Obstetrics

The measurements were done ‘blindly’ without actually seeing the structures under study. Visualising the gestational sac by B-mode ultrasound was first described by the Donald and MacVicar team in In , they were able to demonstrate a 5-weeks gestational sac. Kobayashi also described the ultrasonic appearance of extra-uterine pregnancy using bi-stable B-mode ultrasound in Kenneth Gottesfeld in Denver reported in a large series of patients where fetal death in utero was diagnosed solely on bistable ultrasound scan. The ability to recognise and confirm the presence of fetal cardiac action in early pregnancy was considered to be one of the most indispensible use of ultrasonography and still is. The fetus was first located with B- scan ultrasound and the heartbeat obseved with a directed beam in A- and M-mode also see below. This breakthrough has profound implication in the management of early pregnacy bleeding and threatened miscarriages.

Concerns Regarding Early Fetal Development

Gynaecological Service The female pelvis can be examined using a trans-vaginal approach. This gives the best picture of the uterus, ovaries and pelvis. The ultrasound transducer is similar in size and shape to a tampon: Approximately 2 inches is gently inserted into the vagina in the same way as a tampon, if you prefer you can insert it yourself. Please arrive with an empty bladder. There is no problem if you have a period and are bleeding on the day of the scan, it can still be performed.

What is an ultrasound scan? An ultrasound scan involves transmitting high frequency sound waves through the uterus. These bounce off the baby and the returning echoes (sound waves) are translated by a computer into an image on a screen that reveals the baby’s position and movements.

Please do not empty your bladder before the examination. Guide to number of guests Most clinics can comfortably accommodate 5 guests including children for this scan. If you would like to bring more, please contact your chosen clinic when booking to check how many we can accommodate. Frequently Asked Questions Why choose to have an early pregnancy scan?

You may have chosen to have an early pregnancy scan sometimes called viability or early scan to either confirm you are pregnant or to find out if you are still pregnant. Most of the time, the scan will be able to reassure you at the time it is carried out, that you have an on-going pregnancy and all is well.

About InSight Ultrasound

Medical doctors All medical doctors in Bermuda must be licensed locally before they qualify and – except for those in the public sector working at a hospital – all are private. Basics were unveiled in February by the former Government, which aims to ensure all residents have quality, affordable healthcare. It aims to make health care more affordable and improve access and quality care.

To test for Down’s syndrome and certain other genetic conditions (T18 and 13 and Turners syndrome) from a maternal blood sample. The ultrasound scan will determine viability, if single or multiple fetus are present and accurately date your pregnancy.

Can the scan show the gender of my baby? Examples of ultrasonography you may see used during your pregnancy. Most parents look forward to their scan because it gives them the first glimpse of their baby. You will probably be give you a printout of your baby by the sonographer as a keepsake, it is important to remember the main purpose of the scan.

It is not to provide the first photo for your baby album, or to find out your baby’s sex. It is to check that your baby is growing and developing normally. Who will do the scan? Scans are usually performed by a doctors, midwives or radiographers who are specially trained in ultrasound, and are known as sonographers. Why do I need an ultrasound scan? Ultrasound has been used in pregnancy for about 30 years, it has progressively become an indispensible obstetric tool and plays an important role in the care of every pregnant woman.

The common reasons for your doctor to request an pregnancy ultrasound scan are: To establish the date when the baby is due. To check the number of babies. To establish that the pregnancy is continuing normally.

Ultrasound – Sonogram

Some studies are cited as being too small or having too many confounding factors to draw any useful conclusions. It is difficult to know what to believe Today, millions of ultrasound exams have been performed and millions of babies have been exposed during pregnancy. Without dramatic birth defects to stop its use, more subtle biological sequela may go unrecognized for years to come.

Reviewers analyze huge numbers of studies and create a meta-analysis of research data about these issues. The third edition of the book concludes the following about the potential hazards of obstetric ultrasound:

Purpose: In the musculoskeletal system, structure dictates function and the development of pathology. Interpreting wrist structure is complicated not only by the existence of multiple joints and ligamentous structures but also by variability in bone shapes and anatomical patterns.

Each of our early pregnancy scans come complete with a medical report. If you feel weekly scans will offer more reassurance during the early weeks of pregnancy then these can be arranged in addition to this package. The primary purpose of this scan is to confirm viability of an intrauterine pregnancy and determine well-being.

The scans will last about 10 minutes and a 2D scan picture will be given to you to take home and keep. All early scans are performed by a qualified diagnostic Sonographer. As this package is offered from 6 weeks it is likely any pre week pregnancy scans will require an internal vaginal scan. We always start trans-abdominally but for more accurate results you may be offered an internal scan.

Please attend this appointment with a full bladder If you are unsure of your LMP, you may be asked to provide the date of your first positive pregnancy test to ensure accuracy of dates when booking your appointment. This scan is available to women over 18 years of age or to women of 16 and 17 years who attend with a responsible adult.

Non Invasive Prenatal Test (NIPT) + Scan

Contact Us About us At the Fetal Ultrasound Centre we provide our patients with a professional, informative and memorable ultrasound examination. In addition to the First Trimester Downs Syndrome risk assessment and Fetal Anomaly scans, we also provide services such as early pregnancy dating, gender determination, growths scans and 4D ultrasound scans. She obtained her B-Tech degree in Ultrasound after completing two years of full time training at the world renowned Obstetric Ultrasound Unit in Tygerberg Hospital.

The role of ultrasonography in obstetric practice has continuously evolved since its introduction more than 40 years ago. Indeed, it is difficult to imagine a modern obstetric practice without access to the information provided by real-time ultrasound.

Your blood needs to be taken either by us at the time of your appointment or privately by your midwife, GP or local phlebotomist. When you book online, depending on your chosen location you may be contacted to arrange the most convenient way for you to have this done close by. Note that the results from your baby’s DNA blood test are normally available approximately 7 working days after your appointment and we recommend that you present your results to your usual healthcare professional whose contact details we take at the time of booking.

Your choice of a free rescan may be appropriate if we are unable to perform the primary purpose of this scan. All scans are performed by a qualified Sonographer with diagnostic obstetric scanning experience. Primary purpose of the blood test and scan To test for Down’s syndrome and certain other genetic conditions T18 and 13 and Turners syndrome from a maternal blood sample.

The ultrasound scan will determine viability, if single or multiple fetus are present and accurately date your pregnancy. Pre-scan preparation Need to expose lower abdomen so ideally wear 2 piece garments i. Please do not empty your bladder before the examination. Please bring your hand held notes with you to the scan.

Early Scan

Each of our early pregnancy scans come complete with a medical report. If you feel weekly scans will offer more reassurance during the early weeks of pregnancy then these can be arranged in addition to this package. The primary purpose of this scan is to confirm viability of an intrauterine pregnancy and determine well-being. The scans will last about 10 minutes and a 2D scan picture will be given to you to take home and keep.

All early scans are performed by a qualified diagnostic Sonographer.

The RCSI Fetal Medicine Centre. The RCSI Department of Obstetrics and Gynaecology is staffed with an extensive range of consultants providing all aspects of healthcare for women.

Doppler Ultrasound The doppler shift principle has been used for a long time in fetal heart rate detectors. Further developments in doppler ultrasound technology in recent years have enabled a great expansion in its application in Obstetrics, particularly in the area of assessing and monitoring the well-being of the fetus, its progression in the face of intrauterine growth restriction, and the diagnosis of cardiac malformations.

Doppler ultrasound is presently most widely employed in the detection of fetal cardiac pulsations and pulsations in the various fetal blood vessels. The “Doptone” fetal pulse detector is a commonly used handheld device to detect fetal heartbeat using the same doppler principle. Blood flow characteristics in the fetal blood vessels can be assessed with Doppler ‘flow velocity waveforms’.

Diminished flow, particularly in the diastolic phase of a pulse cycle is associated with compromise in the fetus. Various ratios of the systolic to diastolic flow are used as a measure of this compromise. The blood vessels commonly interrogated include the umbilical artery , the aorta , the middle cerebral arteries , the uterine arcuate arteries , and the inferior vena cava. The use of color flow mapping can clearly depict the flow of blood in fetal blood vessels in a realtime scan, the direction of the flow being represented by different colors.

Color doppler is particularly indispensible in the diagnosis of fetal cardiac and blood vessel defects , and in the assessment of the hemodynamic responses to fetal hypoxia and anemia. A more recent development is the Power Doppler Doppler angiography.

About InSight Ultrasound

Practical Obstetrical Ultrasound, p Rockville, MD, Aspen, Averaging the gestational ages derived from two or more measurements has been shown to be more accurate than using any single parameter. Because of the greater accuracy of the early study, ultrasound examinations subsequent to an early study should not be used to revise the estimated date of confinement EDC , but rather should be used as a measure of the quality of fetal growth between the two studies.

Similarly, it is not appropriate to revise an EDC on the basis of an ultrasound examination if the patient’s menstrual dates are within the range of error of the ultrasound method.

Here’s info on the risks vs. rewards of pregnancy ultrasounds – plus a “middle way” to help you reap all the benefits and minimize the dangers.

Underestimation of gestational age by conventional crown-rump length growth curves. Reprinted with permission of American College of Obstetricians and Gynecologists Variations in the measurement of CRL can be attributed to differences in fetal growth patterns. Such differences are related to factors similar to those that influence birth weight curves, including maternal age and parity, prepregnancy maternal weight, geographic location, and population characteristics. These include incorporation of the yolk sac or lower limbs in the CRL measurement, excessive curling or extension of the fetus, and tangential section of the trunk.

The biparietal diameter BPD is one of the most commonly measured parameters in the fetus. Campbell was the first investigator to link fetal BPD to gestational age 20 ; however, since this original report, numerous publications on this subject have appeared in the literature. The BPD is imaged in the transaxial plane of the fetal head at a level depicting thalami in the midline, equidistant from the temporoparietal bones and usually the cavum septum pellucidum anteriorly Fig.

Transaxial image of the fetal head for biparietal diameter and head circumference measurements. Ultrasound image with biparietal diameter measurement between the solid arrows, outer edge to inner edge and fronto-occipital diameter measurement between the open arrows. The head circumference may be calculated using these diameters or measured directly.

Diagram of the transaxial ultrasound image of the fetal head at the level of the thalami large arrows , midline falx curved arrow , and cavum septi pellucidi open arrow. Gestational age assignment is based on the mean BPD; however, a single BPD encompasses a range of ages in which most fetuses of that size are most likely to fall Table 4. A number of factors may contribute to variation or inaccuracy in the BPD measurement.

Fetal viability

Although maternal mortality due to other causes such as infection, hemorrhage, hypertension, and thromboembolism, has declined over the years, the number of maternal deaths due to penetrating trauma, suicide, homicide and motor vehicle accidents has risen steadily. In the case of gunshot wounds to the pregnant abdomen, overall maternal mortality is low 3. Although the initial assessment and management priorities for resuscitation of the injured pregnant patient are the same as those for other traumatized patients, the specific anatomic and physiologic changes that occur during pregnancy may alter the response to injury and hence necessitate a modified approach to the resuscitation process.

The main principle guiding therapy must be that resuscitating the mother will resuscitate the fetus. Fetal Physiology The effect of trauma on pregnancy depends on the gestational age of the fetus, the type and severity of the trauma, and the extent of disruption of normal uterine and fetal physiology.

Management of the Injured Pregnant Patient. Georges Desjardins MD FRCPC, Assistant Professor of Anesthesiology University of Miami, Miami, FL.

David Todres, in A Practice of Anesthesia for Infants and Children Fourth Edition , Development of Airways and Lungs Neonatal respiratory dysfunction is common because the process of lung development is protracted and differentiation of anatomic structures for gas exchange occurs late in gestation. The limit of viability is around the 24th week, when the lungs develop a gas-exchanging surface and surfactant production begins. Thereafter, survival increases markedly.

The bronchial tree down to and including the terminal bronchioles forms by the 16th week of gestation. The acinus, consisting of all the airway structures distal to the terminal bronchiole and the entire gas-exchanging apparatus, develops throughout the remainder of gestation. Alveoli develop mainly after birth, increasing in number until approximately 8 years of life and in size until growth of the chest wall ceases.

Arteries and veins accompanying the bronchial tree form by the 16th week of gestation. Those vessels lying within the acinus follow the development of the alveoli. The appearance and growth of arterial smooth muscle lags behind the sprouting of new vessels and is not completed until late adolescence. Embryology of the Lungs The lung bud appears as a diverticulum of the embryonic foregut around day 26 of gestation,9 elongating to form the primordial trachea and branching to form the bronchial tree and the epithelial lining of the lungs, including the alveoli.

By day 52, the segmental bronchi are present and the diaphragm is complete, marking the end of the embryonic phase of development, which is succeeded by three stages of fetal tissue differentiation Fig. The glandular stage 7—16 weeks includes formation of intrasegmental airways and associated vessels. Differentiation of cartilage begins in the trachea and main-stem bronchi at 10 weeks, reaching the smallest bronchi at term.

The canalicular stage 16—24 weeks involves growth of the liquid-filled airways, forming new branches that constitute the first vestiges of the acinus.

How accurate is ultrasound in dating a pregnancy?-Dr. Nupur Sood


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