Fetus-general

A free gallery of high-resolution, ultrasound, color doppler and 3D images

Contents of this page:

Normal fetal anatomy

Early pregnancy (1st trimester)

Intrauterine fetal death (IUFD)

Fetal club hand deformity

How to spot the Normal ductus venosus

Color doppler imaging of fetal growth retardation (IUGR) and fetal hypoxia

Doppler of umbilical artery

Doppler evaluation of the MCA (middle cerebral artery)

Doppler evaluation of the Ductus Venosus

Color Doppler imaging of the uterine artery

Normal fetal anatomy:

Early pregnancy (1st trimester):

Sonographic anatomy of 9 week old fetus:

These ultrasound images show a normal early fetus of 9 weeks gestational age (1st trimester) and are taken via the transabdominal route. Among the structures seen are the fetus with the bulkier head (cephalic part) and the fetal heart on Color Doppler and Power Doppler imaging. Spectral Doppler waveform (Topmost row- right) shows the cardiac pulsations with heart rate. The fetal cardiac pulsations are also well visualized in the Power Doppler image of the fetus (2nd row from bottom- Right). The amniotic membrane (amnion) is also well visualized as it covers the fetus and is well clear of the gestational sac (Topmost row -left). At a later date, the amnion merges with the gestational sac and would not be visualized. The early umbilical cord is also visualized as it extends from the fetus to the uterine wall (ultrasound/ Doppler image on bottom row).

1) Intrauterine fetal death (IUFD):

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These ultrasound images of the fetal skull reveal overlap of the bones of the calvarium following fetal demise. This is known as the Spalding sign and is diagnostic of intrauterine fetal death. Images courtesy Dr. Ravi Kadasne, UAE.

2) Fetal club hand deformity:

Club shaped fetal hand:

This 2nd trimester fetus shows short forearm bone (radius) with radial deviation of the wrist. The image 1st (top left) is a B-mode ultrasound image showing this deformity of the hand. The other 3 images are 3-D (3 dimensional) ultrasound images showing the same anomaly in this fetus. These ultrasound images suggest fetal radial club hand anomaly. Radial club hand is the commonest fetal club hand anomaly. It is important to look for other fetal malformations as this anomaly is usually not isolated. Ultrasound images courtesy of Dr. Dilraj Gandhi, India.

Reference: http://www.wheelessonline.com/ortho/radial_club_hand

3) How to spot the Normal ductus venosus:

a: b:

c: d:

It is often difficult to spot the ductus venosus among the numerous vessels in the fetal abdomen. I have devised an easy way out. a) First spot the umbilical vein passing through the fetal abdomen. b) Switch on the color Doppler function to view the flow of the umbilical vein. c) Reduce or increase the PRF (pulse repetition frequency) function of the color flow until you spot a prominent but short vessel with MARKED ALIASING (ie: turbulent flow producing a multiple shades in the flow image). This is most likely to be the ductus venosus. Note the location of the vessel, just anterior to the fetal aorta. d) Now switch on the spectral doppler trace of the vessel. This will give a wavy spectral waveform with 3 waves (d): The S wave, the D wave and the A wave. Note the marked diastolic flow in this waveform. This is diagnostic of a normal Ductus venosus. All images by Joe Antony, MD, using a Toshiba Nemio -XG ultrasound system.

4) Color doppler imaging of fetal growth retardation (IUGR) and fetal hypoxia:

a) Doppler of umbilical artery:

Color doppler and spectral waveform imaging of the umbilical artery shows reversal of diastolic flow. This is an ominous sign of fetal compromise/ hypoxia and requires us to evaluate the fetal middle cerebral artery and ductus venosus. The diastolic flow reversal in umbilical arteries signifies severe placental insufficiency and increased placental vascular resistance, which is bad news for the fetus.

b) Doppler evaluation of the MCA (middle cerebral artery):

Color doppler and spectral waveform of the middle cerebral artery shows increased diastolic flow in the fetal brain suggesting a "fetal brain sparing" effect, whereby, the fetal cerebral vessels "open up", lowering the cerebral vascular resistance to increase flow to the brain thus diverting blood to the important organs in a state of overall fetal hypoxia.

c) Doppler evaluation of the Ductus Venosus (DV):

Doppler spectral waveform of the ductus venosus shows not just absent diastolic flow, but actual flow reversal during diastole. This is an ominous sign and suggest severe fetal compromise (ie: hypoxia). It is associated with very high fetal morbitidity and mortality. In this fetus, the Resistance Index for the vessels in this case are as follows:

Umb. Artery: 0.92 ; MCA: 0.75; DV: 0.99

The cerebro-placental ratio = RI (mca)/ RI (umb. a.) = 0.75/0.92 = 0.81.

The normal ratio is > 1. This suggests severe fetal growth retardation (IUGR) in this fetus possibly due to severe placental insufficiency. Ultrasound imaging and biometry also confirmed evidence of growth retardation in this fetus (28 weeks by ultrasound versus 31 weeks by Last Menstrual period). All these ultrasound and color doppler images suggest fetal growth reardation with fetal compromise and anoxia- meaning we have a very sick fetus that needs prompt delivery.

Images taken by Joe Antony, MD, using Toshiba, Nemio- XG Color doppler machine.

5) Color Doppler imaging of the uterine artery:

14 week pregnancy:

The color Doppler ultrasound images above show the uterine arteries on either side in a 14 week old pregnancy. The technique of tracing the uterine artery is described at:

http://ultrasound-videos.blogspot.com/2011/07/color-doppler-ultrasound-and-spectral.html

The spectral waveform of the right uterine artery shows a normal early diastolic notch which is normally seen till the age of 25 weeks of gestation.PI and RI values early in the pregnancy can be quite high signifying increased resistance in the placental and chorionic vascular beds. Thus PI values are typically higher than 2.5 in 11 to 14 week period, decreasing gradually as the gestation progresses. However, PI and RI values can vary depending on placental position (with low PI values in the uterine artery on the side of the placenta). Persistence of the diastolic notch and high PI and RI values can signify danger of the pre-eclampsia, placental abruption and PIH (pregnancy induced hypertension), and IUGR. Thus uterine artery doppler can be used to predict or exclude danger to the fetus in the coming months.The left uterine artery in the color Doppler image above is smaller in size due to the placenta being more on the right side of the uterus.

Uterine artery in 24 week pregnancy:

The right uterine artery in the color Doppler ultrasound image (top- left) shows bifurcation or division just before it crosses the right external iliac artery and vein. This was a 24 week old pregnancy. The spectral Doppler ultrasound image on right shows normal low resistance flow typically seen at this stage of pregnancy. Video clip of this case can be seen at: color Doppler video clip of bifurcated uterine artery

The RI of the uterine artery in this case measures 0.51, well within the normal limits.

References: Anatomical variants of uterine artery

Reference: 1) http://medind.nic.in/jaq/t05/i2/jaqt05i2p138.pdf (significance of doppler evaluation in fetus).

2) http://www.jultrasoundmed.org/cgi/content/abstract/6/6/291 (abstract)

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This page was last edited on: Wednesday July 20, 2011 01:15 PM

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