Useful in obtaining value information about the fetus, placenta, and the uterus.  Particularly useful in establishing an accurate estimated date of delivery. Indications include, but are not limited to:

 

1.       Size/date discrepancy

2.       Uncertain LMP

3.       Greater or less than expected growth

4.       Prior Cesarean Section

5.       Patient with problem which may require a scheduled delivery (need for accurate EDC)

6.       Past history of preterm delivery

7.       Bleeding

8.       Beyond 12 weeks with no audible fetal heart tones with Doppler

9.       AFP abnormalities

10.     Suspect uterine or fetal anomaly

11.     Multiple gestation

12.     Maternal medical illness

13.     Suspected non-cephalic presentation at 36 weeks or greater

14.     Audible fetal cardiac arrhythmia

 

Documentation:

Results of ultrasounds should be documented in the prenatal record identifying the most accurate assessment of gestational age (i.e. US vs LMP).  LMP dates should be maintained unless there is a discrepancy between the US dates vs LMP greater than the following:

                              <12 weeks           5 days

                              12-15 weeks        7 days

                              15-24 weeks        9 days

                              25+ weeks           14 days

 

If these dates are changed outside these guidelines ultrasound report should include reason (e.g. uncertain last mentrual period, prolonged cycle length).

Documentation of utrasound findings in TraceVue should be as follows:

Document dating criteria under the “Pregnancy” tab. Document other ultrasound findings under the “AP testing” tab.

 

First ultrasound:  identify the date and estimated gestational age in the drop down tabs.  In the comment sections write the date, placental location, and length of cervix, e.g. 1/1/08 anterior placenta, cervix 3.3 cm

          If a patient is to return for an anatomy scan write the date in the comment sections as follows e.g. 1/1/08 anterior placenta, cervix 3.3 cm, scheduled for anatomy scan

 

          Any problems OR genetic counseling identified on the first ultrasound should be identified on the problem list, e.g.

                    EIF on US at ____weeks

Subsequent ultrasounds are generally ordered for those women with early ultrasounds that return for an anatomy scan or for a specific problem that should be identified on the problem list as described above.

                    The results of a normal anatomy scan should be written in the  AP testing tab in the comment section as:  

                    2/1/08 Anatomy WNL 

 

                    The results of an US for a specific problem should go in the problem list e.g.  The problem list states:  S

                              After the US is completed add a note to the problem list that states: US (date) shows appropriate growth/60^th%

 

 

 

 

 

Prepared in conjunction with the  

Division of Maternal-Fetal Medicine

Duke University Medical Center

 

 

                                                                                                                                  Director

 

                                                           

Date

 

 

                                                                

 

 

Ultrasonography

 

 

1.  Rosendahl H, Kivinen S. Antenatal detection of congenital malformations by routine ultrasounography. Obstet Gynecol 1989, 73:947-951.

 

 

3.     Crane, JP, LeFeure MC, Winborn RC et al. A randomized trial of prenatal and ultrasonographic screening: impact on the detection management and outcome of anomalous fetuses. The Radius Study Group. Am J Obstet Gynecol 1995, 172:1641-2.

 

4.     Grandjean et al.  The Performance of Routine Ultrasonographic Screening of Pregnancies in the Eurofetus Study.  American Journal of Obstetrics and Gynecology 1999 Aug; 181 (2):446-54.

 

 

 

 

 

The Clinical Care Guidelines Development Committee of the Perinatal Improvement Board of Duke University Health System has developed a series of multi-disciplinary protocols to offer guidance to health care providers who are caring for pregnant women with high risk conditions.

 

These protocols are designed to assist health care providers in the management of a variety of problems that occur in pregnancy and the time of delivery. They should not be interpreted as standard of care, but instead represent only general guidelines for the care of pregnant women with high risk conditions.  We recognize that services offered by individual providers depend not only on their training, experience and institutional resources, but on the medical facts and circumstances of the specific care situation.

The protocols remain the intellectual property of the Duke University Health System.  They cannot be reproduced in whole or part without the expressed permission of the Health System.

 

These protocols are reviewed by the Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, the Department of Pediatrics Division of Neonatology and the Department of Anesthesiology Division of Women’s Anesthesia.  Please contact Andra H. James (andra.james@duke.edu), Chair, Clinical Care Guidelines Development Committee of the Perinatal Improvement Board with ideas for additional protocols.