The Roles of Ultrasound in

Obstetrics

Triono Adisuroso
MD, SpOG, M.Med, M.Phil
 Ultrasound in pregnancy

Instrumentation
›  Real-time scanners
›  Transabdominal and transvaginal transducers
›  Frequencies:
›  - transabdomen: 3-5 MHz (2-2.25 MHz for obese)
›  - transvagina: 5-10 MHz, early pregnancy
›  Storing method
›  Maintenance

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Transvaginal transducer and examination

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Types of examinations
›  Standard examination
›  - Gestational age
›  - Fetal number
›  - Fetal position
›  - Placental location
›  - Cardiac activity
›  Limited examination
›  - Evaluation of interval growth, AF, cervix, cardiativity
›  Specialized examination
›  - Fetal echocardiography, Doppler US, biophysical profile, AF assessment

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 1st Trimester Ultrasound

Indications

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 General considerations

The purposes
-  Viability confirmation
-  Gestational age
-  Number of fetuses; chorionicity; amnionicity
-  Fetal abnormalities detection
-  Aneuploidy screening
-  Nuchal translucency (NT) measurement

When should be performed?

-  Routine ultrasound is not offered
-  11 – 13+6 weeks
-  Benefits and limitations

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Who should perform?
-  A trained individual

What USG equipment?

-  Real-time, gray-scale, 2D US
-  Transabdominal/transvaginal US
-  Acoustic power controls, zoom, electronic callipers
-  Documentation: print/storage, regular maintenance
Safety
-  As low as reasonably achievable (ALARA)
-  Mechanical index (MI) and Thermal index (TI)
-  Rescan or refer to another practitioner

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 ISUOG Guidelines

Assessment viability
-  Embryonic cardiac activity: 37 days, ≥ 2 mm,

-  Intra/extrauterine
-  Gestational sac: MSD, ‘apparently empty’ sac, ‘double-decidual ring’,
‘pseudosac’
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 Number of fetuses

Triplets 10 weeks

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 ISUOG Guidelines

Gestational sac (GS)

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 ISUOG Guidelines

First trimester measurements

CRL: more accurate than MSD (GS)

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 ISUOG Guidelines

BPD and HC

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ISUOG Guidelines

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ISUOG Guidelines

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 ISUOG Guidelines

NT and nasal bone (NB)

NB

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 ISUOG Guidelines

Increased NT

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 ISUOG Guidelines

Orbits (b) and intact lips (c)

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Spine (left) and heart (right)

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 ISUOG Guidelines

Fetal abdomen

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 ISUOG Guidelines

Hand and fingers

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 ISUOG Guidelines

Leg (b) and umbilical cord insertion (c)

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Dolicocephali / frontal browsing

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Fetal acrania

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Mid Trimester

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Fetal growth evaluation

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 Fetal biometry

BPD, HC (a), AC (b), and FL (c)

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ISUOG Guidelines

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 ISUOG Guidelines

Head

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 ISUOG Guidelines

Face

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 ISUOG Guidelines

Heart

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Four chamber view

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Three vessels view

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ISUOG Guidelines

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Hypoplastic left heart syndrome (HLHS)

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 ISUOG Guidelines
Abdomen, urinary bladder and spine

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Congenital diaphragm hernia

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 ISUOG Guidelines

Normal umbilical cord

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Single umbilical artery (SUA)

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 ISUOG Guidelines
Extremities, placenta and cervix

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Normal placental location

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Complete placental previa

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 ISUOG Guidelines

Fetal genitalia

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 Doppler ultrasonography

Evaluatuion
›  Feto-placental circulation
›  The earliest stages of pregnancy
›  The lowest energy levels
›  MI and TI: TI ≤1.0, 5-10 minutes, no exceeding 60 minutes
›  Calculation of pulsatility index (PI), resistance index (RI), systolic/diastolic
ratio (S/D)
›  Color Doppler
›  Power Doppler

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›  Systolic/Diastolic ratio: S/D
›  Resistance index (RI): S – D /S
›  Pulsatililty index (PI): S – D /A

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Uterine artery

1st trimester: Normal

2st trimester: (a) Normal (b) Abnormal

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Umbilical artery

(a) Normal (b) Abnormal

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Mid cerebri artery (MCA)

Circle of Wilis Normal pattern

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Ductus venosus

Normal pattern

End-diastolic
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Cord entanglement

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3D / 4D ultrasound

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Lip cleft

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Body stalk anomalies

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Omphalocele

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Megacystic

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Thank you

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