NHS FORTH VALLEY. Early Pregnancy Scan

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1 Early Pregnancy Scan Date of First Issue 11/11/2008 Approved 01/11/2013 Current Issue Date 06/12/2013 Review Date 01/06/2018 Version 2.2 EQIA Yes 06/12/2013 Author / Contact Kirsty MacInnes Group Committee Final Approval Unit Clinical Governance Meeting This document can, on request, be made available in alternative formats Version th June 2016 Page 1 of 7

2 Consultation and Change Record for ALL documents Contributing Authors: Consultation Process: Distribution: Dr K Ekevall Circulation to all Midwives, Obstetricians, Supervisors Of Midwives, Team Leaders, Clinical Shift Co-ordinators, Department Managers, Unit Service Manager and Head of Midwifery Midwives, Obstetricians, Supervisors Of Midwives, Team Leaders, Clinical Shift Co-ordinators, Department Managers, Unit Service Manager and Head of Midwifery Change Record Date Author Change Version 06/12/2013 KE All changes highlighted in blue KMacI Adnexae, 2 nd bullet point removed KM First page, under first paragraph and above the heading Uterus the following narrative was added 2.2 Women under 6 weeks gestation should not be offered a pelvic ultrasound scan unless they have symptoms of an ectopic pregnancy. The management of a woman scanned prior to 6 weeks should be discussed with the on call Gynaecologist. Review date changed to June Version number updated to 2.2. Version th June 2016 Page 2 of 7

3 WOMEN & CHILDREN S UNIT Early Pregnancy Scan 1 The report must indicate whether transvaginal, transabdominal or both methods were used. If fetal viability cannot be confirmed by transabdominal scan, measure gestational sac diameter and proceed to transvaginal scan unless refused. Women under 6 weeks gestation should not be offered a pelvic ultrasound scan unless they have symptoms of an ectopic pregnancy. The management of a woman scanned prior to 6 weeks should be discussed with the on call Gynaecologist. Uterus Intrauterine Gestation Sac Number of sacs, note chorionicity Size, document MSD if no fetal pole is visible Site i.e. central or eccentric location Regularity & shape Presence or absence of double ring A MSD of 25mm with no fetal pole or yolk sac on TVS is highly suggestive of a noncontinuing pregnancy. A second scan should be offered prior to medical or surgical management Intrauterine Gestation Sac contents The presence or absence of the following must be documented: Yolk sac Fetal pole CRL if fetal pole present Fetal heart activity A CRL of 7mm with no fetal heart on TVS is highly suggestive of a non-continuing pregnancy. A second scan should be offered prior to medical or surgical management Endometrium Endometrial reaction Measure endometrial thickness if no IUGS seen Echolucent areas should not be described as a?sac RPOC- include measurements of RPOC only if >3cm otherwise mixed echos <3cm can be reported Haematoma Document dimensions & location Hard Copy Image(PACS) Version th June 2016 Page 3 of 7

4 A sagittal view of the uterus & contents including the cervix must be obtained & an image stored in all cases. Version nd June 2016 Page 4 of 7

5 WOMEN & CHILDREN S UNIT Early Pregnancy Scan 2 Adnexae Ovaries Appearance of ovaries Ovarian cyst-record location, 2 dimensional measurement & sonographic features only if > 50mm If the pregnancy is non-continuing, a repeat scan is required after 6 weeks which will be arranged by nurse/midwife from EPAS If the cyst persists on repeat scan arrange a consultant clinic appointment Pouch of Douglas Free fluid-report as none, minimal or significant Mass Appearance of the mass Location Ovaries seen separately or not Record 2 dimensional measurement Is there any evidence of an ectopic pregnancy? Ectopic If an ectopic is suspected on scan the following must be documented: Location Size, document MSD Regularity & shape Double ring Yolk sac Fetal pole CRL if fetal pole present Fetal heart activity Version th June 2016 Page 5 of 7

6 WOMEN & CHILDREN S UNIT Early Pregnancy Scan 3 Report The report must include: The presence of a viable or nonviable intrauterine pregnancy Adnexal Masses Cyst >5cm Ectopic seen on scan The above findings are suggestive of : A viable intrauterine pregnancy A non-viable intrauterine pregnancy (includes RPOC) An intrauterine pregnancy whose viability cannot yet be confirmed and a repeat scan in 14 days is recommended If none of the above: In the absence of a definite extra or intrauterine gestational sac, the phrase ectopic pregnancy cannot be excluded should be used hcg tracking is recommended Do Not Report: Simple ovarian cysts <5cm Nabothian follicles RPOC <3cm? Gestation sac Reference: BMUS recommendations 2008; UKAS Guidelines 2008; RCOG 2011 Version th June 2016 Page 6 of 7

7 Publications in Alternative Formats NHS Forth Valley is happy to consider requests for publications in other language or formats such as large print. To request another language for a patient, please contact For other formats contact , text , fax or - Version th June 2016 Page 7 of 7

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