Guidelines For Professional Working Standards Ultrasound Practice

More documents

Recommendations

Info

Maternal Obesity In order to reduce the likelihood of a sonographer developing work-related musculo-skeletal disorders (WRMSD) and/or exacerbate the condition when present, multiple repeat examinations of clinically obese women should be avoided. Clinical obesity is defined as a body mass index (BMI) >35. (Refer to Section 1.7) Where inadequate visualisation within the allocated appointment time at the routine anomaly scan undertaken between 18 0 and 20 6 weeks is due to clinical obesity of the mother, one repeat examination only should be offered, at a gestational age of 22-23 weeks. Should the anomaly scan remain incomplete at the second examination, the sonographer should record in the report that the routine anomaly scan could not be completed, due to increased maternal BMI and that no further appointment has been given. Similarly serial scans to assess fetal growth in the well but obese mother should be refused. A scan at 36 weeks only, to assess presentation and growth in the multiparous mother, preceded by a growth scan at 32 weeks in the nulliparous mother, is recommended. Ultrasound examinations should not normally be extended beyond the allocated appointment time. Establishing Gestational Age (GA) Gestational age should be assessed and established in accordance with NICE guidelines 1 and using nationally recommended dating charts 2 10 weeks - 13 6 weeks CRL 1 CRL >84mm HC 1 Prior to visualisation of a live embryo, the gestational age may be assessed from the measurement of the mean gestation sac diameter (MSD). This should be calculated using the two maximum diameters of the sac from the longitudinal, sagittal view using the vaginal route 3 . Where a vaginal examination is declined, the full bladder technique should be used and the gestation sac volume calculated 4 . It is recommended that the expected date of delivery (EDD) is only assigned once a live embryo or fetus has been identified. Assigning Gestational Age after 12 Weeks 6 Days As the accuracy of GA assessment declines with increasing crown rump length (CRL), it is recommended that assigning an expected date of delivery between 13 0 and 14 0 weeks is undertaken with caution. Similarly assigning the EDD using head circumference (HC) measurements between 80mm and 120mm (equivalent to 12 4 -15 6 weeks) should also be undertaken with caution. Ultrasound biometry carried out between 16 0 -26 0 weeks should be used. After this gestation biometry should only be used to evaluate fetal growth velocity. Examinations in the First Trimester • First trimester confirmation of pregnancy, dating or growth It is recommended that requests for early pregnancy ultrasound examinations are only carried out on women with a recent positive pregnancy test, and after 5 weeks and 3 days of gestation i.e. after the yolk sac is normally identified. 5 The conclusion from examinations carried out before this gestation will frequently be of a pregnancy of unknown location. 3 This diagnosis is of limited clinical value and will merely necessitate a repeat ultrasound examination in 7-10 days. The optimal gestational age range over which to assess gestational age by ultrasound biometry is 7 0 -12 6 weeks. It is recommended that ultrasound assignment of the EDD is best carried out within this gestational range. © UKAS 34
• Nuchal translucency screening The nuchal translucency screening examination, either as part of a programme combined with serum screening, or as a stand-alone screening option for Down’s screening of twins or higher multiple pregnancies, should follow nationally agreed guidelines. 1,6 The structures which the sonographer should normally examine, and measure correctly according to referenced charts where appropriate, during a first trimester examination are shown in Table 7. TABLE 7 Structures Examined in a First Trimester Ultrasound Examination STRUCTURE EVALUATION MEASUREMENTS Uterus position, appearance Gestation Sac position, appearance, contents Mean gestation sac diameter Embryo heart pulsations present/absent Crown rump length Fetus Placenta Multiple Pregnancy Both Adnexae heart pulsations, present/absent anatomical assessment position, appearance the above + chorionicity appearance Crown rump length Nuchal Translucency Examinations in the Second Trimester The structures which the sonographer should normally examine appropriately and measure correctly according to referenced charts during a second trimester dating examination are shown in Table 8. TABLE 8 Structures Examined in a Second Trimester Ultrasound Dating Examination STRUCTURE EVALUATION MEASUREMENTS Skull And Intracranial Anatomy At Level Of Lateral Ventricles appearance Head Circumference (Biparietal diameter) Intracranial Anatomy At The Sub-Occipito-Bregmatic Level appearance Transcerebellar diameter Abdomen At Level Of Stomach And Umbilical Vein appearance Abdominal circumference Femur appearance Femur length Fetal Movements Placenta Amniotic Fluid observed position relative to the cervical os volume 35 © UKAS
Page 1: Guidelines For Professional Working
Page 4 and 5: Section 3 Reporting 3.1 Guidelines
Page 6 and 7: © UKAS 6
Page 8 and 9: 1.1 Safety Of Medical Ultrasound
Page 10 and 11: 1.3 Ultrasound Examination Procedur
Page 12 and 13: 1.5 Informed Consent For Ultrasound
Page 14 and 15: 1.7 Ergonomic Practice Prevention a
Page 16 and 17: TABLE 1 Recommended Examination Tim
Page 18 and 19: • for growth examinations the ima
Page 20 and 21: By consenting to any ultrasound sca
Page 22 and 23: Observations Examination of focal l
Page 24 and 25: TABLE 2 Structures for Abdominal Ul
Page 26 and 27: In relation to departmental procedu
Page 28 and 29: Assisted Reproductive Techniques Th
Page 30 and 31: 2.4 Guidelines Relevant To Musculo-
Page 32 and 33: Table 6 provides a list of examples
Page 36 and 37: • Fetal Anomaly Screening In keep
Page 38 and 39: TABLE 10 Additional Structures Exam
Page 40 and 41: 2.6 Guidelines Relevant To Paediatr
Page 42 and 43: 2.7 Guidelines Relevant To The Ultr
Page 44 and 45: © UKAS 44
Page 46 and 47: • • Action taken should be repo
Page 48 and 49: EXAMPLES OF EXAMINATION SPECIFIC RE
Page 50 and 51: 3.3 General Medical Ultrasound It m
Page 52 and 53: 3.4 Gynaecological Ultrasound The r
Page 54 and 55: 3.5 Musculo-Skeletal Ultrasound Sho
Page 56 and 57: First Trimester - Nuchal Translucen
Page 58 and 59: Third Trimester Fetal Growth • Gr
Page 60 and 61: 3.8 Superficial Ultrasound Thyroid
Page 62 and 63: Lower/Upper Limb/Graft Arterial Ult
Page 64 and 65: 4.2 Acquisition, Archiving And Use
Page 66 and 67: 4.4 Use Of Patient, Staff And Hospi
Page 68 and 69: 4.6 Guidelines Relevant To Setting
Page 70 and 71: 5.2 Code Of Professional Conduct Fo
Page 72 and 73: FETAL ANOMALY EXAMINATION WORKSHEET
Page 74: FETAL GROWTH EXAMINATION WORKSHEET

Guidelines For Professional Working Standards Ultrasound Practice

Create successful ePaper yourself

Delete template?

Save as template?