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8th World Congress on Ultrasound in Obstetrics & Gynecology

Monday morning, November 2, 1998, Edinburgh, Scotland

Early Diagnosis of Fetal Defects

This panel discussion illustrated just how far sonography has come in diagnosing fetal anomalies very early in fetal life. The panel was made up of Drs. Bronshtein discussing urinary tract problems, Timor-Tritsch on neuro tube, Gembruch on the heart, and Economides wrapping up with a discussion on fetal anomaly screening.

For a hour panel an incredible amount of information was covered... too much for a summary. Some high points were:

• Dr. Bronshtein showed images of fetal dilated kidneys and ureters as early as 12 menstrual weeks. In the discussion of renal cystic disease, he found that in 23/24 with single cysts before 16 weeks were normal. However, his hint for picking up infantile polycystic kidney disease between 9 and 14 weeks was the kidneys will be hyperechoic, large, and the kidneys will be "just too good looking". He concluded that he thought the mast majority of renal anomalies may be diagnosed at 14-16 weeks.
• Dr. Timor-Tritsch uses endovaginal sonography almost exclusively for his studies. He demonstrated the use of the endovaginal transducer on 2nd & 3rd trimester fetuses with images that compare favorably with those common on the new born. He uses the same schema for the planes to study these pregnancies. He gave a brief but good overview of normal anatomy, indicating that the cavum verge will close by about 24 weeks. He also pointed out that true chorid plexus cysts will have bright walls as true cysts. He also uses the lemon & banana sign as early as 12-14 weeks, while the banana sign is the most reliable.
• Dr. Gembruch showed four chamber hearts as early as 9.7 weeks, and recommends trying to look at the heart endovaginally as early as 13-14 weeks. At 9 weeks the ascending aorta should be much larger than the main portal artery, at 10 weeks the aorta will be slightly larger, and by 11-12 weeks the aorta and main portal artery.
• Dr. Economides summed the meeting up covering early screening in the first half of gestation. In general, sonography should be finding approximately 68% of structurally anomalies by the 14th week and 85% by mid pregnancy.

The meeting closed with a brief general debate about endovaginal versis transabdominal sonography in the early pregnancy. The issue was resolved that, unfortunately, often the method of examination is often determined by politics and economics.

This panel definitely shows that sonography is successfully advancing into the early stages of pregnancy.

Terry J. DuBose, M.S., RDMS

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