Govt of India Guidelines of antenatal USG

Govt of India Guidelinesan antenatal USG:--These guidelines have been developed for use by doctors working in government Health   facilities performing obstetric USG and are not a substitute to guidelines for Implementing provisions of PC&PNDT Act and Rules.:-Any doctor conducting obstetric USG has to work within defined parameters of PC&PNDT Act and Rules-.a) Timing of obstetric   ultrasound & Number of Ultrasound in Pregnancy: After reviewing the literature and considering available resources and feasibility, it has been decided that one obstetric ultrasound should be done during pregnancy between 18 and 19 weeks of pregnancy as part of routine Ante Natal Care (ANC)package. Additional ultrasound examinations can be done if clinically indicated. Govt of India Guidelines:-These guidelines have been developed for use by doctors working in government

Health facilities performing obstetric USG and are not a substitute to guidelines for Implementing provisions of PC&PNDT Act and Rules. Any doctor conducting obstetric USG has to work within defined parameters of PC&PNDT Act and Rules.

.a) Timing of obstetric ultrasound. *&

Number of Ultrasound in Pregnancy: After reviewing the literature and considering a available resources and feasibility, it has been decided that one obstetric ultrasound should be done during pregnancy between 18 and 19 weeks of pregnancy as part of routine Ante Natal Care (ANC)package. Additional ultrasound examinations can be done if clinically indicated.

b) Timing of obstetrics ultrasound.

If a single scan is to be performed in pregnancy, ideally it should be done between 18 to 22 weeks of gestation. Routine USG in first trimester has not been able to provide any benefit in low risk pregnancies, except for the diagnosis of ectopic pregnancy. Clinically indicated ultrasound in the presence of risk factors or clinical suspicion based on history and physical examination, can correctly diagnose ectopic pregnancy in 80 to 100% of cases. If the USG is done before 18 weeks, many anomalies will be missed. USG between 18 and 22 weeks provides some information about multiple aspects of pregnancy. It presents an opportunity to diagnose congenital anomalies and/or to detect soft markers of aneuploidy and to identify maternal pelvic pathology. Besides, it can confirm the number of fetuses present, the gestational age and the location of the  placenta. To allow for intervention after USG, if any anomaly is detected, an adequate periodbetween gestational age for USG and the upper limit of gestational age at which MTP is permissible is required. Therefore the upper limit of gestational age for routine scan in

second trimester varies from country to country depending on their MTP law .The law in our country permits MTP up to 20 weeks only; hence a single routine obstetric ultrasound

should be performed between 18 and 19 weeks.

In the last two decades, the infant death rate from congenital anomalies has decreased by 50% in infants born after 24 weeks. This is probably partially related to early diagnosis of congenital anomalies leading to either pregnancy termination or better neonatal care. Second trimester diagnosis of congenital anomalies also provides the opportunity for foetal therapy.

Second trimester Ultrasound Examination can diagnose up to 94.4% twin pregnancies if done before 19-20 weeks. The occurrence of twins, undiagnosed at delivery is extremely rare when women have received a second trimester .

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b) Timing of obstetrics  ultrasound. If a single scan is to be performed in pregnancy, ideally it should be done between 18 to 22 weeks of gestation. Routine USG in first trimester has not been able to provide any benefit in low risk pregnancies, except for the diagnosis of ectopic pregnancy. Clinically Indicated ultrasound in the presence of risk factors or clinical suspicion based on history and physical examination, can correctly diagnose ectopic pregnancy in 80 to 100% of cases.

If the USG is done before 18 weeks, many anomalies will be missed. USG between 18 and22 weeks provides some information about multiple aspects of pregnancy .It presents an opportunity to diagnose congenital anomalies and/or to detect

soft markers of aneuploidy and to identify maternal pelvic pathology.

Besides, it can confirm the number of fetuses present, the gestational age and the location of the Govt of India Guidelines:-These guidelines have been developed for use by doctors working in government

Health   facilities performing obstetric USG and are not a substitute to guidelines for Implementing provisions of PC&PNDT Act and Rules.Any doctor conducting obstetric USG has to work within defined parameters of PC&PNDT Act and Rules

a) Timing of obstetric   ultrasound. *& Number of Ultrasound in Pregnancy: After reviewing the literature and considering a vailable resources and feasibility, it has been decided that one obstetric ultrasound should be done during pregnancy between 18 and 19 weeks of pregnancy as part of  routine Ante Natal Care (ANC)package. Additional ultrasound examinations can be

done if clinically indicated.

b) Timing of obstetrics  ultrasound.

If a single scan is to be performed in pregnancy, ideally it should be done between 18 to 22 weeks of gestation. Routine USG in first trimester has not been able to  provide any benefit in low risk pregnancies, except for the diagnosis of ectopic pregnancy. Clinically  indicated ultrasound in the presence of risk factors or clinical suspicion based on history and physical examination, can correctly diagnose ectopic pregnancy in 80 to 100% of cases.If the USG is done before 18 weeks, many anomalies will be missed.  USG between 18 and  22 weeks provides some information about multiple aspects of

pregnancy.It presents an opportunity to diagnose congenital anomalies and/or to detect soft markers of aneuploidy and to identify maternal pelvic pathology. Besides, it can  confirm the number of fetuses present, the gestational age and the location of the placenta.To allow for intervention after USG, if any anomaly is detected, an adequate period

between gestational age forUSG and the upper limit of gestational age at which MTPis

permissible isrequired. Therefore the upper limit of gestational age for routine scan in

second trimester varies from country to country depending on their MTP law .The law in

our country permits MTP up to 20 weeks only; hence   a single routine obstetric ultrasound

should be performed between 18  and  19 weeks.

In the last two decades, the infant death rate from congenital anomalies has decreased by 50% in infants born after 24 weeks. This is probably partially related to early diagnosis of congenital anomalies leading to either pregnancy termination or better neonatal care. Second trimester diagnosis of congenital anomalies also provides the opportunity for foetaltherapy.

Second trimester Ultrasound Examination can diagnose up to 94.4% twin pregnancies if done before 19-20 weeks. The occurrence of twins, undiagnosed at delivery is extremely

rare when women have received a second trimester ultrasound. The likelihood of unnecessary induction for post date pregnancy and intrauterine growth restriction also decreases significantly by second trimester USG.

Placenta.

To allow for intervention after USG, if any anomaly is detected, an adequate period between gestational age forUSG and the upper limit of gestational age at which MTP  is permissible is required. Therefore the upper limit of gestational age for routine scan in second trimester varies from country to country depending on their MTP law .The law in our country permits MTP up to 20 weeks only; hence  a single routine obstetric ultrasound shoul  be performed between 18 and  19 weeks.

In the last two decades, the infant death rate from congenital anomalies has decreased by 50% in infants born after 24 weeks. This is probably partially related to early diagnosis of congenital anomalies leading to either pregnancy termination or better neonatal care. Second trimester diagnosis of congenital anomalies also provides the opportunity for

foetal  therapy. Second trimester Ultrasound Examination can diagnose up to 94.4% twin pregnancies if

done before 19-20 weeks. The occurrence of twins, undiagnosed at delivery is extremely

rare when women have received a second trimester ultrasound. The likelihood of  unnecessary induction for post date pregnancy and intrauterine growth restriction also

decreases significantly by second trimester USG.