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ULTRASOUND
SARAH B. PINGOL, MD, FPOGS, FPSUOG
Department of Obstetrics & Gynecology
Northern Mindanao Medical Center
Ultrasound Technology
l Ultrasound
Ultrasound Technology
Electrical pulses/Alternating current
Vibration of piezoelectric crystals
(transducer)
Sound waves
Object/Tissues
Echoes
Image
TAS vs TVS
l ADVANTAGES
OF TVS
TVS vs TAS
l DISADVANTAGES
OF TVS
sac (GS)
SONOGRAPHIC FEATURES OF A
NORMAL GS (Nyberg, 1991)
External appearance
Internal landmarks
Yolk sac present when GS > 13 mm
Embryo present when GS > 18 mm; growth: 1 mm/d
TAS
5 mm
LMP
4 wks, 3 days
5 wks
Serum -hCG
2000 mIU/ml
6500 mIU/ml
Mean sac
diameter
Sac
l Placenta
Fetal pole
TVS: 6 menstrual wks
TAS: 7 menstrual wks
Cardiac activity
6 wks by TVS
May be absent for embryos < 4 mm
Always present for embryos 5 mm
Prediction of menstrual
age
GS, using MSD: 5-6.5 wks
Crown-rump length
7 wks
Variability: 4-5 days (increases to 7-10 days
after 12 wks)
Menstrual age = CRL + 6.5
CROWN-RUMP LENGTH
Sensitivity Specificity
PPV
Major Criteria
25 mm MSD w/o embryo
(TVS: 18 mm)
29
100
100
41
100
100
28
99
96
53
99
98
Irregular contour
37
99
97
37
98
94
Low position
20
99
94
Minor Criteria
hematomas (subplacental
> subchorionic)
Ectopic Pregnancy
Absence of an intrauterine yolk sac or
embryo
l Absence of double decidual sign (DDS): 2
rings surrounding the gestational sac
l
Ectopic Pregnancy
l Presence
of gestational structures
within fallopian tube
l Fallopian tube with amorphous
content (e.g. blood clots)
l Indirect signs: empty uterus +
positive pregnancy test blood clots
in cul-de-sac
Ectopic Pregnancy
ULTRASOUND AND SERUM -hCG ASSAY
Intrauterine
pregnancy
Serum
-hCG
Outcome
Ectopic pregnancy
Abnormal uterine pregnancy
Recently aborted, abnormal or
early intrauterine pregnancy
Ectopic pregnancy
HYDATIDIFORM MOLE
TRANSTHALAMIC PLANE
TRANVENTRICULAR PLANE
C: Choroid plexus
VA: Ventricular
atrium
MW & LW: Medial &
lateral walls of
lateral ventricle
TRANSCEREBELLAR
PLANE
CH: Cerebral
hemispheres
CV: Cerebellar vermis
CM: Cisterna magna
CSP: Cavum septum
pellucidum
SPINA BIFIDA:
Lemon sign
TRISOMY 18:
Strawberry sign
ANENCEPHALY
CRANIOSYNOSTOSIS:
Clover-leaf skull
AGENESIS of CORPUS
CALLOSUM: Teardrop sign
HOLOPROSCENCEPHALY
fossa
Cisterna magna: 1 cm
Increased: Dandy-Walker syndrome
SPINA BIFIDA:
Banana sign
DOWN SYNDROME:
Nuchal fold thickness
NORMAL FETAL
SPINE
SPINA BIFIDA
2 arterial valves
Aorta rises wholly from the left ventricle
Pulmonary trunk slightly larger than the
aorta
Pulmonary valve anterior and cranial to
the aortic valve
At their origins the great arteries lie at
right angles and cross over each other
DUODENAL ATRESIA:
Double bubble sign
POLYCYSTIC
KIDNEYS
MULTICYSTIC
DYSPLASIA
1 vein
Dilatation of cord, with echogenic
structure within: omphalocoele
Loops of bowel extruded out through
the abdominal wall: gastroschisis
OMPHALOCOELE
GASTROSCHISIS
bowel
umbilical cord
gender
MALE
FEMALE
FIRST TRIMESTER
Mean Sac Diameter (MSD)
TAS: 5 mm ~ 5 wks and 5 days
TVS: 2-3 mm ~ 4 wks and 3 days
DIAMETER (BPD)
INDEX (CI)
CIRCUMFERENCE (HC)
CIRCUMFERENCE (AC)
FEMORAL LENGTH
Measured from blunt ends (greater trochanter
to lateral epicondyle)
Other parameters:
FETAL FEMUR
PARAMETERS
NON-BIOMETRIC PARAMETERS
FETAL COLONIC GRADE (Zillanti, 1983)
Grade 1: lumen anechoic, thin hypoechoic
muscular and serosal wall (2nd trimester)
Grade 2: lumen more echoic, muscular wall
hypoechoic, increased fat deposits at serosal
layer (early 3rd trimester)
Grade 3: lumen hyperechoic, w acculumation
of meconium; hypoechoic muscular layer
emphasized by surrounding hyperechoic
structures (term gestation)
NON-BIOMETRIC PARAMETERS
PLACENTAL GRADING (Grannum, 1979)
Grade O: smooth chorionic plate on the fetal
surface of the placenta, without calcifications
Grade I: placenta with scattered bright echoes
Grade II: increased basal and comma-like
echogenicities extending into the placenta from
the indentations of the chorionic plate
Grade III: extensive basal, curvilinear
echogenicities extending from the chorionic
plate to the base of the placenta
AFV (cc)
60 (35-100)
200 (125-300)
900 (500-1200)
350 (250-500)
AFV > 2 L
AFV > 90th percentile for a given
gestational age
l OLIGOHYDRAMNIOS
BIOPHYSICAL PROFILE
l Antepartum
fetal surveillance
l Based on Manning, 1980
l 5 parameters:
Fetal breathing movements
Gross fetal movements
Fetal tone
Fetal heart reactivity (NST)
Amniotic fluid volume
BIOPHYSICAL PROFILE
l
Fetal Tone
CNS Center
Cortex-subcortical area
AOG
(wks)
7.5-8.5
9
20-21
Fetal Heart
Reactivity
24-26
Fetal tone
Fetal heart
2 FHR accelarations of at least 15
reactivity (NST) bpm at least 15 sec in duration assoc
with fetal movts in 20 min observation
Amniotic fluid
volume
BIOPHYSICAL PROFILE
l
INTERPRETATION
10/10: normal, nonasphyxiated
8/10: normal, nonasphyxiated
(normal fluid)
8/10: chronic fetal asphyxia
(decreased fluid)
6/10: possible fetal asphyxia
4/10: probable fetal asphyxia
0-2/10: almost certain fetal asphyxia