SONOGRAPHIC DATING AND STANDARD

FETAL BIOMETRY REPORT

-- THE BLACK BOX OF FETAL STATUS --

PANEL DISCUSSION
SFM CORBETT RETREAT, SEPTEMBER 2018
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  PANELISTS:

MODERATOR:  DR ASHOK KHURANA

 DR VIVEK KASHYAP

 DR TLN PRAVEEN

 DR CHANCHAL SINGH
DR BHARTI PANT  DR ANUPAMA FUTELA
GAHTORI  DR SUMITA PRABHAKAR
 PANELISTS

1 2 3
DR ASHOK KHURANA DR VIVEK KASHYAP DR TLN PRAVEEN

SENIOR RADIOLOGIST & SENIOR RADIOLOGIST & SENIOR RADIOLOGIST &

FETAL MEDICINE EXPERT FETAL MEDICINE EXPERT FETAL MEDICINE EXPERT

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 PANELISTS

4 5 6
DR CHANCHAL DR ANUPAMA RAVI DR SUMITA PRABHAKAR
MD ,MRCOG MD , OB-GYN & MD , OB-GYN &
MATERNAL FETAL INFERTILITY (IVF) INFERTILITY (IVF)
MEDICINE SPECIALIST SPECIALIST SPECIALIST

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 I BELIEVE

“Knowledge has to be improved, challenged, and increased constantly, or it vanishes”

So
“If you have knowledge, let others light their candles in it.”

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 JOURNEY SO FAR

1950 1960 1970 1980 1990 2000 +

DR IAN
INTRODUCTION MECHANICAL ENDOVAGINAL 3D/4D 3D
DONALD
OF VAGINAL SECTOR REAL TRANSDUCER ULTRASOUND ADVANCEMENT
USED IT FOR
TRANSDUCER TIME COLOUR & ADVANCE
OBSTETRIC
SCANNERS DOPPLER TRANSDUCERS
PURPOSE
IMAGING

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 AT THE END OF THIS PANEL DISCUSSION

LEARN WHICH USG LEARN HOW TO

TO ASK FOR ? INTERPRET ?

AT WHAT LEARN WHAT TO

GESTATION ? REJECT ?

LEARN WHAT YOU LEARN HOW TO SHED

GET FROM THE SCAN OFF DEPENDENCE
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 QUESTION 1
FOR ALL PANELISTS

QUES 1: How much importance an

ultrasonologist should give to the patient
information ,expected by the machine ?
WHAT TO KEEP IN MIND ………
Correct name, date of birth ( Age)
Dating from LMP ( regularity/ type of conception )
Period of gestation
Obstetric history ( GPAEL ,chorionicity , BOH )
Indication for ultrasound
 Type of ultrasound
 Reffering doctor
 Medicolegal documentation
 QUES 2 : DR ASHOK KHURANA SIR

a) Is the first trimester viability scan

(7-10wks) integral part of antenatal
screening ?
b) How informative and relevant is it ?
Correct dating
Intrauterine / extrauterine pregnancy (most relevant in
presence of symptoms, as per RCOG recommendations)
Multiple pregnancy – establishing chorionicity
Countries who have adopted NIPT in their routine care –
Simon Maegher spoke about the NIPT scan instead of the
NT scan!
In our context, if one has to choose one scan, it would be
rather NT/NB scan than viability
 QUES 3 : DR VIVEK KASHYAP SIR

a)What are the routine measurements done during

the viability scan ?

b)How to assess normal and abnormal findings by this

scan ?
Location
Gestational sac
Number of sacs
Yolk sac
CRL
 Fetal heart rate
Intervening membrane in
twins
Adnexal pathology
 QUES 4 : DR TLN PRAVEEN SIR

a) What are the important parameters measured

during NT-NB scan ?

b) What are the FMF recommendations regarding

measurements of these parameters ?
 Magnification

60%

98%

Image should occupy 60-98% of the screen

NUCHAL TRANSLUCENCY
 QUES 5 ) DR ANUPAMA FUTELA MAM

a)What is the best time to ask for second trimester scan ?

b) What all information do we gather while doing this scan ?

18-22 weeks
Keeping in mind the MTP act, 18-20 weeks more
suitable
• Growth
• Structural abnormalities
• Placenta
• Amniotic fluid
• Cervical length
• Uterine artery Dopplers
QUES 6) DR CHANCHAL
a) Is the 19+5 views in fetal anatomical survey – A myth or
reality ?
 HEAD AND FACE

TRANSVENTRICULAR PLANE
TRANSCEREBELLAR PLANE

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What abnormal findings can one assess by this scan
?

Missed miscarriage
Ectopic pregnancy
Heterotopic pregnancy
Caesarean scar pregnancy
Molar pregnancy
QUES 7) DR ASHOK KHURANA SIR

a) What is the importance of doing fetal biometry in the 18-

22 weeks scan ?
b) What do the measured parameters convey individually ?
QUES 8) DR SUMITA PRABHAKAR MAM

a)What are biometric ratios ? How are they assessed ?

b) What is their relevance in present scenario
QUES 9) DR ANUPAMA FUTELA MAM

a) Are fetal dopplers integral part of routine mid trimester

scan and third trimester scan?
b) What are the indications of conducting it and its
interpretation?
QUES 10) DR VIVEK KASHYAP SIR
a) How is the fetal environment assessed ?
b) Does placental size / volume assessment play a role in
high risk pregnancy ?
QUES 11 ) DR SUMITA PRABHKAR MAM
a) What are the components of the third trimester fetal well
being scan ?
b) What is the best time to recommend it ? Does it change
QUES 12) : DR CHANCHAL

a) If we find that the Estimated fetal weight <10th centile ,

at any gestational age, how to proceed ?
QUES 13) : DR TLN PRAVEEN SIR
Few controversies and where do they stand
a) If soft markers present , how to proceed
b) Measuring scar thickness
c) Mentioning loops of cord
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