精品课件超音波教学

超音波教學 Schedules Section 1 First Trimester Section 2 Fetal Brain Develop (2) Section 3 Fetal Spine Section 4 Face and Neck Section 5 Chest Section 6 Fetal Heart (2) Section 7 Abdominal Wall CF, chorion frondosum; CL, chorion laeve; CS, connecting stalk; DV, decidua vera (along endometrium; E, embryo; ECS, extrachorionic space (endometrial cavity); EEC, extraembryonic coelom; EEM, extraembryonic mesoderm; OM, omphalomesenteric duct; PG, primary gut, Y1 primary yolk sac; Y2, secondary yolk sac. Blastocyst implantation site in spontaneous pregnancies 89.1% had E-GSs detected in the upper region, which was found to be the most frequent region. Minami S, J Nippon Med Sch. 2003 Jun;70(3):250-4. Anembryonic Pregnancy Mean sac diameter 10mm with no Y.S. Mean sac diameter 18mm with no Emb. Empty amnion. Poor color signal around sac. Potential Pitfalls Potential Pitfalls Mistaking yolk sac for embryo Potential Pitfalls Mistaking Y.S. for embryo Mistaking sub-chorionic hemorrhage for G.S. Potential Pitfalls Mistaking Y.S. for embryo Mistaking sub-chorionic hemorrhage for G.S. Missing multiple G.S. IUP Lt adnexal ectopic sac Potential Pitfalls Mistaking Y.S. for embryo Mistaking sub-chorionic hemorrhage for G.S. Missing multiple G.S. Pseudo-sac of E.P. Potential Pitfalls Mistaking Y.S. for embryo Mistaking sub-chorionic hemorrhage for G.S. Missing multiple G.S. Pseudo-sac of E.P. Normal rhombencephalon for cystic brain mass Potential Pitfalls Mistaking Y.S. for embryo Mistaking sub-chorionic hemorrhage for G.S. Missing multiple G.S. Pseudo-sac of E.P. Normal rhombencephalon for cystic brain mass Physiological bowel herniation for omphalocele. MGH mid-gut herniation Topic 2: 1st Trimester Ultrasound Screening 1113+6 weeks scan NT 隋巢原方在诸病源候论 “妊娠三月名始胎，当此之时，血不 流行，形象始化，未有定仪，因感 而变。” V 妇女怀孕3个月时，胚胎已渐次发育成胎儿，这 时虽然已从形体上初步成形。但是还没有定型 ，即所谓“未有定仪”，其可塑性很大，当孕 妇见到带有什么特征的东西，她所怀胎儿的形 象，包括胎儿的形体和精神，也就会随之产生 变化，这就是“见物而变”的本意。故此给那 些想生一个长相漂亮、体力过人、才华出众的 孩子的孕妇提出了要求，在孕期内要多想好事 ，多多行善，多看美好的事物，以期感化腹内 的胎儿。通过母亲美与善的良好“见物”刺激 ，而使胎儿向更加聪明、善良、健康、漂亮的 方面“变化”。 五帝时帝妃子姜源氏妊娠期间性情 清静，喜好稼樯，经常随夫郊祭。 观察植物生长，所以她的儿子后稷 能种五谷，成为我国农业的第二始 祖。这里边即寓有“见物而变”的含 义。古人“见物而变”胎教理论的提 出，当然受当时文化背景的影响， 有时代的局限性，但还是有一定的 实际指导意义。 Screening Methods偵測率 % Maternal Age (MA)30 MA + 1518 weeks 母親血清生化測試50-70 MA + 1113+6 weeks NT70-80 MA + 1113+6 weeks NT +母親血清游離-hCG 27: 613618 R. BECKER Ultrasound Obstet Gynecol 2006; 27: 613618 叫我第一 名 6.57.4 Karl Oliver Kagan,Obstet Gynecol. 2006 Jan;107(1):6-10. WHY AND FOR WHOM IN THE FIRST TRIMESTER? Previous family history of cardiac defects The finding of an increased NT at 11 to 14 weeks. Nasal Bone The gestation should be 11-13+6 weeks and the fetal CRL should be 45-84 mm. In chromosomally normal fetuses the incidence of absent nasal bone is 50% of trisomy 18 and 30% of trisomy 13 fetuses. For a false positive rate of 5%, screening by a combination of sonography for fetal NT and nasal bone and maternal serum free -hCG and PAPP-A can potentially identify more than 95% of trisomy 21 pregnancies. Fetal Medicine Foundation, London 2006 Ductus Venosus At 11-13+6 weeks abnormal ductal flow is observed in 5% chromosomally normal fetuses, in about 80% with trisomy 21 and 75% with all chromosomal abnormalities. Assessment of the ductus venosus can be combined with measurement of fetal NT to improve the effectiveness of early sonographic screening for trisomy 21 Reversed A-wave Tricuspid Valve Regurgitation Large Facial Angle Other Easily Identified Anomalies Single Umbilical Artery Exomphalos Megacystis Take Home Message Intradecidual sac sign (IDSS): 4-4.5 wks Yolk sac: 5-5.5 wks Embryo 5mm: cardiac activity must be seen. Embryo with heart beat: 6-6.5 wks (TVS) Double belb sign: Y.S + amniotic sac Embryo forms within amnion Determine chorionicity/amnionicity in multiple gestations by No. YS = No. amnions Special Concern Ectopic pregnancy (EP) 1.4% No IUP + tubal mass + CDS fluid (best clues) Pseudogestational sac sign Adnexal abnormalities (80-9