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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5782_Библиотеки_им_академика_М_И_Перельмана.pdf
CHAPTER 13 Obstetrical Scanning Protocol for First, Second, and Third Trimesters 309
Uterus
c
Amnion
Chorionic
(“crown”)
l
6. Image demonstrating the YOLK SAC and/or EMBRYO.
Amniotic
cavity
Embryo
Labeled: YOLK SAC SAG or TRV or YOLK SAC / EMBRYO SAG or TRV
7. LONG AXIS image of EMBRYO with length (superior to inferior) or
CRL measurement.
Uterus
Rump
cavity
Yolk sa
Decidual
reaction
Gestationa
sac
Head
Labeled: CRL
8. Same image as number 7 without calipers.
Labeled: CRL
310 PART IV Pelvic Scanning Protocols
Anterior
Posterior
9. Doppler documentation of viability.
.40
m/s
Doppler gate
Trophoblastic
ring
Yolk sac
Gestational
sac
.40
Fetal heart Doppler signal
Labeled: DOP VIAB
Later First Trimester
Sagittal Plane • Transabdominal Approach
1. LONG AXIS image of the UTERUS showing the location of the
gestational sac.
Maternal urinary
bladder
Vagina
Superior
Gestational
sac
Inferior
Uterus
Labeled: UTERUS SAG LONG AXIS
NOTE: Assuming an embryo is identified, the CRL measurement is taken
in the scanning plane where its long axis appears.
CHAPTER 13 Obstetrical Scanning Protocol for First, Second, and Third Trimesters 311
Amniotic
sac
balloon
r
Uterus
Gestational
Left
Scanning Plane Determined by Position of Anatomy •
Transabdominal Approach
2. Longitudinal image of the GESTATIONAL SAC to include the
embryo (if visualized) with measurement from crown to rump (if
applicable) and placenta location (if distinguishable).
Decidual
reaction
Superior
Uterus
Gestational
Anterior
Embryo
Posterior
Labeled: GS SAG or TRV
3. Axial image of the GESTATIONAL SAC to include the embryo (if
visualized) with measurement from crown to rump (if applicable) and
placenta location (if distinguishable).
sac
Anterior
cavity/fluid
Inferior
Foley
Urinary
bladde
Placenta
Right
Embryo
Labeled: GS SAG or TRV
4. Same image as number 3 without calipers (if applicable).
NOTE: In this case, the CRL measurement was not applied to the previous image, therefore an additional image demonstrating the longest axis
of the embryo with CRL measurement must be taken here.
Amniotic
cavity/fluid
Posterior
312 PART IV Pelvic Scanning Protocols
5. LONG AXIS image of the EMBRYO with measurement from crown
to rump.
Limb bud
Calipers for
crown rump
length
Head
Body
Labeled: CRL
6. Same image as number 5 without calipers.
Amniotic
cavity/fluid
Calipers for
crown rump
length
Labeled: CRL
NOTE: In addition to the crown rump length (CRL) measurement, some
institutions require biparietal diameter, abdominal circumference, and
femur length measurements of the embryo during the later part of the
first trimester. However, many experts believe that these additional measurements are not necessary because they do not add any new information to the study and they are not as accurate as the CRL measurement
for determining GA.
CHAPTER 13 Obstetrical Scanning Protocol for First, Second, and Third Trimesters 313
s
Placenta Limb Amniotic fluid Fetal face/head
LimbFetal abdomen/chest
7. Optional view(s) of the embryo demonstrating LIMBS.
Uterus
Leg buds
Gestational
sac
Arm bud
“Tail”
Labeled: LIMBS
NOTE: It may be helpful to magnify the field of view for the limb image(s).
Second and Third Trimester
Sagittal Plane • Transabdominal Approach
1. When the trimester allows, LONG AXIS image of the UTERUS
and contents or best overall longitudinal representation.
Head
NOTE: In this case the trimester was too advanced to image the entire
uterus on a single view.
Labeled: UTERUS SAG
314 PART IV Pelvic Scanning Protocols
Placenta
and abdomen
Fetal limbsMyometrium
Lamina
Anterior
Posterior
Scanning Plane Determined by Position of Anatomy •
Transabdominal Approach
2. Longitudinal image of the PLACENTA.
Lacunae
Amniotic
fluid
Labeled: PLACENTA SAG or TRV
3. Axial image of the PLACENTA.
Centrum
Amniotic
fluid
Portion of
fetal chest
Placenta
Labeled: PLACENTA SAG or TRV
Sagittal Plane • Transabdominal Approach
4. Longitudinal image of the CERVIX to include the internal os.
Placenta
Superior
Uterus
Internal os
Cervical canal
Body
Amniotic
fluid/cavity
Cervix
Inferior
Urinary
bladder
Labeled: CERVIX SAG
CHAPTER 13 Obstetrical Scanning Protocol for First, Second, and Third Trimesters 315
Inferior
Anterior
Posterior
Placenta
Anterior
Posterior
NOTE: An image of the lower uterine segment to include the internal
os is required to rule out placental previa and to document the cervix. In
cases where the head of the fetus or the mother’s body habitus inhibit
imaging of the lower uterine segment, either an endovaginal or translabial image must be obtained. The translabial image is obtained with an
empty or nearly empty bladder. The transducer is covered with a sheath,
condom, or glove and placed between the labia. The transducer is angled
so that the cervix is nearly perpendicular to the ultrasound beam.
Longitudinal translabial image of the lower uterine segment.
Empty maternal
bladder
Amniotic
fluid
Superior
Placenta
Labeled: CERVIX TRANSLAB
Scanning Plane Determined by Position of Anatomy •
Transabdominal Approach
5. Depending on the stage of gestation, an overall longitudinal image
of AMNIOTIC FLUID or the largest pocket with superior to inferior
measurement.
Vagina
Cervix
Bowel
Prominent
uterine
veins
LONG FLUID
cavity/fluid
Labeled: FLUID SAG
Superior
Amniotic
Inferior
316 PART IV Pelvic Scanning Protocols
Placenta
Anterior
Posterior
NOTE: At times a quantitative measurement of amniotic fluid is required.
Anteroposterior (AP) measurements are obtained for the right and left
upper and lower quadrants. The sum of these AP measurements is
called the amniotic fluid index (AFI). Fluid pockets that contain primarily
cord or fetal parts are not included in the measurement.
6. Depending on the stage of gestation, an overall axial image of
AMNIOTIC FLUID or the largest pocket with anterior to posterior
and right to left measurements.
TRANS FLUID
Right
Amniotic
cavity/fluid
Left
Labeled: FLUID TRV
NOTE: Because of the variability of fetal position and movement, the
following fetal anatomy images may be taken in any sequence.
NOTE: An ultrasound examination during the second and third trimesters requires the documentation of a large number of anatomic structures, therefore 2 or more structures can be documented on a single
image if they are well represented.
NOTE: Because of the variability of fetal position and movement, the
scanning plane is not included as part of the film labeling for the following images.
CHAPTER 13 Obstetrical Scanning Protocol for First, Second, and Third Trimesters 317
Posterior
processes
Anterior element
Lumbar
Posterior
Acoustic shadows
7. Longitudinal image of the CERVICAL SPINE.
spinal
Amniotic
fluid
Anterior
spinal
processes
processes
Occipital
bone of
skull
Cervical
spine
Labeled: C SPINE
8. Longitudinal image of the THORACIC SPINE.
Amniotic
fluid
Thoracic
Labeled: T SPINE
9. Longitudinal image of the LUMBAR SPINE.
Placenta
spine
element
Posterior
spinal
Anterior
spinal
processes
spine
Sacral
spine
Labeled: L SPINE
318 PART IV Pelvic Scanning Protocols
Posterior spinal
Fetal bladder
Sacral
Placenta
Clavicles
10. Longitudinal image of the SACRAL SPINE.
processes
Coccyx
Fetal skin
Spinal cord
Anterior
spinal
processes
spine
Labeled: S SPINE
NOTE: In some cases the long axis of the spine can be visualized on a
single image. If so, take the image and label:
Labeled: SPINE LONG AX
11. Axial image of the CERVICAL SPINE.
Amniotic
cavity/fluid
Clavicles
Anterior
spinal
processes
of cervical
vertebra
Labeled: C SPINE
Posterior spinal
processes
of cervical
vertebra