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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
• Small • Large
• Field of
view
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
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
• TRANSVAGINAL
ULTRASOUND GESTATIONAL
SAC
(TVS)
• AT 5 WEEKS AOG YOLK SAC
GESTATIONAL
SAC SHOULD BE
PRESENT
CARDIAC MOTION
USUALLY IS
OBSERVED WHEN
THE EMBRYO IS 5
MM IN LENGTH
(CRL)
AT 6 WEEK
SHOULD SEE EMBRYO
WITH CARDIAC
ACTIVITY
ANEMBRY0NIC EMBRYONIC/FETAL
PREGNANCY DEMISE
❖ FHT
❖ FETAL PRESENTATION
❖ PLACENTA LOCALIZATION , APPEARANCE AND RELATIONSHIP TO THE TO INT OS
AND CORD INSERTION WHEN POSSIBLE
❖ SUSPECTED ABRUPTION
❖ PROM/PRETERM LABOR
❖ CERVICAL INSUFFICIENCY
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
• 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
❖OLIGOHYDRAMNIOS- <2 CM
❖HYDRAMNIOS/POLYHYDRAMNIOS –>24 CM
• ANHYDRAMNIOS- 0 , NO MEASURABLE
AMNIOTIC FLUID ON ALL 4 QUADRANTS
•.
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
CHIARI III
CEPHALOCOELE ENCEPHALOCOELE
MALFORMATION-
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
• LATERAL VENTRICLE = 5 TO 10 MM
AT 15 WEEKS
• MILD VENTRICULOMEGALY IS
DIAGNOSED WHEN THE ATRIAL
WIDTH MEASURES 10 TO 15 MM
. Cleft lip and palate Isolated cleft palate Median cleft palate
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
INTEGRITY OF THE
ABDOMINAL WALL IS
ASSESSED AT THE
LEVEL OF THE CORD
INSERTION DURING
THE STANDARD
EXAMINATION.
Gastroschisis w/o sac, omphalocoele with sac and associated with aneuploidy
OMPHALOCOELE BODY STALK
GASTROSCHISIS ANOMALY
GASTROINTESTINAL ATRESIA
• SO-CALLED DOUBLE-BUBBLE
SIGN, WHICH REPRESENTS
DISTENTION OF THE STOMACH
AND THE FIRST PART OF THE
DUODENUM
KIDNEYS AND
URINARY
TRACT
• (+) 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.
3- AND 4-DIMENSIONAL
SONOGRAPHY
3- AND 4- DIMENSIONAL
ULTRASONOGRAPHY
LIMITATIONS:
1. MUST BE SURROUNDED BY AMNIOTIC FLUID FOR
BETTER VISUALIZATION
Constitutionally small- small but normal fetal doppler, normal amniotic fluid