Basic Obstetric Ultrasound
- Author: Serdar H Ural, MD; Chief Editor: Carl V Smith, MD more...
The basic obstetric ultrasound examination may be used to determine the location of a pregnancy and number of fetuses present and to assist in the assignment of gestational age, prenatal diagnosis of fetal anomalies, and early diagnosis of placental insufficiency.
In 2007, the American Institute of Ultrasound in Medicine (AIUM), in conjunction with the American College of Radiology and the American College of Obstetricians and Gynecologists, released Practice Guidelines for Performance of Obstetric Ultrasound Examinations. The guidelines detail key elements of standard first- and second-trimester fetal evaluation. They classify fetal ultrasound examination into 4 categories: first trimester, standard second or third trimester, limited examinations, and specialized examinations.
Also see the article Targeted Obstetric Ultrasound.
The basic obstetric ultrasound is categorized by the gestational age at which it is performed.
During the first trimester of the pregnancy, the first-trimester basic ultrasound is performed to confirm an intrauterine pregnancy after the patient has a positive pregnancy test. In patients with a positive pregnancy test, the first-trimester ultrasound is especially helpful in ruling out ectopic pregnancy in the setting of pelvic pain or to evaluate for miscarriage or molar pregnancy in the setting of vaginal bleeding. In addition, the first-trimester ultrasound is used to determine the number of fetuses and to evaluate maternal masses. A more-advanced first-trimester ultrasound may be used to evaluate the fetus for aneuploidy (eg, measurement of the Nuchal translucency area and determination of anencephaly).
During the second trimester of the pregnancy, a second-trimester basic ultrasound may be performed. This test is commonly known as an anatomy ultrasound and is routinely used to detect fetal anatomical anomalies and markers for aneuploidy. It can also be used to diagnose or to monitor maternal anatomical problems such as fibroid uterus or ovarian cysts.
A limited ultrasound may be performed at any gestational age and is typically used to evaluate a specific clinical concern. Some examples include evaluating for fetal heart tones that are undetectable with conventional methods, evaluating preterm labor, evaluating vaginal bleeding, assisting in the diagnosing rupture of membranes, determining fetal presentation, and assisting with fetal procedures such as amniocentesis. This study is usually reserved to help in managing certain obstetric procedures or emergencies and is not usually used to replace the second-trimester anatomy ultrasound.
The CDC and ACOG recommend that pregnant women who live in or have traveled to areas with ongoing Zika virus exposure should undergo Zika virus serologic testing and fetal ultrasonography to screen for microcephaly or intracranial calcifications as early as 3-4 weeks after symptoms or exposure.[2, 3] However, the CDC warned that fetal ultrasounds might not detect abnormalities until late second or early third trimester of pregnancy.[2, 4, 5]
Ultrasound has been proven safe to both mothers and fetuses. As with any clinical test, a risk-to-benefit analysis of the test should be considered. Some ultrasonographic modalities, such as Doppler, deliver more energy, and the use of those modalities should be reserved for specific clinical questions and an attempt made to limit their duration of use.
Modern ultrasound equipment has boundaries set by the industry, limiting the fetal exposure to energy derived by the equipment.
As with any medical equipment, adequate care and maintenance should be performed as per manufacturer recommendations.
Additionally, personnel involved with the use of ultrasound equipment should have appropriate training. Some ultrasound suites have quality-assurance programs to evaluate performance of the personnel and the ultrasound unit.
Minimal preparation is required for a transabdominal ultrasound.
A fasting state is not required, in contrast to other ultrasound studies (eg, gallbladder ultrasonography).
Some practitioners advise their patients to arrive to the ultrasound suite with a full bladder, but there is no consensus regarding this recommendation, especially for an obstetric ultrasound performed after 18 weeks’ gestation.
If a transvaginal approach is to be used, the patient is asked to void just before the study to empty her bladder. This minimizes discomfort and collapses the bladder for better visualization of pelvic organs.
American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of obstetric ultrasound examinations. J Ultrasound Med. 2010 Jan. 29(1):157-66. [Medline].
Petersen EE, Polen KN, Meaney-Delman D, et al. Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure - United States, 2016. MMWR Morb Mortal Wkly Rep. 2016 Apr 1. 65 (12):315-22. [Medline].
Practice Advisory: Updated Interim Guidance for Care of Women of Reproductive Age During a Zika Virus Outbreak. ACOG. Available at http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Interim-Guidance-for-Care-of-Obstetric-Patients-During-a-Zika-Virus-Outbreak. June 23, 2016; Accessed: July 27, 2016.
Driggers RW, Ho CY, Korhonen EM, Kuivanen S, Jääskeläinen AJ, Smura T, et al. Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities. N Engl J Med. 2016 Jun 2. 374 (22):2142-51. [Medline].
Kelly JC. Early Ultrasounds May Miss Zika-Induced Microcephaly. Medscape Medical News. Available at http://www.medscape.com/viewarticle/862006#vp_1. April 15, 2016; Accessed: July 27, 2016.
Guidelines for Professional Working Standards. Ultrasound Practice. United Kingdom Association of Sonographers. October 2008.
Preisler J, Kopeika J, Ismail L, Vathanan V, Farren J, Abdallah Y, et al. Defining safe criteria to diagnose miscarriage: prospective observational multicentre study. BMJ. 2015 Sep 23. 351:h4579. [Medline].
Brown T. Miscarriage Ultrasound Diagnosis May Still Need Rescan. Medscape Medical News. Available at http://www.medscape.com/viewarticle/851540. September 25, 2015; Accessed: July 27, 2016.
Sonek J, Nicolaides K. Additional first-trimester ultrasound markers. Clin Lab Med. 2010 Sep. 30(3):573-92. [Medline].
McGahan JP. Sonography of the Fetal Heart. Findings on the Four Chamber View. March 1991. AJR: 156:
Dicke JM, Piper SL, Goldfarb CA. The utility of ultrasound for the detection of fetal limb abnormalities - a 20 year single center experience. Prenat Diagn. 2014 Dec 4. [Medline].
Bignardi T, Condous G, Kirk E, Van Calster B, Van Huffel S, Timmerman D. Viability of intrauterine pregnancy in women with pregnancy of unknown location: prediction using human chorionic gonadotropin ratio vs. progesterone. Ultrasound Obstet Gynecol. 2010 Jun. 35(6):656-61. [Medline].
|Visible Feature||Mean Transvaginal Gestational Sac Diameter (mm)||Mean Transabdominal Gestational Sac Diameter (mm)||Serum b-hCG level (mIU/mL)||Gestational Age (wk)|
|Yolk sac visible||8||20||7,200||5-6|