This document provides an overview of a lecture on second and third trimester emergencies during pregnancy. It discusses essential elements of an emergency ultrasound scan, including determining the fetal lie and position, measuring gestational age using BPD and femur length, locating the placenta, and assessing amniotic fluid levels. Potential emergencies that may occur during this time include preterm labor, placental issues, hemorrhage, and too much or too little amniotic fluid. The document outlines techniques for evaluating these elements in an emergency scan.

1. Second and third trimester
emergencies
Dr. Kosar Kamal Ahmed
H.D diagnostic radiology
Lecture 3

2. Lecture over view
Essential elements of an emergency scan
Determining the presenting part of the fetus
Fetal lie
Measurements of GA (BPD & FL )
Location of placenta
Amniotic fluid assessment
Problems or emergencies during this time
Preterm labor , location of placenta , haemorrhage , oligo / poly
hydramnios
Early second trimester ( < 16 weeks )
cervical incompitence and habitual abortion

3. Essential elements of an emergency scan
presenting part of the fetus

4. Essential elements of an emergency scan
presenting part of the fetus

5. Essential elements of an emergency scan
presenting part of the fetus

6. Essential elements of an emergency scan
The BPD is the maximum diameter of a transverse
section of the fetal skull at the level of the
.parietal eminences

7. Essential elements of an emergency scan
• A single optimal measurement of the BPD will predict the
• gestational age to within ± 5 days.
• It is more accurate at predicting the date of delivery than an
optimal menstrual history.
• It is more accurate than CRL ( Why ?)
• Recent data report that HC is more accurate than BPD

8. • Lateral ventricles view:
• rugby-football-shaped skull
• a long midline equidistant from the proximal
and distal skull echoes
• the cavum septum pellucidum bissecting the
midline one-third of the distance from the
synciput to the occiput
• the two anterior horns of the lateral
ventricles, symmetrically placed about the
Midline
• all or part of the posterior horns of the lateral
ventricles symmetrically placed about the
midline .

9. Thalami view :
● a rugby-football-shaped skull
● a short midline equidistant from the proximal
and distal skull echoes
● the cavum septum pellucidum bisecting the
midline one-third of the distance from the
synciput to the occiput
● the thalami

11. -This measurment is as accurate as BPD
in the prediction of GS
-The upper femur should be selected for
measurement
-To ensure that the section obtained is
not oblique ( soft tissue should be
visible beyond both ends of the
femur and the bone should not
appear to merge with the skin of the
thigh at any point

12. Essential elements of an emergency scan
• The placenta is best identified by scanning the uterus
longitudinally and is easily recognized by its more echogenic
pattern compared with that of the underlying myometrium
• Placenta can be in :
– Proper position
– Low lying
– Marginal previa
– Previa

13. Essential elements of an emergency scan

14. Essential elements of an emergency scan

15. Essential elements of an emergency scan

16. Essential elements of an emergency scan
1. Subjective assessment :
With experience, it is possible to classify amniotic fluid volume into the broad categories
absent, low, normal, increased and excessive.
2. Single deepest pool :
The size of the deepest cord-free pool of amniotic fluid is assessed with the ultrasound
probe perpendicular to the maternal abdomen; The vertical depth of the largest pool is
measured A depth of 2–3 cm is normal
3. Amniotic fluid index :
This is a semiquantitativetechnique for assessing amniotic fluid volume,Using the maternal
umbilicus as a reference point, the abdomen is divided into four quarters.
With the ultrasound probe held in the longitudinal axis of the mother and perpendicular to
the floor the largest vertical pool depth in each quadrant is recorded.

17. Essential elements of an emergency scan
Subjective method

18. Essential elements of an emergency scan

19. Essential elements of an emergency scan