ObjectiveTo assess the advantage of applying uterine fundal pressure to assist transvaginal sonographic imaging of early second-trimester fetal anatomy.MethodsOne hundred consecutive patients with singleton fetuses underwent routine transvaginal sonographic assessment of fetal anatomy between 13 and 17 weeks' gestation. If the entire fetal anatomy including cardiac outflow tracts was not depicted, uterine fundal pressure was applied with the operator's nonscanning hand in a bimanual fashion, to faciliate transvaginal imaging. Transabdominal fashion, to facilitate transvaginal sonography. Observed fetal structures with and without fundal pressure were compare. Factors assessed that may have modified the value of fundal pressure included patient weight, gestational age, fetal presentation, previous abdominal surergy, and the presence of uterine fibroids. Statistical analysis included McNemar test, χ2, Fisher exact test, andttest, withP< .05 considered significant.ResultsVisualization of lower limbs, head (including intracranial structures), upper limbs, kidneys, spine, gender, feet, hands (digits), face, four-chamber view, and cardiac outflow tracts was significantly enhanced by uterine fundal pressure-assisted versus nonassisted transvaginal sonography. Uterine fundal pressure improved transvaginal sonographic imaging in 91% of subjects, and in 51% of all subjects, a complete examination was thus obtained. In 20% of all subjects, transabdominal sonography was required to complete the examination. Complete fetal anatomic scaning was unobtainable despite uterine fundal pressure suplemented by transabdominal sonography in 29% of cases. Completion of the transvaginal sonography in 29% of cases. Completion of the transvaginal sonographic fetal anatomic survey with uterine fundal pressure was related to gestational age (P< .02) and maternal weight (P< .05) yet not related to fetal presentation (P= .13), previous abdominal surgery (P= .06), or uterine fibroids (P= .26).ConclusionUterine fundal pressure applied during early second-trimester transvaginal sonographic evaluation of fetal anatomy significantly improves visualization of fetal structures otherwise loacted beyond the effective range of the transvaginal transducer.