prenatal diagnosis: imaging - gfmer.ch · prenatal diagnosis imaging philippe extermann dianecho,...
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Prenatal diagnosis
Imaging
Philippe ExtermannDianecho, Geneva
Training Course in Sexual and Reproductive Health Research
Geneva, February 2009
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PRENATAL DIAGNOSIS
IMAGING
ULTRASOUND
EMBRYOSCOPY
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FETAL MEDICINE
ULTRASOUND IMAGING
DATING
MULTIPLE PREGNANCY
ANOMALY SCREENING
FETAL GROWTH
AMNIOTIC FLUID VOLUME
PLACENTAL LOCALISATION
DOPPLER STUDIES
FETAL WELL-BEING
GUIDANCE OF INVASIVE PROCEDURES
PSYCHOLOGICAL ASPECTS
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FETAL MEDICINE
ULTRASOUND IMAGING
ULTRASOUND SCREENING DURING PREGNANCY
I : 11 - 14 WKS
II : 19 – 21 WKS
III: 32 - 36 WKS
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ULTRASOUND SCREENING
DURING PREGNANCY
FIRST EXAMINATION (11-14 WKS)
UTERUS, ADNEXAE
GESTATIONAL AGE
CHORIONICITY IN MULTIPLE PREGNANCIES
NUCHAL TRANSLUCENCY (NT)
EARLY MORPHOLOGY
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ASSESSMENT OF GESTATIONAL AGE
MEAN GESTATIONAL SAC DIAMETER +/- 7d
CROWN RUMP LENGTH (CRL) +/- 5d
BIPARIETAL DIAMETER (BPD) ± 7 d < 20 wks
± 10d 20-26 wks
± 2 wks 27-29 wks
± 2.5 wks 30-32 wks
+/- 3 wks > 33 wks
FEMUR LENGTH (FL)
OTHER PARAMETERS (CEPHALIC CIRCUMFERENCE, HUMERUS LENGTH, CEREBELLUM, FOOT LENGTH)
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ASSESSMENT OF GESTATIONAL AGE
MEAN GESTATIONAL SAC DIAMETER +/- 7d
CROWN RUMP LENGTH (CRL) +/- 5d
BIPARIETAL DIAMETER (BPD) +/- 7 d < 20 wks
+/- 10d 20-26 wks
+/- 2 wks 27-29 wks
+/- 2.5 wks 30-32 wks
+/- 3 wks > 33 wks
FEMUR LENGTH (FL)
OTHER PARAMETERS (CEPHALIC CIRCUMFERENCE, HUMERUS LENGTH, CEREBELLUM, FOOT LENGTH)
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ULTRASOUND SCREENING
DURING PREGNANCY
FIRST EXAMINATION (11-14 WKS)
UTERUS, ADNEXAE
GESTATIONAL AGE
CHORIONICITY IN MULTIPLE PREGNANCIES
NUCHAL TRANSLUCENCY (NT)
EARLY MORPHOLOGY
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MULTIPLE PREGNANCIES
"LAMBDA" "T"
BICHORIONIC MONOCHORIONIC
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ULTRASOUND SCREENING
DURING PREGNANCY
FIRST EXAMINATION (11-14 WKS)
UTERUS, ADNEXAE
GESTATIONAL AGE
CHORIONICITY IN MULTIPLE PREGNANCIES
NUCHAL TRANSLUCENCY (NT)
EARLY MORPHOLOGY
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FIRST-TRIMESTER SCREENING FOR FETAL
ANEUPLOIDIES
NUCHAL TRANSLUCENCY MEASUREMENT:
1. CRL 41 - 80 mm
2. MEDIAN SAGITTAL SECTION OT THE FETUS IN NEUTRAL POSITION
3. DISTINCTION BETWEEN FETAL SKIN AND AMNION
4. THE FETUS SHOULD OCCUPY AT LEAST 75% OF THE IMAGE
5. MAXIMUM THICKNESS OF NT SHOULD BE MEASURED
6. CALLIPERS SHOULD BE PLACED ON THE LINES
Snijders RJM et al. Lancet 1998; 352: 343-6.
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FIRST-TRIMESTER SCREENING FOR FETAL
ANEUPLOIDIES
SECONDARY BENEFITS OF NT MEASUREMENT:
WHEN THE FETAL KARYOTYPE IS NORMAL, A NT > 95th CENTILE
MAY BE ASSOCIATED WITH:
1. CONGENITAL CARDIOPATHIES
2. OTHER FETAL ANOMALIES (ORGANIC / SYNDROMIC)
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ULTRASOUND SCREENING
DURING PREGNANCY
SECOND EXAMINATION (19-21 WKS)
GESTATIONAL AGE
MARKERS OF ANOMALY / ANEUPLOIDY
FETAL MORPHOLOGY I
PLACENTAL LOCALISATION
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FETAL MORPHOLOGY SCAN
FETAL ANOMALY SCREENING
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FETAL MORPHOLOGY SCAN
HEAD
SPINE
THORAX (HEART)
DIAPHRAGMA
ABDOMEN
EXTREMITIES
UMBILICAL CORD
FETAL GENDER (?)
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FETAL MORPHOLOGY SCAN
HEAD
CRANIUM
CEREBRAL STRUCTURES
VENTRICLES, POSTERIOR FOSSA
ADDITIONAL STRUCTURES ?
BIPARIETAL DIAMETER
OTHER MEASUREMENTS WHEN NEEDED
FACIAL STRUCTURES, PROFILE
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FETAL MORPHOLOGY SCAN
RACHIS
LONGITUDINAL, TRANSVERSE
AND FRONTAL VIEWS
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FETAL MORPHOLOGY SCAN
THORAX
HEART: POSITION / AXIS, DIMENSIONS, RHYTHM,
4 CHAMBERS, OUTFLOW TRACTS
THORACIC WALL, RIBS
THORACIC CIRCUMFERENCE IF NEEDED
ADDITIONAL STRUCTURES ?
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FETAL MORPHOLOGY SCAN
DIAPHRAGM
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FETAL MORPHOLOGY SCAN
ABDOMEN
DIAMETERS AND/OR CIRCUMFERENCE
CORD INSERTION
STOMACH, LIVER, GALLBLADDER, UMBILICAL VEIN
KIDNEYS: DIMENSIONS, STRUCTURES
BLADDER: PRESENCE (DYNAMIC EVALUATION)
ADDITIONAL IMAGES ?
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FETAL MORPHOLOGY SCAN
EXTREMITIES
FEMORAL LENGTH
MEASUREMENTS OF OTHER LONG BONES WHEN NEEDED
PRESENCE OF ALL 4 EXTREMITIES AND THEIR SEGMENTS
MOBILITY
ATTITUDE
POLYDACTILY ?
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FETAL MORPHOLOGY SCAN
UMBILICAL CORD
NUMBER OF VESSELS
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FETAL MORPHOLOGY SCAN
FETAL SEX (?)
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FETAL MORPHOLOGY SCAN
CRITICAL POINTS
1. TIMING
2. COMPREHENSIVE AND SYSTEMATIC EXAMINATION
3. EXPERIENCE OF NORMAL FETAL IMAGES
4. ONLY ADEQUATELY VISUALISED STRUCTURES
SHOULD BE EVALUATED
5. IMAGING CONDITIONS
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US MARKERS OF FETAL ANOMALIES
OLIGOHYDRAMNIOS
POLYHYDRAMNIOS
EARLY GROWTH RETARDATION
DISHARMONIOUS FETAL GROWTH
ABNORMAL MOTOR ACTIVITY
CARDIAC ARRHYTHMIAS
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US MARKERS OF FETAL
ANEUPLOIDY
2ND-TRIMESTER OLIGOHYDRAMNIOS
POLYHYDRAMNIOS
EARLY GROWTH RETARDATION
DISHARMONIOUS GROWTH
NON-IMMUNOLOGIC HYDROPS
ABNORMAL PROFILE
STRUCTURAL ANOMALIES
SINGLE UMBILICAL ARTERY
ABNORMAL MOTOR ACTIVITY
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ULTRASOUND SCREENING
DURING PREGNANCY
THIRD EXAMINATION (32-36 WKS)
FETAL GROWTH
FETAL MORPHOLOGY II (CNS, HEART,
URINARY AND DIGESTIVE TRACTS,
DIAPHRAGM)
AMNIOTIC FLUID
PLACENTAL LOCALISATION
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ULTRASOUND IN OBSTETRICS
DOPPLER EVALUATION OF FETAL AND
UTERO-PLACENTAL CIRCULATIONS
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PRENATAL DIAGNOSIS
EMBRYOSCOPY
DIRECT, DETAILED OBSERVATION OF FETAL ANATOMY AND INTEGUMENT
TRANSCERVICAL / TRANSABDOMINAL
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FETAL MEDICINE
ULTRASOUND IMAGING
ACCEPTED (PROVEN) BENEFITS
1. BETTER GESTATIONAL AGE ASSESSMENT
2. EARLIER DETECTION OF MULTIPLE PREGNANCIES
3. EARLIER DETECTION OF CLINICALLY UNSUSPECTED
FETAL MALFORMATIONS
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FETAL MEDICINE
ULTRASOUND IMAGING
ANOMALY SCREENING REMAINS A CONFLICTUAL
ISSUE
BUT
A DIAGNOSTIC TEST DEPENDS ON PROPER
MANAGEMENT AFTER DIAGNOSIS TO BECOME
EFFICIENT