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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5802_Библиотеки_им_академика_М_И_Перельмана.pdf
Obstetrics
316
Biparietal diameter
PREPARATION
Full bladder for transabdominal imaging in 1
st
and 2nd trimesters.
POSITION
Mother is in the supine position.
Transaxial image of the fetal skull at the level of thalami and cavum
septum pellucidum is obtained. The transducer must be perpendicular
to the parietal bones.
TRANSDUCER
Transabdominal: 3.0–6.0 MHz curvilinear transducer.
METHOD
Measured at the widest part of the image from the outer edge of the
cranium nearest to the transducer to the inner edge of the cranium farthest from the transducer (as shown in image), or from the outer edge
to the outer edge, perpendicular to the falx.
APPEARANCE
Thalami appear as symmetric low-reective structures on either side
of the linear midline high-reective line (3
rd
ventricle). Calvaria must
appear smooth and symmetric bilaterally. The cerebellum should not
be present in the image.
MEASUREMENTS
10 9 + 1
15 10 + 5
20 12 + 1
25 13 + 3
30 14 + 5
35 16 + 1
40 17 + 3
45 18 + 6
Biparietal diameter
The thalami are symmetric low-reective structures (arrows), and the widest diameter
measured at this level (cursors) indicates BPD.
317
50 20 + 2
55 21 + 6
60 23 + 2
65 24 + 0
70 26 + 4
75 28 + 2
80 30 + 1
85 32 + 0
90 34 + 0
95 36 + 0
100 38 + 2
105 40 + 3
110 42 + 6
Obstetrics
318
FURTHER READING
Verburg BO, Steegers EA, DeRidder M, Snijders RJ, Smith E,
Hofman A, Moll HA, Jaddoe VW, Witteman JC. New charts for
ultrasound dating of pregnancy and assessment of fetal growth:
Longitudinal data from a population-based cohort study.
Ultrasound Obstet Gynecol. 2008; 31:388–396.
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Obstetrics
320
Head circumference
PREPARATION
Full bladder for transabdominal imaging in 2
nd
trimester.
POSITION
Mother is in the supine position.
Transaxial image of the fetal skull at the level of thalami and cavum
septum pellucidum is obtained. The transducer must be perpendicular
to the parietal bones.
TRANSDUCER
Transabdominal: 3.0–5.0 MHz curvilinear transducer.
METHOD
Outer perimeter of cranium is measured. Alternatively, it can be calculated by the following formula:
1.57 × ([outer to outer BPD] + [outer to outer OFD])
BPD = biparietal diameter; OFD = occipito frontal diameter.
APPEARANCE
Thalami appear as symmetric low-reective structures on either side
of the linear midline high-reective line (3
rd
ventricle). Calvaria must
appear smooth and symmetric bilaterally. The cavum septum pellucidum must be visible anteriorly and the tentorial hiatus posteriorly.
MEASUREMENTS
80 13.4 (12.1–14.7) 115 15.6 (14.3–16.9)
85 13.7 (12.4–15.0) 120 15.9 (14.6–17.2)
90 14.0 (12.7–15.3) 125 16.3 (15.0-17.6)
95 14.3 (13.0–15.6) 130 16.6 (15.3–17.9)
100 14.6 (13.3–15.9) 135 17.0 (15.7–18.3)
105 15.0 (13.7–16.3) 140 17.3 (16.0–18.6)
110 15.3 (14.0–16.6) 145 17.7 (16.4–19.0)
Head circumference
The cavum septum pellucidum (arrow) is visible anteriorly and the tentorial hiatus
posteriorly to measure the head circumference.
321
150 18.1 (16.5–19.7) 205 22.5 (20.9–24.1)
155 18.4 (16.8–20.0) 210 23.0 (21.4–24.6)
160 18.8 (17.2–20.4) 215 23.4 (21.8–25.0)
165 19.2 (17.6–20.8) 220 23.9 (22.3–25.5)
170 19.6 (18.0–21.2)
225 24.4 (22.1–26.7)
175 20.0 (18.4–21.6) 230 24.9 (22.6–27.2)
180 20.4 (18.8–22.0) 235 25.4 (23.1–27.7)
185 20.8 (19.2–22.4) 240 25.9 (23.6–28.2)
190 21.2 (19.8–22.8) 245 26.4 (24.1–28.7)
195 21.6 (20.0–23.2) 250 26.9 (24.6–29.2)
200 22.1 (20.5–23.7) 255 27.5 (25.2–29.8)
Obstetrics
322
260 28.0 (25.7–30.3) 315 34.9 (32.2–37.6)
265 28.1 (25.8–30.4) 320 35.5 (32.8–38.2)
270 29.2 (26.9–31.5) 325 36.3 (32.9–39.7)
275 29.8 (27.5–32.1) 330 37.0 (33.6–40.0)
280 30.3 (27.6–33.0) 335 37.7 (34.3–41.1)
285 31.0 (28.3–33.7) 340 38.5 (35.1–41.9)
290 31.6 (28.9–34.3) 345 39.2 (35.8–42.6)
295 32.2 (29.5–34.8) 350 40.0 (36.6–43.4)
300 32.8 (30.1–35.5) 355 40.8 (37.4–44.2)
305 33.5 (30.7–36.2) 360 41.6 (38.2–45.0)
310 34.2 (31.5–36.9)
FURTHER READING
Hadlock FP, Deter RL, Harrist RB, Park SK. Fetal head
circumference: Relation to menstrual age. Am J Roentgenol.
1982; 138:649–653.
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Obstetrics
324
Abdominal circumference
PREPARATION
Full bladder for transabdominal imaging in the 2
nd
trimester.
POSITION
Mother is in the supine position. Transverse image of fetal abdomen
is obtained at the level of the stomach and intrahepatic umbilical vein.
PROBE
Transabdominal: 3.0–5.0 MHz curvilinear transducer.
METHOD
Length of outer perimeter of fetal abdomen.
APPEARANCE
In the correct plane, the abdomen should appear round (rather than
elliptical), the ribs are symmetric, and the conuence of the right and
left portal veins and the fetal stomach should be visible. The intrahepatic umbilical vein appears in short axis.
The fetal stomach (long arrow) is visible on the “round” abdominal view, with the
intrahepatic vein visible in the short axis (short arrow).
Abdominal circumference
MEASUREMENTS
100 15.6 (13.7–17.5) 235 27.7 (25.5–29.9)
105 16.1 (14.2–18.0) 240 28.2 (26.0–30.4)
110 16.5 (14.6–18.4) 245 28.7 (26.5–30.9)
115 16.9 (15.0–18.8) 250 29.2 (27.0–31.4)
120 17.3 (15.4–19.2) 255 29.7 (27.5–31.9)
125 17.8 (15.9–19.7) 260 30.1 (27.1–33.1)
130 18.2 (16.2–20.2) 265 30.6 (27.6–33.6)
135 18.6 (16.6–20.6) 270 31.1 (28.1–34.1)
140 19.1 (17.1–21.1) 275 31.6 (28.6–34.6)
145 19.5 (17.5–21.5) 280 32.1 (29.1–35.1)
150 20.0 (18.0–22.0) 285 32.6 (29.6–35.6)
155 20.4 (18.4–22.4) 290 33.1 (30.1–36.1)
160 20.8 (18.8–22.8) 295 33.6 (30.6–36.6)
165 21.3 (19.3–23.3) 300 34.1 (31.1–37.1)
170 21.7 (19.7–23.7) 305 34.6 (31.1–37.1)
175 22.2 (20.2–24.2) 310 35.1 (32.1–38.1)
180 22.6 (20.6–24.6) 315 35.6 (32.6–38.6)
185 23.1 (21.1–25.1) 320 36.1 (33.6–38.6)
190 23.6 (21.6–25.6) 325 36.6 (34.1–39.1)
195 24.0 (21.8–26.2) 330 37.1 (34.6–39.6)
200 24.5 (22.3–26.7) 335 37.6 (35.1–40.1)
205 24.9 (22.7–27.1) 340 38.1 (35.6–40.6)
210 25.4 (23.2–27.6) 345 38.7 (36.2–41.2)
215 25.9 (23.7–28.1) 350 39.2 (36.7–41.7)
220 26.3 (24.1–28.5) 355 39.7 (37.2–42.2)
225 26.8 (24.6–29.0) 360 40.2 (37.7–42.7)
230 27.3 (25.1–29.5) 365 40.8 (38.3–43.3)
325