Module 2: Ultrasound of fetal anatomy

Learning outcomes
To understand and demonstrate appropriate knowledge, skills and attitudes to perform a fetal anomaly scan, including perform a normal scan, recognise common abnormalities, communicate normal and abnormal results, know limits of competence, complete appropriate documentation Knowledge criteria Clinical competency Professional skills and attitudes Training support Evidence/ Assessment

Principles of ultrasound examination 1. Physics 2. Safety 3. Machine set-up and operation 4. Patient care 5. Principles of report writing 6. Consent 7. Cultural Diversity Understand the principles of conducting a safe and appropriate ultrasound examination Use an ultrasound machine competently and independently Safe use of the ultrasound machine Appropriate care of the patient during examination Course including both: Theory Practical demonstration of machine use and reporting Case discussion in clinic Certificate of attendance at course

Knowledge criteria

Clinical competency

Professional skills and attitudes

Training support

Evidence/ Assessment

Documentation of scan 1. Understand need for accurate documentation of scan 2. Record appropriate images Record scan findings clearly and accurately and keep appropriate hard copy or video records of anomalies. Communicate scan findings to other health professionals Supervised structured clinical learning sessions OSATS: Anomaly scan including recording images of fetus Counselling of normal scan findings with parents Counselling of abnormal scan findings with parents

Knowledge criteria

Clinical competency

Professional skills and attitudes

Training support

Evidence/ Assessment

Anomaly scan 1. Know requirements for minimal and optimal anomaly scan as defined in RCOG report 2000, Ultrasound screening 2. Know anatomical landmarks for performing standard fetal measurements (BPD, HC, AC, FL) 3. Recognise normal appearance of fetal structures and appreciate different appearance at different gestations 4. Know the detection rates of common anomalies Identify fetal position within uterus Be able to move probe with purpose to identify fetal structures Be able to consistently and systematically identify the features described in an optimal anomaly scan as described in RCOG report 2000, Ultrasound Screening Be able to perform standard fetal measurements (BPD, HC, AC, FL) Transcerebellar diameter, Ventricular atrium, nuchal pad, cisterna magna, renal pelvis AP diameter. Identify placental site Recognise limits of competency Recall patients appropriately for further scans if structures not seen clearly RCOG/RCR report 1997 Ultrasound Screening for Fetal Abnormalities Relevant green top guidelines Conduct scan to appropriate standard. Mandatory education and training sessions Theoretical course (local or RCOG) Supervised structured clinical learning sessions Attendance at anomaly scans Personal study Textbooks of obstetric ultrasound RCOG/RCR report 2000 Ultrasound Screening OSATS: Fetal biometry Anomaly Scan including recording images of fetus Certificate of course attendance Case discussion in clinic

Knowledge criteria

Clinical competency

Professional skills and attitudes Recognition and appropriate management or onward referral of anomalies

Training support

Evidence/ Assessment Log of experience Certificate of course attendance Case discussion in clinic OSATS: Anomaly Scan including recording images of fetus

Management of anomalies 1. Recognise common anomalies 2. Be aware of appropriate investigations when an anomaly is identified

Identify anomalies Advise appropriate investigations if anomalies identified Appropriate referral for more complex or detailed evaluation with ultrasound

Mandatory education and training sessions Theoretical course (local or RCOG) Supervised structured clinical learning sessions Personal study textbooks of fetal ultrasound

Knowledge criteria

Clinical competency

Professional skills and attitudes Communicate relevant information to parents and other health professionals

Training support

Evidence/ Assessment Case discussion in clinic

Communication 1. Provide parents with necessary information in a form they understand 2. Communicate scan findings and information given to parents to other health professionals

Provide parents with information about:

Supervised structured clinical learning sessions

If an anomaly is identified:
1. Counsel about ultrasound soft marker 2. Counsel about structural anomaly 3. Discuss risks and benefits of invasive testing if appropriate 4. Counsel about termination of pregnancy if appropriate and methods required at different gestation 5. Counsel about further in utero management.

OSATS: Counselling of abnormal scan findings with parents

Ultrasound of fetal anatomy logbook Competence level Skill Observation Date Signature Direct supervision Date Signature Independent practice Date Signature

Safe use of US machine + correct settings Accurate measurements of BPD, HC, FL, TCD and lateral atrial diameter of the cerebral ventricles Confirm normal anatomy of head and face Confirm normal anatomy of spine Confirm normal anatomy of heart and chest Confirm normal anatomy of abdomen Confirm normal anatomy of limbs Perform full anomaly scan Recognise common structural anomalies

Skill Date Communicating normal results to parents Communicating abnormal results to parents Arranging appropriate follow up or intervention Working in a multi-disciplinary team

Observation Signature

Date

Direct supervision Signature

Independent practice Date Signature

Training Courses or sessions

Title

Signature of educational supervisor

Date

Authorisation of signature:

Name (please print)

Signature

OSATS: Fetal biometry

Clinical details of complexity/ difficulty of case

Needs help Item under observation 1 Counsel patient about procedure 2 Appropriate machine setup/probe selection 3 Confirm fetal heartbeat 4 Measure BPD, HC, TCD, AC, FL transabdominally 5 Demonstrate normal anatomy 6 Demonstrate Biometric anomalies detected on scan and note differences from normal 7 Communicate results to patient and uncertainties 8 Identify placental site or position in relation to the cervical canal if appropriate 9 Assess liquor volume 10 Discuss appropriate referral to other specialities, if indicated 11 Ensure images and video are recorded according to local protocol Comments

Done independently

Signature: _____________________________________ Date: _____________

OSATS: Anomaly scan including recording images of fetus

Clinical details of complexity/ difficulty of case

1 2 3 4

Item under observation Counsel patient about procedure Appropriate machine setup/probe selection Confirm fetal heartbeat Demonstrate normal anatomy and normal biometry including BPD, HC (Atrial measurements lateral ventricle), TCD, AC, FL Demonstrate anomaly(s) detected on scan and differences from normal Communicate results to parents and uncertainties regarding diagnosis & prognosis Identify placental site or placental position in relation to the cervical canal if appropriate Assess liquor volume Discuss appropriate referral to other specialities, if indicated Ensure images and video are recorded according to local protocol Comments

Done independently

Needs help

5 6 7 8 9 10

Signature: _____________________________________ Date: _____________