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Locate the pregnancy exclude ectopic Assess viability assessment of threatened miscarriage Determining gestation & dates
e.g. fibroids, functional ovarian cysts & neoplasms Nuchal fold measure, anencephaly etc.
>30 mm before 18w & >25 mm before 28 w = low risk of pre term delivery
Amniotic fluid index or deepest pool Fetal breathing Fetal movements and tone (the Biophysical Profile) In umbilical arteries Fetal middle cerebral artery Uterine arteries
30% of women cannot provide a LMP Another 25% have a LMP that is >2w different from USS dates When dates are known aneuploidy screening is accurate and errors of delivery are avoided, fewer inductions for post dates etc. Twins have a perinatal mortality that is 2-4x singletons Monitoring for discordant growth with Doppler reduces risk ECV reduces the rate of Caesarean section
Few RCTs of routine ultrasound have shown any effect on overall perinatal mortality and morbidity
Cost effectiveness of universal screening debated Ethical issues and patient choice involved Sensitivity is 13 50% depending on expertise & equipment And only half of these before 20 w gestation False positives occur
Sensitivity is 80-90% But the positive predictive value of neonatal morbidity is only 2550% The rest have constitutional smallness
It is not ionising radiation However, thermal effects and cavitation can occur in tissues exposed to high power ultrasound One RCT of repeated routine ultrasound with Dopplers in the 3rd trimester found a small but significant decrease in birth weight in the exposed cohort
Investigation of menorrhagia
Monitoring of follicle number and growth for IVF Egg recovery for IVF and ICSI Evaluation of pelvic pain
A limited role
Too many false positives