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OBSTETRIC IMAGING: FETAL DIAGNOSIS AND CARE

ISBN: 978-0-323-44548-1 SECOND EDITION

Copyright © 2018 by Elsevier, Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the Publisher. Details on how to seek permission, further information about the Publisher’s permissions policies, and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods, they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence, or otherwise or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Previous edition copyrighted 2012

Library of Congress Cataloging-in-Publication Data

Names: Copel, Joshua A., editor.

Title: Obstetric imaging : fetal diagnosis and care / [edited by] Joshua A. Copel, Mary E. D’Alton, Helen Feltovich, Eduard Gratacós, Deborah Krakow, Anthony O. Odibo, Lawrence D. Platt, Boris Tutschek.

Description: Second edition. | Philadelphia, PA : Elsevier, [2018] | Includes bibliographical references and index.

Identifiers: LCCN 2017029132 | ISBN 9780323445481 (hardcover)

Subjects: | MESH: Congenital Abnormalities—diagnostic imaging | Fetus—abnormalities | Prenatal Diagnosis

Classification: LCC RG626 | NLM QS 675 | DDC 618.3/2075—dc23

LC record available at https://lccn.loc.gov/2017029132

Senior Content Strategist: Robin Carter

Senior Content Development Specialist: Anne Snyder

Publishing Services Manager: Catherine Albright Jackson

Senior Project Manager: Doug Turner

Designer: Renee Duenow

Thorsten Braun, MD, PhD

Consultant Obstetrician and Gynecologist

Charité—University Medicine Berlin

Department of Obstetrics

Campus Virchow Klinikum

Berlin, Germany

Intestinal Obstruction

Fallon R. Brewer, MS, CGC

Genetic Counselor

Department of Genetics

University of Alabama at Birmingham Birmingham, Alabama

Goldenhar Syndrome

Pierre Robin Sequence

Prune-Belly Syndrome

Sirenomelia

VATER Association

Angela Burgess, MD, PhD

Richmond University Medical Center

Mount Sinai Consortium

Department of Obstetrics and Gynecology

Staten Island, New York

Lymphedema and Lymphatic Malformations

Alison G. Cahill, MD, MSCI

Associate Professor

Department of Obstetrics and Gynecology

Washington University School of Medicine

St. Louis, Missouri

Miller-Dieker Syndrome (17p13.3 Deletion Syndrome)

Katherine H. Campbell, MD, MPH

Assistant Professor

Obstetrics, Gynecology, and Reproductive Sciences

Yale School of Medicine

New Haven, Connecticut

Gastroschisis

Omphalocele

Frederic Chantraine, MD, PhD

Consultant Obstetrician and Gynecologist

Department of Obstetrics and Gynecology

CHR Citadelle

University of Liege Liege, Belgium

Abdominal Cysts

Tamara T. Chao, MD

Maternal-Fetal Medicine

MultiCare Health System

Tacoma, Washington

Abnormal Kidney Size

Duplicated Collecting System

Posterior Urethral Valves

Debnath Chatterjee, MD

Associate Professor of Anesthesiology

Children’s Hospital Colorado/University of Colorado School of Medicine

Director of Fetal Anesthesia

Colorado Fetal Care Center

Aurora, Colorado

Open Fetal Surgery

Jaclyn M. Coletta, MD

Assistant Professor

Maternal-Fetal Medicine

Columbia University Medical Center

New York, New York

Chorioangioma

Choriocarcinoma

Gestational Trophoblastic Disease

Vasa Previa

Elena Contro, MD, PhD

Consultant in Obstetrics and Gynecology

S. Orsola-Malpighi University Hospital

Bologna, Italy

Intracranial Hemorrhage, Cysts, Tumors, and Destructive Lesions

Neural Tube Defects

Joshua A. Copel, MD

Professor and Vice Chair

Clinical Operations

Obstetrics, Gynecology, and Reproductive Sciences

Professor of Pediatrics

Yale School of Medicine

New Haven, Connecticut

Thymus

Fetal Adrenal Abnormalities

Gastroschisis

Omphalocele

Cytomegalovirus, Rubella, Toxoplasmosis, Herpes Simplex Virus, and Varicella

Fatima Crispi, MD, PhD

Department of Maternal-Fetal Medicine

BCNatal, Hospital Clínic and Hospital Sant Joan de Déu

University of Barcelona

Barcelona, Spain

Choanal Atresia

Double-Inlet Single Ventricle

Atrial Isomerism

Anomalies of Pulmonary Venous Return

Anomalies of Systemic Venous Return

Cardiomyopathy

Cardiac Tumors

Arrhythmias

Julie A. Gainer, DO

Utah Valley Regional Medical Center

Maternal Fetal Medicine

Intermountain Healthcare

Provo, Utah

Triploidy

France Galerneau, MD, FRCS(C)

Associate Professor

Obstetrics, Gynecology, and Reproductive Sciences

Yale University School of Medicine

New Haven, Connecticut

Fetal Hepatic Calcification

Beckwith-Wiedemann Syndrome

Stephanie L. Gaw, MD, PhD

Assistant Professor

Division of Maternal-Fetal Medicine

Department of Obstetrics, Gynecology, and Reproductive Sciences

University of California, San Francisco

San Francisco, California

Trisomy 13

Trisomy 18

Trisomy 21

Mosaic Trisomies 8, 9, and 16

Kobina Ghartey, MD

Twin Reversed Arterial Perfusion Sequence

Tullio Ghi, MD, PhD

Department of Obstetrics

University of Parma

Parma, Italy

Intracranial Hemorrhage, Cysts, Tumors, and Destructive Lesions

Neural Tube Defects

Katherine R. Goetzinger, MD, MSCI

Assistant Professor

Department of Obstetrics, Gynecology, and Reproductive Sciences

University of Maryland School of Medicine

Baltimore, Maryland

Fryns Syndrome

Pentalogy of Cantrell

Cystic Fibrosis

Tuberous Sclerosis

Miller-Dieker Syndrome (17p13.3 Deletion Syndrome)

Olga Gómez, MD, PhD

Maternal-Fetal Consultant

Department of Maternal-Fetal Medicine

Barcelona Center for Maternal-Fetal and Neonatal Medicine

Hospital Clínic and Hospital Sant Joan de Déu

University of Barcelona

Center for Biomedical Research on Rare Diseases

Barcelona, Spain

Cleft Lip and Palate

Micrognathia and Retrognathia

Facial Dysmorphism

Ultrasound of Normal Fetal Heart

Ventricular Septal Defect

Atrioventricular Septal Defect

Tricuspid Atresia

Ebstein Anomaly and Tricuspid Dysplasia

Pulmonary Stenosis and Atresia

Eduard Gratacós, MD, PhD

Director

Barcelona Center for Maternal-Fetal and Neonatal Medicine

Hospital Clinic and Hospital Sant Joan de Deu

Clinical Institute of Gynecology, Obstetrics, and Neonatology

Professor of Obstetrics and Gynecology

University of Barcelona

Barcelona, Spain

Congenital Cystic Adenomatoid Malformation of the Lung

Bronchopulmonary Sequestration

Hydrothorax

Scimitar Syndrome

Other Thoracic Tumors and Masses

Carole Gravino, RDMS, FE

Yale-New Haven Hospital

New Haven, Connecticut

Atlas of Selected Normal Images

Maureen S. Hamel, MD

Division of Maternal Fetal Medicine

Department of Obstetrics and Gynecology

Women & Infants Hospital of Rhode Island

Providence, Rhode Island

Cloacal Abnormalities

Christina S. Han, MD

Department of Obstetrics and Gynecology

David Geffen School of Medicine at UCLA

University of California, Los Angeles

Center for Fetal Medicine and Women’s Ultrasound

Los Angeles, California

Fetal Adrenal Abnormalities

Fetal Biophysical Profile

Urania Magriples, MD

Associate Professor

Maternal-Fetal Medicine

Yale School of Medicine

New Haven, Connecticut

Intrauterine Growth Restriction

Gustavo Malinger, MD

Director

Division of Ultrasound in Obstetrics and Gynecology

Lis Maternity Hospital

Tel Aviv Sourasky Medical Center

Associate Clinical Professor

Sackler School of Medicine

Tel Aviv University

Tel Aviv, Israel

Cortical Development and Disorders

Cerebellar Anomalies

Congenital Zika Virus Syndrome

Stephanie Martin, DO

Director, Southern Colorado Maternal-Fetal Medicine

Director, Maternal-Fetal Medicine/Centura Southstate

Colorado Springs, Colorado

Clubfoot (Talipes Equinovarus)

Josep M. Martinez, MD, PhD

Senior Consultant in Fetal Medicine

Department of Maternal-Fetal Medicine

BCNatal, Hospital Clínic and Hospital Sant Joan de Déu

University of Barcelona

Barcelona, Spain

Ultrasound of Normal Fetal Heart

Ventricular Septal Defect

Atrioventricular Septal Defect

Tricuspid Atresia

Ebstein Anomaly and Tricuspid Dysplasia

Pulmonary Stenosis and Atresia

Aortic Stenosis and Aortic Atresia

Hypoplastic Left Heart Syndrome and Mitral Atresia

Aortic Coarctation

Interruption of the Aortic Arch

Aortic Arch Anomalies

Tetralogy of Fallot

Transposition of Great Arteries

Double-Outlet Right Ventricle

Common Arterial Trunk

Double-Inlet Single Ventricle

Atrial Isomerism

Anomalies of Pulmonary Venous Return

Anomalies of Systemic Venous Return

Cardiomyopathy

Cardiac Tumors

Arrhythmias

Ahmed I. Marwan, MD

Assistant Professor of Surgery and Pediatrics

Colorado Fetal Care Center

Division of Pediatric Surgery

Children’s Hospital Colorado/University of Colorado School of Medicine

Aurora, Colorado

Open Fetal Surgery

Audrey Merriam, MD

Maternal-Fetal Medicine Fellow

Obstetrics and Gynecology

Columbia University

New York, New York

Placental Abruption

Placenta Circumvallata

Placenta Previa

Silke A. M. Michaelis, MD

Obstetrics

Spitalzentrum Biel—Centre Hospitalier Bienne

Biel-Bienne, Switzerland

Biliary Anomalies

Jena Miller, MD

Assistant Professor

The Johns Hopkins Center for Fetal Therapy

Baltimore, Maryland

Doppler Ultrasound Evaluation of the Fetus and Placenta

Russell S. Miller, MD

Assistant Professor

Obstetrics and Gynecology

Columbia University Medical Center

New York, New York

Radiofrequency Ablation

Selective Laser Photocoagulation

Fetal Shunts

Twin-Twin Transfusion Syndrome

Twin Reversed Arterial Perfusion Sequence

Anne-Elodie Millischer, MD

Pediatric Imaging and Maternal-Fetal Center

Necker Hospital—Sick Children

AP-HP

Paris Descartes University

Paris, France

Magnetic Resonance Imaging in Obstetrics

Ana Monteagudo, MD

Clinical Professor of Obstetrics and Gynecology

New York University School of Medicine and Icahn School of Medicine at Mount Sinai

Carnegie Imaging for Women

New York, New York

Pregnancy of Unknown Location, Early Pregnancy Loss, Ectopic Pregnancy, and Cesarean Scar Pregnancy

Leslie Moroz, MD, MSc

Clinical Fellow

Critical Care and Maternal-Fetal Medicine

New York Presbyterian/Columbia University Medical Center

New York, New York

Placenta Accreta

Claudia Mosquera, MD

Physician

The Valley Hospital

Ridgewood, New Jersey

Radiofrequency Ablation

Rachel G. Sinkey, MD

Department of Obstetrics and Gynecology

Division of Maternal-Fetal Medicine

Morsani College of Medicine

University of South Florida

Tampa, Florida

Cornelia de Lange Syndrome

Noonan Syndrome

Pontocerebellar Disorders

Saul Snowise, MD

Assistant Professor of Obstetrics, Gynecology, and Reproductive Sciences

University of Texas School of Medicine at Houston

McGovern Medical School

Houston, Texas

Nonimmune Hydrops Fetalis

Immune Hydrops Fetalis

Pascale Sonigo, MD

Pediatric Imaging and Maternal-Fetal Center

Necker Hospital—Sick Children

AP-HP

Paris Descartes University

Paris, France

Magnetic Resonance Imaging in Obstetrics

Hindi E. Stohl, MD, JD

Director, Division of Maternal-Fetal Medicine

Harbor–UCLA Medical Center

Torrance, California

Introduction to Aneuploidy

Jens H. Stupin, MD

Departments of Gynecology and Obstetrics

Charité—University Medicine Berlin Berlin, Germany

Choroid Plexus Anomalies: Cysts and Papillomas

Ilan E. Timor-Tritsch, MD

Professor of Obstetrics and Gynecology

New York University School of Medicine

New York, New York

Pregnancy of Unknown Location, Early Pregnancy Loss, Ectopic Pregnancy, and Cesarean Scar Pregnancy

Congenital Zika Virus Syndrome

Ants Toi, MD

Professor of Radiology

Professor of Obstetrics and Gynecology

University of Toronto

Radiologist

Department of Medical Imaging

Mt. Sinai Hospital

Toronto, Ontario, Canada

Cortical Development and Disorders

Gloria Too, MD

Maternal-Fetal Medicine Clinical Fellow

Columbia University Medical Center

New York, New York

Cordocentesis and Fetal Transfusion

Multifetal Pregnancy Reduction

Boris Tutschek, MD, PhD

Consultant Obstetrician and Gynecologist

Prenatal Zurich

Zürich, Switzerland

Professor of Obstetrics and Gynecology

Medical Faculty

Heinrich Heine University

Düsseldorf, Germany

Abdominal Cysts

Hepatic Anomalies

Fetal Spleen

Three-Dimensional Ultrasound: Techniques and Clinical Applications

Methodius G. Tuuli, MD, MPH

Associate Professor

Department of Obstetrics and Gynecology

Washington University School of Medicine

St. Louis, Missouri

Septooptic Dysplasia

Walker-Warburg Syndrome

Fraser Syndrome

Roberts Syndrome

Ignatia B. Van den Veyver, MD

Professor

Department of Obstetrics and Gynecology

Professor and Director

Clinical Prenatal Genetics Service

Department of Molecular and Human Genetics

Baylor College of Medicine

The Jan and Dan Duncan Neurological Research Institute

Texas Children’s Hospital

Houston, Texas

22q11.2 Deletion Syndrome

Chromosome 4p Deletion Syndrome (Wolf-Hirschhorn Syndrome)

Chromosome 5p Deletion Syndrome (Cri du Chat Syndrome)

Tim Van Mieghem, MD, PhD

Department of Obstetrics and Gynecology

Mount Sinai Hospital and University of Toronto

Toronto, Canada

Congenital Diaphragmatic Hernia

Joy Vink, MD

Assistant Professor

Co-Director, Preterm Birth Prevention Center

Division of Maternal-Fetal Medicine

Department of Obstetrics and Gynecology

Columbia University Medical Center

New York, New York

Amniocentesis

Chorionic Villus Sampling

Diagnostic Procedures in Multiples

Paolo Volpe, MD

Fetal Medicine Unit

Di Venere and Sarcone Hospitals

Bari, Italy

Corpus Callosum and Septum Pellucidum Anomalies

Carmela Votino, MD

Fetal Medicine Unit

Di Venere and Sarcone Hospitals

Bari, Italy

Corpus Callosum and Septum Pellucidum Anomalies

Jennifer M. Walsh, MB, BCh, BAO, PhD, MRCOG, FRCPI

Department of Obstetrics and Gynecology

Columbia University Medical Center

New York, New York

Nuchal Translucency

Erika F. Werner, MD, MS, FACOG

Division of Maternal Fetal Medicine

Department of Obstetrics and Gynecology

Women & Infants Hospital of Rhode Island

Providence, Rhode Island

Cloacal Abnormalities

Lisa C. Zuckerwise, MD

Clinical Instructor/Maternal Fetal Medicine Fellow

Department of Obstetrics, Gynecology, and Reproductive Sciences

Division of Maternal-Fetal Medicine

Yale University School of Medicine

New Haven, Connecticut Thymus

Since the publication of the first edition of this text 5 years ago, we have seen many improvements in the quality of fetal imaging, as well as an explosion in related knowledge of the genetics underlying so much of what we do. This edition features new images and videos and a reorganization of the genetics information sections, including skeletal dysplasias. We also have a unique new section on the latest technologies used in our field.

The changes in this edition arise from the creative thinking and persistence of my fellow editors. I was fortunate that all of the editors from the first edition agreed to a reprise and that Deborah Krakow agreed to join the team to supervise the genetics and skeletal dysplasia sections. Even more than in the first edition,

the format of the book is intended for both print and web access. All of the references for the book are in the web version, as are the video clips that add so much more in many diagnoses.

My deep thanks to our editor at Elsevier, Robin Carter, as well as our content specialist, Anne Snyder, who did so much day to day to keep the project moving. Finally, the authors of all the chapters deserve recognition for their work in producing outstanding contributions. All of the editors share my gratitude—and frankly my awe—at what came from our colleagues in producing this volume.

Joshua A. Copel, MD

VIDEO CONTENTS

CHAPTER 4 HYDROTHORAX

VIDEO 4.1 Bilateral Fetal Pleural Effusion or Hydrothorax

VIDEO 4.2 Massive Fetal Pericardial Effusion

CHAPTER 20 GASTROSCHISIS

VIDEO 20.1 Color Doppler Image of the Umbilical Cord Insertion Into the Abdomen Adjacent to the Herniated Bowel in a Fetus With Gastroschisis

VIDEO 20.2 Four-Dimensional Ultrasound of Fetal Torso With Gastroschisis

CHAPTER 21 OMPHALOCELE

VIDEO 21.1 Omphalocele With Levorotated Heart

CHAPTER 24 ABDOMINAL CYSTS

VIDEO 24.1 Partial Resection of Ovarian Cyst in a Neonate

VIDEO 24.2 Endoscopic Retrieval of a Detached Right Ovary With Hemorrhagic Cyst in a Neonate

VIDEO 24.3 Endoscopic Resection of Gastric Duplication in a Neonate

VIDEO 24.4 Normal Fetal Small Bowel Mesentery

CHAPTER 27 CONGENITAL DIAPHRAGMATIC HERNIA

VIDEO 27.1 Ultrasound of Isolated Left-Sided Congenital Diaphragmatic Hernia

VIDEO 27.2 Fetoscopic Removal of Tracheal Balloon in a Fetus With Isolated Congenital Diaphragmatic Hernia

CHAPTER 28 HEPATIC ANOMALIES

VIDEO 28.1 Gray Scale Imaging of Hepatic Hemangioma

VIDEO 28.2 Power Doppler Imaging of a Hepatic Hemangioma

CHAPTER 32 FETAL SPLEEN

VIDEO 32.1 Double Vessel Sign in Left-Isomerism: Transverse View

VIDEO 32.2 Double Vessel Sign in Left-Isomerism: Sagittal View

CHAPTER 39 HOLOPROSENCEPHALY

VIDEO 39.1 Coronar Slices Through the Monocavity of the HPE-Brain in an 18-Week-Old Fetus

VIDEO 39.2 Approximately 13-Week-Old Fetus With Alobar HPE: Horizontal Slices Through the Brain

VIDEO 39.3 Approximately 13-Week-Old Fetus With Alobar HPE: Coronar Slices Through the Brain

VIDEO 39.4 Approximately 13-Week-Old Fetus With Alobar HPE: Coronar Slices Through the Brain

CHAPTER 65 CLEFT LIP AND PALATE

VIDEO 65.1 Three-Dimensional Multiplanar Mode of a Fetus With a Bilateral Cleft Lip and Palate at 21 Weeks’ Gestation

CHAPTER 68 MICROGNATHIA AND RETROGNATHIA

VIDEO 68.1 Agnathia

VIDEO 68.2 Three-Dimensional Reconstruction of a Fetus With Micrognathia

VIDEO 68.3 Four-Dimensional Reconstruction of a Fetus With Micrognathia

CHAPTER 69 FACIAL DYSMORPHISM

VIDEO 69.1 Otocephaly and Micrognathia

CHAPTER 71 NECK TERATOMA

VIDEO 71.1 Unilocular, Encapsulated Complex Tumor of Fetal Neck

VIDEO 71.2 Primarily Solid Neck Tumor

VIDEO 71.3 Neck Teratoma

CHAPTER 74 ULTRASOUND OF NORMAL FETAL HEART

VIDEO 74.1 Normal Drainage of Superior Pulmonary Veins to the Left Atrium

VIDEO 74.2 Normal View of Right Ventricle, Pulmonary Valve, and Ductal Arch

VIDEO 74.3 Normal Ductal Arch

VIDEO 74.4 Normal Aortic Arch

VIDEO 74.5 Normal Aortic Arch

VIDEO 74.6 Drainage of the Superior and Inferior Vena Cava Into the Right Atrium

VIDEO 74.7 Presence of a Normal Ductus Venosus

VIDEO 74.8 Normal Heart Evaluated by Transvaginal Route

VIDEO 74.9 Transposition of Great Arteries

VIDEO 74.10 Examination of a Normal Heart by the Five Short-Axis Views

CHAPTER 75 VENTRICULAR SEPTAL DEFECT

VIDEO 75.1 Small Apical Ventricular Septal Defects

VIDEO 75.2 Large Perimembranous Ventricular Septal Defects

CHAPTER 76 ATRIOVENTRICULAR SEPTAL DEFECT

VIDEO 76.1 Unbalanced Complete Atrioventricular Septal Defects

VIDEO 76.2 Unbalanced Complete Atrioventricular Septal Defects

VIDEO 76.3 Incomplete Atrioventricular Septal Defects

VIDEO 76.4 Incomplete Atrioventricular Septal Defects

1 Atlas of Selected Normal Images

Fig. 1.1 The crown-rump length is a measurement of the length of human fetuses from the top of the crown to the bottom of the rump. It is used to estimate gestational age.
Fig. 1.2 Transvaginal ultrasound and sagittal long-axis view of the endocervical canal. Both the internal os and the external os are well visualized. The cervical length is measured from the internal os to the external os along the endocervical canal.
Fig. 1.4 Sagittal view of the uterus showing a posterior (Post) placenta.
Fig. 1.3 Sagittal view of the uterus with an anterior (Ant) placenta.
Fig. 1.7 Transverse view of the umbilical cord. The umbilical cord is composed of a vein and two smaller arteries.
Cord insertion
Fig. 1.8 Transverse view of the fetal abdomen and the umbilical cord insertion site showing integrity of the central abdominal wall.
Fig. 1.9 Four-chamber view of the fetal heart at 12 weeks of gestation.
Fig. 1.10 Interventricular septum at 12 weeks of gestation.
Fig. 1.6 Fetal umbilical cord insertion site. The umbilical arteries emerge caudally—originating at the iliac arteries and coursing along the margin of the urinary bladder. The umbilical vein proceeds cephalad and joins the fetal portal circulation. 3V, Three-vessel.
Fig. 1.5 Normal umbilical cord insertion into the placenta.

Four-chamber view obtained with a transverse axial view through the fetal thorax. This view provides information on the size of the heart and its chambers; the pulmonary venous connections to the atrial segment; the morphology of the ventricles; the type of atrioventricular (AV) connection; and the integrity of the atrial, AV, and ventricular septa.

1.16 The left ventricular outflow tract (LVOT) view is initially obtained with the ventricular septum horizontal to the transducer in the fourchamber view followed by clockwise or counterclockwise rotation of the transducer. The LVOT view also shows the left ventricular inlet with the anterior leaflet of the mitral valve demarcating both the inlet and the outflow tract.

Fig. 1.11 Left ventricular outflow at 12 weeks of gestation. LVOT, Left ventricular outflow tract.
Fig. 1.12 Three-vessel view shown by color Doppler at 12 weeks of gestation.
Fig. 1.13 Aortic arch (Ao Arch) at 12 weeks of gestation.
Fig. 1.14
Fig. 1.15 Four-chamber view with the fetus in the left decubitus position. The interventricular septum is clearly visualized and appears intact.
Fig.

Fig. 1.29 The transcerebellar view of the fetal head allows measurement of the nuchal fold (Nuch Fold). To obtain this measurement, calipers are placed at the outer edge of the occipital bone and the outer skin edge.

Fig. 1.31 Transverse view of the fetal head at the level of the biparietal diameter (BPD). To obtain the BPD, the view must include the third ventricle, thalamus, and cavum septi pellucidi. The measurements are obtained by placing cursors at the outer edge of one calvarial wall to the inner edge of the opposite calvarial wall. The head circumference (HC) is measured by placing the cursors at the outer edges of the near and far calvarial walls. OFD, Occipitofrontal diameter.

Fig. 1.30 Transcerebellar view of the fetal head showing the posterior fossa, which consists of the cerebellum and cisterna magna (Cist Mag)

Fig. 1.32 Midsagittal view of the fetal face showing the profile. The nasal bone, mandible, and maxilla are seen along with the upper and lower lips.
Nose/Lips
Fig. 1.33 Coronal view of the anterior face displaying the tip of the nose, nostrils, and upper lip shows the integrity of the upper lip.
Fig. 1.34 Coronal view of the anterior face showing the fetal tongue.

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