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Athoracicsonographicevaluationusuallyincludesan appraisal of the general shape of the chest (characteristically abnormal in some chondrodystrophies), the appearance of the lungs, presence of any pleural or pericardiac effusions, an evaluation of the cardiac size, axis and position within the thorax, and a comparison of the thorax with the overall fetal body size. The continuity of the diaphragm on the left and right should be verified, and the chest should be surveyed for abnormal structures such as bowel loops, cystic anomalies, or the stomach bubble. The heart usually occupies approximately the central one-third of the cross-sectional area of the thoracic cavity and its main axis is angled at 45fi to the midline. Deviation of the heart or alteration of the cardiac axis due to a mass defect of anomalous organs in the thorax may suggest the presence of other structures such as bowel or stomach within the thorax, and diaphragmatic hernia. Only very minimal amounts of pleural or pericardiac fiuid should be present on inspection. The chest circumference is measured in the transverse plane at the level of the four-chambered cardiac view but is of limited value in clinical practice because of the difficulty estimating gestational age in some cases and because of the poor correlation between it and pulmonary hypoplasia. Ratios of thoracic diameter to other body dimensions may be helpful in evaluating the size of the chest with relation to gestational age, especially when considering certain chondrodystrophies, such as asphyxiating thoracic dysplasia. The thoracic/abdominal circumference ratio varies minimally over pregnancy (mean 0. Similarly, the thoracic/head circumference varies minimally over pregnancy (mean 0. Abnormal thoracic shape may be due to skeletal dysplasia and spinal abnormalities such as kyphoscoliosis, and oligohydramnios. The fetal cardiac evaluation performed for most basic sonograms usually includes at least one view of the heart, the four-chamber view, documentation of a normal cardiac rate and rhythm, and an assessment of the cardiac axis. It is not clear what the minimum evaluation of the heart should consist of, but even a single normal four-chamber image will exclude up to 90% of cardiac structural anomalies. The number of cardiac images performed may vary by the circumstances of the study. In the best circumstances, significant cardiac structural abnormalities are missed on occasion (Anderson et al. To a certain degree, the sensitivity of cardiac anomaly screening depends on the severity of the cardiac disease present. Additionally some cardiac lesions may actually develop after fetal cardiac imaging has been performed (Allan et al. Characteristics of a normal four-chamber cardiac view include symmetric atria and ventricles, intact intraatrial and intraventricular septa, a foramen ovale with its fiap oriented into the left atrium, and a cardiac axis oriented to the left at about a 45fi angle to the sagittal plane. The left atrium is usually closest to the spine, the tricuspid valve inserts slightly lower on the interventricular septum than the mitral valve, and the heart occupies about one-third of the chest. The four-chamber view of the heart is obtained from an imaging plane that is at an approximate 45fi angle from the view used to obtain the abdominal circumference view.

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Most abnormalities are located near the umbilical cord insertion into the abdomen H. Gastroschisis is usually situated to the right of the umbilicus and does not involve the umbilical cord directly. May form vascular compromise of either the umbilical vein or the omphalomesenteric artery. Ischemic injury to the region of the superior mesenteric artery may explain high rates of jejunal atresia found in association with gastroschisis 4. Defects are generally small, less than 4 cm in diameter, and bowel loops are often covered by an infiammatory exudate a. Be careful in evaluation for omphalocele, as the sac may have ruptured and no longer be evident (obscuring the diagnosis of omphalocele) 5. Many believe that gastroschisis has no apparent association with chromosomal abnormalities b. As previously noted, an omphalocele sac (see below) may no longer beevidentbecauseofrupture. Insuchcases,relianceonthediagnosis of gastroschisis in determining the need for antenatal karyotypic evaluation may yield inaccurate analysis of the likelihood of aneuploidy. If amniocentesis is not elected, care should be taken to ensure that the observed defect conforms closely to the preceding description. If defects are situated to the left of the midline, are moderate or large in size, involve the liver or other abdominal structures, or if other sonographic findings are present, the possibility of ruptured omphalocele should be considered and appropriate evaluation considered. Ventral wall abnormalities that involve herniations of the peritoneal sac and its contents outside the abdominal wall. The anterior abdominal wall is formed by fusion of the cephalic fold with the lateral folds; failure of this fusion yields omphalocele with ectopia cordis, diaphragmatic, and sternal defects. Defective fusion of the lateral folds (between the 2nd and 4th conceptual weeks) leads to isolated omphalocele. Intra-abdominalcontents herniate within the peritoneal sac into the amniotic cavity through the base of the umbilical cord.

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