Obstetric ultrasound with fetal Doppler and biophysical profile report template
A structured obstetric ultrasound with fetal doppler and biophysical profile report template used for fetal doppler, growth with doppler and biophysical profile, multiple pregnancy examination, obstetric doppler. It covers 9 sections and 45 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 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)
- Lie: longitudinal · transverse · oblique · unstable
- Presentation: cephalic · breech · transverse · oblique · variable
- Fetal movements: present · not seen during the scan
Biometry
- BPD (mm)
- HC (mm)
- AC (mm)
- FL (mm)
- EFW (g) calculated
- BPD - GA as reported
- HC - GA as reported
- AC - GA as reported
- FL - GA as reported
- Average GA as reported (with reference)
- EDD by this scan (as reported)
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
Amniotic fluid
- Method: single deepest pocket · amniotic fluid index · subjective assessment
- Measurement (cm)
- Doctor's assessment: appears normal · appears reduced · appears increased
Fetal Doppler
- Umbilical artery PI
- Umbilical artery RI
- Umbilical artery S/D ratio
- UA end-diastolic flow: present · absent · reversed
- MCA PI
- MCA PSV (cm/s)
- Cerebroplacental ratio (MCA PI / UA PI) calculated
- Ductus venosus waveform (description)
Biophysical profile
- Breathing movements (score)
- Gross body movement (score)
- Tone (score)
- Amniotic fluid (score)
- Total (sum of entered scores) calculated
- Non-stress test (if performed)
Cervix
- Approach: transabdominal · transvaginal · transperineal
- Cervical length (mm)
- Internal os: closed · funnelling · open
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.