by Cynthia M. Schmidt, M.D., M.L.S.
Published December 2015
Updated July 2019
You should complete the first, second, and third episode of this tutorial miniseries before beginning this fourth episode.
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/sb4u
-- and continue working on the tutorial in the new browser.
Remember:
If you don't need a recap, you can skip this screen.
It's September 16, 2019. You've completed a prenatal ultrasound examination on Sarah Pilger, an obese, pregnant, 16-year-old. Sarah's LMP suggests a gestational age of 24.5 weeks. Sarah just learned she was pregnant last week. This was her first ultrasound exam.
Sarah's ultrasound examination findings are:
1) fetal brain with:
a) mild ventriculomegaly
b) several, tiny areas in the brain parenchyma that are consistent with intraparenchymal calcifications.
2) fetal abdomen enlarged by ascites.
3) subnormal thickness of fetal subcutaneous fat.
4) placental thickness slightly above normal.
5) fetal measurements including:
Biparietal diameter: 62 mm
Abdominal circumference: 175 mm
Femur length: 37 mm
At this point, you might want to read an ultrasound text that discusses some or all of these conditions. Such a resource would probably address additional ultrasound findings that could be present in these conditions, findings that should be ruled in or out on future ultrasound exams.
There are three 'points of entry' for a search of the McGoogan Library's entire e-book collection.
The first two portals are just different ways of accessing the library's e-Book Finder. The e-Book Finder only allows:
There are two portals for the e-books only search:
1) Find the "Ebooks" area in the middle of the homepage.
2) Alternately, you can find the "Online Journals/Ebooks" link on the homepage. Unfortunately, the link is not always obvious.
*If your browser window is wide enough, you will see buttons above the picture and can click on the "Online Journals/Ebooks" link.
*What if your browser, isn't wide enough to display links above the picture?
No problem. Just find and click on the "Menu" icon.
Click on the "Online Journals/Ebooks" option that appears.
When you reach the "Online Journals/Ebooks" page:
fetal ultrasound
-- in the search box. (Searches for -- prenatal imaging -- or -- ultrasonography -- or -- sonography -- might produce other, potentially useful, results).
You haven't yet dealt with learning issue #5 which concerns the significance of Sarah's thickened placenta. Read the short section on placental findings (section 15.1.7).
According to this chapter, which of the following statements is true?
Section 15.1.4 of the chapter concerns intrauterine growth restriction. It mentions that both symmetric and asymmetric growth restriction may be seen in fetus with viral infections. This leads nicely to the next learning issue.
What do the measurements taken during Sarah's ultrasound indicate about fetal age? Are the measurements appropriate for her possible 24-25 week gestational age?
It would be helpful to have growth charts that could be used to plot the measurements. A faculty member tells you that the following article contains fetal growth charts:
Papageorghiou AT, Ohuma EO, Altman DG, Todros T, Ismail LC, Lambert A, Jaffer YA, Bertino E, Gravett MG, Purwar M, Noble JA. International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21 st Project. The Lancet. 2014 Sep 12;384(9946):869-79
It's important that you know how to obtain the full-text of journal articles available through the library's licenses and subscriptions.
To find the article use the "Online Journal/Ebooks" Finder that you used earlier to find the ultrasound text.
To access the "Online Journal/Ebooks" Finder:
*If so, click on the "Online Journals/Ebooks" link.
*If you don't see links above the picture,
Click on the "Menu" icon in the upper right hand corner of the page.
When the "Menu" options appear, click on the "Online Journals/Ebooks" link.
Lancet
-- in the search box
Which one of the sources is most likely to provide the article you need:
The content of the British and American versions is typically identical (except for ads).
Did you determine that the "Science Direct Journals" package was most likely to provide the 2014 article? If so you are correct.
Most ejournal homepages have a search box. Searching for an article title is usually the easiest way to find an article of interest. Occasionally, it's easier to look for an "issues" or "archives" link on the journal's homepage, click the link/tab, and then look for the year, issue, and page numbers you need.
In this instance an article title search will be easiest.
International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21 st Project
If Sarah's baby's gestational age is at the expected 24.5 weeks, which percentile curve is closest to each of the baby's measurements?
Biparietal diameter: 62 mm Abdominal circumference: 175 mm Femur length: 37 mm
#5. At 24-25 weeks gestational age, which percentile growth curve is closest to the biparietal diameter measurement of 62 mm?
#6. At 24-25 weeks gestational age, which of the percentile curves is closest to the abdominal circumference measurement of 175 mm?
#7. At 24-25 weeks gestational age, which percentile curve is closest to the baby's femur length of 37 mm?
These findings are consistent with borderline growth retardation with brain sparing (asymmetric growth retardation).
The following question covers the major points of this tutorial episode:
You are told that a specific article is available through the library. Which of the following online paths will take you to the library-licensed, online source for the article?
http://list.unmc.edu/gots/tutorial/sb5u