Obstetrical Ultrasound

Obstetrical Ultrasound
Is fundamental to prenatal care. It is used to:
1. Confirm gestational age and viability;
2. Detect and characterize abnormalities of the fetus, amnionic fluid,
and placenta;
3. Assist with diagnostic and therapeutic procedures.
Ultrasound
• The image is produced by sound waves traveling at a frequency above 20,000 hertz that
are reflected back from fluid and tissue interfaces of the fetus, amnionic fluid, and
placenta.
• Dense tissue (bone)  produces high-velocity reflected waves  gray-scale imaging, which is also
known as brightness-mode, these reflected waves are displayed as bright echoes on the screen.
• Fluid  generates few reflected waves  appears dark.
• In early pregnancy, a 5- to 12-megahertz (MHz) transvaginal transducer usually provides
excellent resolution, because the early fetus lies close to the transducer.
• In the first and second trimesters, a 4- to 6-MHz transabdominal transducer is similarly
sufficiently close to the fetus to yield precise images.
• By the third trimester, however, a lower-frequency 2- to 5-MHz transducer may be
needed for tissue penetration-particularly in obese patients-and this can lead to
compromised image resolution.
Embryo and Fetal Safety
• All ultrasound machines are required to display two indices: the thermal index and the mechanical index. The thermal index
measures the relative probability that the examination may raise the temperature enough to induce injury. However, fetal
damage resulting from commercially available ultrasound equipment in routine practice is extremely unlikely. The potential for
temperature elevation is higher with longer examination time and is greater near bone than in soft tissue. Theoretical risks are
higher during organogenesis than later in gestation.The thermal index for soft tissue, Tis, should be used before 10 weeks'
gestation, and that for bone, Tib, at or beyond10 weeks (American Institute of Ultrasound in Medicine, 2018a).
• The thermal index is higher with pulsed Doppler applications than with routine B-mode scanning. In the first tri-mester, if
pulsed Doppler is clinically indicated, the thermal index should be 50.7, and the exposure time should be as brief as possible
(American Institute of Ultrasound in Medi-cine, 2020b). This is an important consideration when pulsed Doppler is applied to
assist with identification or characterization of suspected abnormalities at 11 to 14 weeks' gestation.To document the
embryonic or feral heart rate, motion-mode (M-mode) scanning is used instead of pulsed Doppler imaging.
• The mechanical index is a measure of the likelihood of adverse effects related to rarefactional pressure, such as cavitation,
which is relevant only in tissues that contain air. Microbubble ultrasound contrast agents are not used in pregnancy for this
reason. In mammalian tissues that do not contain gas bodies, no adverse effects have been reported over the range of
diagnostically relevant exposures. Fetuses cannot contain gas bodies and thus are not considered at risk.
• The use of ultrasound for any nonmedical purpose, such as"keepsake fetal imaging," is considered contrary to responsible
medical practice and is not condoned by the Food and Drug Administration (FDA) (2019), the American Institute of Ultrasound
in Medicine (2020b), or the American College of Obstetricians and Gynecologists 2020b). However, images or video clips from
medically indicated ultrasound examinations may be shared with patients.
Operator Safety
• The reported prevalence of work-related musculoskeletal discomfort or
injury among sonographers approximates 70 percent (Janga, 2012; Roll,
2012). The most common injuries are capsulitis and tendonitis of the
shoulder, epicondylitis of the elbow, carpal and cubital tunnel syndrome,
and neck or back strain (Murphey, 2018). The main risk factors for injury
during transabdominal ultrasound examinations are awkward posture,
sustained static forces, and various pinch grips used to maneuver the
transducer (Centers for Disease Control and Preven-tion, 2006). Excessive
flexion, extension, or abduction while scanning places stress on joints and
muscles. Task repetition without adequate recovery time may compound
risks. Maternal habitus can be contributory because more force is often
needed when imaging obese patients.
The following guidelines may help avert
injury:
1. Position the patient close to you on the examination table. As a result, your
elbow is close to your body, shoulder abduction is <30 degrees, and your
thumb is facing up.
2. Adjust the table or chair height so that your forearm is parallel to the floor.
3. Use a chair with back support, if seated. Avoid leaning toward the patient or
monitor. Support your feet, and keep ankles in neutral position.
4. Face the monitor squarely and position it so that it is viewed at a neutral angle
from the horizon, such as 15 degrees downward.
5. Avoid reaching, bending, or twisting while scanning.
6. Take frequent breaks to help prevent muscle strain. Stretching and
strengthening exercises can be helpful.
Gestational Age Assessment
• Gestational age is based on two
things:
1. Last menstrual period (LMP)
date and
2. Ultrasound examination:
Measurements of the embryo
or fetus.