DATING BY LMP AND BIOMETRIES

LMP (Last Menstrual Period)

Confirmed LMP GA by LMP EDD by LMP

First TM ¹ (CRL<=84mm)

Date of ultrasound Crown to Rump Length GA by CRL LMP by CRL EDD by CRL

Second TM ² (BDP<= 70mm)

Biparietal diameter Date of ultrasound GA by BPD LMP by BPD FUR by BPD

Third TM ³ (BPD>70mm)

Head diameter Date of ultrasound GA by HC LMP by HC FUR by HC

Estimate fetal weight

DBP, PC, PA, LF (Hadlock FL)

DBP (mm): HC (mm): AC (mm): FL (mm):

PA, LF (Hadlock FL)

PA (mm): LF (mm):

Growth centile in II TM

Gender: Female Male

BDP first TM (mm): GA first TM: (Weeks) GA first TM: (Days) DBP second TM (mm): GA second TM (weeks): GA second TM (days): Percentile:

Unique percentile III TM

EFW: GA (weeks): GA (days):

Gender: Female Male

Percentile:

Multiple percentile III TM

GA (weeks): GA (days):

Gender larger twin: Female Male

EFW larger twin:

Gender smaller twin: Female Male

EFW smaller twin: Percentile twin A: Percentile twin B: % Discordance [(larger-smaller)/larger]:

Congenital Diaphragmatic Hernia Calculator

Left side Hernia

o/e LHR (%)

Longest diameter method

Right Lung to Head Ratio

Gestational age (weeks): Gestational age (days): Longitudinal diameter A (mm): Transversal diameter B (mm): Head circumference(mm): LHR: o/e LHR (%):

Prediction of survival

Prediction of survival in left CDH

Lung to head ratio o/e (%): Liver up (1=Yes 0=No): Expected survival %:

Right side hernia

o/e LHR (%)

Longest diameter method

Left Lung to Head Ratio

Gestational age (weeks): Gestational age (days): Longitudinal diameter A (mm): Transversal diameter B (mm): Head circumference(mm): LHR: o/e LHR (%):

Prediction of survival

Prediction of survival in right CDH

Lung to head ratio o/e (%): Expected survival %:

Doppler

Umbilical artery

GA (weeks): GA (days): Pulsatility index: Percentile: Result:

Middle cerebral artery

GA (weeks): GA (days): Pulsatility index: Percentile: Result:

Cerebroplacental ratio

GA (weeks): GA (days): Pulsatility index cerebral media artery: Pulsatility index umbilical artery: Cerebroplacental ratio: Percentile: Result:

Uterine arteries

GA (weeks): GA (days): Pulsatility index right uterine artery: Pulsatility index left uterine artery:: Average pulsatility index: Percentile: Result:

Ductus venosus

GA (weeks): GA (days): Pulsatility index: Percentile: Result:

Aortic isthmus

GA (weeks): GA (days): Pulsatility index: Percentile: Result:

TEI index

GA (weeks): GA (days): Isovolumetric contraction time: Isovolumetric relaxation time: Ejection time: TEI index: Percentile: Result:

Gestational Age

Last Menstrual period

EFW (G):

Percentile:

Gender:

Female Male

UA Doppler PI:

Percentile:

UA Diastolic flow

MCA Doppler PI:

Percentile:

Ut.A Right Doppler:

Ut.A Left Doppler:

CPR (Percentile:1)

Mean Ut. A (Percentile:64)

DV PI:

Percentile:

D.V. Atrial Flow:

Fetal Growth restriction:

Stage 2

Recommended management:

Follow-up in 1 week

Recommendations:

Control every two weeks
Amniotic fluid (maximum vertical pocket) + estimated fetal weight or abdominal circumference + peak systolic velocity middle cerebral artery

DIAGNOSTIC ALGORITHM

Confirmed LMP GA by LMP:

Twins gender Female Male

TWIN 1

Maximum vertical pocket of Amniotic fluid (mm)

Bladder

Estimated fetal weight (g)

Abdominal Circumference (mm)

Peak systolic velocity middle cerebral artery (cm/s)

TWIN 2

Maximum vertical pocket of Amniotic fluid (mm)

Bladder

Estimated fetal weight (g)

Abdominal Circumference (mm)

Peak systolic velocity middle cerebral artery (cm/s)

Dating

1. Robinson HP. A critical evaluation of sonar ‘crown-rump length’ measurements. BJOG 1975;82:702-710. Revised BUMS sept 2008.

2. Mul T. A comparative analysis of second-trimester ultrasound dating formulas in pregnancies conceived with artificial reproductive techniques. UOG 1996; 8:397-402.

3. Mongelli M. Third trimester ultrasound dating algorithms derived from pregnancies conceived with artificial reproductive techniques. UOG 2005; 26:129-131.

Fetal Growth

1. Hadlock FP. Estimation of fetal weight with the use of head, body and femur measurements a prospective study. Am J Obstet Gynecol 1985;151(3):333.

2. Hadlock FP. Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements. Radiology, 1984 Feb; 150(2):535.

Growth centile in II TM

1. Pedersen N, Figueras F, Tabor A. Obstetrics and Gynecology 2008; 112(4):765-71.

Unique percentile in III TM

1. Figueras F. Customized birthweight for a Spanish Population. EJOGRM 2008; 136(1):20-4.

Multiple percentile in III TM

1. Kuno A. Comparision of fetal growth in singleton, twin and triplet pregnancies. Hum Reprod 1999.

2. Corbes de referència de pes, perímetro craneal i longitud en nèixer de nounats d'embarassos únics, bessons i trigèmins a Catalunya. Departament de Salut. Generalitat de Catalunya 2000.

Congenital Diaphragmatic hernia

1. Jani J, UOG 2007; 30:67-71.

2. Dekoninck P, BJOG 2015; 122:940-946.

Normal Doppler Values

1. Arduini D J Perinat Med 1990; 18:165.

2. Baschat AA UOG 2003; 21:124.

3. Mari G N Engl J Med 2000; 342:9.

4. Hecher K UOG 1994; 4:381.

5. Rizzo G UOG 1996; 7:401.

Fetal Biometries

1. CC: Snijders RL, UOG 1994.

2. Extremidades: Chitty, LS BJOG 2002.

Monochorionic Twins

1.Van Mieghem T et al.Ultrasound Obstet Gynecol. 2011 Jan;37(1):15-21.

DATING BY LMP AND BIOMETRIES

LMP (Last Menstrual Period)

First TM 1 (CRL<=84mm)

Second TM 2 (BDP<= 70mm)

Third TM 3 (BPD>70mm)

Estimate fetal weight

DBP, PC, PA, LF (Hadlock FL)

PA, LF (Hadlock FL)

Growth centile in II TM

Unique percentile III TM

Multiple percentile III TM

Preeclampsia 1T

Epidemiologic data

Biometric data

First Trimester Data

Congenital Diaphragmatic Hernia Calculator

Left side Hernia

o/e LHR (%)

Longest diameter method

Prediction of survival

Prediction of survival in left CDH

Right side hernia

o/e LHR (%)

Longest diameter method

Prediction of survival

Prediction of survival in right CDH

Anemia

Cerebral Doppler

CALCULATE VOLUME TO TRANSFUSE

Doppler

Umbilical artery

Middle cerebral artery

Cerebroplacental ratio

Uterine arteries

Ductus venosus

Aortic isthmus

TEI index

EFW (G):

Gender:

UA Diastolic flow

CPR (Percentile:1)

Mean Ut. A (Percentile:64)

D.V. Atrial Flow:

Fetal Growth restriction:

Recommended management:

DIAGNOSTIC ALGORITHM

TWIN 1

TWIN 2

Twin-twin transfusion syndromePSV-MCA values not entered, the risk for TAPS can not be assessed.

STAGING

TWIN 1

TWIN 2

RISK OF IUFD WITHIN ONE WEEK AFTER LASER

TWIN 1

TWIN 2

Selective IUGRPSV-MCA values not entered, the risk for TAPS can not be assessed.

TYPE OF IUGR

POOR PROGNOSIS CRITERIA

First TM ¹ (CRL<=84mm)

Second TM ² (BDP<= 70mm)

Third TM ³ (BPD>70mm)