Sarah's Baby 2u: Sarah's Ultrasound Exam

by Cynthia M. Schmidt, M.D., M.L.S.

Published December 2015

Updated October 2018

If you haven't yet completed the first episode of this tutorial, "Sarah's Baby 1: Meet Sarah and Pat"; go to--

http://list.unmc.edu/gots/tutorial/sb1u

Warning:

If you are using Internet Explorer, please STOP now! Open another internet browser (we recommend Firefox) and go to --

http://list.unmc.edu/gots/tutorial/sb2u

-- and continue working on the tutorial in the new browser.

Remember:

• If the screen is flickering and jerking, try right-clicking on the light grey bar in the screen header and selecting the "refresh" or "reload" option from the menu that appears.
• Resize the instruction and right-hand window so that you can see the two next to each other and the instruction screen is as long as possible.

Sarah: Case recap

If you don't need a recap, you can skip this screen and the next screen.

It's September 16, 2019.

Sarah Pilger is an obese, pregnant, 16-year-old who has come in for her first prenatal ultrasound.  She is accompanied by her mother Pat.

What are some of the things you need to learn to become the professional ultrasonographer who can meet this patient's needs?

Sarah: Case recap

Perhaps some of the following are among your learning issues?

#1. How is a second trimester ultrasound examination performed?

#2 What measurements are most important for establishing gestational age around the 24th-25th week of pregnancy?

#3 Does obesity affect the way prenatal ultrasonography should be performed?

Learning issues #1 and #2. US technique and 2nd trimester measurements

When you want to see a video concerning how to conduct a procedure or written information about the process of performing a procedure, check ProceduresConsult.

ProceduresConsult: Procedure Information and Videos

To reach ProceduresConsult:

• Go to the library's homepage (the page currently displayed in the right-hand window)

In the future, you can reach the library's homepage by going to any unmc.edu page, scrolling to the bottom of the page, finding the "Quick Links" list, and clicking the "Library" link.

• Click on "Clinical Resources"

• When you reach the "Clinical Resources" list, click on the "ProceduresConsult" link.

• If asked to do so, login with your UNMC Net ID and password.

ProceduresConsult: Procedure Information and Videos

When you reach the "ProceduresConsult" homepage, search for materials about -

prenatal ultrasound

When the search results appear, click on the link to the "Third-trimester Obstetric Ultrasound" materials.

Notice that a "First-trimester Obstetric Ultrasound" video is also available. Perhaps you'll want to watch it later.

ProceduresConsult: Procedure Information and Videos

 When you reach the materials concerning "Third-Trimester Obstetric Ultrasound," a video box should appear on the left-hand side of the page (see blue arrow in the figure below).

• If the video screen isn't working or doesn't appear on your computer, don't panic.
• • You do not need to watch the video to complete this tutorial.
  • If you want to see the video, it's possible that you will need to update Adobe Flash Player on your computer. You may have to close and reopen your browser after the update.

Click on the "Full Details" tab (see red arrow in the figure above).

ProceduresConsult: Procedure Information and Videos

The date of Sarah's LMP suggests that she is in the second trimester of her pregnancy.

Find the technique usually used to judge gestational age during second trimester.

Hints:

1) Tables and figures are often used to provide this type of information.

2) The sections of the text discussing second trimester may be found most easily by using the "Find-on-page" feature of your browser. You can reach this function, by clicking inside the "Full details" text/frame (to be sure you're looking in the correct area of the page) and using control f ( for Windows users) or command f (for Mac users) to open a "find on page" box. Type --

second trimester

--- in the "find on page" box that appears.  Click through the instances of "second trimester" until you find the needed information. The "find on page" tool may find instances in this tutorial panel first, but should then switch to the "full details" panel.

ProceduresConsult: Procedure Information and Videos

Learning Issue #3: Changes in US technique for the obese?

You have found information on how to perform the ultrasound exam and the measurements which will be most useful in determining gestational age.

You still need information on how the exam might be altered if you are working with an obese patient.  Let's look at another resource that might have information about this issue.

UpToDate: Current Information and Multi-Concept Search

UpToDate:

• is a frequently updated, online resource. 

• provides information on many procedures, conditions and therapies. 

• provides information of use to generalists and specialists.  It also provides more information on topics of interest to subspecialists (like subspecialists in high risk pregnancy) than many standard medical texts.

• claims to base its recommendations on the best available medical evidence.

• has a search engine that can handle somewhat complicated multi-concept searches, like a search for obesity's effects on prenatal ultrasound.

UpToDate: Current Information and Multi-Concept Search

To reach UpToDate:

• Go to the Library's homepage.

• Click the "Clinical Resources" button.

• When you reach the "Clinical Resources" page, click the "UpToDate" link.

• If asked to do so, login with your UNMC Net ID.

• At times, the UpToDate homepage contains UpToDate login boxes. If UpToDate login boxes are present, you can ignore them and use the search box at the upper left.

UpToDate: Current Information and Multi-Concept Search

Search UpToDate for --

prenatal ultrasound obesity

The titles of several potentially useful articles will appear.

(Even more articles of potential interest to an ultrasonographer would be found by a search for -- prenatal ultrasound -- without the obesity concept.)

Find the result entitled --

"Ultrasound examination in obstetrics and gynecology."

Click on the "Obesity" link under this title.

UpToDate: Current Information and Multi-Concept Search

What does this UpToDate article say about adjustments needed for examinations in obese patients?

Want to check your resource knowledge?

The following optional questions cover the major points of this tutorial episode:

Link to episode 3

http://list.unmc.edu/gots/tutorial/sb3u

During the next episode, you will learn Sarah's ultrasound findings.