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ABOUT US THIRD TRIMESTER

ULTRASOUNDS AND
PROCEDURES
GROWTH AND
First trimester / dating ultrasound
WELFARE
Non-Invasive Prenatal Testing (NIPT)

Nuchal translucency ultrasound

Prenatal diagnostic testing

Second trimester morphology

WHAT IS A THIRD TRIMESTER GROWTH AND
Third trimester growth and welfare
WELFARE ULTRASOUND?
3D and 4D ultrasound
A third trimester ultrasound is performed in the last part of the
Pelvic / gynaecologic ultrasound
pregnancy, usually after 22-24 weeks gestation.
Saline Sonohysterogram

HyCoSy

FAQ HOW IS A THIRD TRIMESTER ULTRASOUND Head measurements

REQUEST A BOOKING PERFORMED?
CONTACT A third trimester ultrasound is performed using transabdominal
LINKS ultrasound.

Transabdominal ultrasound involves scanning through your lower

abdomen.  A small amount of ultrasound gel is put on the skin of the
lower abdomen, with the ultrasound probe then scanning through this
gel. The gel helps improve contact between the probe and your skin.

Sometimes a transvaginal ultrasound is also needed during a third

Abdominal measurements
trimester ultrasound. This may be to check for a low lying placenta, to
look at the length of the cervix or there may be another indication to
have this type of scan. Transvaginal ultrasound during pregnancy,
including the third trimester, is safe and will not harm either you or your
baby. Your sonographer will be experienced at performing these
ultrasounds during pregnancy.

Transvaginal ultrasound is an internal ultrasound. It involves scanning

with the ultrasound probe lying in the vagina. The transvaginal
ultrasound probe is thin, about 2cm diameter. The probe is covered with
a disposable protective sheath. A small amount of ultrasound gel is Leg measurements
placed on the end of this probe. The probe is then gently inserted a
short distance into the vagina by the sonographer. All transvaginal
probes have been cleaned and sterilised according to recommended
protocols.

Performing the transvaginal ultrasound usually causes less discomfort

than a pap smear. No analgesia is required for this ultrasound.

Your privacy will always be respected during your ultrasound, especially

the transvaginal examination. You will have a large towel covering your
lower body, in addition to wearing a gown during the transvaginal
Amniotic fluid
ultrasound.

You will always have a choice about whether transvaginal ultrasound is

performed. If you have concerns about transvaginal ultrasound, please
discuss this with your sonographer.

DO I NEED A FULL BLADDER FOR THIS

ULTRASOUND?
We usually get better images during transabdominal ultrasound if the Umbilical artery doppler
bladder is partially filled, so to help your examination we ask you to
drink water prior to the assessment. Please empty your bladder 1 hour
before your appointment, drink 1-2 glasses of water and try not to
empty your bladder again until after your appointment.

A full bladder moves bowel out from the pelvis into the abdomen,
helping visualisation of the pregnancy, uterus and cervix.

Your bladder should not be so full that it causes pain. If your bladder is
very full and painful, you should empty a small amount so you are more
comfortable.
Baby's face in 4D during third
You will be able to empty your bladder after the transabdominal
trimester
ultrasound is completed and before the transvaginal ultrasound begins
(if transvaginal ultrasound is required).

WHY DO WOMEN SOMETIMES FEEL FAINT DURING

THIS ULTRASOUND?
As the baby grows in the last part of the pregnancy, the uterus becomes
larger and heavier. Lying down for this ultrasound can sometimes cause
expectant mothers to become faint and nauseous, especially with a
multiple pregnancy or large baby. This faint feeling is due to a fall in
blood pressure, caused by compression of the veins that run at the back
of the mother’s abdomen (the inferior vena cava) by the uterus and
baby.

Please tell the sonographer if you begin to feel faint or nauseous at all
during your scan. It is no trouble to change your position. Your position
can be changed before you feel worse - lying more on your side or more
upright will usually help resolve your symptoms.
 

WHY WOULD I NEED A THIRD TRIMESTER

ULTRASOUND?
Not all women need to have an ultrasound in the later part of the
pregnancy.

Your doctor may request a third trimester ultrasound for many reasons
including:

Assessment of the baby’s size and welfare (well-being). Your

doctor may be concerned that your baby is too small, not growing
well, or too large. Perhaps you have a condition that may affect the
growth of the baby, such as high blood pressure or diabetes.

Review of the placenta. Your doctor may wish to review the

position of the placenta if there were concerns of a low lying
placenta on your 18-20 week morphology ultrasound or if you have
unexplained vaginal bleeding. Most women with a low-lying
placenta seen at 18-20 weeks will not have a problem by the time
they get to the third trimester. As the uterus gets bigger, it tends to
pull the placenta up and away from the cervix.

Your doctor may be concerned if you have symptoms such as

pain, contractions, vaginal bleeding or reduced fetal movements.
A third trimester ultrasound can help provide reassurance that
baby is well.

Review of the baby’s anatomy.Your doctor may wish to review a

change, concern or abnormality in your baby which was noted at
your 18-20 week morphology ultrasound.

Assess the position of the baby. Your doctor may be uncertain

about the position of the baby (for example, if baby is lying in a
breech position). This becomes more important towards the end
of the pregnancy when the delivery of the baby gets closer.

You have a twin/multiple pregnancy. Twins are at higher risk of

growth problems during the pregnancy. Depending on the type of
twin pregnancy, your babies may also be at increased risk of other
complications (such as twin to twin transfusion syndrome with
monochorionic twins).
 

WHAT WILL USUALLY BE CHECKED AT A THIRD

TRIMESTER ULTRASOUND?
A third trimester ultrasound will usually include each of the following
components however some ultrasounds may focus more on particular
areas.

Your ultrasound is always performed in the context of your clinical

history and the results of previous ultrasounds and investigations.

Measurements of the baby

The third trimester ultrasound will commonly measure:

baby’s head - biparietal diameter (BPD) and head circumference

(HC).
baby’s abdomen  - abdominal circumference (AC).
baby’s leg - femur length (FL).

Each measurement is compared to a normal reference range, which

varies with gestation. Every individual baby has its own characteristics
(for example, some babies have bigger head measurements or shorter
femur measurements). These characteristics are often similar to the
baby’s parents (for example, one parent has a larger than average head
size).

Measurements outside the normal range are not always significant,

especially if the difference is minimal. Your baby will be carefully
assessed if there are concerns about significant deviations from
normal.

These head, abdominal and femur measurements are combined in a

special formula to estimate the weight of your baby.

The size of the baby (the estimated fetal weight).

The estimated fetal weight is compared to the size of other babies at
the same gestation.
This is often expressed as a percentile:

An EFW on the 50th percentile is an average sized baby.

An EFW less than the 10th percentile is a small baby.
An EFW more than the 90th percentile is a big baby.

This ultrasound weight is an estimation of your baby’s size only – there

is a recognised 15% error in this estimation, with your baby being either
15% smaller or 15% larger than the estimated weight. While we
recognise there is this error present in our estimation of your baby’s
size, ultrasound remains the best way your doctor has of checking the
size of your baby.

Serial ultrasounds (more than one ultrasound) are required to assess

the growth pattern of your baby over time. Every baby has its own
individual growth pattern, and this can be monitored if there are
concerns.
Your doctor will usually leave 10-14 days between such ultrasounds to
allow more accurate assessment of growth.

The amount of amniotic fluid around your baby.

This amount of fluid is usually expressed as the “amniotic fluid index”
(AFI). This index is calculated by measuring the maximal vertical
distance of fluid in each quadrant (or corner) of the pregnancy sac.
There is a wide range for the normal volume of amniotic fluid in a
pregnancy, and this range will vary with gestation.

Sometimes, the volume of fluid around your baby may be increased

above normal (polyhydramnios), or perhaps the volume of fluid around
your baby is below the normal range (oligohydramnios).Changes in the
fluid volume are not always significant, especially if the difference is
minimal. You and your baby may be checked for other possible
problems (for example, polyhydramnios can be associated with
gestational diabetes, and oligohydramnios can be associated with small
babies).
The blood flow in the umbilical cord (the umbilical artery).
The blood flow in the umbilical artery (which is in the baby's umbilical
cord) will be measured. Sometimes blood flow in the baby’s brain (the
middle cerebral artery) and liver (the ductus venosus) are also checked.
Such measurements of blood flow in the baby’s blood vessels are
known as doppler studies.

They help assess the function of the placenta and the health, welfare
and well-being of your baby. These measurements are expressed using
different terms, including resistance index (RI), systolic/diastolic ratio
(S/D ratio) and pulsatility index (PI).

Babies that are not growing normally (known as growth restricted) may
show progressive changes in the blood flow of these vessels. Changes
in these measurements are not always significant, especially if the
difference is minimal. Monitoring such changes can help your doctor
decide if your baby needs to be delivered early.

While serial ultrasounds to check the baby’s growth are usually done at
intervals of at least 10-14 days, ultrasounds to review doppler studies
and amniotic fluid volumes can be performed more frequently if
required.

The baby’s heart rate and rhythm.

Your baby’s heart rate will vary, just as it does in adults. Most babies
have a heart rate between 120-180 beats per minute.

The position of the baby.

This ultrasound will tell us what position the baby is lying in:

Head down (cephalic)

Bottom down, with the head at the top of the uterus (breech)
Sideways, across the uterus (transverse)

The position of the baby is more important towards the end of the
pregnancy, when the baby is due for delivery.

The position of the placenta.

Your doctor will want to know that the lowest edge (inferior margin) of
the placenta is not lying too close to the cervix. This is known as
placenta praevia or a low-lying placenta.
Transvaginal ultrasound may be required during your third trimester
ultrasound if there are concerns about the position of the placenta, to
get a better look at the cervix area and lower edge of the placenta.

The anatomy of the baby.

As your baby grows during the pregnancy, it fills up the space inside the
uterus, pressing its body against the wall of the uterus. This means
some parts of the baby may be more difficult to see in the third
trimester, especially hands and feet. The baby’s position will also affect
how well some structures are seen, including the heart, face, and spine.

Some of the structures which we try to routinely review in a third

trimester ultrasound include the baby’s kidneys, bladder and face.

The length of the cervix.

This is especially important if you have premature labour, vaginal
bleeding or pain. The length of the cervix is not as important for us to
know as you get closer to your due date (full term).
Sometimes a transvaginal ultrasound may be required to get a better
view of the cervix.

The uterus
The uterus is checked for problems such as uterine fibroids.
If fibroids are present, their size and location will be noted.

3D/4D images of your baby.

Many parents enjoy the bonding experienced when they see their baby
on 3D/4D imaging.
We aim to obtain good 3D/4D pictures of the baby’s face, but we also
think it is important to make sure that your baby is otherwise healthy
and growing well.
For this reason, the 3D/4D images of your baby are usually done after
the baby has been fully examined with all routine measurements and
other images completed.
The best time to obtain 3D/4D images of baby is between 24 and 34
weeks.

WHAT WILL MY BABY LOOK LIKE AT THE THIRD

TRIMESTER ULTRASOUND?
Beautiful and clear images of your baby, especially baby’s face, are
often seen on this third trimester ultrasound.

It is natural for many parents to think that as their baby grows bigger, it
is always easier to see the baby on ultrasound. This is unfortunately not
always true. In fact, many parents find it more difficult to understand
what they are looking at! The third trimester ultrasound usually focuses
on one part of the baby at a time (for example, baby’s head) rather than
giving an overview of the whole baby at once (for example, like the
images of the baby’s body seen on the nuchal translucency ultrasound).

Many factors influence what parts of the baby can be seen and how
well it is seen. These factors include the position of the baby, the
volume of amniotic fluid (low fluid makes it harder to see) and the size
of the mother’s abdomen (increasing skin thickness makes it harder to
see). The sonographer will attempt to obtain the best possible images
of your baby, and to explain these images as they scan.

Good 3D/4D imaging requires a co-operative baby and adequate

amniotic fluid in front of the structure being imaged. Some babies press
against the wall of the uterus or placenta, or they may have their arms
or hands lying in front of the face. This will make obtaining 3D/4D
images difficult or impossible.

It is good for parents to anticipate seeing their growing baby, but not to
be too disappointed if this ultrasound proves difficult to understand or
the images of baby’s face are impossible to get.

PROUDLY
PARTNERING WITH