P:1Ucu1: ID n u rnbcr: SONOGRAl'HlC APPEARANCE OF N Ali" NV

FETAL ANATOMY:

Oote of blrtb (OD'MM'YYYY): C) (N•.Nortnnl:Ab•Abnorn1al•:

N\'=Nol v'isunU1.ed)
Referring phy1!1ici:111 ' Gray=oplional
Head
or eurn •
Oat• (00 MM 'YYYY):
So.oogr1lpber Sul"T\ 1sor
Ultrasound 1nachinli!:
1suog... lnt'.lCI cranium

Cavum .,epti p<llucidi

normal >hapc

lndicatioo for M n and ttltvaot clinical information :

Midlme falx
Thalami
Gest111io111l 11gc (IV + D): Lateral vcnlriclo
Based on: LM P I Prci·i(llt.< US I 01her :
Cc-rcbc:llum
Technical condition .:Good I Limited by: Cistenw 1nagrn1
Singleton I Mul1ir>I• (u•c I d1ee1/feru) face
=> Chodonidt·:
Upper lip
PLACETA: Po•ition: Mig1U.J pro61c (optionAI)
Relarion 10 ctntc31 o... r cle.ir Jcovering_ min from
Orbrl>and bulb1
er..
Appearance Nornlal Aboormal* 'lasal 1'onc (option>!)
Umbili cal cord _ Nonna!_ Abnormal• Nrtl I Nucba.I fold
A,\!J\10TIC f !.ll!D:0 Normal Thora_,
[Aboonnat• '.J AFI (optioruil):C DVP
Sh,r pe
(optional)
FETAL MO\'EMENT· Nomml C Abnonnat•

M£ASL'REM£NTS mm 1'erecu1Uc
(ltrfrrcncn) Henrt
Jfea1·1activity
Biparlctal diomclcr
Size
Head circ;umfcrcncc Cardiac a.·us and ,itus
Four·chambcr viC'\Y
Abdorrunal <1Numfon:ncc
Len ,-cn1ricul.;u outflo\\ tract

F<mur d1aphp1> leng1h Righi>entneular outflow tract

JVV and 3Vl
EFW (Hadlt><:k ti ol.).
Ahdcnnen
Other: Slon1ac

h Bowel
Other:
Kidneys
C'erviciLI lcngll1 (011tionnl) Urinary bladder
*Abnonual rinding (nlease detain: Abdominal cord i1u¢rtion
Gallbladd<r (op1i<>t1al)
Cord wssch (op11onal}
Spin•
Limbs
!Uglll orm (incl. hand)
!Ught kg (mcl.
COM'IXSION: foot) Lef\ arm
D Nonual and co111p1clc: cxaniination. {ind hand) Left
D Nonnal bu1 u11.'.on1pl cc cxnn1ination.
leg (incl. loot}
Eletlll!-ll lS no1 :i.ccn:
............. Gender (op1io11nl):0 M J F
D Abnormal cxnn1ination: Olh>r:
Plan;. :r No further uhrasound $Can required.
[1Follow up planned in ..... weeks.
L Rcfcm".110 ..
............
C Other.

REMARKS AD O!ITAILED FINDINGS:

(Describe hen: any abnormal findings)
 Produced Pnntd SIOrcd

No. of imngcs