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Ultrasound to Obstetrics
Honor M. Wolfe
GA Assessment
Physics
High frequency sound waves
> 20,000 cycles/second
Frequency
Number of waves per unit time
Expressed as hertz (Hz)
Diagnostic ultrasound
2-10 million Hz (2-10 MHz)
Physics
Frequency
Probes
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Sound waves
- Transducer both sends and
receives
- Reflected by emitting transducer
- Image displayed as:
1. Brightness - intensity of echo
2. Time lag - distance
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Basic Ultrasound
Examination
Fetal number/presentation/life
Placental location
Assessment of AFV
Assessment of gestational age
Survey for gross malformations
Evaluation for maternal pelvic masses
Metric examination
Screening
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Limited Ultrasound
Assessment of AFV, BPP
Guidance for
Amniocentesis
External cephalic version
Comprehensive Ultrasound
Indications
Suspicion of anomalous fetus
History
Clinical evaluation
Previous ultrasound
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Detection
Directly proportional to severity of anomaly
- 89% lethal anomalies
- 77% requiring NICU admission
- 30% minor anomalies
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Lowest rates
Cardiovascular defects
Cleft up / palate
Microcephalus
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Types of Ultrasound
what might be missed?
Basic (76805)
Measurements, AFI,
placenta
Head
Heart (not color)
Abdomen
Comprehensi
ve (76811)
Face, profile
Extremities
Heart
Color doppler
Extremities
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Variable
Score 2
Score 0
Fetal breathing
movements
Fetal movements
Fetal tone
Fetal reactivity
Qualitative amnionic
fluid volume
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RED CELL
ALLOIMMUNIZATION
Frequency of Irregular
Antibodies
%
Kell
Duffy
MNS
Kidd
Lutheran
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ACOG recommends
antenatal RHIG
ACOG recommends
antenatal RHIG
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RED CELL
ALLOIMMUNIZATION
Rhesus Prophylaxis
66% of Rhesus cases
antepartum sensitization
13% of cases inadvertent
omission of RhIG
Hughes et al. Brit J Obstet Gynaecol 1994; 101:297-300
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RED CELL
ALLOIMMUNIZATION
New Onset RhD Sensitization
Follow maternal titers every 2 - 4
weeks until critical value
reached (32 at UNC)
Determine paternal genotype for
involved antigen
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RED CELL
ALLOIMMUNIZATION
New Onset RhD Sensitization
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RED CELL
ALLOIMMUNIZATION
Previous RhD Sensitization
History of previous IUFD,
intrauterine transfusions or
neonatal exchange
transfusions
Maternal titers not helpful
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