Module 7.2 : Detailed Scan Flashcards
1
Q
overall sagittal sweep
A
- sag plane to the other sweep from cervix to fundus of uterus to assess th position of fundus
- image sag fundus/cervix pic
- check for fetal heart motion
- check for number of fetus
- assess for presence of amniotic fluid
2
Q
overall transverse sweep
A
- transverse sweep along the lateral aspect of the uterus to include adnexa
3
Q
overall transverse assessment
A
- fibroids
\+ document in 2 planes
\+ measure in 3 dimensions
\+ doppler
- assess for adnexal masses usually arising from ovary
\+ corpus luteal cyst
\+ dermoid cyst
- two planes 3 dimensions
4
Q
need to establish
A
- viable fetus
- fetal lie
- fetal number
- placental localization
5
Q
placenta
A
- look at placenta position
- asses placental texture
- decide if placenta is low or not
+ placenta previa = placenta over cervix
+ LOWER PLACENTAL EDGE SHOULD BE A MINIMUM OF 2 CM AWAY FROM INTERNAL OS OF CERVIX - document cervix length measure
- document and measure placental edge to internal is
6
Q
what to start with in OB scanning
A
- start with whatever is up
- if fetus with back up anterior start with spine and kidneys
- if fetus laying with chest up always start with heart and face profile
7
Q
cranium
A
- asses head shape
- high on fetal head or cephalic on the fetus the head the shape is round
- at BPD level fetal had more oval
8
Q
cranial images
A
- BPD, OFD, HC
- ventricular image
- bilateral choroid image
- cerebellar image
- orbital image
- nose lip image
- profile
9
Q
BPD assesses
A
- cavum septum pellucidi
- third ventricle
- ambient cistern
- falx cerebri
- shape
10
Q
ventricular image
A
- assesses the dependent ventricle \+ ventricle farthest from transducer - measure ventricular atrium size \+ upper normal is 10mm - assess echo texture of dependent choroid
11
Q
bilateral choroid image
A
- assess echo texture of both choroid together
12
Q
cerebellar image / posterior fossa
A
- used to assess the cerebellar shape and size \+ if vermis is present - presence and size of cisterna magna \+ what is upper limit of normal 10mm - nuchal fold thickness \+ 10mm
13
Q
orbital image
A
- assess for \+ hyper telorism = to far \+ hypoterlorism = to close - size of orbits \+ micropthalmia (small eyes) - seeing lenses on the eyes rules out \+ anopthalima (no eyes)
14
Q
nose lip image
A
- image skims the nose and slip
- rule out
+ cleft lip and abnormal nostrils - want 2 nostrils and septum between
15
Q
profile
A
- line up forehead nose and chin on image
- assess chin
+ micrognathia (small mandible)
+ retrognathia (receding chin) - assess nasal bone
+ present >2.5mm
+ absent or hypoplastic
16
Q
ossification
A
- anterior ossification center is the vertebral body
- posterior ossifications laminar junction
- THESE ARE ONLY VISIBLE AREAS OF THE FETAL SPINE ON ULTRASOUND
17
Q
spinal ossification
A
- as the gestational age increases the lamina ossifies into a linear structure rather than circular
- ossification is not complete until 18 weeks gestation
18
Q
spine
A
- must be viewed in 2 planes
+ trans and sag - if you can not view in a sag plan than coronal acceptable
19
Q
imaging spine
A
- one image at distal end to include sacrum
- on image at cephalic end to include cervical spine into cranium
- include as many vertebral ossifications in image as possible
- MOST IMPORTANT IS TO SWEEP THROUGH SPINE IN TRANSVERSE
- only image taken in trans is at lumbosacral junction (spina bifida)
20
Q
trans spine at sacrum
A
- ideal image include both iliac crests and all 3 ossifications centers
- transducer directly over spine
- fetal bladder included as well
- looking for herniation
- should see amniotic fluid behind spine
21
Q
abdominal circumference (AC)
A
- assesses presence of stomach and position of organs
- is the stomach on the left side
- should only see one stomach bubble
- the GB may be seen
+ do not confuse with stomach
+ ovoid looking on right side
22
Q
what is a good AC
A
- umbilical vein runs in the falciform ligament and becomes ligamentum teres after birth
- confluence of umbilical vein and left portal vein
- referred to as portal sinus
23
Q
heart
A
- 4 chamber view
- assess the size of all chambers and valve placement
- M-MODE ADN MEASURE THE FETAL HEART RATE
- could do chest circumference if needed
24
Q
heart size and placement
A
- size of heart should be 1/3 of chest
- toward the left 45’
25
outflow images
- done to rule out great vessel abnormalities
- RVOT
- LVOT
- not lung tissue around the heart
26
LVOT
- should see valve in aortic sinus
| - probe more cephalic
27
RVOT
- need to take long axis
| - should see branches
28
3 vessel view
- see SVC, aortic arch and pulmonary artery
29
cine clip 6-12 seconds
- beginning at fetal stomach in trans
- sweeping cephalic
- demonstrate
+ stomach
+ 4 chamber
+ LVOT
+ RVOT
+ 3 vessel view
30
fetal heart cine clip
- fetal heart in horizontal plane
- while performing the cine clip LVOT should appear with and change to probe plane
- RVOT should follow
- 3 vessel should be just superior to RVOT
31
longitudinal image of abdomen and chest
- assess location of stomach in relation to diaphragm
- assess echotexture of lungs compared to liver
+ should be isoechoic to lung sin 2nd semester
+ slightly increased echogenicoty to liver in 3rd trimester
32
longitudinal abd and chest image
- heart
- diaphragm (hypo echoic)
- stomach
+ look for diaphragmatic hernia
33
bowel
- small bowel appears as cluster of rings bordered by large bowel
- colon (large bowel) in 3rd trimester may contain meconium particles and appear hypo echoic and prominent
- LARGE BOWEL 17mm DIAMTER AT TERM
* hyper echoic bowel may be trisomy 21 or CF
34
kidneys
- located on either side of spine
- lack of distinction in 2nd trimester
- renal pelvis hypo echoic and minimally dilated up to 3mm
- over 5mm is the upper limit
- 3rd trimester calyces are well seen
- kidneys relate to gestational age
35
kidney images
- spine in middle
- freeze over renal pelvis
- longitudinal images are included if any abnormality is detected in kidney
+ hydronephrosis
+ renal cysts
36
adrenals
- superior and medial to kidneys
- hypo echoic with echogenic centres
- do not confuse adrenals with kidneys
37
bladder
- anehoic structure between iliac crests
- should fill and empty every 20 minutes
- always see a little urine
- just slide down from kidneys
38
umbilical arteries at bladder
- 2 arteries at this level
- identify right and left umbilical arteries around the bladder
- document this view
- add color doppler or power doppler
- deoxygenated blood in the arteries
- soft marker for aniploidy
39
umbilical cord
- 2 arteries 1 vein
- image cord in a trans plane to document all three vessles
- image cord insertion into fetal abdomen wall defects
+omphalocele (liver out body)
- also image cord into placenta
+ cord should insert into placenta more than 3 cm away for edge of planets
40
genitalia
- can be seen if fetus is lying face up with legs seperated
- important to document in twins and sex linked syndromes
- labia can be swollen and look like scrotum
- testicle do not descend until 28 weeks gestation
- scrotum can be tucked up between legs
41
girls
- hamburger sign
42
boy
- sticks and berries
| - turtle
43
bones
- all bones can be assessed on ultrasound
- routinely femur is measured
- humerus also measured at second rimester detail scan
44
upper limbs
- forearm
+ radius and ulna
+ ulna is medial (thinner and longer)
+ radius is lateral (shorter and thicker)
- take and image with and open hand if you see
- right and left
45
lower limbs
- tibia and fibula should be imaged with the foot pointing in the correct direction
- should not see all toes and tie/fib in same image
- tibia>fibula
- not arch of foot
46
rt and lt ankle image
- rule out club foot
| - rocker bottom feet
47
long bones
- with certain syndromes or chromosomal abnormalities required to measure all long bones
- femur
- tibia
- fibula
- humerus
- radius
- ulna
- right and left sides
and clavicles
48
amniotic fluid
- and AFI is not performed at the detailed 18 week assessment
- a subjective assessment observed
+ subjectively decreased
+ subjectively increased
- amniotic fluid volume increases until 34 weeks than slowly diminishes
- fluid is produced by fetal urinary system
+ to lesser extents by the umbilical cord, lungs, skin in early pregnancy
49
vernix
- skin cells floating in the fluid
| - waxy substance that protects baby frombein surrounded by fluid
50
supine hypotension
- mother may feel hot or light headed nauseous or faint
- ROLL ON HER SIDE
+ left side is best
+ if twins then left then right
- roll away from you
