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KO, Karl Anthony L.

Obstetric Ultrasonography Results


Department of Obstetrics and Gynecology
Patient Name:___________________________ Date of Examination:_______________
INDICATION:
History:
Maternal age:
Last period:
EDD by ultrasound: EDD by dates:
Gestational age: Gestational age by dates

First Trimester Ultrasound:


Trans-abdominal Ultrasound Ultrasound view:
Fetal heart action present Rate:
Crown-rump length (CRL)
Biparietal diameter (BPD)
Nuchal translucency (NT)
Nasal bone (tick one or leave blank) Not looked for
Present
Absent
Not able to be visualized for technical reasons
Fetal Anatomy:
Skull/brain:_________ ,heart:___________ ,spine _________, abdomen _________, stomach __________,
bladder _______, hands both _______, feet ________.
Placenta:
Amniotic fluid:

Maternal Structures:
Right ovary: normal morphology
Left ovary: normal morphology

Summary:
Nuchal Translucency:

Name of Specialist:
Sonographer Initials:

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