Principles in addition to Applications of Ultrasound to Obstetrics What is the accuracy of ultrasound in the assessment of gestational age GA Assessment First Trimester: CRL Does maternal BMI impact ultrasound in addition to if so how in addition to why

Principles in addition to Applications of Ultrasound to Obstetrics What is the accuracy of ultrasound in the assessment of gestational age GA Assessment 	First Trimester: CRL Does maternal BMI impact ultrasound in addition to if so how in addition to why www.phwiki.com

Principles in addition to Applications of Ultrasound to Obstetrics What is the accuracy of ultrasound in the assessment of gestational age GA Assessment First Trimester: CRL Does maternal BMI impact ultrasound in addition to if so how in addition to why

Kelly, Kate, Features Reporter has reference to this Academic Journal, PHwiki organized this Journal Principles in addition to Applications of Ultrasound to Obstetrics Honor M. Wolfe What is the accuracy of ultrasound in the assessment of gestational age GA Assessment Accuracy 1/Gestational Age

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Gestational age accuracy 1st trimester + 1 week 2nd trimester + 2 weeks 3rd trimester + 3 weeks First Trimester: CRL 5-12 weeks gestation < 10 wks + 3-5 days > 10 wks less accurate variable position/flexion 5-7 days

2nd in addition to 3rd trimester Accuracy of GA estimates increases as more variables are measured. – Composite estimate of: Biparietal diameter Head circumference Femur length Abdominal circumference Does maternal BMI impact ultrasound in addition to if so how in addition to why Physics High frequency sound waves > 20,000 cycles/second Frequency Number of waves per unit time Expressed as hertz (Hz) Diagnostic ultrasound 2-10 million Hz (2-10 MHz)

Physics Frequency Inversely proportional to penetration Directly proportional to resolution Probes Transabdominal 3.5, 5, 7 mHz Transvaginal 8-9 mHz Sound waves – Transducer both sends in addition to receives – Reflected by emitting transducer – Image displayed as: 1. Brightness – intensity of echo 2. Time lag – distance Ultrasound in addition to BMI Heavier patients Need more penetration (lower mHz) Get less resolution (lower mHz)

What are the types of US – who gets what type of scan Basic Ultrasound Examination Fetal number/presentation/”life” Placental location Assessment of AFV Assessment of gestational age Survey as long as “gross” mal as long as mations Evaluation as long as maternal pelvic masses Metric examination Screening Limited Ultrasound Assessment of AFV, BPP Guidance as long as Amniocentesis External cephalic version Confirmation of fetal death Placental localization (hemorrhage) Fetal presentation

Comprehensive Ultrasound Indications Suspicion of anomalous fetus History Clinical evaluation Previous ultrasound Detailed assessment of fetal anatomy Color/power doppler Arterial/venous doppler What type of anomalies is this patient at risk as long as in addition to how good is ultrasound at finding them How good is ultrasound at finding anomalies It depends on: The anomaly Minor anomalies, heart anomalies hardest When we look When apparent, 20 –24 wks optimal as long as most Who we are looking at Thinner, normal amniotic fluid volume And . Who is looking.

Detection Directly proportional to severity of anomaly – 89% lethal anomalies – 77% requiring NICU admission – 30% minor anomalies Lowest rates Cardiovascular defects Cleft up / palate Microcephalus Types of Ultrasound – what might be missed Basic (76805) Measurements, AFI, placenta Head Heart (not color) Abdomen Comprehensive (76811) Face, profile Extremities Heart Color doppler Extremities

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What about antenatal testing Table 43-1. COMPONENTS AND THEIR SCORES OF THE BIOPHYSICAL PROFILE Variable Score 2 Score 0 Fetal breathing The presence of at least 30 sec of sustained fetal movements breathing movements in 30 min of observation Less than 30 sec of fetal breathing movements in 30 min Fetal movements Three or more gross body movements in 30 min of Two or less gross body movement observation: simultaneous limb in addition to trunk movements in 30 min of observation Fetal tone At least one episode of motion of a limb from position Fetus in position of semi- or of flexion to extension in addition to rapid return to flexionS full-limb extension with no return or slow return to flexion with movement; absence of fetal movement counted as absent tone. Fetal reactivity Two or more fetal heart rate accelerations of least No acceleration or less than 15 beats/min in addition to lasting at least 15 sec in addition to associated two accelerations of fetal with fetal movement in 20 min heart rate in 20 min of observation Qualitative amnionic Pocket of amnionic fluid that measures at least 1 cm Largest pocket of amnionic fluid fluid volume in two perpendicular planes measures< 1 cm in two perpendicular planes From Manning in addition to colleagues (1985), with permission. RED CELL ALLOIMMUNIZATION Previous RhD Sensitization History of previous IUFD, intrauterine transfusions or neonatal exchange transfusions Maternal titers not helpful

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