Unit 6 - Early Demise & Other Structural Anomalies

What is the sonographic appearance of fetal early demise?

• No fetal heart motion

• Irregular shaped sac

• Degenerative trophoblastic tissue

• Subchorionic hemorrhage

What are the indications of fetal early demise?

• Discrepancies in dates and size

• Distortion of sac shape or contour

• Abnormal decidual reaction

• Abnormal growth in serial scans

• Abnormal yolk sac

Early Demise indications: what is considered normal & abnormal growth in serial scans?

• Normal sac grows 1.1 mm per day

• <0.6 mm per day abnormal for sac growth

• Normal embryo grows 1-2 mm per day

Early Demise indications: what is considered an abnormal yolk sac?

• Yolk sac >5.6 mm between 5-10 weeks

• Yolk sac <2 mm between 8-12 weeks

Characteristics that describe the Nuchal Translucency?

• 11-13w6d

• CRL- 45-84mm

• Midsagittal plane

• Magnification

• Neutral position

• On-to-on measurement

Characteristics that describe the Cardiac Activity in a fetus?

• Late 1st Trimester

• 4 chamber heart

  • Ectopia cordis

• Limb-body-wall complex

What is Ectopia Cordis?

Heart is found outside of the chest

What is this US image?

Nuchal Translucency

What is this US image?

Fetal Cardiac Heart

What is this US image?

Choroid Plexus

These structures fill the lateral ventricles.

Choroid Plexus

What is this US image?

Hydrocephalus

What is this US image?

Hydrocephalus

What is Hydrocephalus?

Fluid in the brain, blockage in the ventricular system

What is Hydranencephaly?

Brain necrosis from occlusion of internal carotid arteries

Characteristics of Hydranencephaly?

• Blockage

• Tissue shrinks & stops growing

• No blood flow in the brain

What is the sonographic appearance of Hydranencephaly?

Loss of all intracranial anatomy

What is this US image?

Hydranencephaly

What is this US image?

Hydranencephaly

What is this US image?

Hydranencephaly

• Imaged later in pregnancy

What is Anencephaly?

• Absence of the brain tissue, cranium did not ossify

  • Cranial ossification is not complete yet

  • Repeat US at 12-14 wks

Amniotic fluid can _______ the remaining brain tissue that is affected by Anencephaly.

Degenerate

What is this US image?

Anencephaly

What is this US image?

Anencephaly

What is the difference between Anencephaly & Acrania?

• Acrania ~ Still have brain tissue, just no cranium

• Anencephaly ~ Skull and brain tissue are absence

What are these US images showing?

Acrania

What is this US image?

Acrania

What is Iniencephaly?

• Defect of occipital bone at foramen magnum

• Retroflexion of the head {posterior}

• Open spinal defects

What is this US image?

Iniencephaly

What is this US image?

Iniencephaly

What is Dandy Walker Malformation?

• 4th ventricle enlargement

• Agenesis or dysgenesis of cerebellar vermis

  • Often accompanied with enlarged lateral ventricles

What are these US images showing?

Dandy Walker Malformation

Bowel Herniation characteristics?

• Echogenic mass at base of umbilical cord

• Normal in 1st trimester

• Out and back into abdomen 8-12 weeks

What is a Gastroschisis?

• Bowel and other organs protruding outside the abdomen through an open [has a NO skin covering]

• Always found to the right side of the umbilical cord

• Bowel extends separately from umbilical cord

What is this US image?

Gastroschisis

Gastroschisis & Bowel-Only Omphaloceles are both associated with _________ _______.

Chromosomal disorders

What is an Omphaloceles?

Congenital hernia of the umbilicus, covered by a membrane

What are these US image?

Omphaloceles

Characteristics describing Obstructive uropathy?

• Enlarged bladder into abdomen

• Sono @ 10-12 weeks

What is this US images?

Normal fetal bladder

What is this US image?

Enlarged fetal bladder

What is Exstrophy?

Blood is located outside of the abdomen cavity

What is Bladder Outlet Obstruction [BOO]?

Blockage at the level of the urethra

What is Megacystitis?

Enlarged Bladder

Cloacal anomalies are associated with the…

Urinary System

Cystic Hygroma is associated with…

Chromosome abnormalities, esp. in the 1st trimester [13, 18, 21]

What is Cystic Hygroma?

Cystic mass on the baby’s neck

• If not resolved by 18 weeks, bad

What are these US images?

Cystic Hygroma

What is the sonographic appearance of Cystic Hygroma?

• Nuchal thickening

• “Hammocking” effect

  • Embryo lying on amniotic membrane

  • Pseudomembrane gives false impression

What is this US image?

Cystic Hygroma

What are 1st Trimester Umbilical Cord Cysts?

• Cysts within the cord

  • 2mm- 7.5mm

What are the differential diagnoses for Umbilical Cord Cysts?

• Amniotic inclusion cysts

• Omphalomesenteric duct cysts

• Allantoic cysts

• Vascular anomalies

• Neoplasms

• Wharton’s jelly abnormalities

What is the prognosis for Umbilical Cord Cysts?

• If resolve by 2nd trimester = normal delivery

• IF PERSISTENT in 2nd trimester + associated with other abnormalities = further studies and genetic evaluation

What is this US image?

Umbilical Cord Cysts

What are these US images?

Umbilical Cord Cysts

Abnormalities identified before __ ______ represented only about 22% of all sonographically detected abnormalities in the study population.

14 weeks