산부인과 초음파 - PowerPoint PPT Presentation

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산부인과 초음파

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  1. 산부인과 초음파 부산백병원 박현경

  2. 1st trimester G-sac location Embryo identification CRL Fetal heart motion Fetal number Uterus & adnexal evaluation 2nd& 3rd trimester Fetal number Presentation Fetal heart motion Placental location Amnionic fluid volume Gestational age Survey of fetal anatomy Evaluation for maternal pelvic masses Basic Ultrasound Examination

  3. Fetal Measurements • CRL • BPD : accurate predictor of menstrual age before 20 weeks • HC • AC • FL

  4. Amnionic Fluid Volume • Maximal vertical fluid pocket oligo : < 2cm normal : 2~8cm hydra : > 8cm • amnionic fluid index oligo : < 6cm hydra : > 24cm

  5. Fetal CNS • BPD : gestational age • CNS anomalies : TMC birth defects • 3 transverse view • Transthalamic view • Tranventricular view • Transcerebellar view • Errors in interpreting mormal anatomy : ventriculomegaly

  6. Insula (lat fissure)

  7. Pseudohydrocephalus

  8. Basic axial plane 1. Transthalamic view CSP, 3rd ventricle, thalamus malformation of midline development 2. Transventricular view ventricular atrium, cbr.hemisphere ventriculomegaly 3. Transcerebellar view cbll, cbll vermis, cisterna magna, 4th ventricle DW malformation, myelomeningocele

  9. Transthalamic view

  10. Transventricular view

  11. Transcerebellar view

  12. Hydrocephalus • Measurement : trans. diameter of ventricular atrium at the level of glomus of the CP 2. Overt ventriculomegaly > 15 mm “danging” choroid plexus 3. Mild ventriculomegaly 10 mm ~ 15 mm 4. further evaluation : targeted US, fetal karyotyping, test for congenital viral infection (TORCH)

  13. Dangling choroid plexus

  14. Open Neural Tube Defect • TMC birth defect after CHD • Increased MSAFP in 16~18 wks -> targeted ultrasound

  15. Anecephaly Frog’s face

  16. Brain tissue

  17. Encephalocele • The least common ONTD • Protrusion of intracranial contents through a cranial defects • Site occipital(75%), frontal(13%), parietal • DDx : cystic hygroma

  18. meningocele

  19. Choroid plexus cyst • Incidence : 1% in midtrimester • Majority : isolated & resolve by 24 weeks • Probability of aneuploidy :trisomy 18 : -> targeted ultrasono : fetal anomalies -> amniocentesis : over 32 -> genetic counselling

  20. Holoprosencepahly • Failure of n’l forebrain development • Classification alobar, semilobar, lobar • US of alobar/semilobar type absent falx & IHF → monoventricle fusion of thalamus absence of midline structure : corpus callosum, fornix, optic tract, olfactory bulb

  21. Agenesis of corpus callosum • US tear drop sign distension of interhemisphere fissure upward displacement of 3rd ventricle absence of corpus callosum ** normal cavum septum pellucidum excludes complete ACC

  22. Tear-drop sign 3rd ventricle Lateral ventricle

  23. Dandy-Walker complex • Post. Fossa anomaly의 spectrum • abnormal development of the cbll /c ass. • mal-development of 4th ventricle • Dandy-Walker malformation • Complete/partial agenesis of cbll vermis • Enlarged post. Fossa & elevated tentorium • Dandy-Walker variant • Variable hypoplasia of cbll vermis • Megacisterna magna • Enlarged cbll-medullar cistern

  24. Lip

  25. Cleft lip

  26. Spine • 15-16 weeks: seen well • 3 ossification center : centrum & lamina transverse plane lamina : parallel or inward angulation sagittal & axial plane lamina : parallel

  27. Transverse view Coronal view

  28. Spina Bifida - Myelominingocele • The second most common ONTD • Associated anomalies Arnold-Chiari (type II) malformation • Cranial signs on targeted sono • Small BPD • Ventriculomagaly • Frontal bone scalloping : lemon sign • elongated cbll : bsnana sign • Obliteration of cisterna magna

  29. Myelomeningocele

  30. Myelomeningocele

  31. Lemon sign Banana sign

  32. Chiari II malformation ventriculomagaly meningocele

  33. Nuchal translucency & nuchal fold thickness • Most sensitive & specific single marker for 1st & midtrimester detection of Down’s syndrome • Nuchal translucency : >3mm, at 13wks midsaggittal plane • Nuchal fold thickness : > 6mm, at 15~20 wks suboccipital-bregmatic plane CSP, cbr peduncle, cbll hemisphere, CM

  34. Cystic hygroma • Cong. malformation of the lymphatic system • Location : posterolat. aspect of neck • Ass. anomalies : Turner syndrome • US thin walled, multiseptated cystic mass Ass. hydrops fetalis

  35. Hydrops fetalis