Obstetric Ultrasound Scans

Pemeriksaan ultrasonografi, pertama dimanfaatkan dalam ilmu kebidanan pada tahun 1954. Gelombang suara dipancarkan dengan transducer yang diletakan pada bagian abdomen ibu hamil, dan di gerakan untuk melihat bagian uterus yang diperiksa. Pancaran gelombang ultrasound memantulkan cahaya balik bergantung dengan densitas jaringan terdapat pada fetus. The information obtained from different reflections are recomposed back into a picture on the monitor screen (a sonogram, or ultrasonogram). Movements such as fetal heart beat and malformations in the feus can be assessed and measurements can be made accurately on the images displayed on the screen. Such measurements form the cornerstone in the assessment of gestational age, size and growth in the fetus. A full bladder is often required for the procedure when abdominal scanning is done in early pregnency. There may be some discomfort from pressure on the full bladder. The conducting gel is non-staining but may feel slightly cold and wet. There is no sensation at all from the ultrasound waves. Ultrasound scan adalah pemeriksaan yang tidak terdapat resiko tinggi, tidak-invasive, akurat and murah.

1. Diagnosis dan deteksi kehamilan dini.

Gestational sac dapat terlihat semudah empat setengah minggu dari usia kehamilan. Yolk sac dapat terlihat dalam waktu lima minggu. Embryo dapat diobservasi dan di ukur setelah lima setengah minggu. Ultrasound menjadi sarana yang penting untuk menentukan lokasi kehamilan dalam uterus. 2. Vaginal bleeding in early pregnancy. The viability of the fetus can be documented in the presence of vaginal bleeding in early pregnancy. A visible heartbeat could be seen and detectable by pulsed doppler ultrasound by about 6 weeks and is usually clearly depictable by 7 weeks. If this is observed, the probability of a continued pregnancy is better than 95 percent. Missed abortions and blighted ovum will usually give typical pictures of a deformed gestational sac and absence of fetal poles or heart beat. Fetal heart rate tends to vary with gestational age in the very early parts of pregnancy. Normal heart rate at 6 weeks is around 90-110 beats per minute (bpm) and at 9 weeks is 140-170 bpm. At 5-8 weeks a bradycardia (less than 90 bpm) is associated with a high risk of miscarriage.

Many women do not ovulate at around day 14, so findings after a single scan should always be interpreted with caution. The diagnosis of missed abortion is usually made by serial ultrasound scans demonstrating lack of gestational development. For example, if ultrasound scan demonstrates a 7mm embryo but cannot demonstrable a clearcut heartbeat, a missed abortion may be diagnosed. In such cases, it is reasonable to repeat the ultrasound scan in 7-10 days to avoid any error. The timing of a positive pregnancy test may also be helpful in this

regard to assess the possible dates of conception. A positive pregnancy test 3 weeks previously for example, would indicate a gestational age of at least 7 weeks. Such information would be useful against the interpretation of the scans. Please read the FAQs for more comments. In the presence of first trimester bleeding, ultrasonography is also indispensible in the early diagnosis of ectopic pregnancies and molar pregnancies. 3. Determination of gestational age and assessment of fetal size. Pengukuran badan fetus menandai usia fetus. Pada ibu hamil dengan riwayat haid tidak teratur menjadi pemeriksaan yang diutamakan dengan kepentingan untuk mengetahui usia kehamilan. Dengan mengetahui ukuran dan perkembangan fetus kita dapat mengetahui jika fetus dapat didiagnosis intrauterine growth restriction (IUGR) atau tidak. The following measurements are usually made:

a) The Crown-rump length (CRL) pengukuran CRL dapat di lakukan 7 sampai 13. Dating with the CRL can be within 3-4 days of the last menstrual period. Jika pengukuran CRL dilakukan lagi 6-8 minggu setelah scan pertama akan terlihat seakan-akan fetus tidak bertumbuh sesuai usia. Maka itu timframe antara 7-13 minggu adalah patokan yang paling

optimal. Dalam pemeriksaan CRL itu dimulai dari ujung (Vertex) kepala sama dengan tulang ekor. b) The Biparietal diameter (BPD) adalah diameter antara 2 sisi kepala. Pemeriksaan ini dilakukan setelah 13 minggu. Pada umum nya ukuran BPD meningkat dari 2.4 cm (13 minggu) sampai dengan 9.4 cm (at term). Different babies of the same weight can have different head size, therefore dating in the later part of pregnancy is generally considered unreliable. (Chart and further comments) Dating using the BPD should be done as early as is feasible. c) The Femur length (FL) Measures the longest bone in the body and reflects the longitudinal growth of the fetus. Its usefulness is similar to the BPD. It increases from about 1.5 cm at 14 weeks to about 7.8 cm at term. (Chart and further comments) Similar to the BPD, dating using the FL should be done as early as is feasible. d) The Abdominal circumference (AC) The single most important measurement to make in late pregnancy. It reflects more of fetal size and weight rather than age. Serial measurements are useful in monitoring growth of the fetus. (Chart and further comments) AC measurements should not be used for dating a fetus.

Other important measurements are discussed here. The weight of the fetus at any gestation can also be estimated with great accuracy using polynomial equations containing the BPD, FL, and AC. computer softwares and lookup charts are readily available. For example, a BPD of 9.0 cm and an AC of 30.0 cm will give a weight estimate of 2.85 kg. (comments) 4. Diagnosis of fetal malformation.

Many structural abnormalities in the fetus can be reliably diagnosed by an ultrasound scan, and these can usually be made before 20 weeks. Common examples include hydrocephalus, anencephaly, myelomeningocoele, achondroplasia and other dwarfism, spina bifida, exomphalos, Gastroschisis, duodenal atresia and fetal hydrops. With more recent equipment, conditions such as cleft lips/ palate and congenital cardiac abnormalities are more readily diagnosed and at an earlier gestational age. (Also see the FAQ and Anomalies pages). First trimester ultrasonic 'soft' markers for chromosomal abnormalities such as the absence of fetal nasal bone, an increased fetal nuchal translucency (the area at the back of the neck) are now in common use to enable detection of Down syndrome fetuses. Read also: Soft Markers - A Guide for Professionals and Ultrasonographic "soft markers" of fetal chromosomal defects.

Ultrasound can also assist in other diagnostic procedures in prenatal diagnosis such as amniocentesis, chorionic villus sampling, cordocentesis (percutaneous umbilical blood sampling) and in fetal therapy. 5. Placental localization.

Ultrasonography has become indispensible in the localization of the site of the placenta and determining its lower edges, thus making a diagnosis or an exclusion of placenta previa. Other placental abnormalities in conditions such as diabetes, fetal hydrops, Rh isoimmunization and severe intrauterine growth retardation can also be assessed. 6. Multiple pregnancies. In this situation, ultrasonography is invaluable in determining the number of fetuses, the chorionicity, fetal presentations, evidence of growth retardation and fetal anomaly, the presence of placenta previa, and any suggestion of twin-to-twin transfusion. 7. Hydramnios and Oligohydramnios. Excessive or decreased amount of liquor (amniotic fluid) can be clearly depicted by ultrasound. Both of these conditions can have adverse effects on the fetus. In both these situations, careful ultrasound examination should be made to exclude intraulterine growth retardation and congenital malformation in the fetus such as intestinal atresia, hydrops fetalis or renal dysplasia. See also FAQ and comments. 8. Other areas. Ultrasonography is of great value in other obstetric conditions such as: a) confirmation of intrauterine death. b) confirmation of fetal presentation in uncertain cases. c) evaluating fetal movements, tone and breathing in the Biophysical Profile. d) diagnosis of uterine and pelvic abnormalities during pregnancy e.g. fibromyomata and ovarian cyst.