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

Identify high Diagnosis fetal

risk pregancy abnormalities
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

Standardized
Six-Step
Approach
Idea Focused Basic
Obstetric
Ultrasound
Examination
Introduction

Compare its
Validate the
performance to
focused basic
Aim of the scheduled
obstetric
this study obstetric
ultrasound
ultrasound
examination
examination.
Materials and method

Place and
Design Samples Device
time
Cohort Division of 100 USG
prospective maternal- trimester 2 Voluson E8
Observatio fetal pregnant (Expert
nal medicine women edition) (GE
Eastern 100 healthcare
Virginia trimester 3 ultrasound,
Medical pregnant Milwaukee,
school women WI)
Dec 13-May
14
Materials and method

Baseline
characteristics: USG obstetrics
race, age, examination with
Pregant women
gestational age, six standardized
gracidity, parity, steps
BMI

SPSS 15 analysis
Intrepretation and by t test, chi
calculation of Routine scheduled square, Mann-
time spent in the obstetric USG Whitney, Cohen
procedure Kappa tst in
95%CI
Six standardized steps in focused basic
obstetric USG

Determination of fetal presentation

Determination of fetal cardiac

Six steps in focused
basic obstetric USG

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

head
Biparietal
circumfere
diameter
nce

abdominal
femur
circumfere
length
nce
Results
Results
Results
Results
Results
Discussion

Changed 43%
USG had been
patient But restricted
applied in
management because of
limited
to a planned sonographer
resources
surgical dependency
setting
procedure
Discussion

Our results
showed high
agreement
Standardized between the One of the
six-step focused basic discrepancies is
approach to the obstetric because we
focused basic ultrasound omit TVG USG
obstetric examination to prove the
ultrasound and the presence of low
examination. scheduled lying placenta.
obstetric
ultrasound
examination.
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.