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Diagnostic Ultrasound in Labor and Delivery

Diagnostic Ultrasound in Labor and Delivery. Barry Nicholson MD UAB Selma Family Medicine. Goals and Objectives. Describe and perform basic applications and indications for OB Ultrasound Perform the basic applications Fetal life-Heart beat Number of fetuses Placental location

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Diagnostic Ultrasound in Labor and Delivery

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  1. Diagnostic Ultrasound in Labor and Delivery Barry Nicholson MD UAB Selma Family Medicine

  2. Goals and Objectives • Describe and perform basic applications and indications for OB Ultrasound • Perform the basic applications • Fetal life-Heart beat • Number of fetuses • Placental location • Presentation of fetus • Amniotic Fluid Assessment UAB Selma Family Medicine

  3. Fetal Life • Evidence of fetal demise • No cardiac movement • Hydropic changes • Abnormal lie • Overlapping skull bones • Oligohydramnios UAB Selma Family Medicine

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  7. Fetal number • Search all quadrants • Identify two heads, spines, hearts UAB Selma Family Medicine

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  10. Amniotic Fluid Assessment • Measure the largest vertical pocket in each quadrant; compute sum • Less than 5 cm is oligohydramnios • 5-8 is borderline oligohydramnios • 8-20 is normal • Greater than 20 is polyhydramnios UAB Selma Family Medicine

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  12. Determination of Placental Location • Important because of • Previa • Placental Abruption • Prior to Cesearean • Difficult to do at times because of • Contractions, oligohydramnios • Posterior location, overdistended bladder UAB Selma Family Medicine

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  16. Fetal Lie • Oblique • Transverse • Uterine rupture leads to abnormal fetal lie • Presentation • Is fetal head engaged?

  17. Advanced Applications • Fetal survey • Biometry • Weight and age based on CRL, BPD, AC, and FL • Suspected incompetent cervix • External version guidance • Amniocentesis guidance UAB Selma Family Medicine

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  22. Additional Modalities • Checking for fetal anomalies • Cord insertion • 4 chamber heart • 3 vessel cord • spine and cranial features UAB Selma Family Medicine

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  27. Ultrasound Conclusions • Physicians who deliver babies should learn basic applications and use them frequently • Basic applications will improve clinical management • Extended applications require more study UAB Selma Family Medicine

  28. References • American college of Obstetrics and Gynecologists ACOG: antepartum fetal survellance 1999 Oct 12 (B) • Finnish Medical Society Duodecim. Ultrasound scanning during pregnancy Evidence based guidelines june 28th 2004 (B) • National guidelines clearing hourse www.guidelines.gov • Inforetriever • Advanced Trauma Life Support, Student Course Manual, 8th ed., 2008. UAB Selma Family Medicine

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