Nuchal Translucency Scan

very nice video of 13wk fetus showing CRL, fetal HR waveform, and NT

Spina Bifida (Myelomeningocele)

really nice video explaining about Spina Bifida and how it affects the baby...

Cleft Lip and Palate

central cleft lip

Obtaining images of the fetal face during second trimester are essential to exclude cleft lip and palate. A gap in the upper lip and maxilla that appears anechoic in ultrasound is defined as cleft lip and palate. Cleft lip can be unilateral, bilateral, or central (paramedian). Central being the worst and unilateral being the most common, however, other sources claim that the malformation is usually paramedian. Below are two images of cleft upper lip and palate spotted at Radiographics.







For more images, click on the following links below
bilateral cleft lip and palate
bilateral cleft lip and palate2
bilateral cleft lip and palate3

shouts to Sonoworld

Fetal Hydrops

Fetal Hydrops is when the uterus is too large for dates (large-for-date fetus) and is caused by the following features: fetal edema or skin thickness (macrosomia), polyhydraminous, ascites (liver, abdomen), pericardial effusion, pleural effusion, and abnormally large placenta. In ultrasound, the large placenta would appear homogenous and echogenic. This would occur during Rh incompatibility (mixing of maternal blood and fetal blood btw Rh- and Rh+).

When the mother has Rh- blood and the fetus has Rh+, the blood mixes together and this is termed immune hydrops. However, the mixing of Rh blood will not damage the fetus in the first pregnancy. During the second pregnancy, the anti-bodies produced in the first will attack the fetal red blood cells thereby harming the baby and is called erythroblastosis fetalis. In non-immune hydrops, the two of the six features of fetal hydrops previously mentioned are seen (ie. polyhydraminous, ascites).

Large For Dates

A large for date fetus is when the fetal weight is more than expected by being above the 90th percentile. A large fetus could be due to: polyhydraminous, large placenta (hydrops), macrosomia (skin thickening), or twin/multiple pregancies.

When a mother exhibits a twin pregancy test, automatically she is high risk OB. The most common reason for having twins is by either infertility treatment or genetic. Twins can be described by two types: identical and non-identical.

Identical twins (girl-girl) are monozygotic (one zygote) and have two membranes with the possibility of one chorionic membrane. Describing the membranes (chorionic, amniotic) can be broken down by the following:

1) Dichorionic, Diamniotic (before day 5)
2) Monochorionic, Diamniotic (btw day 5-9, most common)
3) Mochorionic, Monoamniotic (btw day 9-13)
4) Conjoined (after day 13)

Note that if Dichorionic and Diamniotic, then both membranes would have two placentas. However, if Monochorionic and Diamniotic, then one membrane (Mono) would have one placenta whereas the other (Di) would have two placentas. Another way to distinguish between Mono- and Di- is to look at the thickness of the membranes. Mono- will have a thin membrane (one) whereas Di- will have a thick membrane (two). Below are images describing the two membranes.

In non-identical twins (boy-girl), the membranes are "always" Dichorionic, Diamniotic (look at first picture). Non-identical twins are dizygotic (two zygotes). A good way to distinguish if both membranes are Di-Di is to look for "twin peak" sign, which is a traingular projection of placental tissue from the placental surface extending to the intertwin membrane. Below is an ultrasound image of the "twin peak" sign seen btw 10-14 wks GA.



Below are ultrasound images of twin pregnancies

9 Week Monochorionic, Diamniotic Twins

6 Week Dichorionic, Diamniotic Twins

PreTerm Birth (PTB)

PreTerm Birth (PTB) is caused by a weak cervix (or incompetent cervix) that creates changes to the internal cervical os by dilating or increasing the "funneling" angle and reducing cervical length (CL). As a result, the cervix may open early thus inducing a preterm delivery or miscarriage (spontaneous abortion). Essentially, more than 70% of premature babies are born between 34 and 36 wks (late preterm); 12% are born between 32 and 33 wks; and 10% are born between 28 and 31 wks.

In order to prevent this early labor from arising, a procedure known as a cervical "cerclage" is done to suture or stitch shut the cervix to prevent further dilation. The procedure can be done at about 12 to 14weeks before the cervix thins out, or as a emergency measure after the cervix has thinned (rarely done after 24 wks). However, the risks of cervical cerclage are rare but may include: infection, pPROM, cervical stenosis (d/t permanent narrowing or closure of the cervix), damage to the cervix during surgery, and excessive blood loss.

All premature babies are at risk for health problems, but the earlier a baby is born, the greater the risk for serious complications. For example, if a premature baby gets delivered before 32wks GA, the baby will appear small with organs less developed. Or if the baby is born at 36 wks GA but fetal weight is below the 10th percentile (weighing less than 2500 grams), then suspect Intrauterine Growth Restriction (IUGR) or "Small-for-Gestational Age"(SGA) fetus.

IUGR is a smaller than normal fetus caused by wrong LMP (blame mom),diminished amniotic fluid, pPROM, abnormal placenta, or fetal renal anomaly. The fetus is small because of insufficient nutrition due to alcohol/drug abuse, any chronic conditions (HRT Dz), does not eat well, or has had previous pregnancies in which there was poor fetal growth. IUGR has three types: asymmetric (seen late in 3rd Trimester), symmetric (seen early in pregnancy), and femur-sparing pattern.

In asymmetric IUGR, fetal trunk is small. In symmetric IUGR, entire fetus is smaller than normal, which also includes reduced sizes of internal organs (Nuchal thickening can also be assessed). In femur-sparing pattern IUGR, BPD is normal but AC and FL are low thus the brain and head is spared, but body or abdomen is considered small (usually not seen in late 3rd trimester).

News Update

"low birthweight babies at risk for delayed nuerological maturation"

i had to post...interesting article that mentioned about a research study conducted in Barcelona Spain, and found "small for gestational age" infants with normal placental function to be at risk for impaired nuerological development. That is, these babies may have a decrease in sensory (motor skills) and cognitive development that could affect their school as well as their adolescent period. To read the abstact on the Barcelona study, click here. To read the full article spotted on MedicalNewsToday, click on the links..

shouts to Sonoworld

Gender Scan

22 Weeks Gestation


20 Weeks Gestation

Placenta II

Abruptio Placentae (Accidental Hemorrhage Abruption) is bleeding that occurs when the placenta seperates from the uterine wall. The bleed can be seen as anechoic fluid that may eventually form into a clot, which can exhibit low level echoes or internal debris within the area. Later on, the clot would appear echogenic in ultrasound image.

Abruptio placentae can occur at five different sites of the uterus: intraplacental or infarcts (within the placenta), subplacental/retroplacental (between myometrium and placenta), subchorionic/subamniotic (at edge of placenta--marginal bleed), intraamniotic (within amniotic cavity). Below is an image displaying an example of subplacental bleeding in ultrasound.


Causes of abruptio placentae may be difficult to determine but can be the following: rapid loss of amniotic fluid, trauma, or abnormally short umbilical cord (appear as three straight lines in US). Risk factors include: advanced maternal age, cigarette smoking, diabetes, high blood pressure, increased uterine distension (as seen with multiple pregnancies), abnormally large volume of amniotic fluid (polyhydraminous--most likely due to the fetus having trouble swallowing), or large number of prior deliveries. Symptoms include abdominal pain, back pain, and vaginal bleeding. Usually a C-Section is given if the internal bleeding is severe.

First Trimester Sonogram

6 Weeks
in this video you can actually see fetal pole and yolk sac...for another clip of the fetus at 6 weeks, click here

8 Weeks

9-13 Weeks


11 Weeks

Placenta I

The placenta serves as a function to exchange oxygen and carbon dioxide between mother and fetus. Usually maternal and fetal blood don't mix (only exception is till delivery), but if they do, supsect Rh pathology. The placenta also functions to work as defense mechanism to prevent viruses such as AIDS or Hep B&C to pass through the fetus (nicotine can also pass through as well). The placenta usually develops in the early second trimester (week 13), and becomes well established in week 15, which the retroplacental complex can be seen. In ultrasound, the placenta appears homogenous and echogenic. Later on, it becomes more heterogenous due to the development of calcifications and maternal lakes (veins and arteries).

The placenta is composed of three areas: basal layer, substance, and chorionic plate. The location can be anterior, posterior, fundal, or cervical, and must be determined in SAG. If found in the cervical region, in which the placenta has obstructed the whole area, then conisder in mind "placenta previa". The thickness of placenta should not exceed 4cm, and if thick then suspect hydatid form molar pregnancy (abnormal placental tissue implanted in UT).

The placenta can be broken down into stages or grades. Essentially, there are a total of 3 grades (0-3). As the placenta progresses through these grades, it becomes more echogenic and inactive. In Grade 0, the placenta has a smooth chorionic plate with no subtle or mild indentations. Grade 0 placenta is homogenous with no calcifications and is very active (necessary to promote gas exchange within the fetus). In Grade 1 placenta, the chorionic plate exhibits sublte indentations with punctuate calcifications. This normal placenta can be seen after 34 weeks. In Grade 2 placenta, the chorionic plate begins to have mild indentations with the development of comma-shaped calcifications within the placental substance. This normal placenta will appear more echogenic and can be seen after 36 weeks. Lastly, Grade 3 placenta will exhibit major indentations thereby dividing the placenta into segments. Linear calcifications can be seen within the substance and is normal after 38 weeks. For images on placental grading, click here.

The thing to keep in mind is that as the pregancy progresses, the placenta is able to move due to uterine size. As the fetus enlarges, so does the uterus thus affecting the position of the placenta. With that in mind, the placenta can move to the cervical area thereby obstructing the internal os. When this happens, this is termed "placenta previa".

There are different types of placenta previa: complete, partial, marginal, or low lying. Complete placenta previa is when the placenta has completely obstructed the internal cervical os. Partial placenta previa is when the placental tissue blocks only a portion of the internal cervical os. Marginal placental previa occurs when the substance extends up to but not above the internal cervical os (near proximal end of Cx). Low lying placenta, or potential placenta, is when the substance is 1cm away from internal cervical os. It is usually the low lying placenta that causes placental previa thereby inducing vascular malformation within the uterus. Another cause is abnormal uterine enlargement, which can cause the placenta to move towards the proximal end of the cervix. Below is video clip of placenta previa with the addition of abruptio placenta and the consequences that can happen with the condition.

NIH Awards GE $1.2Million to further Push Ultrasound Technology

that's right, you heard correct...NIH recently awarded GE 1.2Million dollars to create effective ultrasound probes necessary for enchancing the quality of healthcare pertaining to ultrasound. This means that these probes will be easier to use, as well as to master, and are able to develop a clear image from the monitor. As an ultrasound tech student, this is exciting news for me, and i'm very glad that the ultrasound field is growing by the addition of these new probes that can "change the game"....to read the full article click here ....shouts to SonoWorld for the news