Fetal US Reporting Template, Children’s National MC/Bulas
OB US
History: [ ] year old whose [< LMP >] [<EDD>] was [ ] consistent with a [ ] gestation. [< >]
A single live intrauterine gestation was identified in [ ] lie. The placenta was [<anterior >] and grade [ ]. The cervix was closed. There was no evidence of previa. Amniotic fluid volume was [<normal>] with amniotic fluid index of [ ] . A [< three-vessel >] cord was identified.
Fetal movement occurred throughout the exam.
[<Biophysical prophile - Tone 2/2, movement 2/2, >] [< breathing 2/2 >]
Fetal US analysis:
BPD of [ ] cm consistent with [ ] weeks [ ] days.
Cerebellum [ ] consistent with [ ] weeks [ ] days
Head circumference of [ ] cm consistent with [ ] weeks [ ] days.
Abdominal circumference of [ ] cm consistent with[ ] weeks [ ] days.
Humeral length of [ ] cm consistent with [ ] weeks [ ] days.
Femoral length of [ ] cm consistent with [ ] weeks [ ] days.
Nuchal thickness of [ ] mm
Nasal Bone [ ]
Estimated fetal weight was [ ] gm which is in the [ ] percentile for gestational age.
Doppler evaluation:
Fetal heart rate of [] bpm.
Umbilical artery shows a SD ratio of [], an RI of [] and a PI of [].
MCA shows a PSV of [] cm/sec, a RI of [] and a PI of [].
Cerebroplacental ratio of [].
Visualized fetal face, brain, and spine were unremarkable. [< Cavum septum pellucidum identified. >]
The ventricles and cerebellum were grossly normal in configuration. No hemorrhages or masses identified.
A normal four-chamber view of the heart and outflow tracts was noted.
A fluid-filled stomach and bladder were present. Cord insertion was normal.
[< The renal fossa were unremarkable >]. The right kidney measured [ ] cm with the left measuring [ ] cm.
The visualized extremities were unremarkable. [< There is no equino varus deformity>]
[< Male >] [< genitalia noted. >]
Impression:
1. Single live intrauterine gestation consistent with [ ] by dates and [ ] by size. [<Normal interval growth>]
2. [ ]