREGNANCY (14 TO 42
WKS)

106
In the 2nd trimester of pregnancy, the fetus has
grown sufficiently in size so that remarkable
anatomic detail can be visualized.
The basic fetal measurements used to
estimate age are the BPD, FL, HC, AC, APBD,
TBD and AC

Biometry: Following the Rules
The BPD can be appropriately measured
through any plane of section that traverses
the 3rd ventricle, thalami and the cavum
septum pellucidum
107

BPD Measurement
108

The FL (Femur Length)
Proper alignment of the transducer to the
long axis of the femur is ensured by
demonstrating that both the femoral head
or the greater trochanter and the femoral
condyle are simultaneously in the plane of
section.
it is the easiest of all the biometric
measurements.
The FL can range from 40 to 80mm
Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth109

The Femur Length
110

The AC (Abdominal
Circumference)
It is measured in a location that estimates
liver size.
The rules of measurement are as follows.
The plane is where the right and left portal
veins are continuous with one another.
After this plane of section is frozen on the
screen, the ellipse is fit to the skin edge
It is usually the most difficult to measure
Keneth 111

AC
Keneth 112

Next lecture

PLACENTAL
ABNORMALITIES
Keneth 114

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