CONTENTS

1. Introduction 1

1.1 Filling up of forms 2

1.2 Relevant history 2

1.3 Preparation and positioning of patient 3

1.4 Machine and transducers 4

1.5 Reporting 5

2. Training 9

2.1 Theoretical aspects 10

2.2 Training parameters 11

2.3 Suggested training schedule 12

2.4 Prerequisite criteria for a trainedultrasonologist 12

2.5 Mandatory proposed certification foran ultrasonologist (Obs. and Gyn.) 14

3. First Trimester 15

3.1 Indications 16

3.2 Normal first trimester embryonic/fetalevaluation 17

3.3 Normal parameter evaluation in thefirst trimester 24

3.4 Abnormal intrauterine pregnancy 26

3.5 Impending early pregnancy failure 30

3.6 Ectopic gestation 30

3.7 Extra-fetal evaluation 34

3.8 Abnormal intrauterine pregnancyforms 38

3.9 Complete abortion 38

3.10 Incomplete abortion 38

3.11 Molar change 38

3.12 Sono-embryology chart 44

3.13 Nuchal translucency 55

3.14 Abnormal fetus 60

3.15 First trimester scan checklist 62

3.16 Dilemmas 63

3.17 First trimester key points 63

3.18 Transvaginal decision flow chart 64

3.19 Decision making in the firsttrimester 65

4. Second Trimester 67

4.1 Indications 68

4.2 Fetal evaluation 69

4.3 Fetal evaluation (malformations) 69

4.4 Cranium 69

4.5 Nuchal skin 70

4.6 Fetal orbits and face 70

4.7 Fetal spine 90

4.8 Fetal thorax 90

4.9 Fetal heart 90

4.10 Fetal abdomen 118

4.11 Fetal skeleton 118

4.12 Fetal biometry 118

4.13 Extra-fetal evaluation 147

4.14 Color Doppler in second trimester 165

4.15 3D and 4D scan 165

4.16 Abnormal second trimester 167

4.17 Dilemmas 167

5. Third Trimester 169

5.1 Indications 170

5.2 Fetal evaluation 171

5.3 Extra-fetal evaluation 171

5.4 Placental checklist 171

5.5 Amniotic fluid assessment 180

5.6 Causes of oligohydramnios 180

5.7 Causes of polyhydramnios 180

5.8 Fetal growth 181

5.9 Fetal surveillance or fetal wellbeing 182

5.10 Biophysical profile 183

5.11 Evaluation by biophysical profile 183

5.12 Interpretation of biophysical profile 184

5.13 Serial evaluation 185

5.14 Color Doppler 185

5.15 Indications for color Doppler 185

5.16 Interpretation of the waveforms 186

5.17 Indications of delivery 195

5.18 Mode of delivery 195

5.19 Abnormal third trimester 196

5.20 Checklist 196

5.21 Dilemmas 196

Index 197