LUTHERAN UNIVERSITY OF BRAZIL COURSE OF MEDICINE Department of Radiology and Diagnostic Imaging Ultrasound in Obstetrics Ultrasound in Obstetrics Chronology

of embryological development Day 14 - fertilization Day 18 - morula Day 20 - blastocyst implantation Day 23 bag germinal Primary Day 28 - yolk sac 5th - 10th week - the cardiovascular sys tem 6th - 10th week - TGI 8th - 10th week - kidneys 10th - 14th week - genitalia 6th - 9th Week - SNC 8 - 9 weeks - members Objectives of Ultrasound in 1st quarter -Find the gestational sac (intrauterine or ectopic)-ID: Embryonic death anembryo nic pregnancy embryos at higher risk of death-estimation of gestational age-rati ng of pregnancies multifetais number of embryos and chorionicity amniocidade Ultassonografia pregnancy normal intrauterine gestational sac: Transvaginal U.S. - seen at 5 weeks of menstrual age or with B-HCG> 1.160mUI/ml sonography - B-HCG> 1.800mUI/ml Bag germination (yolk sac) It is the first structure to emerge in the gestational sac. On sonography is see n when the SG has an average diameter of 10-15mm. At transvaginal U.S. is seen e arlier in SG de8mm or CCN diameter 2.2 mm. Vitellin vesicle: participates in the transfer of nutrients while the placental circulation is desnvolvendo (3rd-4th weeks), promotes hematopoiesis in Week 5 of'gado assume this role until the 8th week, will be part of TGI primitive Sac vitellin vesicle Sac vitellin vesicle Estimation of menstrual age in 1st quarter It is estimated more accurately at this time than at any other stage. By order o f appearance the following structures can be measured as indicators of menstrual age: Size-sac (5 th -10 th weeks) Average of three orthogonal dimensions of the inter face liquid / wall of the bag Mean diameter of gestational sac Up to 8mm: SG 6.6 weeks 16mm: SG + embryo 8.0 weeks 20mm: 8.5 wk. without embryos? CCN (craniocaudal length) with the use of transvaginal U.S. in the 5th week on a measure and has made accuracy less than that of DBP at the start of a quarter Embryo DBP, CC, CA, CF BPD diameter bi-parietal (more precisely at the end of a quarter CC: skull circu mference WC: waist circumference CF: femur length (more precisely on the 2nd and 3rd quarter) if the patient will make only one U.S. examination during pregnanc y the ideal is to make the 2nd quarter (between 1618 weeks)

The 2nd trimester (16-18 weeks) is the most appropriate time to evaluate patient s for routine due dates at clinically relevant information that can be collected from the fetus Bi-parietal diameter (BPD) Skull circumference (WC) Femur length (FL) Other uses: Embryonic death - one of the most important roles of the U.S. in the first quart er is the failure to diagnose early pregnancy and embryonic death. It is estimat ed that about 75% of pregnancies fail embryonic cardiac activity in this period - this is the most important feature individually for confirmation of embryonic and fetal life. Sonography: when an embryo is identified should be cardiac activ ity transvaginal U.S.: CCN with> or = 5mm already identifies Establishment of the date of pregnancy in the 2nd and 3rd quarter Measurements of fetal head-BPD, HC-femur length-abdominal circumference Assignment of gestational age -Up to 26 weeks: ultrasonographic criteria Thereafter, the date of the UPM (if r emembered with certainty) measures fetal gradually lose precision as a factor pr editivoda IG as the pregnancy progresses, so the age given at the first examinat ion shall not be changed thereafter * Gestational age at any stage should be based on the initial U.S. study, calcul ated by adding up to gestational age assigned at the 1st examination of the numb er of Semans passed since the exam. * From measurements of BPD, AC, CC and FC and compared with normal standards for gestational age in question, based on initial U.S., determine if the fetus is in the appropriate size. COMPLICATIONS-ectopic pregnancy Classic triad of pain, abnormal vaginal bleeding and a palpable mass in the anne xes is only observed in 15% of patients. Specific findings to the U.S.: Embryo l ive attached Nonspecific findings to the U.S. (correlate with BHCG) Gestational Uterus empty Pseudosaco Ascites particulate Adnexal Mass Treatment: Surgical Improvement of d iagnostic accuracy, including TVUS, allows earlier diagnosis and a more conserva tive approach