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 NUCHAL CORD OR ENTANGLEMENT OF UMBILICAL CORD AROUND FETAL NECK:

   This is a case of umbilical cord entangling around the fetal neck.

Here, color Doppler imaging leaves little doubt about the cord around the fetal neck. It is not often that the full extent of the cord wrapping itself around the fetal neck is clearly seen as in this case. A single loop of cord may not be as significant clinically, as multiple (4 or more loops) around the neck.

    If ultrasound shows evidence of fetal distress, immediate operative delivery may be indicated. It must be noted that nuchal cord is present in as many as 25%

of pregnancies, and generally not considered very significant in the absence of signs of fetal distress.

    There are 2 types of nuchal cord:

1)      Type A- cord that encircles the neck in a sliding manner

2)      Type B- here the cord encircles the neck in a locked manner.

Type B is more ominous, in the sense, that here, the loop tightens the grip around the neck during delivery or changes in fetal position.

       Ultrasound studies preferably need both axial sections (to see the loop in its entirety) and a sagittal section to determine the number of loops around the neck.  It is also desirable to determine if locking of the cord is present (type B). Multiple loops of cord around fetal neck are associated with relatively poorer prognosis,

including fetal distress and fetal demise.                                                          

(click on image for full size)

Case courtesy of Dr. Vikas Arora, Ferozepur, India.                                                    

References: 1) http://www.thefetus.net/page.php?id=172 

                     2)  The Pregnancy Institute - Case Study

(Important announcement: we are now shifting the gallery to a new site at:

http://www.ultrasound-images.com 

Here too you will find more such high resolution ultrasound images as on this site. This (older) site will still be available).

 3-D images of Nuchal cord:

color doppler image<<Color doppler imaging shows umbilical cord coiled over the posterior aspect of the fetal neck. But it does not show the anterior surface of the neck.

3-D image of nuchal cord<<3-Dimensional (3-D) scan reveals the relationship of the nuchal cord to the anterior surface of the neck of the baby.

3-D ultrasound image<<2 more 3-D pictures reveal the true and ominous location of the cord.

3-D ultrasound image shows hidden part of the cord<<Arrows show the umbilical cord.

 The above  3-D images courtesy of Dr. Arun Mahajan, New Delhi, India. 

ACARDIAC OR PARABIOTIC TWIN:

(CASE AND IMAGES COURTESY OF DR. DURR-E-SABIH, MINAR, MULTAN,

PAKISTAN)

           This obstetric scan shows a twin pregnancy. The healthy twin shows a gestational

age of 18 weeks approximately. The other twin shows absence of head, heart and upper limbs. Rarely, a small 2 chamber heart may be seen.

Only the lower abdomen is visualized as a thick-walled cystic structure. Considerable

swelling of the soft-tissue of the body wall is present.

This twin (also called parabiotic or acardiac twin) receives its blood supply through

an artery to artery and vein to vein anastomosis at the common placenta.

Color Doppler shows the blood flow from the normal twin (called PUMP twin) to

the acardiac twin.

 

         INCIDENCE: of acardiac twins is as low as 1 in 35000 pregnancies.

  

In the absence of the anastomosis of vessels from the pump twin, the

acardiac would be a simple case of 1st trimester twin death.

Poorly oxygenated blood reach the acardiac twin to the lower part of its body.

This circulation is also called (TWIN REVERSED ARTERIAL PERFUSION

or TRAP sequence).

 

PROGNOSIS: Obviously the acardiac twin will not survive L.

The pump twin is also at high risk for congestive cardiac failure and preterm delivery.

Its perinatal mortality of the pump twin is approx. 55% and is directly related

to the ratio of weights of the acardiac to the normal twin. Higher the weight

of the acardiac, the higher the mortality of the normal twin.

(CLICK IMAGE TO VIEW FULL SIZE)

Reference:

 1) TheFetus.net - TRAP, acardiac, acephalus -Luis Izquierdo, MD ...

 2) Acardiac Twin or TRAP Sequence: Learn More

 3) TheFetus.net - TRAP, acardiac, outcome -Dieter Grab, MD, Volker ...

 

 

 CONGENITAL DIAPHRAGMATIC HERNIA (CDH):

 Case courtesy Dr. Nirmali Dutta , NMC HOSPITAL, ADH.

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  These are ultrasound images of a 20 week fetus. Scan of the fetal thorax shows

distended stomach bubble herniated into the left hemi-thorax, displacing the heart to the right.

Different views of the thorax from various angles, confirm the presence of the fetal stomach

in the left hemi- thorax.

Findings suggest a left sided CDH, possibly a Bochdalek hernia. No pleural effusion is evident.

No evidence of polyhydramnios is present (commonly assocated with CDH).

PROGNOSIS: fetal prognosis is poor in this case, as sonographic features were evident before 25 weeks

 gestational age.

 

Click on images to

view full size.

Links and references:1)  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&list_uids=2666635&dopt=Citation

2) http://www.ajronline.org/cgi/content/abstract/166/5/1195

3) http://www.blackwell-synergy.com/links/doi/10.1046/j.1469-0705.1998.12020107.x/abs/ 

 

 Visit: http://www.ultrasound-images.com/fetal-brain.htm to view ultrasound images of fetal brain. Among them are images of Vein of Galen aneurysm, Acrania and Dandy Walker syndrome.