Fetal abdomen and abdominal wall examination

The umbilical vein enters the abdomen and hooks towards the ___ (away from the ____)

Liver, Stomach

Part of the UV drains into the ___ ____ to bring _____ blood directly to the heart via the IVC. The rest continues through the portal sinus bringing blood to the _____

Ductus venosus, oxygenated, liver

2 internal ____ arteries drain into 2 ____ arteries and wrap around the fetal bladder

Iliac, umbilical

The umbilical cord brings ____ blood and waste from baby to the ____

Deoxygenated, placenta

Important to see all ____ within the abdomen and a cross section of the free-floating ____ outside the abdomen

Vessels, cord

The stomach is derived from the ____

Foregut

The stomach is seen as early as __wks

11

The stomach is routinely visualized at/after __wks

14

Stomach is located in the ___ below the diaphragm

LUQ

If the stomach is not seen during the exam, we should reevaluate in ___-___ min; if still not seen, needs to be brought back within __ day- __ week

20-30 ; 1 day ; 1 week

The liver, spleen and gallbladder are all derived from the ____ and start to form around weeks __-__ of gestation

foregut ; 4-5

Fetal liver fills most of the abdomen and has two noticeable lobes, ___ and ___.

right and left

Fetal liver measurements range from __-__ mm from __wks to term

25-44 ; 20

Where is the spleen located in comparison to the stomach?

Posterior to the left

Spleen is best seen during what trimesters?

2nd and 3rd

The gallbladder is normally seen after __wks gestation as an oblong, fluid filled structure more to the right of the abdomen. It may not be seen on every fetus.

20

Most of the small intestine, cecum, ascending colon, and transverse colon are derived from the ____

midgut

The left part of the transverse colon, descending colon, sigmoid colon, and rectum are derived from the ____

hindgut

The small intestine is located more centrally in the abdomen and slightly more ____ compared to the liver

hyperechoic

The large intestine and the colon are seen more peripherally around the abdomen and has “_____ _____,” making it slightly easier to differentiate from the small intestine.

haustral folds

The ____ intestine is more hypoechoic

large

After 27wks, peristalsis of the ____ bowel can be seen. The end of the large intestine and the ____ do NOT persistals.

small ; colon

Normal small intestine lumen diameter is less than or equal to __ mm

5

Normal colon lumen diameter is _-_ mm @ 20wks, can be __mm or larger at term

3-5 ; 23

Depending on fetal age, the bowel can have differing appearances due to more ___-, or can be very ___ in the presence of anomalies.

swallowing ; echogenic

Meconium can be seen at __ months and contains hairs, proteins, vernix, urea and bile

5

The Esophagus is derived from the ___

foregut

A normal esophagus can be seen in the ___ and upper ____ in the 2nd and 3rd trimesters

neck ; chest

The esophagus appears as ___ parallel, echogenic lines (sometimes called a “___-____” pattern)

two ; multi-layered

Usually, the only time the esophagus is nice and visible is when the fetus ____, it’s then distended with ____ fluid as the fluid travels down to the stomach

swallows ; amniotic

Esophageal Atresia

Esophagus ends in blind pouch or connects to ___. ~__-__% with distal Tracheal-Esophageal fistula is most common.

trachea ; 80-90

Esophageal Atresia happens in every 1/____

5,000

Esophageal Atresia ultrasound findings include:

Small or ___ stomach bubble

__hydraminos

absent ; poly

Esophageal Atresia incidence

1:___ births

3,000-4,500

Half of EA cases have T13, 18, 21 and VACTERL

13, 18, 21