医学精品课件：14.2正常妊娠和胎儿畸形超声诊断-ENGLISH.ppt

1、Liu Liping1、Normal pregnancy(正常妊娠)2、Abnormal pregnancy（异常妊娠）3、Trophoblastic disease(滋养细胞疾病滋养细胞疾病)4、Placental abnormality(胎盘异常胎盘异常)5、Fetal malformation(胎儿畸形胎儿畸形)lFirst trimester =0 to 12 weeks of gestationlSecond trimester =13 to 26 weeks of gestationlThird trimester =27 to 42 weeks of getsationlPost

2、term pregnancy=42 weeks of gestationlConfirm presence of intrauterine pregnancylEvaluate for suspected ectopic pregnancylDefine cause of vaginal bleedinglDetermine gestational agelConfirm suspected multiple gestationslAid in invasive procedureslEvaluate pelvic masseslDetect uterine abnormalitiesDefi

3、nition：Pregnancy before 12 weekend.5 weeks pregnant Gestational sac；6-7 weeks pregnant Germ;7-8 Weeks Primitive heart tube pulse；8-11 weeks Yolk sac;9 weeks Embryonic,placenta.lShape:round or ovallPosition:fundal or middle portion of uterus;a center position relative to endometriumlContour:smoothlWa

4、ll:echogenic;3 mm of more in thicknesslInternal landmarks:yalk sac present when gestational sac is larger than 10 mm;embryo present when gestational sac is larger than 18 mmlGrowth:1 mm per day(range:0.7 mm to 1.5 mm per day)Umbilical bordEmbryonic headEmbryonic abdomenYolk sacEmbronic headAmniotic

5、sacl Estimate gestational age for patients with uncertain dateslEvaluate uterine size and clinical date discrepancieslEvaluate fetal growthlEstimate fetal weightlDetermine fetal presentationlEvaluate fetal lifel provide adjunct to amniocentesis,percutaneous umbilical blood sampling procedure,or cerc

6、lage placementlEvaluate uterine abnormalitylEvaluate abnomal maternal serum alpha-fetoprotein valueslEvaluate abnormal amniotic fluidlEvaluate placenta Etc.lSurvey uterus lObserve cardiac activitylDetermine position and number of the fetus and placentalAssess amniotic fluidlLook for uterine of place

7、ntal masses and fetal anomaliesl1、Fetal head：BPD biparietal diameter;l2、Fetal abdomen:AC abdomen circumference;l3、Fetal limb：FL femur length;l4、Others：Placenta,Fetal heart rate,Amniotic fluid,etc.Measuring the Biparietal Diameter(BPD)lObitain biparietal diameter of the fetal head at the transverse l

8、evel of the midbrain:falx,cavum septi pellucidi,and thalamic nucleilMake sure the head is symmetric and ovallMeasure from outer to inner margins of the skulllIn the third trimester,the BPD is not as accurate in predicting fetal age skullthalamic nucleicavum septi pellucidiBPDlThe hepatobiliary syste

9、m:liver,port venous systerm,hepatic veins and arteries,gallbladder,and bile ductslThe gastrointestinal system:the esophagus,stomach,small and large intestines(colon)lThe urinary system:kidneys,adrenal glands,ureters,bladder.The fetal abdomen circumference（AC)is the most widely measured lThe AC shoul

10、d be taken from a round transverse image with the umbilical portion of the left portal vein midline within the liverlThe outer margin of the abdominal wall should be measuredlThe abdominal wall measurement is the least accurategallbladderstomachport venousspinegallbladderstomachlThe upper limbs:the

11、ulna the radius the humeruslThe lower limbs:the femur/the thigh bone the fibula the tibia lThe femur is the most widely measured long bone（FL femur length ）lHyperechonic linear structure represents the ossified portion of the femoral diaphysis and corresponds to femoral length measurement from the g

12、reater trochanter to the femoral condyleslThe normal femur has a straight lateral border and a curved medial borderlFemur length may be used with the same accuracy as BPD to predict gestational agelFemur length may indicate skeletal dysplasias or intrauterine growth restrictionThe radiusThe ulnaThe

13、humerus Femur/thigh boneFibula/perone Tibia/shin bone lThe major role of the placenta is to permit the exchange of oxygenated materinal blood(rich in oxgen and nutrients)with deoxygenated fetal blood.lThe thickness of the placenta varies with gestational age,with a minimum diameter of 15 mm in fetus

14、es greater than 23 weeks.The size of the placenta rarely exceeds 50 mm in the normal fetus.The placentaUmbilical bordAmniotic fluidThe fetalcalcification 41umbilical cord(脐带脐带)One big umbilical vein and Two small umbilical arteries(with arterial blood in vein and venous blood in arteries)FETAL DEFOR

15、MITY 胎儿畸形胎儿畸形Lack of fetal skull,brain parenchyma rarely,brain hemisphere exposure,from a few millimeters to several centimeters of purplish red,amorphous mass.Exophthalmos,like the frogs eyes,but the face is still normal.Anencephaly is the most common disease of open neural tube malformation,girls

16、make up the majority.Little Jackson The United States anencephalyThe absence of brain abnormalities is often associated with spina bifida and polyhydramnios.With polyhydramnios,the uterus is larger than the normal month of pregnancyAbdominal examination often fails to touch the head of the fetus.Ane

17、ncephaly with spina bifida12 to 14 weeks,Fetal skull Aura can not be see when measuring fetal biparietal diameter;The head of the fetus can be seen as a lump of tumor,which is the echo of the facial bone and the skull base of the fetus.The orbital and nasal bones can be found in the facial bones;Atr

18、ophy of the brain tissue,partly of dysplastic brain tissue can be see,is wrapped by the meningeal sac and floating in the amniotic fluid;Anencephaly is often associated with cervical and thoracic spinal bifida,combined with polyhydramnios 4912W 12W Anencephaly10W 10W Anencephaly50Exencephaly and ane

19、ncephaly露脑畸形及无脑儿露脑畸形及无脑儿Anencephaly with spina bifida无脑儿伴脊柱裂无脑儿伴脊柱裂Hydrocephalus is due to large amounts of cerebrospinal fluid retented intracranial.Baby girls with hydrocephalus in IndiaThe cause of increased brain effusionThe choroid plexus produces too much cerebrospinal fluid;Discharge dysfunct

20、ion of cerebrospinal fluid from the ventricles and cistern(脑池脑池)Subarachnoid(蛛网膜下腔蛛网膜下腔)absorption disorderThe lateral ventricles enlarged and showed anechoic area。Ventricular rate 0.5Biparietal diameter is normal or large than that of the same gestational age,vary according to the amount of effusio

21、n.55With large amounts of effusion,the midline(brain curtain)floating in the brain fluid can be see.The brain tissue is compressed to be thin.56Other fetal abnormalities58L-Normal:and depressionFetal spina bifida (59Cleft lip deformity (The upper lip is not continuousOther fetal organs61Fetal chest 胎儿胸腔胎儿胸腔Heart and LungsFetal heart at four-chamber section62Fetal Extremities胎儿肢体胎儿肢体63The Male and Female GenitaliaFetal Genitalia 胎儿性别胎儿性别)6465