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Obstetric dating and assessment
The exam may be performed either trans-abdominally or trans-vaginally.
In the setting of multifetal gestations, amnionicity and chorionicity should be documented.
In the setting of desired genetic testing, nuchal translucency measurement aids in the screening assessment for fetal aneuploidy in conjunction with biomarkers.
In 2014, ACOG published a standardized approach for calculating a patient’s anticipated due date using both ultrasound estimates and menstrual history, specifically the patient’s first day of the last menstrual period.
If the patient is unsure of her last menstrual period (LMP) or has a history of irregular menstrual cycles, dating should be calculated based on ultrasound measurements.
The approximate error in fetal weight prediction methods is approximately 15% and is influenced by patient body habitus, weight range of fetus, technical factors such as machine quality and experience of ultrasonographer.
Although it may be possible to document anatomic structures before this time, the size, position, and movement of a fetus may limit a comprehensive examination of structures and therefore require repeat ultrasound examinations.Ultrasound examination at this time aids in the clinical assessment of pelvic pain and/or vaginal bleeding in the setting of an early pregnancy because it can diagnose an extrauterine pregnancy or an abnormal pregnancy, such as a hydatidiform molar pregnancy, an anembryonic gestation or an incomplete versus complete abortion.A definitive diagnosis of an intrauterine pregnancy can be made when a gestational sac containing a yolk sac is visualized within the uterine cavity.A first trimester ultrasound is also useful for the evaluation of maternal anatomy including assessment of the uterus, cervix and adnexal structures.The presence of adnexal masses, ovarian cysts, and/or leiomyomas should be documented and followed throughout pregnancy.The Harmony ™ Prenatal Test is an early and accurate test for Down syndrome and other trisomy conditions.The test can also evaluate fetal sex and sex chromosome (X, Y) conditions.The basic obstetric ultrasound examination provides an accurate and safe clinical assessment of the gravid uterus throughout a woman’s pregnancy including characterizing pregnancy location, identifying the number of embryos present, and aiding in the prenatal diagnosis of fetal anomalies.In 2013, the American Institute of Ultrasound in Medicine (AIUM), in conjunction with the American College of Radiology (ACR) and the American College of Obstetricians and Gynecologists (ACOG), released updated Practice Guidelines for Performance of Obstetric Ultrasound Examinations.An embryo should be visible by transvaginal ultrasonography with a mean gestational sac diameter of 25 mm or greater.The crown rump length is the maximum length of the infant from cranium to caudal rump in a longitudinal plane.