What the standard says
A woman is offered high-quality ultrasound during pregnancy to assess fetal growth and morphology, and identify stillbirth risks. Ultrasound performance and reporting, and communication of outcomes to the woman, are in line with current best-practice guidelines.
What this means for you
Early in pregnancy, discuss the importance of obstetric ultrasound with the woman. Optimally timed, high-quality ultrasound can help identify factors that may affect a woman’s stillbirth risk, including the presence of a multiple pregnancy, chorionicity, the likelihood of fetal or chromosomal anomalies, and fetal growth restriction.
Discuss recommended obstetric ultrasounds with the woman, including the reasons for the ultrasounds, what they may reveal about her or her baby’s health, and at what stage of pregnancy they are recommended. Provide verbal and written information about these ultrasounds, in line with the woman’s needs and preferences, and answer any questions she has. All women should be offered access to an interpreter, if required to support these discussions, and written information in their preferred language, where available.
Some women may choose to decline some, or all, recommended ultrasounds after considering the information provided, and their right to do so should be respected. Arrange for obstetric ultrasounds that the woman has agreed to, at the appropriate gestation.
Consider the woman’s personal circumstances, including her financial situation, and whether she lives in a rural or remote setting and may need additional support to access recommended care.
Recommended obstetric ultrasounds that should be discussed with the woman, and their relevance to ascertaining stillbirth risk, are noted below.
Dating scan
- Primarily recommended for women who are uncertain of their conception date.
- Helps to ascertain gestational age, and the most appropriate time for other scans (for example, a nuchal translucency scan).
- Can identify the presence of a multiple pregnancy or chorionicity, which can affect stillbirth risk.
If undertaken, the dating scan is recommended between 8 weeks 0 days and 13 weeks 6 days of pregnancy.
Nuchal translucency scan
- Assesses the likelihood of aneuploidy, including trisomy (responsible for Down syndrome), which may increase stillbirth risk.
- Should be offered to all women in combination with maternal plasma testing (combined first trimester screening), as this offers increased sensitivity for aneuploidy detection.
- Can ascertain gestational age, identify a multiple pregnancy, and assess chorionicity, for women who have not had a dating scan.
- Provides early anatomical assessment of the fetus, including for anomalies with high lethality (for example, anencephaly), and visualisation of structures including the placenta, amniotic fluid, cervix, uterus and adnexae.
If undertaken, the nuchal translucency scan is recommended between 12 weeks and 13 weeks 6 days of pregnancy. Maternal plasma testing is recommended between 9 weeks and 13 weeks 6 days of pregnancy.
Mid trimester fetal morphology scan
- Assesses fetal development and anatomy, and the position of the placenta.
- Can identify factors that can affect a woman’s stillbirth risk, including the presence of fetal structural anomalies, placental length and placenta praevia.
The ultrasound is generally performed between 18 and 20 weeks of pregnancy, but may be offered up to 22 weeks in some circumstances. The timing of this ultrasound should ensure that, if structural anomalies are identified, women have time to consider termination within the time frames permitted in their state or territory. In some states and territories, access to termination after 20 weeks of pregnancy is highly restricted.
Screening for chromosomal anomalies
All women should be offered screening for common chromosomal anomalies such as trisomy. This can be undertaken through combined first trimester screening, a nuchal translucency scan alone, NIPT or second trimester maternal serum testing.
Women should be provided with information about the potential benefits, risks and costs of these options, and supported to make decisions that are in line with their needs and preferences.
Further obstetric ultrasound, including in the third trimester
Consider the need for increased obstetric ultrasound surveillance on an individual basis and according to clinical need, rather than as routine monitoring. Indications for further obstetric ultrasounds, including third trimester growth and wellbeing scans, may include:
- Clinical concerns about the risk of fetal growth restriction (for example, as outlined in the Fetal Growth Restriction (FGR) Care pathway) or a small‑for-gestational-age fetus
- Women for whom measurement of fundal height may be inaccurate (for example, high body mass index, large fibroids, polyhydramnios)
- A prenatal diagnosis of a genetic or structural anomaly
- Reassurance for women who have had a previous perinatal loss who request further ultrasounds for reassurance about fetal wellbeing.
Performing and reporting ultrasounds during pregnancy
Obstetric ultrasound should be performed by clinicians who have appropriate training and qualifications, and are working within their scope of practice. All referred obstetric ultrasounds, including dating, nuchal translucency and morphology scans, should be performed, interpreted and reported on by appropriately qualified clinicians, in line with the guidelines for the performance of first, second and third trimester ultrasounds developed by the Australasian Society for Ultrasound in Medicine.
If a woman is being referred for an ultrasound examination, refer her to a service that meets these requirements. Consider social factors such as cost, language, remoteness of residence or distrust of mainstream health care that may be barriers to the woman accessing obstetric ultrasound, and facilitate access to an appropriate service.
If a woman has a history of stillbirth or other perinatal loss, ensure that this information is clearly communicated on any referrals for obstetric imaging. Offer all women the opportunity to have a partner or support person attend the ultrasound with them.
The woman should be advised of the results of her obstetric ultrasound. Offer all women access to an interpreter, when required, and to an Aboriginal and Torres Strait Islander health worker or cross-cultural health worker, where available and in line with the woman’s preferences, to support these discussions. Note that some women may prefer to receive some, but not all, information about the findings of ultrasounds undertaken (for example, opting out of receiving information about an identified fetal anomaly if it is not life limiting), and care should be taken to respect these wishes.
A copy of the report for every ultrasound should be offered to the woman. At a minimum, key findings should be documented in her healthcare record and, with her permission, shared with other clinicians involved in her care – this includes clinicians providing care for Aboriginal and Torres Strait Islander women through ACCHOs and AMSs. If any concerns about the health or wellbeing of the fetus are identified, refer the woman for further investigation and care, and provide information on how she can access relevant support in the interim.
Use clear and sensitive language to communicate with the woman regarding concerning or unexpected findings. Provide empathic care, in line with the recommendations in the Parent-centred Communication in Obstetric Ultrasound Guidelines developed by the Australasian Society for Ultrasound in Medicine.