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Fetal Biometry DR Vino SRM
Fetal Biometry DR Vino SRM
Schedulingofinvasiveprocedures
Interpretationofbiochemicaltests
Latepregnancy
Evaluatingfetalgrowth
Spontaneousorplannedelectivedelivery
AccuracyofbiometryinpredictingGA
Firsttrimester 35days
12to18wks 1week
Thirdtrimester unreliable
Gestationalsac
earliestsonographic signofpregnancy
precisetermchorionicsac
Chorionicvilli echogenic ring
Fluidwithinthesacchorionicfluidinearly
pregnancies
TVSprobes seenby5menstrualweek
Gestationalsac
Gestationalsac
Intradecidualsign
Chorionicsacdisplacestheendometrialstripe
Actuallyresidesindeciduanotinendometrial
cavity
TVS 4.55wksofGA
Intradecidual sign-an echogenic area embedded in the thickened
decidua that is eccentrically located on one side of the uterine cavity,
which appears as a well-defined endometrial stripe.
Intradecidualsign
Gestationalsac
Doubledecidual sacsign
sonographic visualisation ofthreelayersofdecidua
2echogenic layers
Innerringgestationalsac&itsechogenic outerlayerof
chorion
Outerringechogenic endometrium withdecidual reation
Markerofintrauterinepregnancy
Doubledecidualsac
sign
The double decidual sac sign is useful in
distinguishing between an early intrauterine
pregnancy (IUP) and a pseudogestational sac.
Meansacdiameter
MSD
Meaninternaldiameterofsac
Obtainedfromtheinterfaceofchorionicvilli
andchorionicfluid
Wallofthesacnotincluded
MSD
MeanofAP,transverse,
longitudinaldiameter
length&depth
measuredinlong.
Image,widthin
transverseimage
MSD
23mm whenfirstobserved
Increases1mm/dayinearlygestation
2mmat44.5wks
5mmat5weeks
UntilMSDof25
GAindayscalculatedbyadding30toMSD
Eg;MSDof5mm=35days/5wks
MSD
5.5wksyolksacappears
6wksembryoappears
MSDof214mmhighlyreliable
Accuracydeterioratesafter14mm
MSDlessreliableinlate1st trimester
Watchcarefullyif
MSD>8mmwithoutyolksac
MSD>16mmwithoutembryo
Yolksac
Firststructureseeningestationalsac
Diagnosticofintrautrine gestation
Connectedtomidgutbyvitelline duct
Growsatrateof0.1mm/mmgrowthofMSDuntilMSD<15
mm
Iftheembryoisvisualised,measurementofchoiceis
CRL
MSDequals14mmwhenCRLmeasures5mm
Embryoinasaggitalsection
Measurefromthetipofthecephalicpole crown
tothetipofthecaudalpole rump
CRL
CRL
Maximalstraightlinelengthofthefetus
AverageCRLmeasurementfrom3satisfactory
images
OptimaltimeforpredictionofGAfromCRL 69
WKS
predictablity+/ 35days
Decreasesasthepregnancyprogresses
BPDissuperiorthanCRLat1214wks
CRL
Pitfalls:
Faultymeasurementsdueto:
FetalPosition
Excessiveflexionorhyperextension=
underestimation
Poormeasurementplane
InclusionofYSinCRLmeasurementinearly
pregnancy
Transitionbn1st &2nd trimester(1314
weeks)appropriatetimetomaketransition
fromCRLtoBPD,HC,AC,&FL
BPD
Accuratepredictorofmenstrualagebefore20
weeks
Bn14&20wks,variablity:+/ 1wk
After20wksvariablity:+/ 3.5wks
BPD
Twodimentionalmeasurement
Anyplaneofsectionthattraverses3rd ventricleandthalamus
Transducer
Perpendiculartoparietalbones
Incorrectcephalocaudalpositiontointersect3v&
thalami
Consistantandaccuratemeasurement
BPD
BPD
Threerules
Correctplaneofsectionthrothirdventricle&thalami
Calvaria smooth&symmetricalbilatrally
Positioningofcursors properendpointsofmeasurement
outeredgeofnearcalvarialwalltoinneredgeoffar
calvarialwall
Inneredgeofnearcalvariumtoouteredgeoffar
calvarium
Middleofnearcalvariumtomiddleofoutercalvarium
Cephalicindex
Toassessheadshape
CI=BPD OFDx100
CI 75%=dolicocephalic
CI 85%=brachicephalic
OFDmeasuredfromouterto
outeredgeofcalvaria
HC
Threedimentionalmeasurement
Independentofheadshape
PredictGAtowithin1wkbefore20wks
Variablityof3.8wksinlatethirdtrimester
HC
Obtainedthrosingleplaneofsection parallelsthebaseof
skull
Transducer
Perpendiculartoparietalbones
Incorrectcephalocaudalpositiontointersect3v&thalami
Properlyorientedtoskullbase
HC
RulesformeasuringHC
Correctplanethro3v&thalamiincentre
Cavumseptumpellucidianteriorportion
Tentorialhiatusposteriorportion
Smooth&bilaterallysymmetricalcalvaria
HC
Arrowsign
Featherscavum
septumpellucidi&
frontalhorns
3v&sylvianaqueduct
shaft
Ambient&
quadrigerminalcisterns
&tentorialhiatus
arrowhead
HC
Cursors atouteredgeofnearcalvarialwall
&outeredgeoffarcalvarialwall
Computergeneratedelipsefittedtocalvaria
Entireperimeterofcalvarianeednotbe
demonstrated
Elipsemeasuresadequatelyevenwhenthe
entirecalvariaisnotentirelyimaged
HC
HC
ProperBPDcanbeobtainedfromsameimage
forHCMEASUREMENT
Reverseisnottrue
ProperlypositionedcursorsforHC
inappropriateforBPD
ForHCelipsefittedtocalvarianottheskinof
thescalp
HC
FL
Technicallytheeasiestofcommonbiometric
measurements
Accuratepredictorofageinearly2nd trimester( 1
wk)
Transduceralignedtolongaxisofdiaphysis
EntirefemurLnotmeasured
Onlyossifiedportionsofdiaphysis&metaphysis
measured
Cartilaginousendsexcluded
FL
Properalignment
cartilaginousfemoralheadorgreatertrochander
femoralcondylesinsamesection
Positioningcursors
Atthejunctionofbonewithcartilage
Avoiddistalfemoralpoint
FL
FL
FL
Distalfemoralepiphysis appearat34wksin
94%offetuses
Proximaltibialepiphysis appearat37wksin
80%offetuses
Forconfirmingbiometricdatainlate
pregnancy
AC
Threedimentionalmeasurement
Acutelyaffectedbygrowthdisturbances
Mostdifficultofthefourmeasurements
AC
Measuredatgreatest
trasversediameterof
liver
Rt&Ltportalveins
continuouswitheach
other hockeystick
appearance
AC
RulesformeasurementofAC
Perpendiculartomidline
Correctcephalocaudalplane
Symmetriclowerribs
ShortestLofumblicalsegmentofLtportal
vein
Elipsefittoskinedge
AC
AC
Whenanatomiclandmarksdifficultto
demonstrate
Followtherule:roundCoversamultitude
ofsins
Circumferenceestimatemoreaccurate
Avoidexcessivepressuretotransducer
AC
FL/ACRATIO
FL/ACratio=22
Constantfrom22wksonwards
HelpfulindiagnosingasymmetricIUGR
Transcerebellardiameter
Notaffectedbygrowth
disturbances
Fetusindirectoccipito
anteriorposition
Diameterinmm
correspondstoGAin1st 26
wksofpregnancy
Cisternamagnanot>than
9mm
Datingwithothermeasurements
Longbonesofarms&legs
Fetalchest
Orbital&interorbitaldistance
FootLength
Claviclelength
conclusion
Establisedmenstrualageshouldneverbechangedlaterin
pregnancy
Subsequentfetalmeasurementsindexoffetalgrowthrather
thanmenstrualage
Examinershouldavoidthetemptationtomassagethe
endpointsofmeasurementsionbcoztheagecomputationis
smallerorlarger
Insteaditiscrucialtolearntherulesforeachmeasurement
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