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The 12 Week

Scan

Early Anomaly

Scan

Dr Fred UshakovUniversity ollege London Hospital

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Dr Fred Ushakov The 12 Week Sc

FMF 11-13 wks Anatomical Assessment

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Dr Fred Ushakov The 12 Week Sc

Increased NT and normal karyotype

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Dr Fred Ushakov The 12 Week Sc

NT, TR and DV

Markers forcongenital heart defects

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Follow-up Scan at 16 weeks

Proposition for women with increased NT and/orinconclusive findings

***

Resolution:

Transabdominal scan at 16 weeks = Transvaginal scan at 12 weeks

Patient stresswaiting 3-4 weeks forreassurance

More complications in the case of TOP

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U/S visualization of fetal anatomy

Fetal structure 7 wks 8 9 10 11 12 13 14 wks

Neural tube + + + + + + + +

Head + + + + + + + +

Midgut herniation + + + +

Falx cerebri + + + + + +

Choroid plexus + + + + + +

Thalamus + + + + + +

Humerus & femur + + + + + +

Fingers + + + + + +

Tibia & radius + + + +

Toes + + + +

Cerebellum + + + +

Face + + + +

Heart - 4 chambers + + + +

Lens + + +

Stomach + +

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Transvaginal scan:Advantages

close to the region of interest high-resolution excellent Doppler irrespective of abdominal wall thickness

Good for fetal anatomy, TR, DV

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Transvaginal scan:Shortcomings

Low penetration Difficult orientation Needs preparation (to empty bladder, to clean and cover

transducer)

Less convenient to patient and operator Needs high level of expertise

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Dr Fred Ushakov The 12 Week Sc

Special Course:Technique of Transvaginal 12 Week

Anomaly Scan + Echocardiography

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Dr Fred Ushakov The 12 Week Sc

Sonographic markers of aneuploidy

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Dr Fred Ushakov The 12 Week Sc

Acrania 11 wks

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Dr Fred Ushakov The 12 Week Sc

Acrania 12 wks

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Dr Fred Ushakov The 12 Week Sc

Acrania brain 12 wks

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Dr Fred Ushakov The 12 Week Sc

Acrania 3D

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Dr Fred Ushakov The 12 Week Sc

Acrania - DCDA twins 12 wks

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Dr Fred Ushakov The 12 Week Sc

Acrania amniotic bands 12 wks

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Dr Fred Ushakov The 12 Week Sc

Amniotic bands 11 wks

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Dr Fred Ushakov The 12 Week Sc

D/D amniotic bands vitelline artery

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Dr Fred Ushakov The 12 Week Sc

D/D amniotic bands vitelline artery

CRL = 26 mm

9+3 wks

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Dr Fred Ushakov The 12 Week Sc

D/D amniotic bands vitelline artery

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Dr Fred Ushakov The 12 Week Sc

Body stalk anomaly - 12 wks

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Dr Fred Ushakov The 12 Week Sc

Body stalk anomaly - 12 wks

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Dr Fred Ushakov The 12 Week Sc

Body stalk anomaly - 12 wks

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Dr Fred Ushakov The 12 Week Sc

Thoracopagus + body stalk anomaly - 12 wks

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Dr Fred Ushakov The 12 Week Sc

Spina bifida

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Dr Fred Ushakov The 12 Week Sc

Normal brain - 12 wks

Dandy-Walker malformation triploidy

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Dr Fred Ushakov The 12 Week Sc

Dandy-Walker malformation triploidy 12 wks

Dandy-Walker malformation triploidy

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Dr Fred Ushakov The 12 Week Sc

Dandy-Walker malformation triploidy 12 wks transabdominal scan

Triploidy partial mole early IUGR

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Dr Fred Ushakov The 12 Week Sc

Triploidy, partial mole, early IUGR 12 wks

T i l id i l l 12 k

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Dr Fred Ushakov The 12 Week Sc

Triploidy, partial mole 12 wks

C l t l 12 k

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Dr Fred Ushakov The 12 Week Sc

Complete mole 12 wks

C l t l 12 k

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Dr Fred Ushakov The 12 Week Sc

Complete mole 12 wks

DCDA twins: Complete mole and

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Dr Fred Ushakov The 12 Week Sc

DCDA twins Complete mole andNormal Fetus 18 wks

E h l l 12 k

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Dr Fred Ushakov The 12 Week Sc

Encephalocele 12 wks

Encephalocele 12 wks

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Dr Fred Ushakov The 12 Week Sc

Encephalocele 12 wks

Cephalocele 11 wks

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Dr Fred Ushakov The 12 Week Sc

Cephalocele 11 wks

Cephalocele 11 wks

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Dr Fred Ushakov The 12 Week Sc

Cephalocele 11 wks

Cephalocele (not visible) 11 wks

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Dr Fred Ushakov The 12 Week Sc

Cephalocele (not visible) 11 wks

Encephalocele 12 wks missed

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Dr Fred Ushakov The 12 Week Sc

Encephalocele 12 wks - missed

Encephalocele missed 12 wks

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Dr Fred Ushakov The 12 Week Sc

now 20 wks

Cystic hygroma 12 wks

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Dr Fred Ushakov The 12 Week Sc

normal karyotype

Cystic hygroma 13 wks

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Dr Fred Ushakov The 12 Week Sc

normal karyotype - HLHS

Cystic hygroma + CPC 11 wks l k

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Dr Fred Ushakov The 12 Week Sc

normal karyotype - CDH

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Hydropic fetus - 13 wks(TOP CVS)

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Dr Fred Ushakov The 12 Week Sc

(TOP no CVS)

Abnormal 4 ventricle future vermisi 12 k

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Dr Fred Ushakov The 12 Week Sc

agenesis 12 wks

Holoprosencephaly - 12 wks( l k t )

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Dr Fred Ushakov The 12 Week Sc

(normal karyotype)

Holoprosencephaly - 12 wks(T13)

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Dr Fred Ushakov The 12 Week Sc

(T13)

Holoprosencephaly - 12 wks(T13)

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Dr Fred Ushakov The 12 Week Sc

(T13)

Holoprosencephaly + proboscis - 12 wks(T13)

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Dr Fred Ushakov The 12 Week Sc

(T13)

? Spina bifida 12 wks

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Dr Fred Ushakov The 12 Week Sc

p

Spina bifida? Umbilical cord

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Dr Fred Ushakov The 12 Week Sc

p

Cleft lip/palate 13 wks

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Dr Fred Ushakov The 12 Week Sc

p p

Cleft lip/palate + polydactylyT13

13 wks

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Dr Fred Ushakov The 12 Week Sc

13 wks

Congenital Diaphragmatic Hernia12wk

(normal karyotype)

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Dr Fred Ushakov The 12 Week Sc

(normal karyotype)

Normal Heart 4CV 13w1d

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Dr Fred Ushakov The 12 Week Sc

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Congenital Diaphragmatic Hernia + TR

11wks (normal karyotype)

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Dr Fred Ushakov The 12 Week Sc

11wks (normal karyotype)

Congenital Diaphragmatic Hernia +Abnormal Kidneys 11wks

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Dr Fred Ushakov The 12 Week Sc

Abnormal Kidneys 11wks

Kidneys normal 13 wks

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Dr Fred Ushakov The 12 Week Sc

Kidneys echogenic & enlarged13 wks

HLHS (normal karyotype)

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Dr Fred Ushakov The 12 Week Sc

HLHS (normal karyotype)

Kidneys echogenic & enlarged45X0

12 wks

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Dr Fred Ushakov The 12 Week Sc

w

???

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Dr Fred Ushakov The 12 Week Sc

Megacystisobstructive uropathy

12 wks (normal karyotype)

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Dr Fred Ushakov The 12 Week Sc

( y yp )

Megacystis 12 wks (normal karyotype)

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Dr Fred Ushakov The 12 Week Sc

Single Multicystic Kidney 14 wks

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Dr Fred Ushakov The 12 Week Sc

Bilateral Agenesis of Kidneys 15 wks

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Dr Fred Ushakov The 12 Week Sc

Bilateral Agenesis of Kidneys 15 wks

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Dr Fred Ushakov The 12 Week Sc

Omphalocele T18 12 wks

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Dr Fred Ushakov The 12 Week Sc

Omphalocele12 wks

(risk 1:2 normal karyotype)

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Dr Fred Ushakov The 12 Week Sc

Omphalocele nearly missedT18

12 wks

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Dr Fred Ushakov The 12 Week Sc

Omphalocele & Abnormal HandsT18

12 wks

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Dr Fred Ushakov The 12 Week Sc

Omphalocele & Abnormal LegsT18

12 wks

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Dr Fred Ushakov The 12 Week Sc

Gastroschisis - 11 weeks

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Dr Fred Ushakov The 12 Week Sc

Single Umbilical Artery T18 12 wks

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Dr Fred Ushakov The 12 Week Sc

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Agenesis of Ductus Venosus45X0

12 wks

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Dr Fred Ushakov The 12 Week Sc

Agenesis of Ductus Venosus15 wks

(normal karyotype)

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Dr Fred Ushakov The 12 Week Sc

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Dr Fred Ushakov The 12 Week Sc