1st Trimester OB Exams (0 weeks 1 day to 13 weeks 6 days)

Indications Pelvic pain
Ectopic pregnancy
Vaginal bleeding
Embryonic / fetal demise
Prep  Adult patient to drink 32 oz of water, finishing 60 minutes prior to exam. Patient should not empty bladder until transabdominal exam is completed. ED patients require no prep.
Transabdominal Imaging* Sagittal uterus in midline with and without length and AP measurement.
Sagittal uterus left and right.
Sagittal endometrium (no measurement).
Transverse uterus inferior to superior with and without measurement at widest point.
Sagittal and transverse left ovary without measurements.
Sagittal and transverse right ovary without measurements.
Sagittal and transverse left adnexa.
Sagittal and transverse right adnexa.

Measurement of the gestational sac in S/I, A/P and transverse using calculation package calipers. Do not add to calculation package unless noembryo/fetus is identified.

Image of fetus without measurement.
Endovaginal Imaging* Sagittal uterus in midline (no measurement).
Sagittal uterus left and right.
Sagittal endometrium with and without measurement (if no gestational sac is visualized).
Transverse uterus inferior to superior (no measurement).
Sagittal and transverse left ovary with and without measurements.
Sagittal and transverse right ovary with and without measurements.
Sagittal and transverse left adnexa.
Sagittal and transverse right adnexa.

2-3 measurements of embryo/fetus from crown to rump.

Measurement of fetal heart using M-Mode. Cine clip showing regular heart activity or lack of activity.
*Minimum imaging requirements. Must note in tech notes if unable to visualize ovaries.
  If the uterus cannot be seen secondary to empty bladder in the ED, measure the uterus transvaginally. 
Additional imaging to include  Measurement in 1 plane to determine greatest diameter of simple ovarian cysts (measure largest cyst of multiple cysts observed).

Measurement in 3 planes for complex cysts or masses within the ovaries. Include color flow/Doppler of complex cysts and ovarian masses.

Images of any additional pathology including hydrosalpinx, free fluid in the posterior cul de sac, etc.

Sagittal and transverse images of any adnexal mass including measurements and color flow.

Sagittal and transverse imaging to include cervical area.

Sagittal and transverse images of the placenta if developed.

Information must be entered on the patient data page including LMP and Gravida/Para information. Reason for the exam must be included in the comment section of the patient data page (or free texted on initial blank imaging page if comment section not available). It is important to ask the patient the reason they are having the exam and the patient information should be shared with the radiologists via the comments section and tech notes.

Patient sex/age/exam type should be visible on each image.
LMP and Gravida/Para information should be visible on each image
"PIP" (patient inserted probe) or "TIP" (technologist inserted probe) should be visible on each encovaginal image.

Exam performed on Philips equipment should include 3D coronal views of the endometrium.
The calculation package should be used to store measurements. The worksheet image with measurements should be stored as the last image of the exam.

Chaperone initials should be included on each endovaginal image. male sonographers must have a chaperone for all endovaginal exams. Female sonographers may obtain a chaperone if they believe it would be appropriate. (See UNMH Guideline "chaperone Services" and Internal Guideline "Radiology code of Ethics" appendix I).

Non latex probe cover must cover the endovaginal transducer for each exam.
The endovaginal probe must soak in Cidex OPA following the manufacturer's guidelines after each endovaginal exam.

visibly bloody transducer covers, pads, tampons and chuks must be placed in a biohazard bag and the bag must be placed in a biohazard bin (not sharps container). Bloody linens should be placed in the blue linen bag like all other linens; do not red bag bloody linens.

An endovaginal exam should not be performed on a patient unable to consent. The only exception would be a signed consent from two providers in the event that a patient is unable to consent and the providers state the exam is emergent.

When completing the exam, bill only charges must be selected for both the TA and EV portions of the exam (drag 2 charges from the left over to the right). Coronal 3D images should also be charged as a "bill only" 76376 "Render w/o post processing."

Ectopic pregnancy is considered a critical result. Sonographers must contact the radiologist and notify of findings whether positive or negative.