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LUTHERAN UNIVERSITY OF BRAZIL COURSE OF MEDICINE

Department of Radiology and Diagnostic Imaging


Ultrasound in Obstetrics
Ultrasound in Obstetrics
Chronology of embryological development
Day 14 - fertilization Day 18 - morula Day 20 - blastocyst implantation Day 23 -
bag germinal Primary Day 28 - yolk sac 5th - 10th week - the cardiovascular sys
tem 6th - 10th week - TGI 8th - 10th week - kidneys 10th - 14th week - genitalia
6th - 9th Week - SNC 8 - 9 weeks - members
Objectives of Ultrasound in 1st quarter
-Find the gestational sac (intrauterine or ectopic)-ID: Embryonic death anembryo
nic pregnancy embryos at higher risk of death-estimation of gestational age-rati
ng of pregnancies multifetais number of embryos and chorionicity amniocidade
Ultassonografia pregnancy normal intrauterine gestational sac:
Transvaginal U.S. - seen at 5 weeks of menstrual age or with B-HCG> 1.160mUI/ml
sonography - B-HCG> 1.800mUI/ml
Bag germination (yolk sac)
It is the first structure to emerge in the gestational sac. On sonography is see
n when the SG has an average diameter of 10-15mm. At transvaginal U.S. is seen e
arlier in SG de8mm or CCN diameter 2.2 mm. Vitellin vesicle: participates in the
transfer of nutrients while the placental circulation is desnvolvendo (3rd-4th
weeks), promotes hematopoiesis in Week 5 of'gado assume this role until the 8th
week, will be part of TGI primitive
Sac vitellin vesicle
Sac vitellin vesicle
Estimation of menstrual age in 1st quarter
It is estimated more accurately at this time than at any other stage. By order o
f appearance the following structures can be measured as indicators of menstrual
age:
Size-sac (5 th -10 th weeks) Average of three orthogonal dimensions of the inter
face liquid / wall of the bag
Mean diameter of gestational sac
Up to 8mm: SG 6.6 weeks
16mm: SG + embryo 8.0 weeks
20mm: 8.5 wk. without embryos?
CCN (craniocaudal length) with the use of transvaginal U.S. in the 5th week on a
measure and has made accuracy less than that of DBP at the start of a quarter
Embryo
DBP, CC, CA, CF
BPD diameter bi-parietal (more precisely at the end of a quarter CC: skull circu
mference WC: waist circumference CF: femur length (more precisely on the 2nd and
3rd quarter) if the patient will make only one U.S. examination during pregnanc
y the ideal is to make the 2nd quarter (between 1618 weeks)
The 2nd trimester (16-18 weeks) is the most appropriate time to evaluate patient
s for routine due dates at clinically relevant information that can be collected
from the fetus
Bi-parietal diameter (BPD)
Skull circumference (WC)
Femur length (FL)
Other uses:
Embryonic death - one of the most important roles of the U.S. in the first quart
er is the failure to diagnose early pregnancy and embryonic death. It is estimat
ed that about 75% of pregnancies fail embryonic cardiac activity in this period
- this is the most important feature individually for confirmation of embryonic
and fetal life. Sonography: when an embryo is identified should be cardiac activ
ity transvaginal U.S.: CCN with> or = 5mm already identifies
Establishment of the date of pregnancy in the 2nd and 3rd quarter
Measurements of fetal head-BPD, HC-femur length-abdominal circumference
Assignment of gestational age
-Up to 26 weeks: ultrasonographic criteria Thereafter, the date of the UPM (if r
emembered with certainty) measures fetal gradually lose precision as a factor pr
editivoda IG as the pregnancy progresses, so the age given at the first examinat
ion shall not be changed thereafter
* Gestational age at any stage should be based on the initial U.S. study, calcul
ated by adding up to gestational age assigned at the 1st examination of the numb
er of Semans passed since the exam.
* From measurements of BPD, AC, CC and FC and
compared with normal standards for gestational age in question, based on initial
U.S., determine if the fetus is in the appropriate size.
COMPLICATIONS-ectopic pregnancy
Classic triad of pain, abnormal vaginal bleeding and a palpable mass in the anne
xes is only observed in 15% of patients. Specific findings to the U.S.: Embryo l
ive attached
Nonspecific findings to the U.S. (correlate with BHCG) Gestational Uterus empty
Pseudosaco Ascites particulate Adnexal Mass Treatment: Surgical Improvement of d
iagnostic accuracy, including TVUS, allows earlier diagnosis and a more conserva
tive approach