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Cerebroplacental ratio (CPR) is a reliable predictor of an impaired neonatal outcome. CPR provides information about fetal hemodynamics and the redistribution of fetal blood volume in response to a metabolic change. CPR is defined as the quotient of the Doppler pulsatility indices (PI) of the middle cerebral artery (MCA) and the umbilical artery (UA). If the fetus is in a hypoxic state or growth retardation, the cerebral vessels dilate to maintain blood flow to the brain – brain sparing effect. This is reflected as a decrease in the MCA PI and an increase in the placental blood flow resistance causing an increased UA PI. As a result of the change in perfusion, the CPR is reduced. A CPR of < 1.08 is abnormal and significantly associated with an increased risk of caesarian section due to fetal distress. A borderline CPR value of 1.08 should also prompt follow-up review with a clinical specialist or at a tertiary center. Abnormal blood flow in the MCA or UA should be assessed within its own parameters. CPR should be routinely assessed in IUGR fetuses, monochorionic twin pregnancies, fetal anaemia, reduced fetal movement, estimated fetal weight less than the 10th centile, and preeclampsia or high risk for preeclampsia patients. Integrating CPR into routine doppler studies in clinical practice will help better identify fetuses at risk.
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Hello,
Unfortunately, we do not currently have a protocol we can provide you at this time.
Please follow the guidance of your radiologist or local guidelines.
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After a review of literature and Mirena care information by your friendly experts, there is no contraindication with regard to transvaginal ultrasound after Mirena insertion. However, please defer to the care instructions provided by the doctor or healthcare provider in this case.
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Hi,
A decidual reaction alone is not enough to confirm intrauterine pregnancy and exclude a pregnancy of an unknown location.
The yolk sac is the first intrauterine structure to be visualised on ultrasound and so is a good indication that the pregnancy is intrauterine.
However, heterotopic pregnancies can occur and so the best way to exclude a PUL is to identify an embryo within a gestational sac
Please see:
https://www.isuog.org/static/uploaded/bb90c8fe-3b24-4318-8d1ae9bf49418431.pdf
https://www.isuog.org/static/uploaded/4daa1ea7-bc64-4c24-b81b17df5a684a38.pdf
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Thank you for your question,
Peripherally inserted venous catheter (PIVC) are being performed by sonographers in both the public and private sectors to our knowledge. It appears that certification is currently obtained primarily through the institution in which the sonographer is working, however there are also a select range of POCUS courses specific to PIVC insertion available.
Each institution will vary in its training and certification process; however, the majority will involve an initial theory and practical component (with supervision by a trained medical officer, trained health professional or nurse educator) with ongoing maintenance of skill and infection control.
The ASA have produced an online learning module on ultrasound guided IV cannulation. We recommend completing this module as it will provide you with further information. I've attempted to provide a link below for you. Otherwise you will find it in the Online learning modules in the CPD area.
https://www.sonographers.org/cpds/asa-advance---US_guided_IV_Cannulation
Thanks,
Vascular SIG
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Firstly, a referral is a legal document and the request should be followed, not replaced with a scan that is going to be less appropriate.
They are also not the same scan. NT and NB information are very important and not replaced by the blood test. They are part of the anatomy of a fetus and so should be assessed at this stage. Normal blood results can be false negative. Absent/hypoplastic NB and/or thickened NT will still prompt further testing regardless of blood results.
If things like this are missed because an inappropriate scan was done, you leave yourself open to legal liability and litigation.
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Thank you for your question,
To ensure accreditation compliance, we recommend reviewing the current DIAS guidelines (accessible via the link below). This will allow you to tailor your department's procedures to these standards.
DIAS Guidelines: DI2104 Disinfection Requirements for Reusable Semi-Critical Medical Devices
Additional valuable resources that will also provide assistance include flowcharts from ASUM and BMUS, along with the Australian Guidelines for the Prevention and Control of Infection in Healthcare, available at NHMRC's Infection Control Guidelines (February 2020).
For more personalized guidance, we suggest that you consider consulting with your local infection control or infectious diseases departments. They may be able to offer specific assistance tailored to your facility's needs.
There are multiple brands/manufactures that produce consumables that are suitable. If you search "high level disinfectants" for ultrasound it will provide you with links to the specific companies and their products.
Best regards,
Vascular SIG
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Thank you for your question.
The guideline is specifically for patients in the mid trimester scan, ie. morphology. In the guideline a specific subgroup for third trimester patients was not included, as there is limited clinical value in performing CL measurements after 24 weeks. Therefore a CL measurement (either TV or TA) is not required in third trimester, unless specifically requested by the referring doctor or as per your radiologist.
If a patient presents to you in third trimester (these would usually be surveillance), to have a CL assessment at the request of the referrer, it is usually appropriate to do a TV scan, as long as it is not contraindicated (ie. Preterm labour).
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Thanks for the question, Royal Darwin!
We got a very enthusiastic response from the group which I'm sure will help.
Every member of the group is in agreement that retrograde flow must be demonstrated in the ovarian veins for them to be labelled incompetent. This is in keeping with the latest classification by the American Vein & Lymphatic Society (Meissner et al 2021).
That isn’t to say diameter isn’t important. The above paper found >70% positive predictive value for reflux in ovarian vein with diameters ranging from 0.5-0.8cm. In actual practice, the overall experience of the vascular SIG is that ovarian veins with a diameter >0.5cm are often incompetent.
As far as protocol is concerned, having the patient well hydrated is definitely the way to go. Patients can be scanned in the supine position – if views of the ovarian veins are equivocal then scanning patient in a semi recumbent or erect position can help.
As part of this scan, you’ll also want to rule in/out left renal vein (Nutcracker)and left common iliac vein compression (May Thurner) as well as performing a full assessment of the IVC and bilateral iliac veins to assess for patency, flow direction and waveform.
One of the SIG members suggested this would be a great topic for a travelling workshop in Darwin – would that be of interest to you?
Thanks
Vasc SIG
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There are no specific measurements for the lateral ventricles at the 12-13 week scan. Instead, Using a subjective approach to assess ventricular anatomy. This is consistent with current research as no systemic approaches are currently used.
Ventriculomegaly and its prognosis is highly dependent on the underlying cause. It may be associated with both chromosomal and non chromosomal causes. Development may occur later in the pregnancy just as ventriculomegally may resolve as the pregnancy progresses.
Currently, suspected isolated ventriculomegaly at the 12 - 13 week scan requires further investigation by fetal neurosonography or tertiary referral.
Attached are some relevant articles.
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Thank you for your question.
This is a very tricky scenario. ASA has no "standpoint" on the topic.
However, we would suggest speaking to your radiologist who is reporting and following your local guidelines.
A strategy to approaching these requests would be to speak to your patient, let them know what normal practice is and ensure your ask them if you can check FHR.
We cannot do anything without patient consent. If the patient declines any imaging of the fetus, please ensure you are clear on your worksheet and document that the patient declined.
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Thanks for your question regarding GCA. It brought with it a unanimous answer from three members of the vascular SIG. The points made where that there are no official guidelines for assessing for GCA in Australia and yes, the axillary artery should definitely be included as part of the study as GCA has been well documented in this vessel.
Its more the Rheumatology space that investigates GCA - please find the attached paper from EULAR.
Thanks
Vasc SIG
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Sorry , for the delay but after asking around I haven't found a supplier of vertical arm slings. All the best
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Hi, apologies for the delayed response.
We fast for HCC screens for the usual 4 hours to reduce bowel gas, but also if they are going to have a liver elastography as well. Non fasting artificially increases elastography values.
Disclaimer: by using this service you recognise that the information provided is general in nature; it does not constitute professional advice. Any views expressed are those of individual(s) and may not reflect ASA’s views. The ASA does not endorse any product or service identified. You use any information provided at your sole risk and the ASA is not responsible for any errors or for any consequences arising from that use.
Unfortunately, we cannot comment on specific cases. For clarification on your case, please refer to your clinic protocols, your senior or chief sonographer and the reporting radiologist. However, IUGR criteria is below the 10th%ile
As always, the sonographer must make a decision on whether and how the scan needs to be extended. If you have concerns about the fetal wellbeing at any point, regardless of the numbers, please consult your radiologist and extend the scan as appropriate.