Early pregnancy / dating and viability report template
A structured early pregnancy / dating and viability report template used for early pregnancy, dating and viability, first-trimester examination, nuchal translucency examination. It covers 6 sections and 19 fields.
Demonstration content. Review and approve this template with your clinical lead before clinical use. Reference values shown in SonoTez are notes only and are never applied automatically.
Technique
Transabdominal and/or transvaginal obstetric ultrasound.
What to include: sections and measurements
Gestation
- Number of fetuses: singleton · twin · triplet · higher order
- Chorionicity / amnionicity (as documented)
Fetus repeatable
- Cardiac activity: present · absent · not yet assessable
- Fetal heart rate (entered) (bpm)
Early pregnancy
- Gestational sac: intrauterine · not seen in the uterus · other location (describe)
- Mean sac diameter (mm)
- Yolk sac: seen · not seen
- Embryo: seen · not seen
- CRL (mm)
- GA from CRL (days) calculated
- Location description
Placenta
- Location: anterior · posterior · fundal · lateral
- Segment: upper segment · lower segment
- Relation to internal os: clear of the os (no previa) · low-lying · covering the os
- Distance from internal os (mm)
- Maturity grade (doctor-assessed): grade 0 · grade i · grade ii · grade iii
- Other placental findings
Adnexa
- Adnexal findings
Other findings
- Other findings
Writing the impression
Answer the clinical question first, list the remaining findings in order of importance, and keep anything new out of the impression. If a structure was not fully seen, say so and give the reason. See how to write an ultrasound report for wording and certainty terms.