EKHOKARDIOGRAFI JANIN DASAR

EKHOKARDIOGRAFI JANIN DASAR

Judi Januadi Endjun

DEPARTEMEN OBSTETRI DAN GINEKOLOGI RS PENDIDIKAN RSPAD GATOT SOEBROTO DITKESAD / FKUI (Indonesia Army Hospital Gatot Soebroto) 2014

RENUNGAN • KELAINAN KONGENITAL TERBANYAK ….. 90% terjadi pada kelompok risiko rendah

http://www.fetal.com/FetalEcho/Images/sweepa.jpg

http://www.rjmatthewsmd.com/Definitions/img/4chamber.jpg

RENUNGAN

http://openi.nlm.nih.gov/imgs/512/46/2778174/2778174_OGI2009-958496.001.png Ritz Carlton/2014/12/07

ISUOG-INDONESIA

AGENDA • • • • • • • •

Pendahuluan Tujuan Embriologi & Anatomi jantung janin Ekhokardiografi jantung janin trimester 1 (skrining 11 – 13+6 minggu) Ekhokardiografi jantung janin trimester 2 (skrining 20 – 22 minggu) POGI : Standar Pemeriksaan USG Obstetri dan pencapaian kompetensi Pesan dibawa pulang Kepustakaan

PENDAHULUAN • Prevalensi : 1 : 8000 – 1 : 1000 persalinan • > 90% PJB ditemukan pada populasi normal (risiko rendah) • Skrining sangat penting dilakukan • SpOG terstandarisasi & terlatih baik + potongan jantung dalam beberapa bidang (3VV, 4CV, dan 5CV) deteksi PJB 60 – 80% Ulrich G et al, Fetal Cardiology, 2003

TUJUAN • UMUM : – Mampu melakukan pemeriksaan ekhokardiografi janin dasar

• KHUSUS : – Memahami embriologi dan anatomi jantung janin normal – Mampu melakukan pemeriksaan ekhokardiografi dasar trimester 1 dan 2 – Mampu membuat laporan USG Dasar OBGIN sesuai panduan POGI – Mampu merujuk kasus dengan kecurigaan PJB

EMBRIOLOGI JANTUNG

Margaret LK et al, Fetal Cardiology, 2003

JJE/2013/04/10

HANYA UNTUK PENDIDIKAN & PENELITIAN

https://classconnection.s3.amazonaws.com/417/flashcards/2588417/jpg/embryologic_development_of_heart1359533275485.jpg

Cornelia T, Fetal Cardiology, 2003

ANATOMI JANTUNG JANIN

JJE/2013/04/10


SIRKULASI JANIN • Parallel arrangement of ventricular pumps : both left and right ventricle are perfusing systemic circulation

• Mixing of venous return • High impedance and low flow in pulmonary circulation • Presence of shunts : foramen ovale, ductus venosus, ductus arteriosus

JJE/2013/04/10


PRASYARAT TEKNIS • Gestational age (GA) • Ultrasound transducer • Gray scale presetting : cardiac, MI, Tib, Focus • Zoom and cine-loop • Color Doppler presetting JJE/2013/04/10


PANDUAN EKHOKARDIOGRAFI • 2D ultrasound with cine-loop, zoom facilities, and high resolution transducers, 5 – 7 MHz • 1st Trimester : 11 – 13+6 weeks NT, Situs, FHR, 4-CV

• 2nd Trimester : 18 – 22 weeks (optimum : 20 – 22 W) JJE/2013/04/10


Trimester 1

Routine 1st Trimester US Work Sheet

ISUOG, 2013 Ritz Carlton/2014/12/07

ISUOG-INDONESIA

EKHOKARDIOGRAFI TRIMESTER 1 PERKUMPULAN OBSTETRI GINEKOLOGI INDONESIA KELOMPOK KERJA ULTRASONOGRAFI

LAPORAN USG TRIMESTER I !

Pasien:

No. RM :

Tgl lahir (hr/bln/thn ) : Perujuk : Tgl periksa (hr/bln/thn) : Sonografer / Supervisor : Indikasi USG dan data klinis terkait :

HPHT : Kondisi teknis : Baik/Terbatas krn : Tunggal/Kembar (gunakan 1 lembar/janin) : => Khorionisitas : ADNEKSA: Gambaran USG Anomali :

Normal

PENGUKURAN Crown-rump length Nuchal transluscency (optional) Biparietal diameter Head circumference Abdominal circumference Femoral diaphysis length

mm

Abnormal* Centile (Reference range)

*Temuan abnormal (uraian rinci):

Prakiraan usia gestasi berdasarkan USG : ……… minggu + ……… hari

GAMBARAN USG ANATOMI JANIN: (N = Normal; Ab = Abnormal*; TT = tidak dapat ditampakkan; Abu-abu = optional)

N

Ab*

TT

Kepala Bentuk Osifikasi cranium Falx cerebri Plexus choroideus Wajah Orbita Profil Leher Thoraks Area paru Diaphragma Jantung Aktivitas jantung Ukuran Axis jantung Four-chamber view Abdomen Gaster Usus Ren Vesica urinaria Insersi umbilicus / Dinding abdomen Vaskular umbilicus Vertebra Ekstremitas Tangan kanan (termasuk telapak) Kaki kanan (termasuk telapak) Tangan kiri (termasuk telapak) Kaki kiri (termasuk telapak) Jenis kelamin :

L

P

Lain-lain : KESIMPULAN : Normal dan pemeriksaan lengkap. Normal tetapi pemeriksaan tidak lengkap. Tampak abnormal* Rencana: Tidak perlu pemeriksaan USG lagi Periksa ulang ….. minggu. Rujuk kepada: Lain-lain:

Produced

Cetak

Simpan

Jumlah gambar Keterangan tambahan :

Tanda tangan :

Referensi : ISUOG (2013) PERHATIAN : pemeriksaan USG merupakan alat bantu diagnostik. Janin setiap saat mengalami pertumbuhan dan perkembangan sesuai dengan usia kehamilan, yang mungkin saja mengalami gangguan atau penyakit sehingga terjadi kelainan. Oleh karena USG hanya menilai sesaat (pada waktu diperiksa), maka mungkin saja tidak setiap kelainan dapat dideteksi, artinya tidak ada jaminan bahwa seluruh kelainan bawaan dapat dideteksi sebelum lahir. Pemeriksaan USG berikutnya akan dilakukan lagi pada kehamilan 18 – 22 minggu dan 28 – 32 minggu terutama untuk penapisan cacat bawaan dan pertumbuhan janin. Hal ini penting untuk dipahami oleh pasien dan dokter pemeriksa.!

Diaphragma Jantung Aktivitas jantung Ukuran Axis jantung Four-chamber view Abdomen

EKHOKARDIOGRAFI TRIMESTER 1 • AKTIVITAS : tanda kehidupan, M-mode, frekuensi dan keteraturan DJJ normal abnormal tidak dapat divisualisasi

• UKURAN : bila memungkinkan (optional) • AKSIS : apex menuju sisi kiri, sumbu jantung, sudut 450 ± 200

• 4CV : bila memungkinkan (optional) • Perhatikan marker anomali : NT, NB, IT, TR, EB

EKHOKARDIOGRAFI TRIMESTER 1

EKHOKARDIOGRAFI TRIMESTER 1 • The normal position of the heart on the left side of the chest (levocardia) should be documented • More detailed sonographic assessment of cardiac anatomy has been demonstrated to be feasible at 11 to 13 + 6 weeks, but this is not part of routine assessment. • For safety reasons, use of Doppler is not indicated during routine scanning

Axial section of the fetal thorax at the level of the four-chamber view of the heart, with the cardiac apex pointing to the left (L). Note atria and ventricles are symmetrical on either side of the septum (arrow). Lung fields are of homogeneous echogenicity and symmetrical. Aorta is just to left side of spine (S).

http://api.onlinelibrary.wiley.com/asset/v1/doi/10.1002%2Fuog.12342/asset/image_n%2Fuog12342-fig-0005.png?l= SkaBT8QEx2pYfNwRFVCgBcwSrhdPbT0MnDI46%2FM8BfFBd3wKQHiOpnrR%2Fhk2HscEpc%2F9%2FpwdKoY%3D&s =%227d017ce4f28e4758b8d9cfa2921d5632%22

DuBose TJ, Cunyus JA, & Johnson L; Embryonic Heart Rate and Age. J Diagn Med Sonography 1990; 6:151-157. Schats R, Jansen CAM, & Waldimiroff JW; "Embryonic heart activity: appearance and development in early human pregnancy"; Brit J Obstet and Gynaecol, 1990; 97:989-994. Qasim SM, Sachdev R, Trias A, et al; The predictive value of first trimester embryonic heart rates in fertility patients. Obstetrics & Gynecology. 89(6):934-6, 1997 June; DuBose TJ; FETAL SONOGRAPHY, Chapter 12 Heart Rate; W. B. Saunders Co. 1996; p. 274-263.

Ritz Carlton/2014/12/07

ISUOG-INDONESIA

http://i834.photobucket.com/albums/zz265/sarahmomma13/2013-09-24233515_zps3796d1a9.png

DJJ : 12 MINGGU


ISUOG-INDONESIA

EKHOKARDIOGRAFI TRIMESTER 2 PERKUMPULAN OBSTETRI DAN GINEKOLOGI INDONESIA KELOMPOK KERJA ULTRASONOGRAFI

PEMERIKSAAN USG TRIMESTER 2 DAN 3 ! Pasien : !

!

Tgl lahir (hr/bln/thn ) : Dokter perujuk :

Tgl periksa (hr/bln/thn) : Sonografer / Supervisor : Indikasi USG dan data klinis terkait :

Usia Gestasi (minggu + hari) : Berdasar : HPHT / USG terdahulu / Lainnya : Kondisi teknis : Baik/Terbatas krn : Tunggal/Kembar (gunakan 1 lembar/janin) : => Khorionisitas : PLASENTA: Letak : Hubungan dengan OUI : jauh menutupi ___mm dr OUI Tampilan Normal Abnormal* Derajat Maturasi : 0 / I / II / III CAIRAN AMNION: Normal Abnormal* GERAK JANIN: Normal Abnormal* MEASURMENT

mm

Percentile (Reference)

Biparietal diameter Head circumference Abdominal circumference Femur diaphysis length Other: Other: Other:


KESIMPULAN : Normal dan pemeriksaan lengkap. Normal tetapi pemeriksaan tidak lengkap. Tampak abnormal* Rencana: Tidak perlu pemeriksaan USG lagi Periksa ulang ….. minggu. Rujuk kepada : Lain-lain :

GAMBARAN USG ANATOMI JANIN : (N = Normal; Ab = Abnormal*; TT = tidak dapat ditampakkan; Abu-abu = optional) Kepala Bentuk Cavum septum pellucidum Falx cerebri Thalamus Ventrikel lateral Cerebellum Cisterna magna Wajah Bibir atas Profil mediana Orbita Hidung Lubang hidung Leher Thorax Bentuk Tidak tampak massa Jantung Aktivitas jantung Ukuran Axis jantung Four-chamber view Left ventricular outflow Right ventricular outflow Abdomen Gaster Usus Ginjal Vesica urinaria Insersi umbilicus di abdomen Vaskular umbilikus Vertebra Ekstremitas Tangan kanan (termasuk telapak) Kaki kanan (termasuk telapak) Tangan kiri (termasuk telapak) Kaki kiri (termasuk telapak) Jenis kelamin : L P Lain-lain :

Produced

N

Ab*

Cetak

TT

Simpan

Jumlah gambar Tanda tangan :

Keterangan tambahan :

Referensi : ISUOG (2013) PERHATIAN : pemeriksaan USG merupakan alat bantu diagnostik. Janin setiap saat mengalami pertumbuhan dan perkembangan sesuai dengan usia kehamilan, yang mungkin saja mengalami gangguan atau penyakit sehingga terjadi kelainan. Oleh karena USG hanya menilai sesaat (pada waktu diperiksa), maka mungkin saja tidak setiap kelainan dapat dideteksi, artinya tidak ada jaminan bahwa seluruh kelainan bawaan dapat dideteksi sebelum lahir. Pemeriksaan USG akan dilakukan lagi pada kehamilan 18 – 22 minggu dan 28 – 32 minggu terutama untuk penapisan cacat bawaan dan pemantauan pertumbuhan janin. Hal ini penting untuk dipahami oleh pasien dan dokter pemeriksa.!

Tidak tampak massa Jantung Aktivitas jantung Ukuran Axis jantung Four-chamber view Left ventricular outflow Right ventricular outflow

SKRINING 20 – 22 MINGGU • • • • • •

Aktivitas jantung : M-mode Ukuran : 33% Axis : sudut 450 ± 200 4CV : 4 rongga, equal LVOT RVOT

Trimester 2

TEKNIK PEMERIKSAAN

ISUOG Guidelines, 2013

ORIENTASI

JJE/2013/04/10


http://www.fetal.com/FetalEcho/Images/sweepa.jpg

LANGKAH AWAL • First, determine the situs. Define the right and left sides of the fetus • Locate the fetal position • Identify the fetal stomach (beware, it is not always on the left side) and other abdominal organs • Verify the relationship of the fetal stomach to the fetal heart • The apex of the heart should be on the left JJE/2013/04/10


http://www.em.emory.edu/ultrasound/images/Image%202%20M-Mode%20Fetal%20Heart%20Tones.jpg

M-mode

JJE/2013/04/10


M- Mode : ABNORMAL

Arhytmia

JJE/2013/04/10

SVT HANYA UNTUK PENDIDIKAN & PENELITIAN

UKURAN JANTUNG • Jantung menempati sepertiga rongga thoraks sisi kiri (33%) • Perhatikan anomali kongenital – Kardiomegali ec ? – Hernia diafragmatika : tersering dari sisi kiri jantung terdorong ke kanan – Hipoplasia thoraks : Thanatophoric Dwarfism

KARDIOMEGALI • The heart occupies > 1/3 of the fetal chest (CTR > 0,33%) • ↑ CTR can be due to : - ↓ chest size (skeletal dysplasia or oligohydramnios)

- ↑ heart size caused by abnormal inlet / outlet valves ; abnormal great vessels ; functional disturbance (hydrops fetalis, arrhytmias, TTTS JJE/2013/04/10


AKSIS JANTUNG NORMAL

JJE/2013/04/10


POSISI JANTUNG DI DALAM RONGGA THORAKS 1.

4.

Identify the position of the fetus in utero Determine if the left side is up or down Identify the stomach and the heart to be on the left side Situs solitus : normal visceral

5.

Situs inversus : mirror image

6.

Situs ambiguous :

7.

Cardiac apex point to the left (levocardia). In normal situs + dextrocardia : ↑ 95% CoHD

2. 3.

situs

of the situs solitus, but stomach is on the left side

anatomically undetermined type of visceral situs

JJE/2013/04/10


Figure 1 (a) Abdominal situs is ascertained in a transverse view of the fetal abdomen. After determining fetal laterality from position of the fetus in utero, the stomach should be identified on the fetal left side with the descending aorta (D. Aorta) and inferior vena cava (IVC) to the left and right sides of the spine, respectively. A short segment of the umbilical vein (UV) is seen. (b) Cardiac position and axis: the heart is mainly on the left (L) side. The cardiac apex points to the left by 45 ± 20◦ in relation to the anteroposterior axis of the chest. LA, left atrium;LV, left ventricle; R, right; RA, right atrium; RV, right ventricle.

ISUOG, 2013

CARA MEMERIKSA 4CV • Horizontal section of the fetal thorax just above diaphragm • Obtained by scanning down, caudally from BPD. Easier to slide the transducer cranially from the AC view. • A good trans-thoracic section with at least one whole rib present • The stomach and the abdominal organs are not visible • Left ventricular outflow tract (LVOT) not visible

JJE/2013/04/10


Figure 2 Four-chamber view. The key elements of the normal mid-trimester four-chamber view include heart area no more than one third of chest area, right- and left-sided structures approximately equal (chamber size and wall thickness), a patent foramen ovale with its valve in the left atrium, an intact cardiac ‘crux’ with normal offset of the two atrioventricular valves and intact ventricular septum. The morphological right ventricle (RV) is identified by the presence of the moderator band and tricuspid valve, this valve inserting more apically in the septum than does the mitral valve (normal offset). D. Aorta, descending aorta; L, left; LA, left atrium; LV, left ventricle; R, right; RA, right atrium.

ISUOG, 2013

Figure 3 The five axial views for optimal fetal heart screening. The color image shows the trachea (Tr), heart and great vessels, liver and stomach, with the five planes of insonation indicated by polygons corresponding to the gray-scale images, as indicated. (I) Most caudal plane, showing the fetal stomach (St), cross-section of the descending aorta (dAo), spine (Sp) and liver (Li). (II) Four-chamber view of the fetal heart, showing the right and left ventricles (RV, LV) and atria (RA, LA), foramen ovale (FO) and pulmonary veins (PV) to the right and left of the dAo. (III) Left ventricular outflow tract view, showing the aortic root (Ao), LV, RV, LA and RA and a cross-section of the dAo. (IV) Slightly more cephalad view (right ventricular outflow tract view) showing the main pulmonary artery (MPA) and the bifurcation into the right (RPA) and left (LPA) pulmonary arteries and cross-sections of the ascending aorta (Ao) and dAo aorta. (V) Three vessels and trachea view showing the superior vena cava (SVC), pulmonary artery (PA), ductus arteriosus (DA), transverse aortic arch (from proximal Ao to dAo) and trachea (Tr). IVC, inferior vena cava; L, left; R, right. Modified with permission from Yagel et al.70.

ISUOG, 2013

Figure 4 Fetal heart scanning technique. The four-chamber view is obtained through an axial scanning plane across the fetal chest. Cephalad tilting of the transducer from the four-chamber view towards the fetal head gives the outflow tract views sequentially: left ventricular outflow tract (LVOT), right ventricular outflow tract (RVOT), three-vessel (3V) and three vessels and trachea (3VT) views.

ISUOG, 2013

ISUOG, 2013

ORIENTASI • Locate the spine • Opposite the spine is the anterior chest wall or sternum • Below the sternum is the blunt ended RV • The descending aorta is seen as a pulsatile circle in the mediastinum immediately anterior to the spine • Related to the aorta anteriorly is the LA

JJE/2013/04/10

• The RA and the LV may also identified • MV is mobile and allows the LA to LV communications • The tricuspid valve inserts onto the IVS, a little lower than MV and allows the RA to RV communication. • The FO flap should be mobile and sees in LA • The IVS is intact


http://www.fetal.com/FetalEcho/Images/4chview.jpg

http://www.rjmatthewsmd.com/Definitions/img/4chamber.jpg

KARAKTERISTIK 4 CV • Size : occupies one third of the fetal chest • Position : cardiac axis is about 45o to the left

• Structure : Two atria of equal size (1:1) ,

two ventricles of equal size (1:1), and intact crux

• Function : two opening atrioventricular

valves and two equally contracting ventricles

JJE/2013/04/10


GAMBARAN 4CV NORMAL • The internal surface of the left ventricle is smooth-looking compared with the trabeculated right ventricle containing the moderator band (MB in RV thicker than LV)

• The RV lies under anterior chest wall JJE/2013/04/10


MB

RV

GAMBARAN 4 CV NORMAL • The two AV-valve meet at the junction of the interatrial and interventricular septa to form the crux of the heart. • The mitral and tricuspid valves should move freely, with the tricuspid valve attached slightly more apical JJE/2013/04/10


APEX

GAMBARAN 4 CV NORMAL • The appearance of the 4CV will vary greatly according to the orientation of the fetus. • FO protrudes into the left atrium • The 3rd trimester features : - RV may be slightly larger than LV - Pulmonary artery > aorta JJE/2013/04/10


GAMBARAN 4 CV NORMAL • Scanning up and down horizontally at the back of LA may reveal the pulmonary veins entering LA • Views of fetal liver adjacent to RA common reveal IVC and hepatic vein entering RA with slight medial tilting SVC parallel with ascending aorta may also be located draining RA

JJE/2013/04/10


OUT FLOW TRACTS • Both the aorta and pulmonary outflow tracts are about the same size except at the pulmonary valve where the pulmonary artery is larger • The pulmonary artery arises from the right ventricle and branches into 2 LPA and RPA, and the ductus arteriosus • The aorta arises from the LV and gives rise to the arch with 3 vessels • The aorta and pulmonary artery cross each other from where they originate • Both the pulmonary and aortic valves should be seen

JJE/2013/04/10


TEKNIK PEMERIKSAAN


ISUOG Guideline : LVOT Cardiac screening examination of the fetus: guidelines for performing the basic and extended basic cardiac scan

http://www3.interscience.wiley.com/cgi-bin/fulltext/112221709/HTMLSTART HANYA UNTUK PENDIDIKAN & PENELITIAN JJE/2013/04/10

Figure 5 Left ventricular outflow tract (LVOT) view. This view shows a vessel connected to the left ventricle (LV). It is important to demonstrate continuity between the interventricular septum and the anterior wall of this vessel, which in the normal heart corresponds to the aorta. The aortic valve should not be thickened and should be shown to open freely. The aortic valve is closed in (a) and open in (b). D. Aorta, descending aorta; L, left; LA, left atrium; R, right; RA, right atrium; RV, right ventricle.

ISUOG 2013

ISUOG Guideline : RVOT Cardiac screening examination of the fetus: guidelines for performing the basic and extended basic cardiac scan

http://www3.interscience.wiley.com/cgi-bin/fulltext/112221709/HTMLSTART

JJE/2013/04/10


http://www.obgyn.net/sites/default/files/obgyn/1897407.png

Figure 6 Right ventricular outflow tract (RVOT) view. This view shows a vessel connected to the right ventricle (RV). In the normal heart this vessel crosses over the aorta, which helps in identifying it as the main pulmonary artery (PA). The pulmonary valve should not be thickened and should open freely. In (a), the bifurcation of the PA into both pulmonary branches can be seen. The pulmonary valve is closed. In (b), the plane of insonation is slightly more cephalad. The PA, right pulmonary artery (RPA) and arterial duct are seen. D. Aorta, descending aorta; L, left; LPA, left pulmonary artery; R, right; SVC, superior vena cava.

ISUOG, 2013

Sumber: ISUOG

JJE/2013/04/10


3-VV (Triple Vessels View) • Cranial to the 4-CV • Pulmonary artery, ductus arteriosus, aorta, right pulmonary artery, superior vena cava (SVC) • Pointers to abnormalities : dilatation of the aorta, pulmonary trunk or SVC; one of the two great arteries being small & the other being large; abnormal vessel alignment; abnormal vessel arrangement; only two vessels; additional vessels; right descending aorta; and abnormal origin of one pulmonary artery from the aorta JJE/2013/04/10


TEKNIK PEMERIKSAAN


http://www.rjmatthewsmd.com/Definitions/img/4st4.jpg

Three-vessel (3V) view. This view best demonstrates the relationship between the pulmonary artery, aorta and superior vena cava (SVC) in the upper mediastinum. It is important to note the correct position and alignment of the three vessels as well as their relative size. The pulmonary artery, to the left, is the largest of the three and the most anterior, whereas the SVC is the smallest and most posterior. D. Aorta, descending aorta.

ISUOG, 2013

Three vessels and trachea (3VT) view. This view best demonstrates the transverse aortic arch and its relationship with the trachea. In the normal heart, both the aortic arch and the ductal arch are located to the left of the trachea, in a ‘V’-shaped configuration. L, left;R, right; SVC, superior vena cava

ISUOG, 2013

JJE/2013/04/10


AIUM 2010

JJE/2013/04/10


AIUM 2010

JJE/2013/04/10


PEMBUATAN LAPORAN • PANDUAN POGI (mengacu pada ISUOG) • Waktu Ekhokardiografi Janin – Trimester 1 : 11 – 13+6 minggu – Trimester 2 dan 3 : 20 – 22 minggu dan 30 – 32 minggu

• Dokumentasikan foto dan videoclips yang benar-benar baik • Arsipkan : minimal 5 tahun aspek medikolegal

PERKUMPULAN OBSTETRI GINEKOLOGI INDONESIA KELOMPOK KERJA ULTRASONOGRAFI

LAPORAN USG TRIMESTER I !

Pasien:

No. RM :

(N = Normal; Ab = Abnormal*; TT = tidak dapat ditampakkan; Abu-abu = optional)

Tgl lahir (hr/bln/thn ) : Perujuk : Tgl periksa (hr/bln/thn) : Sonografer / Supervisor : Indikasi USG dan data klinis terkait :

HPHT : Kondisi teknis : Baik/Terbatas krn : Tunggal/Kembar (gunakan 1 lembar/janin) : => Khorionisitas : ADNEKSA: Gambaran USG Anomali :

Normal

PENGUKURAN Crown-rump length Nuchal transluscency (optional) Biparietal diameter Head circumference Abdominal circumference Femoral diaphysis length

mm

GAMBARAN USG ANATOMI JANIN:

Abnormal* Centile (Reference range)


Prakiraan usia gestasi berdasarkan USG : ……… minggu + ……… hari

N

Ab*

TT

Kepala Bentuk Osifikasi cranium Falx cerebri Plexus choroideus Wajah Orbita Profil Leher Thoraks Area paru Diaphragma Jantung Aktivitas jantung Ukuran Axis jantung Four-chamber view Abdomen Gaster Usus Ren Vesica urinaria Insersi umbilicus / Dinding abdomen Vaskular umbilicus Vertebra Ekstremitas Tangan kanan (termasuk telapak) Kaki kanan (termasuk telapak) Tangan kiri (termasuk telapak) Kaki kiri (termasuk telapak) Jenis kelamin :

L

P

Lain-lain : KESIMPULAN : Normal dan pemeriksaan lengkap. Normal tetapi pemeriksaan tidak lengkap. Tampak abnormal* Rencana: Tidak perlu pemeriksaan USG lagi Periksa ulang ….. minggu. Rujuk kepada: Lain-lain:

Produced

Cetak

Simpan

Jumlah gambar Keterangan tambahan :

Tanda tangan :

Referensi : ISUOG (2013) PERHATIAN : pemeriksaan USG merupakan alat bantu diagnostik. Janin setiap saat mengalami pertumbuhan dan perkembangan sesuai dengan usia kehamilan, yang mungkin saja mengalami gangguan atau penyakit sehingga terjadi kelainan. Oleh karena USG hanya menilai sesaat (pada waktu diperiksa), maka mungkin saja tidak setiap kelainan dapat dideteksi, artinya tidak ada jaminan bahwa seluruh kelainan bawaan dapat dideteksi sebelum lahir. Pemeriksaan USG berikutnya akan dilakukan lagi pada kehamilan 18 – 22 minggu dan 28 – 32 minggu terutama untuk penapisan cacat bawaan dan pertumbuhan janin. Hal ini penting untuk dipahami oleh pasien dan dokter pemeriksa.!

POGI/USG/Dasar/2014


PERKUMPULAN OBSTETRI DAN GINEKOLOGI INDONESIA KELOMPOK KERJA ULTRASONOGRAFI

PEMERIKSAAN USG TRIMESTER 2 DAN 3 ! !

Pasien : !

Tgl lahir (hr/bln/thn ) : Dokter perujuk :

Tgl periksa (hr/bln/thn) : Sonografer / Supervisor : Indikasi USG dan data klinis terkait :

Usia Gestasi (minggu + hari) : Berdasar : HPHT / USG terdahulu / Lainnya : Kondisi teknis : Baik/Terbatas krn : Tunggal/Kembar (gunakan 1 lembar/janin) : => Khorionisitas : PLASENTA: Letak : Hubungan dengan OUI : jauh menutupi ___mm dr OUI Tampilan Normal Abnormal* Derajat Maturasi : 0 / I / II / III CAIRAN AMNION: Normal Abnormal* GERAK JANIN: Normal Abnormal* MEASURMENT

mm

Percentile (Reference)

Biparietal diameter Head circumference Abdominal circumference Femur diaphysis length Other: Other: Other:


KESIMPULAN : Normal dan pemeriksaan lengkap. Normal tetapi pemeriksaan tidak lengkap. Tampak abnormal* Rencana: Tidak perlu pemeriksaan USG lagi Periksa ulang ….. minggu. Rujuk kepada : Lain-lain :

GAMBARAN USG ANATOMI JANIN : (N = Normal; Ab = Abnormal*; TT = tidak dapat ditampakkan; Abu-abu = optional) Kepala Bentuk Cavum septum pellucidum Falx cerebri Thalamus Ventrikel lateral Cerebellum Cisterna magna Wajah Bibir atas Profil mediana Orbita Hidung Lubang hidung Leher Thorax Bentuk Tidak tampak massa Jantung Aktivitas jantung Ukuran Axis jantung Four-chamber view Left ventricular outflow Right ventricular outflow Abdomen Gaster Usus Ginjal Vesica urinaria Insersi umbilicus di abdomen Vaskular umbilikus Vertebra Ekstremitas Tangan kanan (termasuk telapak) Kaki kanan (termasuk telapak) Tangan kiri (termasuk telapak) Kaki kiri (termasuk telapak) Jenis kelamin : L P Lain-lain :

Produced

N

Ab*

Cetak

TT

Simpan

Jumlah gambar Tanda tangan :

Keterangan tambahan :

Referensi : ISUOG (2013) PERHATIAN : pemeriksaan USG merupakan alat bantu diagnostik. Janin setiap saat mengalami pertumbuhan dan perkembangan sesuai dengan usia kehamilan, yang mungkin saja mengalami gangguan atau penyakit sehingga terjadi kelainan. Oleh karena USG hanya menilai sesaat (pada waktu diperiksa), maka mungkin saja tidak setiap kelainan dapat dideteksi, artinya tidak ada jaminan bahwa seluruh kelainan bawaan dapat dideteksi sebelum lahir. Pemeriksaan USG akan dilakukan lagi pada kehamilan 18 – 22 minggu dan 28 – 32 minggu terutama untuk penapisan cacat bawaan dan pemantauan pertumbuhan janin. Hal ini penting untuk dipahami oleh pasien dan dokter pemeriksa.!

POGI/USG/Dasar/2014


POGI/USG/Dasar/2014


USULAN JENJANG RUJUKAN USG

POGI/USG/Dasar/2014


PPDS OBGIN FK..

SPOG

POGI CABANG

± 1500 orang

KOLEGIUM OBGIN

± 3200 orang

POKJA USG POGI

PELATIHAN USG DASAR OBGIN BERBASIS KOMPETENSI dalam waktu 3 hari

SERTIFIKAT KESERTAAN BUKU LOG : 50 PASIEN dalam waktu 6 bulan

SERTIFIKAT KOMPETENSI POGI/USG/Dasar/2014


AFTA 2015

SERTIFIKAT KESERTAAN LAPORAN USG & BUKU LOG (selesai dalam 6 bulan) VERIFIKASI PPDS OBGIN : KPS SPOG : KETUA POGI CABANG KOLEGIUM OBGIN SERTIFIKAT KOMPETENSI POGI/USG/Dasar/2014


BUKU LOG USG OBSTETRI GINEKOLOGI

STANDARISASI DAN SERTIFIKASI PELATIHAN USG DASAR OBSTETRI GINEKOLOGI BERBASIS KOMPETENSI

Periode Pelatihan : ……………………………………….

Nama Peserta : ……………………………………………………………………

KOLEGIUM OBSTETRI GINEKOLOGI INDONESIA PERKUMPULAN OBSTETRI DAN GINEKOLOGI INDONESIA 2014

1

POGI/USG/Dasar/2014


PESAN DIBAWA PULANG • PJB merupakan kelainan kongenital terbanyak • Skrining perlu dilakukan • ISUOG & POGI : Ekhokardiografi Dasar – 11 – 13 +6 minggu – 20 – 22 minggu – 4CV, 3VV, LVOT, RVOT – Standarisasi & Sertifikasi : Jenjang Kompetensi

• Mari kita memulai pemeriksaan jantung janin

CONGENITAL HEART DISEASE

NORMAL FHR: 120 – 160 bpm regular

FETAL ANOMALY OR DISEASE

NORMAL CRL :

EARLY SIGN OF IUGR

1 mm / day


ISUOG-INDONESIA

TERIMA KASIH

EKHOKARDIOGRAFI JANIN DASAR

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