ultrasound allows accurate estimation of gestational age determination of viability and presentation position of the placenta measurement of amniotic fluid estimation of fetal weight and identification of multiple pregnancies it can also be used to detect some fetal abnormalities this film will show you how to prepare for scanning how to examine and measure the fetus using both a standardized 6 step approach and part of issue Oggs 20 planes and two sweeps approach and finally how to provide aftercare for the woman the examples used will incorporate pregnancies of different jet stations to best illustrate the specific steps of the scanning procedure before starting the ultrasound scan enter the woman's details and confirm them with her explain the process and the indication for the scam make sure she is ready to proceed and answer any questions she may have although there can be exceptions the scan is usually performed with the woman lying to the right of you and facing you adjust the height of the couch and stool to allow you to work in a comfortable position the woman should be properly covered and her clothing protected from the ultrasound gel now apply the gel over her lower abdomen select the probe and preset which are most suitable for the gestational age and body mass index or BMI of the woman hold the probe with your right hand and operate the machine controls with your left placing the probe in a transverse position on the lower abdomen use its marker as a reference to make sure that the right side of the mother is displayed on the left side of the screen you can check this by pressing your finger beside the probe in the abdomen placing the probe in a longitudinal position and using its marker as a reference the uterine fundus should be displayed on the left side of the screen and the maternal bladder on the right to keep the image orientation correct rotate the probe in a clockwise direction when changing from a transverse plane to a longitudinal plane and anti-clockwise when changing from longitudinal to transverse always keep the orientation of the probe consistent and don't rotate it more than a hundred degrees the probe can only be moved in four ways by sliding rotating dipping or angling asou OGG recommends using the six step approach for the performance of a basic second or third trimester obstetric ultrasound examination begin by placing the probe in a transverse position in the center of the lower abdomen just above the synthesis angle the probe forwards and backwards to identify the presenting fetal part this fetus is K phallic maintaining a transverse orientation slide the probe up towards the maternal amber like us to identify the fetal heart and heartbeat if the fetal heart is not seen in this sweep slide the probe to the maternal right and then left to locate it and confirm that the heart is beating let the woman view the screen maintaining the transverse orientation slide the probe up the right side of the uterus from the synthesis to the fundus repeat this movement in the center of the uterus and also on the left side of the uterus the size of the uterus will determine whether two or three transfers sweeps are required to complete this step rotate the probe to a longer toodle position and survey the whole uterus by sliding the probe from the right side to the left above and below the umbilicus keep the probe perpendicular to the floor as you slide it the screen here shows a singleton and here you can see twins you maintaining a longitudinal orientation starting at the right fundus slide the probe down towards the synthesis keeping it perpendicular to the floor slide along the three tracks indicated to identify the location of the placenta here you can see first anterior then posterior and here a low-lying placenta slide the probe into the midline and using small movements locate the leading edge of the placenta in relation to the internal us here you can see a low-lying anterior placenta mentally divided the maternal abdomen and uterus into four quadrants keeping the probe in longitudinal orientation and perpendicular to the floor slide it from the lower right quadrant through the other three quadrants identify the deepest vertical pocket of amniotic fluid in each that does not contain any fetal parts or umbilical cord and measure by placing the calipers at 90 degrees to the horizontal the amniotic fluid index or AFI is the sum of these four measurements the deepest vertical pocket or DVP is the largest measurement of the four beware here of reverberation artifacts that could make you underestimate one or more of these measurements to take the biometric measurements apply the first sweep and planes for 5 7 and 11 of issuu aux standardized 20 planes and two sweeps approach it is good practice to take each measurement at least three times to make sure your technique is consistent store each measured image on the machine perform the first sweep by rotating the probe to obtain a longitudinal section of the fetus identify the positions of the fetal head and long axis of its body the first measurements to take are the biparietal diameter or BPD and head circumference or HC from the longitudinal axis of the fetus rotate the probe by 90 degrees at the level of the fetal head angle slide rotate and then dip the probe to obtain the correct head shape and intracranial landmarks which indicate the transfer tricular plane known as plane for take the biparietal diameter measurement at the widest point across the skull depending on local charts the BPD may be measured outer to outer or outer to inner to obtain an outer two outer BPD measurement place the calipers on the outer edge of both upper and lower parietal bones to obtain an outer to inner BPD measurement place the lower caliper on the inner border of the lower parietal bone next measure the head circumference by placing the ellipse caliper on the outer edge of the skull then rotate from the trans ventricular plane to the truant cerebellar plane or plane six by keeping the que vem septum pellucidum in view and rotating the probe towards the fetal neck measure the truant cerebellar diameter or tcd by placing the linear calipers across the maximum diameter of the cerebellum rotate back to the trance ventricular plane and slide the probe down through the chest where you will observe the heart beating this is plane seven to obtain the correct section to measure the abdominal circumference or AC you may need to make small rotating and angling movements of the probe as you slide this will allow you to maintain a transverse orientation of the fetus plane 11 is where the landmarks visible are the stomach and a small central portion of the umbilical vein place the ellipse caliper on the outer edge of the abdomen to measure the AC the final stage of the stan is to measure the femur length or FL maintaining a transverse section of the fetal body slide the probe down from plane 11 towards the fetal pelvis and rotate it to view a longitudinal section of the femur this technique will prevent you from accidentally measuring the humerus place the calipers at each end of the femur and measure the longest visible diathesis don't include spur artifacts on the ends of the diathesis and be sure to measure along the long axis of the bone the scanning procedure is now complete clean the probe and return it safely to the probe holder on the ultrasound scanner clean the woman's abdomen and allow her to sit up now wash your hands bring up the report mode on the ultrasound screen and check the measurements explain the scan results to the woman and give her the opportunity to ask any questions provide her with a handwritten or printed report which she can then pass on to her caregiver the woman is now free to leave so you can clear her information from the screen by ending the examination and prepare for the next scam you