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Routine Anomaly Scan

Routine Anomaly Scan. Ilse Erasmus. Routine Anomaly Scan. Timing: 18 – 23 weeks Costs about R 230 – 00. RCOG Guidelines October 1997 Timing of sonars. Routine Anomaly Scan. Waste of resource to request routine anomaly scan in the late second or 3 rd trimester

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Routine Anomaly Scan

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  1. Routine Anomaly Scan Ilse Erasmus

  2. Routine Anomaly Scan • Timing: • 18 – 23 weeks • Costs • about R 230 – 00

  3. RCOG Guidelines October 1997Timing of sonars

  4. Routine Anomaly Scan • Waste of resource to request routine anomaly scan in the late second or 3rd trimester • Waste of resource to request growth scan in 3rd trimester in the absence of an early sonar

  5. Routine Anomaly Scan • Indication in SA cost considerations??? • Routine late bookers • High risk • Previous fetal/ neonatal anomalies • Previous IUD • AMA • Maternal: • disease index pregnancy / history of • Medication • Congenital anomalies

  6. Routine Anomaly Scan • Cochrane Database • Reduction in post term inductions • Twin Pregnancies • Radius?!?

  7. Routine Anomaly Scan • Screening? • 1/55 babies born with major anomaly • Structural anomalies > single gene defects • UK Fetal anomalies = 15% of perinatal deaths and 15% of deaths in first year of life

  8. Routine Anomaly Scan • Screening? • Six objectives • Reassurance that baby is apparently normal • Or the identification of: • Non –viable anomalies • Anomalies associated with high morbidity and long term handicap • Fetal conditions with the potential for intrauterine therapy • Fetal conditions requiring postnatal investigation and/ or therapy • Parental preparation

  9. Routine Anomaly Scan • Screening? • Lethal anomalies – anencheph, BRA, thanatophoric dwarfs • High morbidity and long term handicap – NTD, cardiac,aneuploidy • Potential intrauterine therapy – RH, Parvo,TTS • Fetal conditions requiring postnatal investigation and/ or therapy – renal, facial cleft • Parental preparation

  10. RCOGGuidelines October 1997Detection Rates for Specific anomalies

  11. RCOGGuidelines October 1997Detection Rates for Specific anomalies

  12. RCOG Routine sonar in PregnancyJuly 2000

  13. RCOG 2000 JulyMinimum standard for a 20 week anomaly scan • Gestational age • BPD, HC, FL, AC

  14. Measurments

  15. RCOG 2000 JulyMinimum standard for a 20 week anomaly scan • Gestational age • BPD, HC, FL, AC • Fetal Normality • Head shape and internal structures • CSP, Cerebellum, Ventricular size at atrium (<10mm) • Spine longitudinal and transverse • Abdominal shape and content at the level of the stomach

  16. RCOG 2000 JulyMinimum standard for a 20 week anomaly scan • Renal Pelvis (<5mm AP) • Longitudinal axis – abdominal thoracic appearance (diaphragm/bladder) • Thorax at level of 4ch cardiac view • Arms – 2 x 3 long bones + hands (not counting fingers) • Legs - 2 x 3 long bones + feet (not counting toes)

  17. RCOG 2000 JulyMinimum standard for a 20 week anomaly scan

  18. RCOG 2000 JulyOptimal standard for a 20 week anomaly scan • The above plus: • Cardiac outflow tracts • Face and lips

  19. RCOG 2000 JulyMarker scans • Not considered “routine” • Isolated markers of dubious value • Increased overall detection rate increase from 51% - 55% but FPR from 1/2332 to 1/188!!!!! (Boyd PA Lancet 1998) • Two or more markers significant • Screening using maternal age, age + NT, age+ serum will identify 50 – 80% • So marker scan as screening in unscreened population unlikely to be of use

  20. RCOG 2000 JulyMarker scans • “Markers” • CPC • Ventriculomegaly(>10mm at atrium) • Echogenic bowel(equivalent to bone density) • Head shape • Nuchal skinfold thickness(>5mm at 20 weeks) • CM • Cleft lip • Echogenic intracardiac focus

  21. RCOG 2000 JulyMarker scans • Dilated renal pelvis(>5mmAP) • Short Femur/Humerus • Talipes • Sandal gap • Clinodactyly • Clenched hand • Two vessel cord

  22. RCOG 2000 JulyMarker scans • Other risk factors • Maternal age > 35 • Serum screening results • Nuchal translucency at 11 – 14 weeks

  23. Standard views • Pilu, Nicolaides CD - ROM • ISUOG Standards

  24. Standard views • Intrauterine • Amount of fetuses • Cardiac activity • Placental Position, Appearance • Cord vessels • Liquor

  25. Standard viewsHead and Brain

  26. Standard viewsFace

  27. Standard viewsFace

  28. Standard viewsSpine

  29. Standard viewsHeart

  30. Standard viewsGIT

  31. Standard viewsLimbs

  32. Anomaly scan • Skull & Brain • Normal and abnormal

  33. Anomaly scan • Face • Normal and abnormal

  34. Anomaly scan • Spine • Normal and abnormal

  35. NormalSpine

  36. Abnormal Spine

  37. Anomaly scan • GIT • Normal and abnormal

  38. Anomaly scan • Heart • Normal and abnormal

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