SONOGRAPHIC DATING AND STANDARD

FETAL BIOMETRY REPORT

-- THE BLACK BOX OF FETAL STATUS --

PANEL DISCUSSION
SFM CORBETT MEET, SEPTEMBER 2018
MODERATOR – DR BHARTI PANT GAHTORI
MBBS MD ( MAMC) DELHI
ADVANCE USG AND DOPPLER EXPERT

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 PANELISTS

1 2 3
DR ASHOK KHURANA DR VIVEK KASHYAP DR TLN PRAVEEN

SENIOR RADIOLOGIST & SENIOR RADIOLOGIST & SENIOR RADIOLOGIST &

FETAL MEDICINE EXPERT FETAL MEDICINE EXPERT FETAL MEDICINE EXPERT

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PANELISTS

4 5 6
DR CHANCHAL DR ANUPAMA RAVI DR SUMITA PRABHAKAR
MD ,MRCOG MD , OB-GYN & MD , OB-GYN &
MATERNAL FETAL INFERTILITY (IVF) INFERTILITY (IVF)
MEDICINE SPECIALIST SPECIALIST SPECIALIST

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 I BELIEVE

“Knowledge has to be improved, challenged, and

increased constantly, or it vanishes” So
“If you have knowledge, let others light their candles
in it.”

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 USG JOURNEY SO FAR

1950 1960 1970 1980 1990 2000 +

DR IAN
INTRODUCTION MECHANICAL ENDOVAGINAL 3D/4D 3D
DONALD
OF VAGINAL SECTOR REAL TRANSDUCERC ULTRASOUND ADVANCEMENT
USED IT FOR
TRANSDUCER TIME OLOUR & ADVANCE
OBSTETRIC
SCANNERS DOPPLER TRANSDUCERS
PURPOSE
IMAGING

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 AT THE END OF THIS PANEL DISCUSSION

LEARN WHICH USG LEARN HOW TO

TO ASK FOR ? INTERPRET ?

AT WHAT LEARN WHAT TO

GESTATION ? REJECT ?

LEARN WHAT YOU LEARN HOW TO SHED

GET FROM THE SCAN OFF DEPENDENCE
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 QUESTION 1
FOR ALL
PANELISTS

QUES 1: How much importance an

ultrasonologist should give to the patient
information ,expected by the machine ?
WHAT TO KEEP IN MIND ………
 Correct name, date of birth ( Age)
 Dating from LMP ( regularity/ type of conception )
 Period of gestation
 Obstetric history ( GPAEL ,chorionicity , BOH )
 Indication for ultrasound
 Type of ultrasound
 Referring doctor
 Medicolegal documentation
QUES 2 : DR ASHOK KHURANA SIR

a) Is the first trimester viability scan

(7-10wks) integral part of antenatal
screening ?
b) How informative and relevant is it ?
IMPORTANT POINTS TO KEEP IN MIND………..

 Correct dating
 Intrauterine / extrauterine pregnancy (most relevant in
presence of symptoms, as per RCOG recommendations)
 Multiple pregnancy – establishing chorionicity
 In our context, if one has to choose one scan, it would be rather
NT/NB scan than viability
QUES 3 : DR VIVEK KASHYAP SIR

a)What are the routine measurements done during the

viability scan ?

b)How to assess normal and abnormal findings by this

scan ?
ROUTINE  Location
MEASUREMENTS  Gestational sac
 Number of sacs
 Yolk sac
 CRL
 Fetal heart rate
 Intervening membrane in
twins
 Adnexal pathology
What abnormal findings can one assess by this
scan ?

• Size-dates Discrepancy
• Early pregnancy failure
• Ectopic pregnancy
• Heterotopic pregnancy
• Caesarean scar pregnancy
• Gestational trophoblastic Disease
 QUES 4 : DR TLN PRAVEEN SIR

a) What are the important parameters measured

during NT-NB scan ?

b) What are the FMF recommendations regarding

measurements of these parameters ?
PARAMETERS ASSESSED DURING NT –NB SCAN

• CRL
• Nuchal Translucency
• Presence Of Nasal Bone
• Presence Of Intracranial Translucency
• Fetal Heart Rate
• Flow Across Tricuspid Valve
• Ductus Venosus Wave Form
• Uterine A dopplers
 Magnification

60%

98%

Image should occupy 60-98% of the screen

NUCHAL TRANSLUCENCY
QUES 5 ) DR ANUPAMA FUTELA MAM

 
a)What is the best time to ask for second trimester
scan ?

b) What all information do we gather while doing

this scan ?
• 18-22 weeks
• Keeping in mind the MTP act, 18-20 weeks
more suitable
• Biometry for Growth
• Other biometry of significance- Atrial width ,
cisterna magna , Nuchal fold thickness , NBL ,
• Structural abnormalities
• Placenta
• Amniotic fluid
• Cervical length
• Uterine artery Dopplers
QUES 6) DR CHANCHAL

a) Optimal views in fetal anatomical survey –

A myth or reality ?
QUES 7) DR ASHOK KHURANA SIR

a) What is the importance of doing fetal biometry in

the 18-22 weeks scan ?

b) What do the measured parameters convey

individually ?
 • BPD
COMMON BIOMETRIC • HC
PARAMETERS • AC
• FL
• TCD

• Atrial Width
OTHER BIOMETRY • Cisterna Magna
• Nuchal Fold
Thickness
• Nasal Bone Length
 QUES 8) DR SUMITA PRABHAKAR MAM

a)What are biometric ratios ? How are they assessed ?

b) What is their relevance in present scenario
• TCD /AC RATIO

Other Ratios
• Ratio Used In Thorax (lung /head ratio)
 QUES 9) DR ANUPAMA FUTELA MAM

a) Are fetal dopplers integral part of routine

mid trimester scan and third trimester scan?

b) What are the indications of conducting it

and its interpretation?
Uterine artery Doppler should be taken at
midtrimester scan
Too late for prevention
But important for screening for PE/FGR and
appropriate surveillance
 QUES 10) DR VIVEK KASHYAP SIR

a) How is the fetal environment assessed ?

b) Does placental size / volume assessment play a
role in high risk pregnancy ?
• Amniotic fluid
• Placenta
• Umbilical cord
• Cervix
 QUES 11 ) DR SUMITA PRABHAKAR MAM

a) What are the components of the third trimester fetal

well being scan ?

b) What is the best time to recommend it ? Does the

timing change according to patients clinical profile
• Biometry
• Use of growth charts
• Dopplers – Umbilical and MCA
• Cerebroplacental ratio for diagnosis of late FGR
QUES 12) : DR CHANCHAL

a) If we find that the Estimated fetal weight

<10th centile , at any gestational age, how to
proceed ?
• Wrong Dates
• SGA versus FGR
• Dopplers - AFI - Uteroplacental insufficiency
• UA > 95 centile
Mean uterine A > 95 centile
CPR >1
• Fetal infection
• Chromosomal ab
QUES 13) : DR TLN PRAVEEN SIR

Few controversies and where do they stand

a) If soft markers present , how to proceed list
b) Measuring scar thickness
c) Mentioning loops of cord
( Am J Perinatalogy 2015)
No impact on obstetric or neonatal outcomes
15% 3rd trimester scan reduces to 4% by term
THANK YOU