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      A pictorial guide for the second trimester ultrasound

      , FRANZCOG, DDU, COGU , 1 , 2 , , FRANZCR 1 , , Grad Dip US, AMS 1 , , MBBS, BMed Sci 1

      Australasian Journal of Ultrasound in Medicine

      John Wiley and Sons Inc.

      imaging, prenatal ultrasound, second trimester routine ultrasound

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          Abstract

          Introduction: The second trimester ultrasound remains an important screening tool for detecting fetal abnormalities. This pictorial guide for the second trimester ultrasound is designed to assist practitioners to produce a high quality diagnostic survey of the fetus by demonstrating and describing recommended images.

          Methods: Each image is discussed in detail and has an associated drawn line diagram to aid in the identification of the important features of that image. There is a description of the salient landmarks and relevant measurements.

          Result: The authors hope this article may act as a useful guide to all practitioners performing second trimester ultrasounds.

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          Most cited references 39

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          Sonographic examination of the fetal central nervous system: guidelines for performing the 'basic examination' and the 'fetal neurosonogram'.

            (2006)
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            Mid-trimester endovaginal sonography in women at high risk for spontaneous preterm birth.

            Although shortened cervical length has been consistently associated with spontaneous preterm birth, it is not known when in gestation this risk factor becomes apparent. To determine whether sonographic cervical findings between 16 weeks' and 18 weeks 6 days' gestation predict spontaneous preterm birth and whether serial evaluations up to 23 weeks 6 days' gestation improve prediction in high-risk women. Blinded observational study performed between March 1997 and November 1999 at 9 university-affiliated medical centers in the United States in 183 women with singleton gestations who previously had experienced a spontaneous birth before 32 weeks' gestation. Certified sonologists performed 590 endovaginal sonographic examinations at 2-week intervals. Cervical length was measured from the external os to the functional internal os along a closed endocervical canal. Funneling and dynamic cervical shortening were also recorded. Spontaneous preterm birth before 35 weeks' gestation, analyzed by selected cutoff values of cervical length. Forty-eight women (26%) experienced spontaneous preterm birth before 35 weeks' gestation. A cervical length of less than 25 mm at the initial sonographic examination was associated with a relative risk (RR) for spontaneous preterm birth of 3.3 (95% confidence interval [CI], 2.1-5.0; sensitivity = 19%; specificity = 98%; positive predictive value = 75%). After controlling for cervical length, neither funneling (P =.24) nor dynamic shortening (P =.054) were significant independent predictors of spontaneous preterm birth. However, using the shortest ever observed cervical length on serial evaluations, after any dynamic shortening, the RR of a cervical length of less than 25 mm for spontaneous preterm birth increased to 4.5 (95% CI, 2.7-7.6; sensitivity = 69%; specificity = 80%; positive predictive value = 55%). Compared with a single cervical measurement at 16 weeks' to 18 weeks 6 days' gestation, serial measurements at up to 23 weeks 6 days significantly improved the prediction of spontaneous preterm birth in a receiver operating characteristic curve analysis (P =.03). Cervical length assessed by endovaginal sonography between 16 weeks' and 18 weeks 6 days' gestation, augmented by serial evaluations, predicts spontaneous preterm birth before 35 weeks' gestation in high-risk women.
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              Exclusion of fetal ventriculomegaly with a single measurement: the width of the lateral ventricular atrium.

              The ventricular atria in 100 healthy fetuses with gestational ages ranging from 14 to 38 menstrual weeks were evaluated and compared with those of 38 fetuses in whom ventriculomegaly had been diagnosed in utero. Axial sonograms of the brain through the atrium of the lateral ventricle demonstrated that the normal atrial diameter remained relatively constant throughout the gestational age range observed. The atrium had a mean diameter of 7.6 +/- 0.6 mm (standard deviation [SD]). Measurement of this structure can be quickly performed, is reproducible with low intra- and interobserver variation, and permits ventriculomegaly to be excluded. Atrial diameters exceeding 10 mm (above 4 SDs) suggest ventriculomegaly, with a low false-positive rate.
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                Author and article information

                Journal
                Australas J Ultrasound Med
                Australas J Ultrasound Med
                10.1002/(ISSN)2205-0140
                AJUM
                Australasian Journal of Ultrasound in Medicine
                John Wiley and Sons Inc. (Hoboken )
                1836-6864
                31 December 2015
                August 2013
                : 16
                : 3 ( doiID: 10.1002/ajum.2013.16.issue-3 )
                : 98-113
                Affiliations
                [ 1 ]Medical Imaging Department The Mercy Hospital for Women Melbourne VictoriaAustralia
                [ 2 ]Specialist Women's Ultrasound Box Hill Melbourne VictoriaAustralia
                Author notes
                [* ]Correspondence to email michael@ 123456swus.com.au
                Article
                AJUM00106
                10.1002/j.2205-0140.2013.tb00106.x
                5029995
                © 2013 Australasian Society for Ultrasound in Medicine
                Page count
                Figures: 53, Tables: 0, References: 52, Pages: 16
                Product
                Categories
                Education
                Education
                Custom metadata
                2.0
                AJUM00106
                August 2013
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.4 mode:remove_FC converted:05.09.2016

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