Khao Sat Sieu Am San Khoa

KHO ST SIU M
SN KHOA
BS. NGUYN QUANG TRNG
KHOA CHN ON HNH NH

BNH VIN AN BNH-TP.HCM
NI DUNG
i cng.
Mc tiu kho st trong tam c nguyt I.
Mc tiu kho st trong tam c nguyt II & III.
Ti liu tham kho.
I CNG
Ian Donald v cng s a siu m vo sn khoa

t nm 1958.
T n nay, khng c bt c bng chng khoa hc
no chng t siu m nh hng n s pht trin ca
thai nhi.
Trn 50 triu sn ph c siu m v nhiu
nghin cu dch t c bo co cho thy khng
tng tn sut thai cht, thai d dng, thai chm pht
trin trong t cung, u c tnh tr em.
C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition. 2005. p1039-1055
Cng khng c bng chng cho thy tr sinh ra b ri

lon hnh vi, cng nh khng nh hng n kh
nng c, vit, ton hcca tr.
Cho n nay, ngi ta cho rng sn ph cn c siu
m 3 ln cho mt thai k:
Tam c nguyt I (11-14 tun).
Tam c nguyt II (18-22 tun).
Tam c nguyt III (31-33 tun).
MC TIU KHO ST TRONG TAM C NGUYT I

1. Ti thai (gestational sac), ti
non hon (yolk sac), phi
thai (embryo), hot ng tim
thai.
2. S thai (i/nhau).
3. o chiu di u-mng
(CRL:crown-rump length).
4. Kho st lp m vng gy
(NT: nuchal translucency).
5. Kho st xng mi (nasal
bone) (tun 11-14 thai k).
6. Kho st van 3 l.
7. Kho st ng tnh mch.

TI THAI-TI NON HON-PHI THAI-TIM THAI
Lu rng, khi siu m qua ng m o, mt phi thai c chiu di

u-mng (CRL) < 5 mm, c th cha thy c tim thai !
Ch c chn on thai h sm (early pregnancy failure) khi CRL
5 mm m vn khng thy tim thai.
TVS: CRL > 5mm, khng thy tim thai Thai h sm

S THAI
a thai
N. Perrot et al. Echographie Endovaginale-Doppler couleur en Gynecologie-Obstetrique. 2004
MC TIU KHO ST TAM C NGUYT I

O CHIU DI U-MNG
A: cch o chnh xc
B: o khng chnh xc
o chiu di u-mng (CRL), o

b dy lp m vng gy (NT).
MC TIU KHO ST TAM C NGUYT I

KHO ST LP M VNG GY
CCH O NT
1. Ly mt ct dc gia.
2. u thai nhi t th trung gian.
NUCHAL TRANSLUCENCY
-Thc hin t tun th 11-14 (CRL=4584mm).
3. Phng i hnh nh sao cho u v

ngc thai nhi chim ton b mn hnh.
-> 95% trng hp ta c th o c NT

trn siu m qua ng bng, ch < 5% phi
thc hin qua ng m o.
4. Chn o v tr lp m ln nht.
- Bt thng khi 3mm.
5. o trong-trong (on-to-on).
- ngha: Nguy c cao Trisomy 21, 18, 13.
Lu :
1. Khng c lm b mt da gy vi
mng i (v nh ln bng hoc yu
cu thai ph ho vi ting).
2. Dy rn qun c i khi lm vi dy
bt thng NT.
Lp m
vng gy
Bt thng
NST
3,5-4,4 mm
4,5-5,4 mm
5,5-6,4 mm
>6,5 mm
NST bnh thng
21,1%
Thai cht
2,7%
D tt ln
10,0%
33,3%
50,5%
64,5%
3,4%
10,1%
19,0%
18,5%
24,2%
46,2%
Tn sut Trisomy 21 tng:

- Gp 3 ln khi NT = 3mm.
Mt ct dc gia
u qu nga
u t th trung gian
Phng i hnh nh
CRL: 54 mm
1.5
2.9
Chn v tr lp m lp nht
Cch o chun (trong-trong)
o khng chun
o thiu
o tha
Khng lm mng i vi da gy ca thai nhi
Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003
Khng lm dy rn qun c vi dy bt thng NT
Thai 12 tun, lp m vng gy = 3,7mm
TRISOMY 21
Thai 12 tun, NT = 8mm: Trisomy 21
Katherine W. Fong et al. Detection of Fetal Structural Abnormalities with US during Early
Pregnancy. Radiographics. 2004;24:157-174.
Thai 12,5 tun, NT = 4,3mm:

Trisomy 21.
Thai 13 tun, NT = 5 mm, thai ph

42 tui: Trisomy 21.
NT = 5,6 mm: Trisomy 18
Dy bt thng lp m vng gy
TRISOMY 21

KHO ST XNG MI
Cc nghin cu ch ra rng 73% thai nhi Trisomy 21

khng thy xng mi khi siu m vo tun 11-14:
EQUAL SIGN (-).
Ngc li, thai nhi bnh thng, xng mi thy
c trong 99,5% trng hp: EQUAL SIGN (+).
XNG MI (NASAL BONE)

- Kho st t tun th 11.
- Bt sn: khng thy xng mi.
- ngha: Nguy c cao Trisomy 21.
CCH KHO ST NASAL BONE

- Ly mt ct dc gia mt thai nhi, c gng
chnh hng u d sau cho ng trncm to vi chm tia siu m mt gc 450.
- Phng i hnh nh sao cho u v ngc
thai nhi chim ton b mn hnh.
- Bnh thng ta thy hai ng hi m dy
song song (du =: equal sign); ng trn l
da vng mi, ng di l xng mi.
ng th 3 cao hn lin tc vi da, l
chp mi (tip).
EQUAL SIGN (-)
Thai 12 tun, Equal sign (-):

Trisomy 21.
Katherine W. Fong et al. Detection of Fetal Structural Abnormalities with US during Early
Pregnancy. Radiographics. 2004;24:157-174.

KHO ST VAN BA L
Cc nghin cu ch ra rng h van 3 l thy

74% thai nhi Trisomy 21.
Ngc li, thai nhi bnh thng ch thy h
van 3 l trong 7% trng hp.
H VAN 3 L (TRICUSPID REGURGITATION)

- Kho st t tun th 11.
- c xem l ph h van 3 l khi v > 60cm/s
v ko di ti thiu na th tm thu.
(v vn tc van MP c th t vmax = 50cm/s).
CCH KHO ST
- Ly mt ct 4 bung t mm (apical four chamber
view).
Ph m van 3 l
- Dng Doppler kho st.

- Ca s (gate) t l van 3 l, bao gm c nh v
tht phi, kch thc ca s = 3mm.
- ng kho st to vi vch lin tht mt gc <
300 (gc l tng l 00).
Ph m van MP ( 50cm/s)
Fetal Medicine Foundation - Down Syndrome Screening at 11-14 Weeks
Ph m van MP ( 50cm/s)
Ph h van 3 l
Ph h 3 l thong qua (< na th

tm thu) khng c ngha bnh l.
H VAN 3 L (TRICUSPID REGURGITATION)
Ngoi ra ngi ta cn dng Doppler mu nh gi h van 3 l da

vo ph h trong th tm thu.
Greggory R. DeVore, MD. Fetal Echocardiography. 2005

KHO ST NG TNH MCH
TM rn (UV) chy vo
gan hp vi xoang tnh
mch ca (portal sinusPS).
Sozos J. Fasouliotis, MD et al. The Human Fetal Venous System

Normal Embryologic, Anatomic, and Physiologic Characteristics and Developmental Abnormalities.
J Ultrasound Med 21:1145-1158 0278-4297, 2002
15 cm/s
15 cm/s
50%
Ductus venosus
50% lng mu t xoang

TM ca qua gan tr v
cc TM gan (hepatic veinsHV) ri v TM ch
di (inferior vena cavaIVC).
Mu t TMCD v TMCT
(superior vena cava-SVC)
vo nh (P) vi tc thp
(15cm/s).

J Ultrasound Med 21:1145-1158 0278-4297, 2002
60 cm/s
15 cm/s
50%
50%
Ductus venosus
50% mu giu oxy t TM

rn i vo ng tnh mch
(ductus venosus-DV) vi tc
cao (60cm/s) (do co bp
ca thnh mch) trc tip
vo TMCD, ri vo nh
(P), qua l bu dc, ti nhtht (T), t vo MC v
ln nui no thai nhi.

J Ultrasound Med 21:1145-1158 0278-4297, 2002
C s phn dng trong lng TMCD:

Mu t cc TM gan v TMCD, chy dc theo
pha sau-bn (postero-lateral) v nh (P) vi
vn tc 15cm/s.
Mu t ng TM v TMCD, chy dc theo pha
trc-trong (antero-median) v nh (P) vi vn
tc 60cm/s.
60cm/s
15cm/s
Mu t nh (P) xung tht (P), qua MP gc, ri qua

ng ng mch (ductus arteriosus) vo MC xung
nui phn di ca thai nhi.
Jerald P.Kuhn. Caffey's Pediatric Diagnostic Imaging. 10th Edition. 2004
Sau khi sinh:

- TM rn teo li tr thnh dy chng trn (ligamentum teres).
- ng tnh mch teo li tr thnh dy chng tnh mch (ligamentum venosum).
- Xoang TM ca tr thnh TM ca (T).
- L bu dc ng li, khng cn s thng thng gia nh (P) v nh (T).
- ng ng mch teo li tr thnh dy chng ng mch (ligament arteriosum).
- Hai M rn, on t M chu trong n bng quang tr thnh M bng quang
trn, on t bng quang n rn tr thnh dy chng rn bn (lateral umbilical
ligament).
- Bnh thng, S # 50-60cm/s, a > 0.

- Doppler ng TM bt thng khi: a = 0 hoc m
(ni ln s chnh lch p sut cao nh (P)).
- Tam c nguyt I (t tun 11-14): Doppler ng
TM bt thng gp thai nhi bt thng NST
v d tt tim.
Ph bnh thng
vi a > 0.
- Tam c nguyt II & III: Doppler ng TM bt

thng gp thai chm pht trin trong t cung
(IUGR) v thai d tt tim.
T tun 11-14: Doppler ng tnh mch bt thng gp 5% thai nhi c NST

bnh thng, v gp 80% thai nhi Trisomy 21.
Ph Doppler ng tnh mch bao gm 3 pha:
-S: tm thu tht, ng thi ng TM co bp mu qua l bu dc.
-D: tm trng tht, van 3 l m to p lc m, ht mu v tim.
-a: nh (P) co bp cui tm trng to ph o ngc.
Sau khi dng Doppler

mu xc nh ng tnh
mch, ta dng Doppler
xung o ph lt ct
dc cnh gia (P) hoc
lt ct ngang bng.
IVC
S
D
DV
UV
Bnh thng
A=0
A o ngc
KHO ST C BIT LU TRONG TAM C NGUYT I
1. Lp m vng gy (nuchal translucency).

2. Xng mi (nasal bone).
3. Van 3 l (tricuspid valve).
4. ng tnh mch (ductus venosus).
MC TIU KHO ST TRONG TAM C NGUYT II&III
S thai.
Ngi thai.
Gii phu thai nhi:
u v c .
Mt.
Ngc-bng.
Gii tnh.
Ct sng.
T chi.
o c kch thc thai.
Ch s i (AFI: amniotic fluid index).
Bnh nhau.
Dy rn.
T cung v phn ph ca sn ph.

S THAI
Vic u tin khi lm siu m thai l phi kim tra s thai.

Khi thai qu nh c th b st nhng trng hp a thai.
Khi thai qu ln, nu khng kim tra cn thn, rt d b
st, v vng kho st ca u d khng bao qut ht ton
bc thai.
Thm na, mt s trng hp a thai c bin chng, mt thai
nh dnh st vo thnh t cung, nu khng ch s b st.
Cht mt trong hai thai tam c nguyt II vi

hnh nh chng khp s (mi tn).

NGI THAI
Hng ct ca u d phi ng theo quy c quc t.

Qut u d dc v ngang bng thai ph gip nh v ngi
thai.
tam c nguyt II, ngi thai cn di ng.
Qua tam c nguyt III, ngi thai thng c nh.
Tuy nhin vn c nhng trng hp c bit, thai tr u vo
nhng tun cui ca thai k.
THAI NGI U (cephalic presentation)

THAI NGI MNG ( breech presentation)

THAI NGI NGANG ( transverse presentation)

THAI NGI NGANG ( transverse presentation)


KHO ST U-C
Vo th im ny, ta c th kho st hu ht cc cu
trc no trn siu m.
Ba mt ct chun (standard views) l:
Mt ct i th (thalamic view).
Mt ct no tht (ventricular view).
Mt ct tiu no (cerebellar view).
C.M.Rumack et al. Diagnostic

Ultrasound. 3rdEdition. 2005.
p1039-1055

KHO ST U - O B DY DA GY
Lu rng NT (nuchal translucency lp m vng

gy) ch kho st t tun th 11-14 ca thai k (cui
tam c nguyt I).
tam c nguyt II, ngi ta nhn thy rng thai nhi
b Trisomy 21 thng c s d tha lp da vng gy.
Cc nghin cu cng ch ra rng, khi b dy da gy
6 mm, th thai nhi c nguy c cao b Trisomy 21.
CCH KHO ST
T lt ct chun o BPD, ta
chch u v vng gy thai nhi,
ly lt ct qua tiu no v b ln.
B DY DA GY (NUCHAL FOLD)
-Thc hin t tun th 15-20.

- Bt thng khi 6mm (do cc np
da tha vng gy to thnh).
Cc nghin cu ch ra rng tng b dy da gy thy 33% thai

nhi Trisomy 21, trong khi t l ny thai nhi bnh thng l 0,6%.
NF=8mm. Trisomy 21
Ta phi phn bit lp m vng gy (nuchal translucency - NT) v b dy da gy

(nuchal fold - NF):
- Lp m vng gy - NT:
+ Thc hin lt ct dc gia thai nhi.
+ o vo cui tam c nguyt I (tun 11-14).
+ 3mm: nguy c cao bt thng nhim sc th (Trisomy 21, Trisomy 18,
Trisomy 13).
- B dy da gy - NF:
+ Thc hin lt ct ngang qua tiu no.
+ o vo u tam c nguyt II (tun 15-20).
+ 6mm: nguy c cao Trisomy 21.
NT
NF
http://www.thefetus.net
http://www.jultrasoundmed.org
http://radiographics.rsnajnls.org
24/06/2008
63

KHO ST MT

KHO ST XNG MI
cui tam c nguyt I (tun 11-14), bt sn xng

mi thai nhi l du hiu nguy c Trisomy 21.
Qua tam c nguyt II, ngi ta tip tc i tm s bt
sn hoc thiu sn xng mi.
Tuy nhin, cn phi lu rng xng mi ca thai
nhi cng nh ca ngi thuc mt s chng tc da
mu (c mi thp) thng ngn hn chng tc da
trng.
Xng mi bnh thng / thai 18 tun

XNG MI (NASAL BONE)
- Kho st trong tam c nguyt II.
- Bt thng:
+ Bt sn.
+ Thiu sn: Chiu di xng mi
< 2,5mm (hoc BPD/NB > 10).
Bt sn xng mi: Trisomy 21

Anthony O. Odibo, MD et al. Evaluating the Efficiency of Using Second-Trimester Nasal Bone
Hypoplasia as a Single or a Combined Marker for Fetal Aneuploidy. J Ultrasound Med 2006 25:437441
Thai 20 tun, xng mi bnh thng
Thai 19 tun, thiu sn xng mi
Thai 16 tun, bt sn xng mi
Thai 26 tun, bnh thng

Wesley Lee, MD et al. Nasal Bone Evaluation in Fetuses With Down Syndrome During the
Second and Third Trimesters of Pregnancy. J Ultrasound Med 2003 22:55-60
Thai 20 tun, trisomy 21

Wesley Lee, MD et al. Nasal Bone Evaluation in Fetuses With Down Syndrome During the
Second and Third Trimesters of Pregnancy. J Ultrasound Med 2003 22:55-60
LU
- Bt sn c gi tr hn thiu sn xng mi trong nh gi
nguy c bt thng NST.
- Cc nghin cu ch ra rng: xng mi ca thai nhi bnh
thng thuc mt s chng tc da mu c mi thp thng
ngn hn chng tc da trng. Do vy, cn cn thn khi kt
lun thiu sn xng mi thai nhi cc chng tc ny (trong
c Vit Nam).

KHO ST NGC-BNG
Khi u bng vic kho st situs (kiu hnh tng quan cc

tng ca thai nhi). Hu ht thai nhi c kiu hnh situs solitus:
Mm tim bn (T), MC xung bn (T), d dy bn (T).
Tip n nh gi 4 bung tim: bnh thng 4 bung tim cn
i.
Dng TM mode o nhp tim thai. Vi nhng trng hp
thai ra huyt hoc thai ph khng cm nhn c c ng ca
thai, th cn phi chp v lu hnh TM mode biu din nhp
tim thai.
SITUS V TN SUT BNH TIM BM SINH
Mm tim bn (T), MC xung

bn (T), d dy bn (T).
Mm tim bn (P), MC xung

bn (P), d dy bn (P).
Mm tim bn (T), MC xung

bn (T), d dy bn (P).
Mm tim bn (P), MC xung

bn (P), d dy bn (T).
NGI U
Tim bn (T),
d dy bn (T),
MC xung
bn (T)
NGI MNG
Tim bn (P)
D dy bn (P)
MC xung bn (P)
- Trc tim bnh thng 450.

- Phn ln tim nm bn (T) ca lng ngc, ch c nh (P) nm bn (P)
ca lng ngc.
- Nh (T) l cu trc nm gn ct sng nht.
- im giao nhau ca vch lin nh vi b sau tim (im P) nm ngay bn
phi ca im gia lng ngc.
- Din tch tim 1/3 din tch lng ngc.
- MC ngc nm bn (T) ct sng, TMCD nm bn (P) ct sng.
Tim thai chm (bradycardia) khi < 100 ln/pht

Tim thai nhanh (tachycardia) khi > 180 ln/pht
i vi khm siu m thai thng quy, vic kho st tim thai c

xem l khi: thai ph khng c yu t nguy c, thai nhi situs solitus
(hoc situs inversus), din tch tim 1/3 din tch lng ngc, 4 bung
tim cn i, nhp tim u v tn s tim trong gii hn bnh thng.
C 3 cu trc vng ngc bng cn lu tm kim,

v nu c s tng nguy c bt thng nhim sc th:
m hi m dy trong tim.
Rut hi m dy.
Dn i-b thn.

KHO ST M HI M DY TRONG TIM
M HI M DY TRONG TIM
- Do vi ha tr c.
- Thy mt ct 4 bung tim.
- Thy 25% thai nhi Trisomy 21,
trong khi thai nhi bnh thng t l
ny l 4%.
m hi m dy trong hai
bung tht: Trisomy 21

KHO ST RUT HI M DY
RUT HI M DY
- C th thy Trisomy 21, 18 v 13.
- Thy 13% thai nhi Trisomy 21,
trong khi thai nhi bnh thng t l
ny l 0,6%.
Rut hi m dy : Trisomy 21

KHO ST B THN
DN B THN
- Gi l dn b thn khi ng knh
trc-sau ca b thn:
+ 5mm: tam c nguyt II.
+ 7mm: tam c nguyt III.
- Dn b thn nh thy 18% thai nhi
Trisomy 21, trong khi thai nhi bnh
thng t l ny l 3%.
Dn b thn 7mm hai bn:
Trisomy 21
- Dn b thn va v nng thng

thy Trisomy 18 v 13.

KHO ST GII TNH
Lut php cm BS tit l gii tnh cho thai ph. Tuy nhin
iu khng c ngha l BS khng cn phi kho st gii
tnh cho thai nhi.
Vic kho st gii tnh c bit hu ch nhng trng hp a
thai, cha m mc bnh di truyn theo nhim sc th gii tnh.
Ngoi ra, ta cn c th chn on c mt s thai nhi bnh l
vi gii tnh m h (ambiguous sex).
Trong kt qu siu m, phn gii tnh ta nn tr li l c thy
(trong trng hp gii tnh bnh thng), khng thy (trong
trng hp khng kho st c).
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24/06/2008
89

KHO ST CT SNG
MC TIU KHO ST TAM TRONG C NGUYT II&III

KHO ST T CHI
Polydactyly: Trisomy 18
Clubfoot

KHO ST XNG I NGN
XNG I NGN
- Xng i ngn c th thy
Trisomy 21v 18.
- 41% thai nhi Trisomy 21 c xng
i ngn, trong khi t l ny thai nhi
bnh thng l 5%.
Gi l xng i ngn khi 90% so vi
tr s bnh thng, hoc < 3rd centile

Anthony O. Odibo, MD et al. Evaluating the Efficiency of Using Second-Trimester Nasal Bone Hypoplasia as
a Single or a Combined Marker for Fetal Aneuploidy. J Ultrasound Med 2006 25:437-441
MC TIU KHO ST TAM C NGUYT II&III

O NG KNH LNG NH-CHU VI VNG U

O NG KNH CHIU DI XNG I

KHO ST NC I
Cho n nay vn cn nhiu cch nh gi nc i

khc nhau. Tuy nhin nh gi ch s i (amniotic
fluid index - AFI) c xem l ng tin cy nht.
AFI c o thng quy t tam c nguyt III.
kt qu khng sai lch, ta cn phi tun th nhng
nguyn tc khi tin hnh o c.
- Khoang i c o v tr ln nht mi , v tnh bng n v cm.

+ Khoang i ny phi c b ngang ti thiu 1cm.
+ o theo chiu dc ng.
+ Loi tr cc phn nh ca thai nhi v dy rn.
- AFI l tng ca 4 s o:
+ AFI < 2: V i.
+ AFI < 4 : Thiu i nng
+ AFI < 8 : Thiu i
+ AFI > 24 : a i
+ AFI > 32 : a i nng
Thumb rule: - Gi l a i khi khoang i ln nht c b dy > 8cm.
- i bnh thng khi khoang i ln nht c b dy 2-8cm.
- Gi l thiu i khi khoang i ln nht c b dy < 2cm.
Mark Deutchman,MD. Obstetric Ultrasound Principles and Techniques.1995.

KHO ST BNH NHAU
trng thnh ca bnh nhau gip nh gi s

trng thnh phi ca thai nhi. iu ny rt quan
trng cho cc nh sn khoa trong vic hn ch n
mc thp nht nhng trng hp tr sinh non mc
bnh mng trong.
Kho st v tr bm ca bnh nhau gip tin lng
nhau tin o.
TRNG THNH CA BNH NHAU THEO GRANNUM
0: Hi m ng dng, b nhn
1: Hi m th, b g gh
2: Vi ha y v cc mi
nhau
3: Vi ha nhiu v nhng
vng hi m trng
TRNG THNH CA BNH NHAU THEO GRANNUM
0: Hi m ng dng, b nhn
1: Hi m th, b g gh
2: Vi ha y v cc mi nhau
3: Vi ha nhiu v nhng vng

hi m trng
Y. Robert et al. Echographie en practique

Obstetricale. 2003
TRC 28 TUN
(xc nh v tr bm ca mp trn bnh nhau)
Nhau mt trc:
- Nhm I: mp trn bnh nhau bm sau-trn.
- Nhm II: mp trn bnh nhau bm trc-trn.
- Nhm III: mp trn bnh nhau bm trc-di.
Nhau mt sau:
- Nhm I: mp trn bnh nhau bm trc-trn.
- Nhm II: mp trn bnh nhau bm sau-trn.
- Nhm III: mp trn bnh nhau bm sau-di.
TIN LNG NHAU TIN O DA VO B TRN

CA BNH NHAU THEO DENHEZ
B trn na trn thn t
cung: nguy c nhau tin
o < 10%.
B trn vt qua im gia

y t cung: khng c
nguy c nhau tin o.
B trn na di thn t
cung: nguy c cao nhau
tin o.
Y. Robert et al. Echographie en practique Obstetricale. 2003
SAU 28 TUN
(xc nh v tr bm ca mp di bnh nhau)
- Nhau bm thp: mp di nhau cch l trong CTC < 2cm.
- Nhau bm mp: mp di nhau bm st l trong CTC.
- Nhau tin o: mp di nhau ph qua l trong CTC.
Lu : nhau bm thp hoc nhau bm mp

gia tam c nguyt III c th tr thnh
nhau bm bnh thng vo cui thai k.
PHN LOI NHAU TIN O THEO NYBERG-CALLEN
SA qua ng thnh bng
SA qua ng m o
Marginal placenta previa

Placenta previa

KHO ST DY RN
Doppler mu c th gip ta chn on c cc bt

thng dy rn: dy rn qun c (mt hoc nhiu
vng), hnh nh trn ln cung rn trong thai i mt
mng m/mt mng i (MC/MA twins), cung rn
tht nt (cord knot), cung rn c s lng mch mu
bt thng (2 hoc 4) v vasa previa (cung rn tin
o).
Hai cung rn trn ln MC/MA twins

Cord knot
Velamentous insertion (cung

rn cm mng)
Central insertion (99%)
Eccentric insertion
Velamentous insertion: tng nguy c thai chm pht trin trong TC,
thai sinh non, d tt thai, c thai ra huyt, vasa previa.
Thai 20 tun ra huyt
Eccentric cord insertion
Thai 32 tun, IUGR, M rn c

RI cao, NST bnh thng.
Chuyn d 35 tun, thai nng 1700g, bnh nhau rt nh.
Vasa previa: cung rn cm mng (velamentous insertion), bng qua

l trong c TC (cung rn tin o). T l thai cht rt cao do xut
huyt xy ra khi mch mu b x rch lc chuyn d hoc khi v i.
Xo nh do chuyn ng c th
lm vi vasa previa, do vy cn
phi dng Doppler xung xc
nh ph mch mu ca cung rn
chn on xc nh.
KHO ST C BIT LU TRONG TAM C NGUYT II
1. Van 3 l (tricuspid valve).

2. ng tnh mch (ductus venosus).
3. Xng mi (nasal bone).
4. B dy da gy (nuchal fold, nuchal pad).
5. m hi m dy trong tim (echogenic foci in the fetal heart).
6. Rut hi m dy (echogenic bowel).
7. Dn b thn (pyelectasis).
8. Xng i ngn (short femur).
TI LIU THAM KHO

N. Perrot et al. Echographie Endovaginale-Doppler couleur en GynecologieObstetrique. 2004
Y. Robert et al. Echographie en practique Obstetricale. 2003
William Cusick, MD et al. Fetal Nasal Bone Length in Euploid and Aneuploid
Fetuses Between 11 and 20 Weeks Gestation. J Ultrasound Med 2004. 23:13271333
Katherine W. Fong et al. Detection of Fetal Structural Abnormalities with US
during Early Pregnancy. Radiographics. 2004;24:157-174.
Jodi M. Barboza, MD et al. Prenatal Diagnosis of Congenital Cardiac Anomalies:
A Practical Approach Using Two Basic Views. Radiographics. 2002;22:11251138.
Wesley Lee, MD et al. Nasal Bone Evaluation in Fetuses With Down Syndrome
During the Second and Third Trimesters of Pregnancy. J Ultrasound Med 2003
22:55-60
Anthony O. Odibo, MD et al. Evaluating the Efficiency of Using SecondTrimester Nasal Bone Hypoplasia as a Single or a Combined Marker for Fetal
Aneuploidy. J Ultrasound Med 2006 25:437-441

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KHO ST SIU M

KHOA CHN ON HNH NH

Ian Donald v cng s a siu m vo sn khoa

Cng khng c bng chng cho thy tr sinh ra b ri

C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition. 2005. p1039-1055

C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition. 2005. p1039-1055

C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition. 2005. p1039-1055

MC TIU KHO ST TRONG TAM C NGUYT I

MC TIU KHO ST TRONG TAM C NGUYT I

Lu rng, khi siu m qua ng m o, mt phi thai c chiu di

TVS: CRL > 5mm, khng thy tim thai Thai h sm

MC TIU KHO ST TRONG TAM C NGUYT I

MC TIU KHO ST TAM C NGUYT I

o chiu di u-mng (CRL), o

C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition. 2005. p1039-1055

MC TIU KHO ST TAM C NGUYT I

3. Phng i hnh nh sao cho u v

-> 95% trng hp ta c th o c NT

- Bt thng khi 3mm.

- ngha: Nguy c cao Trisomy 21, 18, 13.

NST bnh thng

Tn sut Trisomy 21 tng:

Cch o chun (trong-trong)

Khng lm mng i vi da gy ca thai nhi

Peter M. Doubilet et al. Atlas of Ultrasound in Obstetrics and Gynecology. 2003

Khng lm dy rn qun c vi dy bt thng NT

Thai 12 tun, lp m vng gy = 3,7mm

Thai 12 tun, NT = 8mm: Trisomy 21

Thai 12,5 tun, NT = 4,3mm:

Thai 13 tun, NT = 5 mm, thai ph

NT = 5,6 mm: Trisomy 18

MC TIU KHO ST TRONG TAM C NGUYT I

Cc nghin cu ch ra rng 73% thai nhi Trisomy 21

XNG MI (NASAL BONE)

CCH KHO ST NASAL BONE

EQUAL SIGN (-)

Thai 12 tun, Equal sign (-):

MC TIU KHO ST TRONG TAM C NGUYT I

Cc nghin cu ch ra rng h van 3 l thy

H VAN 3 L (TRICUSPID REGURGITATION)

- Dng Doppler kho st.

Fetal Medicine Foundation - Down Syndrome Screening at 11-14 Weeks

Ph h 3 l thong qua (< na th

H VAN 3 L (TRICUSPID REGURGITATION)

Ngoi ra ngi ta cn dng Doppler mu nh gi h van 3 l da

Greggory R. DeVore, MD. Fetal Echocardiography. 2005

MC TIU KHO ST TRONG TAM C NGUYT I

Sozos J. Fasouliotis, MD et al. The Human Fetal Venous System

50% lng mu t xoang

Sozos J. Fasouliotis, MD et al. The Human Fetal Venous System

50% mu giu oxy t TM

Sozos J. Fasouliotis, MD et al. The Human Fetal Venous System

C s phn dng trong lng TMCD:

Mu t nh (P) xung tht (P), qua MP gc, ri qua

Jerald P.Kuhn. Caffey's Pediatric Diagnostic Imaging. 10th Edition. 2004

Sau khi sinh:

- Bnh thng, S # 50-60cm/s, a > 0.

- Tam c nguyt II & III: Doppler ng TM bt

T tun 11-14: Doppler ng tnh mch bt thng gp 5% thai nhi c NST

Sau khi dng Doppler

KHO ST C BIT LU TRONG TAM C NGUYT I

1. Lp m vng gy (nuchal translucency).

MC TIU KHO ST TRONG TAM C NGUYT II&III

MC TIU KHO ST TRONG TAM C NGUYT II&III