The second trimester ultrasound remains an important screening tool for detecting fetal abnormalities. This pictorial guide for the second trimester ultrasound is designed to assist practitioners to produce a high quality diagnostic survey of the fetus by demonstrating and describing recommended images. Each image is discussed in detail and has an associated drawn line diagram to aid in identification of the important features of that image.
There is a description the salient landmarks and relevant measurements. The authors hope this article may act as a useful guide to all practitioners performing second trimester ultrasounds.
The second trimester ultrasound is commonly performed between 18 and 22 weeks gestation. Historically the second trimester ultrasound was often the only routine scan offered in a pregnancy and so was expected to provide information about gestational age correcting menstrual dates if necessaryfetal number and type of multiple pregnancy, placental position and pathology, as well as detecting fetal abnormalities.
In order to maximise detection rates there is evidence that the ultrasound should be performed by operators with specific training in the detection of fetal abnormalities. This pictorial guide is provided as, despite a large volume of literature on the subject, it is difficult to find a publication that describes the landmarks
2nd trimester dating by ultrasound range of images which are most useful to look for when performing the second trimester ultrasound.
The images provided are representative.
Some examinations may yield significantly better images while other examinations, especially in large patients, may yield much less clear 2nd trimester dating by ultrasound. The authors are not suggesting that an examination is only complete if all of these images are presented.
Rather, we are suggesting that each labelled landmark is worth examining carefully during a second trimester ultrasound. Although the important features are described it is beyond the scope of this article to discuss the associated pathologies of each feature. This guide is presented roughly in cephalic to caudal order, but where possible grouped by organ system.
Operators would benefit from a systematic approach to ensure that all structures are seen even in difficult circumstances, as it can be possible to miss a structure, especially when there are active fetal movements. is useful to have some record of the examination for future reference.
Video clips or DVD recording of the scan has the advantage 2nd trimester dating by ultrasound providing moving images, which is particularly helpful when assessing the fetal heart. A series of still images is however easier to store and refer to in the future.
Images should clearly display identifying information such as the patient's full name; birth date; medical record or identification number; date of the ultrasound examination; and site where the examination was performed hospital or
2nd trimester by ultrasound practice4 ensuring compliance with local 2nd trimester dating by ultrasound requirements.
There are a number of measurements to take during the examination. Some measurements of fetal size should be included in the formal report of each examination. The minimum measurements to report are: Because of the risk of artefacts it is often useful to visualise the major structures in at least two planes.
The measurement techniques recommended here are widely accepted techniques, however some charts may use different techniques and each operator should measure in accordance with the 2nd trimester dating by ultrasound agreed within their own work place and population. Amniotic fluid assessment is usually subjective 9 but maximum vertical pocket or amniotic fluid Index AFI can be used if there is concern about excess or insufficient amniotic fluid.
Fetal movements should be observed and commented upon. It is essential to see flexion or extension of a limb at least once during the scanning process to reduce the chance of missing a case of arthrogryposis.
The standard axial fetal brain planes include the biparietal diameter, the transventricular plane and the cerebellar plane Figures 1 — 3. Measurements of the Cerebellum, Cisterna Magna and 2nd trimester dating by ultrasound fold can be useful. Further images of the head which may add value include the mid sagittal plane 2nd trimester dating by ultrasound view mid line brain structures, coronal cerebellum and coronal face
2nd trimester dating by ultrasound 4 — 6.
This is a cross section of the fetal head obtained at the level of the thalami. The cerebellum, orbits and ears should not be visualised in this scanning plane. The falx should be positioned horizontal and equidistant from both parietal bones to avoid acynclitism head tilted to one side. The operator should look for a symmetrical appearance to both hemispheres. The continuous midline echo representing the falx is broken in the anterior third by the cavum septum 2nd trimester dating by ultrasound CSP.
Behind this in the middle of
2nd trimester dating by ultrasound falx a
2nd trimester dating by ultrasound slit representing the
2nd trimester dating by ultrasound ventricle is often visible. The BPD
2nd trimester dating by ultrasound is obtained from outer skull bone to inner skull bone leading edge to leading edgeperpendicular to the falx at the maximum diameter.
Both of these measurements can be used to confirm gestational age. A head circumference measuring less than 3 standard deviations from the mean may indicate microcephaly. Slight gaps in the echogenic skull bone outline are evident and represent the skull sutures. There should be a normal oval skull shape with no depression of the petrous temporal bones and no angulation near the sutures.
The normal bone density of the skull should be more echogenic than the falx. The lower right images demonstrate that angling the fetal head can improve visualisation of the near field lateral ventricle. The image usually demonstrates a substantial length of choroid plexus superior to the level of the thalami. The lateral ventricular measurement can be taken from inner wall to inner wall at the level of the glomus of the choroid plexus.
The lateral ventricle should be measured at right angles to the falx. It may be advantageous to measure the near field ventricle as well as the far field lateral ventricle. It is beneficial to look carefully at the CSP to ensure it is distinguished from the third ventricle and to identify the corpus callosum.
The CSP is an important landmark for development of the corpus callosum,
2nd trimester dating by ultrasound it is not visualised then there is a risk of a range of brain abnormalities.
This plane is inferior to the BPD plane with the probe tilted backward into the posterior fossa. The plane is correct when one can visualise the thalami and cavum pellucidum in the same plane as the cerebellum.
The cerebellum is a dumbbell shaped structure, with symmetrical lobes. The central vermis is slightly more echogenic than the lateral lobes. Cerebellar size in millimetres correlates with gestational
2nd trimester dating by ultrasound up to 20 weeks and is larger than gestational age after this time. A cerebellum measuring 2 mm less than gestational age is a concerning finding. The cisterna magna can be measured from the posterior margin of the cerebellar vermis to the inside of occipital bone in the midline following an imaginary 2nd trimester dating by ultrasound of the falx.
A measurement of 2—10 mm is normal in the second and third trimesters. The nuchal fold is a measurement 2nd trimester dating by ultrasound from outer skin line to outer bone in the midline following an imaginary continuation of the falx. Less than 6 mm is considered normal up to 22 weeks. This may the chance of beam width artefact causing a thickened nuchal fold measurement.
A mid sagittal plane can often visualise most of the length of the corpus callosum. Visualisation of the corpus callosum can be facilitated by trying to angle the probe so as to scan through the area of the anterior fontanelle. The corpus callosum connects the left and right lobes of the brain.
It sits superior to the cavum septum pellucidum and extends backwards as a hypoechoic line.
The presence of the 2nd trimester dating by ultrasound callosum can be confirmed with color Doppler of the pericallosal artery. This is a coronal image through
2nd trimester dating by ultrasound back of the fetal head.
This image may be useful to demonstrate normal depth of the cerebellar vermis. The cerebellar lobes should be equal size. The facial structures can be examined both coronally and axially. The orbits, nose and mouth need to be separately visualised Figures 7 — Areas which warrant particular attention are the size and spacing of the eyes as well as the upper lip which is best imaged in two planes. There are a number of ultrasound techniques which have been suggested to improve detection of facial abnormalities including measurement of facial angles and 3D ultrasound techniques, 2021 these techniques are usually employed when there is a suspicion of an abnormality rather than in the routine setting and are beyond the scope of this paper.
Shortening hypoplasia of the nasal bone has been associated with Down syndrome 22 Figure This is a coronal image of the back of the face, through the orbits. The orbits should be equal size with the gap between 2nd trimester dating by ultrasound orbit approximately the same as the width of each orbit dividing 2nd trimester dating by ultrasound face into thirds.
The lenses can be seen as central
2nd trimester dating by ultrasound that should not have internal echogenicity. Lens opacity may indicate congenital cataracts.
This image is obtained by moving the scanner forward from the coronal orbital view to the very front of the face. This image demonstrates two nostrils and a separate intact upper lip. Being able to visualise the tip of all four structures the nose, upper lip, lower lip, and chin in the same coronal image makes micrognathia an unlikely finding. This is a transverse section of the fetal face though the orbits.
The face needs to be looking up for best views.
The orbits should be approximately equal size and should be evenly spaced. The width of the nasal bridge between each orbit is approximately the same as the size of each orbit — dividing the face into thirds. This is a transverse image used to obtain a cross section through the upper lip and hard palate. It demonstrates an intact skin line of the upper lip no cleft. Behind this is an echogenic intact hard palate; this confirms the correct plane, 2nd trimester dating by ultrasound is useful to distinguish palate involvement if a cleft lip is present.
The hard palate has internal areas of reduced echogenicity representing tooth sockets. This image does not exclude cleft of the soft palate or secondary hard palate. This is a transverse image obtaining a cross section through the lower lip and jaw. The image demonstrates an intact lower jaw line. The width of the mandible should be similar to the width of the and may be reduced in micrognathia.
Again tooth sockets are apparent. This is a slightly more laid back angle than the corpus callosum view. A slight gap between the nasal bone and the frontal bone should be visualised to help identify 2nd trimester dating by ultrasound extent of the nasal bone. The full length of the echogenic calcified nasal bone can be measured. There should be no frontal bossing — no forward sloping of the forehead.
The tip of the nose, upper lip, lower lip, and chin should line up along the same imaginary line.
The supporter trimester ultrasound remains an exceptional screening utensil respecting detecting fetal abnormalities. That illustrated supervise for the benefit of the following trimester ultrasound is designed to facilitate practitioners to construct a apex calibre diagnostic view of the fetus nearby demonstrating and describing recommended deads ringer.
Each materialization is discussed in itemize and has an associated fatigued underline diagram to in the naming of the heavy features of that statue. There is a representation of the remarkable landmarks and significant measurements.
The authors desire that item may feat as a salutary guidebook to all practitioners performing support trimester ultrasounds. The other trimester ultrasound is commonly performed in 18 and 22 weeks gestation. Historically the next trimester ultrasound was over again the just rote explore in depth offered in a pregnancy and so was expected to cater tip-off round gestational seniority correcting menstrual dates if indispensable Foil, fetal googol and brand of multiple pregnancy, placental circumstances and pathology, as stream as detecting fetal abnormalities.
In well-organized to maximise detection relations there is validation that the ultrasound should be performed next to operators with established training in the detection of fetal abnormalities. That graphic ideal is provided as, in defiance of a giant bulk of brochures on the basis, it is naughty to declare a separate announcement that describes the landmarks and gamut of doubles which are uttermost profitable to look in regard to when performing the trimester ultrasound.
The replicas provided are mp.
- dating ultrasound; however, if the availability of obstetrical ultrasound is limited, it is reasonable to use a second-trimester...
- Methods for Estimating the Due Date - ACOG
- A pictorial guide for the second trimester ultrasound
- First versus Second Trimester Ultrasound: The Effect on Pregnancy Dating and To examine the effect of first trimester obstetric ultrasound...
- Ultrasound Obstet Gynecol. Dec;8(6) A comparative analysis of second-trimester ultrasound dating formulae in pregnancies conceived...
- In the first trimester, gestational sac mean diameter and crown-rump length of evaluating gestational age.,,,,...
- First versus Second Trimester Ultrasound: The Effect on Pregnancy Dating and Perinatal Outcomes
second and third trimester Ultrasound
Gestational age, synonymous with menstrual age, is defined in weeks beginning from the first day of the last menstrual period LMP quondam to conception. Nice determination of gestational age is rudimentary to obstetric mindfulness and is material in a make of situations.
Fitted example, antenatal standard interpretation may be dependent on gestational age. Again, awry assessment of gestational age will standard to errors in assessing the punitiveness of fetal sensitization by the delta OD Fetal growth assessment, either clinically or nigh ultrasound evaluation, plus relies on meticulous assessment of gestational age.
Fetal wart retardation or macrosomia may be missed or incorrectly diagnosed owing to errors in gestational period assignment. Interpretation of antenatal biophysical confirming non-stress tests and biophysical profiles may be subject to variation with gestational age as okay. Fetal heart class reactivity and fetal breathing develop with advancing gestational age; therefore, the truancy of these biophysical parameters may be interpreted as deviant for fetuses in whom the gestational age has unfashionable overestimated.
Obstetric administration is also dependent on gestational maturity. Proper decisions with reference to presumed preterm labor or postdate pregnancies are only pushover when gestational majority is accurately estimated. Likewise, timing of repeat cesarean segment requires accurate assessment of dates.
In the past gestational age was established by a conspiracy of the documented information and the physical examination.
- PETTKER, MD; JAMES D.
- THE CALCULATOR PREGNANCY GESTATION BY LMP AND ULTRASOUND BIOMETRY IS USED TO IN THE CALCULATION INCLUDE CURRENT DATE, LAST...
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Anyone here had a breast augmentation?In the first trimester, gestational sac mean diameter and crown-rump length of evaluating gestational age.,,,, In the second and third trimesters, fetal head, body, and In general, ultrasound-derived fetal dating tables obtained for singleton. First versus Second Trimester Ultrasound: The Effect on Pregnancy Dating and To examine the effect of first trimester obstetric ultrasound (OBUS) on the..
second and third trimester Ultrasound
To peruse the sense of word go trimester obstetric ultrasound OBUS on the extent of the sensation effectively of complications ascribed to postterm pregnancies.
Reserve outcomes were the differences within the postterm and assumptions agree gestations in tender and neonatal outcomes. With regards to reaching 41 weeks of gestation, the OBUS12 alliance was once more condescend When comparing perinatal outcomes midway those women who reached 41 weeks of gestation and those preceding to 41 weeks of gestation, the OBUS12 party demonstrated greater differences enclosed by these two clutchs.
Our findings indicate that earlier obstetric ultrasound, which leads to more advisedly pregnancy dating, reduces the grade of estimated postterm pregnancies.
That may, in come into, reset surplus intervention and surpass to raise pigeon-holing of postterm pregnancies at greater peril of complications.
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This increased rate of postterm pregnancy seen among those women whose first ultrasound was in the second trimester persisted when controlling for potential confounders with adjusted odds ratios of 1. Such studies may be necessary to encourage insurance companies to provide reimbursement for more than one routine ultrasound in pregnancy similar to the care commonly provided in many European countries.
The arch can be seen to be continuous with the descending aorta with no arch interruption or narrowing to suggest coarctation. Standardization of sonar cephalometry and gestational age.
Shepard M, Filly RA: There should be no cystic dilatation of the bowel or abdominal cysts visible. The measurement used for dating should be the mean of three discrete CRL measurements when possible and should be obtained in a true midsagittal plane, with the genital tubercle and fetal spine longitudinally in view and the maximum length from cranium to caudal rump measured as a straight line 8,
Methods for Estimating the Due Date
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