<p> OBSTETRICAL ULTRASOUND NAME:______DATE: ______MR #:______REASON FOR EXAM: ______LMP: ______EDD _____ GA ______</p><p>______CERVIX: closed open Length: ______PLACENTA Ant Post Fundal Previa Partial previa Low lying Grade: 0 1 2 3 CORD: 3V 2V AMNIOTIC FLUID VOLUME: normal high normal increased decreased AFI: ______</p><p>FETUS Sex: M F Biophysical profile Breathing 0 1 2 Position cephalic breech transverse variable Tone 0 1 2 Movement 0 1 2 Situs:…………………… nl abnl Face…………………… nl abnl not seen Orbits…………………nl abnl not seen Profile……………….. nl abnl not seen Chin ______Lips/nose…………… nl abnl not seen Nasal bone ____ mm Neck…………………… nl abnl not seen Nuchal thickness ______mm Brain…………………… nl abnl not seen Ventricles R _____mm L ______mm Third _____ mm C septum pellucidum nl abnl Hanging choroid Y N Corpus callosum nl abnl Cerebellum……………. nl abnl not seen Cbl diameter ______mm Cisterna magna ______mm Spine…………………… nl abnl not seen Lungs nl abnl Heart 4 chamber…….. nl abnl not seen Outflow tracts…… nl abnl not seen Stomach ………………. nl abnl not seen Bowel………………… nl abnl not seen Cord insertion………… nl abnl not seen Kidneys R………… nl abnl not seen length______AP pelvis______Renal AA Y N Caliectasis Y N Hydroureter Y N L………… nl abnl not seen length______AP pelvis______Renal AA Y N Caliectasis Y N Hydroureter Y N Bladder………………… nl abnl not seen Extremities arms - R nl abnl not seen legs - R nl abnl not seen - L nl abnl not seen - L nl abnl not seen hands- R nl abnl not seen feet - R nl abnl not seen - L nl abnl not seen - L nl abnl not seen</p><p>DOPPLER Heart rate ______MCA PSV______cm/sec RI ______PI ______Umbilical artery S/D _____ abn nl RI ______PI ______CerebroPlacental ratio ______abn nl Umbilical vein nl pulsatile Ductus venosus nl pulsatile</p><p>ADDITIONAL MEASUREMENTS FOR SKELETAL DYSPLASIA Humerus R______% nl abnl Femur R______% nl anbl Chest circumference ______L ______% nl abnl L ______% nl abnl Clavicles ______Radius R______% nl abnl Tibia R______% nl abnl Scapula ______L ______% nl abnl L ______% nl abnl Foot length ______Ulna R______% nl abnl Fibula R______% nl abnl OOD ______L ______% nl abnl L ______% nl abnl IOD ______</p><p>ESTIMATED GESTATIONAL AGE ____ weeks ____days ESTIMATED FETAL WEIGHT______gms, ______% ______COMMENTS : ______Modified on 2/20115/19/2011 12:16:00 AM</p>