2NDAND 3RD TRIMESTER

CYESIS
BY
BODE ADEWUNMI PHD,MAMUP,MARN
2ND/3RD TRIMESTER INDICATION

• Evaluation of fetal anatomy

• Estimation of gestational age
• Evaluation of fetal growth
• Evaluation of vaginal bleeding
• Evaluation of abdominal or pelvic pain
• Evaluation of cervical insufficiency
• Determination of fetal presentation
• Suspected fetal death
• Evaluation of fetal well-being
• Suspected amniotic fluid abnormality
• Suspected placental abruption
PROBE MOVEMENT

There are only 3 simple probe movement

• Long Axis (slide or angle)
• Short Axis (slide or angle
• Rotate (clockwise or counter clockwise)
• Movement along the probe long axis centers anatomy
• Movement along the probe short axis locates anatomy of
interest
• Rotate = Elongate or shortens anatomy
NOTE

• Short axis: locate general anatomy

• Long axis : centre anatomy on display
• Short axis: locate specific anatomy
• Rotate : elongate or shortens displayed anatomy
CERVICAL COMPETENCE

• Measure length
• Normal >3.0cm
• Short < 3.0cm
• Visual signs of funneling
BIPARIETAL DIAMETER {BPD}

By the end of the first trimester, measurement of the Biparietal

Diameter (BPD) becomes more accurate than the CRL, which by
that time reflects error associated with fetal flexion and extension.

The BPD is imaged in the transaxial plane of the fetal head at a

level depicting thalami in the midline, equidistant from the
temporopariental bones and usually the cavum septum pellucidum
anteriorly.
• The ‘widest’ BPD is not always obtained through a plane of
section that traverses the third ventricle and thalami.
Occasionally, the widest BPD is obtained in a more
cephalad location. Searching for the widest BPD is likely to
engender errors because there will be a tendency to accept
an erroneous measurement wherein the error overestimates
the measurement
• Any plane of section through a 360 degree arc that passes
through the Thalame and third ventricle is acceptable for
measuring the BPD. The rules for measuring the BPD are as
follows:
• Current plane of section is through the third ventricle and
Thalami

• Caveria are smooth and symmetric bilaterally.

HEAD CIRCUMFERENCE {HC}

• HC can be obtained through an infinite number of planes

however, in the strictest sense, the HC is best obtained through a
single plane of sector. HC measured must be seen as a three –
dimensional measurement. To measure the HC the two criteria
for BPD must be fulfilled, the transducer plane must be properly
oriented to the skull base, also the cavum septum pellucidium
must be visible in the anterior portion of the brain and the
tantorial hiatus must be visible in the posterior portion of the
brain, the calveria must be smooth and symmetric bilaterally.
After the proper plane of the section is obtained the cursors
are positioned at the outer edge of the calvaria.

An analysis of an observed error should give the interpreter

a sense of both the directional magnitude of error e.g. the
sonographer put the eclipse to the skin of the scalp and not
to the calveria, the error will increase the HC measurement
EFFECT OF HEAD SHAPE AND
BPD
Dolichocephaly seconding to prematurity or to a relative lack of amniotic fluid e.g.
wall PROM or IUGR may lead to an underestimation and gestational age.

conversely, brachycephaly may lead to a larger than expected BPD and this is an
overestimation of gestational age.

The degree to which head shape affects the BPD may be estimated by calculation
of the cephalic index (CI) using the formula: CI = BPD/OFD X 100%

Where: OFD is the Occipito Frontal Diameter. Normal range is 75-85%

4-CHAMBER HEART

• Demonstrating all four chambers of the heart helps when

searching for congenital heart malformation
THORACIC SPINE

• It is assess for fetal spine malformation like spina bifida

•
ABDOMINAL CIRCUMFERENCE
{AC}
• the circumference of the fetal abdomen is most conventional
and reproducible measured through the liver, using a level that
includes the horizontal portion of the portal sinus. AC is
obtained rapidly with real time by visualizing transverse
sections of the fetus at right angle to the spine, but the
umbilical vein covers the fetal abdomen and travels through
the liver obliquely in cephaled and posterior direction seen that
shows the umbilical vein extending to the Anterior abdominal
wall is probably an oblique rather than a true transverse seen.
KIDNEY VIEW

• The fetal kidney are lateral to the transverse fetal spine,

they are found bilaterally inferior to the stomach and
superior to the abdominal umbilical cord insertion,
• They are slightly more hypoechoic than the surrounding
structures.
ABDOMINAL CORD INSERTION

• Below the fetal kidneys

• Above the fetal bladder
FETAL BLADDER

• Located below the umbilical cord insertion, it is filled with

fluid.
FEMUR LENGTH {FL}

• The FL measurement is technically the easiest of the common

biometric measurements, this is because the transducer need only be
aligned to the long axis of the bone to obtain a proper plane of section.
The first feature to understand about FL is that one does not actually
measure the entire femur, only the diaphysis and metaphysis are
measured .

• The cartilagious ends of the femur is more visible sonographically than

the ossified ends, nonetheless, the cartilagious ends of the femur are
readily demonstrated.
THANK YOU