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Case discussion - Posterior fossa- 3
#Blake's pouch cyst (BPC)
BPC is most common type of anomalies of the posterior fossa.
The ultrasonography findings of Blake's pouch cyst are
- Normal anatomy and size of vermis
- Mild to moderate rotation of the vermis
- Normal size of the cisterna magna
the antenatal ultrasonography shows communication between the fourth ventricle and the cisterna magna resulting in a unilocular, avascular cyst in the posterior fossa – ‘key-hole’ sign.
#Associated abnormalities:
- Usually an isolated finding.
- Risk of chromosomal abnormalies, mainly trisomy 21, in up to 5% of non isolated cases.
#Investigations:
Detailed Neurosonography.
Fetal brain MRI
Invasive testing and array is recommended in non-isolated cases.
#Follow_up:
Ultrasound scans every 4 weeks
Spontaneous resolution by 24-26 weeks in 50% of cases.
#Prognosis:
Neurodevelopment: good in 90% of cases, mild impairment in 10%.
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.10138
#Blake's pouch cyst (BPC)
BPC is most common type of anomalies of the posterior fossa.
The ultrasonography findings of Blake's pouch cyst are
- Normal anatomy and size of vermis
- Mild to moderate rotation of the vermis
- Normal size of the cisterna magna
the antenatal ultrasonography shows communication between the fourth ventricle and the cisterna magna resulting in a unilocular, avascular cyst in the posterior fossa – ‘key-hole’ sign.
#Associated abnormalities:
- Usually an isolated finding.
- Risk of chromosomal abnormalies, mainly trisomy 21, in up to 5% of non isolated cases.
#Investigations:
Detailed Neurosonography.
Fetal brain MRI
Invasive testing and array is recommended in non-isolated cases.
#Follow_up:
Ultrasound scans every 4 weeks
Spontaneous resolution by 24-26 weeks in 50% of cases.
#Prognosis:
Neurodevelopment: good in 90% of cases, mild impairment in 10%.
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.10138
Case discussion👆👆👆
Fetal Echocardiography
#Heterotaxy_syndrome
Right atrial isomerism with hypoplastic left ventricle, DORV TGA
Fetal Echocardiography
#Heterotaxy_syndrome
Right atrial isomerism with hypoplastic left ventricle, DORV TGA
*New Address* *JFMRC*
Dr Chandra Kant Garg
*Jaipur Fetal Medicine and Research Centre*
(Advanced Centre of Fetal Medicine)
Swasthya Kalyan Gama Bhawan,
Narayan Singh road, Near Trimurti circle,
Jaipur
For appointment
+919672503555
+919672503444
Google Map👇👇
https://maps.app.goo.gl/sbJHsRC3osV2vmTr5
Dr Chandra Kant Garg
*Jaipur Fetal Medicine and Research Centre*
(Advanced Centre of Fetal Medicine)
Swasthya Kalyan Gama Bhawan,
Narayan Singh road, Near Trimurti circle,
Jaipur
For appointment
+919672503555
+919672503444
Google Map👇👇
https://maps.app.goo.gl/sbJHsRC3osV2vmTr5
ARSA
(Aberrant Right Subclavian Artery) - A 2nd trimester marker for chromosomal abnormality.
Incidence in normal population is 0.5-2%.
Incidence in Down syndrome is 28%
Increased risk of congenital heart defects
Association with 22q11 microdeletion
Identifying the position of Right Subclavian Artery in fetus is not difficult for trained fetal medicine specialist,
However is not easy to identify at routine postnatal Echocardiography.
If this is associated with other marker, the risk for T21 increases significantly.
(Aberrant Right Subclavian Artery) - A 2nd trimester marker for chromosomal abnormality.
Incidence in normal population is 0.5-2%.
Incidence in Down syndrome is 28%
Increased risk of congenital heart defects
Association with 22q11 microdeletion
Identifying the position of Right Subclavian Artery in fetus is not difficult for trained fetal medicine specialist,
However is not easy to identify at routine postnatal Echocardiography.
If this is associated with other marker, the risk for T21 increases significantly.
Pentalogy of Cantrell
Is a rare congenital anomaly (1 in 65000 to 200000 live birth) characterized by a defect in the lower sternum, anterior diaphragm, and anterior abdominal wall, ectopia cordis and congenital heart disease.
It is a very rare congenital anomaly and the prenatal diagnosis is possible in the beginning of second trimester of pregnancy using the conventional ultrasonography.
This was 15 wks pregnany
Is a rare congenital anomaly (1 in 65000 to 200000 live birth) characterized by a defect in the lower sternum, anterior diaphragm, and anterior abdominal wall, ectopia cordis and congenital heart disease.
It is a very rare congenital anomaly and the prenatal diagnosis is possible in the beginning of second trimester of pregnancy using the conventional ultrasonography.
This was 15 wks pregnany
First trimester scan (NT scan) @ 13 wks
Demonstration of the #Pericallosal artery and its branches is a Indirect appreciation of the developing CC.
A defective course or an abnormal biometry of the pericallosal artery could be an early sonographic marker for identifying abnormal development of the corpus callosum.
http://www.ajnr.org/content/39/3/589
Demonstration of the #Pericallosal artery and its branches is a Indirect appreciation of the developing CC.
A defective course or an abnormal biometry of the pericallosal artery could be an early sonographic marker for identifying abnormal development of the corpus callosum.
http://www.ajnr.org/content/39/3/589
The first trimester is defined as the first 13 weeks 6 days of pregnancy following the last normal menstrual period (some authors refer to early pregnancy as 0-10 weeks).
It can be divided into a number of phases, each of which has typical clinical issues.
These phases are:
*1.conceptus phase*
: 3-5 weeks
conception usually occurs 2 weeks after a woman's last menstrual period (LMP) and the gestational sac is usually too small to be seen for 3 weeks
*2. embryonic phase*:
6-10 weeks
*3. fetal phase*:
During the first trimester, the pregnancy progresses from a tiny gestational sac with no visible embryo, to an ~84 mm fetus with identifiable features and internal organs.
Ultrasound during this period is predominantly concerned with the following clinical issues:
- confirming intrauterine pregnancy (IUP).
- Early features supportive of an intrauterine pregnancy.
- double decidual sac sign.
- intradecidual sign.
- double bleb sign.
- confirming the number of pregnancies.
- Dating of the pregnancy
- crown-rump length (CRL) measurement is most accurate, however if no fetal pole is seen, the mean sac diameter (MSD) may be used.
- assessment of suspected early pregnancy failure.
- assessment of suspected ectopic pregnancy.
- antenatal screening for aneuploidy (nuchal lucency measurement).
Antenatal ultrasound
0-4.3 weeks: no ultrasound findings.
4.3-5.0 weeks:
possible small gestational sac.
possible double decidual sac sign (DDSS).
possible intradecidual sac sign (IDSS).
5.1-5.5 weeks:
1. gestational sac should be visible by this time.
5.5-6.0 weeks
yolk sac should be visible by this time.
gestational sac should be ~6 mm in diameter.
double bleb sign.
>6.0 weeks
fetal pole may be identifiable on endovaginal ultrasound (1-2 mm).
fetal heart rate (FHR) should be ~100-115 bpm.
gestational sac should be ~10 mm in diameter.
- 6.5 weeks crown rump length (CRL) should be ~5 mm.
- 7-8 weeks CRL is between 11-16 mm.
cephalad and caudal poles can be identified.
- 8-9 weeks
CRL is between 17-23 mm>
limb buds appear( limb buds will see exactly at 9 weeks of gestational age).
head can be seen as separate from the body.
- 9-10 weeks
CRL is between 23-32 mm.
fetal heart rate 170-180 bpm.
fetal movement can be seen.
a round hypoechoic structure in the fetal brain represents a developing embryonic/fetal rhombencephalon.
nuchal translucency may begin to be seen.
*Around 49 % of major structural anomalies* were detected during the first-trimester scan, the highest rates corresponding to acrania , holoprosencephaly , hypoplastic left heart syndrome, omphalocele, megacystis and hydrops fatalist.
Summary of most common abnormal ultrasound findings between 5- 8 weeks.
- Irregular gestational sac.
- Subchorionic hemorrhage-This condition occurs when the membranes or the sac that holds the fetus in the uterus, partially separate from the uterine wall. Blood leaks into the area between the uterine wall and the pregnancy which may be visible on ultrasound.
- Abnormal yolk sac-Having a yolk sac that is too large or too small has been associated with pregnancy loss.
- Small crown-rump length-Between six and eight weeks of gestation, the crown-rump length is the measurement of the entire length of the embryo. Smaller than expected fetuses at this gestational age may mean there is a concern for miscarriage.
- Low fetal heart rate-In general, a low fetal heart rate is considered to be fewer than 100-120 beats per minute. This condition is also known as fetal bradycardia. A low fetal heart rate can be an early marker of potential miscarriage.
- Blighted ovum ETC.
For prenatal awareness 👍
Dr.C.K.Garg
Fetal Medicine Consultant
Jaipur Fetal Medicine & Research Centre, Jaipur
It can be divided into a number of phases, each of which has typical clinical issues.
These phases are:
*1.conceptus phase*
: 3-5 weeks
conception usually occurs 2 weeks after a woman's last menstrual period (LMP) and the gestational sac is usually too small to be seen for 3 weeks
*2. embryonic phase*:
6-10 weeks
*3. fetal phase*:
During the first trimester, the pregnancy progresses from a tiny gestational sac with no visible embryo, to an ~84 mm fetus with identifiable features and internal organs.
Ultrasound during this period is predominantly concerned with the following clinical issues:
- confirming intrauterine pregnancy (IUP).
- Early features supportive of an intrauterine pregnancy.
- double decidual sac sign.
- intradecidual sign.
- double bleb sign.
- confirming the number of pregnancies.
- Dating of the pregnancy
- crown-rump length (CRL) measurement is most accurate, however if no fetal pole is seen, the mean sac diameter (MSD) may be used.
- assessment of suspected early pregnancy failure.
- assessment of suspected ectopic pregnancy.
- antenatal screening for aneuploidy (nuchal lucency measurement).
Antenatal ultrasound
0-4.3 weeks: no ultrasound findings.
4.3-5.0 weeks:
possible small gestational sac.
possible double decidual sac sign (DDSS).
possible intradecidual sac sign (IDSS).
5.1-5.5 weeks:
1. gestational sac should be visible by this time.
5.5-6.0 weeks
yolk sac should be visible by this time.
gestational sac should be ~6 mm in diameter.
double bleb sign.
>6.0 weeks
fetal pole may be identifiable on endovaginal ultrasound (1-2 mm).
fetal heart rate (FHR) should be ~100-115 bpm.
gestational sac should be ~10 mm in diameter.
- 6.5 weeks crown rump length (CRL) should be ~5 mm.
- 7-8 weeks CRL is between 11-16 mm.
cephalad and caudal poles can be identified.
- 8-9 weeks
CRL is between 17-23 mm>
limb buds appear( limb buds will see exactly at 9 weeks of gestational age).
head can be seen as separate from the body.
- 9-10 weeks
CRL is between 23-32 mm.
fetal heart rate 170-180 bpm.
fetal movement can be seen.
a round hypoechoic structure in the fetal brain represents a developing embryonic/fetal rhombencephalon.
nuchal translucency may begin to be seen.
*Around 49 % of major structural anomalies* were detected during the first-trimester scan, the highest rates corresponding to acrania , holoprosencephaly , hypoplastic left heart syndrome, omphalocele, megacystis and hydrops fatalist.
Summary of most common abnormal ultrasound findings between 5- 8 weeks.
- Irregular gestational sac.
- Subchorionic hemorrhage-This condition occurs when the membranes or the sac that holds the fetus in the uterus, partially separate from the uterine wall. Blood leaks into the area between the uterine wall and the pregnancy which may be visible on ultrasound.
- Abnormal yolk sac-Having a yolk sac that is too large or too small has been associated with pregnancy loss.
- Small crown-rump length-Between six and eight weeks of gestation, the crown-rump length is the measurement of the entire length of the embryo. Smaller than expected fetuses at this gestational age may mean there is a concern for miscarriage.
- Low fetal heart rate-In general, a low fetal heart rate is considered to be fewer than 100-120 beats per minute. This condition is also known as fetal bradycardia. A low fetal heart rate can be an early marker of potential miscarriage.
- Blighted ovum ETC.
For prenatal awareness 👍
Dr.C.K.Garg
Fetal Medicine Consultant
Jaipur Fetal Medicine & Research Centre, Jaipur