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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5802_Библиотеки_им_академика_М_И_Перельмана.pdf
Obstetrics
356
40 24.3
41 24.9
42 25.3
43 25.7
44 26.1
45 26.7
46 27.1
47 27.7
48 28.1
49 28.9
50 29.3
51 29.9
52 30.3
53 30.9
54 31.4
55 32.0
56 32.6
57 33.1
58 33.6
59 34.1
60 34.9
61 35.3
62 35.9
63 36.6
64 37.1
65 37.7
Fetal humerus length
66 38.3
67 38.9
68 39.6
69 40.1
FURTHER READING
Jeanty P, Rodesch F, Delbeke D, Dumont JE. Estimation of
gestational age from measurements of fetal long bones. J
Ultrasound Med. 1984; 3:75–79.
357
Obstetrics
358
Transcerebellar diameter
PREPARATION
Full bladder for transabdominal imaging in 2
nd
trimester.
POSITION
Mother is in the supine position.
TRANSDUCER
Transabdominal: 3.0–6.0 MHz curvilinear transducer.
METHOD
The transcerebellar plane; an oblique view through the posterior fossa
that includes visualization of the midline thalamus, cerebellar hemispheres, and the cisterna magna is obtained. Calipers are kept at the
outer margins of the cerebellum at its maximum width.
APPEARANCE
A dumbbell-shaped structure in the posterior fossa, behind the thalami
and in front of the cisterna magna.
A view at the level of the midline thalamus (arrow) with cursors placed at the measuring
points of the cerebellar hemispheres (Cereb) and cisterna magna (CM).
Transcerebellar diameter
MEASUREMENTS
Transcerebellar diameter (TCD) in millimeters correlates with the
gestational age up to 22–24 weeks. After 24 weeks of GA, this direct
correlation no longer exists.
15 14
16 16
17 17
18 18
19 19
20 20
21 21
22 23
23 24
24 26
25 27
26 28
27 30
28 31
29 33
30 35
31 38
32 39
33 40
34 41
35 42
36 43
37 45
38 48
39 52
40 55
359
Obstetrics
360
1.2 13.3 13.6 14.5 15.6 15.9
1.3 13.9 14.2 15.1 16.2 16.5
1.4 14.6 14.9 15.7 16.8 17.1
1.5 15.2 15.5 16.4 17.4 17.7
1.6 15.9 16.1 17.0 18.1 18.4
1.7 16.5 16.8 17.7 18.7 19.0
1.8 17.2 17.4 18.3 19.4 19.7
1.9 17.8 18.1 19.0 20.1 20.4
2.0 18.4 18.7 19.7 20.8 21.1
2.1 19.1 19.4 20.3 21.5 21.8
2.2 19.7 20.0 21.0 22.2 22.5
2.3 20.3 20.7 21.7 22.9 23.2
2.4 21.0 21.3 22.3 23.6 23.9
2.5 21.6 21.9 23.0 24.3 24.6
2.6 22.2 22.5 23.7 25.0 25.4
2.7 22.8 23.2 24.3 25.7 26.1
2.8 23.4 23.8 25.0 26.4 26.8
2.9 24.0 24.4 25.6 27.1 27.5
3.0 24.6 25.0 26.3 27.7 28.2
3.1 25.2 25.6 26.9 28.4 28.9
3.2 25.8 26.2 27.5 29.1 29.5
3.3 26.3 26.8 28.1 29.7 30.2
3.4 26.9 27.3 28.7 30.4 30.8
3.5 27.4 27.9 29.3 31.0 31.5
3.6 28.0 28.4 29.9 31.6 32.1
Transcerebellar diameter
3.7 28.5 29.0 30.4 32.2 32.7
3.8 29.0 29.5 31.0 32.8 33.3
3.9 29.5 30.0 31.5 33.3 33.8
4.0 30.0 30.5 32.0 33.8 34.4
4.1 30.5 31.0 32.5 34.3 34.9
4.2 31.0 31.5 33.0 34.8 35.3
4.3 31.4 31.9 33.4 35.3 35.8
4.4 31.9 32.4 33.9 35.7 36.2
4.5 32.3 32.8 34.3 36.1 36.6
4.6 32.7 33.2 34.7 36.4 36.9
4.7 33.1 33.6 35.0 36.8 37.2
4.8 33.5 34.0 35.4 37.0 37.5
4.9 33.9 34.3 35.7 37.3 37.8
5.0 34.3 34.7 36.0 37.5 38.0
5.1 34.6 35.0 36.2 37.7 38.1
5.2 34.9 35.3 36.5 37.8 38.2
361
FURTHER READING
Chavez MR, Ananth CV, Smulian JC, Yeo L, Oyelese Y, Vintzileos
AM. Fetal transcerebellar diameter measurement with particular
emphasis in the third trimester: A reliable predictor of gestational
age. Am J Obstet Gynecol. 2004; 91:979–984.
Gottlieb AG, Galan HL. Nontraditional sonographic pearls in
estimating gestational age. Semin Perinatol. 2008; 32:154–160.
Obstetrics
362
Head to abdominal circumference ratio
PREPARATION
Full bladder for transabdominal imaging in 2
nd
trimester.
POSITION
Mother is in the supine position. Transaxial image of fetal skull at level
of thalami and cavum septum pellucidum and transverse image of fetal
abdomen at level of the stomach and intrahepatic umbilical vein are
obtained.
TRANSDUCER
Transabdominal: 3.0–6.0 MHz curvilinear transducer.
METHOD
Outer perimeter of the cranium is divided by the outer perimeter of the
fetal abdomen. An elevated head-to-abdomen circumference ratio is a
sign of intrauterine growth retardation (IUGR, small for gestational
age).
MEASUREMENTS
13–14 1.23 (1.14–1.31)
15–16 1.22 (1.05–1.39)
17–18 1.18 (1.07–1.29)
19–20 1.18 (1.09–1.39
21–22 1.15 (1.06–1.25)
23–24 1.13 (1.05–1.21)
25–26 1.13 (1.04–1.22)
27–28 1.13 (1.05–1.21)
29–30 1.10 (0.99–1.21)
31–32 1.07 (0.96–1.17)
33–34 1.04 (0.96–1.1)
Head to abdominal circumference ratio
35–36 1.02 (0.93–1.11)
37–38 0.98 (0.92–1.05)
39–40 0.97 (0.87–1.06)
41–42 0.96 (0.93–1.00)
FURTHER READING
Hadlock FP, Deter RL, Harrist RB, Park SK. Fetal abdominal
circumference as a predictor of menstrual age. Am J Roentgenol.
1982; 139:367–370.
363
Obstetrics
364
Transcerebellar diameter to
abdominal circumference ratio
PREPARATION
Full bladder for transabdominal imaging in 2
POSITION
Mother is in the supine position. Transcerebellar plane of fetal skull at
level of thalami, cerebellum, and cisterna magna, and transverse image
of fetal abdomen at level of the stomach and intrahepatic umbilical
vein are obtained.
TRANSDUCER
Transabdominal: 3.0–6.0 MHz curvilinear transducer.
METHOD
The transcerebellar diameter (TCD) is divided by the outer perimeter of
the fetal abdomen. The elevated TCD-to-abdomen circumference (AC)
ratio is a better indicator of intrauterine growth retardation (IUGR),
especially in a pregnancy with uncertain dates. The TCD/AC ratio is a
stable, gestational age-independent parameter that may be useful in the
early detection of fetal growth abnormalities.
MEASUREMENT
TCD/AC ratio (mean ± SD) = 13.69 ± 0.94
The ratio remained constant throughout pregnancy irrespective to gestational age.
FURTHER READING
Meyer WJ, Gauthier DW, Goldenberg B, Santolaya J, Sipos J,
Cattledge F. The fetal transverse cerebellar diameter/abdominal
circumference ratio: A gestational age-independent method of
assessing fetal size. J Ultrasound Med. 1993; 12:379–382.
nd
trimester.
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