the early gestation scan l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
The Early Gestation Scan PowerPoint Presentation
Download Presentation
The Early Gestation Scan

Loading in 2 Seconds...

play fullscreen
1 / 22

The Early Gestation Scan - PowerPoint PPT Presentation


  • 188 Views
  • Uploaded on

The Early Gestation Scan. Embryonic/fetal growth 1 st trimester. Crown rump length best index of gestational length Phase of most rapid growth in length (up to first ½ preg.) Time when growth influenced most by genome aneuploidy external influences infection drugs

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'The Early Gestation Scan' - vallerie


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
embryonic fetal growth 1 st trimester
Embryonic/fetal growth 1st trimester
  • Crown rump length best index of gestational length
  • Phase of most rapid growth in length (up to first ½ preg.)
  • Time when growth influenced most by

genomeaneuploidy

external influences infection

drugs

Stage being set for later effects smoking

maternal nutrition

uterine circulation

slide3

ROUTINE EARLY ULTRASOUND

(Cochrane Library)

earlier detection of multiple pregnancies

twins undiagnosed at 26 weeks OR 0.08, 95% C I 0.04 to 0.16

reduced induction

post-term pregnancy O R 0.61, 95% C I 0.52 to 0.72

No differences detected for substantive clinical outcomes

perinatal mortality O R 0.86, 95% C I 0.67 to 1.12

Where detection of fetal abnormality was a specific aim

number of terminations of pregnancy for fetal anomaly increased.

slide4
Uterus
    • Endometrial decidual reaction
    • Gestational sac
      • Position
      • Size
      • Shape
    • Yolk sac
    • Fetal pole- measure crown rump length
    • Cardiac activity
    • Adnexae
      • Corpus luteum
      • Free fluid
msd 2cm and no fetal pole visible likely anembryonic pregnancy
MSD> 2cm and no fetal pole visible = likely anembryonic pregnancy

Two vertical measurements same diameter, therefore, 2 horizontal and 1 vertical added and divided by 3 to give MSD

gestational dating
Gestational dating
  • CRL BEST measurement
    • Fetus in longest axis
    • Fetus not curled up
    • Measurement from rump to top of head
  • CRL until 12 weeks
  • BPD after 15 weeks
  • 13- 15 weeks ? Wait until 15 weeks
  • Give an EDD on report using obstetric calculator
  • DO NOT CHANGE DATES IF CRL OR EARLY BPD
chorionicity an important 1st trimester diagnosis
CHORIONICITYan important 1st trimester diagnosis
  • Discordant nuchal translucency in MC twins -40% risk TTTS
  • MC twins-10X morbidity & mortality of DC
  • Intertwin transfusion - a normal event-10-15%MC
  • Complications- acute TTTS after fetal death - chronic TTTS

- acardiac(TRAP)

(high incidence of antenatally acquired cerebral lesions)

chorionicity
Chorionicity
  • Monochorionic Diamniotic (MCDA)
    • One placenta
    • Thin membrane
    • ‘T’ shaped insertion
    • Same sex
    • One chorion, 2 amnions (visible early)
  • Dichorionic Diamniotic (DCDA)
    • One or two placentae
    • ‘Twin peak’ or ‘Lambda’ sign
extra special problems of monochorionic twins
Extra Special Problems of Monochorionic Twins
  • Monoamniotic twins (1% of MCs)
  • TRAP
  • Congenital anomaly in 1
  • Conjoined twins
  • Nb can get TTTS
placental anastomoses
PLACENTAL ANASTOMOSES
  • A-A
  • A-V
  • V-V
  • TTTS associated with absence of AAA
  • isolated A-V seem to be implicated
acute ttts
ACUTE TTTS
  • Occurs when 1 dies
  • in 25% 2nd twin dies soon after
  • in 25 - 40%  neurological sequelae

Treatment

i) prevention

ii) delivery - “viability”

slide21

Twin To Twin Transfusion Syndrome

U/S for prediction diagnosis and management