1. Timing of TIFA
Performed ideally between 18 to 22 weeks gestation.
In special cases (e.g., diabetes, previous anomalies), an early TIFA may be done between 16 to 18 weeks, followed by repeat if needed.
2. Equipment & Technical Requirements
Use high-resolution real-time ultrasound machines with color and spectral Doppler capabilities.
Ensure proper image orientation, zoom, gain, and calibration.
Preferably performed via transabdominal route; transvaginal may be used if needed for better detail (e.g., spine, cervix).
3. Sonographer/Operator Guidelines
Must be trained in fetal anatomy, anomaly detection, and Doppler use.
Must follow a standardized scanning protocol.
Should maintain patient privacy, consent, and documentation.
4. Systematic Anatomical Survey (Standard Views)
Follow an organized head-to-toe approach, typically including:
- A. Head & Brain:
Head shape
Lateral ventricles
Cavum septum pellucidum
Cerebellum and cisterna magna
Midline falx and thalami - B. Face:
Orbits (rule out hypotelorism, anophthalmia)
Lip and nose (for cleft lip/palate) - C. Spine: Longitudinal and transverse views of cervical, thoracic, umbar, and sacral spine, Skin covering
- D. Thorax & Heart: Four-chamber view of the heart, Outflow tracts (LVOT, RVOT), Three-vessel view, Cardiac situs and axis
- E. Abdomen: Stomach position and presence, Abdominal wall integrity (rule out gastroschisis, omphalocele), Kidneys, bladder, Umbilical cord insertion
- F. Limbs: Upper and lower limbs including hands and feet, Bone lengths (femur, humerus, radius, ulna, tibia, fibula)
- G. Placenta & Amniotic Fluid: Placental position and structure, Amniotic fluid index (AFI) or single deepest pocket
- H. Cervix: Length and integrity (especially in high-risk pregnancies)
5. Biometry and Growth
Measure
BPD,
HC,
AC,
FL (± others) and plot on growth chart.
Evaluate consistency with gestational age and rule out growth restriction or macrosomia.
6. Use of Doppler
Umbilical artery, MCA, ductus venosus, Uterine artery Doppler when indicated (especially in high-risk pregnancies).
7. Documentation & Reporting
Clearly record all standard views and anomalies detected.
Use standardized terminologies (e.g., ISUOG, FMF, AIUM).
Mention if any part of the anatomy was not visualized and why.
Provide conclusion and recommendations (e.g., follow-up, fetal echocardiography, genetic counseling).
8. Patient Communication
Provide clear explanation of findings.
Avoid causing unnecessary anxiety; refer complex cases to specialists.
Discuss follow-up plans and additional testing if needed.
9. Legal and Ethical Considerations
Obtain informed consent.
Maintain confidentiality and accurate medical records.
Follow national prenatal screening laws, especially regarding anomaly reporting and termination.
10. Follow-up & Re-evaluation
Repeat scan if:
- Any part of the fetus was not adequately visualized
- There are suspicious but inconclusive findings
- A structured follow-up is needed (e.g., cardiac, growth, soft markers)
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