Visualización de la anatomía fetal por ecografía prenatal entre las semanas 11-13+6 / Visualising foetal anatomy by prenatal ultrasound between weeks 11-13+6

Objetivo. Comunicar la capacidad de visualización de estructuras anatómicas fetales durante la ecografía habitual de valoración de marcadores entre las semanas 11 y 13+6 de gestación en la Unidad de Ecografía del Centro Gutenberg de Málaga. Métodos. Evaluamos 990 pacientes que consultaron para valoración del cálculo de riesgo para trisomía 21, de las cuales 652 fueron utilizadas para el análisis. En 20 minutos realizamos la evaluación del grosor de la translucencia nucal y marcadores ecográficos adicionales, además de intentar valorar las principales estructuras anatómicas fetales, incluido el corazón, por vía abdominal o transvaginal según preferencia del operador. Resultados. El índice de masa corporal materno medio fue de 23,9; la media de la edad gestacional fue de 12 semanas; la longitud craneocaudal media fue de 62,6mm y la translucencia nucal se consideró por encima del percentil 95 en el 8,6% de los casos. Obtuvimos más del 90% de visualización (normal o con malformación) de cabeza y cerebro, cara, cuello, tórax, abdomen, extremidades y columna. Sin embargo, el corazón y los riñones ofrecieron mayor dificultad con una identificación global del 76 y 67% respectivamente. La mayoría del las exploraciones se realizaron con abordaje abdominal. Conclusiones. Es posible visualizar la anatomía fetal en más del 90% de los fetos, con más facilidad y éxito en la semana 13. La valoración del corazón y los riñones presentó siempre más dificultades. Destacamos la importancia de evaluar la anatomía fetal junto a los marcadores de aneuploidía en las semanas 11-13+6(AU)

Objective. To report the feasibility of identifying the foetal anatomy during the routine 11 to 13+6 weeks scan in the Ultrasound Unit at the Gutenberg Centre in Malaga, Spain. Methods. We examined 990 patients who attended our Unit to carry out the ultrasound screening for chromosomal abnormalities and risk assessment for trisomy 21, and 652 were included for the analysis. We measured the nuchal translucency thickness and additional ultrasound markers during the 20minutes allocated. In addition, we tried to visualise the main foetal anatomic structures, including the heart. The scans were done abdominally or by transvaginal approach, according to the preference of the operator. Results. The mean maternal body mass index was 23.9 and the mean gestation was 12 weeks; the mean crown rump length was 62.6mm and the nuchal translucency thickness was above the 95th centile for gestation in 8.6% of the foetuses. Visualisation of the foetal anatomy was successful in 90% of cases, classified as normal or abnormal, in most of the structures. However, the heart and kidneys were more difficult to identify with confidence and success was achieved in 76% and 67%, respectively. The large majority (93%) of the scans were performed abdominally. Conclusions. It is feasible to visualise the foetal anatomy in more than 90% of the cases during the routine first trimester scan. The heart and the kidneys remained the most difficult. We would like to stress the importance of the anatomical survey in the 11 to 13+6 weeks scan, in addition to the ultrasound markers assessment for the screening of chromosomal defects(AU)

Frontomaxillary facial angle at 11 + 0 to 13 + 6 weeks in Chinese population.

OBJECTIVES: To establish the normal range of frontomaxillary facial (FMF) angle in the first trimester in a Chinese population. METHODS: In a prospective study from March 2007 to June 2007, three-dimensional (3D) volumes of the fetal profile in the mid-sagittal plane were recorded from 129 Chinese pregnant women who were screened for trisomy 21 by the combination of fetal nuchal translucency (NT) thickness, maternal serum free ß-human chorionic gonadotropin (ß-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 11 to 13 + 6 weeks. 3D volumes were examined using multiplanar techniques. The FMF angle of each case was measured. The relationship between the measured FMF angle with the other parameter was also examined. RESULTS: The mean FMF angle decreased from 86.8 degree for a crown-rump length (CRL) of 45 mm to 76.0 degree for a CRL of 84 mm (FMF angle = 99.49 - 0.28 x CRL, r=0.377, p<0.0001). There was no significant association between the FMF angle with serum PAPP-A or ß-hCG. The mean (SD) difference between FMF angle derived from Chinese formula and that from the published Caucasian equation was 1.47 (0.61) (95% CI 1.37-1.58) (p<0.0001). CONCLUSIONS: In the first trimester, the FMF angle decreases with fetal CRL. There was similarity in the normal value of FMF angle between the Chinese and Caucasian populations.

Frontomaxillary facial angles in screening for trisomy 21 at 14-23 weeks' gestation.

OBJECTIVE: The objective of the study was to investigate the potential value of the frontomaxillary facial (FMF) angle in second-trimester ultrasound screening for trisomy 21. METHODS: We examined stored images of fetal profiles taken before amniocentesis at 14-24 weeks from 100 euploid fetuses and 34 with trisomy 21. The FMF angles between the upper surface of the upper palate and the frontal bone (FMF(bone)) and the skin over the forehead (FMF(skin)) were measured. RESULTS: In the euploid group the FMF angles decreased with gestation. In the fetuses with trisomy 21, the FMF(bone) and FMF(skin) angles were 79.4% and 87.9% above the 95th percentile for gestation of the respective values from the euploid group. In trisomy 21 fetuses, there was no significant difference in FMF angles between those with nasal bone hypoplasia (n = 19) and those without (n = 15). CONCLUSION: The FMF angle is substantially higher in trisomy 21 than euploid fetuses. Measurement of the FMF angles is likely to prove a useful method in prenatal screening for trisomy 21 in the second trimester.

Frontomaxillary facial angle in fetuses with trisomy 21 at 11-13(6) weeks.

OBJECTIVE: The objective of the study was to investigate the location of the front of the maxilla in relation to the forehead in fetuses with trisomy 21 at 11-13 weeks of gestation. STUDY DESIGN: A three-dimensional volume of the fetal head was obtained before karyotyping in 100 fetuses with trisomy 21 and 300 euploid fetuses. The frontomaxillary facial (FMF) angle, defined as the angle between the upper surface of the upper palate and the frontal bone in a midsagittal view of the fetal face, was measured. RESULTS: The FMF angle was significantly larger in the trisomy 21 than in the euploid fetuses (mean 88.7 degrees, range 75.4-104 degrees vs mean 78.1 degrees, range 66.6-89.5 degrees, P < .001). The FMF angle was more than 85 degrees in 69% of the trisomy 21 fetuses and in 5% of the euploid fetuses. There was no significant association between the FMF angle and nuchal translucency thickness. CONCLUSION: Measurement of FMF angle is likely to be a useful adjunct in screening for trisomy 21.