1、Ultrasonography on Obstetrics,Liu Liping,The role of Ultrasound in Obstetrics,Obstetric common diseases,1、 Normal pregnancy(正常妊娠) 2、 Abnormal pregnancy（异常妊娠） 3、 Trophoblastic disease(滋养细胞疾病) 4、 Placental abnormality(胎盘异常) 5、 Fetal malformation(胎儿畸形),Natural pregnancy,TRIMESTERS,First trimester = 0 t
2、o 12 weeks of gestation Second trimester = 13 to 26 weeks of gestation Third trimester = 27 to 42 weeks of getsation Postterm pregnancy = 42 weeks of gestation,Indications for First-Trimester Sonography,Confirm presence of intrauterine pregnancy Evaluate for suspected ectopic pregnancy Define cause
3、of vaginal bleeding Determine gestational age Confirm suspected multiple gestations Aid in invasive procedures Evaluate pelvic masses Detect uterine abnormalities,Nonage pregnancy (First-Trimester),Definition ：Pregnancy before 12 weekend.,5 weeks pregnant Gestational sac； 6-7 weeks pregnant Germ; 7-
4、8 Weeks Primitive heart tube pulse； 8-11 weeks Yolk sac;9 weeks Embryonic, placenta.,The Normal First Trimester,Sonographic Features of a Normal Gestational Sac,Shape: round or oval Position: fundal or middle portion of uterus; a center position relative to endometrium Contour: smooth Wall: echogeni
5、c; 3 mm of more in thickness,Internal landmarks: yalk sac present when gestational sac is larger than 10 mm; embryo present when gestational sac is larger than 18 mm Growth: 1 mm per day (range: 0.7 mm to 1.5 mm per day),4-5 weeks pregnantIn the gestational sac we can see a embryo point, the earlies
6、t embryo.,7 weeks pregnantFetus is about 4 mm，we can see apparent heart throb, and small limb bud .,8 weeks pregnantThree-dimensional ultrasound show its beginning of the shape of a human.,Umbilical bord,Embryonic head,Embryonic abdomen,Yolk sac,Embronic head,Amniotic sac,9 weeks pregnantKnown as a
7、fetal，Development of the various parts of the fetus, tends to improve.,12 weeks pregnant The spine is identifiable , as the two bead-like high echo-level. Ears, limbs, bones can be shown and measurement.,The Second- and Third-Trimester ( Metaphase and terminal prengancy),Mid-pregnancy:13-27 weeks pr
8、egnancy.Late-pregnancy:More than 28 weeks of pregnancy.,Ultrasound of the Second and Third Trimesters,Indications for Second- and Third-Trimester,Estimate gestational age for patients with uncertain dates Evaluate uterine size and clinical date discrepancies Evaluate fetal growth Estimate fetal weig
9、ht Determine fetal presentation Evaluate fetal life,provide adjunct to amniocentesis, percutaneous umbilical blood sampling procedure, or cerclage placement Evaluate uterine abnormality Evaluate abnomal maternal serum alpha-fetoprotein values Evaluate abnormal amniotic fluid Evaluate placentaEtc.,Sc
10、anning Techniques,Survey uterus Observe cardiac activity Determine position and number of the fetus and placenta Assess amniotic fluid Look for uterine of placental masses and fetal anomalies,Check contents,1、Fetal head ：BPD biparietal diameter; 2、Fetal abdomen: AC abdomen circumference; 3、Fetal lim
11、b： FL femur length ; 4、Others：Placenta, Fetal heart rate, Amniotic fluid, etc.,1 、 Fetal head,Measuring the Biparietal Diameter(BPD) Obitain biparietal diameter of the fetal head at the transverse level of the midbrain: falx, cavum septi pellucidi, and thalamic nuclei Make sure the head is symmetric
12、 and oval Measure from outer to inner margins of the skull In the third trimester, the BPD is not as accurate in predicting fetal age,Fetal head, after 12 weekend pregnant,skull,thalamic nuclei,cavum septi pellucidi,Fetal head, after 12 weekend pregnant,BPD,Fetal head, after 12 weekend pregnant,Feta
13、l side profile, we can observe its forehead, nose ,lip, and chin, etc.,2、Fetal abdomen,The hepatobiliary system: liver, port venous systerm, hepatic veins and arteries, gallbladder, and bile ducts The gastrointestinal system: the esophagus, stomach, small and large intestines(colon),The urinary syst
14、em: kidneys, adrenal glands, ureters, bladder.The fetal abdomen circumference（AC) is the most widely measured,Measuring the Abdominal Circumference(AC),The AC should be taken from a round transverse image with the umbilical portion of the left portal vein midline within the liver The outer margin of
15、 the abdominal wall should be measured The abdominal wall measurement is the least accurate,The fetal liver,gallbladder,stomach,port venous,spine,gallbladder,stomach,3、Fetal limbs,The upper limbs: the ulna the radiusthe humerus The lower limbs: the femur/the thigh bonethe fibulathe tibia The femur i
16、s the most widely measured long bone （FL femur length ）,Femur measurement,Hyperechonic linear structure represents the ossified portion of the femoral diaphysis and corresponds to femoral length measurement from the greater trochanter to the femoral condyles The normal femur has a straight lateral b
17、order and a curved medial border Femur length may be used with the same accuracy as BPD to predict gestational age Femur length may indicate skeletal dysplasias or intrauterine growth restriction,Long section of the upper limbs,The radius,The ulna,The humerus,Femur/thigh bone,Fibula /perone,Tibia/sh
18、in bone,Long section of the lower limbs,4、 The placenta（胎盘）,The major role of the placenta is to permit the exchange of oxygenated materinal blood(rich in oxgen and nutrients) with deoxygenated fetal blood.The thickness of the placenta varies with gestational age,with a minimum diameter of 15 mm in
19、fetuses greater than 23 weeks. The size of the placenta rarely exceeds 50 mm in the normal fetus.,Anterior placenta at 21 weeks of gastation,The placenta,Umbilical bord,Amniotic fluid,The fetal,Posterior placenta at 29 weeks of gestation,calcification,Anterior placenta at 39 weeks of gastation,41,um
20、bilical cord(脐带),One big umbilical vein and Two small umbilical arteries(with arterial blood in vein and venous blood in arteries),FETAL DEFORMITY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 mas
21、s. Exophthalmos, like the frogs eyes, but the face is still normal.,Anencephalus（无脑儿),Anencephaly is the most common disease of open neural tube malformation, girls make up the majority.,Little Jackson The United States anencephaly,The absence of brain abnormalities is often associated with spina bi
22、fida and polyhydramnios. With polyhydramnios, the uterus is larger than the normal month of pregnancy Abdominal examination often fails to touch the head of the fetus.,Anencephaly with spina bifida,12 to 14 weeks , Fetal skull Aura can not be see when measuring fetal biparietal diameter; The head of
23、 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;,Ultrasound findings,Atrophy of the brain tissue, partly of dysplastic brain tissue can be see, is wrapped by the meningeal sa
24、c and floating in the amniotic fluid; Anencephaly is often associated with cervical and thoracic spinal bifida, combined with polyhydramnios,49,12W Anencephaly,10W Anencephaly,50,Exencephaly and anencephaly 露脑畸形及无脑儿,Anencephaly with spina bifida 无脑儿伴脊柱裂,Hydrocephalus（脑积水）,Hydrocephalus is due to lar
25、ge amounts of cerebrospinal fluid retented intracranial .,Baby girls with hydrocephalus in India,The cause of increased brain effusion The choroid plexus produces too much cerebrospinal fluid; Discharge dysfunction of cerebrospinal fluid from the ventricles and cistern(脑池) Subarachnoid(蛛网膜下腔) absorp
26、tion disorder,The lateral ventricles enlarged and showed anechoic area 。 Ventricular rate 0.5 Biparietal diameter is normal or large than that of the same gestational age, vary according to the amount of effusion.,Ultrasound findings,55,With large amounts of effusion, the midline (brain curtain) flo
27、ating in the brain fluid can be see. The brain tissue is compressed to be thin.,56,Other fetal abnormalities,58,L-Normal : appears as two bead-like high-echoes R-Abnormal: with discontinuity and a depression,Fetal spina bifida (胎儿脊柱裂),59,Cleft lip deformity (唇裂畸形),The upper lip is not continuous,Oth
28、er fetal organs,61,Fetal chest 胎儿胸腔,Heart and Lungs Fetal heart at four-chamber section,62,Fetal Extremities胎儿肢体,63,The Male and Female Genitalia,Fetal Genitalia (胎儿性别),64,65,Calm little face,Eating toe,Eating fingers,Crying,Poutting,Fetal with umbilical cord around the neck,Fetal with cleft lip,smiling,Bao bao,Bei bei 1 years birthday!,
