Early First Trimester (GS) ultrasound

📝 FETAL ULTRASOUND TEMPLATES

🧾 Early First Trimester (GS)

🧾 First Trimester (Embryo 6–10w 6d)

🧾 First Trimester (11–13w 6d)

🧾 Second Trimester

🧾 Third Trimester

🧾 NT Screening

🧾 NT Screening – Specific Doppler

🧾 Fetal Anomalies Screening / TIFA

🧾 TIFA-Specific Fetal Doppler

🧾 Doppler Studies

🧾 Biophysical Profile / NST

🧾 RMT Assessment

───🧾 Early First Trimester (GS) ultrasound ───

Templates

▸

📄 Very Early Pregnancy

📄 Double Decidual Sac Sign

📄 GS

📄 GS + Yolk Sac

📄 GS Interval Growth Assessment [if-IVF]

📄 Irregular Gestational Sac

📄 Small Gestational Sac for Dates

📄 Collapsed / Crenated Gestational Sac

📄 Low-Lying Gestational Sac

📄 Empty Gestational Sac (Anembryonic Pregnancy)

📄 Absent Yolk Sac

📄 Enlarged Yolk Sac

📄 Irregular / Calcified Yolk Sac

📄 Absent Fetal Pole

📄 Static Gestational Sac Size

📄 Slow GS Growth (<1 mm/day)

📄 GS Smaller than CRL

📄 Interval Non-visualization of Embryo

📄 Irregular GS + Enlarged Yolk Sac

📄 Abnormal GS with Absent Cardiac Activity

📄 Dichorionic Diamniotic Twins (Two GS)

📄 Monochorionic Diamniotic Twins

📄 Monochorionic Monoamniotic Twins

📄 Twin Pregnancy with Vanishing Twin

📄 Trichorionic Triamniotic Triplets (Three GS)

📄 Dichorionic Triamniotic Triplets

📄 Monochorionic Triamniotic Triplets

📄 Higher-Order Pregnancy (Quadruplets or More)

📄 Vanishing Fetus in Multiple Pregnancy

📄 Pseudogestational Sac

📄 Tubal Ectopic Pregnancy

📄 Interstitial (Cornual) Pregnancy

📄 Cervical Ectopic Pregnancy

📄 Cesarean Scar Pregnancy

📄 Ovarian Ectopic Pregnancy

📄 Abdominal Ectopic Pregnancy

📄 Heterotopic Pregnancy

📄 Ovarian Ruture Ectopic Pregnancy

📄 Tubal Ectopic Pregnancy

📄 Complete Hydatidiform Mole

📄 Partial Hydatidiform Mole

📄 Early Complete Mole (Pre–snowstorm appearance)

📄 Pregnancy with Complete Mole and Coexisting Normal GS

📄 Invasive Mole ❌ No

📄 Choriocarcinoma ❌ No

📄 Placental Site Trophoblastic Tumor (PSTT) ❌ No

📄 Epithelioid Trophoblastic Tumor (ETT) ❌ No

📄 Subchorionic Hematoma

📷 Insert Image

Patient Info

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OBSTETRICS FINDINGS

FIST TRIMESTER

[GS related findings ]

Irregular Gestational Sac
Small Gestational Sac for Dates
Collapsed / Crenated Gestational Sac
Low-Lying Gestational Sac
Empty Gestational Sac (Anembryonic Pregnancy)
Absent Yolk Sac
Enlarged Yolk Sac
Irregular / Calcified Yolk Sac
Absent Fetal Pole
Static Gestational Sac Size
Slow Gestational Sac Growth (<1 mm/day)
Gestational Sac Smaller than CRL
Interval Non-visualization of Embryo
Irregular GS + Enlarged Yolk Sac
Abnormal GS with Absent Cardiac Activity
Dichorionic Diamniotic Twins (Two GS)
Monochorionic Diamniotic Twins
Monochorionic Monoamniotic Twins
Twin Pregnancy with Vanishing Twin
Trichorionic Triamniotic Triplets (Three GS)
Dichorionic Triamniotic Triplets
Monochorionic Triamniotic Triplets
Higher-Order Pregnancy (Quadruplets or More)
Vanishing Fetus in Multiple Pregnancy
Tubal Ectopic Pregnancy
Tubal Ectopic Pregnancy
Interstitial (Cornual) Pregnancy
Cervical Ectopic Pregnancy
Cesarean Scar Pregnancy
Ovarian Ectopic Pregnancy
Abdominal Ectopic Pregnancy
Heterotopic Pregnancy
Ovarian Ruptured Ectopic Pregnancy
Tubal Ectopic Pregnancy
Complete Hydatidiform Mole
Partial Hydatidiform Mole
Early Complete Mole (Pre–snowstorm appearance)
Pregnancy with Complete Mole and Coexisting Normal GS

[Embryo related findings ]

HR Not Detected in Normal Early Embryonic Pole
Absent Cardiac Activity (Embryonic Demise)
Bradycardia (<100 bpm)
Tachycardia (>180 bpm)
CRL Smaller than Expected for Dates
Failure of Interval Embryonic Growth
CRL–GS Size Discordance
Inevitable Abortion
Enlarged Yolk Sac with Embryo
Absent Yolk Sac with Visible Embryo
Dichorionic Diamniotic Twins
Dichorionic Diamniotic Twins (DCDA)
Monochorionic Diamniotic Twins (MCDA)
Monochorionic Monoamniotic Twins (MCMA)
Vanishing Twin Syndrome
Live Tubal Ectopic Pregnancy
Interstitial (Cornual) Pregnancy with Embryo
Cervical Pregnancy with Cardiac Activity
Cesarean Scar Pregnancy with Embryo
Heterotopic Pregnancy
Partial Hydatidiform Mole with Embryo
Complete Mole with Coexisting Normal Embryo
Complete Mole with Pseudogestational Embryonic Structures

[Early malformation ]

Acrania
Anencephaly
Holoprosencephaly
Cephalocele / Meningocele
Facial Clefts
Absent Nasal Bone
Cystic Hygroma
Spina Bifida
Ectopia Cordis
Omphalocele
Gastroschisis
Megacystis
Megacystis
Fetal Anasarca (Hydrops Fetalis)
Polydactyly
Fetal Pleural Effusion
Fetal Pericardial Effusion
Fetal Ascites
Twin Anemia–Polycythemia Sequence (TAPS)
Twin-to-Twin Transfusion Syndrome (TTTS)
Stuck Twin Syndrome
Fetus Papyraceus
Hydrops Fetalis
Isolated Fetal Ascites
Extensive Fetal Lymphedema
Primary Fetal Chylothorax
Fetal Lymphangiectasia
Hydropic Changes with Suspected Down Syndrome
Vein of Galen Malformation
Turner Syndrome (45,X)
Immune Fetal Hydrops (Ascites)
Fetal Skin Edema / Anasarca
Placental Edema (Placentomegaly)
Fetal Pericardial Effusion
Fetal Death In Utero (FDIU)
Single Fetus FDIU in Stuck Twin Syndrome
Single Fetus FDIU in Twin Pregnancy
Single Fetus FDIU in Triplet Pregnancy
Double Fetal Demise (FDIU) in Triplet Pregnancy

[Others finding ]

Subchorionic Hematoma
Retroplacental Hemorrhage (Early)

2nd AND 3rd TRIMESTER FINDINGS

Fetal viability abnormalities

Intrauterine Fetal Demise (IUFD)
Persistent Fetal Bradycardia
Persistent Fetal Tachycardia

Fetal growth abnormalities

Early-Onset Fetal Growth Restriction (FGR)
Biometric Discordance (BPD / HC / AC / FL)
Asymmetrical Biometric Discordance (Reduced AC Size)
Symmetrical Intrauterine Growth Restriction (IUGR)
Asymmetrical Intrauterine Growth Restriction (IUGR)

Pregnancy loss (second trimester)

Missed Abortion (Late)
Incomplete Abortion
Inevitable Abortion

Multiple pregnancy (14–27 weeks)

Dichorionic Diamniotic Twins
Monochorionic Diamniotic Twins
Monochorionic Monoamniotic Twins
Triplet / Higher-Order Pregnancy
Growth Discordance (>20%)
Twin-to-Twin Transfusion Syndrome (TTTS)
Selective Fetal Growth Restriction (sFGR)
Single Fetal Demise in Multiple Pregnancy
Fetus Papyraceus

Placental abnormalities

Placenta Previa
Low-Lying Placenta
Placental Abruption (Retroplacental Hematoma)
Placenta Accreta Spectrum (Suspicion)
Placental Mass / Chorioangioma

Umbilical cord abnormalities

Single Umbilical Artery
Marginal Cord Insertion
Velamentous Cord Insertion
Umbilical Cord Cyst
True Knot of Umbilical Cord
Single Loop Nuchal Cord
Double Loop Nuchal Cord
Triple Loop Nuchal Cord
Four Loop Nuchal Cord

Amniotic fluid abnormalities

Mild Oligohydramnios
Moderate Oligohydramnios
Severe Oligohydramnios
Mild Polyhydramnios
Moderate Polyhydramnios
Severe Polyhydramnios
Amniotic Band Syndrome

Structural anomalies (anomaly scan)

Ventriculomegaly
Spina Bifida
Dandy–Walker Malformation
Cleft Lip and Palate
Micrognathia
Congenital Heart Disease
Abnormal Outflow Tracts
Omphalocele
Gastroschisis
Hydronephrosis
Multicystic Dysplastic Kidney
Short Long Bones
Skeletal Dysplasia

Molar & trophoblastic disease

Partial Mole with Fetus
Complete Mole with Coexisting Fetus

Associated complications

Cervical Incompetence
Preterm Premature Rupture of Membranes (PPROM)
Chorioamnionitis (Indirect Signs)

SYSTEMIC STUDY OF FETAL ANOMALY

Hydrops fetalis or water baby

1. Fetal Hydrops (≥2 Abnormal Fluid Compartments)

Fetal Skin Edema with Ascites
Fetal Skin Edema with Ascites and Pericardial Effusion
Fetal Skin Edema with Ascites, Pericardial and Pleural Effusion

2. PLACENTAL & AMNIOTIC FINDINGS

Placentomegaly
Hydropic Placenta
Polyhydramnios
Oligohydramnios (Late / Terminal)

3. IMMUNE HYDROPS

Immune Hydrops Fetalis
Rh Isoimmunization–Related Hydrops
Severe Fetal Anemia (Immune)
Elevated MCA Peak Systolic Velocity (>1.5 MoM)

4. NON-IMMUNE HYDROPS : CARDIAC

Structural Congenital Heart Disease with Hydrops
Fetal Cardiomyopathy
Fetal Arrhythmia–Related Hydrops
High-Output Cardiac Failure

5. NON-IMMUNE HYDROPS : HEMATOLOGIC

Severe Fetal Anemia (Non-Immune)
Parvovirus B19–Related Hydrops
Fetomaternal Hemorrhage
Alpha Thalassemia–Associated Hydrops

6. NON-IMMUNE HYDROPS : LYMPHATIC / THORACIC

Primary Chylothorax
Lymphangiectasia
Extensive Fetal Lymphedema
Congenital Pulmonary Airway Malformation with Hydrops

7. NON-IMMUNE HYDROPS : CHROMOSOMAL / GENETIC

Turner Syndrome–Associated Hydrops
Down Syndrome with Hydropic Changes
Trisomy 18–Associated Hydrops
Trisomy 13–Associated Hydrops

8. NON-IMMUNE HYDROPS : CNS / VASCULAR

Vein of Galen Malformation with Hydrops
Large Arteriovenous Malformation

9. NON-IMMUNE HYDROPS : GI / ABDOMINAL

Isolated Fetal Ascites
Meconium Peritonitis with Ascites
Intestinal Atresia with Secondary Hydrops

10. NON-IMMUNE HYDROPS : TWIN & PLACENTAL

Twin Reversed Arterial Perfusion Sequence (TRAP)
Twin-to-Twin Transfusion Syndrome with Hydrops

11. SEVERITY & TEMPORAL CLASSIFICATION

Mild Hydrops
Severe Generalized Hydrops
Early-Onset Hydrops (Poor Prognosis)
Late-Onset Hydrops

12. DOPPLER & HEMODYNAMIC FINDINGS

Raised MCA PSV
Absent / Reversed Ductus Venosus a-Wave
Umbilical Vein Pulsations

13. OUTCOME / STATUS

Progressive Hydrops on Serial Scans
Partial Resolution of Hydrops
Intrauterine Fetal Demise with Hydrops

Conjoined twins

1. Conjoined twins (monozygotic monochorionic)

Inseparable Fetal Bodies on Real-Time Scan
Constant Relative Fetal Positions
Inability to Separate Fetal Skin Contours

2. Type classification (by site of fusion)

Thoracopagus (Chest Fusion)
Omphalopagus (Abdominal Fusion)
Thoraco-Omphalopagus
Craniopagus (Head Fusion)
Ischiopagus (Pelvic Fusion)
Pygopagus (Sacral Fusion)
Parapagus (Side-by-Side Fusion)

3. Cardiac & vascular assessment

Shared Heart (Single or Fused Cardiac Chambers)
Separate Hearts with Vascular Connections
Complex Congenital Heart Disease
Shared Great Vessels

4. Cns & craniofacial findings

Shared Brain Structures
Fused Skull with Separate or Common Brains
Facial Duplication or Fusion

5. Abdominal & thoracic organ sharing

Shared Liver (Most Common)
Shared Gastrointestinal Tract
Shared Diaphragm
Shared Genitourinary Structures

6. Limb & skeletal findings

Complete limb fusion
Partial limb fusion
Sirenomelia (Mermaid syndrome)
Soft tissue fusion
Skeletal fusion

7. Prognostic & counseling indicators

Surgical Separability Assessment
Associated Structural Anomalies
Overall Survival Prognosis

Fetal Genetic Abnormalities and Syndromes

1. Genetic abnormalities & syndromes – overview

Syndromic vs Non-Syndromic Pattern
Multiple Congenital Anomalies (MCA)
Isolated Soft Markers

2. Chromosomal aneuploidy syndromes

Down Syndrome (Trisomy 21)
Edwards Syndrome (Trisomy 18)
Patau Syndrome (Trisomy 13)
Turner Syndrome (45,X)
Klinefelter Syndrome (47,XXY)
Triploidy

3. NT / first-trimester–associated syndromes

Noonan Syndrome
DiGeorge Syndrome (22q11.2 Deletion)
Smith–Lemli–Opitz Syndrome
Cornelia de Lange Syndrome
Skeletal Dysplasia–Related Syndromes

4. Cns & neural tube–related syndromes

Dandy–Walker Syndrome
Arnold–Chiari II (Spina Bifida)
Holoprosencephaly Syndromes
Agenesis of Corpus Callosum (Syndromic)
Lissencephaly–Associated Syndromes

5. Cardiac syndromes

Holt–Oram Syndrome
Ellis–van Creveld Syndrome
Alagille Syndrome
Ivemark Syndrome (Heterotaxy)

6. Facial / craniofacial syndromes

Pierre Robin Sequence
Treacher Collins Syndrome
Goldenhar Syndrome
Binder Syndrome

7. Skeletal dysplasia syndromes

Thanatophoric Dysplasia
Achondroplasia
Osteogenesis Imperfecta
Campomelic Dysplasia
Short Rib–Polydactyly Syndrome

8. Abdominal / gi syndromes

Beckwith–Wiedemann Syndrome
VACTERL Association
Meconium Peritonitis (Syndromic)
Potter Sequence

9. Renal / genitourinary syndromes

Potter Sequence
Fraser Syndrome
Meckel–Gruber Syndrome

10. Multisystem / rare genetic syndromes

Bardet–Biedl Syndrome
Joubert Syndrome
Joubert Syndrome
Zellweger Syndrome
Russell–Silver Syndrome
Prader–Willi Syndrome (Suspected)

11. Twin & placental syndromes

Twin–Twin Transfusion Syndrome (TTTS)
Twin Anemia–Polycythemia Sequence (TAPS)
TRAP Sequence (Acardiac Twin)
Conjoined Twin Syndrome

12. Genetic testing & counseling

NIPT / cfDNA Screening
Invasive Testing (CVS / Amniocentesis)
Karyotype / Microarray
Whole Exome Sequencing (WES)
Genetic Counseling Recommended

Umbilical Cord

1. Umbilical cord – core assessment

Number of Vessels (Two- vs Three-Vessel Cord)
Cord Insertion Site Assessment
Cord Length (Short / Normal / Long)
Cord Coiling Index (Hypo- / Normo- / Hypercoiled)
Wharton’s Jelly Quantity

2. Vessel abnormalities

Single Umbilical Artery (SUA)
Supernumerary Umbilical Vein
Persistent Right Umbilical Vein (PRUV)
Umbilical Vein Varix (Intra-abdominal / Extra-abdominal)
Umbilical Artery Thrombosis

3. Insertion abnormalities

Central (Normal) Cord Insertion
Eccentric Cord Insertion
Marginal Cord Insertion (Battledore)
Velamentous Cord Insertion
Furcate Cord Insertion

4. Course & entanglement

Single Loop Nuchal Cord
Double Loop Nuchal Cord
Triple Loop Nuchal Cord
Multiple Loop Nuchal Cord (≥4)
Incomplete / Partial Nuchal Loop
Nuchal Cord with Body Loop
Nuchal Cord with Limb Loop
Nuchal Cord with True Knot
Umbilical Cord Around Trunk
Thoracic (Chest) Loop
Abdominal Loop
Shoulder Girdle Loop
Neck–Body Combined Loop
Umbilical Cord Around Arm
Umbilical Cord Around Forearm
Umbilical Cord Around Hand
Umbilical Cord Around Thigh
Umbilical Cord Around Leg
Umbilical Cord Around Foot
Single Limb Entanglement
Multiple Limb Entanglement
Neck + Limb Entanglement
True Knot of Umbilical Cord
False Knot (Vessel Redundancy / Wharton’s Jelly)
Neck + Trunk Entanglement
Neck + Trunk Entanglement
Figure-of-Eight Cord Loop
Interlocking Cord Loops
Cord Prolapse with Entanglement
Cord Prolapse with Entanglement
Entanglement in Multiple Pregnancy
Cord Entanglement in Monoamniotic Twins
Cord Entanglement with Short Umbilical Cord
Cord Entanglement with Velamentous Insertion

5. Length & structural abnormalities

Short Umbilical Cord
Long Umbilical Cord
Cord Cyst (True / Pseudocyst)
Umbilical Cord Hematoma
Absent or Reduced Wharton’s Jelly
Thin cord
Thickened cord
Hypocoiled cord
Hypercoiled cord
Absent coiling

6. Doppler abnormalities

Absent End-Diastolic Flow (AEDF)
Reversed End-Diastolic Flow (REDF)
Increased Umbilical Artery PI
Umbilical Vein Pulsations
Abnormal Arterio-Venous Ratio

7. Associated syndromes & conditions

Fetal Growth Restriction–Associated Cord Abnormalities
Chromosomal Anomalies Associated with SUA
Stillbirth Risk–Associated Cord Lesions

Placenta

1. Placenta – Core Assessment

Placental Thickness
Placental Texture & Homogeneity
Placental Maturity for Gestational Age

2. Position & Relation To Internal Os

Low-Lying Placenta
Placenta Previa – Marginal
Placenta Previa – Partial
Placenta Previa – Complete

3. Morphological Variants

Bilobed Placenta
Succenturiate Lobe
Circumvallate Placenta
Circummarginate Placenta
Placenta Membranacea

4. Placental Adherence Disorders

Placenta Accreta Spectrum (PAS)
Placenta Accreta
Placenta Increta
Placenta Percreta
Loss of Retroplacental Clear Zone

5. Vascular & Perfusion Abnormalities

Placental Lakes (Venous Lakes)
Placental Lacunae (PAS-Related)
Subchorionic Hematoma
Retroplacental Hematoma (Abruption)
Intervillous Thrombosis

6. Size Abnormalities

Placentomegaly
Small Placenta for Gestational Age
Thin Placenta
Thick Placenta

7. Doppler Findings

Increased Uterine Artery PI
Early Diastolic Notching
Reduced Placental Perfusion
Abnormal Placental Vascularity

8. Tumors & Rare Lesions

Placental Chorioangioma
Placental Teratoma
Placental Mesenchymal Dysplasia

9. Twin & Multifetal Conditions

Monochorionic Placenta
Dichorionic Placenta
Twin–Twin Transfusion Syndrome (TTTS)
Twin Anemia–Polycythemia Sequence (TAPS)
Selective Fetal Growth Restriction (sFGR)

10. Clinical Associations

Placental Abruption Risk Features
Preeclampsia-Related Placental Changes
Maternal Vascular Malperfusion (MVM)
Villous Infarction
Accelerated Villous Maturation
Distal Villous Hypoplasia
Fetal Growth Restriction–Associated Placental Disease
Intervillous Thrombi
Placental Hypoplasia
Stillbirth Risk–Associated Placental Findings

Amniotic Fluid

Borderline Low Amniotic Fluid (AFI 5–8 cm)
Mild Oligohydramnios (AFI 4–5 cm)
Moderate Oligohydramnios (AFI 2–4 cm)
Severe Oligohydramnios (AFI <2 cm)
Borderline Increased Amniotic Fluid (AFI 20–24 cm)
Mild Polyhydramnios (AFI 25–29 cm)
Moderate Polyhydramnios (AFI 30–34 cm)
Severe Polyhydramnios (AFI ≥35 cm)
Echogenic Amniotic Fluid
Meconium-Stained Amniotic Fluid
Amniotic Fluid with Debris / Vernix Particles
Amniotic Fluid with Suspended Echoes
Premature Rupture of Membranes (PROM)

Fetal face

1. Midline & orbital abnormalities

Hypotelorism (Reduced Interorbital Distance)
Hypertelorism (Increased Interorbital Distance)
Telecanthus
Cyclopia / Synophthalmia
Absent or Hypoplastic Nasal Bone
Single Nostril / Proboscis

2. Nasal & nasomaxillary abnormalities

Flat Nasal Bridge
Broad Nasal Bridge
Bifid Nose
Choanal Atresia (Indirect Signs)
Nasal Bone Shortening (Soft Marker)

3. Orofacial clefts

Unilateral Cleft Lip
Bilateral Cleft Lip
Cleft Lip with Cleft Palate
Isolated Cleft Palate (Indirect Ultrasound Signs)
Median Facial Cleft

4. Mandibular & jaw abnormalities

Micrognathia
Retrognathia
Prognathism
Agnathia
Mandibular Asymmetry

5. Ear & lateral facial abnormalities

Low-Set Ears
Posteriorly Rotated Ears
Microtia / Anotia
Preauricular Tags or Pits

6. Functional & dynamic assessment

Normal Fetal Swallowing Movements
Normal Mouth Opening and Closure
Tongue Visualization within Oral Cavity
Macroglossia

7. Associated soft markers

Absent / Hypoplastic Nasal Bone (Aneuploidy Marker)
Flat Facial Profile
Increased Prefrontal Thickness

8. Etiological & syndromic associations

Chromosomal Abnormalities (Trisomy 13, 18, 21)
Holoprosencephaly Spectrum
Pierre Robin Sequence
Treacher Collins Syndrome
Goldenhar Syndrome (Oculo-Auriculo-Vertebral Spectrum)
Skeletal Dysplasias

Fetal neck

1. Fetal neck – core assessment

Normal Fetal Neck Contour
Normal Nuchal Region without Mass or Thickening
Symmetrical Cervical Soft Tissues
Normal Cervical Spine Alignment

2. Nuchal thickness / nt assessment

Normal Nuchal Translucency (11–13+6 Weeks)
Increased Nuchal Translucency
Thickened Nuchal Fold (Second Trimester)
Absent or Indistinct Nuchal Fold

3. Cystic & fluid collections

Cystic Hygroma (Septated)
Non-Septated Cystic Hygroma
Posterior Cervical Fluid Collection
Generalized Nuchal Edema

4. Solid / complex masses

Cervical Teratoma
Lymphatic Malformation
Hemangioma / Vascular Malformation
Thyroid Enlargement (Fetal Goiter)

5. Airway & functional considerations

Normal Fetal Neck Extension and Flexion
Airway Compression or Deviation
Tracheal Displacement
Impaired Fetal Swallowing

6. Associated findings

Associated Hydrops Fetalis
Polyhydramnios (Swallowing Impairment)
Abnormal Cervical Spine or Vertebral Defects
Facial or Thoracic Extension of Neck Mass

7. Soft markers & screening significance

Increased NT – Aneuploidy Risk
Thickened Nuchal Fold – Trisomy 21 Marker
Persistent Nuchal Edema

8. Etiological & syndromic associations

Chromosomal Abnormalities (Trisomy 21, 18, 13)
Turner Syndrome (45,X)
Noonan Syndrome
Congenital Heart Disease
Skeletal Dysplasias

Fetal Central Nervous System

1. Central nervous system – core assessment

Normal Cranial Shape and Size
Intact Calvarium
Normal Brain Echogenicity
Symmetrical Cerebral Hemispheres

2. Ventricular system

Normal Lateral Ventricles (<10 mm)
Mild Ventriculomegaly (10–12 mm)
Moderate Ventriculomegaly (13–15 mm)
Severe Ventriculomegaly (>15 mm)
Dangling Choroid Plexus

3. Midline structures

Cavum Septi Pellucidi Present
Absent Cavum Septi Pellucidi
Corpus Callosum Visualized
Agenesis / Dysgenesis of Corpus Callosum
Midline Shift

4. Posterior fossa

Normal Cerebellum (Transcerebellar Diameter Appropriate)
Normal Cisterna Magna (2–10 mm)
Dandy–Walker Malformation
Blake’s Pouch Cyst
Mega Cisterna Magna
Cerebellar Hypoplasia

5. Neural tube defects

Anencephaly
Acrania / Exencephaly
Encephalocele
Spina Bifida (Indirect Cranial Signs)
Lemon Sign
Banana Sign

6. Cortical & migration abnormalities

Normal Sulcation Pattern (Gestational Age Appropriate)
Lissencephaly
Polymicrogyria
Schizencephaly
Gray Matter Heterotopia

7. Intracranial cysts & masses

Arachnoid Cyst
Porencephalic Cyst
Choroid Plexus Cyst
Intracranial Hemorrhage
Intracranial Tumor

8. Cerebral vasculature

Normal Pericallosal Artery
Vein of Galen Aneurysmal Malformation
Abnormal Intracranial Doppler Flow

9. Functional & dynamic assessment

Normal Fetal Head Movements
Normal Brainstem Appearance
Abnormal Fetal Neurological Behavior

10. Soft markers & associations

Choroid Plexus Cysts (Aneuploidy Marker)
Ventriculomegaly – Chromosomal Risk
Absent CSP – Holoprosencephaly Spectrum

11. Etiological & syndromic associations

Chromosomal Abnormalities (Trisomy 13, 18)
Congenital Infections (TORCH)
Genetic Syndromes
Neural Tube Defects
Fetal Ischemic or Hemorrhagic Injury

Neural Tube Defects [ Cranium and Spine ]

1. Neural tube defects – core assessment

Intact Cranial Vault
Intact Vertebral Arches
Normal Skin Coverage over Spine
Normal Craniospinal Alignment

2. Cranial neural tube defects

Anencephaly
Acrania
Exencephaly
Encephalocele (Occipital / Parietal / Frontal)
Cranial Meningocele
Craniorachischisis

3. Spinal neural tube defects

Open Spina Bifida
Closed Spina Bifida
Myelomeningocele
Meningocele
Myeloschisis
Rachischisis
Sacral / Lumbar / Thoracic / Cervical Level Defect

4. Indirect cranial signs (spina bifida)

Lemon Sign (Frontal Bone Scalloping)
Banana Sign (Cerebellar Shape Abnormality)
Obliterated Cisterna Magna
Ventriculomegaly
Small Posterior Fossa

5. First-trimester markers

Absent Cranial Vault (11–13+6 Weeks)
Irregular Brain Tissue Exposure
Abnormal Brainstem-to-Occipital Bone Ratio
Intracranial Translucency Absent

6. Associated CNS abnormalities

Chiari I Malformation
Arnold–Chiari II Malformation
Chiari III Malformation
Chiari IV Malformation
Hydrocephalus
Agenesis of Corpus Callosum
Posterior Fossa Abnormalities

7. Associated systemic findings

Lower Limb Deformities
Clubfoot (Talipes)
Neurogenic Bladder
Polyhydramnios

8. Etiological & risk factors

Folic Acid Deficiency
Maternal Diabetes Mellitus
Antiepileptic Drug Exposure
Genetic Predisposition
Hyperthermia in Early Pregnancy

9. Prognostic & counseling points

Level of Lesion Determines Neurological Outcome
Open vs Closed Defect Prognosis
Associated Chromosomal / Structural Anomalies
Eligibility for Prenatal or Postnatal Surgical Repair

Cardiac Anomalies

1. Cardiac anomalies – core cardiac assessment

Normal Cardiac Position (Levocardia)
Normal Cardiac Axis (45° ± 20°)
Normal Cardiac Size (Cardiothoracic Ratio)
Normal Situs (Situs Solitus)
Normal Heart Rate and Rhythm

2. Four-chamber view abnormalities

Atrioventricular Septal Defect (AVSD)
Ventricular Septal Defect (VSD)
Atrial Septal Defect (Primum / Secundum)
Hypoplastic Left Heart Syndrome
Hypoplastic Right Heart Syndrome
Single Ventricle Physiology

3. Atrioventricular valves

Tricuspid Atresia
Mitral Atresia
Ebstein Anomaly
Atrioventricular Valve Regurgitation
Common AV Valve

4. Outflow tract abnormalities

Transposition of the Great Arteries (TGA)
Tetralogy of Fallot
Double Outlet Right Ventricle (DORV)
Persistent Truncus Arteriosus
Pulmonary Atresia
Aortic Stenosis / Atresia

5. Three-vessel & arch view

Normal Three-Vessel View
Absent or Abnormal Pulmonary Artery
Right-Sided Aortic Arch
Coarctation of Aorta (Suspicious Features)
Interrupted Aortic Arch

6. Rhythm & conduction disorders

Fetal Tachyarrhythmia
Fetal Bradyarrhythmia
Atrioventricular Block
Supraventricular Tachycardia
Irregular Rhythm (Ectopic Beats)

7. Functional assessment

Normal Ventricular Contractility
Cardiac Failure / Poor Contractility
Cardiomegaly
Pericardial Effusion

8. Doppler findings

Abnormal AV Valve Doppler
Outflow Tract Turbulence
Abnormal Ductus Venosus Flow
Reversed Flow in Aortic Arch

9. Associated findings

Hydrops Fetalis
Extracardiac Structural Anomalies
Increased Nuchal Translucency
Growth Restriction

10. Etiological & syndromic associations

Chromosomal Abnormalities (Trisomy 21, 18, 13)
22q11 Deletion Syndrome
Maternal Diabetes Mellitus
Congenital Infections
Familial Congenital Heart Disease

Fetal Thorax

1. Fetal thorax – core assessment

Normal Thoracic Shape and Size
Symmetrical Thoracic Cavity
Normal Thoracic Circumference
Intact Thoracic Wall

2. Lung parenchyma

Normal Homogeneous Lung Echotexture
Increased Lung Echogenicity
Reduced Lung Volume
Lung Mass Lesion

3. Congenital lung malformations

Congenital Pulmonary Airway Malformation (CPAM)
Bronchopulmonary Sequestration
Hybrid Lung Lesion
Bronchogenic Cyst

4. Diaphragm

Intact Diaphragm
Congenital Diaphragmatic Hernia (Left-sided)
Congenital Diaphragmatic Hernia (Right-sided)
Eventration of Diaphragm

5. Mediastinum

Normal Mediastinal Position
Mediastinal Shift
Compression of Heart

6. Pleural space

No Pleural Effusion
Unilateral Pleural Effusion
Bilateral Pleural Effusion
Chylothorax

7. Thoracic skeletal structures

Normal Rib Number and Orientation
Short Ribs
Rib Fractures
Narrow / Bell-Shaped Thorax

8. Functional & doppler assessment

Normal Fetal Breathing Movements
Reduced or Absent Breathing Movements
Abnormal Pulmonary Blood Supply

9. Associated findings

Polyhydramnios
Hydrops Fetalis
Cardiac Displacement
Associated Extrathoracic Anomalies

10. Etiological & syndromic associations

Chromosomal Abnormalities
Skeletal Dysplasias
Congenital Infections
Isolated Thoracic Anomaly

Fetal Gastrointestinal Abnormalities

1. Gastrointestinal abnormalities – core assessment

Normal Abdominal Situs
Normal Abdominal Wall Integrity
Normal Stomach Position and Size
Normal Bowel Echogenicity
Normal Peristalsis

2. Upper gastrointestinal tract

Absent Stomach Bubble
Small Stomach
Persistently Enlarged Stomach
Esophageal Atresia (Indirect Signs)
Duodenal Atresia (Double Bubble Sign)

3. Mid & lower gastrointestinal tract

Dilated Small Bowel Loops
Dilated Large Bowel / Colon
Bowel Obstruction (Level Uncertain)
Ileal / Jejunal Atresia
Colonic Atresia

4. Bowel echogenicity & content

Echogenic Bowel
Intraluminal Debris / Meconium
Meconium Ileus
Calcified Meconium

5. Abdominal wall defects

Omphalocele
Gastroschisis
Umbilical Hernia
Body Stalk Anomaly
Limb–Body Wall Complex (LBWC)
Abdominoschisis
Thoracoabdominoschisis
Amorphous Fetus

6. Peritoneal findings

Ascites
Meconium Peritonitis
Peritoneal Calcifications
Pseudocyst Formation

7. Functional & dynamic assessment

Normal Swallowing
Impaired Swallowing
Absent or Reduced Peristalsis

8. Associated findings

Polyhydramnios
Oligohydramnios
Growth Restriction
Extracardiac Structural Anomalies

9. Etiological & syndromic associations

Cystic Fibrosis (Syndrome Association)
Congenital Infections (TORCH)
Vascular Insults
Isolated Gastrointestinal Malformation

Fetal Genitourinary Abnormalities

1. Genitourinary abnormalities – core assessment

Normal Renal Position
Normal Renal Size and Shape
Bilateral Renal Visualization
Normal Renal Echogenicity
Normal Urinary Bladder Filling and Emptying

2. Renal agenesis & dysgenesis

Unilateral Renal Agenesis
Bilateral Renal Agenesis
Multicystic Dysplastic Kidney (MCDK)
Renal Hypoplasia
Renal Dysplasia

3. Renal position & fusion anomalies

Pelvic Kidney
Ectopic Kidney
Horseshoe Kidney
Crossed Fused Renal Ectopia

4. Collecting system abnormalities

Pyelectasis
Hydronephrosis
Hydroureter
Duplex Collecting System
Ureterocele

5. Lower urinary tract

Enlarged Urinary Bladder (Megacystis)
Thickened Bladder Wall
Posterior Urethral Valves (Keyhole Sign)
Urethral Atresia

6. Amniotic fluid association

Normal Amniotic Fluid Volume
Oligohydramnios
Anhydramnios
Polyhydramnios

7. External genitalia

Normal Male Genitalia
Normal Female Genitalia
Ambiguous Genitalia
Hypospadias (Indirect Signs)
Undescended Testes

8. Associated findings

Pulmonary Hypoplasia
Growth Restriction
Single Umbilical Artery
Extrarenal Structural Anomalies

9. Etiological & syndromic associations

Chromosomal Abnormalities
Obstructive Uropathy
Congenital Infections
Syndromic Associations (VACTERL, Meckel–Gruber)
Isolated Genitourinary Anomaly

Fetal Musculoskeletal

1. Fetal skeletal dysplasia – core assessment

Normal Skeletal Growth Pattern
Normal Skeletal Growth Pattern
Lethal vs Non-Lethal Dysplasia Pattern
Symmetrical vs Asymmetrical Limb Involvement

2. Limb length & proportions

Mesomelia (Middle Segment Shortening)
Mesomelia (Middle Segment Shortening)
Acromelia (Distal Limb Shortening)
Micromelia (Severe Global Limb Shortening)
Isolated Short Long Bones

3. Long bone morphology

Bowed Long Bones
Fractures of Long Bones
Angulated Long Bones
Dumbbell-Shaped Bones
Thickened or Thin Long Bones

4. Thorax & ribs

Narrow Thorax
Bell-Shaped Thorax
Short Ribs
Rib Fractures
Thoracic Hypoplasia (Lethal Indicator)

5. Skull & facial findings

Macrocephaly
Microcephaly
Frontal Bossing
Cloverleaf Skull (Kleeblattschädel)
Depressed Nasal Bridge

6. Hands & feet

Polydactyly
Syndactyly
Brachydactyly
Clinodactyly
Trident Hand

7. Spine

Platyspondyly
Hemivertebrae
Scoliosis
Kyphosis

8. Bone mineralization

Normal Ossification
Hypomineralization
Poor Skull Ossification (Compressible Skull)

Lethal Skeletal Dysplasias

Thanatophoric Dysplasia
Osteogenesis Imperfecta Type II
Achondrogenesis
Campomelic Dysplasia

Non-Lethal / Variable Prognosis Dysplasias

Achondroplasia
Hypochondroplasia
Osteogenesis Imperfecta (Non-Type II / Survivable Forms)
Short Rib–Polydactyly Syndromes
Ellis–van Creveld Syndrome

Other Fetal Skeletal Dysplasias

Diastrophic Dysplasia
Spondyloepiphyseal Dysplasia
Chondrodysplasia Punctata
Cleidocranial Dysplasia
Metatropic Dysplasia

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End of Topic

You have reached the end of this First-Trimester Ultrasound topic.

Content is intended for educational, training, and clinical reference only.

Declaration:
I, R. K. Mouj, declare that the material presented in this topic titled “First-Trimester Gestational Sac (GS) Assessment” has been prepared solely for educational and academic purposes. Any measurements, examples, or references provided are illustrative in nature. Clinical correlation, follow-up imaging, and professional judgment are essential before making diagnostic or management decisions.

Author: ____________________
Name: R. K. Mouj [Radio-imaging Technologist]
Domain: Diagnostic Sonography & Obstetric Imaging
Platform: SonoAcademy
Supervisor / Guide: Department radiologist
Department: Radiology

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