2nd trimester

scanning

2nd trimester
scanning
Confirming dating of pregnancy
Fetal normality/ abnormality
Placental localisation
AF volume

BPD
Correct levels
2 views: lateral ventricle view, thalamic
view
More accurate than CRL +/- 5 days
Maximum diameter of transverse section
of fetal skull at level ofthe parietal
eminences

BPD
Lateral ventricle view:
Rugby shaped skull
Long midline equidistant prox-distal skull
echoes
Cavum septum pellucidum (CSP) bisecting
midline
Two anterior horns of lat ventricle- symmetrical
Post horns of lat ventricle- symmetrical

BPD
Lateral ventricle
view

BPD
Thalamic view:
Rugby ball shape
Short midline
CSP
The thalami (arrow head)

Thalamic view

BPD

BPD
Both levels
comparable
HC/OFD same level
Outer to outer
Outer to inner
OA/OP position

BPD
To obtain the correct level

BPD
Estimating GA from BPD:
Not to rely on estimates of GA from US
software
GA should not be made from single
parameter
Different charts
GA and growth require different charts and
charting

BPD
Estimating GA from
BPD

BPD
Confirming or assigning GA:
If LMP and earlier dating 1st trimester US matchesstick to this date
2nd trimester US is only for growth and not for
dating
If the 2nd trimester US is the first scan done error
is greater:
below 24w +/- 2 w
After24w >3w

Head circumference
Same view as BPD
Outer to outer
Superior to BPD for
dating

Abdominal
circumference
Landmark features:
Circular section with ribs
One vertebra -triangle of 3
white spots
Umbilical vein (short) hockey stick
Stomach left abdomen
Good for dating of pregnancy
Sensitive to growth aberrations
Fetal weight assessment

Abdominal
circumference

Femur length
As accurate as BPD for GA
From 12w to term
Slide probe caudally from AC section till iliac
bones
Cross section of 1 femur seen
Upper femur for measurement
Rotate

Femur length

Femur length

Placental localisation
Placenta is more echogenic than
myometrium
Alignment of probe standardised
Cervix to the right
Fundus to the left

Placental localisation

Placental localisation
Cervical canal directly posterior to bladder
Lower edge >5 cm from internal os
<5cm low lying
Placentae previa after 28w
Braxton hicks

Placental localisation

Placental localisation
Localisation at 20-22w
5% low lying
Only 1% placenta previa

Placental localisation

Amniotic fluid volume

Produced by fetal kidneys (urine) and removed
by fetal bowel (swallowing)
Oligohydromnios = decreased volume
Polyhydromnios = increased volume
Measurements : Visual
Max vertical depth 3cm
AFI - <5cm =oligo, >25cm = poly

Fetal anatomy
assessment
Dependant on sonographer- correct
images, correct interpretation
Go through all-complete coverage--> then
no major abnormalities will be missed
E.g.After 12w - anencephaly

Fetal anatomy
assessment

Fetal anatomy
assessment
After 20-22w:
encephalocoele
cystic hygroma
abdominal wall defect
lemon sign - spina bifida
banana sign - hydrocephalus
severe limb reduction
ascites
pleural effusion
severe oligo/ polyhydramnios

Fetal anatomy
assessment

Fetal anatomy
assessment

Cerebral ventricles

Fetal anatomy
assessment

Anterior horn

Fetal anatomy
assessment

Posterior horn

Fetal anatomy
assessment
AVHR/PVHR:
< 0.5 after 18w gestation
Ventriculomegaly

Fetal anatomy
assessment

Fetal anatomy
assessment

Fetal anatomy
assessment
Fetal heart:
Occupy 1/3 with apex pointing to the
left
3 views of the heart:
4 chamber view
2 outflow tract views

Fetal anatomy
assessment
Fetal heart:
moderator band = right ventricle
2 ventricles/ walls of equal size
2 atria / walls of equal size
apex point left of fetal chest
foramen ovale moving in left atrium
pulmonary veins entering left atrium
motion of mitral valves (left side) regular
motion of tricuspid valves (right side) regular
'offset crux' of the heart: AV valve should not insert into IV septum at the
same level
intervertebral septum should be complete

Fetal anatomy
assessment

Fetal anatomy
assessment
Fetal heart:
Abnormalities of 4c view:
No disparity in size between 2 ventricles
Tricuspid/ mitral valve defects:
Enlargement of atrium
Hypoplasia of ventricle

Fetal anatomy
assessment
eg: (i) regurgitation of tricuspid valve - enlarged right atrium
(ii) hypoplastic left heart syndrome - left ventricle small
(iii) coarctation - right ventricle enlarged
(iv) Ebstein anomaly - enlarged right atrium due to
abnormal implantation of tricuspid valve
normal IV septum - excludes VSD
normal offset crux - exclude AVSD
Both ASD & AVSD are assessed with trisomy 21

Fetal anatomy
assessment

Fetal heart:

The aortic outflow

tract rotate to right
fetal shoulder

Fetal anatomy
assessment
Demonstrate left ventricle: continuity of IV septum-> ant wall of aorta--> aortic valve & short section of
ascending aorta
Abnormal AOT:
Overriding aorta
Aortic stenosis
Double outlet right ventricle
Fallot's tetralogy

Fetal anatomy
assessment
Pulmonary artery outflow
tract:
Demonstrate:
Right ventricle
Pulmonary valve
Main pulmonary artery
abnormal in double
outlet right ventricle &
pulmonary stenosis

Fetal anatomy
assessment
Fetal abdomen:
Single left sided stomach bubble-->
after 16w
Cord insertion
Abdominal defects --> oomphalocoele,
gastrochisis
Kidneys

Fetal anatomy
assessment
Cleft lip and palate:
Incidence 1:700 births
80% isolated incidence
But association with trisomy 13 &18,
anti epileptics drugs

Fetal anatomy
assessment
Fetal sex:
Recognisable from 14 weeks

Craniospinal
abnormality
Causes of increased
AFP

Craniospinal
abnormality

Craniospinal
abnormality

Craniospinal
abnormality

Craniospinal
abnormality

Craniospinal
abnormality

Craniospinal
abnormality
Between 16-24w -->
only as a marker

Craniospinal
abnormality
Hydrocephalus

Craniospinal
abnormality
Encephalocoele

Craniospinal
abnormality
Hydrancephaly
Porencephalic cysts

Craniospinal
abnormality
Dandy walker
malformation

Chest
abnormality
Diaphragmatic
hernia

Fetal abdominal
abnormality

Double bubbleduodenal atresia

Fetal abdominal
abnormality
Double bubbleoesophageal atresia

Fetal abdominal
abnormality
Dilated bowels

Fetal abdominal
abnormality
Oomphalocoele

Fetal abdominal
abnormality
Gastrochisis

Fetal abdominal
abnormality

Renal agenesis

Cystic disease of the

kidneys

Fetal abdominal
abnormality

Fetal hydrops