Do Your Protocols Comply With the NEW 2nd Trimester OB Ultrasound Practice Guidelines?

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New guidelines have been released regarding 2nd trimester Obstetrical Ultrasound protocols. Is your facility using the new guidelines?

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“CHD is a leading cause of infant mortality, with an estimated incidence of about 4–13 per 1000 live births. Between 1950 and 1994, 42% of infant deaths reported to the World Health Organization were attributable to cardiac defects. Structural cardiac anomalies were also among the abnormalities most frequently missed by prenatal ultrasonography” (ISUOG Practice Guidelines p.348)

With 2013 being deemed “The Year of Ultrasound” by the American Institute of Ultrasound in Medicine (AIUM), there has been an ever growing demand for medical practitioners to integrate diagnostic ultrasound into practice to improve performance/interpretation skills. The goal is to increase the integration of ultrasound education and use throughout all levels of healthcare clinical applications. Increased utilization of ultrasound will provide the best care to patients in a cost-effective manner.

Among these specialties, there has been an increased demand for healthcare providers to update protocols regarding fetal heart screening. The implementation of the new guidelines for 2nd Trimester OB Ultrasound has been a collaborative effort by ACR–ACOG–AIUM–SRU. The guidelines have been implemented to ensure a more comprehensive screening of the fetal heart to improve early detection of congenital heart defects.

Guideline updates specific to the fetal heart include:

Standard Second or Third Trimester Examination

A standard obstetrical sonogram in the second or third trimester includes an evaluation of fetal presentation, amniotic fluid volume, cardiac activity, placental position, fetal biometry, and fetal number, plus an anatomic survey. The maternal cervix and adnexa should be examined as clinically appropriate when technically feasible.

The routine fetal heart exam is no longer just a four-chamber evaluation. Routine protocols should now include:
-Four-chamber view
-Left Ventricular outflow tract
-Right ventricular outflow tract

In addition to updates regarding fetal heart evaluation, the AIUM has also released statements regarding physician maintenance of certification:

Maintenance of Competence in Fetal Echocardiography

All physicians performing fetal echocardiograms should demonstrate evidence of continuing competence in the interpretation and reporting of those examinations. A minimum of 100 diagnostic fetal echocardiograms per year is recommended to maintain the physician’s skills.

Continuing Medical Education in Fetal Echocardiography

The physician should complete 10 hours of AMA PRA Category 1 Credits specific to fetal echocardiography every 3 years.

View the updated guidelines at: Practice Guideline for the Performance
of Obstetrical Ultrasound

ISUOG Practice Guidelines p.348:

To accommodate medical professionals need to incorporate advanced fetal heart screening techniques as outlined in the new guidelines, Gulfcoast Ultrasound Institute is offering a one-day Fetal Heart Examination hands-on workshop (June 20, 2014 in St. Pete Beach, FL). For those who are not interested in hands-on and would still like to have access to the lectures, the program will also be streamed live online.

The Fetal Heart Screening Examination


This course is designed to increase the participants’ knowledge of imaging views and fetal heart anatomy and physiology for the screening examination of the fetal heart during the routine OB second trimester anatomy exam. The course will cover an exam protocol including determination of situs, the four-chamber view, left and right outflow tract views and the three vessels and trachea view. The utilization of color Doppler and a review of fetal heart abnormalities will also be discussed.

Jill Beithon, RT( R), RDMS, RDCS, RVT
For more information on the program, visit: The Fetal Heart Screening Exam: A Comprehensive Hands-On Course

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