(医学影像学）14.2正常妊娠和胎儿畸形超声诊断-english

Ultrasonography on Ultrasonography on ObstetricsObstetrics Liu Liping The role of Ultrasound in The role of Ultrasound in ObstetricsObstetrics Obstetric common diseasesObstetric common diseases 1、 Normal pregnancy(正常妊娠) 2、 Abnormal pregnancy（异常妊娠） 3、 Trophoblastic disease(滋养细胞疾病) 4、 Placental abnormality(胎盘异常) 5、 Fetal malformation(胎儿畸形) Natural pregnancyNatural pregnancy TRIMESTERSTRIMESTERS lFirst trimester = 0 to 12 weeks of gestation lSecond trimester = 13 to 26 weeks of gestation lThird trimester = 27 to 42 weeks of getsation lPostterm pregnancy = 42 weeks of gestation Indications for First-Trimester Indications for First-Trimester SonographySonography lConfirm presence of intrauterine pregnancy lEvaluate for suspected ectopic pregnancy lDefine cause of vaginal bleeding lDetermine gestational age lConfirm suspected multiple gestations lAid in invasive procedures lEvaluate pelvic masses lDetect uterine abnormalities Nonage pregnancyNonage pregnancy ( ( First-Trimester) First-Trimester) Definition ：Pregnancy before 12 weekend. 5 weeks pregnant Gestational sac； 6-7 weeks pregnant Germ; 7-8 Weeks Primitive heart tube pulse； 8-11 weeks Yolk sac; 9 weeks Embryonic, placenta. The Normal First TrimesterThe Normal First Trimester Sonographic Features of a Sonographic Features of a Normal Gestational SacNormal Gestational Sac lShape: round or oval lPosition: fundal or middle portion of uterus; a center position relative to endometrium lContour: smooth lWall: echogenic; 3 mm of more in thickness lInternal landmarks: yalk sac present when gestational sac is larger than 10 mm; embryo present when gestational sac is larger than 18 mm lGrowth: 1 mm per day (range: 0.7 mm to 1.5 mm per day) 4-5 weeks pregnant4-5 weeks pregnant In the g In the gestational sestational sac we can see a ac we can see a embryo point, the earliest embryo. embryo point, the earliest embryo. 7 weeks pregnant7 weeks pregnant Fetus is about 4 mmFetus is about 4 mm，we can see we can see apparent heart throb, and sapparent heart throb, and small limb budmall limb bud . . 8 weeks pregnant8 weeks pregnant Three-dimensional ultrasound show its beginning Three-dimensional ultrasound show its beginning of the shape of a humanof the shape of a human. . Umbilical bord Embryonic head Embryonic abdomen Yolk sac Embronic head Amniotic sac 9 weeks pregnant9 weeks pregnant Known as a fetalKnown as a fetal，Development of the Development of the various parts of the fetus, tends to improvevarious parts of the fetus, tends to improve. . 12 weeks pregnant12 weeks pregnant The spine is identifiable , as the two bead-like high The spine is identifiable , as the two bead-like high echo-level. Ears, limbs, bones can be shown and echo-level. Ears, limbs, bones can be shown and measurement. measurement. The Second- and The Second- and Third-TrimesterThird-Trimester ( ( Metaphase and terminal prengancy) Metaphase and terminal prengancy) Mid-Mid- pregnancy:pregnancy:13-27 13-27 weeks pregnancy.weeks pregnancy. Late-Late- pregnancy:pregnancy:More More than 28 weeks of than 28 weeks of pregnancypregnancy . . Ultrasound of the Second and Ultrasound of the Second and Third TrimestersThird Trimesters Indications for Second- and Indications for Second- and Third-TrimesterThird-Trimester l Estimate gestational age for patients with uncertain dates lEvaluate uterine size and clinical date discrepancies lEvaluate fetal growth lEstimate fetal weight lDetermine fetal presentation lEvaluate fetal life l provide adjunct to amniocentesis, percutaneous umbilical blood sampling procedure, or cerclage placement lEvaluate uterine abnormality lEvaluate abnomal maternal serum alpha- fetoprotein values lEvaluate abnormal amniotic fluid lEvaluate placenta Etc. Scanning TechniquesScanning Techniques lSurvey uterus lObserve cardiac activity lDetermine position and number of the fetus and placenta lAssess amniotic fluid lLook for uterine of placental masses and fetal anomalies Check contentsCheck contents l1、Fetal head ：BPD biparietal diameter; l2、Fetal abdomen: AC abdomen circumference; l3、Fetal limb： FL femur length ; l4、Others：Placenta, Fetal heart rate, Amniotic fluid, etc. 1 1 、 Fetal headFetal head Measuring the Biparietal Diameter(BPD) lObitain biparietal diameter of the fetal head at the transverse level of the midbrain: falx, cavum septi pellucidi, and thalamic nuclei lMake sure the head is symmetric and oval lMeasure from outer to inner margins of the skull lIn the third trimester, the BPD is not as accurate in predicting fetal age Fetal head, after 12 weekend Fetal head, after 12 weekend pregnantpregnant skull thalamic nuclei cavum septi pellucidi Fetal head, after 12 weekend Fetal head, after 12 weekend pregnantpregnant BPD Fetal head, after 12 weekend Fetal head, after 12 weekend pregnantpregnant Fetal side profile, we Fetal side profile, we can observe its forehead, can observe its forehead, nose ,lip, and chin, etc.nose ,lip, and chin, etc. 2 2、Fetal abdomenFetal abdomen lThe hepatobiliary system: liver, port venous systerm, hepatic veins and arteries, gallbladder, and bile ducts lThe gastrointestinal system: the esophagus, stomach, small and large intestines(colon) lThe urinary system: kidneys, adrenal glands, ureters, bladder. The fetal abdomen circumference（AC) is the most widely measured Measuring the Abdominal Measuring the Abdominal Circumference(AC)Circumference(AC) lThe AC should be taken from a round transverse image with the umbilical portion of the left portal vein midline within the liver lThe outer margin of the abdominal wall should be measured lThe abdominal wall measurement is the least accurate The fetal liverThe fetal liver gallbladde r stomach port venous spine gallbladder stomach 3 3、Fetal limbsFetal limbs lThe upper limbs: the ulna the radius the humerus lThe lower limbs: the femur/the thigh bone the fibula the tibia lThe femur is the most widely measured long bone （FL femur length ） Femur measurementFemur measurement lHyperechonic linear structure represents the ossified portion of the femoral diaphysis and corresponds to femoral length measurement from the greater trochanter to the femoral condyles lThe normal femur has a straight lateral border and a curved medial border lFemur length may be used with the same accuracy as BPD to predict gestational age lFemur length may indicate skeletal dysplasias or intrauterine growth restriction Long section of the upper limbsLong section of the upper limbs The radius The ulna The humerus Femur/thigh bone Fibula /perone Tibia/shin bone Long section of theLong section of the lower limbslower limbs 4 4、 The placentaThe placenta（胎盘）（胎盘） lThe major role of the placenta is to permit the exchange of oxygenated materinal blood(rich in oxgen and nutrients) with deoxygenated fetal blood. lThe thickness of the placenta varies with gestational age,with a minimum diameter of 15 mm in fetuses greater than 23 weeks. The size of the placenta rarely exceeds 50 mm in the normal fetus. Anterior placenta at 21 weeks of Anterior placenta at 21 weeks of gastationgastation The placenta Umbilical bord Amniotic fluid The fetal Posterior placenta at 29 Posterior placenta at 29 weeks of gestationweeks of gestation calcification Anterior placenta at 39 weeks of gastationAnterior placenta at 39 weeks of gastation 41 umbilical cord(脐带) One big umbilical vein and Two small umbilical arteries(with arterial blood in vein and venous blood in arteries) FETAL DEFORMITY 胎儿畸形 Lack of fetal skull, brain parenchyma rarely, brain hemisphere exposure, from a few millimeters to several centimeters of purplish red, amorphous mass. Exophthalmos, like the frogs eyes, but the face is still normal. AnencephalusAnencephalus（无脑儿（无脑儿) ) Anencephaly is the most common disease of open neural tube malformation, girls make up the majority. Little Jackson The United States anencephaly The absence of brain abnormalities is often associated with spina bifida and polyhydramnios. With polyhydramnios, the uterus is larger than the normal month of pregnancy Abdominal examination often fails to touch the head of the fetus. Anencephaly with spina bifida 12 to 14 weeks , Fetal skull Aura can not be see when measuring fetal biparietal diameter; The head of the fetus can be seen as a lump of tumor, which is the echo of the facial bone and the skull base of the fetus. The orbital and nasal bones can be found in the facial bones; Ultrasound findingsUltrasound findings Atrophy of the brain tissue, partly of dysplastic brain tissue can be see, is wrapped by the meningeal sac and floating in the amniotic fluid; Anencephaly is often associated with cervical and thoracic spinal bifida, combined with polyhydramnios 49 12W Anencephaly 10W Anencephaly 50 Exencephaly and anencephaly 露脑畸形及无脑儿 Anencephaly with spina bifida 无脑儿伴脊柱裂 HydrocephalusHydrocephalus（脑积水）（脑积水） Hydrocephalus is due to large amounts of cerebrospinal fluid retented intracranial . Baby girls with hydrocephalus in India The cause of increased brain effusion The choroid plexus produces too much cerebrospinal fluid; Discharge dysfunction of cerebrospinal fluid from the ventricles and cistern(脑池) Subarachnoid(蛛网膜下腔) absorption disorder The lateral ventricles enlarged and showed anechoic area 。 Ventricular rate 0.5 Biparie