Obstetrics Book

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Second Trimester Ultrasound

Aka: Second Trimester Ultrasound, Fetal Survey, Second Trimester Fetal Survey
  1. Findings
    1. All Ultrasounds:
      1. Fetal Presentation
      2. Fetal Viability
      3. Fetal Biometry
      4. Fetal Survey
      5. Evaluation of amniotic fluid volume
    2. Level I Ultrasound: standard exam
      1. Biometry
      2. Fetal Survey
    3. Level II Ultrasound: High risk
      1. Usually performed by perinatologist
  2. Exam: Second and third trimester focus areas
    1. Fetal Biparietal diameter
    2. Fetal Head Circumference
    3. Fetal Abdominal Circumference
    4. Fetal Femur Length
    5. Composite Fetal Age
      1. Simple average (regression formulas)
      2. Best combination for accuracy
        1. Fetal Head Circumference
        2. Fetal Femur Length
  3. Exam
    1. Intracranial Anatomy
      1. Start with biparietal diameter view
      2. Rotate transducer 20-30 degrees
        1. Still transects Thalamus
        2. Now transects Cerebellum
        3. Also transects cisterna magna and nuchal thickness
      3. Evaluate structures
        1. Cerebellum
        2. Choroid plexus
        3. Cisterna magna
        4. Lateral Ventricles
        5. Cavum septum pellucidum
      4. Assess for meningomyelocele
      5. Image
        1. ObUltrasoundCerebellum.jpg
    2. Chest including four chamber heart
      1. Critical to confirm that septum is not off axis
      2. Assess left and right outflow tracts
      3. Images
        1. ObUltrasoundHeartChambers.jpg
    3. Stomach location
      1. Assess for Diaphragmatic Hernia
    4. Diaphragm
      1. ObUltrasoundDiaphragm.jpg
    5. Kidneys and Bladder
      1. Use lower longitudinal spine view to start
      2. Scan anterior to spine to capture Kidneys
    6. Cord insertion and three vessel cord
      1. ObUltrasoundUmbilicusInsertion.jpg
    7. Spine
      1. Cervical Spine
      2. Thoracic Spine
      3. Lumbosacral Spine
    8. Extremities
      1. Evaluate arms, legs and hands

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