Download - Missed anomalies- how not to miss?
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MISSED ANOMALIES- HOW NOT TO MISS?
DR VIDYALEKSHMY R DGO, DNB,MRCOG
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CONGENITAL ANOMALIES
• Real trauma to the family• Diagnosed usually after 20 Weeks.• 20 Weeks is the upper limit for legal MTP in India.
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TAS
Done between 18-23 Weeks Should be offered to all pregnant
women High sensitivity to detect fetal
anomalies To be done systematically
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TAS
SKULL BRAIN FACE CARDIAC THORAX ABDOMEN SKELETAL PLACENTA AND CERVIX
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FACE AND CNS
Transverse view at Septum Cavum Pellucidum- to measure BPD, Head Circumference and Ventricles
Suboccipito bregmatic view- Cerebellum and Cisterna magna
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FACE &CNS
Transverse view of face through orbit, upper lip and maxilla
Sagittal view of face to show nasal bone.
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NEUROSONOGRAM
Transventricular plane Transcerebellar plane
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Transventricular plane
To measure BPD Head circumference Cerebral hemispheres Ventricles Choroid plexus
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Transventricular plane
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Transventricular plane
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Transcerebellar view
Posterior fossa Cisterna magna Cerebellum
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Transcerebellar view
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COMMON CNS ANOMALIES
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CNS Anomalies
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Neural tube defects
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Choroid plexus cyst
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FACE
Forehead Orbit Nose Lips Oral cavity
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FACE
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CLEFT LIP & PALATE
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CLEFT PALATE
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CARDIAC EVALUATION
Four chamber view
3 vessel view
Ventricular outflow tracts
Heart rate and Rhythm
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FETAL ECHOCARDIOGRAPHY
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OUTFLOW TRACTS- LV
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PULMONARY OUTFLOW
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Ventricular Septal defects
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CARDIAC ANOMALIES
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Falot’s Tetrology
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THORAX
Shape Lungs Diaphragm
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LUNGS
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LUNG CYSTS
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Pleural effusion
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ABDOMEN
Abdominal circumference Transverse view to demonstrate
kidneys Transverse view at umbilicus-
Abdominal wall defects Transverse view at the level of
bladder Stomach, Liver
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DIAPHRAGMATIC HERNIA
Diagnosed by the presence of stomach, intestine or liver in thorax
Mediastinal shift
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Diaphragmatic Hernia
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ANTERIOR ABDOMINAL WALL- normal appearance
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EXOMPHALOS
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GASTROSCHISIS
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GIT- esophageal atresia
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Duodenal atresia- double bubble
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KIDNEYS AND URINARY TRACT
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Renal agenesis
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Renal agenesis- renal artery Doppler
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POLYCYSTIC KIDNEY
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Hydronephrosis
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SPINE
Examination of neck for nuchal fold thickness
Longitudinal views of spine- at least 2 views
Coronal view at Lumbosacral region Transverse view
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SPINE
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Spinal Anomalies
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SKELETAL EVALUATION
Longitudinal view of femur Longitudinal view of foot and leg Upper limb bones Imaging of open hand Fetal movements
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SKELETON
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CLUBFOOT- CTEV
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Achondroplasia
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OTHER ANOMALIES
Chromosomal anomalies- major and minor markers
Fetal tumours Hydrops fetalis
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WHY ANOMALIES ARE MISSED ??
TOO EARLY TO DIAGNOSE.
EVOLVING ANOMALY
OPERATOR INEXPERIENCE
NOT FOLLOWING PROTOCOLS
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THANK YOU