The Fetal Abdomen

and Marcelo Zugaib4



(1)
São Paulo University, Bauru, Brazil

(2)
Parisian University, Bauru, France

(3)
Member of International Fetal Medicine and Surgery Society, Bauru, Brazil

(4)
Obstetrics, University of São Paulo, Bauru, Brazil

 



The recognition of the normal anatomy of the fetal abdomen is fundamentally important in diagnosing fetal pathological conditions.

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Fig. 9.1
Axial section of the fetal abdomen showing the stomach € and umbilical vein (VU), which is continuous with the portal hepatic vein (P). The aorta (Ao) is observed in an axial section anterior to the column (C). It is the ideal plane for measuring the abdominal circumference


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Fig. 9.2
Axial section of the fetal abdomen showing stomach (E) and abdominal insertion of the umbilical cord (CU). VB gallbladder, C column


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Fig. 9.3
Sagittal section of the fetal abdomen and leg (P), demonstrating normal insertion of the umbilical cord (CU)


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Fig. 9.4
Axial section of the abdomen in the pregnancy at 31 weeks and 1 day showing a typical image of abdominal double bubble (arrow), which corresponds to fetal duodenal stenosis. Typical image of the stomach on the left, with its small and large curvatures, and a more rounded image on the right (second bubble) that corresponds to the initial portion of the duodenum


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Fig. 9.5
The same case in an axial section of the abdomen during the third trimester, shows a typical image of double bubble and the transition between the stomach and duodenum, and it is possible to visualize an abnormal pylorus (p = pylorus, arrows). EST stomach, D duodenum, AO aorta, COL column


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Fig. 9.6
Axial section at the level of the fetal abdomen during the third trimester, which demonstrates an image of double bubble corresponding to fetal duodenal stenosis. EST stomach, D duodenum, AO aorta, COL column


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Fig. 9.7
Oblique axial section of the fetal abdomen at 28 weeks, 2 days gestation showing an abnormal dilatation of the stomach (EST) in the case of pyloric stenosis


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Fig. 9.8
The same image as in Fig. 9.6 in the axial section showing dilation of the pyloric region (P) in a very dilated stomach. Because of this picture, we suggest repeating the examination after 2 weeks


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Fig. 9.9
Nonhabitual aspect of the gastric bubble. Stomach (E) presents peristalsis, which mimics the signal of double bubble (duodenal stenosis not confirmed)


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Fig. 9.10
Axial section of the abdomen in a 31 weeks pregnancy where gastroschisis (gastros) is observed. Notice that abdominal umbilical vein insertion is normal (VU), just beside the abdominal wall defect. Also notice the presence of fetal intestine with its free loops in contact with amniotic fluid (ALCAS). COL RACHIS


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Fig. 9.11
Axial section of the abdomen in a 18 weeks pregnancy where gastroschisis (gastros) is observed. Note the normal umbilical insertion (icumb) using a color Doppler window which is a characteristic of this pathology


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Fig. 9.12
Gastroschisis: image of the herniated fetal stomach (E) through the defect of the wall in fetal gastroschisis (arrows)


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Fig. 9.13
Axial section of the fetal abdomen demonstrating the paramedian opening (F), on the right, where the intestinal loops pass through, in fetal gastroschisis (P). C column


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Fig. 9.14
Axial section of the fetal abdomen showing freeintestinal loops (A) in amniotic fluid (LA), which characterizes gastroschisis. M fetal limb


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Fig. 9.15
Oblique sagittal section in in the third trimester where gastroschisis can be observed with free intestinal loops in amniotic fluid (arrow, loops), which is a paraumbilical defect of the abdominal wall. The intestinal loops (arrows) are in contact with the amniotic fluid without parietal peritoneum coating. Observe the insertion of the umbilical cord (ICUMB). COL column, AO aorta, EST stomach, F femur, J knee


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Fig. 9.16
Gastroschisis: free intestinal loops (A) in amniotic fluid (LA). Note the amorphous thick content in the lumen and the echogenic walls of the intestinal loops, which is different from Fig. 9.15


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Fig. 9.17
Gastroschisis: the intestinal loops appears free (A) in amniotic fluid (LA), presenting signs of suffering (dilatation and echogenic walls, arrows)


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Fig. 9.18
Sagittal section of a fetus at 14 weeks, demonstrating omphalocele (O). Observe that the herniated content is surrounded by peritoneum. PC cephalic polo, P legs


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Fig. 9.19
Sagittal sections of a fetus at 24 weeks and 4 days showing body stalk anomaly (short cord). An abnormal tortuosity of the column on the left is demonstrated (arrows). This rare anomaly is characterized by a rudimentary umbilical cord or absence of it and this pathological condition is associated with defects of the abdominal wall (image on the right, arrows) and pronounced kyphoscoliosis (image on the left). It may be associated with limb defects. As a general rule, this pathological condition is lethal because of pulmonary hypoplasia


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Fig. 9.20
Omphalocele: oblique section at the level of the fetal inferior limbs. In this case, the differential diagnosis of the vesical exstrophy is plausible. MI = inferior limbs, ONF omphalocele, PP pelvic pole


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Fig. 9.21
Axial section of the fetal abdomen showing omphalocele in a fetus at 24 weeks. Observe the insertion of the umbilical cord (CU) into the extremity of the omphalocele and the presence of the stomach, which is still intra-abdominal (EST). COL column, PLAC placenta


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Fig. 9.22
Axial section of the fetal abdomen showing omphalocele (O) in a fetus at 30 weeks. Note the presence of an intra-abdominal stomach (E)


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Fig. 9.23
Axial section of the fetal abdomen at 28 weeks showing an small omphalocele (arrows) in a case of Trisomy 18, Edwards Syndrome (AB is abdomen, C column).


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Fig. 9.24
Axial view of fetal thorax at 13 weeks showing early aspect of extrofia cordis (arrow). C column


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Fig. 9.25
Axial view of fetal thorax at 14 weeks 5 days showing aspect of extrofia cordis (COR). COR heart, L amniotic fluid


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Fig. 9.26
Axial view of fetal abdomen at 33 weeks gestation showing a moderate size omphalocele (O) with the presence of feal stomach in the herniated sac (E). C column


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Fig. 9.27
Image of newborn with Beckwith-Wiedmann Syndrome after surgical correction of omphalocele. This syndrome may involve the triad: macrosomia, macroglossia (see tongue protusion in the newborn and corrected abdominal wall defect surgical scar)


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Fig. 9.28
Coronal section of fetal head and neck showing an elongated wide anechoic image, with dilatation of its upper portion (arrow) corresponding to an enlarged fetal esophagus at its proximal portion (pouch or bag sign), which is characteristic of esophageal stenosis

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Dec 28, 2017 | Posted by in GYNECOLOGY | Comments Off on The Fetal Abdomen
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