Table of contents:

1. Recommendations of the Polish Gynaecological Society on ultrasound diagnostics in obstetrics and gynaecology
2. Equipment requirements
3. Standard of obstetric ultrasound examination
4. Ultrasound examination up to the 10th week of pregnancy
5. Ultrasound examination between 11-14 weeks' gestation
6. Ultrasonographic evaluation of the development pregnancy (18.-22ndweek of pregnancy) and (28.-32ndweek of pregnancy)
7. Ultrasound examination of the fetal heart (performed by an obstetrician-gynaecologist)
8. Recommended management of multifetal pregnancy

Recommendations of the Polish Gynaecological Society on ultrasound diagnostics in obstetrics and gynaecology

On 8-9 May 2004, a meeting of a group of experts appointed by the Executive Board of the Polish Gynaecological Society was held on standards for ultrasound examination in obstetrics and gynaecology.

The Expert Commission consisted of: Prof. Marek Spaczyński, Prof. Krzysztof Szaflik, Prof. Jacek Brązert, Prof. Romuald Dębski, Prof. Tomasz Pertyński, Prof. Maria Respondek-Liberska, doc. Mariusz Zimmer, doc. Krzysztof Sodowski, doc. Artur Czekierdowski, doc. Jacek Szamatowicz, doc. Krzysztof Preis, doc. Włodzimierz Sawicki, dr Dariusz Borowski, dr Mirosław Wielgoś, dr Marek Pietryga, dr Mariola Ropacka, dr Piotr Sieroszewski, dr Piotr Kaczmarek.

The main objective of the meeting was to develop an up-to-date scheme for ultrasound examination in obstetrics and gynaecology. Ultrasound examination has become one of the basic diagnostic methods in obstetrics and gynaecology and is an indispensable part of the doctor's daily work.

The ability to perform this examination on a basic level is part of the training of the gynaecologist and obstetrician, and it should therefore be performed by the gynaecologist-obstetrician, as a screening examination in pregnancy and in most gynaecological indications. Ultrasound examinations can be performed by doctors with skills confirmed by a certificate from the Ultrasound Section of the Polish Gynaecological Society.

Equipment requirements

Ultrasound equipment in obstetric-gynaecological diagnostics should have:

• 2D real-time presentation, at least 128-degree grey scale, should have the ability to measure distance (at least two measurements), circumference and area, and an obstetric programme.

It should be equipped with three types of heads:

• transabdominal convex (sector) type with a frequency of 3.5 - 7.5 MHz
• linear with a frequency of 4.0 - 7.5 MHz (breast examination)
• transvaginal convex (sector) with a frequency of 4.0 - 7.5 MHz

A valuable addition to the ultrasound scanner's capabilities should be the option of colour Doppler and photographic documentation.

The standard of obstetric ultrasound examination includes

1. The performance of three ultrasound examinations - screening in pregnancy:

• 11 - 14 weeks of pregnancy,
• 20 week of pregnancy ( +/- 2 hbd )
• 30th week of pregnancy ( +/- 2 hbd )

2. In exceptional clinical situations, the committee recommends an additional ultrasound examination mainly on medical grounds before 10 weeks of pregnancy.

3. The result of the ultrasound examination should include the following data:

• name, surname, date of birth or PESEL of the patient,
• the place and date of the examination, the person performing the examination,
• information on the name of the ultrasound machine and the type and frequency of transducers used to perform the examination,
• preliminary diagnosis of the referring physician,
• date of last menstrual period (OM) and week of pregnancy according to OM,
• stage of pregnancy according to any previous Medical US examinations
• examination documentation
  • ultrasonograms(videoprinter)
  • magnetic tape (video)
  • diskette, disc (computer)

Ultrasound examination up to the 10th week of pregnancy

During this period, the purpose of ultrasound examination by medical indication is:

• to visualise and localise the foetal egg.
• assess the gestational age (GS,CRL)
• visualisation of fetal heart function
• evaluation of the number of embryos, chorionic villi and amniotic fluid.
• determination of normal or pathological development of pregnancy

The result of the examination should include an assessment:

1. The uterus:

• shape (regular, irregular)
• structure (normal, abnormal: defects, myomas)
• size (normal, enlarged)

2. Location and structure of the appendages

3. Pregnancy follicle(Gestation Sac ) :

• location in the uterine cavity
• number of gestation follicles
• shape (round, flattened, regularity of outline )
• measurement of the gestational follicle (GS - average of 3 dimensions)

4. Yolk sac

• presence of YS (yes/no)
• diameter
• description of any abnormalities (shape, echogenicity)

5. Embryo

• presence (yes/no)
• measurement of parietotemporal length / CRL /
• presence of cardiac function / if CRL over 6 mm /

Ultrasound examination between the 11th and 14th week of pregnancy

A detailed assessment of the fetal egg structure includes the following:

1. Number of gestational follicles in the uterine cavity.
2. Assessment of fetal heart function (FHR)
3. Biometric measurements: - parietal-liver length (CRL) and biparietal dimension of the fetal head (BGCF)
4. Assessment of fetal anatomy:

• skull (shape), brain sickle, vascular plexuses of the lateral ventricles,
• abdominal wall including physiological umbilical hernia up to 12 weeks' gestation,
• stomach,
• fetal heart - location and function of the heart,
• urinary bladder,
• spine,
• upper and lower limbs.

5. Assessment of the chorionic villi.
6. Assessment of nuchal translucency (HTN) and nasal bone (NB)

PTG recommendations - Medical US diagnosis in obstetrics, photo: panthermedia

Theperformance of an ultrasound examination between 11 and 14 weeks' gestation with assessment of nuchal translucency (HTN) and nasal bone (NB) and other markers of genetic defect syndromes should take place at a reference centre according to the principles of the Fetal Medicine Foundation.

Optimal time for prenatal testing (11.0 - 13+6 t.c. ) ;. CRL 45 - 84 mm

Abnormal HTN values suggest an increased risk of occurrence:

1. chromosomal aberrations
2. haemodynamic abnormalities
3. fetal heart defects
4. foetal blood transfusion syndrome

The finding of any abnormality or doubt is an indication to extend the diagnosis in the reference centre

Ultrasonographic evaluation of the development of pregnancy (18.-22nd week of pregnancy) and (28.-32nd week of pregnancy)

1. Determination of fetal number, position and cardiac function.
2. Fetal biometry.

BGCF, HC, AC, FL + possible approximate fetal weight (OPM).

3. Assessment of fetal structure.

• skull - continuity, shape
• brain - ventricles, choroid plexuses, posterior cranial fossa, cerebellum,
• face - profile, eye sockets, nasal bones, possible assessment of palate and upper lip,
• spine - continuity, symmetry,
• thorax, heart - size, position, normal picture of the four cavities, frequency and regularity,
• abdominal cavity - continuity of abdominal wall, stomach (location, size, shape), intestinal echogenicity
• urinary bladder
• kidneys - description of any abnormalities ( width of the UCI ),
• limbs - assessment of the presence of femurs, humerus, forearm, shin, hands and feet, limb mobility.

4. Assessment of the placenta.

• location
• structure - degree of maturity according to Grannum (description of possible structural abnormalities, extramedullary haematomas )

5. Evaluation of the umbilical cord.

• number of vessels,
• description of any abnormalities

6. Assessment of the amount of amniotic fluid - in case of abnormalities AFI (Amniotic Fluid Index)
7. Possible evaluation of myomas, pathological changes in the adnexa.
8. In clinically justified cases - assessment of the cervix (length, shape of internal orifice) - transvaginal probe examination

Ultrasound examination of the heart of the fetus (performed by an obstetrician-gynaecologist)

This examination should include an evaluation:

1. Position of the heart
2. Size of the heart (1/3 of the chest )
3. Quadriplegia of the heart (visualisation of the so-called "cross heart" )
4. Heart rhythm (regular heart rate 120 - 170/min)
5. It is advisable to visualise the junction of the great vessels (left and right ventricular outflow tract)

An abnormality regarding the position, size, structure or rhythm of the heart is an indication for a fetal cardiological examination at a reference centre.

Recommended management of multifetal pregnancy

1. Assessment of chorionic villi and amniotic fluid
2. Assessment of divergent fetal growth
3. Follow-up investigations

- normal course - every 4 weeks

- complicated course - diagnosis and treatment in a reference centre.

divergent fetal growth - every 2 weeks or more frequently

intrauterine death of one of the fetuses

• < 16 w.c. - every 4 weeks
• > 16 wks - every 2 weeks or more frequently

TTTS (twin to twin transfusion syndrome), TRAP (twin reversed arterial perfusion), singleton, monochorionic pregnancy - from 26 weeks of gestation every one week or more frequently depending on the degree of abnormalities observed.