Problem-based obstetric ultrasound

723 Pages·2007·7.042 MB·English

by  Thilaganathan, Basky

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PROBLEM-BASED OBSTETRIC
ULTRASOUND
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PROBLEM-BASED OBSTETRIC
ULTRASOUND
Basky Thilaganathan
MDMRCOG
Consultant and Director
Fetal Medicine Unit
St George’s Hospital Medical School
London
UK
Shanthi Sairam
MDMRCOG
Senior Clinical Fellow
Fetal Medicine Unit
St George’s Hospital Medical School
London
UK
Aris T Papageorghiou
MRCOG
Consultant Maternal-Fetal Medicine
Fetal Medicine Unit
St George’s Hospital Medical School
London
UK
Amar Bhide
MDMRCOG
Consultant Maternal-Fetal Medicine
Fetal Medicine Unit
St George’s Hospital Medical School
London
UK
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CONTENTS
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Sabaratnam Arulkumaran
1. Ventriculomegaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2. Intracranial cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
3. Abnormal skull shape . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
4. Facial clefts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
5. Absent nasal bones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
6. Micrognathia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
7. Chest tumours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
8. Chest fluid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
9. Dextrocardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
10. Abnormal four-chamber view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
11. Anterior abdominal wall defect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
12. Abdominal cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
13. Abdominal echogenicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
14. Empty renal fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
15. Cystic kidney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
16. Fluid filled kidney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
17. Abnormal bladder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
18. Short femur length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
19. Joint abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
20. Hand abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
21. Spinal abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
22. Head and neck masses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
23. Increased nuchal translucency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
24. Placental abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
25. Single umbilical artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
26. Oligohydramnios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
27. Polyhydramnios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
28. Amniotic shelf/band . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
29. Hydrops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
30. Small fetus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
31. Twin–twin transfusion syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
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FOREWORD
This short textbook on problem-based obstetric ultrasound is an important and needed text for
those who scan for fetal anomalies. The book takes a pragmatic approach by first defining an
anomaly followed by a decision tree that indicates what other features need to be investigated
to reach the definitive diagnosis. In a short text it is difficult to cover the entire pathology seen
on scanning, but it covers more than adequately most of the common problems.
In addition to the decision algorithms, the text is well illustrated by the appropriate scan
pictures which would be of immense value.
I am delighted that such a book is produced at last by a team of four experts in the field of
fetal medicine.
Sabaratnam Arulkumaran
Professor and Head, Obstetrics and Gynaecology
St George’s University of London
London
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Chapter_01.qxp 1/25/2007 2:12 PM Page 1
1
VENTRICULOMEGALY
The lateral cerebral ventricles are best measured in that part of the posterior horn at the level of
the choroids plexus (atrium). The following terminology is followed most often:
(cid:1) normal: measurement (cid:1)10mm
(cid:1) mild/borderline ventriculomegaly: 10–12mm
(cid:1) moderate ventriculomegaly: 12–15 mm
(cid:1) severe ventriculomegaly: (cid:2)15mm.
In the majority of cases, the outcome is good for isolated mild/borderline or unilateral ventricu-
lomegaly, suggesting that it is a normal variant. When the ventriculomegaly is bilateral or the
measurement is above the 97.5th centile ((cid:2)12 mm), the neonatal outcome is associated with the
cause of the ventriculomegaly rather than the amount of fluid in the ventricle.
Aneuploidy
Advanced maternal age, high risk screen test results, or the presence of other ultrasound
markers of chromosomal abnormality should raise the possibility of fetal aneuploidy. Typically,
aneuploidy, if present, is associated with mild rather than moderate or severe ventriculomegaly.
Congenital viral infection
Although rare, the presence of ultrasound features confers a terrible prognosis for congenital
fetal viral infection. Typical ultrasound features include severe fetal growth restriction, micro-
cephaly, focal brain hyperechogenicities, and cardiac abnormalities.
Brain haemorrhage
Clots are rarely seen on fetal brain ultrasound, but if seen are characteristic of intracerebral
bleed as a cause. In the absence of such a finding, parental blood should be taken to exclude the
possibility of fetal alloimmune thrombocytopenia.
Structural brain abnormality
The finding of other structural brain abnormality generally confers a poor neonatal prognosis.
The exceptions to this rule are arachnoid cyst (see ‘Intracranial cysts’) and isolated agenesis of
the corpus callosum with normal gyral development.
Bibliography
1. Gaglioti P, Danelon D, Bontempo S et al. Fetal cerebral ventriculomegaly: outcome in 176 cases.
Ultrasound Obstet Gynecol 2005; 25(4): 372–7.
2. Laskin MD, Kingdom J, Toi A, Chitayat D, Ohlsson A. Perinatal and neurodevelopmental outcome
with isolated fetal ventriculomegaly: a systematic review. J Matern Fetal Neonatal Med 2005; 18(5):
289–98.