FETAL IMAGING

MARIA JENINA MENDOZA SOYAO, MD, FPOGS,FPSUOG

SONOGRAPHY IN OBSTETRICS

ROLE OF ULTRASOUND
❖GESTATIONAL AGE
❖FETAL NUMBER
❖VIABILITY
❖PLACENTA LOCALIZATION
❖DIAGNOSIS OF FETAL ANOMALIES
• TECHNOLOGY
AND SAFETY
 The real time
image is produced
by the sound
waves that are
reflected back
from the fluid and
tissue interfaces of
fetus, amniotic fluid
and placenta.
Piezoelectric
crystals converts
electrical energy to
sound waves
picture displayed is produced by sound waves reflected back from the imaged structure
Alternating current is applied to a transducer containing piezoelectric crystals, which
converts electrical energy to high-frequency sound waves
Ultrasound refers to the sound
waves traveling at a frequency
above 20,000 hertz.

TVS TAS

• Probe • 5-10 mHz • 4-6 mHz

frequency

• Resolution • Very high • Moderate

• Small • Large
• Field of
view

OR 20kHz, ABOVE THE HIGHEST AUDIBLE FREQUENCY

 SAFETY
THE ALARA PRINCIPLE OR ”AS LOW AS REASONABLY
ACHIEVABLE”
• LOWEST POSSIBLE EXPOSURE SETTING TO GAIN NECESSARY
DIAGNOSTIC INFORMATION

• THERMAL & MECHANICAL INDICES

• NO CONFIRMED DAMAGING BIOLOGICAL EFFECTS IN
MAMMALIAN TISSUE

• NO FETAL HARM HAS BEEN DEMONSTRATED IN MORE THAN 30

YEARS OF USE

THERMAL INDEX
MECHANICAL INDEX
 GESTATIONAL AGE ASSESSMENT

CRL BPD FL AC HC
Most Most Correlates Most More
accurate accurate in well with affected by reliable
the 2nd BPD fetal growth than BPD if
+/-5-7 days head shape
trimester +/- 7-11 days +/- 14-21
days is abnormal
+/- 7-10days

if u want to confirm the aog and the edd-request ultrasound.

1(st trimester: tvs)(2nd And 3rd tri: pelvic or transabdominal utz.)
 GESTATIONAL AGE ASSESSMENT

The earlier the sonography is performed the

more accurate the age of gestation( AOG)

BPD, HC, AC, FL (composite aging) more

accurate in dating the AOG in 2nd and 3rd
trimester

1st trimeter: CRL most accurate in dating pregnancy on the 1st tri.
2nd and 3rd trimester: composite or the average of bpd, hc, ac and fl. the
machine computes for the AOG and EDD/ you can also compute for the
EDD manually-that is the 40th week of the fetus.
FIRST TRIMESTER
ULTRASOUND
 COMPONENTS OF FIRST
TRIMESTER ULTRASOUND
❖ GESTATIONAL SAC SIZE, LOCATION, AND NUMBER
❖ EMBRYO AND YOLK SAC
❖ CRL
❖ FETAL NUMBER, INCLUDING AMNIONICITY AND CHORIONICITY OF
MULTIFETAL GESTATIONS
❖ EMBRYONIC/FETAL CARDIAC ACTIVITY
❖ ASSESSMENT OF EMBRYONIC /FETAL ANATOMY APPROPRIATE FOR
1ST TRIMESTER
❖ EVALUATION OF MATERNAL UTERUS, ADNEXA AND CUL-DE-SAC.
❖ EVALUATION OF FETAL NUCHAL REGION WITH CONSIDERATION OF
FETAL NUCHAL TRANSLUCENCY ASSESSMENT

ALL LISTED IN THE ULTRASOUND REPORT, EXCEPT NUCHAL TRANSLUCENCY, YOU

HAVE TO REQUEST DONE AT 11-14 WEEKS
 INDICATIONS FOR FIRST TRIMESTER
ULTRASOUND
❖ CONFIRM INTRAUTERINE PREGNANCY

❖ EVALUATE A SUSPECTED ECTOPIC PREGNANCY

❖ DEFINE CAUSE OF AUB

❖ EVALUATE PELVIC PAIN
❖ ESTIMATE AOG
❖ DIAGNOSE OR EVALUATE MULTIFETAL GESTATION

❖ CONFIRM FETAL HEART TONE (FHT)

❖ ASSIST CHORIONIC VILLI SAMPLING, EMBRYO TRANSFER, LOCALIZATION, REMOVAL
OF IUD.

❖ ASSESS FOR FETAL ANOMALIES

❖ EVALUATE MATERNAL PELVIC MASSES/UTERINE ABNORMALITIES

❖ MEASURE NUCHAL TRANSLUCENCY WHEN PART OF SCREENING PROGRAM FOR FETAL

ANEUPLOIDY(11-14 WEEKS)

❖ EVALUATE SUSPECTED GTD

 CLINICAL SIGNIFICANCE

• TRANSVAGINAL
ULTRASOUND GESTATIONAL
SAC
(TVS)
• AT 5 WEEKS AOG YOLK SAC

GESTATIONAL
SAC SHOULD BE
PRESENT

5 WEEKS, IF SURE OF MENSES AND REGULARLY MENSTRUATING

CLINICAL SIGNIFICANCE

CARDIAC MOTION
USUALLY IS
OBSERVED WHEN
THE EMBRYO IS 5
MM IN LENGTH
(CRL)

AT 6 WEEK
SHOULD SEE EMBRYO
WITH CARDIAC
ACTIVITY

ALL EMBRYOS MEASURING MORE THAN 7 mm SHOULD HAVE CARDIAC ACTIVITY,

IF ABSENT EMBRYONIC DEMISE
 CLINICAL SIGNIFICANCE

ANEMBRY0NIC EMBRYONIC/FETAL
PREGNANCY DEMISE

MSD >25 mm ABSENT CRL > 7 mm

YOLK SAC AND EMBRYO ABSENT FHT

IF MSD IS 25 mm, THERE SHOULD BE YOLK SAC OR EMBRYO, IF ABSENT

ANEMBRYONIC PREGNANCY OR BLIGHTED OVUM
 NUCHAL TRANSLUCENCY

• DONE BETWEEN 11-14 WEEKS

• FETAL NUCHAL TRANSLUCENCY (LESS THAN : 3.0.MM)
• OFTEN IN CONJUNCTION WITH MATERNAL SERUM MARKERS
• DETECTION OF ANEUPLOIDY

MAXIMUM THICKNESS OF THE SUBCUTANEOUS TRANSLUCENT AREA BETWEEN THE

SKIN AND SOFT TISSUE OVERLYING THE FETAL SPINE AT THE BACK OF THE NECK
SECOND AND THIRD TRIMESTER
ULTRASOUND
 COMPONENTS OF STANDARD 2ND AND 3RD
TRIMESTER ULTRASOUND
❖ FETAL NUMBER, INCLUDING AMNIONICITY AND CHORIONICITY OF MULTIFETAL
GESTATIONS

❖ FHT
❖ FETAL PRESENTATION
❖ PLACENTA LOCALIZATION , APPEARANCE AND RELATIONSHIP TO THE TO INT OS
AND CORD INSERTION WHEN POSSIBLE

❖ AMNIOTIC FLUID VOLUME

❖ GESTATIONAL AGE ASSESSMENT

❖ FETAL WEIGHT ESTIMATION

❖ FETAL ANATOMICAL SURVEY, INCLUDING DOCUMENTATION OF TECHNICAL

LIMITATIONS

❖ EVALUATION OF MATERNAL, UTERUS , ADNEXA, AND CERVIX WHEN

APPROPRIATE..
 MATERNAL INDICATIONS
❖ VAGINAL BLEEDING

❖ ABDOMINAL /PELVIC PAIN

❖ PELVIC MASS
❖ SUSPECTED UTERINE ABNORMALITY

❖ SUSPECTED ECTOPIC PREGNANCY

❖ SUSPECTED MOLAR PREGNANCY

❖ SUSPECTED PLACENTA PREVIA

❖ SUSPECTED ABRUPTION

❖ PROM/PRETERM LABOR
❖ CERVICAL INSUFFICIENCY

❖ ADJUNCT TO CERVICAL CERCLAGE

❖ ADJUNCT TO AMNIOCENTESIS
❖ ADJUNCT TO EXTERNAL CEPHALIC VERSION
 FETAL INDICATIONS
❖ GESTATIONAL AGE ESTIMATION
❖ FETAL GROWTH EVALUATION
❖ SIGNIFICANT UTERINE SIZE/DATE DISCREPANCY
❖ SUSPECTED MULTIFETAL GESTATION
❖ FETAL ANATOMICAL GESTATION
❖ FETAL ANOMALY SCREENING/ FF UP
❖ ASSESSMENT FOR FINDING THAT RAISE THE ANEUPLOIDY RISK
❖ ABNORMAL BIOCHEMICAL MARKERS
❖ FETAL PRESENTATION DETERMINATION
❖ SUSPECTED OLIGO/POLYHYDRAMNIOS
❖ FETAL WELL-BEING EVALUATION
❖ HISTORY OF CONGENITAL ANOMALY PRIOR TO PREGNANCY
❖ SUSPECTED FETAL DEATH
❖ FETAL CONDITION EVALUATION IN LATE REGISTRANTS FOR PRENATAL CARE
 THREE TYPES OF EXAMINATION

SPECIALIZED/ LIMITED
STANDARD (SPECIFIC )
TARGETED
FETAL NUMBER AND ❖CONGENITAL Fetal
PRESENTATION presentation
ANOMALY SCAN
CARDIAC ACTIVITY
Viability
AMNIOTIC FLUID ❖FETAL ECHO
VOLUME
AFV
PLACENTAL POSITION
FETAL BIOMETRY
Placenta
FETAL ANATOMY localization
 INDICATIONS FOR TARGETED FETAL ANATOMIC
ULTRASOUND EXAM
❖ MATERNAL DIABETES DIAGNOSED BEFORE 24 WEEKS
❖ ASSISTED REPRODUCTIVE TECHNOLOGY TO ACHIEVE CONTRACEPTION

❖ MATERNAL PREPREGNANCY BMI > 30 KGS/M

❖ MULTIFETAL GESTATION

❖ ABNOMAL SERUM AFP OR ESTRIOL LEVELS

❖ TERATOGEN EXPOSURE
❖ NT EQUAL ≥3 MM
❖ PARENTAL CARRIAGE OF GENETIC/CHROMOSOMAL ANOMALIES

❖ MATERNAL AGE ≥35 AT DELIVERY

❖ ABNORMAL ANEUPLOIDY SCREENING TEST RESULT
❖ MINOR ANEUPLOIDY MARKER

fetus at risk of anomalies--congenital

anomaly scan
 INDICATIONS FOR TARGETED FETAL ANATOMIC
ULTRASOUND EXAM
❖CONGENITAL INFECTION
❖DRUG DEPENDENCE
❖ALCOHOL ABUSE
❖ALLOIMMUNIZATION
❖AMNIOTIC FLUID ABNORMALITY

rubella- HEART DEFECTS, DEAFNESS, CATARACT, GLAUCOMA//CMV:

MICROCEPHALY, BLINDNESS, M.R//XRAY: MICROCEPHALY, SPINA BIFIDA, CLEFT
LIP/PALATE, LIMB DEFECTS//FETAL ALCOHOL SYNDROME: SMALL HEAD, FLAT
MIDFACE, SMOOTH PHILTRUM, SMALL EYE OPENING, SHORT NOSE, THIN UPPER LIP.
 2ND AND 3RD TRIMESTER ULTRASOUND

• FETAL BIOMETRY
1. BIPARIETAL DIAMETER (BPD)
2. HEAD CIRCUMFERENCE (HC)
3. ABDOMINAL CIRCUMFERENCE (AC)
4. FEMUR LENGTH (FL)
 GESTATIONAL AGE ASSESSMENT

BPD FL AC HC
Most Correlates Most More reliable
accurate in well with BPD affected by than BPD if
the 2nd fetal growth head shape is
+/- 7-11 days abnormal
trimester
+/- 14-21
+/- 7-10days days

4 parameters we measure to compute for the aog, bpd and fl usually

comparable with aog on the 2nd tri. AC not reliable affected by diet
 CERVICAL LENGTH MEASUREMENT

Requested if with history of preterm,

recurrent preterm, you have to request
not part of routine ultrasound. More
accurate if done using TVS. Cervix can
be T-shaped, y-shaped,v-shaped or u
shaped..
 AMNIOTIC FLUID MEASUREMENT

❖AMNIOTIC FLUID VOLUME

❖SINGLE VERTICAL POCKET:
NORMAL RANGE: 2-8 CM

❖OLIGOHYDRAMNIOS- <2 CM
❖HYDRAMNIOS/POLYHYDRAMNIOS –>24 CM
• ANHYDRAMNIOS- 0 , NO MEASURABLE
AMNIOTIC FLUID ON ALL 4 QUADRANTS

Oligohydramnios - seen as obvious

crowding of the fetus and absence of
any significant pockets of fluid.
NORMAL AND
ABNORMAL
FETAL
ANATOMY
CNS
 NEURAL TUBE DEFECTS

•.
SECOND MOST COMMON CONGENITAL ANOMALY.
DEFECTS INCLUDE ANENCEPHALY,
MYELOMENINGOCOELE (SPINA BIFIDA),
CEPHALOCOELE, OR OTHER SPINAL FUSHION (SCHISIS)

•.
ABNORMALITIES.
RESULT FROM INCOMPLETE CLOSURE OF NEURAL TUBE
BY THE EMBRYONIC AGE OF 26-28 DAYS.
CAN BE PREVENTED BY FOLIC ACID SUPPLEMENTATION.
MULTIFACTORIAL IF ISOLATED.
RECURRENCE RISK IS 3-5% IF W/O PERICONCEPTIONAL
FOLIC ACID SUPPLEMENTATION
 NEURAL TUBE DEFECTS

ANENCEPHALY ACRANIA
Absence of cranium absence of the
and telecephalic cranium with
structures above the protrusion of
level of skull base and disorganized brain
orbits. tissue
Final stage of acrania

Suspected, inability to see bpd and polyhydramnios. In cases of

polyhydramnios look for abnormality in the fetus and placenta
 NEURAL TUBE DEFECTS

CHIARI III
CEPHALOCOELE ENCEPHALOCOELE
MALFORMATION-

• herniation of • brain tissue, • herniation of

cerebellum and
meninges meninges, other posterior
with or CSF herniates fossa structures
without brain through skull
tissues defect.
through • MENINGOCOELE:
cranial • protrusion of
defect, meninges and
typically on CSF
the midline
occipital
region

depends on what protrudes on the cranium -meninges/brain

NEURAL TUBE DEFECTS
 NEURAL TUBE DEFECTS
SPINA BIFIDA
FIVE CRANIAL SIGNS:
1. SMALL BIPARIETAL DIAMETER (BPD)
2. VENTRICULOMEGALY
3. FRONTAL BONE SCALLOPING OR THE SO-CALLED
LEMON SIGN
4. ELONGATION AND DOWNWARD DISPLACEMENT OF
THE CEREBELLUM—THE SO-CALLED BANANA SIGN
5. EFFACEMENT OR OBLITERATION OF THE CISTERNA
MAGNA
 NEURAL TUBE DEFECTS

CHIARI II MALFORMATION
OR ARNOLD CHIARI MALFORMATION
SONOLOGIC FINDINGS
1. LEMON SIGN-FRONTAL SCALLOPING OF
FRONTAL BONES
2. BANANA SIGN-EFFACEMENT OF
CISTERNA MAGNA
3. VENTRICULOMEGALY

chiari 2 malformation usually have a form of

spina bifida(meningomyelocoele)
 CYSTIC HYGROMA

• VENOLYMPHATIC MALFORMATION WITH FLUID

FILLED SACS THAT EXTENDS FROM THE POSTERIOR
NECK.

• CAN BE DIAGNOSED AS EARLY AS FIRST TRIMESTER.

• 70% ASSOCIATED WITH ANEUPLOIDY

• ASSOCIATED WITH TRISOMY 21, TRISOMY XO

AND TRISOMY 18.

• SMALL CYSTIC HYGROMA MAY UNDERGO

SPONTANEOUS RESOLUTION, NORMAL KARYOTYPE
AND NORMAL HEART

• LARGE CYSTIC HYGROMA IS ASSOCIATED WITH

HYDROPS FETALIS AND CARRY A POOR
PROGNOSIS
 VENTRICULOMEGALY
• ENLARGEMENT OF THE CEREBRAL
VENTRICLES

• LATERAL VENTRICLE = 5 TO 10 MM
AT 15 WEEKS

• MILD VENTRICULOMEGALY IS
DIAGNOSED WHEN THE ATRIAL
WIDTH MEASURES 10 TO 15 MM

• SEVERE VENTRICULOMEGALY WHEN

IT EXCEEDS 15 MM
Lateral ventricle should be less than 10 mm,
-A dangling choroid plexus characteristically is
found in severe cases
-prognosis is determined by both etiology and
rate of progression
 DANDY-WALKER MALFORMATION

• ABNORMALITY OF THE POSTERIOR FOSSA

• COMPONENTS:
• AGENESIS OF THE CEREBRAL VERMIS
• ENLARGEMENT OF THE POSTERIOR FOSSA
• ELEVATION OF THE TENTORIUM
• SONOGRAPHIC FINDINGS:
• FLUID IN THE ENLARGED CISTERNA MAGNA
VISIBLY COMMUNICATES WITH THE 4TH
VENTRICLE THROUGH THE DEFECT IN THE
CEREBRAL VERMIS
•FACE AND NECK
 THREE MAIN TYPE OF CLEFTS

. Cleft lip and palate Isolated cleft palate Median cleft palate

Can be unilateral or • Begins with uvula, • Found and

bilateral soft palate and may association with
• Multifactorial involve you hard several conditions
• 40% associated with palate like agenesis of
aneuploidy • Not expected to be primary palate,
visualized during hypotelorism,
• Recurrence risk- 3-
standard holoprosencephaly.
5%
sonographic exam.
 THREE MAIN TYPE OF CLEFTS

b: isolated cleft lip- difficult to diagnose ( with arrow)

THORAX
THORAX

• THE LUNGS APPEAR

HOMOGENOUS AND
SURROUND THE HEART
OCCUPIES 2/3RDS OF THE
CAVITY

• HEART OCCUPIES 1/3 RD.

 DIAPHRAGMATIC HERNIA

❖THIS IS THE DEFECT IN THE DIAPHRAGM

THROUGH THE ABDOMINAL ORGANS
HERNIATE INTO THE THORAX,

❖75%- LEFT SIDED, 20% -RIGHT SIDED, 5%

BILATERAL

❖MAJOR CAUSES OF MORTALITY ARE

PULMONARY HYPERPLASIA AND PULMONARY
HYPERTENSION.
 DIAPHRAGMATIC HERNIA

SONOGRAPHIC FINDINGS:
❖ REPOSITIONING OF THE HEART
TO THE MIDDLE, OR RIGHT SIDE
OF THE THORAX BY THE BOWELS
AND LIVER
❖ ABSENCE OF THE STOMACH
BUBBLE WITHIN THE ABDOMEN
❖ SMALL ABDOMINAL
CIRCUMFERENCE
❖ BOWEL PERISTALSIS SEEN IN THE
FETAL CHEST

Absent stomach bubble on the abdomen with cystic structure

on the chest area beside the heart
 HEART
❖HEART MALFORMATIONS ARE THE MOST COMMON CLASS OF
CONGENITAL ANOMALIES

❖VSD IS THE MOST COMMON.

❖90% MULTIFACTORIAL OR POLYGENIC.,

❖1-2% SINGLE GENE DISORDER OR GENE DELETION SYNDROME

❖1-2 % FROM TERATOGEN EXPOSURE (ISOTRETINOIN, HYDANTOIN,
DM)
❖TRISOMY 21 (50%) , OTHER TRISOMY 18, 22Q.2 DELETION,
TRISOMY 13 AND MONOSOMY X.
❖CARDIAC RHADDOMYOMA: MOST COMMON CARDIAC TUMOR
WITHIN THE VENTRICLES OR OUTFLOW TRACT

Almost 90 percent of cardiac defects

are multifactorial or polygenic,
ABDOMINAL WALL AND
GASTROINTESTINAL TRACT.
GASTROINTESTINAL TRACT

• STOMACH IS VISIBLE IN 98 %OF FETUSES AFTER 14 WEEKS

• THE LIVER, SPLEEN, GALLBLADDER, AND BOWEL CAN BE
IDENTIFIED IN MANY SECOND- AND THIRD-TRIMESTER
FETUSES

• NON-VISUALIZATIONOF THE STOMACH WITHIN THE

ABDOMEN IS ASSOCIATED WITH A NUMBER OF
ABNORMALITIES.
 ABDOMINAL WALL

INTEGRITY OF THE
ABDOMINAL WALL IS
ASSESSED AT THE
LEVEL OF THE CORD
INSERTION DURING
THE STANDARD
EXAMINATION.

Always look for the cord insertion on

routine scan, sometimes not visualized
if there is fetal crowding, oligo, fetus in
prone position
 ABDOMINAL WALL DEFECTS
GASTROSCHISIS OMPHALOCOELE BODY STALK ANOMALY

FULL THICKNESS FORMS WHEN THE LIMB-BODY WALL

ABDOMINAL WALL LATERAL COMPLEX
DEFECT LOCATED TO THE ECTOMESODERMAL RARE LETHAL ANOMALY
RIGHT OF THE UMBILICAL FOLDS FAIL TO MEET IN CHARACTERIZED BY
CORD INSERTION. THE MIDLINE. ABNORMAL FORMATION
BOWEL HERNIATES THE ABDOMINAL OF THE BODY WALL.
THROUGH THE CONTENTS COVERED ABDOMINAL ORGANS
ABDOMINAL CAVITY. ONLY BY 2 LAYERED SAC EXTRUDE TO
NOT ASSOCIATED WITH OF AMNION AND EXTRAAMNIONIC
ANEUPLOIDY AND THE PERITONEUM INTO WHICH COELOM.
SURVIVAL RATE IS 90-95%. THE UMBILICAL CORD
HERNIATES.
WITH ACUTE ANGLE
ASSOCIATED WITH SCOLIOSIS.
ANEUPLOIDY AND OTHER
ANOMALIES.
COMPONENT OF
BECHWITH-WIEDMANN ,
CLOACAL EXSTROPHY,
PENTALOGY OF CANTRELL

Gastroschisis w/o sac, omphalocoele with sac and associated with aneuploidy
 OMPHALOCOELE BODY STALK
GASTROSCHISIS ANOMALY
 GASTROINTESTINAL ATRESIA

❖MOST ATRESIAS ARE CHARACTERIZED BY OBSTRUCTION WITH

PROXIMAL BOWEL DILATATION

❖ THE MORE PROXIMAL THE OBSTRUCTION, THE MORE LIKELY IT

IS TO BE ASSOCIATED WITH HYDRAMNIOS .

❖ESOPHAGEAL ATRESIA MAY BE SUSPECTED WHEN THE

STOMACH CANNOT BE VISUALIZED AND HYDRAMNIOS IS
PRESENT.

❖TRACHEOESOPHAGEAL FISTULA-FLUID MAY ENTER THE

STOMACH (90%)

❖DUODENAL ATRESIA : DOUBLE BUBBLE SIGN, (+)

POLYHYDRAMNIOS
 DUODENAL ATRESIA

• SO-CALLED DOUBLE-BUBBLE
SIGN, WHICH REPRESENTS
DISTENTION OF THE STOMACH
AND THE FIRST PART OF THE
DUODENUM
 KIDNEYS AND
URINARY
TRACT

The placenta and membranes produce amnionic

fluid early in pregnancy,. but after 16 to 20 weeks,
most of the fluid is produced by the kidneys
Fetal urine production increases from 5 mL/hr at 20
weeks to about 50 mL/hr at term
 KIDNEYS AND URINARY TRACT

❖FETAL KIDNEYS ARE ADJACENT TO SPINE .

❖LENGTH: 20 MM, GROWS ABOUT 1.1 MM EACH WEEK
❖FETAL BLADDER- ROUND ANECHOIC STRUCTURE IN HE ANTERIOR
MIDLINE OF THE PELVIS. OUTLINED BY SUPERIOR VESICAL
ARTERIES AS THEY BECOME THE UMBILICAL ARTERIES OF THE
UMBILICAL CORD.

❖FETAL URETERS AND URETHRA NOT VISIBLE SONOGRAPHICALLY

UNLESS ABNORMALLY DILATED

The placenta and membranes produce amnionic fluid early in pregnancy,.

but after 16 to 20 weeks, most of the fluid is produced by the kidneys
 RENAL AGENESIS
❖NO KIDNEYS ARE SEEN
ULTRASONOGRAPHICALLY AT
ANY POINT DURING
GESTATION.

❖THE ADRENAL GLANDS

TYPICALLY ENLARGE AND
OCCUPY THE RENAL FOSSAE,
WHICH HAVE APTLY TERMED
THE “LYING DOWN ADRENAL
SIGN”

Anhydramnios: no kidneys= no urine starting 18 weeks aog. In cases of early

anhydramnios—look for fetal kidneys.
 INFANTILE POLYCYSTIC KIDNEY DISEASE
• ABNORMALLY LARGE
KIDNEYS THAT FILL THE FETAL
ABDOMEN AND APPEAR TO
HAVE A SOLID, GROUND-
GLASS TEXTURE.

• (+) ABDOMINAL
CIRCUMFERENCE IS
ENLARGED

• (+) SEVERE
OLIGOHYDRAMNIOS
 MULTICYSTIC DYSPLASTIC KIDNEY
DISEASE
• ARISE FROM COMPLETE OBSTRUCTION OR ATRESIA AT
THE LEVEL OF THE RENAL PELVIS OR PROXIMAL URETER
PRIOR TO 10 WEEKS.

abnormally dense renal parenchyma with multiple peripheral cysts of varying

size that do not communicate with each other or with the renal pelvis.
 NOT ROUTINELY
USED DURING
STANDARD
EXAMINATION
NOR
CONSIDERED A
REQUIRED
MODALITY

3- AND 4-DIMENSIONAL
SONOGRAPHY
 3- AND 4- DIMENSIONAL
ULTRASONOGRAPHY
LIMITATIONS:
1. MUST BE SURROUNDED BY AMNIOTIC FLUID FOR
BETTER VISUALIZATION

2. LENGTHENED TIME FOR COMPLETION OF STUDY

American College of Obstetricians and

Gynecologists recommend that 3-d
ultrasound be used only as an adjunct to
conventional sonography.
 DOPPLER VELOCIMETRY

USED TO DETERMINE THE VOLUME AND RATE OF

BLOOD FLOW THROUGH MATERNAL AND FETAL
VESSELS
 DOPPLER VELOCIMETRY

CLINICAL APPLICATIONS OF OB DOPPLER:

1. PREDICTION OF HYPERTENSION AND IUGR LATER
IN THE COURSE OF PREGNANCY

2. FETAL MONITORING - WHEN TO DELIVER SEVERELY

PRETERM FETUS WITH IUGR.

3. DIFFERENTIATE CONSTITUTIONALLY SMALL FETUS VS

IUGR.

Constitutionally small- small but normal fetal doppler, normal amniotic fluid