obstetrical us in the 1st trimester20%c... · 2019. 6. 12. · 12-14주: crl, bpd, ac t x g. mean...
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Obstetrical US in the 1st Trimester
성균관의대삼성제일병원
조 정 연
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산전초음파
1기초 (5-8주): 임신확인, 임신주수측정
1기말 (10-13주): 초기태아기형진단
2기 (18-22주): 태아기형, 태아성장, 태반, 자궁경부
3기 (32-36주): 태아성장, 태아기형, 태아자세, 태반위치
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Contents
임신의진단
임신주수의결정
임신초기의흔한문제
임신초기태아기형진단
-염색체이상진단
-태아구조적기형진단
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임신의진단
임상적진단
무월경
기타증상
Urine test
초음파진단
임신확진
위치확인
viability 확인
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태낭 (Gestational Sac)
4.5주에보이기시작, 5mm 면항상보임Echogenic rim: decidual reactionDouble decidual sac sign
4.5 4.5 WkWk 5.3 5.3 WkWk
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난황 (Yolk Sac)
5주에보이기시작
8주면항상보임
Round well-defined
10주까지크기증가(5-6mm)
1기말에는보이지않음
형태이상, 크기가클경우 failure 가능성시사
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배아 (Embryo)
5주에보이기시작, 6-6.5주에는항상보임
10주이전: embryo (*fetal pole)10주이후: fetus
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배아심박동
5주에보이기시작, 6-6.5주에항상보임8주이후심박동 (+): 실패확률 2-3%배아 5mm에심박동 (-): demise 가능, 추적검사
정상심박수
5-6주: 100-1159주: 140이후: 130-140
서맥: demise 가능성추적검사
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양막 (Amniotic Membrane)
배아 5mm면보임, 7mm 이상이면항상보임
Double bleb sign: 7주이후에는보이지않음
12-16주에 chorion과융합
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제태연령(임신주수)의결정
LMP: 기본, 부정확한경우많음
임신초기측정이가장정확
이후측정으로임신주수바뀔수없음
측정방법
6주이전: Mean G-sac diameter (MSD)
6-12주: Crown-rump length (CRL)
12-14주: CRL, BPD, AC
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Mean Sac Diameter
5-10주사이MSD = (AP + Length + Width) / 3재태일수 = MSD(mm) + 30
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Crown–Rump Length
임신 6-12주에측정
배아성장
6주: 3mm8주: 17mm12주: 54-55mm (*1mm/day)
재태일수 = CRL(mm) + 42
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임신초기흔한문제
Vaginal bleeding
Pregnancy failure: demise, abortion
Ectopic pregnancy
Ovarian problems
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Vaginal Bleeding
약 25% 에서발생
초음파상대개정상
* implantation bleeding
* subchorionic hematoma
Threatened abortion: vaginal bleeding withliving embryo (< 20wk)
Ectopic pregnancy, GTD
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Pregnancy Failure
Blighted ovum: anembryonic pregnancy
Embryonic demise: death of embryo*missed abortion
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Irregular G-sac with poor decidual reaction
No interval growth of G-sac
No yolk sac in G-sac larger than 8mm
No heart beat in G-sac larger than 16mm
Abnormal yolk sac
No beat in embryo larger than 5mm
Small G-sac compared with embryo
Bradycardia
Suggesting Findings
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CRL = 12 mmCRL = 12 mm MSD = 13 mmMSD = 13 mm
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자궁외임신
가임여성응급복부상황: 항상가능성생각
진단이어려운경우가많음
-적극적인초음파검사필요
-반드시 hCG level 고려해야
- F/U 필요한경우가많음
- Pseudo-lesion 주의: pseudo G-sac ovarian cyst, PID, bowel
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CornualCornual (Interstitial)(Interstitial) CervicalCervical
HeterotophicHeterotophic
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난소낭종
Corpus luteal cyst: 가장흔함
대개임신중기이전에크기줄거나소실됨
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임신 1기태아기형진단
염색체이상진단
-염색체검사: chorionic vilIi sampling
-혈액검사: PAPP-A, hCG
-초음파검사 (10-13주)nuchal translucency measurementnasal bone measurement
태아구조적기형진단
: TVUS
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Nuchal Translucency (10-13wk)
정상기준: 3mm / 2.5mm / 95%Down, Edward, Patau, Turner syndromeCardiac, renal, skeletal anomalies, CDH
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Thick NT in CDH
12wk Congenital Diaphragmatic Hernia
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Nasal Bone Length (10-13wk)
정상의 95-99.5%에서보임Down syndrome의 66-73%에서안보임Other trisomy syndromes, bone dysplasia
독립적 screening tool: 아직불확실
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DownDown NormaNormal
OsteogenesisOsteogenesis ImperfectaImperfecta
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임신1기태아구조적기형진단
CNS anomalies
Abdominal wall defect
Urinary anomalies
Cardiovascular anomalies
Musculoskeletal anomalies
Facial anomalies
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Holoprosencephaly
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Abdominal Wall Defect
Physiological Physiological HerniationHerniationGastroschsisGastroschsis
OmphaloceleOmphalocele Omphalocele in Edward SyndromeOmphalocele in Edward Syndrome
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Cardiac Anomaly
DextrocardiaDextrocardia, Corrected TGA, PS, Corrected TGA, PS
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