- cervix – assess if closed and measure length between internal and external os
- assess placental location and distance from internal os.
- check for retroplacental haemorrhages, placental masses etc
- maternal adnexae (if indicated, also maternal kidneys)
confirm heart beat & rate
foetal lie: ( eg cephalic, spine to maternal left) if breech, describe the ‘type’ of breech.
- cavum septum pellucidum
- heart~ rate (check for arrhythmia) position & orientation (4 chambers, outflow tracts)
- lungs (homogenous & echogenic relative to liver)
- anterior abdo wall & cord insertion
- 12 long bones
- position of hands/feet
- movement & tone
- spine: symmetry from c spine to the sacral taper and an intact posterior skin edge
- cervical length
- placenta to internal os distance(>3cm)
- biparietal diameter(bpd)
- head circumference(hc)
- abdominal circumference(ac)
- femur length(fl)
- foetal heart rate (fhr)
- amniotic fluid index (afi)
- umbilical artery: resistive index (ua ri)
- if ua ri is abnormal.check the ductus venosus and middle cerebral artery: pulsatility index(mca pi)
biophysical profile assessment
(for utero-placental vascular insufficiency)
- look for foetal movements such as leg, hand flexing and diaphragmatic movements.
- assess foetal tone and posture.
biophysical score is a combination of the following assessments giving them a mark out of 8 in total.
- foetal breathing 2/2
- foetal limb/body movements 2/2
- foetal posture 2/2
- afi 2/2
if the score is below 7 then this is a concern which will need close follow up. the assessment must span a minimum of a 30minute period before a negative report is suggested.