Basic OB

Ultrasound

Brandie Bach, BS,RDMS,RVS,RT (R)(S)(ARRT)

 Road map for OB
Ultrasound
Anatomy & Measurements

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 • The aims of early pregnancy scanning are:
THE EARLY • 1. Determine viability
PREGNANCY • 2. Gestational age
SCAN • 3. Fetal number
• 4. In addition, the adnexa should be visualized to
exclude significant pathology

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 Methods

• Trans-abdominal (general probe)

• Must have full bladder
• Usually done after 10 weeks

• Trans-vaginal (TV probe)

• Best resolution, most comfortable ( if pelvic exams have been done)
• Usually done less than 10 weeks
 The First Trimester

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 GESTATIONAL SAC

• Earliest sign of pregnancy

• Seen at 4.5- 5 weeks
• Can be used for dating
• A normal gestational sac grows by 1mm per
day

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 Gestational Sac Measurment

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 YOLK SAC

• Seen at 5 weeks gestation.

• A yolk sac rules out the possibility of a
pseudo sac, seen in an ectopic

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 Yolk sac Measurement

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 Fetal Pole

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 Crown Rump Length Measurement

• The baby is measured, in

centimeters, from the top of their
head (crown) to the bottom of their
buttocks (rump).The limbs and
yolk sac are not included in the
measurement. The CRL can be
measured starting around six or
seven weeks of pregnancy up until
13 weeks.

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 First Trimester Measurements

Measure inner to inner

A: Gestational sac
B: Crown-rump length of embryo
C: Amniotic sac
D: Yolk sac

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 ORDER OF FETAL STRUCTURES

• Gestational sac- 4- 5 weeks

• Yolk Sac – 5 to 6 weeks
• Fetal pole – 6 to 7 weeks
• Cardiac Activity- 6 to 7 weeks

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 Fetal Heart Rate

• Fetal heart beat can be detected as early

as 34 days (just under 6 weeks) gestation
on good quality, high frequency
transvaginal ultrasound, as a 
crown rump length (CRL) of as little as 1-2
mm.
• If a fetal heartbeat cannot be identified
with a CRL ≥7 mm using transvaginal
scanning, then embryonal demise can be
diagnosed. 
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 Non Viable Pregnancy

A Pregnancy is considered non-viable on if:

1. No fetal heart beat where -CRL is greater or equal to 7mm.
2. No fetal pole where: -MSD is greater than 25mm with no embryo. - Both
fetus and gestational sac are expected to grow 1mm/day. Hence, absence or
inadequate growth on serial scans at least 7-10 days apart is suggestive of
non-viability

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 ECTOPIC PREGNANCY
• Ectopic pregnancy, also called extrauterine
pregnancy, is when a fertilized egg grows outside a
woman’s uterus, somewhere else in their belly. It
can cause life-threatening bleeding and needs
medical care right away.
• In more than 90% of cases, the egg implants in a
fallopian tube. This is called a tubal pregnancy.
• An ectopic pregnancy can cause your fallopian
tube to burst or rupture. Emergency symptoms
include major pain, with or without severe
bleeding. 

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 Ectopic pregnancy
• Transvaginal ultrasound is recommended over
abdominal ultrasound because it is far more sensitive in
the early stages of pregnancy. Additionally, the angle is
better for viewing a possible ectopic mass.
• Most often, an ectopic pregnancy develops in the
fallopian tube. More rarely, it can grow in other
surrounding organs, including the ovary, cervix, a
cesarean scar, and the abdominal cavity

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 Ectopic pregnancies

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 Suspect an ectopic pregnancy if:

• There are findings on ultrasound that

are indicative of possible ectopic
pregnancy. Positive findings include an
empty uterine cavity, a thick
echogenic endometrium, free fluid
in the pelvis with a positive
pregnancy test or a pseudo-
gestational sac in the presence of
beta hCG levels above the
discriminatory zone.

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 Test your
knowledge
• Patient presents with positive pregnancy test
• Hypotensive
• Severe pelvic and shoulder pain
• With these images, what is your Dx?

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 Test your knowledge

• Patient presents with positive

pregnancy test
• Hx of fertility treatments
• Pelvic pain and bleeding
• With this image, what is your
Dx?

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 Fetal Head
Measurement
Planes

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 2nd and 3rd Trimester:
BPD & HC
• Beginning at 13 to 14 weeks gestation the
biparietal diameter (BPD) & head
circumference (HC) should be measured.
•  Visualization of the thalami, the midline falx,
and the box-like cavum septi pellucidi (CSP)
are possible.  The presence or absence of the
CSP is a key factor in defining abnormal
brain anatomy.

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 Measurements : BPD & HC
• The BPD should be measured on an
axial plane that traverses the thalami,
and cavum septum pellucidum. The
transducer must be perpendicular to
the central axis of the head, and thus
the hemispheres and calvaria should
appear symmetric. 
The calipers should be placed at the:
outer edge & inner edge of the far
calvarial wall

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 Measurements: BPD & HC

• HC (head circumference), the

length going around the baby's
head.
• In the same plane & image you
took the BPD, move the calipers
outer to outer.
• Then hit elipse, to go around the
skull line of the head.

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 CB/CM
• Transverse cerebellar measurement (in
millimeters) correlates with gestational age
until 20 weeks
• Can be a good adjunct for confirming pregnancy
dates
• Never ignore a cerebellum measuring >2 weeks
behind
• A crowded posterior fossa or “banana”
shaped cerebellum should raise suspicion
for spina bifida
• Cisterna Magna
• Cisterna magna should be measures from
vermis to inside of skull bone
• Normal: 2-10 mm
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 LV

• The lateral ventricular width

(LVW) range for normal fetuses
is 0.7 to 1.0 cm.
• The lateral ventricle should never
measure more than 1 cm at any
time during the pregnancy.
• The measurements are taken in
the posterior horn & calipers are
inner to inner.

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 Fetal Head Review

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 Test your knowledge. What is your Dx?

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 Test your knowledge. What is your Dx?

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 Test your knowledge. What is your Dx?

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 Fetal Thorax

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 Situs
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 Fetal
Cardiac
views

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 Measurements: AC
• Abdominal circumference is a transverse
section through the upper abdomen, which
should demonstrate the following fetal
landmarks:
• fetal stomach, umbilical vein & portal sinus.
• AC measurement should not be taken on a
foreshortened abdomen and the calipers
should be on the skin surface (skin surface
should be visible). 
• The kidneys and cord insertion should not
be visible. The umbilical vein should not be
seen up to the skin line.  
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 Fetal kidneys

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 Fetal Bladder

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 Measurements: FL

• Femur Length (FL) – measures the

length of the thigh bone

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 Test your knowledge.
What is your Dx?

• Patient presents with oligohydramnios

• Denies leaking any fluid
• What is your dx based on these images?

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 Test your knowledge. What is your Dx?

• Patient presents with

polyhydramnios
• What is your Dx based on this
image?

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2nd and 3rd Trimester: Lower
Uterine Segment

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 • The placenta can be situated anywhere on the surface of
the uterus.

Placenta
• The front wall is called anterior. The back wall is called
posterior.
• The side walls are called left lateral or right lateral. The

Location
top wall is called fundal.
• What matters most is where the lower edge of the
placenta extends because if it is too low in the uterus it
can cause bleeding and prevent the descent of the fetal
head during labor. This is a placenta previa.
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 Placenta Location

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 Placenta & Previas

• A low lying placenta that is

close to but not covering
the cervical opening
(usually within 2 cm).
• Placenta previa is covering
the as any instance where
the placenta covers part or
all of the cervix.
• We no longer use ‘marginal’
previa as a term.

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 Fetal Position

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 Fetal Position

• To determine fetal position, put

probe on the lower uterine
segment.
• See which part is presenting
(Head, bottom, spine) and
follow that the the end of the
baby.

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 Test your knowledge. Normal or abnormal?

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 Test your knowledge. What is this?

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 Test your
knowledge.
What is your
Dx?

• Patient presents with cramping

• Prior history of preterm birth
• What is your Dx from these images?
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 Uterine Artery Doppler

• Uterine artery Doppler waveform

analysis has been extensively studied
in the second trimester of pregnancy
as a predictive marker for the later
development of preeclampsia and
fetal growth restriction. The use of
Doppler interrogation of this vessel in
the first trimester has gained
momentum in recent years.

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 Progressive
Preeclampsia

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 Uterus Transplant

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 Things to Remember:

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Looking for
more • https://www.pocus101.com/obstetric-ob-ultrasound-made-easy-
step-by-step-guide/

information? • https://www.youtube.com/watch?v=yUKdf-HTD8M
• https://obimages.net/free-chapter-normal-fetal-ultrasound-biom
etry/
• https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.12403
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 Now that you know how to get
there… any questions?

Thank You!

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