Name of the Procedure:

Ultrasound, pregnant uterus, real-time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; each additional gestation (List separately in addition to code for primary procedure)

Summary

This procedure involves using real-time ultrasound imaging to measure the nuchal translucency (fluid-filled space at the back of a fetus's neck) in the first trimester of pregnancy. It can be performed transabdominally or transvaginally and includes measurements for each additional gestation in the case of multiple pregnancies.

Purpose

The procedure aims to assess the risk of chromosomal abnormalities, such as Down syndrome, in the developing fetus. It helps in early detection and intervention planning if required.

Indications

• Pregnant women in the first trimester
• Patients with a family history of chromosomal abnormalities
• Women over the age of 35
• Pregnancies achieved through assisted reproductive technology (ART)

Preparation

• No special preparation is required for a transabdominal ultrasound.
• A full bladder may be necessary for better imaging in transabdominal ultrasound.
• Patients may need to empty their bladder for the transvaginal approach.
• Routine obstetric evaluations.

Procedure Description

1. Transabdominal Approach:
   • The patient lies on her back.
   • A gel is applied to the abdomen.
   • A transducer (ultrasound probe) is moved over the abdomen to capture images.

2. Transvaginal Approach:

   • The patient lies on her back with feet in stirrups.
   • A lubricated transducer is inserted into the vagina to obtain images.

   The procedure involves capturing real-time images and measuring the nuchal translucency of each fetus in cases of multiple pregnancies.

Duration

Approximately 30 to 45 minutes.

Setting

Typically performed in a hospital radiology department, outpatient clinic, or specialized prenatal center.

Personnel

• Obstetrician or maternal-fetal medicine specialist
• Sonographer (ultrasound technician)
• Nurse (if necessary)

Risks and Complications

• Minimal risks associated with ultrasound imaging
• Possible discomfort from the transducer, especially in the transvaginal approach
• Rarely, minor vaginal spotting may occur after transvaginal ultrasound

Benefits

• Early detection of potential chromosomal abnormalities
• Non-invasive and generally painless
• Provides valuable information for prenatal care

Recovery

• No recovery time needed
• Patients can resume normal activities immediately
• Follow-up appointments may be scheduled depending on the findings

Alternatives

• Second trimester maternal serum screening
• Cell-free fetal DNA testing
• Invasive diagnostic procedures like chorionic villus sampling (CVS) or amniocentesis, which carry higher risk but provide definitive results

Patient Experience

• Patients may experience mild discomfort during the procedure.
• Transabdominal ultrasound feels similar to a regular abdominal ultrasound, while transvaginal might feel a bit more invasive but is typically well tolerated.
• Pain management is generally not required, and the procedure is conducted with care to ensure patient comfort.