2nd trimester scan
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Transcript of 2nd trimester scan
2nd trimester scanning
2nd trimester scanning
Confirming dating of pregnancy
Fetal normality/ abnormality
Placental localisation
AF volume
BPD
Correct levels
2 views: lateral ventricle view, thalamic view
More accurate than CRL +/- 5 days
Maximum diameter of transverse section of fetal skull at level ofthe parietal eminences
BPD
Lateral ventricle view:
Rugby shaped skull
Long midline equidistant prox-distal skull echoes
Cavum septum pellucidum (CSP) bisecting midline
Two anterior horns of lat ventricle- symmetrical
Post horns of lat ventricle- symmetrical
BPDLateral ventricle view
BPD
Thalamic view:
Rugby ball shape
Short midline
CSP
The thalami (arrow head)
BPDThalamic view
BPD
Both levels comparable
HC/OFD same level
Outer to outer
Outer to inner
OA/OP position
BPDTo obtain the correct level
BPDEstimating GA from BPD:
Not to rely on estimates of GA from US software
GA should not be made from single parameter
Different charts
GA and growth require different charts and charting
BPDEstimating GA from BPD
BPDConfirming or assigning GA:
If LMP and earlier dating 1st trimester US matches- stick to this date
2nd trimester US is only for growth and not for dating
If the 2nd trimester US is the first scan done error is greater:
below 24w +/- 2 w
After24w >3w
Head circumference
Same view as BPD
Outer to outer
Superior to BPD for dating
Abdominal circumference
Landmark features:
Circular section with ribs
One vertebra -triangle of 3 white spots
Umbilical vein (short) - hockey stick
Stomach left abdomen
Good for dating of pregnancy
Sensitive to growth aberrations
Fetal weight assessment
Abdominal circumference
Femur length
As accurate as BPD for GA
From 12w to term
Slide probe caudally from AC section till iliac bones
Cross section of 1 femur seen
Upper femur for measurement
Rotate
Femur length
Femur length
Placental localisation
Placenta is more echogenic than myometrium
Alignment of probe standardised
Cervix to the right
Fundus to the left
Placental localisation
Placental localisation
Cervical canal directly posterior to bladder
Lower edge >5 cm from internal os
<5cm low lying
Placentae previa after 28w
Braxton hicks
Placental localisation
Placental localisation
Localisation at 20-22w
5% low lying
Only 1% placenta previa
Placental localisation
Amniotic fluid volume
Produced by fetal kidneys (urine) and removed by fetal bowel (swallowing)
Oligohydromnios = decreased volume
Polyhydromnios = increased volume
Measurements : Visual
Max vertical depth 3cm
AFI - <5cm =oligo, >25cm = poly
Fetal anatomy assessment
Dependant on sonographer- correct images, correct interpretation
Go through all-complete coverage--> then no major abnormalities will be missed
E.g.After 12w - anencephaly
Fetal anatomy assessment
Fetal anatomy assessment
After 20-22w:
encephalocoele
cystic hygroma
abdominal wall defect
lemon sign - spina bifida
banana sign - hydrocephalus
severe limb reduction
ascites
pleural effusion
severe oligo/ polyhydramnios
Fetal anatomy assessment
Fetal anatomy assessment
Cerebral ventricles
Fetal anatomy assessment
Anterior horn
Fetal anatomy assessment
Posterior horn
Fetal anatomy assessment
AVHR/PVHR:
< 0.5 after 18w gestation
Ventriculomegaly
Fetal anatomy assessment
Fetal anatomy assessment
Fetal anatomy assessment
Fetal heart:
Occupy 1/3 with apex pointing to the left
3 views of the heart:
4 chamber view
2 outflow tract views
Fetal anatomy assessment
Fetal heart:
moderator band = right ventricle
2 ventricles/ walls of equal size
2 atria / walls of equal size
apex point left of fetal chest
foramen ovale moving in left atrium
pulmonary veins entering left atrium
motion of mitral valves (left side) regular
motion of tricuspid valves (right side) regular
'offset crux' of the heart: AV valve should not insert into IV septum at the same level
intervertebral septum should be complete
Fetal anatomy assessment
Fetal anatomy assessment
Fetal heart:
Abnormalities of 4c view:
No disparity in size between 2 ventricles
Tricuspid/ mitral valve defects:
Enlargement of atrium
Hypoplasia of ventricle
Fetal anatomy assessment
eg: (i) regurgitation of tricuspid valve - enlarged right atrium
(ii) hypoplastic left heart syndrome - left ventricle small
(iii) coarctation - right ventricle enlarged
(iv) Ebstein anomaly - enlarged right atrium due to abnormal implantation of tricuspid valve
normal IV septum - excludes VSD
normal offset crux - exclude AVSD
Both ASD & AVSD are assessed with trisomy 21
Fetal anatomy assessment
Fetal heart:
The aortic outflow tract rotate to right fetal shoulder
Fetal anatomy assessment
Demonstrate left ventricle: continuity of IV septum--> ant wall of aorta--> aortic valve & short section of ascending aorta
Abnormal AOT:
Overriding aorta
Aortic stenosis
Double outlet right ventricle
Fallot's tetralogy
Fetal anatomy assessment
Pulmonary artery outflow tract:
Demonstrate:
Right ventricle
Pulmonary valve
Main pulmonary artery abnormal in double outlet right ventricle & pulmonary stenosis
Fetal anatomy assessment
Fetal abdomen:
Single left sided stomach bubble--> after 16w
Cord insertion
Abdominal defects --> oomphalocoele, gastrochisis
Kidneys
Fetal anatomy assessment
Cleft lip and palate:
Incidence 1:700 births
80% isolated incidence
But association with trisomy 13 &18, anti epileptics drugs
Fetal anatomy assessment
Fetal sex:
Recognisable from 14 weeks
Craniospinal abnormality
Causes of increased AFP
Craniospinal abnormality
Craniospinal abnormality
Craniospinal abnormality
Craniospinal abnormality
Craniospinal abnormality
Craniospinal abnormality
Between 16-24w --> only as a marker
Craniospinal abnormality
Hydrocephalus
Craniospinal abnormalityEncephalocoele
Craniospinal abnormalityHydrancephaly
Porencephalic cysts
Craniospinal abnormalityDandy walker
malformation
Chest abnormalityDiaphragmatic hernia
Fetal abdominal abnormality
Double bubble- duodenal atresia
Fetal abdominal abnormalityDouble bubble-
oesophageal atresia
Fetal abdominal abnormalityDilated bowels
Fetal abdominal abnormality
Oomphalocoele
Fetal abdominal abnormalityGastrochisis
Fetal abdominal abnormality
Renal agenesis
Cystic disease of the kidneys
Fetal abdominal abnormality
Fetal hydrops