Introduction: The second trimester ultrasound remains an important screening tool for detecting fetal abnormalities. This pictorial guide for the second trimester ultrasound is designed to assist practitioners to produce a high quality diagnostic survey of the fetus by demonstrating and describing recommended images.
Methods: Each image is discussed in detail and has an associated drawn line diagram to aid in the identification of the important features of that image. There is a description of the salient landmarks and relevant measurements.
Result: The authors hope this article may act as a useful guide to all practitioners performing second trimester ultrasounds.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Objective
To ascertain Australian obstetric sonographers knowledge and current practice when assessing for vasa praevia in the mid‐trimester ultrasound with the view to improve prenatal diagnosis.
Methods
Between August and September 2018, a survey was emailed to 4868 Australian sonographers registered to participate in Australian Sonography Association Registry (ASAR) facilitated research projects. A total of 577 responses were received. The sonographers survey response was compared with published Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) recommendations.
Results
There appears to be an unfamiliarity with the RANZCOG recommendations, in particular that vasa praevia is defined as a fetal vessel lying within 20 mm of the cervical internal os (IOS). Transabdominally, if a vasa praevia risk factor is identified (including a fetal vessel observed in the lower uterine segment), less than 48% of surveyed sonographers proceed to a targeted transvaginal scan.
Conclusion
To enable effective diagnosis of vasa praevia, it is important to recognise associated risk factors that can raise suspicion for a potential vasa praevia; these are velamentous cord insertion, succenturiate lobe, and low‐lying placenta. A lower threshold of performing a transvaginal ultrasound when risk factors are identified (including a fetal vessel is identified in the lower uterine segment) may significantly improve vasa praevia diagnosis in the mid‐trimester ultrasound.
IntroductionThis study investigated the addition of 3D ultrasound imaging to 2D ultrasound imaging when assessing the fetal spine in the second trimester in relation to: the diagnostic confidence of image assessors in interpretation, sonographer perceptions of the challenges in acquiring 3D images, and the additional time required to acquire 3D images.MethodsSix image assessors rated their diagnostic confidence when assessing 2D and 3D images of the fetal spine images acquired from second trimester morphology scans. Sonographer perceptions were investigated using a questionnaire assigned to eight sonographers. The mean time required to take 3D images of the fetal spine was retrospectively calculated using the time stamps from the ultrasound images of 100 second trimester morphology scans.ResultsCommon reasons for assessor's lack of confidence in reporting were poor quality or insufficient images of the upper spine (cervical/thoracic), the scapulae and/or the ribs. Diagnostic confidence of image assessors increased significantly (<.001) when 3D imaging was added to 2D imaging. All sonographers who completed the questionnaire stated that they found 3D ultrasound of the fetal spine useful in addition to 2D. 87.5% of these sonographers sometimes found 3D ultrasound challenging, mostly due to fetal position, or maternal obesity. The mean additional time required to perform 3D ultrasound to assess the fetal spine was 2 minutes and 19 seconds.ConclusionAdding 3D ultrasound of the fetal spine to a 2D second trimester obstetric morphology scan increased the diagnostic confidence of image assessors with only a small additional time requirement.
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