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 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?
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?
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.
To reach ProceduresConsult:
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.
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.
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).
Click on the "Full Details" tab (see red arrow in the figure above).
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.
According to the information in ProceduresConsult, the gestational age during second trimester is usually determined using:
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:
To reach UpToDate:
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.
What does this UpToDate article say about adjustments needed for examinations in obese patients?
Which of the following (a,b, or both) might be helpful when performing a prenatal ultrasound on an obese woman?
The following optional questions cover the major points of this tutorial episode:
You need to see the steps involved in passing a nasogastric tube through the nose, pharynx and esophagus to reach the stomach. Which of the following online paths would reach a resource that might be useful?
Which of the following (a,b, or both a and b(c) ) is true concerning UpToDate?
http://list.unmc.edu/gots/tutorial/sb3u
During the next episode, you will learn Sarah's ultrasound findings.