OB 2nd and 3rd trimester Initial Scan /
- Nuchal fold up to 22 weeks
- Humeral length up to 22 weeks
- Label left/ right on extremities and annotate with body part
- Color flow over cervix to R/O vasa previa
- Placental cord insertion gray scale and color
- Document fetal movement on OLF
- 4ch heart
- Situs with label (L) over fetal left side and annotating position as breech/ transverse or vertex
- LVOT
- RVOT
- Diaphragm sagittal/ coronal
- Placental cord insertion
- Cine sweeps of fetal face
- Humeral length on biometry
- Placental cord insertion
- Macro Polyclinic OB initial
OB 2nd and 3rd trimester Limited / Follow-up Scan /
- Lateral ventricle
- Cisterna Magna
- TCD up to 30 weeks
- Identify normal anatomy: 4 CH heart, LVOT and RVOT
- Stomach
- Kidneys
- Bladder
- Diaphragm
- Document fetal movement on OLF
- Please only get cervix length up to 32 weeks TA only unless requested to do TV.
- Diaphragm sagittal/ coronal
- Situs with label (L) over fetal left side and annotating position as breech/ transverse or vertex
- Macro Ob limited > 32 weeks or OB limited < 32 weeks.
- Macro Polyclinic OB follow-up
Nuchal translucency /
- Done between CRL= 45-84 mm.
- Early anatomy to include: CP, extremities, nasal bone, situs where possible, CI, bladder and stomach.
- When documenting first trimester for dates need Uterus, ovaries and adnexa in addition to CRL, YS etc.
- Report impression should include CRL in mm corresponding to # of weeks/ days and NT in mm.
- Nuchal translucency + first trimester OB for dating: US OB + NT
- Nuchal translucency alone
- US NT
OB Special considerations /
- Funneling of LUS document cervix length on TV on any 2nd up to 28 weeks
- When Biometry/ AC lagging by at least 2 weeks or when EFW < 10% do cord and MCA Doppler
- On patients with hypertension in pregnancy do Cord Doppler
- Variation with Cord insertion:
Velamentous:inserting into membranes.
Central: (-90%): normal situation Eccentric:lateral insertion of the umbilical cord at > 2 cm of the placental margin
- Cervix does not need to be imaged TV or TA after 32 weeks
- Document fetal movement on OLF for OB complete & OB Follow up.
- Add Transvaginal exam in header and procedure line and document TV done in report
- MCA and Cord Doppler Macros
Renal /
- Renal volumes
- Renal cortical thickness on requests for chronic renal disease or when patient GFR < 60 ml/min.
- For indications: recurrent UTIs, urinary frequency, BPH and concerns about residual volume please do pre and post void volumes.
- Pre and post void bladder for indications: Incontinence, frequency, recurrent urinary tract infection and enlarged prostate/ BPH.
- Renal cortical thickness
(normal > 8mm) - Report renal volumes
- Report residuals volume and % residual.
Renal Transplant /
- Resistive indices at interlobar arteries upper, mid and lower poles angle 0, instead angle transducer
- Main renal artery PSV @ anastomosis, mid and hilum PSV
- Report RIs for interlobar arteries at upper, mid and lower pole
Liver Doppler /
- PHA, LHA and RHA RIs
- RPV, MPV, LPV, splenic vein waveforms and direction
- RHV, LHV, MHV, IVC, waveform and direction
- Report RIs for arteries
Macro: Abdominal Doppler or Liver Doppler depending on whether complete abdomen or limited abdomen done.
Testicular or Ovarian Doppler /
- Document arterial and venous flow BOTH (complete)
- Document one side OR just artery alone or vein alone (limited)
- Add Doppler Macro
When to call MD to check
Abnormal US cases:
When you see an abnormality such as acute cholecystitis, ovarian mass or things that require the attention of a radiologist because we might ask for Doppler or extra images, please call and check BEFORE you send the patient away.
Gynecologic Emergencies:
- For clinical indication of R/O torsion in acute pelvic pain. If you see a mass and patient is in acute pain: always ask referring to request and do Doppler to document BOTH venous outflow and arterial inflow to the ovaries. Limited charge applies if only 1 ovary or only arterial flow done.
- Ectopic pregnancy.
- When a complex pelvic fluid collection is identified as this can be an abscess or related to PID/TOA.
- Ovarian Hyperstimulation syndrome: i.e. when a patient is taking clomid, pergonal or other fertility treatments to conceive and comes in with acute pain.
Obstetrical Emergencies:
- Pregnant patient with tenderness over fibroid may be undergoing necrosis and can be at risk for abscess, premature labor etc.
- Oligohydramnios.
- Hydrops.
- Note that the normal placental thickness is 1mm per week of pregnancy and if placenta is unusually thick, this can be an early sign.
- If hydrops is present: look for causes such as:
- Signs of anemia: obtain MCA peak systolic velocity
- Arrhythmias: M mode.
- If SVT HR usually between 220-230 bpm.
- If complete heart block, HR usually between 65-90 bpm.
- Any bradycardia defined as sustained HR < 100 bpm.
- Infection: most common cause is parvovirus B19
- Fetal masses: CPAM, CDH, tracheal atresia, sequestration.
- Any ABNORMAL pregnancy: molar, fetal aneuploidy or demise.
- Cord prolapse
- Nuchal cord which involves 2+ loops around the fetal neck.
- Twins: oligo/poly sequence of TTS, lack of distension of stomach or bladder.
- Vasa Previa: fetal vessels are fixed in front of the os seen when:
- Cord insertion into placenta is Velamentous—therefore always look at the placental cord insertion site
- Succenturiate lobe is present.
- Accreta: when there is a history of prior C-section and you have a placenta previa please look for:
- Loss of retroplacental hypoechoic zone
- Myometrial thinning less than 3mm
- Placental venous lakes.
- Placental abruption. This is seen with maternal hypertension, trauma and IVDA especially with cocaine.
- Postpartum excessive blood loss:
- Uterine rupture
- In patients who have had a prior myomectomy with pain or blood loss post delivery—worry about uterine dehiscence.
Updated 2016.