obstetrical us in the 1st trimester20%c... · 2019. 6. 12. · 12-14주: crl, bpd, ac t x g. mean...

Obstetrical US in the 1st Trimester

성균관의대삼성제일병원

조 정 연

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Case 1Case 1Case 1Case 1Case 1Case 1Case 1Case 1

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

기존의 endometriosis, teratoma, other tumors�24/M

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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 Down

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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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Acrania & Anencephaly

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Encephalocele

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Holoprosencephaly

Alobar / Semilobar / Lobar�24/M

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Myelomeningocele

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Bladder outlet obstruction

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Abdominal Wall Defect

Physiological Physiological HerniationHerniationGastroschsisGastroschsis

OmphaloceleOmphalocele Omphalocele in Edward SyndromeOmphalocele in Edward Syndrome

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Limb-Body Wall Complex

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Cardiac Anomaly

DextrocardiaDextrocardia, Corrected TGA, PS, Corrected TGA, PS

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Thanatophoric Dysplasia

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Summaries

임신의진단: 확진, 위치, viability

임신주수의결정: MSD, CRL

임신초기의흔한문제진단

: bleeding, failure, ectopy, ovary problem

임신초기태아기형진단

-염색체이상진단: NT, NB-태아의구조적기형진단

임신 1기초음파의역할�24/M

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obstetrical us in the 1st trimester20%c... · 2019. 6. 12. · 12-14주: crl, bpd, ac t x g. mean...

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