Ultrasound examination in the second and third trimester

Aleksandra Mikic Novakov, MD, PhD

Novi Sad, Yugoslavia

Normal fetal morphology

Transverse section of the skull at the biparietal diameter level

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  • complete ossification of the skull
  • choroid plexuses fill the anterior and posterior horns of the lateral ventricles
  • anterior and posterior horns less than 10 mm (Va/Hem ratio less than 0.5)

Biometry of the skull and brain at the biparietal diameter level

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  • measurement of biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HC),
  • anterior horn of the lateral ventricle (Va), posterior horn of the lateral ventricle (Vp) and hemisphere (Hem)

Transverse section of the skull at the level of the posterior fossa

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  • cerebellum exists, normal shape
  • vermis seen in whole
  • cisterna magna bigger than 3.5 mm
  • nuchal fold less than 5 mm.

Biometry of the skull and brain at the level of the posterior fossa

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Measurement of :

  • transcerebellar diameter (TCD),
  • cisterna magna (CM),
  • nuchal fold (NF)

Transverse section of the head at the level of the orbits

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  • orbits of the same size
  • normal interorbital diameter
  • lenses visible
  • measurement of IOD

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Hard palate

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continuity of the hard palate

Coronal section of the face

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  • continuity of the upper and lower lip
  • normal shape of the nostril
  • the tip of the nose and the chin seen at the same time

Fetal profile

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  • nasal bone seen
  • normal size and shape of the chin, nose and forehead

Neck

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continuity of the cervical spine and the skin that covers it

Chest

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  • lungs of normal echogenicity, homogenous
  • apex of the heart points to the front and left
  • right chamber closer to the thorax, seems shorter and coarser than the right one
  • both ventricles of the same size
  • both atria of the same size
  • continuity of the interventricular septum
  • continuity of the interatrial septum

Heart - left ventricle outflow tract

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  continuity of the interventricular septum and front wall of the aorta  

Heart - great vessels

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  longitudinal section of the pulmonary artery transverse section of the aorta 

Heart - longitudinal section of the aortic arch

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  aortic arch with the branches for head and neck (t. brachiocephalicus, a. carotis communis sin, a. subclavia sin)

 

Longitudinal section of the fetus - chest and abdomen

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  • diaphragm completely divides thorax from the abdomen
  • stomach in the abdomen only
  • thorax of the normal size compared to the abdom en

Abdomen - measurement of abdominal circumference

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  • continuity of the ribs
  • stomach at the left, normal size and shape
  • measurement of the abdominal circumference
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Abdomen - umbilical cord insertion 

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  • complete continuity of the abdominal wall
  • normal cord insertion

Kidneys

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  • normal echogenicity of the parenchyma
  • anteroposterior diameter of the pelvis 5 mm and less

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Bladder

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  normal size and shape of the bladder  

Fetal sex- female / male

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Arm and hands

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  • both hands seen at the same time or enough away from each other to be sure that they both exist
  • all phalanx seen
  • extension of all the fingers on both hands
  • normal length and form of all the long bones
  • movements seen in all the joints

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Leg and foot

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  • both feet seen
  • five toes, normal position of the big toe
  • normal position of the foot, shin and thigh
  • normal length and form of all the long bones
  • movements seen in all the joints

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Spine - longitudinal section

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  continuity of the spine and the skin above it  

Spine - transverse section

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  • three ossification centres form closed circle
  • continuity of the skin above the spine

Spine - coronal section

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  three parallel lines

Umbilical cord

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  three vessels in the umbilical cord - one vein and two arteries

Uterine cervix

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  • measure the length of the cervix
  • check whether there is funneling

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