OBSTETRICS

Question 1

Beckwith wideman

Answer 1

• exomphalos
• macroglossia
• gigantism

Question 2

Morgagni hernia

Answer 2

• congenital heart disease, bowel malrotation
• chromosomal abnormality (Downs, Turners)
• mentral retardation
• pericardial deficiency.

Question 3

Ovarian hyperstimulation syndrome

Answer 3

• B = OHSS signs:
o Bilateral ovarian enlargement (≥ 5cm, often > 10cm)
o Numerous large follicular cysts with dramatically increased local blood flow (some cysts may contain haemorrhage)
o Echogenic stromal tissue
o Ascites & effusions

Question 4

Trisomy 18

( EDWARDS)

Answer 4

Background

1. IUGR, 60%
2. Polyhydramnios
3. Single umbilical artery, 80%

Brain

1. Choroid plexus cysts, 30% (1%-2% of normal population) All CP cysts resolve, but resolution does not alter association Normal if no other abnormality

Face

1. Dolichocephaly
2. strawberry skull
3. Micrognathia Low-set ears

Thorax

1. CHD, 90%

GI anomalies

1. hernia
2. omphalocele.
3. Atresias

If omphalocele contains liver, it is less likely to be associated with trisomy 18.

Skeletal abnormalities

1. Clenched hand with overlap of 2nd and 3rd digits, 80%
2. Rockerbottom feet

Question 5

Trisomy 21

Answer 5

• 13%-50% may not have any sonographically detectable abnormalities.
• Most common anomaly is CHD
• (40%-50%); AV canal defect is usually mentioned, but ASD and VSD are most common. Other anomalies: •Intrauterine growth restriction (IUGR)

Face

1. Absent nasal bone

Neck

1. Increased nuchal thickness, 40% Nuchal translucency: ≥ 3 mm at 11 to 14 weeks; can resolve after 14 weeks.
2. Measure AP diameter on axial image at level of cerebellum Nuchal fold: ≥ 6 mm at 15 to 21 weeks; measure on sagittal image of neck

Chest

1. Hydrothorax
2. Most common anomaly is CHD

(40%-50%

Heart

1. Echogenic (= bone) intracardiac focus (papillary muscle): Most commonly in LV Can also be seen in RV.
2. AV canal defect is usually mentioned, but ASD and VSD are most common.
3. Hydrops

Abdomen

1. Duodenal atresia (rarely identified before 25 weeks), 50%
2. Pyelectasis >4 mm before 33 weeks >7 mm after 33 weeks
3. Omphalocele
4. Echogenic bowel: other causes of echogenic bowel (similar or increased echogenicity compared with adjacent bone):
   
   1. Cystic fibrosis
   2. CMV
   3. Intraamniotic bleeding normal

Limbs

1. Short femur length
2. Shorter humeral length
3. Widening of iliac angle (normal angle of iliac crests on axial view, 60°)
4. Separation of great toe from second toe (“sandal gap”)
5. Hypoplasia of fifth digit and clinodactyly (incurving of fifth digit to fourth

• 5% of normal More common in Asians
• Minimally increased risk of Down, no amniocentesis if isolated • Small frontal lobes )
• Simian crease

Question 6

Trisomy 13

Answer 6

Background

• IUGR

Brain

1. Agenesis of the corpus callosum
2. Dandy-Walker malformation
3. Holoprosencephaly
4. Hydrocephalus
5. Microcephaly

Face

1. Cleft defects
2. Microphthalmia/hypotelorism

Cardiac

1. CHD, 80%

GU anomalies

1. Hyperechoic kidney
2. Bladder exstrophy

Skeletal abnormalities

1. Polydactyly, 70%
2. Rockerbottom feet