Ultrasound Scan

• We have limited ultrasound scan facilities

in public health institutions and
therefore we should think carefully when
requesting a scan. Also remember
women have to pay for the scan.
 Dating scan for gestational age
• When there is doubt regarding date of last
menstrual period or when there is a
discrepancy of 4 weeks or more between
palpation and suggested dates, perform a scan.
• The dating scan should be done before
20weeks
• Generally it is unhelpful to scan for dates after
32 weeks.
 Congenital abnormality
• Any woman who had previously delivered a
baby with a congenital malformation, or who
is at high risk of one (diabetes,
polyhydramnios, multiple pregnancy) should
have a scan as early as possible, preferably at
20-24 weeks if she presents early enough.
 Miscariages
• The USS is helpful to confirm
– Viable pregnancy and reassuring for the mother in
cases of threatened miscarriage
– Diagnosis of missed miscarriage
– If you suspect complete miscarriage
• Incomplete miscarriage, the diagnosis is
mostly clinical
 Antepartum haemorrhage
• Do not send a patient for a scan if she has
active moderate to severe vaginal bleeding.
• In cases of mild APH, the scan will localize
placental site.
 Ectopic pregnancy
• If you are suspecting a ruptured ectopic you
should never send a patient for a scan. She
may die there.
• If however you think she may have an
unruptured ectopic pregnancy, a scan will help
to confirm or exclude an intra-uterine
pregnancy and also demonstrate a complex
mass in the adnexum.
 Multiple pregnancy
• Whenever there is polyhrdamnios, or if there
is a family history of twins on her side, or the
uterus is larger than dates by 4 weeks or more
send her for an early scan to exclude twins.
 Malpresentations
• All women with a malpresentation at 36
weeks or more should have a scan to exclude
placenta praevia or fetal anomaly. The scan
result will be helpful in deciding mode of
delivery for the patient.
 Viability
• When a woman reports with no fetal
movements or when we fail to pick up a fetal
heart beat, scan will help to make a definitive
diagnosis.
 Growth
• This is the most useful investigation in patients with PIH,
diabetes, previous LBW babies, twinse.t.c.
• A single scan is often of little value and we need to do
serial scans every 2-4 weeks depending on the gestation.
• Important parameters on a growth scan include:
– Ratio of abdominal vs head circumference to see if this is
symmetrical or asymmetrical growth retardation.
– Amniotic fluid (indicate the chronicity of placental
insufficiency)
– Estimated fetal weight
 Estimation of fetal weight
• In cases of breech presentation or where pre-
term delivery is being planned ultrasound scan
can be used to estimate the weight of the
foetus.