Division Of Maternal Fetal Medicine
	Department of Obstetrics and Gynaecology
	Ramathododi Hospital
	Rama VI Road, Bangkok, Thailand 10400
Second Trimester Ultrasound

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Indication	{{@$json->indication}}
Method	{{@$json->history}}
Pregnancy	Singleton pregnacy. Number of fetuses: {{@$json->number_of_fetuses}}
Dating	Date Details Gest. age EDD External assessment 16 w + 5 d {{date('d/m/Y')}} U/S {{date('d/m/Y')}} based upon BPD, HC, AC, Femur 16 w + 4 d {{date('d/m/Y')}} Agreed dating based on the external assessment 16 w + 4 d {{date('d/m/Y')}}
General	Cardiac activity present. FHR 149 bpm. Fetal movements: present. Presentation: breech
Evaluation	Placenta: anterior Umbilical cord: normal, 3 vessel cord Amniotic fluid: Normal amount
Fetal Biometry	BPD 34.20 mm 16w 4d 41% AC 108.30 mm 16w 5d 50% OFD 45.9 mm 16w 0d 33% Femur 20.50 mm 15w 1d 22% HC 128.40 mm 16w 4d 29% Humerus 19.80 mm 9% Cerebellum 17.40 mm 93% HC / AC 1.9 44% tr Nuchai fold 2.72 mm Fetal Weight Calculation: EFW 157 g 16w 2d 26% EFW by Hadlock (BPD-HC-AC-FL) Head / Face / Neck Biometry BPD / OFD 0.7 mm   7% CM 3.2 mm   19% Vp 7.04 mm Inner IOD 11.3 mm The following structures appear normal : Head / Neck Cranium. Lateral ventricles. Choroid plexus. Midline falx. Cavum septi pellucidi, {{nbsp(18)}} Cerebellum. Cisterna magna Face{{nbsp(11)}} Lips. Profile. Nose Heart / Thorax4-chamber view. RVOT View. LVOT view. 3-vessel view. 3-Vessl-trachea view. Abdomen{{nbsp(4)}}Cord insertion. Stomach. Kidneys. Bladder. Genitals. Spine{{nbsp(11)}}Cervical spine. Thoracic spine. Lumbar Spine. Sacral spine. Extremities / Arms. Hands. Legs. Feet. Skeleton Impression : No obvious fetal defect.
Fetal Doppler	Ductus Venosus: S-wave -36.96 cm/s   PLI   0.76

	S-Wave -34.64 cm/s   S/a   4.10       A-wave -9.01 cm/s   a/S   0.24       TAmax -29.18 cm/s   D/a   3.84       PIV 0.96   HR   144 bpm     PVIV 0.81
Invasive	Amio-{{nbsp(11)}}Start 10:00. End 10:25
Procedures	centesis{{nbsp(8)}}Instrument: TA 20G needle. Insertion site: lower abdomen mid. Method: {{nbsp(20)}}transplacental. Entries uterus: 2 {{nbsp(20)}}Sample: obtained. Sample amount 15 ml. Sample quality: clear yellow {{nbsp(20)}}1st attempt contaminated blood {{nbsp(20)}}2st attempt clear AF
	Lab request{{nbsp(2)}}Karyotyping Evaluation{{nbsp(4)}}Post cardiac activity: present, normal. FHR post 157 bpm
Impression	Growth and anatomy survey appears normal.
Follow-up	Repeat evaluation for fetal growth assessment and anatomy survey is recommended

Ultrasound cannot exclude all chromosomal or genetic abnormalities in the fetus. Some congenital malformations may be missed durung the scan, even with high quality sonographic equipment in the best of hands. Some fetal abnormalities may develop later in pregnacy. Visualisation of fetal structures may be limited by the following sub-optimal scanning conditions - maternal adiposity, scarring of abdominal wall, reduced liquor volume, fetal activity and fetal position.

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