什麼是胎兒結構性超聲波? 進行胎兒結構性超聲波, 旨在詳細檢查胎兒是否有結構異常大部份胎兒均屬正常, 得出的一個正常超聲波報告能令父母更為安心倘若胎兒出現結構異常, 能夠及早在出生前作出準確診斷, 對懷孕處理是非常重要父母產科醫生及兒科醫生能夠對胎兒缺陷先作了解, 有助為胎兒出生作最充足的準

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1 認識胎兒結構性超聲波 Knowing Fetal Morphology Scan 養和醫院婦產科中心 Obstetrics & Gynaecology Centre Hong Kong Sanatorium & Hospital

2 什麼是胎兒結構性超聲波? 進行胎兒結構性超聲波, 旨在詳細檢查胎兒是否有結構異常大部份胎兒均屬正常, 得出的一個正常超聲波報告能令父母更為安心倘若胎兒出現結構異常, 能夠及早在出生前作出準確診斷, 對懷孕處理是非常重要父母產科醫生及兒科醫生能夠對胎兒缺陷先作了解, 有助為胎兒出生作最充足的準備若胎兒有嚴重缺陷, 父母或可選擇終止懷孕 What is fetal morphology scan? A fetal morphology scan aims to carry out a thorough check of the structure of the fetus. Most babies are normal and the parents can be reassured with the normal ultrasound findings. In case a baby has some structural defects, it might be important to find out before he or she is born. By knowing the abnormalities, prenatal diagnosis might be possible and the parents, the obstetricians and the paediatricians might be better prepared for the birth of such affected child. For certain major congenital defects, the parents might have the option of a termination of the pregnancy if prenatal diagnosis can be established. 結構性超聲波與一般產前檢查的超聲波有甚麼分別? 一般產前超聲波會檢查胎兒心跳大小胎位羊水量及胎盤位置結構性超聲波除作以上各項檢查外, 更會仔細檢查胎兒結構及內臟器官;一般會檢查的器官包括頭骨腦眼腔唇脊骨心臟肺橫隔膜胃腎膀胱肚子臍帶四肢及性器官 1

3 How is this morphology scan different from the ordinary antenatal ultrasound? During an ordinary antenatal ultrasound, the fetal heart pulsation, fetal size and presentation, amniotic fluid volume around the fetus and the placental site are usually assessed. For a fetal morphology scan, the above parameters are checked. In addition, the fetal structures are carefully assessed. Structures that are commonly assessed during a morphology scan include: cranium, intracranial structure, orbits, lips, spine, heart, lung, diaphragm, stomach, kidneys, bladder, other structures within the fetal tummy, umbilical cord, limbs and fetal genital organ. 結構性超聲波最適合在何時進行? 結構性超聲波一般在十八至廿二孕週進行, 期間胎兒的結構及內臟器官較為清晰, 容易檢查當然, 若有需要, 也可在十八孕週前作結構性超聲波檢查由於超聲波儀器愈來愈先進, 很多異常結構都可以在十一至十四週時成功診斷出來;但若太早進行檢查, 某些器官 ( 如心臟 ) 會可能因胎兒太小而未能看得清楚在懷孕後期如足月期間 ( 三十七孕週後 ), 胎兒發育完整的骨頭可能會遮擋內臟器官, 亦令檢查胎兒結構較為困難;再者, 即使在廿四孕週後發現胎兒有缺陷, 香港法例亦不容許終止懷孕 When is the best timing for fetal morphology scan? A fetal morphology scan is usually performed during weeks of gestation. At this gestation, there are usually good views of the fetal parts and internal organs. Fetal structure can also be assessed earlier than 18 weeks if indicated. With the advance of ultrasound machines, many congenital anomalies can be picked up between weeks of gestation. However, assessment of some complex structures such as the fetal heart might be difficult at early gestation. Assessment of the fetal structure might be difficult at the late gestation such as after 37 weeks because the fetal bony structures are mature, causing acoustic shadow on the internal organs. Also, if it is scheduled after 24 weeks of gestation, termination of pregnancy is not permitted by law in Hong Kong even a major fetal defect is discovered. 2

4 結構性超聲波有什麼限制? 結構性超聲波會礙於許多因素, 未能診斷出所有胎兒的結構異常這些因素包括器官異常的嚴重程度及性質胎兒位置是否理想孕婦腹部脂肪層的厚度或有否動過手術超聲波儀器的質素負責進行超聲波的人員是否有足夠的訓練及經驗等等 What are the limitations of morphology scan? Not all congenital defects can be picked up on a fetal morphology scan. The pick-up rate depends on a number of factors, including the severity and nature of the abnormality, whether the fetal position is optimal for scanning, women s factors such as whether the tummy is thick or there is surgical scar, the quality of the ultrasound machine and whether the medical personnel are experienced in or have received adequate training in this practice. 三維 (3D) 及四維 (4D) 超聲波對檢查胎兒結構如何重要? 對例行結構性超聲波而言, 二維 (2D) 超聲波已經足夠三維 (3D) 及四維 (4D) 超聲波可說是錦上添花, 有助加強孕婦及家人與小生命之間的連繫;大部份孕婦都樂於觀看胎兒 3D/4D 圖像倘若經 2D 超聲波診斷出或懷疑胎兒結構異常,3D 或 4D 技術有助釐清及確定 2D 超聲波之診斷, 有助孕婦及家人了解異常結構的情況 3

5 What are the roles of 3D/4D ultrasound in assessing the fetal structures? For a routine assessment of the fetal morphology, 2D ultrasound is already adequate. The addition of 3D and/ or 4D scan is a bonus and may enhance the bonding between the family and the unborn child. Most women also find it pleasurable watching the 3D/4D pictures of their babies. 3D/4D ultrasound is increasingly important when fetal abnormalities are suspected or picked up. These new modalities of ultrasound can help by clarifying the abnormalities. The 3D ultrasound pictures may also help the family appreciate to what extent the baby is affected. 結構性超聲波對胎兒是否安全? 產前超聲波早於六零年代用作診斷用途大量有關出生前接受過超聲波檢查之兒童的研究指出, 現時未有任何証據顯示產前超聲波會對胎兒構成不良影響 Is a morphology scan safe to the fetus? Diagnostic ultrasound has been used since 60 s. Based on numerous follow-up studies on children who were scanned before birth, there is no evidence that in-utero exposure of antenatal ultrasound is associated with any undesirable biological effects. 4

6 超聲波影像 Ultrasound Images 早孕期 First Trimester 懷孕六週的胎囊與卵黃囊 Gestational sac and yolk sac at 6 weeks 懷孕九週的胚胎頭臀長 The crown-rump length of the embryo at 9 weeks 懷孕十二週的胎兒頭臀長 The crown-rump length of the fetus at 12 weeks 5 早孕期頸皮厚度 The nuchal translucency thickness in the first trimester

7 早孕期側面輪廓 Facial profile in the first trimester 懷孕十二週的胎兒手掌 Fetal hand at 12 weeks 懷孕十二週的男性胎兒性器官 ( 箭咀 ) Male genital organ (arrow) at 12 weeks 懷孕十二週的女性胎兒性器官 ( 箭咀 ) Female genital organ 6 (arrow) at 12 weeks

8 中孕期 - 頭及面部 Second Trimester - Head and face 中孕期的胎兒腦部 Fetal brain in the second trimester 懷孕十七週的胎兒小腦 Fetal cerebellum at 17 weeks 中孕期的側面輪廓 Facial profile in the second trimester 7 中孕期的鼻子與咀唇 Fetal nose and lips in the second trimester

9 脊椎 Spine 腹部 Abdomen 中孕期的胎兒脊骨 Fetal spine in the second trimester 胎兒肚子之橫切面 Cross-sectional view of the fetal abdomen 胎兒肚子之臍帶入口 Umbilical cord insertion of the fetal abdomen 胎兒膀胱 Fetal bladder 8

10 心臟 Heart 兩個胎兒腎臟 Two fetal kidneys 胎兒心臟四腔平面圖 The 4-chamber view of fetal heart 胎兒心臟主動脈外流道平面圖 The aortic outflow tract from the fetal heart 9 胎兒心臟肺動脈外流道平面圖 The pulmonary outflow tract from the fetal heart

11 胎兒心臟三血管平面圖 The 3 vessels view of the fetal heart 心臟主動脈外流道以彩色顯示血流方向 Aortic outflow tract with colour indicating the flow 四肢 Limps 肺動脈與主動脈血流 Colour flow of both pulmonary artery and aorta 懷孕二十週的胎兒手掌 The fetal hand at 20 weeks 10

12 男性 Gender - Male 女性 Gender - Female 懷孕十八週的男性胎兒性器官 ( 箭咀 ) Male genital organ (arrow) at 18 weeks 後孕期 Third trimester 懷孕二十週的女性胎兒性器官 ( 箭咀 ) Female genital organ (arrow) at 20 weeks 後孕期的側面輪廓 Facial profile in the third trimester 1 臍帶動脈多普勒檢查 Umbilical artery doppler study

13 三維 / 四維立體超聲波圖像 3D/4D Images 中孕期及後孕期 Second and Third Trimester 懷孕二十週胎兒面部的三維圖像 3D fetal face at 20 weeks 懷孕二十週胎兒脊骨的三維圖像 3D fetal spine at 20 weeks 懷孕二十八週男性胎兒性器官的三維圖像 3D fetal genital organ in a male fetus at 28 weeks 12

14 13 胎兒面部的三維圖像 - 是否所有胎兒面部外觀都一樣? 3D face Do all fetuses look the same?

16 婦產科中心香港跑馬地山村道二號養和醫院李樹芬院五樓查詢或預約, 歡迎聯絡我們 : 電話 : 傳真 : 電郵 : [email protected] 香港養和醫院有限公司版權所有 Obstetrics & Gynaecology Centre Hong Kong Sanatorium & Hospital 5/F, Li Shu Fan Block, 2 Village Road, Happy Valley, Hong Kong For enquiries and appointment, please contact us at: Tel : Fax : [email protected] Hong Kong Sanatorium & Hospital, Ltd. All rights reserved OGCF7a 11/2012

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唐氏綜合症是甚麼? 唐氏綜合症是最常見的遺傳病之一患者的細胞比正常人多出一條第 21 條染色體, 導致先天性弱智, 外貌亦與常人有明顯分別 ; 其他器官結構也可能出現缺陷, 例如先天性心臟病腸塞等唐氏綜合症患者一般可活到成年經特別訓練, 患者或可担任簡單工作 ; 但由於智能的障礙, 他們大都早孕期一站式唐氏綜合症篩查 First Trimester One Stop Clinic for Assessment of Risk for Down s Syndrome 養和醫院婦產科中心 Obstetrics & Gynaecology Centre Hong Kong Sanatorium & Hospital 唐氏綜合症是甚麼? 唐氏綜合症是最常見的遺傳病之一患者的細胞比正常人多出一條第