Download - Second and third trimester emergencies
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Second and third trimester emergencies
Dr. Kosar Kamal Ahmed H.D diagnostic radiology
Lecture 3
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Lecture over view Essential elements of an emergency scan
Determining the presenting part of the fetus
Fetal lie
Measurements of GA (BPD & FL )
Location of placenta
Amniotic fluid assessment
Problems or emergencies during this time
Preterm labor , location of placenta , haemorrhage , oligo / poly
hydramnios
Early second trimester ( < 16 weeks )
cervical incompitence and habitual abortion
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Essential elements of an emergency scanpresenting part of the fetus
Cephalic presentation
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Essential elements of an emergency scanpresenting part of the fetus
Breech presentation
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Essential elements of an emergency scanpresenting part of the fetus
Back and abdomen presentation
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Essential elements of an emergency scanEstimation of gestational age
BPD The BPD is the maximum diameter of a transverse
section of the fetal skull at the level of the
.parietal eminences
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Essential elements of an emergency scanEstimation of gestational age
BPD • A single optimal measurement of the BPD will predict the
• gestational age to within ± 5 days.
• It is more accurate at predicting the date of delivery than an
optimal menstrual history.
• It is more accurate than CRL ( Why ?)
• Recent data report that HC is more accurate than BPD
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Estimation of gestational age BPD
• Lateral ventricles view:• rugby-football-shaped skull• a long midline equidistant from the proximaland distal skull echoes• the cavum septum pellucidum bissecting the
midline one-third of the distance from thesynciput to the occiput
• the two anterior horns of the lateralventricles, symmetrically placed about theMidline
• all or part of the posterior horns of the lateralventricles symmetrically placed about themidline .
Measurement of the BPD can be done in two ways or two schools :
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Estimation of gestational age BPD
Thalami view : ●a rugby-football-shaped skull
●a short midline equidistant from the proximal
and distal skull echoes
●the cavum septum pellucidum bisecting the
midline one-third of the distance from the
synciput to the occiput
●the thalami
Measurement of the BPD can be done in two ways or two schools :
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Estimation of gestational age BPD Measurement of the BPD can be done in two ways or two schools :
However thalami view Is the view of choice in American literature and
Many departments in UK
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Estimation of gestational age FL
-This measurment is as accurate as BPD
in the prediction of GS -The upper femur should be selected for
measurement -To ensure that the section obtained is
not oblique ( soft tissue should be
visible beyond both ends of the
femur and the bone should not
appear to merge with the skin of the
thigh at any point
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Essential elements of an emergency scanIdentification of location of placenta
• The placenta is best identified by scanning the uterus
longitudinally and is easily recognized by its more echogenic
pattern compared with that of the underlying myometrium
• Placenta can be in :
– Proper position
– Low lying
– Marginal previa
– Previa
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Essential elements of an emergency scan
Identification of location of placenta
Fundal , anterior or posterior Normal
>2 cm away from internal Os
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Essential elements of an emergency scan
Identification of location of placenta
Placenta is partially covering the internal Os
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Essential elements of an emergency scanIdentification of location of placenta
Covering the internal Os
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Essential elements of an emergency scanAmniotic fluid assesment
Three methods 1. Subjective assessment :
With experience, it is possible to classify amniotic fluid volume into the broad categories
absent, low, normal, increased and excessive.
2. Single deepest pool :
The size of the deepest cord-free pool of amniotic fluid is assessed with the ultrasound
probe perpendicular to the maternal abdomen; The vertical depth of the largest pool is
measured A depth of 2–3 cm is normal
3. Amniotic fluid index :
This is a semiquantitativetechnique for assessing amniotic fluid volume,Using the maternal
umbilicus as a reference point, the abdomen is divided into four quarters.
With the ultrasound probe held in the longitudinal axis of the mother and perpendicular to
the floor the largest vertical pool depth in each quadrant is recorded.
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Essential elements of an emergency scanAmniotic fluid assesment
Three methods
Subjective method
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Essential elements of an emergency scanAmniotic fluid assesment
Three methods Deepest vertical pocket
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Essential elements of an emergency scanAmniotic fluid assesment Three methods
Amniotic fluid index (AFI )
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End of part one Thank you