OB Lecture 2 - SONOGRAPHIC PRENATAL DETECTION OF FETAL - Are there structural/functional anomalies present

ANATOMIC CONGENITAL ANOMALIES

USTMED ’07 Sec C - AsM
A.I.U.M. Guidelines: 2nd and 3rd Trimester
Congenital Anomaly
- consists of a departure from the normal anatomic
architecture of an organ or system
- individual alterations of form or structure can be
classified as malformations, deformations, and
disruptions
Malformation is a morphologic defect of an organ, part of an
organ, or a larger area of the body resulting from an intrinsically
abnormal developmental process.
Deformation refers to an abnormal form, shape, or position of a
part of the body caused by non-disruptive mechanical forces.
- assessment of gestational age should be accomplished
by using BPD, FL;Fetal growth assessment requires the
addition of FAC
- evaluation of the uterus and adnexae
- study should include cerebral ventricles, spine,
stomach, urinary bladder, umbilical cord insertion site
and renal region
- Fetal lie, number and presentation should be
documented
- An estimate of the amount of amniotic fluid
(increased, decreased, normal) reported
- The placental location should be recorded and its
relationship to the internal os determined

Disruption is a morphologic defect of an organ, part of an Criterion Date Error

organ, a larger region of the body resulting from a breakdown, Gestational sac 5-10 wks < 7 days
or interference with an originally normal developmental CRL 8-12 wks <10 days
process.
BPD & FL 12-28 wks < 14 days
FAC 26 wks onwards
Incidence of Congenital Anomalies:
Accurate documentation depends on many factors including:
- the type of examination (body surface examination, Amniotic Fluid Volume
extensive examination including evaluation of internal 1. Single vertical depth (Manning) > 2 cm
organs); and 2. AFI (Phelan) 9 cm up to 22 cm
- ethnic, geographic, and social variations in the
incidence of individuals malformations. The incidence
of major anomalies was 2.04% while that of minor
anomalies was 14.7%.

• The cardinal principle behind the diagnosis of

congenital anomalies with ultrasound is recognition
of a departure from normal fetal anatomy.
• The sonographic recognition of congenital anomalies
depends on knowledge of normal fetal anatomy,
ultrasound resolution, and the natural history of the
disorder.

Anomalies Identified by Ultrasound

(A/N: I didn’t include all the pictures because they weren’t clear. Try to cross-
reference with other books)
- Early Hydrocephalus - Dandy-Walker
Cysts umbilical artery waveforms in a normal and growth-restricted fetus at
approximately the same gestational age.

- fin -

audrey_cl@yahoo.com

- Longitudinal Fetal Spine - Spina Bifida

Ultrasound Historical Background

- Shift of major proportions brought in by the late
professor Ian Donald in his pioneering work in
obstetrics ultrasound, early 60s.

A.I.U.M. Guidelines: First Trimester

- location of the gestational sac should be documented;
the embryo should be identified and the crown-rump
length recorded
- presence or absence of fetal life should be reported
- fetal number should be documented
- evaluation of the uterus (including cervix) and adnexal
structures should be performed

Fundamental and Basic Questions of Fetal Assessment

- what is the fetal age?
- How many fetuses are there?