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  6. Estimated Due Date (EDD) Ultrasound Scan (501)
Important: please update your RDS app to version 4.7.3

Welcome to the March 2025 update from the RDS team

1.     RDS issues - resolutions

1.1 Stability issues - Tactuum implemented a fix on 24th March which we believe has finally addressed the stability issues experienced over recent weeks.  The issue seems to have been related to the new “Tool export” function making repeated calls for content when new toolkit nodes were opened in Umbraco. No outages have been reported since then, and no performance issues in the logs, so fingers crossed this is now resolved.

1.2 Toolkit URL redirects failing– these were restored manually for the antimicrobial calculators on the 13th March when the issue occurred, and by 15th March for the remainder. The root cause was traced to adding a new hostname for an app migrated from another health board and made live that day. This led to the content management system automatically creating internal duplicate redirects, reaching the maximum number of permitted redirects and most redirects therefore ceasing to function.

This issue should not happen again because:

  • All old apps are now fully migrated to RDS. The large number of migrations has contributed to the high number of automated redirects.
  • If there is any need to change hostnames in future, Tactuum will immediately check for duplicates.

1.3 Gentamicin calculators – Incidents have been reported incidents of people accessing the wrong gentamicin calculator for their health board.  This occurs when clinicians are searching for the gentamicin calculator via an online search engine - e.g. Google - rather than via the health board directed policy route. When accessed via an external search engine, the calculator results are not listed by health board, and the start page for the calculator does not make it clearly visible which health board calculator has been selected.

The Scottish Antimicrobial Prescribing Group has asked health boards to provide targeted communication and education to ensure that clinicians know how to access their health board antimicrobial calculators via the RDS, local Intranet or other local policy route. In terms of RDS amendments, it is not currently possible to change the internet search output, so the following changes are now in progress:

  • The health board name will now be displayed within the calculator and it will be made clear which boards are using the ‘Hartford’ (7mg/kg) higher dose calculator
  • Warning text will be added to the calculator to advise that more than one calculator is in use in NHS Scotland and that clinicians should ensure they access the correct one for their health board. A link to the Right Decision Service list of health board antimicrobial prescribing toolkits will be included with the warning text. Users can then access the correct calculator for their Board via the appropriate toolkit.

We would encourage all editors and users to use the Help and Support standard operating procedure and the Editors’ Teams channel to highlight issues, even if you think they may be temporary or already noted. This helps the RDS team to get a full picture of concerns and issues across the service.

 

2.     New RDS presentation – RDS supporting the patient journey

A new presentation illustrating how RDS supports all partners in the patient journey – multiple disciplines across secondary, primary, community and social care settings – as well as patients and carers through self-management and shared decision-making tools – is now available. You will find it in the Promotion and presentation resources for editors section of the Learning and support toolkit.

3.     User guides

A new user guide is now available in the Guidance and tips section of Resources for providers within the Learning and Support area, explaining how to embed content from Google Calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream and Jotforms into RDS pages. A webinar for editors on using this new functionality is scheduled for 1 May 3-4 pm (booking information below.)

A new checklist to support editors in making all the checks required before making a new toolkit live is now available at the foot of the “Request a new toolkit” standard operating procedure. Completing this checklist is not a mandatory part of the governance process, but we would encourage you to use it to make sure all the critical issues are covered at point of launch – including organisational tags, use of Alias URLs and editorial information.

4.Training sessions for RDS editors

Introductory webinars for RDS editors will take place on:

  • Tuesday 29th April 4-5 pm
  • Thursday 1st May 4-5 pm

Special webinar for RDS editors – 1 May 3-4 pm

This webinar will cover:

  1. a) Use of the new left hand navigation option for RDS toolkits.
  2. b) Integration into RDS pages of content from external sources, including Google Calendar, Google Maps and simple Jotforms calculators.

Running usage statistics reports using Google analytics

  • Wednesday 23rd April 2pm-3pm
  • Thursday 22nd May 2pm-3pm

To book a place on any of these webinars, please contact Olivia.graham@nhs.scot providing your name, role, organisation, title and date of the webinar you wish to attend.

5.New RDS toolkits

The following toolkits were launched during March 2025:

SIGN guideline - Prevention and remission of type 2 diabetes

Valproate – easy read version for people with learning disabilities (Scottish Government Medicines Division)

Obstetrics and gynaecology induction toolkit (NHS Lothian) – password-protected, in pilot stage.

Oral care for care home and care at home services (Public Health Scotland)

Postural care in care homes (NHS Lothian)

Quit Your Way Pregnancy Service (NHS GGC)

 

6.New RDS developments

Release of the redesign of RDS search and browse, archiving and version control functionality, and editing capability for shared content, is now provisionally scheduled for early June.

The Scottish Government Realistic Medicine Policy team is leading development of a national approach to implementation of Patient-Reported Outcome Measures (PROMs) as a key objective within the Value Based Health and Care Action Plan. The Right Decision Service has been commissioned to deliver an initial version of a platform for issuing PROMs questionnaires to patients, making the PROMs reports available from patient record systems, and providing an analytics dashboard to compare outcomes across services.  This work is now underway and we will keep you updated on progress.

The RDS team has supported Scottish Government Effective Prescribing and Therapeutics Division, in partnership with Northern Ireland and Republic of Ireland, in a successful bid for EU funding to test develop, implement and assess new integrated care pathways for polypharmacy, including pharmacogenomics. As part of this project, the RDS will be working with NHS Tayside to test extending the current polypharmacy RDS decision support in the Vision primary care electronic health record system to include pharmacogenomics decision support.

7. Implementation projects

We have just completed a series of three workshops consulting on proposed improvements to the Being a partner in my care: Realistic Medicine together app, following piloting on 10 sites in late 2024. This app has been commissioned by Scottish Government Realistic Medicine to support patients and citizens to become active partners in shared decision-making and encouraging personalised care based on outcomes that matter to the person. We are keen to gather more feedback on this app. Please forward any feedback to ann.wales3@nhs.scot

 

 

Estimated Due Date (EDD) Ultrasound Scan (501)

Warning
Please report any inaccuracies or issues with this guideline using our online form

EDD should be calculated from the first scan ≥ 11+ 2 weeks gestational age (≥ 45mm).

If the initial scan is performed < 11+2 weeks gestation, the patient should have a return appointment at approximately 12-13 weeks gestation to perform optimal dating +/- NT measurements.
(Refer to Screening / Non-screening Pathways)

Upper and lower limbs must be assessed as well as cranial anatomy

As adapted from Chudleigh, Loughna & Evans (2011) from BMUS.

Parameter 

Parameter used for establishing EDD

Down’s Syndrome Screening method

CRL < 45.0mm

Unable to date. Re-scan at 12-13 weeks gestation

N/A

CRL 45.0mm – 84.0mm

CRL

First Trimester CUBS 

CRL >84mm  and HC< 101.0mm

Unable to date.  Re-scan ≥ 14+2 weeks gestation

No screening until EDD confirmed

HC ≥ 101.0mm – 172.0mm

HC

Second Trimester Bloods only (AFP)

Recommended criteria for measurement of CRL for pregnancy dating (UKNSC, 2015):

CRL DETAIL TO BE DEMONSTRATED
MIDLINE SECTION
  • Sagittal section of the fetus with the head in line with the full length of the body
  • Echogenic tip of the nose
  • Rectangular shape of the palate
  • Translucent Diencephalon
  • CRL axis should be between 0-30 degrees to horizontal
  • Clearly defined crown and rump 
POSITION
  • Pocket of fluid, at least equivalent in size to the width of the palate, should be visible between the fetal chin and chest 
  • Fetal palate angle should be 30º to 60º relative to the horizontal 
  • Nasal tip should be level or above the anterior abdominal wall 
MAGNIFICATION
  • Entire CRL section should fill over 60% of the screen 
CALIPER PLACEMENT
  • Correct calliper placement on outer borders of crown and rump
  • Longest length of the fetus should be measured
IMAGE ARCHIVING
  • The CRL should be measured at least twice and the maximum measurement that meets the criteria should be recorded 
  • The image demonstrating the measured CRL which has been reported should be archived

The HC should be calculated using the recommended values of Altman and Chitty as per BMUS recommendations.

Technique for calculation of HC:

A cross-sectional view of the fetal head at the level of the ventricles should be obtained. The image should have the midline echo lying as close as possible to the horizontal plane.

The following landmarks should be identified and the image frozen:

  • rugby ball shape;
  • centrally positioned, continuous midline echo broken at one third of its length by the cavum septum pellucidum;
  • anterior walls of the lateral ventricles centrally placed around the midline;
  • the choroid plexus should be visible within the posterior horn of the ventricle in the distal hemisphere.
  • Callipers should be placed on the outer border of the occipital and frontal bones as close as possible to the midline across the longest part of the skull.

If HC measurements cannot be made then EDD should be calculated using the femur length (FL)

Technique for calculation of FL:

The image should be obtained with the femur lying as close as possible to the horizontal plane. The full length of the bone should be visualised with soft tissue visible at both ends. Calipers should be placed at the centre of the ‘U’-shape at each end of the bone.

After 25 completed weeks the patient will be classed as ‘LATE BOOKER'.

All three measurement parameters [HC, AC and FL] should be obtained.

An EDD will be calculated from the HC measurement and entered on Badgernet. On the ultrasound report page type in comments ‘EDD based on HC >25 weeks GA’ and create a LATE BOOKER alert.

If there is discrepancy in the sizes between the fetuses, the EDD should be calculated from the largest fetus, using the criteria above.

Gestational age may be assessed from measurements of the mean sac diameter (MSD). This is calculated from the maximal diameters of the gestation sac (in mm) in the longitudinal and transverse views on transvaginal scan. The Mean gestation sac volume should be calculated where a transvaginal examination is declined using the full bladder technique.

An EDD should only be generated once a live embryo or fetus has been identified measuring ≥ 45mm.

Editorial Information

Last reviewed: 31/05/2022

Next review date: 31/05/2026

Author(s): Donna Maria Bean.

Version: 2

Approved By: Obstetrics Clinical Governance Group

Document Id: 501

References

Altman DG & Chitty LS (1997). New charts for ultrasound dating of pregnancy. Ultrasound Obstet Gynecol 10:174-91

Antenatal Care: Routine care for the pregnant healthy woman. National Institute of Clinical Excellence (NICE) Guildeline.

Chudleigh, T., Loughna, P and Evans, T. (2011). A practical solution to combining dating and screening for down’s syndrome. Education & Training 1:154-71

Fetal Anomaly Screening Programme Handbook for Ultrasound Practitioners. UKNSC  April 2015.

Fetal Size and Dating:Charts Recommended for Clinical Obstetric Practice. BMUS, Jan 2008

Guidelines for Professional Working Standards. Ultrasound Practice. United Kingdom Association of Sonographers. October 2008