Ppt Usg Obstetrik 2p4i6o

Standardized Six-Step Approach to the Performance of the Focused Basic Obstetric Ultrasound Examination Putri Aini Daulay

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY H. ADAM MALIK HOSPITAL FACULTY OF MEDICINE UNIVERSITY OF SUMATERA UTARA MEDAN 2016

Introduction

Integral of prenatal care

Diagnosis fetal abnormalities

Identify high risk pregancy Obstetric ultrasound

Its availabity is increasing in limited resource setting

But dependent on competent operator

Introduction

No standardized guideline for USG course

Previous regular USG was considered too complex Develop new standard focused and simple basic USG obstetric approach

Introduction

Idea

Standardized Six-Step Approach Focused Basic Obstetric Ultrasound Examination

Introduction

Aim of this study

Validate the focused basic obstetric ultrasound examination

Compare its performance to the scheduled obstetric ultrasound examination.

Materials and method

Design • Cohort prospective • Observatio nal

Place and time • Division of maternalfetal medicine Eastern Virginia Medical school • Dec 13-May 14

Samples • 100 trimester 2 pregnant women • 100 trimester 3 pregnant women

Device • USG Voluson E8 (Expert edition) (GE healthcare ultrasound, Milwaukee, WI)

Materials and method

Pregant women

Intrepretation and calculation of time spent in the procedure

Baseline characteristics: race, age, gestational age, gracidity, parity, BMI

USG obstetrics examination with six standardized steps

Routine scheduled obstetric USG

SPSS 15 analysis by t test, chi square, MannWhitney, Cohen Kappa tst in 95%CI

Six standardized steps in focused basic obstetric USG

Six steps in focused basic obstetric USG

Determination of fetal presentation Determination of fetal cardiac activity Identification of the number of fetuses in uterus Location and position of the placenta Estimating the amniotic fluid volume Fetal biometric measurements

Step 1: Determination of fetal presentation

Ultrasound transducer is placed transversely Fetal, buttocks, or if not both oblique/transverse lie

Step 2: Determination of fetal cardiac activity

Transducer is moved toward umbilicus to line 1,2, and 3

Identify cardiac activity

Step 3: Identification of the number of fetuses in uterus

Move cephalad toward upper abdomen based on the lines Identifiy number of fetal head presented

Step 4: Location and position of the placenta

Move toward right abdomen in sagital position

Check location of placenta Identify any low lying placenta or placenta previa

Step 5: Estimating the amniotic fluid volume

Move toward right abdomen in sagital position while avoiding any cord and fetal parts

MVP >= 8 cm  polyhydramnions MVP <2 cm oligohydramnions

Step 6: Fetal biometric measurements

Biparietal diameter

head circumfere nce

abdominal circumfere nce

femur length

Results

Results

Results

Results

Results

Discussion

USG had been applied in limited resources setting

Changed 43% patient management to a planned surgical procedure

But restricted because of sonographer dependency

Discussion

Standardized six-step approach to the focused basic obstetric ultrasound examination.

Our results showed high agreement between the focused basic obstetric ultrasound examination and the scheduled obstetric ultrasound examination.

One of the discrepancies is because we omit TVG USG to prove the presence of low lying placenta.

Conclusion 

A six-step standardized approach to the focused basic ultra- sound examination reduces the operator dependency of ultrasound and has the potential to enhance ultrasound training and competency evaluation in trainees with no prior ultrasound training.