Lesson 1Placenta: location, morphology, and grading; cord insertion assessmentExplains how to identify placental site, grade, and morphology, recognise previa and accreta spectrum clues, and evaluate cord insertion, including marginal, velamentous, and vasa previa patterns that alter obstetric management and require careful documentation.
Determining anterior, posterior, or fundal placentaLow‑lying placenta and placenta previa criteriaPlacental lakes, thickness, and texture changesGrannum grading and clinical relevance limitsCord insertion: central, marginal, velamentousScreening for vasa previa and color Doppler useLesson 2Limitations of ultrasound at 21 weeks and when to recommend targeted tertiary referralReviews technical and biological limitations of 21-week ultrasound, including maternal habitus, fetal position, and equipment constraints, and defines when incomplete views or suspected anomalies warrant targeted tertiary referral or repeat scans for further evaluation.
Impact of maternal BMI, scars, and fibroidsFetal position, movement, and shadowing issuesEquipment resolution and operator dependenceWhen suboptimal views justify repeat scanningCriteria for tertiary anomaly or cardiac referralCommunicating limitations clearly to cliniciansLesson 3Restating clinical question and ultrasound role in mid-trimester painFocuses on clarifying the clinical question in women with mid-trimester pain, defining ultrasound’s role in excluding obstetric emergencies, assessing cervix, placenta, membranes, and adnexa, and recognising when findings need urgent escalation to multidisciplinary teams.
Clarifying pain onset, pattern, and associated signsAssessing fetal well‑being during maternal painEvaluating placenta, membranes, and retroplacental areaTransvaginal cervical length and funneling signsAdnexal, uterine, and urinary tract assessmentRed flags requiring urgent obstetric reviewLesson 4Probe selection, patient positioning and scanning planes for anatomy and biometryCovers optimal transducer types, frequency selection, patient positioning for comfort and image quality, and standard longitudinal, transverse, and oblique planes needed to obtain reproducible anatomy and biometry measurements at 21 weeks in routine practice.
Curved array probe selection and settingsMaternal positioning and tilt for safetyTransverse and sagittal uterine survey planesStandard planes for head and brain biometryStandard planes for abdominal and femur biometryOptimizing depth, focus, and gain controlsLesson 5Amniotic fluid assessment: AFI and single deepest pocket technique and interpretationExplains methods for assessing amniotic fluid using AFI and single deepest pocket, including measurement technique, normal ranges at 21 weeks, and recognition of oligohydramnios and polyhydramnios with clinical implications for fetal well-being and management.
Quadrant division and AFI measurement stepsSingle deepest pocket technique and limitsNormal fluid ranges for mid‑trimester gestationOligohydramnios thresholds and implicationsPolyhydramnios thresholds and implicationsCommon technical errors and how to avoid themLesson 6Reporting structure for mid-trimester anatomy scan and key phrases to includeDescribes a structured mid-trimester report, including mandatory headings, standard phrases, and recommended terminology for normal and abnormal findings, ensuring clarity, medicolegal robustness, and easy comparison with follow-up scans in clinical records.
Essential report sections and layout orderStandard wording for normal fetal anatomyDescribing soft markers and minor variantsClear phrasing for suspected major anomaliesDocumenting measurements and reference chartsRecommendations, follow‑up, and disclaimer textLesson 7Indications and relevant maternal/fetal history to collectOutlines key maternal and fetal indications for a 21-week scan, including routine screening and high-risk scenarios, and specifies the relevant history, medications, and prior imaging that should be collected before scanning to inform the examination.
Routine screening versus high‑risk indicationsMaternal medical, surgical, and obstetric historyCurrent pregnancy complications and medicationsAssisted reproduction and multiple gestationsPrior ultrasound, screening, and lab resultsFamily history of anomalies or genetic diseaseLesson 8Fetal presentation and lie, basic fetal Doppler targets (umbilical artery) and when to useExplains assessment of fetal lie, presentation, and placental relationship, and introduces basic umbilical artery Doppler indications, technique, indices, and interpretation, including when Doppler adds value at 21 weeks for enhanced diagnostic accuracy.
Determining lie, presentation, and situsRelationship of presenting part to placentaUmbilical artery Doppler indications at 21 weeksSampling technique and angle optimizationSystolic/diastolic ratio, PI, and RI basicsAbnormal waveforms and follow‑up strategyLesson 9Relevant guideline references for obstetric dating and anomaly screening (how to locate)Guides learners to key international and national guidelines on dating and anomaly screening, explaining how to locate, interpret, and apply recommendations, including measurement standards, timing windows, and documentation requirements in practice.
Major societies: ISUOG, ACOG, SMFM, RCOGAccessing online guideline libraries and appsKey dating recommendations and CRL to biometryStandard anomaly screening checklists and timingUsing guideline charts and z‑score calculatorsDocumenting adherence to guideline standardsLesson 10Detailed fetal anatomy survey: organs and structures to evaluate at 18–22 weeksDetails the systematic fetal anatomical survey at 18–22 weeks, including brain, face, spine, thorax, heart, abdomen, kidneys, limbs, and genitalia, with key normal landmarks and common structural anomalies to recognise and document thoroughly.
Cranial vault, midline, and posterior fossa viewsFacial profile, orbits, lips, and palate checksCervical, thoracic, lumbar, and sacral spine viewsFour‑chamber heart and outflow tract viewsAbdominal wall, stomach, bowel, and kidneysLimbs, hands, feet, and genitalia assessmentLesson 11ALARA principle in obstetric scanning and safety considerationsEmphasises ultrasound safety in pregnancy, detailing the ALARA principle, prudent use of output power and dwell time, understanding TI and MI indices, and avoiding unnecessary Doppler exposure, especially in early gestation and fetal brain areas.
Biological effects of diagnostic ultrasoundUnderstanding TI and MI on the screenApplying ALARA in routine obstetric scansLimiting Doppler use and exposure timeSafety in first‑trimester and fetal brain scansCounseling patients about ultrasound safetyLesson 12Biometry and dating: head, abdominal circumference, femur length norms and reference chartsCovers standard biometric parameters at 21 weeks, including BPD, HC, AC, and FL, with correct planes, caliper placement, and use of reference charts or z-scores for dating, growth assessment, and detection of size discordance in fetuses.
BPD and HC planes and caliper positioningAbdominal circumference plane and pitfallsFemur length technique and artifactsChoosing appropriate reference chartsUsing centiles and z‑scores for datingInterpreting small or large for gestational age
