this is what we presented at AICOG 2012 varanasi .............USG A WATCH DOG FOR PREGNANCY...................please let me know what more any one wants to see, i can keep uploading my presentations.....
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.
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 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.
This document provides an overview of obstetric ultrasound procedures and measurements. It discusses estimating gestational age using biometric measurements like crown-rump length, biparietal diameter, abdominal circumference, and femur length in each trimester. It also covers assessing fetal number, position, growth, amniotic fluid, and potential complications like placenta previa or abruption. Key ultrasound goals are determining gestational age, fetal well-being, and detecting any anomalies or complications.
Smart sonography is an ultrasound Diagnostic Centre in Accra. We provide ultrasound services and basic ultrasound training for health practitioners. If you wish to train with us visit our website at www.smartsonography-gh.com.
Obstetric ultrasonography, or prenatal ultrasound, is the use of medical ultrasonography in pregnancy, in which sound waves are used to create real-time visual images of the developing embryo or fetus in the uterus.
Presentation1.pptx, ultrasound examination of the 1st trimester pregnancy.Abdellah Nazeer
Ultrasound is used in the first trimester to assess gestational age, viability, and maternal well-being. It can identify issues like bleeding, pain, uncertain dates, or risk of ectopic pregnancy. The ultrasound examines fetal structures like the gestational sac, yolk sac, fetal pole, heart, and crown-rump length. It can determine viability, number of fetuses, and detect anomalies or complications like thickened nuchal translucency, hemorrhage, molar pregnancy, or ectopic pregnancy. Precise technique and measurements are needed for an accurate assessment and dating of early pregnancies.
This document discusses color Doppler ultrasound techniques for fetal surveillance. It describes the anatomy of fetal and placental circulation and examines the uterine, umbilical and middle cerebral arteries. Waveform analysis using indices like S/D ratio, resistance index and pulsatility index is discussed. Normal and abnormal Doppler findings are presented along with their clinical significance and management. Precise techniques for imaging and interpreting various fetal blood vessels are provided.
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.
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 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.
This document provides an overview of obstetric ultrasound procedures and measurements. It discusses estimating gestational age using biometric measurements like crown-rump length, biparietal diameter, abdominal circumference, and femur length in each trimester. It also covers assessing fetal number, position, growth, amniotic fluid, and potential complications like placenta previa or abruption. Key ultrasound goals are determining gestational age, fetal well-being, and detecting any anomalies or complications.
Smart sonography is an ultrasound Diagnostic Centre in Accra. We provide ultrasound services and basic ultrasound training for health practitioners. If you wish to train with us visit our website at www.smartsonography-gh.com.
Obstetric ultrasonography, or prenatal ultrasound, is the use of medical ultrasonography in pregnancy, in which sound waves are used to create real-time visual images of the developing embryo or fetus in the uterus.
Presentation1.pptx, ultrasound examination of the 1st trimester pregnancy.Abdellah Nazeer
Ultrasound is used in the first trimester to assess gestational age, viability, and maternal well-being. It can identify issues like bleeding, pain, uncertain dates, or risk of ectopic pregnancy. The ultrasound examines fetal structures like the gestational sac, yolk sac, fetal pole, heart, and crown-rump length. It can determine viability, number of fetuses, and detect anomalies or complications like thickened nuchal translucency, hemorrhage, molar pregnancy, or ectopic pregnancy. Precise technique and measurements are needed for an accurate assessment and dating of early pregnancies.
This document discusses color Doppler ultrasound techniques for fetal surveillance. It describes the anatomy of fetal and placental circulation and examines the uterine, umbilical and middle cerebral arteries. Waveform analysis using indices like S/D ratio, resistance index and pulsatility index is discussed. Normal and abnormal Doppler findings are presented along with their clinical significance and management. Precise techniques for imaging and interpreting various fetal blood vessels are provided.
Ultrasound has become an essential tool in obstetrics, allowing visualization of the fetus and assessment of growth and well-being. Doppler ultrasound can evaluate blood flow in fetal and maternal vessels. While ultrasound is generally safe, concerns have been raised about potential neurological effects with prolonged or frequent use. Estimation of fetal weight and biophysical profiling helps monitor high-risk pregnancies. Overall, ultrasound has dramatically improved prenatal care and outcomes over the past decades.
This document provides an overview of imaging modalities used in gynecology, including ultrasound, MRI, CT, and their applications. Key points discussed include:
- Ultrasound is the primary imaging method due to lack of radiation. Resolution depends on transducer proximity and frequency. It is used to evaluate the endometrium, ovaries, fibroids, and adnexal masses.
- MRI provides additional detail on adenomyosis, leiomyosarcoma differentiation, and mapping of large or multiple fibroids.
- CT is used for evaluating lung or upper abdominal metastases and staging of ovarian cancer.
- Transvaginal ultrasound criteria for evaluating ovarian tumors, cysts, and assessing risk
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.
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 the interpretation of various types of Doppler ultrasound during pregnancy. It describes:
1. Umbilical artery Doppler which can detect placental hypoxia and increased resistance, predicting abnormal outcomes. Abnormal readings include increased resistance index and absent/reversed end diastolic flow.
2. Middle cerebral artery Doppler which can detect fetal anemia by increased blood flow to the brain. It is also used to time delivery of growth restricted infants.
3. Ductus venosus Doppler which has moderate predictive value for growth restriction in preterm infants.
4. Uterine artery Doppler has limited use in predicting fetal growth restriction but can identify maternal causes by abnormal readings.
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.
This document provides information on ultrasound technology and its use in obstetrics. It describes how ultrasound works using piezoelectric crystals, discusses imaging modes including 2D, 3D and Doppler, and covers applications of ultrasound in evaluating early pregnancy, fetal anatomy and growth, and screening for fetal anomalies. Key examination parameters are outlined for assessing gestational age, fetal anatomy and abnormalities.
This document discusses Doppler ultrasound of the umbilical artery. It begins by introducing Doppler ultrasound and its use in assessing fetal circulation. It then covers the physics of Doppler ultrasound and different Doppler modalities used such as continuous wave, pulsed wave, and color Doppler. Key aspects of Doppler waveform analysis are also outlined like peak systolic frequency and end-diastolic frequency. The document concludes by noting that abnormal Doppler readings can indicate fetal compromise and are correlated with adverse perinatal outcomes like growth restriction or preeclampsia.
NT SCAN (11-13.6 weeks) & Serum BIOPROFILEDrNisheethOza
- The document discusses first trimester screening (FTS), which involves an NT scan and serum biochemistry between 11-13.6 weeks of pregnancy.
- FTS allows for early prediction, prevention, diagnosis and management of complications like aneuploidies, preeclampsia, fetal growth restriction, and preterm birth.
- The NT scan measures nuchal translucency thickness, which is increased in fetuses with chromosomal abnormalities. Combined with blood tests, FTS can assess risk for conditions like Trisomy 21, 18, 13, preeclampsia and more.
This document describes the fetal anomaly scan, also known as the second trimester targeted scan, which is performed between 18-22 weeks gestation to evaluate fetal anatomy and detect any anomalies. It outlines the "Rule of Three" systematic scanning method to thoroughly examine the head, face, and other structures. Specific anatomical planes and landmarks are identified for different areas, along with common variations and abnormalities that may be seen. The objectives are to determine normalcy, identify severe abnormalities, and raise suspicion of potential issues warranting further evaluation.
first trimester ultrasound and overview of obs imagingBharat Jain
Ultrasound is a safe, non-invasive imaging technique used to evaluate pregnancies. This document discusses the use of ultrasound in the first trimester to confirm intrauterine pregnancy location, estimate gestational age, diagnose ectopic pregnancies or multiples, and evaluate vaginal bleeding or pain. Normal ultrasound anatomy is shown for the gestational sac, embryo, and fetus. The second and third trimesters are used to further assess fetal growth and anatomy, amniotic fluid levels, placental location, and fetal well-being. Detailed guidelines are provided for assessing the fetal head, chest, abdomen, extremities, and gender.
This document discusses the role of color Doppler ultrasound in antepartum fetal surveillance. It begins by outlining the purposes of fetal surveillance, which include reducing fetal death and optimizing delivery timing. It then discusses various maternal and fetal conditions that require increased surveillance due to risks of chronic hypoxia. The document covers different methods of antepartum surveillance and provides detailed explanations of Doppler ultrasound principles, techniques like uterine and umbilical artery Doppler, and how abnormal Doppler readings can predict complications like fetal growth restriction.
Abnormal uterine bleeding is evaluated using various ultrasound techniques and parameters according to the IETA model. Transvaginal ultrasound is used to measure endometrial thickness and assess echogenicity, vascularity, and the endo-myometrial junction. Additional techniques like saline infusion sonography can outline intracavitary lesions in more detail. Precise ultrasound evaluation and scoring systems can detect endometrial abnormalities and help determine the risk of endometrial cancer. Following guidelines and algorithms helps manage patients and determine if further testing or procedures are needed.
Presentation1.pptx, ultrasound examination of the 2nd & 3rd trimester pregnancy.Abdellah Nazeer
This document provides guidance on performing an ultrasound examination of the fetus in the second and third trimesters of pregnancy. It details the standard views and measurements that should be obtained, including images of the head, heart, abdomen, limbs and other structures. Potential abnormalities are also listed for each structure. Fetal echocardiography is important for detecting congenital cardiac defects, which occur in 2-6.5% of live births and can have serious consequences if not identified prenatally.
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.
Nuchal translucency
It is a sonographic pre natal screening scan to detect cardiovascular abnormality in a fetus.
NT can also detect altered extra cellular matrix composition and limited lymphatic drainage
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.
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.
Interventional ultrasound in obstetrics dr rabiRabi Satpathy
usg in pregnancy, interventional ultrasound, pregnancy ultrasound, obstetric ultrasound, congenital disease, intra uterine treatment of the fetus, fetal therapy,
The document discusses criteria used to diagnose early pregnancy failure via ultrasound. Current guidelines have variation and are based on limited evidence. The discriminatory size of 5mm CRL and 20mm gestational sac may be unsafe cut-off levels, risking misdiagnosis. A new recommendation is an MSD of 25mm empty sac or CRL of 7mm without cardiac activity for diagnosis. National guidelines should be reviewed to avoid misdiagnosing viable pregnancies as failures.
An abnormal first trimester scan can indicate several potential issues:
1. Miscarriage, ectopic pregnancy, or molar pregnancy which are diagnosed by ultrasound signs such as bleeding, gestational sac size, presence of a yolk sac or embryo, and fetal cardiac activity.
2. Other causes include threatened miscarriage, pregnancy of unknown location, failed early pregnancy, anembryonic pregnancy, or pregnancy of uncertain viability which are diagnosed based on gestational sac size, presence of a yolk sac or embryo, and fetal size and cardiac activity.
3. Specific conditions like subchorionic hematoma are also diagnosed using ultrasound features like localization and echotexture of blood collection. Further evaluation and follow up scans
Ultrasound has become an essential tool in obstetrics, allowing visualization of the fetus and assessment of growth and well-being. Doppler ultrasound can evaluate blood flow in fetal and maternal vessels. While ultrasound is generally safe, concerns have been raised about potential neurological effects with prolonged or frequent use. Estimation of fetal weight and biophysical profiling helps monitor high-risk pregnancies. Overall, ultrasound has dramatically improved prenatal care and outcomes over the past decades.
This document provides an overview of imaging modalities used in gynecology, including ultrasound, MRI, CT, and their applications. Key points discussed include:
- Ultrasound is the primary imaging method due to lack of radiation. Resolution depends on transducer proximity and frequency. It is used to evaluate the endometrium, ovaries, fibroids, and adnexal masses.
- MRI provides additional detail on adenomyosis, leiomyosarcoma differentiation, and mapping of large or multiple fibroids.
- CT is used for evaluating lung or upper abdominal metastases and staging of ovarian cancer.
- Transvaginal ultrasound criteria for evaluating ovarian tumors, cysts, and assessing risk
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.
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 the interpretation of various types of Doppler ultrasound during pregnancy. It describes:
1. Umbilical artery Doppler which can detect placental hypoxia and increased resistance, predicting abnormal outcomes. Abnormal readings include increased resistance index and absent/reversed end diastolic flow.
2. Middle cerebral artery Doppler which can detect fetal anemia by increased blood flow to the brain. It is also used to time delivery of growth restricted infants.
3. Ductus venosus Doppler which has moderate predictive value for growth restriction in preterm infants.
4. Uterine artery Doppler has limited use in predicting fetal growth restriction but can identify maternal causes by abnormal readings.
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.
This document provides information on ultrasound technology and its use in obstetrics. It describes how ultrasound works using piezoelectric crystals, discusses imaging modes including 2D, 3D and Doppler, and covers applications of ultrasound in evaluating early pregnancy, fetal anatomy and growth, and screening for fetal anomalies. Key examination parameters are outlined for assessing gestational age, fetal anatomy and abnormalities.
This document discusses Doppler ultrasound of the umbilical artery. It begins by introducing Doppler ultrasound and its use in assessing fetal circulation. It then covers the physics of Doppler ultrasound and different Doppler modalities used such as continuous wave, pulsed wave, and color Doppler. Key aspects of Doppler waveform analysis are also outlined like peak systolic frequency and end-diastolic frequency. The document concludes by noting that abnormal Doppler readings can indicate fetal compromise and are correlated with adverse perinatal outcomes like growth restriction or preeclampsia.
NT SCAN (11-13.6 weeks) & Serum BIOPROFILEDrNisheethOza
- The document discusses first trimester screening (FTS), which involves an NT scan and serum biochemistry between 11-13.6 weeks of pregnancy.
- FTS allows for early prediction, prevention, diagnosis and management of complications like aneuploidies, preeclampsia, fetal growth restriction, and preterm birth.
- The NT scan measures nuchal translucency thickness, which is increased in fetuses with chromosomal abnormalities. Combined with blood tests, FTS can assess risk for conditions like Trisomy 21, 18, 13, preeclampsia and more.
This document describes the fetal anomaly scan, also known as the second trimester targeted scan, which is performed between 18-22 weeks gestation to evaluate fetal anatomy and detect any anomalies. It outlines the "Rule of Three" systematic scanning method to thoroughly examine the head, face, and other structures. Specific anatomical planes and landmarks are identified for different areas, along with common variations and abnormalities that may be seen. The objectives are to determine normalcy, identify severe abnormalities, and raise suspicion of potential issues warranting further evaluation.
first trimester ultrasound and overview of obs imagingBharat Jain
Ultrasound is a safe, non-invasive imaging technique used to evaluate pregnancies. This document discusses the use of ultrasound in the first trimester to confirm intrauterine pregnancy location, estimate gestational age, diagnose ectopic pregnancies or multiples, and evaluate vaginal bleeding or pain. Normal ultrasound anatomy is shown for the gestational sac, embryo, and fetus. The second and third trimesters are used to further assess fetal growth and anatomy, amniotic fluid levels, placental location, and fetal well-being. Detailed guidelines are provided for assessing the fetal head, chest, abdomen, extremities, and gender.
This document discusses the role of color Doppler ultrasound in antepartum fetal surveillance. It begins by outlining the purposes of fetal surveillance, which include reducing fetal death and optimizing delivery timing. It then discusses various maternal and fetal conditions that require increased surveillance due to risks of chronic hypoxia. The document covers different methods of antepartum surveillance and provides detailed explanations of Doppler ultrasound principles, techniques like uterine and umbilical artery Doppler, and how abnormal Doppler readings can predict complications like fetal growth restriction.
Abnormal uterine bleeding is evaluated using various ultrasound techniques and parameters according to the IETA model. Transvaginal ultrasound is used to measure endometrial thickness and assess echogenicity, vascularity, and the endo-myometrial junction. Additional techniques like saline infusion sonography can outline intracavitary lesions in more detail. Precise ultrasound evaluation and scoring systems can detect endometrial abnormalities and help determine the risk of endometrial cancer. Following guidelines and algorithms helps manage patients and determine if further testing or procedures are needed.
Presentation1.pptx, ultrasound examination of the 2nd & 3rd trimester pregnancy.Abdellah Nazeer
This document provides guidance on performing an ultrasound examination of the fetus in the second and third trimesters of pregnancy. It details the standard views and measurements that should be obtained, including images of the head, heart, abdomen, limbs and other structures. Potential abnormalities are also listed for each structure. Fetal echocardiography is important for detecting congenital cardiac defects, which occur in 2-6.5% of live births and can have serious consequences if not identified prenatally.
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.
Nuchal translucency
It is a sonographic pre natal screening scan to detect cardiovascular abnormality in a fetus.
NT can also detect altered extra cellular matrix composition and limited lymphatic drainage
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.
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.
Interventional ultrasound in obstetrics dr rabiRabi Satpathy
usg in pregnancy, interventional ultrasound, pregnancy ultrasound, obstetric ultrasound, congenital disease, intra uterine treatment of the fetus, fetal therapy,
The document discusses criteria used to diagnose early pregnancy failure via ultrasound. Current guidelines have variation and are based on limited evidence. The discriminatory size of 5mm CRL and 20mm gestational sac may be unsafe cut-off levels, risking misdiagnosis. A new recommendation is an MSD of 25mm empty sac or CRL of 7mm without cardiac activity for diagnosis. National guidelines should be reviewed to avoid misdiagnosing viable pregnancies as failures.
An abnormal first trimester scan can indicate several potential issues:
1. Miscarriage, ectopic pregnancy, or molar pregnancy which are diagnosed by ultrasound signs such as bleeding, gestational sac size, presence of a yolk sac or embryo, and fetal cardiac activity.
2. Other causes include threatened miscarriage, pregnancy of unknown location, failed early pregnancy, anembryonic pregnancy, or pregnancy of uncertain viability which are diagnosed based on gestational sac size, presence of a yolk sac or embryo, and fetal size and cardiac activity.
3. Specific conditions like subchorionic hematoma are also diagnosed using ultrasound features like localization and echotexture of blood collection. Further evaluation and follow up scans
What do you mean by Anomaly? What are its types? Is Anomaly Scan a ‘MUST’?
In our family there has been no case of Anomaly.
I have already undergone FTS, So will it give any additional information?
Can it guarantee that my fetus is 100% normal? If an abnormality is found, can it be cured?
What options are available if an Anomaly is detected?
Can it Surely (100%) rule out Down’s Syndrome?
Can Anomaly be 100% prevented?
If such questions arise in your mind, please watch my eight small videos on this subject.
Ultrasonography scans in pregnancy serve several purposes. There are typically two recommended scans: the 11-14 week NT scan to screen for anomalies and the 18-22 week anomaly scan. Additional scans may be needed depending on risk factors and medical history. The NT scan screens for conditions like Down syndrome while the anomaly scan checks for structural abnormalities. Follow-up scans later in pregnancy monitor growth, check high-risk conditions like preeclampsia, and assess fetal well-being. Ultrasound is a valuable screening tool when used appropriately during pregnancy.
Recurrent Pregnancy Loss Sharing Personal Experience (10 years) Lifecare Centre
Complete over view of the causes diagnosis management of Recurrent Pregnancy Loss
it is a personal experience of treating recurrent miscarriages with excellent result
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 common diseases seen in well baby clinics, including a case of a 7-month-old girl presenting with an umbilical hernia along with details on evaluating and managing pediatric umbilical hernias such as watching for incarceration or strangulation and referring based on hernia size or complications. Risk factors, physical exam findings, and treatment options for umbilical hernias in infants are also reviewed.
This document provides an overview of antepartum fetal assessment. It discusses the history and importance of assessing fetal well-being during pregnancy. A variety of assessment methods are described, including clinical assessment of fetal movement, ultrasound to evaluate fetal growth and anatomy, non-stress tests to monitor fetal heart rate, and biophysical profiles which combine multiple tests for a thorough evaluation of fetal status. The document outlines indications for increased surveillance and management protocols based on test results. The goal of antepartum assessment is early detection of at-risk fetuses to improve neonatal outcomes.
Prenatal diagnosis detects fetal abnormalities before birth through non-invasive and invasive techniques. Non-invasive techniques include ultrasound, fetal echocardiography, and magnetic resonance imaging to visualize the fetus. Maternal serum screening analyzes markers in the mother's blood to assess risk of fetal conditions like Down syndrome. Invasive techniques obtain fetal tissue through procedures like amniocentesis for cytogenetic or molecular testing to diagnose genetic disorders. Prenatal diagnosis aims to provide risk information to families for informed decision making during pregnancy.
Screening and assessment of high-risk pregnancies involves identifying women at increased risk of complications through non-invasive tests like ultrasounds, NSTs and CSTs. Diagnostic tests then establish or rule out conditions and include invasive procedures like amniocentesis and cord blood sampling. Ultrasounds provide fetal images and assess growth while NSTs and CSTs monitor the fetal heart rate during rest and contractions. Amniocentesis analyzes amniotic fluid for genetic disorders while cord blood sampling draws fetal blood for similar tests when earlier methods were inconclusive. Both invasive procedures have a risk of miscarriage but can diagnose many conditions affecting the developing baby.
This document provides guidelines and pathways for gynaecology referrals in Sarawak, Malaysia. It includes standardized guidance for managing common conditions like cervical screening abnormalities, abnormal uterine bleeding, and ovarian tumors. The pathways are evidence-based and aim to enhance familiarization with management. They provide quick and easy referral processes for various gynaecological issues, including comprehensive summaries of evaluation, treatment recommendations, and referral criteria. The goal is to standardize care and ensure fast access to specialist evaluation when needed.
Common algorithm of the management of InfertilityRupal Shah
The document outlines Dr. Rupal N Shah's qualifications and experience in reproductive medicine and infertility treatment. It then discusses common algorithms and guidelines for managing infertility, including initial investigations, treatment options based on factors like age and ovarian reserve, and when to pursue assisted reproductive technologies like IUI or IVF. The goal is to present practical concepts and best clinical management options based on local perspectives.
This document outlines key landmarks and assessments that can be made using ultrasound during the first trimester of pregnancy. Sonographic landmarks like the gestational sac, yolk sac, amnion, and embryo normally appear between 4-8 weeks and allow confirmation of intrauterine pregnancy and accurate dating. Major fetal anomalies affecting the head, chest, abdomen or extremities can sometimes be diagnosed as early as 11-13 weeks. Chorionicity and zygosity in multiple pregnancies influence placental structure and can be assessed after 8 weeks. Nuchal translucency measurement between 11-13 weeks, along with other markers, provides risk assessment for chromosomal abnormalities. Pregnancy failure can be diagnosed before symptoms via ultrasound if
This document summarizes antepartum fetal surveillance and aneuploidy screening. It discusses:
1) The importance and benefits of antepartum fetal surveillance in predicting risks like perinatal death and detecting conditions like fetal growth restriction.
2) The various methods used in aneuploidy screening including ultrasound measurements, maternal serum markers, cell-free DNA testing, and invasive diagnostic tests.
3) The guidelines and best practices for aneuploidy screening including integrating first and second trimester screens and contingent screening models based on risk levels.
This document discusses prenatal screening and diagnosis of fetal anomalies. It describes various risks that can affect every fetus, including chromosomal anomalies, structural anomalies, growth disorders, placental problems, infections, and liquor problems. Screening tests are recommended to triage mothers into high-risk and low-risk categories, prevent maternal complications, and screen the fetus for chromosomal and structural defects to decide the optimal time and mode of delivery. Approximately 3% of viable fetuses would be born with a severe anomaly, and prenatal diagnosis has reduced the incidence of severe defects at birth by diagnosing many early in the first trimester.
Adnexal masses are commonly identified in pregnancy but they are rarely malignant. Most adnexal masses either resolve spontaneously or can be managed conservatively during pregnancy. Pregnancy may alter the serum levels of tumour markers, making the interpretation of results difficult.
This document provides an overview of a basic training on gynecological ultrasound examinations. It discusses the key learning objectives which are to recognize normal ultrasound appearances of the uterus, cervix, ovaries, and adnexae. It describes the proper scanning techniques, orientation, and normal ultrasound findings for the cervix, uterus, ovaries and adnexae in women both before and after menopause. It also reviews how to identify a correctly positioned IUD.
Total Pregnancy Care is a website providing comprehensive pregnancy information. It is compiled by Dr. Shantala, an experienced Indian obstetrician. The site covers topics from pre-conception to postpartum and offers services like ultrasounds, genetic counseling, and high-risk pregnancy care. It aims to promote holistic pregnancy approaches and provide maternity resources for Indian women.
This document discusses invasive prenatal diagnostic tests including cordocentesis, amniocentesis, and chorionic villus sampling. It provides details on the prerequisites, techniques, risks, and post-procedure care for each test. Cordocentesis involves puncturing the umbilical vein under ultrasound guidance to obtain a fetal blood sample and has a risk of fetal loss between 1-2%. Amniocentesis involves inserting a needle through the abdomen into the amniotic sac to extract amniotic fluid and has a risk of fetal loss up to 1%. Chorionic villus sampling collects placental tissue and has a fetal loss risk of 1-2%. The document emphasizes aseptic technique and ultrasound guidance for
FETAL GROWTH ASSESSMENT CONCEPT OF F.G.R. & PLOTTING GROWTH CHARTSNARENDRA C MALHOTRA
This document lists the extensive qualifications and achievements of Dr. Narendra Malhotra. He has received over 50 awards and honors for his work in obstetrics and gynecology. He currently holds leadership roles in multiple hospitals and organizations related to women's health. Dr. Malhotra has published over 125 papers and book chapters on obstetrics and gynecology topics. He is also an advisor and professor at several medical institutions.
This document discusses the ultrasound evaluation of adnexal masses in reproductive age women. It provides clinical background information on adnexal masses and covers ultrasound techniques like 2D, Doppler, 3D and power Doppler imaging. Pattern recognition is emphasized as the best method for distinguishing benign from malignant tumors. The IOTA simple rules classification system is presented as well as newer markers for characterizing adnexal masses with ultrasound like impedance values and vascular patterns.
This document summarizes the journey and accomplishments of Dr. Jaideep Malhotra and Dr. Narendra Malhotra, an OBGYN couple from India. It details how they met and graduated together from JNMC AMU Aligarh in the 1980s. After their post-graduation, they learned from renowned teachers around the world and established themselves as experts in ultrasound and infertility. Over decades, they authored numerous books and papers, held leadership roles in professional organizations, trained other doctors, and received many prestigious awards for their contributions to the field of OBGYN.
This document reviews the use of Diosmin in treating hemorrhoids during pregnancy. It discusses the increased prevalence of hemorrhoids during pregnancy, which is attributed to factors like constipation, hormonal changes, and labor/delivery. The pathophysiology involves increased intra-abdominal pressure causing venous engorgement. Diosmin is a bioflavonoid that has been used to treat hemorrhoids by improving venous tone and drainage, reducing inflammation and capillary permeability. Studies show Diosmin effectively treats hemorrhoid symptoms during pregnancy without adverse effects on the fetus.
This document provides information about FOGSI's Uniform Consents project including:
1. An introduction from Dr. Alpesh Gandhi, President of FOGSI, thanking the experts involved and explaining the purpose of developing standard consent forms for common OBGYN procedures.
2. A foreword from Dr. Sanjay Gupte emphasizing the importance of informed consent and how the forms were developed in accordance with Supreme Court guidelines.
3. An introduction from the consent form experts, Dr. M.C. Patel, Prof. Dr. Nikhil Datar, and Dr. Dilip Walke, thanking FOGSI for the opportunity and outlining their process for developing the forms.
The document discusses the benefits of exercise for mental health. It states that regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against developing mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
This document provides guidelines and recommendations for staying safe during an avalanche. It begins by advising people to check weather conditions before going to snow-capped mountains. It provides tips for what to do if caught in an avalanche, such as trying to stay on the surface and creating an air pocket. After the avalanche, it recommends digging oneself out and marking the locations of others. First aid procedures are outlined, such as removing snow from the mouth and administering CPR. The document concludes by describing avalanche-prone areas to watch out for.
Ferrous ascorbate current clinical place in management of idaNARENDRA C MALHOTRA
Ferrous ascorbate is an effective oral iron supplement for treating iron deficiency anemia. It has a higher bioavailability than other iron preparations, with absorption rates as high as 67%. Ferrous ascorbate is stable in the gastrointestinal tract and does not dissociate. It prevents iron from oxidizing to the ferric state, allowing for greater absorption. Clinical studies show ferrous ascorbate effectively raises hemoglobin levels and is well tolerated with minimal side effects. Therefore, ferrous ascorbate plays an important role in managing iron deficiency anemia.
1) The study examined the effects of a digital prenatal program called the Baby Care Program (BCP) on 512 first-time mothers. The BCP included mindfulness activities like meditation, yoga, music, and baby bonding exercises.
2) Results showed statistically significant benefits for mothers who used the BCP, including lower stress, better sleep, fewer preterm births and higher birth weights, compared to mothers who did not participate.
3) The BCP was found to help mothers develop a stronger bond with their babies, better manage nutrition and pregnancy symptoms, and have an overall healthier pregnancy experience.
- Women with bacterial vaginosis (BV) and abnormal vaginal flora are at higher risk of preterm delivery and late miscarriage. Probiotics containing Lactobacillus species have been shown to reduce the risk of recurrent BV and preterm birth by restoring the normal vaginal microbiome.
- Children born preterm face increased risks of mortality and health and developmental problems. Supplementation of probiotics to pregnant mothers has been associated with reduced risks of preterm birth, preeclampsia, and atopic diseases in infants.
- Studies indicate probiotic intake during pregnancy, especially late pregnancy, can help reduce the incidence of preterm birth and pregnancy complications like preeclampsia.
This document discusses adnexal masses in reproductive age women. It provides clinical background and epidemiology of adnexal masses. It discusses ultrasound techniques for evaluating adnexal masses such as 2D ultrasound, Doppler ultrasound, 3D and power Doppler ultrasound. Pattern recognition of benign disease using ultrasound is covered. The document also discusses predicting malignancy using systems like IOTA simple rules and pattern recognition. Characterization of adnexal masses and predicting histopathology and management are key focuses.
This document provides biographical and professional details about Prof. Narendra Malhotra. It lists his current and past positions including Professor at University of Sarajevo School of Science & Technology and various roles in medical associations. It also outlines his areas of specialization in obstetrics and gynecology as well as lists his publications, awards, and presentations. He is currently based in Agra, India and is director of several fertility clinics.
Dr. Jaideep Malhotra is an IVF specialist based in Agra, India. He has over 50 published papers and 100 conference presentations. He is a fellow of many Indian and international obstetrics and gynecology organizations. He has received several awards for his work, including producing India's first IVF birth and test tube baby of Nepal. He practices at his nursing home in Agra and is a consulting IVF specialist at multiple other locations in Northern India and Nepal.
This document provides information about Prof. Narendra Malhotra's qualifications and experience. It lists that he holds positions such as Professor at Dubrovnick International University, Vice President of WAPM, past president of ISAR, president of other organizations. It notes that he has published over 50 papers and given over 100 guest lectures. He is the editor of 18 books and on the editorial board of several journals. The document also provides information about Malhotra Nursing & Maternity Home Pvt. Ltd. and Global Rainbow Health Care in Agra where he practices as an obstetrician gynecologist with interests in areas like high risk obstetrics, ultrasound, and infertility.
The document discusses recommendations from a joint collaborative group regarding vaccinating pregnant and lactating women against COVID-19. It provides background on the impact of the pandemic on women's health and reviews evidence from studies on vaccine safety and efficacy. The group recommends that: 1) the option of vaccination should be discussed with women in the second and third trimester; 2) COVAXIN be approved for emergency use in pregnant and lactating women; and 3) vaccination in lactating women be advocated immediately while collecting safety data. The aim is to save lives by reducing COVID-19 severity in pregnant women through vaccination.
FOGSI POSITION STATEMENT COVID VACCINATION FOR PREGNANT & BREASTFEEDING WOMENNARENDRA C MALHOTRA
This document discusses recommendations and guidelines regarding COVID-19 vaccination for pregnant and breastfeeding women. It provides information on the current COVID-19 situation globally and in India, the different types of COVID vaccines available in India, benefits of vaccination for the general population and pregnant women, safety of the vaccines for pregnant women, and international recommendations that vaccination should be offered to pregnant women similar to non-pregnant individuals based on risk-benefit analysis. The document concludes by stating current recommendations in India do not support vaccination of pregnant or breastfeeding women due to lack of safety data, but international organizations support vaccination for pregnant women.
The document discusses the benefits of exercise for mental health. It states that regular exercise can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help alleviate symptoms of mental illnesses.
Corona is here to stay and it is predicted that over 70% of population will get the infection (fortunately not all will fall sick or very sick). (Recovery rate of over 74% & Death rate around 2%).
A lot of confusion exists regarding testing for covid and what test to do, when and how to interpret these tests.
Compiled by Dr. Narendra Malhotra
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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
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14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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USG WATCH DOG IN PREGNANCY
1. ULTRASOUND AS A WATCH DOG
FOR PREGNANCY
narendra malhotra
jaideep malhotra
neharika malhotra
www.malhotrahospitals.com
2. http://en.wikipedia.org/wiki/watch dog
• Watchdog may refer to:
Dog
Guard dog,
a dog that barks to alert its owners of
an intruder's presence
WIKTIONARY
Noun
watchdog (plural watchdogs)
a guard dog
a person or organization that monitors and publicizes the behavior of
others (individuals, corporations, governments) to discover undesirable
activity.
3. PREGNANCY IS THE OWNER
AND THE “GREAT OBSTETRICAL SYNDROME” IS THE
INTRUDER
AND ULTRASOUND THE WATCH DOG
AND WE OBSTETRICIANS ARE THE DOG TRAINERS
so it becomes a very doggy-bitchy story and lecture
5. Obstetrical Disease
• Preterm labor
• Preterm Rupture of membranes
• Pre-eclampsia
• SGA/IUGR
• Fetal Death
In addition to the above ;first trimester preg failure,early anomalies ,late anomalies
6. The History of Obstetrics
• A search for a single test to predict each
obstetrical disorder has failed.
• The discovery of an effective treatment
and preventive strategy has not been
successful.
7. Diagnostic tools
Only one single
diagnostic tool has
proven to be the only
tool which can predict
problems and watch the
pregnancy like a watch
dog and indicate the
intruders of the “great
obstetrical syndrome”
12. OBSTETRICAL ULTRASOUND HELPS
PICK UP ALL THESE PROBLEMS EARLY
• EARLY SCAN TO DETECT PREGNANCY AND
RULE OUT ECTOPIC
• FETAL CARDIAC ACTIVITY/VIABILITY SCAN
• CHORIONICITY IN MULTIPLE GESTATION
• 11-14 WEEKS GENETIC SCAN
• 20 WEEKS ANOMALY SCAN
• 24 WEEKS DOPPLER
• THIRD TRIMESTER GROWTH AND LIQUOR
13. Definite signs of Early Pregnancy
Failure
• Absence of cardiac activity in an embryo
-Embryonic demise
• Absence of yolk sac/embryo in a large GS
-Blighted ovum
FAILED PREGNANCY
14. Definite signs of Early Pregnancy
Failure
What is the descriminatory size for safe diagnosis?
Mean Sac diameter
CRL
15. GUIDELINES FOR DIAGNOSIS
OF EARLY PREGNANCY FAILURE
Society of American College
Royal College of Obstetricians and of Radiologists
Obstetricians Gynaecologists of (ACR) 2000
and Canada (SOGC) 2005
Gynaecologists • CRL > 5mm with no
• CRL > 5mm with no visible visible cardiac activity
(RCOG) 2006 cardiac activity, >9mm(TAS)
• MSD > 16mm without a
• CRL ≥ 6mm with no • MSD > 8mm without a visible visible embryo or yolk sac
visible cardiac activity yolk sac, 20mm (TAS)
• MSD ≥ 20mm without
AIUM, 2007
• MSD > 16mm without a • CRL > 5mm (TVS) with no
a visible embryo or visible embryo, (25mm (TAS)
yolk sac visible cardiac activity
LEVEL 11-2 a
16. GUIDELINES FOR DIAGNOSIS
OF EARLY PREGNANCY FAILURE
Australian Society Practice in the
Hongkong College Philippines
of Obstetricians for Ulltrasound in
and Gynaecologists Medicine (ASUM)
(HKCOG) 2004
• CRL > 5mm with no
• CRL > 5mm (TVS), >9mm • CRL > 6mm with no
visible cardiac activity
(TAS) with no visible visible cardiac activity
cardiac activity • MSD > 18mm without a
• MSD > 20mm without a
visible embryo or yolk sac
• MSD ≥ 20mm without a visible embryo or yolk sac
OB-GYN USG for practicing
visible embryo or yolk sac Clinician 2nd Ed
FOGSI GUIDELINES A FEW YEARS BACK
MSD >20without YS/E :CRL >6mm without cardiac activity
IFUMB/ICMU and ICOG
17. RECOMMENDATIONS
Empty GS = an MSD of 25 mm with out yolk sac
or embryo
Embryonic demise= A CRL of 7mm with
no cardiac activity
Wait for 7-10 days before a repeat scan if results are
below the descriminatory level.
18. Down syndrome screening
• NT (11-13+6wk), PAPP-A, beta-hCG
• Best at 12 wk for anomaly as well
• One-stop
• 90% sensitivity at 5% FP rate
• Addition of Doppler assessment of blood
flow in the ductus venosus and across the
tricuspid valve together with above can
identify more than 95% of all major
aneuploidies for a FP rate of less than 3%.
19. Why 13+6 wk?
• To provide women with affected
fetuses the option of first- rather
than second-trimester
termination,
• The incidence of abnormal
accumulation of nuchal fluid in
chromosomally abnormal
fetuses decreases after 13 weeks
• The success rate for taking a
measurement decreases after 13
weeks because the fetus
becomes vertical, making it
more difficult to obtain the
appropriate image.
21. Cardiac defect
• Major cardiac
defect in 7.6% of
chromosomally
normal fetuses
with NT>=3.5mm
• Indication for fetal
echocardiography
• Detailed cardiac
scan at 14 wk
22. OTHER MARKERS BY USG
ICT
DV
NB
CORD DIAMETER
WIDE ILIAC BONES
FACIAL ANGLE
24. ULTRASOUND IS A GOOD WATCH DOG
FOR FIRST TRIMESTER PREGNANCY
PROBLEM PREDICTION
25. The mid-trimester fetal ultrasound scan
Who should have one: everyone
……all pregnant women should
be offered an ultrasound scan
for the detection of fetal
anomalies and pregnancy
complications…….if problems
in unselected low risk have
also to be picked up….(no
clear evidence on usefulness)
26. The mid-trimester fetal ultrasound scan
When should the scan be performed?
• “18-22 weeks”
• Earlier scans date better
• Earlier scans require equipment, expertise and
time
• Later scans see better
• Later scans see more
• Local legislation
27. The mid-trimester fetal ultrasound scan
And now coming to the core stuff!
•Fetal biometry
and well being
•Anatomical
survey
28. The mid-trimester fetal ultrasound scan
Fetal biometry and well being
• Fetal biometry
• Amniotic fluid assessment
• Fetal movement
• Doppler ultrasonography
• Multiple gestation
30. Fetal biometry
Parameters
• Standardised manner and strict quality criteria
• Audit of results
• Still images to document the measurements
31. Fetal well being
Estimated fetal weight
• The degree of deviation from normal at this
early stage of pregnancy that would justify
action (e.g. follow-up scan to assess fetal growth
or fetal chromosomal analysis) has not been
firmly established
• if gestational age is determined at an earlier
scan, EFW can be compared to dedicated
normal, preferably local, reference ranges for
this parameter
32. Fetal well being
Amniotic fluid assessment
• Amniotic fluid volume can be estimated
subjectively or by using sonographic
measurements
• Subjective estimation is not inferior to the
quantitative measurement techniques (e.g.
deepest pocket, amniotic fluid index) when
270
250
performed by experienced examiners
Amniotic Fluid Index
230
210
190
170
150
• Patients with deviations from normal
130
110 should have more detailed anatomical
90
70 evaluation and clinical follow-up
16 18 20 22 24 26 28 30 32 34 36 38 40
Week
33. Fetal well being
Fetal movement
• There are no specific movement
patterns at this stage of pregnancy
• Temporary absence or reduction of
fetal movements during the scan
should not be considered as a risk
• Abnormal positioning or unusually
restricted or persistently absent
fetal movements may suggest
abnormal fetal conditions such as
arthrogryposis
34. Fetal well being
Fetal movement
• The biophysical profile is not considered part of
a routine mid-trimester scan!
• Fetal brain is not yet mature enough to control
sympathetic and parasympathetic of fetal heart!
35. Fetal well being
Doppler ultrasonography
• The application of Doppler
techniques is not currently
recommended as part of the routine
second-trimester ultrasound
examination
• There is insufficient evidence to
support universal use of uterine or
umbilical artery Doppler evaluation
for the screening of low-risk
pregnancies
36. Fetal well being
Multiple gestations
• visualization of the placental cord
insertion
• distinguishing features (gender,
unique markers, position in
uterus)
• determination of chorionicity is
sometimes feasible in the second
trimester if there are clearly two
separate placental masses and
discordant genders. Chorionicity
is much better evaluated before
14–15 weeks (lambda sign or T-
sign).
37. The anatomical survey in second trimester
At a glance
Head Intact cranium Abdomen
Cavum septi pellucidi Stomach in normal position
Midline falx Bowel not dilated
Thalami Both kidneys present
Cerebral ventricles Cord insertion site
Cerebellum Skeletal
Cisterna magna No spinal defects or masses (transverse and
Face Both orbits present sagittal)
Median facial profile Arms and hands present, normal
Mouth present relationships
Upper lip intact Legs and feet present, normal relationships
Neck Absence of masses (e.g. cystic hygroma) Placenta
Position
Chest/Heart No masses present
Normal shape/size of chest and lungs Accessory lobe
Heart activity present Umbilical cord
Four-chamber view of heart in normal Three-vessel cord
position Genitalia
Aortic and pulmonary outflow tracts Male or female
No evidence of diaphragmatic hernia
38. Placenta
Guidelines for maturity and position
+
+
+
+ +
+
• Women with a history of uterine surgery and low anterior placenta or placenta previa are
at risk for placental attachment disorders. In these cases, the placenta should be examined
for findings of accreta, the most sensitive of which are the presence of multiple irregular
placental lacunae that show arterial or mixed flow
• Abnormal appearance of the uterine wall–bladder wall interface is quite specific for
accreta, but is seen in few cases. Loss of the echolucent space between an anterior
placenta and the uterine wall is neither a sensitive nor a specific marker for placenta
accreta
39. Maternal anatomy
Guidelines
• Currently, there is sufficient
evidence to recommend
routine cervical length
measurements with a
transvaginal scan at the mid
trimester even in an
unselected population
• Uterine fibroids and
adnexal masses should be
documented
40. THIRD TRIMESTER SCAN
Great obstetrical syndrome
• Preterm labor
• Preterm
Rupture of
membranes
• Pre-eclampsia
• SGA/IUGR
• Fetal Death
Fetal growth restriction
41. FGR may be
Symmetrical Asymmetrical
and body
Fetal brain (BPD & HC) Fetal brain (BPD & HC) and
(AC) and long bones are long bones are large when
proportionately small. compared to the AC (liver).
may occur when the fetus may occur when the fetus
experiences a problem during experiences a problem during
early development. later development
Chromosomal malformation
Constituently Small (Small Hypoxemic hypoxia
Mother Small Baby ) utero placental insufficiency
43. Accurate fetal biometry
to measure the size of
fetus – AC & EFW
Accurate measurement
of fetal growth - Indian
Predictive tools & customized
rule of 2 fetal growth charts
44. Accurate fetal biometry
to measure the size of
fetus – AC & EFW
Accurate measurement
of fetal growth - Indian
Predictive tools rule & customized fetal
of 2 growth charts
Accurate knowledge of fetal
physiology and intrauterine
environment - fetal
Doppler study & AFI ACHARYA
DR.PRASHANT
45. • Biometric tests (tests to measure size)
• Biometric tests are designed to
predict size and growth
AC, EFW
46. USG TOOLS – HOW EFFECTIVE ?
• Ratio measures, such as head to
abdominal circumference (HC/AC)
and femoral length to abdominal
circumference (FL/AC) ratios are
poorer than AC or EFW alone in
predicting IUGR
47. Ask for serial measurements
and plot the findings in
growth chart – not
single USG reading
2/3/2012 DR.PRASHANT ACHARYA 47
49. PROPOSED INDIAN CUSTOMISED GROWTH CHART
• The term 40 weeks birth • The term 40 weeks birth
weight of fetus is 3051 for weight of fetus is 3455 for
normal primi patient normal primi patient
having average weight 52 having average weight 64
Kgs & average height of Kgs & average height of
152 cms 163 cms
50. Role of Doppler study in FGR
• In diagnosing fetal
hypoxia by detecting
redistribution of
fetal blood flow
• Helps in deciding
the Timing of Doppler detects flow of RBCs in any
delivery vessel - Quantity and speed
• Measuring AFI
51. Uterine artery Doppler waveform
• Impaired placentation
• P I P I P (OBS SYNDROME)
50-67% Positive predictive value
>95 % negative predictive value
52. Impaired placentation
Uterine artery
Doppler
Good
diastolic flow
High resistance ,
persistence of diastolic
notching and even absent end
systolic forward flow can
persist through out pregnancy
if PLACENTATION IS
INADEQUATE
In 50-67 % is associated Early
diastolic
notch Poor diastolic
with complication of flow
P I P I P &PPIH
DR.PRASHANT ACHARYA 2/3/2012 52
53. Prediction & Prevention of
FGR by
UTERINE ARTERY DOPPLER
P I P I P GREAT OBSTETRICAL SYNDROME
Preeclampsia
IUD
Prematurity
IUGR
Placental abruption
54. UMBILICAL ARTERY FLOW
characteristic saw-tooth appearance of arterial flow in
one direction and continuous umbilical venous blood flow
in the other.
54
55. Absent / Reversed end diastolic volume
(AEDV/REDV)
• AEDV/REDV + PREMATURITY = high chances of HMD
• neonatal complications are Asphyxia ,ICH are increased
2/3/2012 DR.PRASHANT ACHARYA
56. When Umbilical artery Doppler
parameters are altered
Multi vessel Doppler
Hypoxia and
examination (MCA and re
DV) distributation
Bio Physical Profile Score CNS
57. Umbilical artery Doppler
• When end diastolic
flow is present ,
delay delivery until
at least 35 weeks,
provided other
surveillance
findings are
normal.
58. MCA abnormality expressed by the
compromised fetus
Brain sparing effect – Fetal anemia
Cerebral perfusion
increased ( RI & PI
decreased)
MCA supplies blood to Brain - the most important
organ of body-
MCA PSV evaluates speed of fetal RBCs flow which
has DIRECT application in FETAL ANEMIA
59. Middle cerebral artery
An early stage in fetal
adaptation to hypoxemia - central
redistribution of blood flow
( brain-sparing reflex)
increased blood flow to protect the
brain, heart, and adrenals
reduced flow to the peripheral and
placental circulations
61. • The aortic isthmus PI is increased and
absolute velocities (especially the TAMXV)
are reduced in intrauterine growth-restricted
fetuses
Aortic isthmus blood flow velocimetry provides important information on fetal cardiovascular
function, i.e. individual performance of ventricles, relative changes in upper (including brain)
and lower (including placenta) body resistances and fetal oxygenation, and has the potential
to become a valuable clinical tool for fetal evaluation
62. FETAL DECENDING AORTA
• it is important to be aware of the fact that
the brief reversal of flow during end-systole,
which is a normal finding in the third
trimester, can give falsely high PI values
65. Ductus venosus (DV)
Final
verdict
• Sensitive to fetal oxygenation status
• Dilates as fetal hypoxia worsens
• In severe hypoxia –reversal of (a) wave
• Immediate delivery of Fetus- in abnormal
DV flow
66. • Reflects VOLUME
MANAGEMENT by RIGHT
atrium and is responsive to
fetal oxygenation
• Dilates as fetal hypoxia
worsens
• In severe hypoxia –reversal
of (a) wave ,due to atrial
contraction s/o cardiac
failure and decompansation
due to increase in severe
after load
• Needs immediate delivery of
Fetus
2/3/2012 DR.PRASHANT ACHARYA 66
67. Amniotic Fluid Index
• Reduction in AFI is Supporting evidence of a
hostile intrauterine environment
• Amniotic fluid volume monitoring is very
helpful in monitoring the physiological status
of the fetus rather than the anatomical
growth.
68. BPPS or Modified BPPS ??
• VAST
• AFI
• Instant, Easy and cost
effective
• Helps in delivering the fetus at
optimal gestational age
70. Take Home Message
• Worldwide, it is likely that much of the
ultrasonography currently performed is carried
out by individuals with little or no formal
training(hence misinterpretations)
• Performed with proper guidelines
ROUTINE USG IN PREGNANCY can
predict many problems and be a good watch dog
for fetal and maternal wellbeing