Quick NT Screening Flowchart

Quick NT Screening Flowchart

Start ➔ First Trimester USG (11–13+6 weeks)

Confirm:
- Crown-Rump Length (CRL) between 45–84 mm
- Fetal viability confirmed

Measure:
- Nuchal Translucency (NT)
- Use mid-sagittal view
- Fetal neck in neutral position

Evaluate NT Result:
➔ NT < 95th percentile ➔ Routine follow-up
➔ NT ≥ 95th percentile (or ≥ 3.5 mm) ➔ HIGH RISK: NIPT / Invasive Testing / Detailed Scan / Echo

Combine with:
- Maternal Age
- Serum Markers (free β-hCG + PAPP-A)

Risk Assessment:
➔ Low Risk ➔ Reassure, Routine Care
➔ High Risk ➔ Genetic Counseling + Diagnostic Testing

Visual Summary

Step	Action
Step-1	Confirm CRL + Viability
Step-2	Measure NT Accurately
Step-3	Assess NT Thickness
Step-4	Combine with Maternal Serum Markers
Step-5	Calculate Risk (High or Low)
Step-6	Advise NIPT or Invasive Testing if High Risk

Quick Pearls:
- NT > 3.5mm needs further evaluation.
- Cystic hygroma = much higher risk.
- Normal NT reduces, but doesn't eliminate all risks.
- Combine with Double Marker test for best accuracy!

Judgment of Fetal Lie and Fetal Position

Lies Longitudinal Cephalic Presentation

Scanning Method:

The probe is moved on the mother’s abdomen surface longitudinally and transversely in turn, to find the relationship between the fetal long axis and the mother’s long axis. When the fetal long axis is in the same direction as the mother’s, the fetus is in a longitudinal lie. In cephalic presentation, the fetal head lies toward the mother’s foot side.

Lies Longitudinal Cephalic Presentation of Fetus:

Section Structure:

• AF – Amniotic Fluid
• LEG – Leg
• FB – Fetal Body
• FH – Fetal Head

Clinical Application Value:

Determination of fetal lie is helpful in fetal morphological examination and obstetrical management.

Cephalic Presentation

Types of Cephalic Presentation:

1. ROA – Right Occiput Anterior
2. ROT – Right Occiput Transverse
3. ROP – Right Occiput Posterior
4. RMP – Right Mentum Posterior
5. RMA – Right Mentum Anterior
6. LOA – Left Occiput Anterior
7. LOT – Left Occiput Transverse
8. LOP – Left Occiput Posterior
9. LMP – Left Mentum Posterior
10. LMA – Left Mentum Anterior

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Cephalic – Right Occiput Anterior (ROA)

In ROA presentation, the middle line of the thalamus section is deflected slightly upward to the right. The fetal occipital bone points toward the right anterior side of the mother.

• OC – Occipital Bone
• RLCV – Right Lateral Cerebral Ventricle
• CSP – Cavum Septum Pellucidum
• Frontal Bone
• T – Thalamus

Cephalic – Right Occiput Transverse (ROT)

Also known as Right Occiput Lateral, this position often involves a slightly extended fetal spine. The baby’s back is on the mother’s right, and the occiput points laterally. Often a transitional position before rotating anteriorly.

Cephalic – Right Occiput Posterior (ROP)

In ROP, the fetal occiput is directed toward the right and posterior pelvis. The fetal back lies posteriorly, and this position may lead to longer labor due to the malalignment of the fetal head with the birth canal.

Cephalic – Right Mentum Posterior (RMP)

This is a face presentation with the chin pointing toward the maternal right and posterior pelvis. The fetal head is hyperextended, and vaginal delivery is usually not possible unless the chin rotates anteriorly.

Cephalic – Right Mentum Anterior (RMA)

In RMA, the fetal chin is directed to the mother's right anterior quadrant. The hyperextended face presents first. If no cephalopelvic disproportion exists, vaginal delivery may be possible.

Cephalic – Left Occiput Anterior (LOA)

LOA is considered the optimal position for vaginal delivery. The thalamus section tilts slightly to the left, and the occiput is directed toward the left anterior pelvis. The fetal back is on the mother’s left.

• SP – Septum Pellucidum
• Frontal Bone
• OC – Occipital Bone
• LLCV – Left Lateral Cerebral Ventricle
• T – Thalamus

Cephalic – Left Occiput Transverse (LOT)

In LOT, the occiput is directed to the maternal left side in a transverse alignment. This is often a transitional position before rotating to LOA. The fetal spine usually lies on the maternal left side.

Cephalic – Left Occiput Posterior (LOP)

The occiput is pointed toward the mother’s left posterior pelvis. The fetal back is posterior and left-sided. Similar to ROP, this position may lead to prolonged or obstructed labor.

Cephalic – Left Mentum Posterior (LMP)

In LMP, the fetal face presents with the chin directed toward the left posterior pelvis. Due to the hyperextension and malpositioning, cesarean section is typically recommended.

Cephalic – Left Mentum Anterior (LMA)

This is a face presentation with the chin facing the maternal left anterior quadrant. The hyperextended head allows the face to present first. Vaginal delivery may be possible if labor progresses favorably.

Lies Longitudinal – Breech Presentation

Scanning Method:
The probe is moved on the mother’s abdominal surface both longitudinally and transversely to determine the relationship between the fetal long axis and the mother’s long axis. When both axes align, the fetus is said to be in a longitudinal lie. In breech presentation, the fetal head lies toward the mother's head side.

Lies Longitudinal Breech Presentation of Fetus

Section Structure:

1. FH - Fetal Head
2. AF - Amniotic Fluid
3. FB - Fetal Body

The Clinical Application Value:
Determining the fetal lie is essential for accurate fetal morphological examination and obstetric management decisions.

Types of Breech Presentation

1. Complete Breech Position
2. Flank Breech
3. Incomplete Breech (Single Footing)
4. Double Footing
5. RSA – Right Sacrum Anterior
6. LSP – Left Sacrum Posterior

Complete Breech Position

In this position, the fetus has its hips and knees flexed. Both buttocks and feet are presenting together at the birth canal. It is the most favorable of all breech types for vaginal delivery.

Flank Breech

Also referred to as an oblique breech, in which the fetal body lies diagonally, with the breech not directly over the cervix. The presentation can shift easily to another type with fetal movement or uterine contraction.

Incomplete Breech (Single Footing)

In this presentation, one of the fetal hips is flexed and the other extended, so that one foot presents at the birth canal along with the buttocks.

Double Footing

Both fetal hips and knees are extended, with both feet presenting below the buttocks, often seen in preterm pregnancies or uterine anomalies.

Breech – Right Sacrum Anterior (RSA)

In this breech presentation, the fetal sacrum (buttocks) is located in the right anterior quadrant of the maternal pelvis. The bitrochanteric diameter aligns with the right oblique diameter of the maternal pelvis.

Breech – Right Sacrum Posterior (RSP)

Here, the fetal back faces the mother's back, and the sacrum is directed toward the posterior quadrant of the maternal pelvis. This position is less favorable for vaginal delivery.

Breech – Left Sacrum Anterior (LSA)

In LSA position, the fetal sacrum lies in the left anterior quadrant of the maternal pelvis, with the fetal back directed toward the mother’s left front side.

Breech – Left Sacrum Posterior (LSP)

The fetal sacrum is positioned in the left posterior quadrant of the pelvis. This breech type is similar to RSP and may complicate vaginal delivery.

Left Occipitoanterior (LOA) Position of Fetus

1. Scanning Method:

To assess fetal position, the mother lies in a supine or semi-recumbent position. A transabdominal probe is placed on the abdomen and moved in both longitudinal and transverse directions. In the LOA position, the fetal occiput (back of the head) is directed toward the mother’s left anterior pelvis. This implies a cephalic (head-down) presentation with the fetal back curved along the maternal left side. LOA is considered the most favorable fetal position for vaginal delivery.

2. Section Structure:

1. FH – Fetal Head: Head-down, positioned near the lower uterine segment on the maternal left side.
2. FB – Fetal Body: Body curves along the maternal left anterior quadrant.
3. Sp – Fetal Spine: Spine visualized along the maternal left side, anteriorly placed.
4. AF – Amniotic Fluid: Anechoic fluid surrounding the fetus, ensuring cushioning and mobility.

3. Measuring Method:

Standard biometric parameters like Biparietal Diameter (BPD) and Head Circumference (HC) are measured in transverse axial planes. Measurements are taken intima-to-intima (inner edge to inner edge) to ensure consistency. The ultrasound transducer must be perpendicular to the fetal skull plane, avoiding oblique angles, and capturing symmetrical structures. This technique ensures accurate assessment of gestational age and fetal growth.

4. Clinical Application Value:

The LOA position is clinically significant as it is the most favorable position for labor and delivery. This alignment facilitates smoother descent through the birth canal, reducing the need for operative interventions. Recognition of LOA in antenatal scans assists obstetricians in labor planning and counseling. It also supports better prediction of labor progression, fetal outcomes, and delivery mode.

Right Occipitoanterior (ROA) Position of Fetus –3.34

1. Scanning Method:

The subject is positioned in a supine or semi-recumbent position. A transabdominal probe is applied using gel on the abdomen to allow proper visualization. The probe is moved systematically in both longitudinal and transverse planes to locate the fetal head. In ROA, the fetal occiput is directed toward the mother’s right anterior pelvis. This position implies a cephalic presentation with the fetal back curved along the maternal right side.

2. Section Structure:

1. FH – Fetal Head: Presenting part, located near the maternal pelvis, head-down on the right side.
2. FB – Fetal Body: Curved along the maternal right anterior quadrant.
3. Sp – Fetal Spine: Spine appears anteriorly on the right side of the maternal abdomen.
4. AF – Amniotic Fluid: Appears anechoic and surrounds the fetus, especially noted in posterior areas.

3. Measuring Method:

Biometric parameters such as Biparietal Diameter (BPD), Head Circumference (HC), Abdominal Circumference (AC), and Femur Length (FL) are measured. For BPD and HC, the transducer is aligned perpendicular to the axial plane of the fetal head, ensuring symmetry of landmarks. Measurements are taken intima-to-intima, which means from the inner edge of one side to the inner edge of the opposite structure, to maintain standardization and accuracy.

4. Clinical Application Value:

The ROA position is a favorable cephalic presentation for spontaneous vaginal delivery. It allows efficient engagement of the fetal head in the pelvis and promotes a natural rotation during labor. Recognizing ROA helps clinicians prepare for a likely normal labor course, reducing the chances of operative delivery. ROA also helps in predicting fetal attitude and delivery progression, offering reassurance in prenatal counseling.

Dating & Growth Percentiles in 2nd & 3rd trimester

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In the second and third trimesters, fetal growth is assessed using biometric parameters including:

Biparietal Diameter (BPD)

Head Circumference (HC)

Abdominal Circumference (AC)

Femur Length (FL)

Estimated Fetal Weight (EFW)

These values are plotted against gestational age-specific percentile charts, which help determine whether the fetus is growing normally.

Biparietal Diameter (BPD)

Measurement Method:
Plane:
Axial (transverse) plane of the fetal head at the level of:
- Thalami
- Cavum Septi Pellucidi (CSP)
- Third ventricle

Technique:
- Ensure head is oval and symmetrical.
- Midline falx should be equidistant from both skull bones.
- Calipers should be placed from the outer edge of the near skull (proximal) to the inner edge of the far skull (distal).
- This is known as the “outer-to-inner” method.
Optimal View Criteria:
- Head should appear round or oval (not compressed or elongated).
- Midline falx should be clearly visible and centered.
- CSP should be seen anterior to the thalami.
- Avoid oblique sections or pressure-induced distortion.
Best Time to Measure:
- From 13+ weeks gestation onward, most reliable during the 2nd trimester.
Pitfalls to Avoid:
- Do not include orbits (too low) or skull vault (too high).
- Avoid oblique angles or compression by uterine wall or limbs.
- Consider using Head Circumference (HC) if skull shape is abnormal.

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Head Circumference (HC)

Measurement Method:
Plane:
Axial (transverse) plane of the fetal head at the level of:
- Thalami
- Cavum Septi Pellucidi (CSP)
- Third ventricle

Technique:
- Ensure a symmetrical, oval cross-section of the fetal head.
- Use the ellipse tool to trace the outer edge of the skull bone (outer-to-outer).
- Calipers must not include scalp or soft tissues.
Optimal View Criteria:
- Midline falx is centered and equidistant.
- CSP visible anterior to thalami.
- Head shape is oval, not round or compressed.
Best Time to Measure:
- After 13+ weeks gestation, especially reliable in the 2nd trimester.
Pitfalls to Avoid:
- Avoid measuring in oblique sections.
- Do not include skin or scalp in circumference.
- Prefer HC over BPD in cases of dolichocephaly or brachycephaly.

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Abdominal Circumference (AC)

Measurement Method:
Plane:
Axial (transverse) view of the fetal abdomen at the level of:
- Stomach bubble
- Left portal vein (hockey stick or J-shaped configuration)
- Umbilical portion of the left portal vein

Technique:
- Ensure the abdomen is round and symmetrical, not oval or distorted.
- Use the ellipse tool to trace along the outer skin edge (skin-to-skin).
- Do not include the ribs or spine prominence in measurement.
Optimal View Criteria:
- Stomach bubble and portal sinus are clearly visible.
- Spine is at a lateral position (ideally between 3 to 5 o’clock or 7 to 9 o’clock).
- No obliquity or compression of the fetal abdomen.
Best Time to Measure:
- Most reliable in the second and third trimesters for fetal weight estimation.
Pitfalls to Avoid:
- Avoid measuring in oblique or distorted planes.
- Do not include subcutaneous tissue excessively or exclude the skin edge.
- Avoid measurement during fetal movement or respiration.

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Femur Length (FL)

Measurement Method:
Plane:
Longitudinal view of the femur (preferably the femur closest to the probe).

Technique:
- Align the transducer to obtain a straight, unforeshortened view of the entire femoral diaphysis.
- Measure only the ossified diaphysis (bone shaft).
- Exclude femoral head epiphysis and distal cartilaginous ends from the measurement.
- Calipers should be placed at the outer margins of the ossified diaphysis (outer to outer).
Optimal View Criteria:
- Bone appears straight and clearly visualized without curvature.
- Ends of the diaphysis should appear sharp, not fuzzy or oblique.
Best Time to Measure:
- From the second trimester onwards, reliable for dating and fetal growth assessment.
Pitfalls to Avoid:
- Avoid measuring a foreshortened femur (due to oblique angle).
- Do not include the cartilaginous epiphysis in the measurement.
- Use only the femur clearly visible and properly aligned — not the shadowed opposite side.

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Estimated Fetal Weight (EFW)

Double Fetal Demise (FDIU) in Triplet Pregnancy

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Figure-1

📄 Report Sample Line - Double Fetal Demise (FDIU) in Triplet Pregnancy

Ultrasound evaluation demonstrates a triplet gestation. Two of the three fetuses (Fetus A and Fetus B) show absence of cardiac activity and fetal movement, with reduced amniotic fluid volume. Biometric measurements of both demised fetuses correspond to approximately XX and YY weeks, respectively. There is evidence of fetal maceration in Fetus A (or B), including overlapping cranial bones and skin edema. No gross structural anomalies are identified. The third fetus (Fetus C) exhibits normal cardiac activity, fetal movements, biometry appropriate for gestational age, and adequate amniotic fluid. Placental evaluation suggests a [trichorionic triamniotic / dichorionic triamniotic / monochorionic triamniotic] configuration. No signs of twin-twin transfusion syndrome or cord entanglement are present. Maternal adnexa appear normal.

Conclusion: 📋 Intrauterine Fetal Demise (FDIU) of two fetuses (Fetus A and B) in a triplet pregnancy. Fetus C remains viable with normal sonographic findings.

Recommendation: Urgent referral to maternal-fetal medicine. Close surveillance of the surviving fetus with serial growth, Doppler, and wellbeing assessments. Investigations to determine possible causes of fetal demise (e.g., thrombophilia, infection, placental pathology) are advised. Multidisciplinary counseling regarding pregnancy continuation, risks, and delivery planning is essential.

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Note: If you select English, answer all questions in English.
यदि आप हिंदी चुनते हैं, तो सभी प्रश्न हिंदी में हल करें।

1. “Double fetal demise” in a triplet pregnancy means: 1. ट्रिपलेट प्रेगनेंसी में "डबल फेटल डिमाइस" का क्या अर्थ है?
A. Death of two fetuses in utero while one fetus remains alive
B. Death of all three fetuses
C. Intrauterine growth restriction in two fetuses
D. Twin pregnancy with one fetal demise

2. The single most important factor that determines risk to the surviving fetus after double FDIU is: 2. डबल FDIU के बाद जीवित शिशु के जोखिम को निर्धारित करने वाला सबसे महत्वपूर्ण कारक कौन सा है?
A. Chorionicity / placental sharing (e.g., monochorionic vs dichorionic)
B. Maternal age
C. Fetal sex of the survivor
D. Time of day when demise occurred

3. In a monochorionic pregnancy, demise of co-fetuses can most directly cause which problem in the surviving twin? 3. मोनोकोरियोनिक गर्भावस्था में सह-भ्रूणों के मृत्यु होने से जीवित जुड़वाँ में सबसे सीधे किस समस्या का कारण बन सकता है?
A. Maternal DIC immediately in all cases
B. Placental abruption in every case
C. Acute hemodynamic shift causing ischemic brain injury / neurological damage
D. Guaranteed normal outcome for survivor

4. After detecting double fetal demise in a triplet pregnancy, the most appropriate immediate step is: 4. ट्रिपलेट प्रेगनेंसी में डबल फेटल डिमाइस मिलने के बाद सबसे उपयुक्त तत्काल कदम क्या है?
A. Confirm chorionicity and perform detailed ultrasound with fetal Dopplers and infection screen; counsel parents
B. Immediate cesarean delivery in all cases
C. Start immediate chemotherapy
D. No further evaluation required

5. Maternal coagulopathy (DIC) after fetal demise is: 5. भ्रूण मृत्यु के बाद मातृ कोआगुलोपैथी (DIC) कितनी बार होती है?
A. Very common immediately after any fetal demise
B. Rare but possible, especially with prolonged retention of dead fetus and infection
C. Impossible — never occurs
D. Only occurs if the fetus is above 40 weeks gestation

6. Best surveillance plan for the surviving fetus after double demise (if expectant management) includes: 6. डबल मृत्यु के बाद जीवित भ्रूण के लिए (यदि प्रत्याशित प्रबंधन) सर्वश्रेष्ठ निगरानी योजना में क्या शामिल है?
A. Serial ultrasound for growth, umbilical and middle cerebral artery Dopplers, CTG/NST as indicated, and MRI brain if suspicious findings
B. One-time ultrasound and then no follow-up
C. Immediate termination of pregnancy only
D. Start empiric anticoagulation for mother always

7. Which management is usually recommended if there is no maternal compromise and the surviving fetus is stable? 7. यदि माँ की स्थिति सामान्य है और जीवित भ्रूण स्थिर है तो आमतौर पर कौन सा प्रबंधन सुझाया जाता है?
A. Immediate delivery regardless of gestation
B. Immediate aggressive surgery on placenta
C. Expectant management with close surveillance and counseling
D. Routine home care with no monitoring

8. Which statement about prognosis is true? 8. किस कथन के बारे में पूर्वानुमान सही है?
A. Surviving fetus outcome is uniformly poor regardless of chorionicity and GA
B. Prognosis is better in trichorionic pregnancies compared with monochorionic due to lack of placental vascular anastomoses
C. Outcome solely depends on fetal sex
D. There is no risk to the surviving fetus ever

9. Indication for earlier delivery of the surviving fetus would include: 9. जीवित भ्रूण के जल्दी जन्म के लिए संकेत में क्या शामिल होगा?
A. Evidence of fetal distress, abnormal Dopplers or maternal sepsis/coagulopathy
B. Parental anxiety only, without clinical abnormalities
C. Maternal hair color change
D. Always deliver at 24 weeks regardless of status

10. Key counseling point to parents after double FDIU in triplets is: 10. ट्रिपलेट में डबल FDIU के बाद माता-पिता को दिया जाने वाला प्रमुख परामर्श क्या है?
A. There is no risk to the survivor and no monitoring needed
B. Explain increased risk of preterm delivery and possible neurological compromise (depending on chorionicity and timing); outline close surveillance plan and possible neonatal care needs
C. Immediately recommend pregnancy termination always
D. Suggest no obstetric follow-up until term

Single Fetus FDIU in Triplet Pregnancy

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Figure-1

📄 Report Sample Line - Single Fetus FDIU in Triplet Pregnancy

Ultrasound evaluation reveals a triplet gestation. Of the three fetuses, Fetus B shows absence of cardiac activity, no fetal movement, and reduced amniotic fluid volume. Biometric parameters of Fetus B correspond to approximately XX weeks gestation. No definitive structural anomalies are identified. Fetus A and Fetus C demonstrate normal cardiac activity, movements, and biometry appropriate for gestational age with adequate amniotic fluid volume. Placental morphology suggests a [trichorionic triamniotic / dichorionic triamniotic / monochorionic triamniotic] configuration. No signs of twin-twin transfusion or cord entanglement are noted. Maternal uterus and adnexal structures appear normal.

Conclusion: 📋 Single Intrauterine Fetal Demise (FDIU) of Fetus B in an ongoing triplet pregnancy. Fetus A and Fetus C are viable with sonographically normal findings.

Recommendation: Continued close surveillance of the surviving fetuses with serial growth assessment and Doppler studies. Maternal evaluation for potential causes (e.g., thrombophilia, infection) is recommended. Multidisciplinary management with a maternal-fetal medicine team is advised.

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Note: If you select English, answer all questions in English.
यदि आप हिंदी चुनते हैं, तो सभी प्रश्न हिंदी में हल करें।

1. "Single fetal demise" in a triplet pregnancy means: 1. ट्रिपलेट प्रेगनेंसी में "सिंगल फेटल डिमाइस" का क्या अर्थ है?
A. Death of one fetus in utero while two fetuses remain alive
B. Death of all three fetuses
C. Birth of one fetus only
D. Simultaneous demise of two fetuses

2. The most important factor determining risk to surviving fetuses after single FDIU is: 2. सिंगल FDIU के बाद जीवित भ्रूणों के जोखिम को निर्धारित करने वाला सबसे महत्वपूर्ण कारक कौन सा है?
A. Chorionicity / placental sharing (monochorionic vs dichorionic / trichorionic)
B. Maternal diet
C. Fetal gender of the deceased fetus
D. Time of day when demise was discovered

3. In monochorionic placentation, single fetus demise may directly lead to which complication in surviving co‑fetuses? 3. मोनोकोरियोनिक प्लैसेंटेशन में, एक भ्रूण की मृत्यु जीवित सह‑भ्रूणों में सीधे किस जटिलता का कारण बन सकती है?
A. Guaranteed normal outcome
B. Only maternal fever
C. Acute hemodynamic shift via placental anastomoses causing ischemic brain injury or multi‑organ injury
D. Decreased risk of preterm delivery

4. Immediate evaluation after identifying single FDIU in triplets should include: 4. ट्रिपलेट में सिंगल FDIU की पहचान के बाद तत्काल मूल्यांकन में क्या शामिल होना चाहिए?
A. Confirm chorionicity and perform detailed ultrasound with fetal Dopplers, consider infection screen and counsel parents
B. Immediate cesarean delivery in all cases
C. Start chemotherapy for mother
D. No evaluation required

5. Maternal disseminated intravascular coagulation (DIC) after single fetal demise is: 5. एक भ्रूण मृत्यु के बाद मातृ डायस्मिनेटेड इंट्रावास्कुलर कोआगुलेशन (DIC) क्या है?
A. Very common immediately after any fetal demise
B. Rare but possible, especially with prolonged retention, infection or large dead fetus
C. Impossible
D. Only occurs after delivery

6. Best surveillance plan for surviving fetuses when expectant management is chosen includes: 6. प्रत्याशित (expectant) प्रबंधन चुने जाने पर जीवित भ्रूणों के लिए सर्वश्रेष्ठ निगरानी योजना में क्या शामिल है?
A. Serial ultrasound for growth, umbilical and MCA Dopplers, CTG/NST as indicated; consider fetal MRI if neurological concerns arise
B. Single ultrasound only
C. Immediate planned termination of pregnancy
D. No follow-up required

7. If the mother is stable and surviving fetuses show normal growth and Dopplers, recommended management is: 7. यदि माँ स्थिर है और जीवित भ्रूणों में सामान्य वृद्धि और डॉप्लर है, तो अनुशंसित प्रबंधन क्या है?
A. Immediate delivery regardless of gestation
B. Emergency hysterectomy
C. Expectant management with close surveillance and parental counseling
D. No monitoring needed

8. Prognosis for surviving fetuses is generally better when the pregnancy is: 8. जीवित भ्रूणों का पूर्वानुमान सामान्यतः बेहतर होता है जब गर्भावस्था किस प्रकार की होती है?
A. Monochorionic (shared placenta)
B. Trichorionic or dichorionic (separate placentas)
C. Depends only on maternal age
D. Prognosis is identical in all types

9. Indication for earlier delivery of surviving fetuses would include: 9. जीवित भ्रूणों के जल्दी जन्म के लिए संकेत में क्या शामिल होगा?
A. Evidence of fetal distress, abnormal Dopplers, maternal sepsis or coagulopathy
B. Parental preference only without clinical indication
C. Change in maternal hair color
D. Always deliver immediately at any gestation

10. Key counseling point for parents after single FDIU in triplets is: 10. ट्रिपलेट में सिंगल FDIU के बाद माता‑पिता को दिया जाने वाला प्रमुख परामर्श क्या है?
A. There is no risk to the surviving fetuses and no monitoring needed
B. Explain increased risk of preterm delivery and possible neurological compromise (depending on chorionicity and timing); outline close surveillance plan and neonatal care possibilities
C. Immediate termination is mandatory
D. No obstetric follow-up until term

Single fetus FDIU in twin pregnancy

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Figure-1

📄 Report Sample Line - Single Fetus FDIU in Twin Pregnancy

shows a twin pregnancy. Twin A demonstrates absent fetal cardiac activity, no fetal movements, and reduced amniotic fluid volume. Fetal biometry of Twin A corresponds to approximately XX weeks of gestation. No structural anomalies are definitively seen. Twin B shows normal cardiac activity and movements, with appropriate biometric parameters for gestational age and normal amniotic fluid volume. The placentation appears [monochorionic/diamniotic OR dichorionic/diamniotic] with [single/separate] placental masses.

Conclusion: 📋 Findings suggestive of Single Intrauterine Fetal Demise (FDIU) in a twin pregnancy. Twin A: FDIU; Twin B: Viable with normal findings.

Recommendation: Serial monitoring of the surviving twin with growth and Doppler studies. Further evaluation for underlying causes if indicated. Consider maternal blood investigations for coagulation profile and infection screening. Referral to a maternal-fetal medicine specialist is advised.

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Note: If you select English, answer all questions in English.
यदि आप हिंदी चुनते हैं, तो सभी प्रश्न हिंदी में हल करें।

1. "Single fetal demise" in a twin pregnancy means: 1. ट्विन प्रेगनेंसी में "सिंगल फेटल डिमाइस" का क्या अर्थ है?
A. Death of one fetus in utero while the other fetus remains alive
B. Death of both fetuses
C. Birth of one fetus only
D. Simultaneous demise of two fetuses

2. The single most important factor determining risk to the surviving twin after single FDIU is: 2. सिंगल FDIU के बाद जीवित जुड़वाँ के जोखिम को निर्धारित करने वाला सबसे महत्वपूर्ण कारक कौन सा है?
A. Chorionicity / placental sharing (monochorionic vs dichorionic)
B. Maternal age
C. Fetal sex of the deceased fetus
D. Time of day when demise occurred

3. In a monochorionic twin pregnancy, single fetal demise can directly cause which complication in the surviving twin? 3. मोनोकोरियोनिक ट्विन गर्भावस्था में, एक भ्रूण की मृत्यु जीवित जुड़वाँ में सीधे किस जटिलता का कारण बन सकती है?
A. Guaranteed normal outcome
B. Only maternal fever
C. Acute hemodynamic shift via placental anastomoses causing ischemic brain injury or organ injury
D. Decreased risk of preterm delivery

4. Immediate evaluation after identifying single FDIU in twins should include: 4. ट्विन्स में सिंगल FDIU की पहचान के बाद तत्काल मूल्यांकन में क्या शामिल होना चाहिए?
A. Confirm chorionicity and perform detailed ultrasound with fetal Dopplers, consider infection screen and counsel parents
B. Immediate cesarean delivery in all cases
C. Start chemotherapy for mother
D. No evaluation required

5. Maternal coagulopathy (DIC) after single fetal demise is: 5. एक भ्रूण मृत्यु के बाद मातृ कोआगुलोपैथी (DIC) क्या है?
A. Very common immediately after any fetal demise
B. Rare but possible, especially with prolonged retention, infection or large dead fetus
C. Impossible
D. Only occurs after delivery

6. Best surveillance plan for the surviving twin when expectant management is chosen includes: 6. प्रत्याशित प्रबंधन चुने जाने पर जीवित जुड़वाँ के लिए सर्वश्रेष्ठ निगरानी योजना में क्या शामिल है?
A. Serial ultrasound for growth, umbilical and middle cerebral artery Dopplers, CTG/NST as indicated; consider fetal MRI if neurological concerns arise
B. Single ultrasound only
C. Immediate planned termination of pregnancy
D. No follow-up required

7. If mother is stable and surviving twin shows normal growth and Dopplers, recommended management is: 7. यदि माँ स्थिर है और जीवित जुड़वाँ में सामान्य वृद्धि और डॉप्लर है, तो अनुशंसित प्रबंधन क्या है?
A. Immediate delivery regardless of gestation
B. Emergency hysterectomy
C. Expectant management with close surveillance and parental counseling
D. No monitoring needed

8. Prognosis for the surviving twin is generally better when the pregnancy is: 8. जीवित जुड़वाँ के लिए पूर्वानुमान सामान्यतः बेहतर होता है जब गर्भावस्था किस प्रकार की होती है?
A. Monochorionic (shared placenta)
B. Dichorionic (separate placentas)
C. Depends only on maternal age
D. Prognosis is identical in all types

9. Indication for earlier delivery of the surviving twin would include: 9. जीवित जुड़वाँ के जल्दी जन्म के लिए संकेत में क्या शामिल होगा?
A. Evidence of fetal distress, abnormal Dopplers, maternal sepsis or coagulopathy
B. Parental preference only without clinical indication
C. Change in maternal hair color
D. Always deliver immediately at any gestation

10. Key counseling point for parents after single FDIU in twins is: 10. ट्विन्स में सिंगल FDIU के बाद माता‑पिता को दिया जाने वाला प्रमुख परामर्श क्या है?
A. There is no risk to the surviving twin and no monitoring needed
B. Explain increased risk of preterm delivery and possible neurological compromise (depending on chorionicity and timing); outline close surveillance plan and neonatal care possibilities
C. Immediate termination is mandatory
D. No obstetric follow‑up until term

Single fetus FDIU in stuck twin syndrome

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Figure-1

📄 Report Sample Line - Single FDIU in Stuck Twin Syndrome

Diamniotic monochorionic twin gestation. One twin (Twin A) shows no detectable fetal cardiac activity or movements, with measurements corresponding to a gestational age of approximately 15 weeks. Twin A appears compressed against the uterine wall with oligohydramnios, consistent with "stuck twin" appearance. The amniotic sac is severely reduced in volume, and fetal anatomy is difficult to assess due to crowding. The co-twin (Twin B) with measurements corresponding to a gestational age of approximately 20 weeks demonstrates normal cardiac activity and active movements with adequate amniotic fluid volume and biometric parameters appropriate for gestational age. Placenta is single and shared. Twin-Twin Transfusion Syndrome (TTTS) Stage II–III features may be present.

Conclusion: 📋 Findings suggestive of Single Fetal Demise (FDIU) in Monochorionic Diamniotic Twin Pregnancy, with features of Stuck Twin Syndrome. Twin A: FDIU; Twin B: Viable.

Recommendation: Evaluate for complications such as anemia, neurological sequelae, or TTTS progression.

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Note: If you select English, answer all questions in English.
यदि आप हिंदी चुनते हैं, तो सभी प्रश्न हिंदी में हल करें।

1. "Stuck twin" syndrome typically refers to: 1. "स्टक ट्विन" सिंड्रोम सामान्यतः किसे दर्शाता है?
A. A donor twin in severe TTTS becoming 'stuck' to uterine wall due to profound oligohydramnios (monochorionic diamniotic)
B. A twin stuck in the birth canal during delivery
C. Both twins with polyhydramnios
D. A twin with placental abruption only

2. The major factor that determines risk to the surviving twin after single FDIU in stuck twin syndrome is: 2. स्टक ट्विन सिंड्रोम में सिंगल FDIU के बाद जीवित जुड़वाँ के जोखिम को निर्धारित करने वाला प्रमुख कारक क्या है?
A. Chorionicity and presence of placental vascular anastomoses (monochorionic vs dichorionic)
B. Maternal age
C. Fetal sex
D. Maternal BMI

3. In monochorionic twins with placental anastomoses, demise of one twin commonly risks: 3. प्लेसेंटल एनोस्तोमोसिस वाले मोनोकोरियोनिक जुड़वां में, एक भ्रूण की मृत्यु आमतौर पर किस जोखिम से जुड़ी है?
A. Maternal hypertension only
B. No risk to surviving twin
C. Acute haemodynamic shift through anastomoses causing ischemic brain or organ injury in survivor
D. Guaranteed term delivery without complications

4. Immediate steps after diagnosis of single FDIU in stuck twin syndrome should include: 4. स्टक ट्विन सिंड्रोम में सिंगल FDIU के निदान के बाद तत्काल कदमों में क्या शामिल होना चाहिए?
A. Confirm chorionicity, perform detailed ultrasound with fetal Dopplers, consider fetal MRI and infection screen; counsel parents
B. Immediate cesarean delivery in all cases
C. Start maternal chemotherapy
D. No evaluation required

5. Fetoscopic laser photocoagulation in TTTS aims to: 5. TTTS में फेटोस्कोपिक लेज़र फोटोकोएगुलेशन का उद्देश्य क्या है?
A. Increase amniotic fluid in donor twin directly
B. Ablate placental vascular anastomoses to stop transfusion imbalance
C. Deliver the babies immediately
D. Always prevent fetal demise

6. After single fetal demise in stuck twin syndrome, best surveillance for the surviving twin includes: 6. स्टक ट्विन सिंड्रोम में एक भ्रूण मृत्यु के बाद जीवित जुड़वाँ के लिए सर्वश्रेष्ठ निगरानी में क्या शामिल है?
A. Serial ultrasound for growth, umbilical and middle cerebral artery Dopplers, CTG/NST as indicated; consider fetal MRI if neurological concern
B. Single ultrasound only
C. Immediate delivery at any gestation
D. No monitoring required

7. Which finding increases the likelihood of adverse neurodevelopmental outcome in the surviving twin? 7. किस खोज से जीवित जुड़वाँ में प्रतिकूल नयूरोविकासात्मक परिणाम की संभावना बढ़ जाती है?
A. Stable ventricular size and normal Dopplers
B. Abnormal cerebral findings on MRI or abnormal MCA/umbilical Dopplers
C. Late-term delivery only
D. Maternal skin rash

8. Indication for earlier delivery of the surviving twin would be: 8. जीवित जुड़वाँ के जल्दी जन्म का संकेत क्या होगा?
A. Evidence of fetal distress, abnormal Dopplers, maternal sepsis or coagulopathy
B. Parental anxiety alone without clinical abnormality
C. Change in maternal eye color
D. None — always wait until term

9. Maternal disseminated intravascular coagulation (DIC) after retained dead fetus is: 9. मृत भ्रूण के बने रहने पर मातृ डायस्मिनेटेड इंट्रावास्कुलर कोआगुलेशन (DIC) क्या है?
A. Very common immediately in all cases
B. Rare but possible, especially with prolonged retention, infection or large dead fetus
C. Impossible
D. Only occurs after 42 weeks

10. Key counseling point for parents after single FDIU in stuck twin syndrome is: 10. स्टक ट्विन सिंड्रोम में सिंगल FDIU के बाद माता‑पिता के लिए प्रमुख परामर्श क्या है?
A. There is no risk to the surviving twin and no monitoring needed
B. Explain increased risk of neurological injury and preterm delivery (especially if monochorionic); outline close surveillance plan, discuss fetal MRI and neonatal care possibilities
C. Immediate termination of pregnancy is mandatory
D. No obstetric follow‑up until term

Fetal Death In Utero (FDIU) at 14 Weeks

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Figure-1

📄 Report Sample Line - Fetal Death In Utero (FDIU) at 14 Weeks

Ultrasound examination reveals a single intrauterine gestation with absent fetal cardiac activity and no fetal movements. The fetus measures approximately 14 weeks of gestation based on biparietal diameter and crown-rump length. The fetal posture appears fixed. A tight nuchal cord loop is noted around the neck, with umbilical cord visualized encircling the neck region. No signs of hydropic changes are evident. Amniotic fluid volume is within normal limits. Placental location is anterior, and no gross placental abnormalities are observed.

Conclusion: 📋 Findings consistent with Fetal Death In Utero (FDIU) at approximately 14 weeks' gestation. A tight umbilical cord loop around the fetal neck is identified as a likely contributing factor.

Recommendation: Counseling and support advised. Recommend follow-up with obstetrician for management and further evaluation. Consider fetal karyotyping and placental histopathology if recurrent loss or anomalies suspected.

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Note: If you select English, answer all questions in English.
यदि आप हिंदी चुनते हैं, तो सभी प्रश्न हिंदी में हल करें।

1. Fetal death in utero (FDIU) at 14 weeks is defined on ultrasound primarily by: 1. अल्ट्रासाउंड पर 14 सप्ताह पर गर्भ में भ्रूण मृत्यु (FDIU) का प्राथमिक सुझाव क्या है?
A. Absence of fetal cardiac activity on real‑time scan with appropriate fetal size
B. Presence of fetal movements only
C. Maternal report of decreased fetal motion (only)
D. Enlarged placenta only

2. The most common cause of FDIU in the first trimester/early second trimester is: 2. पहले ट्राइमेस्टर/प्रारम्भिक दूसरे ट्राइमेस्टर में FDIU का सबसे सामान्य कारण क्या है?
A. Chromosomal abnormalities
B. Maternal trauma
C. Maternal hypertension
D. Placental abruption

3. If the ultrasound at 14 weeks is inconclusive, the best next step is: 3. यदि 14 सप्ताह के अल्ट्रासाउंड से निष्कर्ष स्पष्ट नहीं है, तो अगला सबसे अच्छा कदम क्या है?
A. Repeat scan (possibly transvaginal) after short interval to confirm absence of cardiac activity
B. Immediate termination without confirmation
C. Start antibiotics immediately
D. Ignore and follow up after 3 months

4. Important investigations after confirmed FDIU at 14 weeks include: 4. 14 सप्ताह पर पुष्टि किए गए FDIU के बाद महत्वपूर्ण जांचों में क्या शामिल है?
A. Offer karyotype/microarray, infection screen (TORCH), maternal Rh type and routine baseline labs
B. Only a chest X‑ray for the mother
C. Immediate MRI for the mother
D. No investigations needed

5. Maternal disseminated intravascular coagulation (DIC) after FDIU at 14 weeks is: 5. 14 सप्ताह पर FDIU के बाद मातृ DIC क्या है?
A. Common immediately in all cases
B. Rare but possible, especially with prolonged retention or infection
C. Impossible
D. Only occurs after 40 weeks

6. Management options for FDIU at 14 weeks include: 6. 14 सप्ताह पर FDIU का प्रबंधन विकल्प क्या हैं?
A. Expectant management, medical induction (e.g., misoprostol) or surgical evacuation depending on clinical scenario
B. Only immediate cesarean section
C. Long‑term antibiotics only
D. No options — prognosis fixed

7. Indication for urgent evacuation in the setting of FDIU at 14 weeks would be: 7. 14 सप्ताह पर FDIU के सेटिंग में त्वरित निकासी के लिए संकेत क्या होगा?
A. Maternal sepsis, heavy bleeding or coagulopathy
B. Parental anxiety alone without clinical problem
C. Mild pelvic discomfort only
D. Change in fetal sex

8. Counseling parents after confirmed FDIU at 14 weeks should include: 8. 14 सप्ताह पर पुष्टि किए गए FDIU के बाद माता‑पिता को परामर्श में क्या शामिल होना चाहिए?
A. Explanation of probable causes (e.g., chromosomal, infection), offer genetic counseling/tests, discuss management options and emotional support
B. Tell them nothing and discharge immediately
C. Only discuss diet
D. Recommend immediate travel abroad

9. On ultrasound, signs of a retained demised fetus (early) may include: 9. अल्ट्रासाउंड पर एक मृत भ्रूण के रहने के प्रारम्भिक संकेत क्या हो सकते हैं?
A. Absence of cardiac activity; collapsed fetal contour/overlapping skull bones may appear later
B. Increased vigorous fetal movements
C. Hyperactive heart on Doppler
D. New onset fetal breathing movements

10. Which follow‑up test is useful to help determine recurrence risk after FDIU at 14 weeks? 10. 14 सप्ताह पर FDIU के बाद पुनरावृत्ति जोखिम निर्धारित करने में कौन सी अनुवर्ती जांच उपयोगी है?
A. Fetal karyotype/microarray or parental genetic testing when indicated
B. Mother's shoe size measurement
C. Immediate MRI of the mother's brain in all cases
D. No tests are ever useful