1、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 & GI Section 8 GU system Section 9 Muscular System & U.C. Section 10 Placenta,超音波教學 Section I,Speaker 陳志堯醫師Dire
2、ctor 趙灌中主任 洪正修主任August 25, 2006,Topic 1,Normal Early Pregnancy,Day 22,Day 23,Day 26,Day 13,Day 21,Day 28,AL, allantois; CF, chorion frondosum; CL, chorion laeve; CS, connecting stalk; DV, decidua vera (along endometrium; E, embryo; ECS, extrachorionic space (endometrial cavity); EEC, extraembryonic
3、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
4、 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-chorion
5、ic 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
6、 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. Norm
7、al 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。”,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
8、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。,Fetal Medicine Fo
9、undation, London 2006,胎兒NT增厚之病生學,心臟功能失調 頭部及頸部靜脈充血 細胞外間質成分轉變 巴管排泄失能 貧血 低蛋白血症 先天性感染,R. BECKER Ultrasound Obstet Gynecol 2006; 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?,Pr
10、evious 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
11、 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
12、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 Valv
13、e RegurgitationLarge 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 +
14、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 (80-95%) Tubal hematoma (40-60%) Tubal ring (50%) Ring of fire 85% of EP on the same side of corpus luteum Sonar (-) in 5-10% Suspect EP if no IUP and hCG 2000,Thanks for listening,To be continued!,I Will Be Back,
