Doppler obstetric sonography and obstetricians. Magdalena V. Hospital Martinez - Pacheco. Tigre. Dr. M. Isabel Lopes. 1ER ultrasound.

QUARTER. Evaluation: Gestational sac development embryonic development. cardiac activity. embryonic movements. VALUATION OF AGE GESTATIONAL. Measurement of saccular diameter medium (DSM) and LEM subb 1200 mIU HCG (eco TV) embryonic

Gestational sac. Time of occurrence: 35 + / - sd of amenorrhea. subb 3600 mIU HCG (Transabdominal echo). Gestational sac. Trained by: Yolk Sac mm per day.

Embryo Chorionic Cavity Cavity

Aminótica grows 1

Appearance chronology Saco Eco TV: wk 4 Embryo: Act Heart wk 5: 6 wk Mov. Embryonic: Tra nsabdominal Eco Bag: Embryo 5 wk: 6 wk Act Heart: wk 7 Mov. Embryonic: sem cephalic wk 7: 12 wk 8. Cephalic Polo: wk 12

Gestational sac. Rate: Shape (regular, irregular, kidney-shaped, etc.) Area ovulate deployment lo cation (orthotopic or ectopic) Growth (standard and progressive) Presence of Yol k Sac. Ultrasound of 2nd and 3rd Quarter At this stage the ultrasound takes into account the fetus, placenta and amniotic fluid. Intended to assess fetal growth, placental maturity and amniotic fluid v olume. Fetal Biometry. From the 20th week is abandoned as the embryo and the sack and will now consider specific structures such as biparietal diameter (BPD) measured on a table out side contralateral internal table. Has linear growth until 30 weeks and then slo ws the growth curve. Head circumference: avoid errors due to different conform ations of the head. Fetal biometry Measurement of Long Bones: You can measure all the long bones but the most commonly used are the femur and humerus. The femur has a linear somatostatin throughout pregnancy and therefore represents a good parameter to estimate gestational age throughout pregnancy. Ca n be measured from week 12 and has a typical form of golf club. Fetal Biometry Abdominal Circumference: Measuring waist circumference is directly related to fetal macrosomia or intraut erine growth restriction. should be measured at the umbilical vein, stomach an d adrenal. Fetal Morphology There should be an assessment of fetal anatomy. nd output of large Chest and Heart: 4 cameras a

vessels. CNS indemnity of the spine and brain structures. Cara. Kidneys and blad der. Abdomen: abdominal wall, stomach, cord income. Extremities. Placenta. Assessment of placental location. Placenta previa total occlusive Partia l Placenta Previa Placenta Voiceless Lateral Marginal Placenta Placenta fund ic or later or earlier. Placenta. Placental maturation. The ultrasonographic features of each of the placental layers varies EG. Grannum Rating: Grade O: homogeneous Grade I: Small echogenic substance parallel pl acental chorionic plate Grade II: Waves more marked in the chorionic plate. Grade III: chorionic plate undulating walls that reach the basal plate. Placenta placental maturation is accelerated in pregnancies with IUGR. It is commonly found grade III placenta at 33 weeks. delay in placental maturation RH Neg patients, gestational DBT pa tients treated with heparin. Obstetric Doppler. Allows study the utero-placental flow through the study of the arteries uetrinas. fetal placental flow through the m easurement of umbilical artery flow. The behavior fetal hypoxia to assess feta l cerebral vessels, cerebral media. Clinical usefulness. As the fetus grows, it requires more oxygen and nutrients which increases the uterus and fetal placental flow by a progressive decrease of resistance in uterine and umbilical arteries. The e nd diastolic flow is equivalent to peripheral resistance so as pregnancy progres ses resistance decreases, flow increases diastolic and systolic / diastolic inde x. Normal and pathological patterns. As gestation increases the resistance decreases as diastolic flow in umbilical arteries increases. From week 30 the accepted value of S / D is 3. The decrease in diastolic flow repr esents a pathological relationship. The absence of end diastolic flow and reve rse flow are signs of very poor prognosis. At the level of resistance of uterine arteries is reduced throughout pregnancy. In pathological cases the reduction of diastole ac ts as a predictor of diabetes during pregnancy (preeclampsia) A fetal brain oc curs at the redistribution of cerebral blood flow. Assessment of amniotic fluid. Subjective. Pocket Isolated: VN 3-8 cm. l Phelan Index: VN 8-22 cm. Technica

the four quadrants, with no fetal parts, no umbilical cord and taking the larges t AP diameter of the pocket. Values are compared with tables of percentile accor

ding to gestational age.