The first level ultrasound consists of the ultrasound performed on the territory to all the pregnant women.
The regional protocol foresees three echography:
The first trimester, at 10-13 weeks, aims to confirm the viability of the foetus and to date pregnancy, i.e. to establish whether the size of the foetus is compatible with the weeks of reported amenorrhea. Furthermore, in the evaluation of twin pregnancies, the determination of chronicity (= number of placentas) plays a fundamental role.
The second trimester, at 18-22 weeks (morphological), aims to evaluate the anatomy of the foetus, according to the guidelines. The guidelines are directives that guarantee a quality standard (ie the operator is obliged to look at certain fundamental structures). The amount of amniotic fluid and the position of the placenta are also observed during the examination. Furthermore, the foetus is measured to check that growth is regular and that development proceeds normally.
The third trimester, at 30-34 weeks (growth), aims to assess foetal growth. The amount of amniotic fluid and the position of the placenta is also checked.
What is second level ultrasound?
The level 2 ultrasound is an ultrasound on indication that is aimed at solving a specific question. Local operators send the patient for more detailed control in a centre where more sophisticated ultrasound machines are available. The indications for the second level can be multiple:
- Suspected malformation
- Finding of soft markers
- Control of foetal growth, if there is a suspicion of a defect or over-growth
- Reduction or excess of amniotic fluid
- Taking teratogenic drugs in pregnancy
- Infection in pregnancy
- Some maternal pathologies, for example insulin-dependent diabetes
- Previous born with malformation
- Increased alpha-fetoprotein in amniotic fluid
What is third-level ultrasound?
In the case where second level ultrasound has been confirmed as the existence of a malformation picture, the ultrasound evaluation will be performed by personnel who are particularly expert in the evaluation of anatomy and in the management of foetal pathology. This must be done in accordance with the most modern concepts of foetal medicine, and with the help of the most recent literature data.
The expert in foetal medicine (who is an obstetric doctor), performs the diagnosis and uses the advice of professionals of different specialties: geneticist, pediatric cardiologist, infectivologist, orthopedist, neurologist, pediatric surgeon (depending on the malformation highlighted), who they are called to complete prenatal counseling and to establish continuity of treatment after birth.
What is the minimal ultrasound?
The minimal ultrasound is that ultrasound check that simply aims to supplement the clinical examination. The parameters that can be evaluated include, for example, the display of the fetal heart rate, the amount of amniotic fluid and the fetal presentation (ie the position of the foetus in utero). The ultrasound clinic that performs “minimum” checks is not required to issue a report, but can record the result of this check in the patient's medical record. It is therefore important to point out that not all doctors who handle ultrasound probes are ultrasound scanners, and that a check carried out without issuing written reports IS NOT AND DOES NOT REPLACE an official ultrasound scan.