超音波教學 Schedules Section 1 First Trimester

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1 超音波教學 Schedules Section 1 First Trimester
Section Fetal Brain Develop (2) Section Fetal Spine Section Face and Neck Section Chest Section Fetal Heart (2) Section Abdominal Wall & GI Section GU system Section Muscular System & U.C. Section 10 Placenta

2 超音波教學 Section I Speaker 陳志堯醫師 Director 趙灌中主任 洪正修主任 August 25, 2006

3 Normal Early Pregnancy
Topic 1 Normal Early Pregnancy

4 Day 22

5 Day 23

6 Day 26

7 Day 13 Day 21 Day 28

8 AL, allantois; CF, chorion frondosum; CL, chorion laeve; CS, connecting stalk; DV, decidua vera (along endometrium; E, embryo; ECS, extrachorionic space (endometrial cavity); EEC, extraembryonic coelom; EEM, extraembryonic mesoderm; OM, omphalomesenteric duct; PG, primary gut, Y1 primary yolk sac; Y2, secondary yolk sac.

9 Blastocyst implantation site in spontaneous pregnancies
89.1% had E-GSs detected in the upper region, which was found to be the most frequent region. Minami S, J Nippon Med Sch Jun;70(3):250-4.

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14 Anembryonic Pregnancy
Mean sac diameter > 10mm with no Y.S. Mean sac diameter > 18mm with no Emb. Empty amnion. Poor color signal around sac.

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16 Potential Pitfalls

17 Potential Pitfalls Mistaking yolk sac for embryo

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19 Potential Pitfalls Mistaking Y.S. for embryo
Mistaking sub-chorionic hemorrhage for G.S.

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21 Potential Pitfalls Mistaking Y.S. for embryo
Mistaking sub-chorionic hemorrhage for G.S. Missing multiple G.S.

22 IUP Lt adnexal ectopic sac

23 Potential Pitfalls Mistaking Y.S. for embryo
Mistaking sub-chorionic hemorrhage for G.S. Missing multiple G.S. Pseudo-sac of E.P.

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27 Potential Pitfalls Mistaking Y.S. for embryo
Mistaking sub-chorionic hemorrhage for G.S. Missing multiple G.S. Pseudo-sac of E.P. Normal rhombencephalon for cystic brain mass

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29 Potential Pitfalls Mistaking Y.S. for embryo
Mistaking sub-chorionic hemorrhage for G.S. Missing multiple G.S. Pseudo-sac of E.P. Normal rhombencephalon for cystic brain mass Physiological bowel herniation for omphalocele.

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31 MGH mid-gut herniation

32 Topic 2: 1st Trimester Ultrasound Screening
11~13+6 weeks scan

33 NT

34 隋·巢原方在《诸病源候论》 “妊娠三月名始胎，当此之时，血不流行，形象始化，未有定仪，因感而变。”

35 妇女怀孕3个月时，胚胎已渐次发育成胎儿，这时虽然已从形体上初步成形。但是还没有定型，即所谓“未有定仪”，其可塑性很大，当孕妇见到带有什么特征的东西，她所怀胎儿的形象，包括胎儿的形体和精神，也就会随之产生变化，这就是“见物而变”的本意。故此给那些想生一个长相漂亮、体力过人、才华出众的孩子的孕妇提出了要求，在孕期内要多想好事，多多行善，多看美好的事物，以期感化腹内的胎儿。通过母亲美与善的良好“见物”刺激，而使胎儿向更加聪明、善良、健康、漂亮的方面“变化”。

36 五帝时帝妃子姜源氏妊娠期间性情清静，喜好稼樯，经常随夫郊祭。观察植物生长，所以她的儿子后稷能种五谷，成为我国农业的第二始祖。这里边即寓有“见物而变”的含义。古人“见物而变”胎教理论的提出，当然受当时文化背景的影响，有时代的局限性，但还是有一定的实际指导意义。

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39 Maternal Age (MA) 30 MA + 15~18 weeks 母親血清生化測試 50-70
Screening Methods 偵測率 % Maternal Age (MA) 30 MA + 15~18 weeks 母親血清生化測試 50-70 MA + 11~13+6 weeks NT 70-80 MA + 11~13+6 weeks NT +母親血清游離-hCG & PAPP-A 85-90 MA + 11~13+6 weeks NT & NB 90 MA + 11~13+6 weeks NT & NB + 母親血清游離-hCG & PAPP-A 95 Fetal Medicine Foundation, London 2006

40 胎兒NT增厚之病理生理學 心臟功能失調 頭部及頸部靜脈充血 細胞外間質成分轉變 淋巴管排泄失能 貧血 低蛋白血症 先天性感染

41 R. BECKER Ultrasound Obstet Gynecol 2006; 27: 613–618

42 R. BECKER Ultrasound Obstet Gynecol 2006; 27: 613–618

43 Karl Oliver Kagan,Obstet Gynecol. 2006 Jan;107(1):6-10.
叫我第一名 6.5~7.4 Karl Oliver Kagan,Obstet Gynecol Jan;107(1):6-10.

44 WHY AND FOR WHOM IN THE FIRST TRIMESTER?
Previous family history of cardiac defects The finding of an increased NT at 11 to 14 weeks.

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47 Nasal Bone

48 The gestation should be 11-13+6 weeks and the fetal CRL should be 45-84 mm.
In chromosomally normal fetuses the incidence of absent nasal bone is < 1% in Caucasian populations and about 10% in Afro-Caribbeans. The nasal bone is absent in 65-70% of trisomy 21 fetuses and in > 50% of trisomy 18 and 30% of trisomy 13 fetuses. For a false positive rate of 5%, screening by a combination of sonography for fetal NT and nasal bone and maternal serum free β-hCG and PAPP-A can potentially identify more than 95% of trisomy 21 pregnancies. Fetal Medicine Foundation, London 2006

49 Ductus Venosus At weeks abnormal ductal flow is observed in 5% chromosomally normal fetuses, in about 80% with trisomy 21 and 75% with all chromosomal abnormalities. Assessment of the ductus venosus can be combined with measurement of fetal NT to improve the effectiveness of early sonographic screening for trisomy 21

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51 Reversed A-wave

52 Tricuspid Valve Regurgitation
Large Facial Angle

53 Other Easily Identified Anomalies
Single Umbilical Artery Exomphalos Megacystis

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55 Take Home Message Intradecidual sac sign (IDSS): 4-4.5 wks
Yolk sac: wks Embryo > 5mm: cardiac activity must be seen. Embryo with heart beat: wks (TVS) Double belb sign: Y.S + amniotic sac Embryo forms within amnion Determine chorionicity/amnionicity in multiple gestations by No. YS = No. amnions

56 Special Concern Ectopic pregnancy (EP) 1.4%
No IUP + tubal mass + CDS fluid (best clues) Pseudogestational sac sign Adnexal abnormalities (80-95%) Tubal hematoma (40-60%) Tubal ring (50%) Ring of fire 85% of EP on the same side of corpus luteum Sonar (-) in 5-10% Suspect EP if no IUP and hCG > 2000

57 Thanks for listening To be continued!!!

58 I Will Be Back