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For the ultrasound studies, 7.5-MHz )Tj -42.493 -1.383 Td (transducers were used.)Tj 0 0 1 rg /TT0 1 Tf 0 -2.865 TD (4 weeks)Tj ET EMC EMC /WebCaptureCN <>BDC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Artifact <>BDC BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(1 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 806 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 125.098 69.934 272.627 222.588 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.902 69.934 272.627 222.588 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.6512 Tm (At 4 weeks and 3 days, a tiny gestational sac becomes visible within the\ decidua.)Tj ET q 258.8235321 0 0 208.784317 270.9019623 345.1825104 cm /Im0 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 132 315.2062 Tm (Uterus \(transverse view\); Gestational Sac \(arrow\) and the decidual r\ eaction)Tj 9.4902 0 0 9.4902 559.7214 315.2062 Tm ( )Tj ET q 258.8235321 0 0 203.6078491 132 79.4238281 cm /Im1 Do Q q 258.8235321 0 0 208.784317 409.8039246 76.8356018 cm /Im2 Do Q EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(2 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 807 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 445.644 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 132 570.2982 Tm (Uterus \(longitudinal view\) with identification )Tj 0 -1.473 TD (of the Gestational Sac \(5,0mm mean )Tj T* (diameter\) and color doppler maping of the )Tj T* (uterine vessels, trophobastic flow \(TF\) and )Tj T* (peri-endometrial flow.)Tj 9.4902 0 0 9.4902 256.1923 504.5969 Tm ( )Tj 11.1493 0 0 11.1493 409.8039 554.0488 Tm (Uterus \(longitudinal view\) with identification )Tj 0 -1.2 TD (of the Gestational Sac \(5,0mm mean )Tj T* (diameter\) and color doppler energy maping )Tj 0 -1.2 TD (of the uterine vessels )Tj 0 0 1 rg /TT1 1 Tf -33.429 -4.784 Td (5 weeks)Tj 0 0 0 rg /TT0 1 Tf 0 -2.867 TD (The yolk sac is first visible at 5 weeks and it is always present by 5 w\ eeks and 4 days. There are lacunary structures at the si)Tj (te )Tj 0 -1.473 TD (of implantation. The embryonic pole appears adjacent to the yolk sac, so\ on showing cardiac activity. Since the connecting stalk )Tj T* (is short, the embryonic pole is found near the wall. At the end of week \ 5, the heart rate is about 100 bpm.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 637.5782 395.7583 Tm ( )Tj ET q 258.8235321 0 0 197.568634 135.0196075 173.3484192 cm /Im0 Do Q q 258.8235321 0 0 208.784317 406.784317 167.7405701 cm /Im1 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 177.4667 144.4473 Tm (Longitudinal view of the uterus )Tj -3.563 -1.2 Td (Gestational Sac + Yolk Sac \(embryionic pole )Tj 8.566 -1.2 Td (not visible\))Tj 15.565 1.8 Td (end of the week 5 and visualization of the )Tj 0 -1.2 TD (embryo)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(3 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 808 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 239.712 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 247.6078491 135.0196075 337.6862793 cm /Im0 Do Q 0 0 0 rg BT /TT0 1 Tf 9.4902 0 0 9.4902 406.7843 458.3727 Tm ( )Tj 11.1493 0 0 11.1493 135.0196 314.3929 Tm (Coronal section showing the implantation )Tj 0 -1.2 TD (\(fundus+left corno\), normal decidual )Tj T* (reaction )Tj 9.4902 0 0 9.4902 406.7843 301.5588 Tm ( )Tj 0 0 1 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 254.6389 Tm (6 weeks \(crown\226rump length 4\2268 mm\))Tj 0 0 0 rg /TT0 1 Tf 0 -2.867 TD (The embryonic pole, yolk sac and heart activity are now always present. \ The heart rate increases to 130 bpm. At the end of )Tj 0 -1.473 TD (week 6, the first sign of the rhombencephalic cavity appears as a tiny h\ ypoechogenic area in the cranial pole of the embryo. )Tj T* (The amniotic cavity can be seen surrounded by a thin membrane around the\ embryo.)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(4 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 809 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 238.9803925 135.0196075 346 cm /Im0 Do Q q 258.8235321 0 0 238.9803925 406.784317 346 cm /Im1 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 135.0196 322.0629 Tm (Figure 1a)Tj /TT1 1 Tf ( - Embryo at 6 weeks \(crown\226)Tj 0 -1.473 TD (rump length 5 mm\). Coronal section with )Tj T* (arrows pointing to the embryo. The yolk sac )Tj T* (lies adjacent to the embryo)Tj 9.4902 0 0 9.4902 289.1924 272.7869 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 406.7843 322.0629 Tm (Figure 1b)Tj /TT1 1 Tf ( - Embryo at 6 weeks \(crown\226)Tj T* (rump length 5 mm\). 3D reconstruction with )Tj T* (arrows pointing to the embryo \(CRL\). The )Tj T* (yolk sac lies adjacent to the embryo)Tj 9.4902 0 0 9.4902 610.1479 272.7869 Tm ( )Tj ET q 258.8235321 0 0 194.1176453 135.0196075 55.1221771 cm /Im2 Do Q BT /TT1 1 Tf 9.4902 0 0 9.4902 406.7843 149.0635 Tm ( )Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(5 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 810 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 404.22 735.059 30.229 re f EMC EMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 37.098 512.097 m 340.784 512.097 l 339.059 510.371 l 38.824 510.371 l h f 37.098 512.097 m 37.098 436.175 l 38.824 437.9 l 38.824 510.371 l h f 0.313 0.313 0.313 rg 340.784 512.097 m 340.784 436.175 l 339.059 437.9 l 339.059 510.371 l h f 37.098 436.175 m 340.784 436.175 l 339.059 437.9 l 38.824 437.9 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 38.824 510.371 m 76.784 510.371 l 75.922 509.508 l 39.686 509.508 l h f 38.824 510.371 m 38.824 474.136 l 39.686 474.998 l 39.686 509.508 l h f 0.949 0.945 0.935 rg 76.784 510.371 m 76.784 474.136 l 75.922 474.998 l 75.922 509.508 l h f 38.824 474.136 m 76.784 474.136 l 75.922 474.998 l 39.686 474.998 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 77.647 474.998 260.549 34.51 re f 0.457 0.449 0.431 rg 76.784 510.371 m 339.059 510.371 l 338.196 509.508 l 77.647 509.508 l h f 76.784 510.371 m 76.784 474.136 l 77.647 474.998 l 77.647 509.508 l h f 0.949 0.945 0.935 rg 339.059 510.371 m 339.059 474.136 l 338.196 474.998 l 338.196 509.508 l h f 76.784 474.136 m 339.059 474.136 l 338.196 474.998 l 77.647 474.998 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 38.824 474.136 m 76.784 474.136 l 75.922 473.273 l 39.686 473.273 l h f 38.824 474.136 m 38.824 437.9 l 39.686 438.763 l 39.686 473.273 l h f 0.949 0.945 0.935 rg 76.784 474.136 m 76.784 437.9 l 75.922 438.763 l 75.922 473.273 l h f 38.824 437.9 m 76.784 437.9 l 75.922 438.763 l 39.686 438.763 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 77.647 438.763 260.549 34.51 re f 0.457 0.449 0.431 rg 76.784 474.136 m 339.059 474.136 l 338.196 473.273 l 77.647 473.273 l h f 76.784 474.136 m 76.784 437.9 l 77.647 438.763 l 77.647 473.273 l h f 0.949 0.945 0.935 rg 339.059 474.136 m 339.059 437.9 l 338.196 438.763 l 338.196 473.273 l h f 76.784 437.9 m 339.059 437.9 l 338.196 438.763 l 77.647 438.763 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 135.0196 573.6708 Tm (Figure 1c)Tj /TT1 1 Tf ( - Embryo at 6 weeks \(crown\226)Tj 0 -1.473 TD (rump length 5 mm\). Embryo cardiac ativity )Tj T* (with a heart rate of 126 bpm.)Tj 9.4902 0 0 9.4902 301.7131 540.8201 Tm ( )Tj 11.072 1.423 Td ( )Tj -38.955 -4.278 Td ( )Tj ET q 34.5098114 0 0 34.5098114 39.6862793 474.9984894 cm /Im0 Do Q q 258.8235321 0 0 21.568634 78.5098114 481.4690857 cm /Im1 Do Q q 34.5098114 0 0 34.5098114 39.6862793 438.7631989 cm /Im0 Do Q q 258.8235321 0 0 21.568634 78.5098114 445.2337799 cm /Im2 Do Q 0 0 1 rg BT /TT2 1 Tf 11.1493 0 0 11.1493 37.098 419.1475 Tm (7 weeks \(crown\226rump length 9\22614 mm\))Tj 0 0 0 rg 0 -2.866 TD (External form)Tj /TT1 1 Tf 0 -1.938 TD (The embryonic body appears as a triangle in the sagittal section. The si\ des consist of \(1\) the back, \(2\) the roof of the )Tj 0 -1.473 TD (rhombencephalon, and \(3\) the frontal part of the head, the base of the\ umbilical cord, and the embryonic tail. The embryonic )Tj T* (body is slender in the coronal plane. The limbs are short, paddle-shaped\ outgrowths.)Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Central nervous system)Tj /TT1 1 Tf 0 -1.938 TD (The hypoechogenic brain cavities can be identified, including the separa\ ted cerebral hemispheres. The lateral ventricles are )Tj 0 -1.473 TD (shaped like small, round vesicles. The cavity of the diencephalon \(futu\ re third ventricle\) runs posteriorly. In the smallest )Tj T* (embryos, the medial telencephalon forms a continuous cavity between the \ lateral ventricles. The future foramina of Monro are )Tj T* (wide during week 7. In the sagittal plane, the height of the cavity of t\ he diencephalon is slightly greater than that of the )Tj T* (mesencephalon \(future Sylvian aqueduct\). Thus, the wide border between\ the cavities of the diencephalon and the )Tj T* (mesencephalon is indicated. The curved tube-like mesencephalic cavity li\ es anteriorly, its rostral part pointing caudally. It )Tj T* (straightens considerably during the following weeks. By week 8, it is re\ gularly identified. The relatively broad and shallow )Tj T* (rhombencephalic cavity is always visible from 7 weeks onwards. It then h\ as a well-defined rhombic shape in the cranial pole of )Tj T* (the embryo.)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(6 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 811 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 125.529 37.24 272.627 264 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 37.24 272.627 264 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 181.1764679 270.9019623 401.4509735 cm /Im0 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 132.4314 372.3374 Tm (Figure 2)Tj /TT1 1 Tf ( - Embryo at 7+2 weeks \(crown\226rump length 12 mm\). Oblique transvers\ e section )Tj 0 -1.473 TD (through the head demonstrating the rhombencephalon \(Rh\), diencephalon \ \(Di\) and )Tj T* (hemispheres \(H\). The connections between the lateral ventricles and th\ ird ventricle \(foramina )Tj T* (of Monro\) are still wide. The echogenic ring to the left is the yolk sa\ c)Tj 9.4902 0 0 9.4902 518.9337 323.0614 Tm ( )Tj ET q 258.8235321 0 0 250.1960754 132.431366 44.1417847 cm /Im1 Do Q q 258.8235321 0 0 208.784317 409.3725433 64.8476562 cm /Im2 Do Q EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(7 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 812 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 98.353 428.513 m 702.275 428.513 l 700.549 426.787 l 100.078 426.787 l h f 98.353 428.513 m 98.353 352.591 l 100.078 354.317 l 100.078 426.787 l h f 0.313 0.313 0.313 rg 702.275 428.513 m 702.275 352.591 l 700.549 354.317 l 700.549 426.787 l h f 98.353 352.591 m 702.275 352.591 l 700.549 354.317 l 100.078 354.317 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 100.078 426.787 m 138.039 426.787 l 137.176 425.925 l 100.941 425.925 l h f 100.078 426.787 m 100.078 390.552 l 100.941 391.415 l 100.941 425.925 l h f 0.949 0.945 0.935 rg 138.039 426.787 m 138.039 390.552 l 137.176 391.415 l 137.176 425.925 l h f 100.078 390.552 m 138.039 390.552 l 137.176 391.415 l 100.941 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 138.902 391.415 260.549 34.51 re f 0.457 0.449 0.431 rg 138.039 426.787 m 400.314 426.787 l 399.451 425.925 l 138.902 425.925 l h f 138.039 426.787 m 138.039 390.552 l 138.902 391.415 l 138.902 425.925 l h f 0.949 0.945 0.935 rg 400.314 426.787 m 400.314 390.552 l 399.451 391.415 l 399.451 425.925 l h f 138.039 390.552 m 400.314 390.552 l 399.451 391.415 l 138.902 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 1 1 1 rg 401.176 391.415 36.235 34.51 re f 0.457 0.449 0.431 rg 400.314 426.787 m 438.275 426.787 l 437.412 425.925 l 401.176 425.925 l h f 400.314 426.787 m 400.314 390.552 l 401.176 391.415 l 401.176 425.925 l h f 0.949 0.945 0.935 rg 438.275 426.787 m 438.275 390.552 l 437.412 391.415 l 437.412 425.925 l h f 400.314 390.552 m 438.275 390.552 l 437.412 391.415 l 401.176 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 439.137 391.415 260.549 34.51 re f 0.457 0.449 0.431 rg 438.275 426.787 m 700.549 426.787 l 699.686 425.925 l 439.137 425.925 l h f 438.275 426.787 m 438.275 390.552 l 439.137 391.415 l 439.137 425.925 l h f 0.949 0.945 0.935 rg 700.549 426.787 m 700.549 390.552 l 699.686 391.415 l 699.686 425.925 l h f 438.275 390.552 m 700.549 390.552 l 699.686 391.415 l 439.137 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 100.078 390.552 m 138.039 390.552 l 137.176 389.689 l 100.941 389.689 l h f 100.078 390.552 m 100.078 354.317 l 100.941 355.179 l 100.941 389.689 l h f 0.949 0.945 0.935 rg 138.039 390.552 m 138.039 354.317 l 137.176 355.179 l 137.176 389.689 l h f 100.078 354.317 m 138.039 354.317 l 137.176 355.179 l 100.941 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 138.902 355.179 260.549 34.51 re f 0.457 0.449 0.431 rg 138.039 390.552 m 400.314 390.552 l 399.451 389.689 l 138.902 389.689 l h f 138.039 390.552 m 138.039 354.317 l 138.902 355.179 l 138.902 389.689 l h f 0.949 0.945 0.935 rg 400.314 390.552 m 400.314 354.317 l 399.451 355.179 l 399.451 389.689 l h f 138.039 354.317 m 400.314 354.317 l 399.451 355.179 l 138.902 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 1 1 1 rg 401.176 355.179 36.235 34.51 re f 0.457 0.449 0.431 rg 400.314 390.552 m 438.275 390.552 l 437.412 389.689 l 401.176 389.689 l h f 400.314 390.552 m 400.314 354.317 l 401.176 355.179 l 401.176 389.689 l h f 0.949 0.945 0.935 rg 438.275 390.552 m 438.275 354.317 l 437.412 355.179 l 437.412 389.689 l h f 400.314 354.317 m 438.275 354.317 l 437.412 355.179 l 401.176 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 439.137 355.179 260.549 34.51 re f 0.457 0.449 0.431 rg 438.275 390.552 m 700.549 390.552 l 699.686 389.689 l 439.137 389.689 l h f 438.275 390.552 m 438.275 354.317 l 439.137 355.179 l 439.137 389.689 l h f 0.949 0.945 0.935 rg 700.549 390.552 m 700.549 354.317 l 699.686 355.179 l 699.686 389.689 l h f 438.275 354.317 m 700.549 354.317 l 699.686 355.179 l 439.137 355.179 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 132.4314 571.3178 Tm (Figure 3a)Tj /TT1 1 Tf ( - Embryo at 7+5 weeks \(crown\226)Tj 0 -1.473 TD (rump length 14 mm\). Sagittal section )Tj T* (through the \221triangular\222 body demonstrating )Tj T* (the shallow cavity of the rhomben-cephalon )Tj T* (\(Rh\), the curved tube-like mesencephalon )Tj T* (\(Mes\), the diencephalon \(Di\) and the )Tj T* (umbilical cord \(U\))Tj 9.4902 0 0 9.4902 232.4296 472.7658 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 409.3725 554.8925 Tm (Figure 3b)Tj /TT1 1 Tf ( - Embryo at 7+5 weeks \(crown\226)Tj T* (rump length 14 mm\). Coronal section )Tj T* (through the head and body demonstrating )Tj T* (the shallow cavity of the rhomben-cephalon )Tj T* (\(Rh\), choroid plexus \(CP\))Tj 9.4902 0 0 9.4902 552.0393 489.1911 Tm ( )Tj -54.26 -5.131 Td ( )Tj ET q 34.5098114 0 0 34.5098114 100.9411774 391.4147797 cm /Im0 Do Q q 258.8235321 0 0 21.568634 138.9019623 397.885376 cm /Im1 Do Q q 34.5098114 0 0 34.5098114 401.1764679 391.4147797 cm /Im0 Do Q q 258.8235321 0 0 21.568634 440 397.885376 cm /Im2 Do Q q 34.5098114 0 0 34.5098114 100.9411774 355.1794891 cm /Im0 Do Q q 258.8235321 0 0 21.568634 138.9019623 361.6500702 cm /Im3 Do Q q 34.5098114 0 0 34.5098114 401.1764679 355.1794891 cm /Im0 Do Q q 258.8235321 0 0 21.568634 440 361.6500702 cm /Im4 Do Q BT /TT1 1 Tf 9.4902 0 0 9.4902 37.098 344.7286 Tm ( )Tj /TT2 1 Tf 11.1493 0 0 11.1493 37.098 332.1128 Tm (Heart)Tj /TT1 1 Tf 0 -1.938 TD (The heart can be recognized as a beating, large and bright structure bel\ ow the embryonic head at 7 weeks. The heart rate )Tj 0 -1.473 TD (increases from 130 bpm to 160 bpm. Details of the heart anatomy are not \ visible, but the atrial and ventricular compartments )Tj 0 -1.473 TD (can sometimes be distinguished by the reciprocal movements of the walls.\ )Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Intestinal tract)Tj /TT1 1 Tf 0 -1.938 TD (The short umbilical cord shows a large celomic cavity at its insertion, \ where the primary intestinal loop can be identified. The)Tj ( )Tj 0 -1.473 TD (first sign of herniation of the gut occurs during week 7 as a thickening\ of the cord and showing a slight echogenic area at the )Tj T* (abdominal insertion. Within a few days, this echogenic structure becomes\ more distinct.)Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Extra-embryonic structures)Tj /TT1 1 Tf 0 -1.938 TD (The amniotic cavity becomes visible at the beginning of week 7. The mean\ diameter of the amniotic cavity is almost the same )Tj 0 -1.473 TD (as the corresponding crown\226rump length.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 272.1592 141.9694 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(8 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 813 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 304.959 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 208.784317 270.9019623 384.431366 cm /Im0 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 270.902 373.4355 Tm (Identification of the yolk sac and the )Tj 0 -1.473 TD (placenta vascularization and yolk sac)Tj 9.4902 0 0 9.4902 479.3274 357.0101 Tm ( )Tj 0 0 1 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 319.8866 Tm (8 weeks \(crown\226rump length 15\22622 mm\))Tj 0 0 0 rg /TT2 1 Tf 0 -2.866 TD (Gestational Sac and Yolk Sac )Tj ET q 258.8235321 0 0 203.6078491 138.0392151 65.514328 cm /Im1 Do Q q 258.8235321 0 0 203.6078491 403.7647095 65.514328 cm /Im2 Do Q EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(9 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 814 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 203.6078491 138.0392151 383.2548981 cm /Im0 Do Q q 258.8235321 0 0 203.6078491 403.7647095 383.2548981 cm /Im1 Do Q BT /TT0 1 Tf 9.4902 0 0 9.4902 37.098 368.4903 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 355.8745 Tm (External form)Tj /TT0 1 Tf 0 -1.938 TD (The body gradually grows thicker and becomes cuboidal. At the end of the\ week, the elbows become obvious, the hands angle )Tj 0 -1.473 TD (from the sagittal plane and the fingers are distinguishable.)Tj ET q 258.8235321 0 0 208.784317 270.9019623 89.8220215 cm /Im2 Do Q BT /TT2 1 Tf 11.1493 0 0 11.1493 270.902 65.8849 Tm (Figure 4)Tj /TT0 1 Tf ( - 3D scan - the body grows, )Tj 0 -1.473 TD (visualization the future upper and lower )Tj T* (limbs.)Tj 9.4902 0 0 9.4902 304.6732 33.0343 Tm ( )Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(10 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 815 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 139.48 140.808 267.451 244.157 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 1 1 1 rg 411.245 140.808 249.903 244.157 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 9.4902 0 0 9.4902 37.098 581.9383 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 569.3225 Tm (Central nervous system)Tj /TT0 1 Tf 0 -1.938 TD (The brain cavities are easily seen as large \221holes\222 in the embryon\ ic head. The hemispheres enlarge, developing via thick round )Tj 0 -1.473 TD (slices originating antero-caudally from the third ventricle into a cresc\ ent shape. The choroid plexus in the lateral ventricles )Tj 0 -1.473 TD (becomes visible as tiny echogenic areas. The future foramina of Monro be\ come more accentuated during week 8. The third )Tj T* (ventricle is still relatively wide, as is the mesencephalic cavity. At t\ his stage, the mesencephalon lies at the top of the head)Tj (. The )Tj T* (increased growth of the rostral brain structures and the deepening of th\ e pontine flexure leads to the deflection of the brain. )Tj T* (The rhombencephalic cavity \(future fourth ventricle\) has a pyramid-lik\ e shape with the central deepening of the pontine flexure )Tj 0 -1.473 TD (as the peak of the pyramid. The first signs of the bilateral choroid ple\ xuses are lateral echogenic areas originating near the )Tj 0 -1.473 TD (branches of the medulla oblongata caudal to the lateral recesses. Within\ a short time, the choroid plexuses traverse the roof of)Tj ( )Tj T* (the fourth ventricle, meeting in the mid-line and dividing the roof into\ two portions, about two-thirds are located rostrally an)Tj (d )Tj T* (one-third caudally. In the sagittal section, the choroid plexuses are id\ entified as an echogenic fold of the roof.)Tj ET q 258.8235321 0 0 235.5294189 143.7937317 145.1221771 cm /Im0 Do Q BT /TT2 1 Tf 11.1493 0 0 11.1493 415.5584 287.3299 Tm (Figure 5)Tj /TT0 1 Tf ( - Embryo at 8+1 weeks \(crown\226)Tj 0 -1.473 TD (rump length 17 mm\). Section through the )Tj T* (rhomb-encephalon \(Rh\) and )Tj T* (mesencephalon \(arrow, M\))Tj 9.4902 0 0 9.4902 566.1412 238.0539 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(11 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 816 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 209.6470642 143.7937317 375.7254944 cm /Im0 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 415.5584 562.4807 Tm (Figure 6)Tj /TT1 1 Tf ( - Embryo at 8+5 weeks \(crown\226)Tj 0 -1.473 TD (rump length 18 mm\). Slightly parasagittal )Tj T* (section demonstrating the ventricle of )Tj T* (one hemisphere \(H\) leading through the )Tj T* (foramen of Monro into the third ventricle, )Tj T* (which is the cavity of the diencephalon )Tj T* (\(Di\). The wide mesencephalic cavity )Tj 0 -1.473 TD (\(Mes\) lies at the top of the head and the )Tj 0 -1.473 TD (cavity of the rhombencephalon lies )Tj T* (posteriorly. The arrow points at the )Tj T* (choroid plexus of the rhombencephalon)Tj 9.4902 0 0 9.4902 637.4411 398.2273 Tm ( )Tj ET q 258.8235321 0 0 196.7058868 143.7937317 166.0784302 cm /Im1 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 415.5584 280.8414 Tm (Figure 6a)Tj /TT1 1 Tf ( - Embryo at 8+5 weeks )Tj 0 -1.201 TD (\(crown\226rump length 20 mm\). Sagittal )Tj 0 -1.2 TD (section vascularization and the umbilical )Tj 0 -1.2 TD (cord.)Tj 9.4902 0 0 9.4902 37.098 149.5883 Tm ( )Tj /TT2 1 Tf 11.1493 0 0 11.1493 37.098 136.9725 Tm (Heart)Tj /TT1 1 Tf 0 -1.938 TD (The heart rate has increased to 160 bpm. Occasionally it is possible to \ identify the atrial and ventricular walls moving )Tj 0 -1.473 TD (reciprocally as early as at the end of week 8. The atrial compartment ap\ pears wider than the ventricular compartment, and the )Tj 0 -1.473 TD (heart covers about 50% of the transverse thoracic area. A kind of four-c\ hamber view of the heart can then be obtained, where )Tj T* (the atrial compartment is wider than the ventricular part.)Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Intestinal tract)Tj /TT1 1 Tf 0 -1.938 TD (There is no sign of the stomach during week 7. In some cases, it is poss\ ible to recognize the fluid-filled stomach as a small )Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(12 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 817 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 535.584 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 582.4581 Tm (hypoechogenic area on the left side of the upper abdomen below the heart\ at the end of week 8.)Tj 0 0 1 rg /TT1 1 Tf 0 -2.865 TD (9 weeks \(crown\226rump length 23\22631 mm\))Tj 0 0 0 rg /TT2 1 Tf 0 -2.866 TD (External form)Tj /TT0 1 Tf 0 -1.938 TD (The body develops an ellipsoid shape with a large head. The soles of the\ feet touch in the mid-line at the end of the week. At )Tj 0 -1.473 TD (the same time, it is possible to obtain acceptable images of the profile\ ; thus, it should be possible to examine the mouth. The )Tj 0 -1.473 TD (ventral body wall is well defined.)Tj /TT1 1 Tf ( )Tj ET q 258.8235321 0 0 208.784317 270.9019623 236.0784302 cm /Im0 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 270.902 212.1414 Tm (Figure 7 - )Tj /TT0 1 Tf (Embryo at 9-10 weeks \(crown\226)Tj 0 -1.473 TD (rump length 30 mm\). 3D scan showing the )Tj T* (external form of the fetal body \(upper and )Tj T* (lower limbs\).)Tj 9.4902 0 0 9.4902 37.098 135.7693 Tm ( )Tj /TT2 1 Tf 11.1493 0 0 11.1493 37.098 123.1535 Tm (Central nervous system)Tj /TT0 1 Tf 0 -1.938 TD (The lateral ventricles are always visible. They are best seen in the par\ asagittal plane, where the C-shape becomes apparent. )Tj 0 -1.473 TD (The cortex is smooth and hypoechogenic. The bright choroid plexuses of t\ he lateral ventricles are regularly detectable at 9 )Tj 0 -1.473 TD (weeks 4 days. They show rapid growth, similar to the hemispheres, and so\ on fill most of the ventricular cavities. The width of )Tj T* (the diencephalic cavity narrows gradually, while the width of the mesenc\ ephalon remains wide. A distinct border \(\221isthmus )Tj T* (prosencephali\222\) has developed between the cavity of the mesencephalo\ n and the third ventricle. The wall of the diencephalon, )Tj T* (initially very thin, thickens considerably starting from week 8 to 9. Th\ e isthmus rhombencephali is always distinct. The cavity )Tj (of )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(13 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 818 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 130.706 236.86 267.451 212.235 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 578.9921 Tm (the mesencephalon remains relatively large, especially the posterior par\ t. The height and the width are about the same size. )Tj 0 -1.473 TD (During weeks 8 and 9, the rhombic fossa becomes deeper due to the progre\ ssive flexure of the pons. The lateral corners of the )Tj T* (rhombencephalic cavity, called the lateral recesses, are easily identifi\ ed at weeks 7 and 8. During this period, the distance )Tj T* (between these recesses increases \(rhombencephalon width\). Later, durin\ g weeks 9 and 10, the lateral recesses often become )Tj T* (covered by the enlarging cerebellar hemispheres. Thus, only the central \ part of the hypoechogenic fourth ventricle, which is )Tj T* (divided by the choroid plexuses, is visible. The choroid plexuses of the\ fourth ventricle are bright landmarks, dividing the )Tj T* (ventricle into rostral and caudal compartments. The cerebellar hemispher\ es are easily detectable. The primordia of cerebellar )Tj 0 -1.473 TD (hemispheres are clearly separated in the mid-line during the embryonic p\ eriod.)Tj ET q 258.8235321 0 0 157.8823547 135.0196075 264.0361938 cm /Im0 Do Q q 258.8235321 0 0 203.6078491 406.784317 241.1734467 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 135.0196 217.2364 Tm (Figure 7a )Tj /TT0 1 Tf (- Embryo at 9+4 weeks \(crown\226)Tj 0 -1.473 TD (rump length 28 mm\). Sagittal section )Tj T* (demonstrating the relatively large head and )Tj T* (the cavities of the diencephalon \(Di\), )Tj T* (mesencephalon \(Mes\) and rhombencephalon )Tj T* (\(Rh\). The arrow points at the genital )Tj T* (tubercle, but at this stage it is not possible )Tj 0 -1.473 TD (to differentiate between male and female )Tj 0 -1.473 TD (gender)Tj 9.4902 0 0 9.4902 174.0199 85.8337 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 406.7843 192.5984 Tm (Figura 7b)Tj /TT0 1 Tf ( - Embryo at 9+4 weeks \(crown\226)Tj 0 -1.473 TD (rump length 28 mm\). Sagittal section )Tj T* (demonstrating the relatively large head and )Tj T* (the cavities of the diencephalon \(Di\), )Tj T* (mesencephalon \(Mes\), rhombencephalon )Tj T* (\(Rh\) and umbilical cord \(U\).)Tj 9.4902 0 0 9.4902 564.3242 110.4717 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 55.6121 Tm ( )Tj /TT2 1 Tf 0 -1.937 TD (Heart)Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(14 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 819 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 88.929 735.059 30.229 re f EMC EMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 37.098 160.57 m 340.784 160.57 l 339.059 158.845 l 38.824 158.845 l h f 37.098 160.57 m 37.098 120.884 l 38.824 122.609 l 38.824 158.845 l h f 0.313 0.313 0.313 rg 340.784 160.57 m 340.784 120.884 l 339.059 122.609 l 339.059 158.845 l h f 37.098 120.884 m 340.784 120.884 l 339.059 122.609 l 38.824 122.609 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 38.824 158.845 m 76.784 158.845 l 75.922 157.982 l 39.686 157.982 l h f 38.824 158.845 m 38.824 122.609 l 39.686 123.472 l 39.686 157.982 l h f 0.949 0.945 0.935 rg 76.784 158.845 m 76.784 122.609 l 75.922 123.472 l 75.922 157.982 l h f 38.824 122.609 m 76.784 122.609 l 75.922 123.472 l 39.686 123.472 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 77.647 123.472 260.549 34.51 re f 0.457 0.449 0.431 rg 76.784 158.845 m 339.059 158.845 l 338.196 157.982 l 77.647 157.982 l h f 76.784 158.845 m 76.784 122.609 l 77.647 123.472 l 77.647 157.982 l h f 0.949 0.945 0.935 rg 339.059 158.845 m 339.059 122.609 l 338.196 123.472 l 338.196 157.982 l h f 76.784 122.609 m 339.059 122.609 l 338.196 123.472 l 77.647 123.472 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (During week 9, the heart rate reaches a maximum of mean 175 bpm.)Tj /TT1 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Intestinal tract)Tj /TT0 1 Tf 0 -1.938 TD (From 8 weeks 3 days to 10 weeks 4 days of gestational age, all embryos h\ ave herniation of the midgut, most distinctive during )Tj 0 -1.473 TD (weeks 9 and 10. At this stage, the midgut herniation presents as a large\ hyperechogenic mass. The stomach can be detected in )Tj T* (75% of the embryos before 10 weeks.)Tj ET q 258.8235321 0 0 208.784317 270.9019623 278.9321289 cm /Im0 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 270.902 254.9951 Tm (Figure 7c - )Tj /TT0 1 Tf (Embryo at 9+4 weeks \(crown\226)Tj T* (rump length 28 mm\). Longitudinal section )Tj T* (demonstrating the the physiological midgut )Tj T* (herniation present as a large hyperechogenic )Tj T* (mass.)Tj 9.4902 0 0 9.4902 304.1269 189.2937 Tm ( )Tj -28.137 -2.855 Td ( )Tj ET q 34.5098114 0 0 34.5098114 39.6862793 123.4720917 cm /Im1 Do Q q 258.8235321 0 0 21.568634 78.5098114 129.942688 cm /Im2 Do Q 0 0 1 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 103.8564 Tm (Postembryonic period, weeks 10 and 11 \(crown\226rump length 32\22654 mm\ \))Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(15 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 820 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 266.588 247.043 267.451 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.4 0.4 0.4 rg 189.373 70.34 421.882 16.83 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5804 Tm (External form)Tj /TT1 1 Tf 0 -1.938 TD (The human features of the fetus become clearer. The fetal body elongates\ , the arms and the legs develop into upper and lower )Tj 0 -1.473 TD (arms and legs, the hands and fingers and the feet and toes. In the large\ st fetuses, the soles of the feet rotate from the sagitt)Tj (al )Tj 0 -1.473 TD (plane. The head is still relatively large with a prominent forehead and \ a flat occiput. The future skull can be distinguished; )Tj 0 -1.564 TD (ossification starts at about 11 weeks with the occipital bone)Tj 8.9195 0 0 8.9195 373.172 507.5424 Tm (14)Tj 11.1493 0 0 11.1493 384.5176 504.6881 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 388.5759 504.6881 Tm ( )Tj ET q 258.8235321 0 0 208.784317 270.9019623 277.6772308 cm /Im0 Do Q 1 1 1 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 332.2638 254.3839 Tm (3D scan at 11-12 weeks)Tj 0 0 0 rg /TT3 1 Tf 9.4902 0 0 9.4902 37.098 235.5565 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 37.098 222.251 Tm (Central nervous system)Tj /TT1 1 Tf 0 -1.938 TD (The thick crescent-shaped lateral ventricles fill the anterior part of t\ he head and conceal the diencephalic cavity. The thickne)Tj (ss )Tj 0 -1.473 TD (of the cortex is about 1 mm at the end of the first trimester. The dienc\ ephalon lies between the hemispheres, and the )Tj 0 -1.473 TD (mesencephalon gradually moves towards the center of the head. After an i\ nitial increase, the width of the third ventricle )Tj T* (becomes narrow towards the end of the first trimester. The cerebellar he\ mispheres seem to meet in the mid-line during weeks )Tj T* (11\22612. After 10 weeks 3 days, the choroid plexuses of the fourth vent\ ricle can always be visualized. The distance between the )Tj T* (choroid plexuses and the cerebellum becomes shorter during weeks 9\22611\ because of cerebellar growth. The onset of )Tj 0 -1.473 TD (ossification of the spine occurs at the end of the first trimester.)Tj /TT4 1 Tf ( )Tj 1 1 1 rg 16.871 -2.421 Td (3D volume at 10 weeks - Central Nervous System Slices)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(16 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 821 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 455.961 406.941 155.294 182.039 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 189.373 385.797 262.275 16.83 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 455.961 385.797 155.294 16.83 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 455.961 199.444 155.294 182.039 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 189.373 178.3 262.275 16.83 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 455.961 178.3 155.294 16.83 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 178.5882416 191.0980377 408.6666718 cm /Im0 Do Q q 124.2352905 0 0 163.9215698 471.4901886 416 cm /Im1 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 226.5378 390.5498 Tm (slice at frontal lobe level \(sagital\))Tj 20.865 0 Td (frontal lobe level \(coronal\))Tj ET q 258.8235321 0 0 178.5882416 191.0980377 201.1698303 cm /Im2 Do Q q 124.2352905 0 0 163.9215698 471.4901886 208.5031738 cm /Im3 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 238.2055 183.053 Tm (slice at midline level \(sagital\))Tj 20.865 0 Td (midline level \(coronal\))Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(17 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 822 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 455.961 407.49 155.294 182.039 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 189.373 386.346 262.275 16.83 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 455.961 386.346 155.294 16.83 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 455.961 199.993 155.294 182.039 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 189.373 165.47 262.275 30.209 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 455.961 165.47 155.294 30.209 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 178.5882416 191.0980377 409.215683 cm /Im0 Do Q q 124.2352905 0 0 163.9215698 471.4901886 416.5490265 cm /Im1 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 235.775 391.0988 Tm (slice at thalamo level \(sagital\))Tj 20.865 0 Td (thalamo level \(coronal\))Tj ET q 258.8235321 0 0 178.5882416 191.0980377 201.7188568 cm /Im2 Do Q q 124.2352905 0 0 163.9215698 471.4901886 209.0521851 cm /Im3 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 219.0789 176.9124 Tm (slice at posterior fossalevel \(sagital\))Tj 22.978 0.6 Td (posterior fossa level )Tj 2.944 -1.2 Td (\(coronal\))Tj /TT1 1 Tf -42.244 -2.263 Td (Heart)Tj /TT0 1 Tf 0 -1.938 TD (At 10 weeks, the moving valves and the interventricular septum can be id\ entified. The heart rate slows down to 165 bpm at the )Tj 0 -1.473 TD (end of week 11. The ventricles, atria, septa, valves, veins and outflow \ tracts become identifiable.)Tj /TT1 1 Tf 0 -1.937 TD (Intestinal tract)Tj /TT0 1 Tf 0 -1.938 TD (Midgut herniation has its maximal extension at the beginning of week 10 \ and returns into the abdominal cavity during weeks )Tj 0 -1.473 TD (10\22611. The gut retracts into the abdominal cavity between 10 weeks 4 \ days and 11 weeks 5 days. Fetuses which are older than )Tj T* (11 weeks 5 days usually do not demonstrate any sign of the herniation. T\ he esophagus can be identified as an echogenic )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(18 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 823 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 172.781 735.059 30.229 re f EMC EMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 37.098 244.422 m 340.784 244.422 l 339.059 242.697 l 38.824 242.697 l h f 37.098 244.422 m 37.098 204.736 l 38.824 206.462 l 38.824 242.697 l h f 0.313 0.313 0.313 rg 340.784 244.422 m 340.784 204.736 l 339.059 206.462 l 339.059 242.697 l h f 37.098 204.736 m 340.784 204.736 l 339.059 206.462 l 38.824 206.462 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 38.824 242.697 m 76.784 242.697 l 75.922 241.834 l 39.686 241.834 l h f 38.824 242.697 m 38.824 206.462 l 39.686 207.324 l 39.686 241.834 l h f 0.949 0.945 0.935 rg 76.784 242.697 m 76.784 206.462 l 75.922 207.324 l 75.922 241.834 l h f 38.824 206.462 m 76.784 206.462 l 75.922 207.324 l 39.686 207.324 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 77.647 207.324 260.549 34.51 re f 0.457 0.449 0.431 rg 76.784 242.697 m 339.059 242.697 l 338.196 241.834 l 77.647 241.834 l h f 76.784 242.697 m 76.784 206.462 l 77.647 207.324 l 77.647 241.834 l h f 0.949 0.945 0.935 rg 339.059 242.697 m 339.059 206.462 l 338.196 207.324 l 338.196 241.834 l h f 76.784 206.462 m 339.059 206.462 l 338.196 207.324 l 77.647 207.324 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (double line anterior to the aorta, leading into the stomach. The stomach\ is visible in all specimens before 11 completed weeks.)Tj ET q 258.8235321 0 0 217.4117584 270.9019623 346.3589783 cm /Im0 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 227.3333 322.4219 Tm (Figure 8a)Tj /TT0 1 Tf ( - Embryo at 10 weeks \(crown\226rump length 32 )Tj 0 -1.473 TD (mm\). Horizontal section through the abdomen )Tj T* (demonstrating the umbilical cord. The arrows show the )Tj T* (extension of the physiological midgut herniation)Tj 9.4902 0 0 9.4902 497.1915 273.1459 Tm ( )Tj -48.481 -2.855 Td ( )Tj ET q 34.5098114 0 0 34.5098114 39.6862793 207.3242798 cm /Im1 Do Q q 258.8235321 0 0 21.568634 78.5098114 213.7948761 cm /Im2 Do Q BT /TT0 1 Tf 9.4902 0 0 9.4902 343.3725 233.9715 Tm ( )Tj 0 0 1 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 187.7086 Tm (Fetal growth from 7 to 12 weeks)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(19 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 824 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.4 0.4 0.4 rg 130.706 278.354 267.451 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 278.354 267.451 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 130.706 30.308 267.451 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 30.308 267.451 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 577.9393 Tm ( )Tj 0 -1.1 TD (The longitudinal measurements of the biparietal diameter, occipito-front\ al diameter, mean abdominal diameter, crown\226rump )Tj 0 -1.2 TD (length, amniotic cavity diameter and chorionic cavity diameter show a hi\ gh degree of uniformity with virtually the same growth )Tj 0 -1.2 TD (velocities. The yolk sac demonstrates uniform growth until week 10 only.\ )Tj 9.4902 0 0 9.4902 448.7867 538.9166 Tm ( )Tj -43.38 -1.147 Td ( )Tj ET q 258.8235321 0 0 208.784317 135.0196075 308.9876251 cm /Im0 Do Q q 258.8235321 0 0 208.784317 406.784317 308.9876251 cm /Im1 Do Q 1 1 1 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 203.4725 285.6943 Tm (3D scan at 5-6 weeks)Tj 24.375 0 Td (3D scan at 7-8 weeks)Tj ET q 258.8235321 0 0 208.784317 135.0196075 60.9417725 cm /Im2 Do Q q 258.8235321 0 0 208.784317 406.784317 60.9417725 cm /Im3 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 207.436 37.6485 Tm (3D scan 9-10 weeks)Tj 23.384 0 Td (3D scan at 11-12 weeks)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(20 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 825 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 570.033 735.059 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 1 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 577.381 Tm (Fetal growth from 12 to 14 weeks)Tj 0 0 0 rg 0 -2.186 TD (CNS)Tj /TT1 1 Tf 9.4902 0 0 9.4902 62.5296 553.0051 Tm ( )Tj -2.68 -1.329 Td ( )Tj /TT2 1 Tf 11.1493 0 0 11.1493 37.098 527.0819 Tm (In this phase the development of the ventricular system, cerebellum, cis\ terna magna \(the posterior fossa\). At this time the )Tj 0 -1.473 TD (vermis is not completely closed. The complete development of the cerebel\ lum will be completed at 17 weeks gestation. )Tj /TT1 1 Tf 9.4902 0 0 9.4902 712.7246 510.6566 Tm ( )Tj ET q 258.8235321 0 0 271.7647095 135.0196075 219.6585236 cm /Im0 Do Q q 258.8235321 0 0 271.7647095 406.784317 219.6585236 cm /Im1 Do Q EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(21 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 826 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 271.7647095 135.0196075 322.2352905 cm /Im0 Do Q q 258.8235321 0 0 271.7647095 406.784317 322.2352905 cm /Im1 Do Q q 258.8235321 0 0 271.7647095 135.0196075 37.5294189 cm /Im2 Do Q q 258.8235321 0 0 271.7647095 406.784317 37.5294189 cm /Im3 Do Q EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(22 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 827 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - 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The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 130.706 553.901 267.451 35.393 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 553.901 267.451 35.393 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 130.706 306.293 267.451 36.235 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 306.293 267.451 36.235 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 130.706 59.527 267.451 35.393 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 59.527 267.451 35.393 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 1 1 1 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 135.0196 574.6244 Tm (Descending Aorta, kidneys arteries, iliac )Tj 0 -1.2 TD (bifurcation)Tj /TT1 1 Tf 24.375 1.2 Td (Abdome:)Tj /TT0 1 Tf ( Abdome Circunference, estomach, )Tj 0 -1.201 TD (liver and spine.)Tj ET q 258.8235321 0 0 194.1176453 135.0196075 351.1555481 cm /Im0 Do Q q 258.8235321 0 0 194.1176453 406.784317 351.1555481 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 135.0196 327.4413 Tm (Kidneys:)Tj /TT0 1 Tf ( coronal section showing the 2 )Tj T* (kidnets, spine and iliac wings)Tj 24.375 1.2 Td (Descending Aorta, kidneys arteries, iliac )Tj 0 -1.2 TD (bifurcation)Tj ET q 258.8235321 0 0 194.1176453 135.0196075 103.5477142 cm /Im2 Do Q q 258.8235321 0 0 194.1176453 406.784317 103.5477142 cm /Im3 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 135.0196 80.2506 Tm (Umbilical insertion, bladder, umbilical )Tj T* (arteries \(2 arteries\))Tj /TT1 1 Tf 24.375 1.2 Td (Limbs:)Tj /TT0 1 Tf ( evaluation of the upper and lower )Tj 0 -1.201 TD (limbs. Measurement of the femur.)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(27 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 832 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 130.706 344.824 267.451 22.431 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 344.824 267.451 22.431 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.6 rg 32.784 244.745 735.059 23.122 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 199.272 735.059 22.007 re f EMC EMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 37.098 331.02 m 340.784 331.02 l 339.059 329.294 l 38.824 329.294 l h f 37.098 331.02 m 37.098 291.333 l 38.824 293.059 l 38.824 329.294 l h f 0.313 0.313 0.313 rg 340.784 331.02 m 340.784 291.333 l 339.059 293.059 l 339.059 329.294 l h f 37.098 291.333 m 340.784 291.333 l 339.059 293.059 l 38.824 293.059 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 38.824 329.294 m 76.784 329.294 l 75.922 328.431 l 39.686 328.431 l h f 38.824 329.294 m 38.824 293.059 l 39.686 293.922 l 39.686 328.431 l h f 0.949 0.945 0.935 rg 76.784 329.294 m 76.784 293.059 l 75.922 293.922 l 75.922 328.431 l h f 38.824 293.059 m 76.784 293.059 l 75.922 293.922 l 39.686 293.922 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 77.647 293.922 260.549 34.51 re f 0.457 0.449 0.431 rg 76.784 329.294 m 339.059 329.294 l 338.196 328.431 l 77.647 328.431 l h f 76.784 329.294 m 76.784 293.059 l 77.647 293.922 l 77.647 328.431 l h f 0.949 0.945 0.935 rg 339.059 329.294 m 339.059 293.059 l 338.196 293.922 l 338.196 328.431 l h f 76.784 293.059 m 339.059 293.059 l 338.196 293.922 l 77.647 293.922 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 208.784317 135.0196075 375.8823547 cm /Im0 Do Q q 258.8235321 0 0 208.784317 406.784317 375.8823547 cm /Im1 Do Q 1 1 1 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 221.1107 352.3767 Tm (Cervical Length)Tj 24.375 0 Td (Cervical Length)Tj 0 0 0 rg 9.4902 0 0 9.4902 37.098 332.6472 Tm ( )Tj ET q 34.5098114 0 0 34.5098114 39.6862793 293.9215698 cm /Im2 Do Q q 258.8235321 0 0 21.568634 78.5098114 300.3921509 cm /Im3 Do Q BT /TT0 1 Tf 9.4902 0 0 9.4902 37.098 276.4825 Tm ( )Tj 1 1 1 rg /TT1 1 Tf 12.0784 0 0 12.0784 37.098 252.3464 Tm (CENTRAL NERVOUS SYSTEM DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 229.8942 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 206.6202 Tm (Acrania/exencephaly/anencephaly)Tj /TT0 1 Tf 0 -2.187 TD (Prenatal ultrasonographic diagnosis of anencephaly during the second and\ third trimesters of pregnancy is based on the )Tj 0 -1.564 TD (demonstration of an absent cranial vault and cerebral hemispheres)Tj 8.9195 0 0 8.9195 413.9451 167.6588 Tm (15)Tj 11.1493 0 0 11.1493 425.2906 164.8046 Tm (. Animal studies have shown that, in the absence of the )Tj -34.818 -1.473 Td (cranial vault, there is progressive degeneration of the exposed cerebral\ tissue to anencephaly)Tj 8.9195 0 0 8.9195 564.5947 151.2335 Tm (16)Tj 11.1493 0 0 11.1493 575.9403 148.3792 Tm (.)Tj -48.33 -1.847 Td (In normal human fetuses, there is histological evidence that the onset o\ f ossification of the cranial vault is at 10 weeks of )Tj T* (gestation)Tj 8.9195 0 0 8.9195 88.8643 113.2063 Tm (17)Tj 11.1493 0 0 11.1493 100.2099 110.3521 Tm ( and that, ultrasonographically by 11 weeks, there is hyperechogenicity \ of the skull in comparison to the underlying )Tj -5.661 -1.473 Td (tissues)Tj 8.9195 0 0 8.9195 75.6747 96.781 Tm (18)Tj 11.1493 0 0 11.1493 87.0202 93.9267 Tm (. Ultrasound reports have demonstrated that in the human, as in animal s\ tudies, there is progression from acrania to )Tj -4.478 -1.473 Td (exencephaly and finally anencephaly \()Tj 0 0 0.4 rg (Table 1)Tj 0 0 0 rg (\))Tj 8.9195 0 0 8.9195 298.3378 80.3556 Tm (19\22623)Tj 11.1493 0 0 11.1493 326.7017 77.5014 Tm (. In the first trimester, the pathognomonic feature is acrania, the brai\ n )Tj -25.975 -1.47 Td (being either entirely normal or at varying degrees of distortion and dis\ ruption.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 477.9199 61.1092 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(28 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 833 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 116.902 571.6354 Tm (Table 1)Tj /TT1 1 Tf ( - Case reports on the prenatal diagnosis of anencephaly at 11\22614 wee\ ks of gestation )Tj ET 0.5 0.5 0.5 rg 116.902 547.255 m 116.902 548.98 l 683.725 548.98 l 682.863 548.118 l 117.765 548.118 l 117.765 548.118 l h f 0.875 0.875 0.875 rg 683.725 548.98 m 683.725 547.255 l 116.902 547.255 l 117.765 548.118 l 682.863 548.118 l 682.863 548.118 l h f 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 116.902 518.1347 Tm (Author)Tj 20.816 0 Td (Case)Tj 4.231 0.6 Td (Gestational )Tj 0.996 -1.2 Td (\(weeks\))Tj 13.244 1.2 Td (12 weeks)Tj -1.916 -1.2 Td (13 and 14 weeks)Tj ET 0.5 0.5 0.5 rg 116.902 494.614 m 116.902 496.34 l 683.725 496.34 l 682.863 495.477 l 117.765 495.477 l 117.765 495.477 l h f 0.875 0.875 0.875 rg 683.725 496.34 m 683.725 494.614 l 116.902 494.614 l 117.765 495.477 l 682.863 495.477 l 682.863 495.477 l h f 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 116.902 466.2914 Tm (Schidt and Kubli 1982)Tj 8.9195 0 0 8.9195 240.4699 469.1456 Tm ( 19)Tj 11.1493 0 0 11.1493 358.911 466.7948 Tm (1)Tj 5.716 0 Td (13)Tj 11.087 0 Td (anencephaly)Tj -38.509 -2.637 Td (Johnson et al., 1985)Tj 8.9195 0 0 8.9195 231.5393 440.2436 Tm ( 20)Tj 11.1493 0 0 11.1493 358.911 437.8928 Tm (2)Tj 5.716 0 Td (11)Tj 11.087 0 Td (anencephaly)Tj -38.509 -2.754 Td (Rottem et al. 1989 )Tj 8.9195 0 0 8.9195 226.6113 410.0409 Tm (21)Tj 11.1493 0 0 11.1493 358.911 407.6901 Tm (3)Tj 6.034 0.6 Td (9 )Tj -0.318 -1.2 Td (11 )Tj 8.445 1.2 Td (abnormal cephalic pole )Tj 2.642 -1.2 Td (anencephaly )Tj -38.509 -2.077 Td (Kennedy et al. 1990 )Tj 8.9195 0 0 8.9195 234.4939 380.7009 Tm (22)Tj 11.1493 0 0 11.1493 358.911 378.3501 Tm (4)Tj 5.716 0 Td (10)Tj 11.11 0 Td (exencephaly)Tj -38.532 -3.877 Td (Bronshtein and Ornoyet al. 1991 )Tj 8.9195 0 0 8.9195 304.6565 337.9818 Tm (23)Tj 11.1493 0 0 11.1493 316.0021 335.1276 Tm ( )Tj 3.849 0.045 Td (5)Tj 6.034 1.8 Td (9 )Tj -0.318 -1.2 Td (11 )Tj 0 -1.2 TD (12 )Tj T* (14 )Tj 12.481 3.6 Td (normal )Tj T* (normal )Tj -0.071 -1.2 Td (acrania )Tj -1.322 -1.2 Td (anencephaly )Tj ET 0.5 0.5 0.5 rg 116.902 298.731 m 116.902 300.457 l 683.725 300.457 l 682.863 299.594 l 117.765 299.594 l 117.765 299.594 l h f 0.875 0.875 0.875 rg 683.725 300.457 m 683.725 298.731 l 116.902 298.731 l 117.765 299.594 l 682.863 299.594 l 682.863 299.594 l h f 0 0 0 rg BT /TT2 1 Tf 11.1493 0 0 11.1493 37.098 278.1927 Tm (Goldstein )Tj /TT3 1 Tf (et al)Tj /TT2 1 Tf (. reported the difficulties with early diagnosis of anencephaly; the 12-\ week scan showed no defects but repeat examination at 26)Tj ( )Tj 0 -1.578 TD (weeks demonstrated anencephaly)Tj 8.9195 0 0 8.9195 206.2778 263.4527 Tm (24)Tj 11.1493 0 0 11.1493 216.1963 260.5985 Tm (. Rottem )Tj /TT3 1 Tf (et al)Tj /TT2 1 Tf (. reported a fetus at 9 weeks with an abnormal shape of the cephalic pol\ e and cervical spine; at )Tj -16.064 -1.473 Td (11 weeks, the diagnosis of anencephaly and open cervical spina bifida wa\ s made)Tj 8.9195 0 0 8.9195 438.6743 247.0274 Tm (21)Tj 11.1493 0 0 11.1493 448.5927 244.1732 Tm (. Kennedy )Tj /TT3 1 Tf (et al)Tj /TT2 1 Tf (. described a case of acrania at 10 weeks in )Tj -36.908 -1.368 Td (which the brain was of normal volume but appeared echogenic and disorgan\ ized; at 14 weeks, the fragmented and degenerating brain)Tj ( was )Tj T* (visualized)Tj 8.9195 0 0 8.9195 86.0436 214.1767 Tm (22)Tj 11.1493 0 0 11.1493 95.962 211.3225 Tm (. Bronshtein and Ornoy reported a case with no abnormal findings at 9 an\ d 11 weeks, but at 12 weeks there was acrania and at 14 )Tj -5.28 -1.473 Td (weeks there was anencephaly)Tj 8.9195 0 0 8.9195 186.4432 197.7514 Tm (23)Tj 11.1493 0 0 11.1493 196.3616 194.8972 Tm (.)Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(29 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 834 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n q 305.4117584 0 0 287.2941132 92.3137207 302.784317 cm /Im0 Do Q q 305.4117584 0 0 287.2941132 402.9019623 302.784317 cm /Im1 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 92.3137 284.4589 Tm (Figure 9)Tj /TT1 1 Tf ( - Acrania in an 13-14 week fetus)Tj ET q 410.6666718 0 0 182.9019623 194.9803925 90.5490265 cm /Im2 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 250.7121 73.5139 Tm (Courtesy from Dr. Laura Hurtado \()Tj 0 0 0.4 rg (www.thefetus.net)Tj 0 0 0 rg (\))Tj 9.4902 0 0 9.4902 37.098 55.9413 Tm ( )Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(30 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 835 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 234.254 722.98 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 220.8627472 0 0 220.8627472 172.9803925 363.7254944 cm /Im0 Do Q q 220.8627472 0 0 220.8627472 406.784317 363.7254944 cm /Im1 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 172.9804 340.4322 Tm (13 weeks - cephalic pole, absence of )Tj 0 -1.2 TD (the calvarium. yellow arrows pointing )Tj T* (the encephalic tissue and the orbit)Tj 20.97 1.8 Td (MRI - yellow arrows pointing the )Tj T* (encephalic tissue.)Tj /TT1 1 Tf -18.475 -2.961 Td (Courtesy Prof Dr. Jacob Szenjfeld - CURA & Radiology UNIFESP\251 2001)Tj /TT0 1 Tf 9.4902 0 0 9.4902 37.098 267.8363 Tm ( )Tj 1 1 0 rg /TT2 1 Tf 11.1493 0 0 11.1493 43.1373 249.1813 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 224.6659 Tm ( )Tj 11.1493 0 0 11.1493 37.098 212.0424 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks and 16\22618 weeks of gestation, all three fetuses )Tj 0 -1.564 TD (with acrania/anencephaly were correctly identified at the first scan)Tj 8.9195 0 0 8.9195 412.2393 197.4645 Tm (25)Tj 11.1493 0 0 11.1493 423.5848 194.6103 Tm (. Another screening study examined 3991 patients by )Tj -34.665 -1.383 Td (ultrasound at 11\22614 weeks and again at 18\22620 weeks; there were two\ cases of exencephaly \(one associated with spina bifida )Tj T* (and another with iniencephaly\) and they were both diagnosed at the earl\ y scan)Tj 8.9195 0 0 8.9195 483.5838 164.6138 Tm (26)Tj 11.1493 0 0 11.1493 494.9293 161.7596 Tm (. Two screening studies for chromosomal )Tj -41.064 -1.383 Td (abnormalities by fetal nuchal translucency at 10\22614 weeks in a total \ of 6861 pregnancies correctly diagnosed all seven cases of )Tj T* (anencephaly in the first-trimester scan)Tj 8.9195 0 0 8.9195 254.9669 131.7632 Tm (27,28)Tj 11.1493 0 0 11.1493 280.9047 128.9089 Tm (.)Tj -21.867 -1.847 Td (In a multicenter study of screening for chromosomal abnormalities, by as\ sessment of fetal nuchal translucency thickness at 10\226)Tj T* (14 weeks of gestation, there were 53 435 singleton and 901 twin pregnanc\ ies)Tj 8.9195 0 0 8.9195 475.6566 93.736 Tm (29)Tj 11.1493 0 0 11.1493 487.0021 90.8818 Tm (. There were 47 fetuses with anencephaly, )Tj -40.353 -1.383 Td (including three from twin pregnancies. The diagnosis of anencephaly was \ made at the early scan in 39 cases and at the 16\22622-)Tj 0 -1.473 TD (week scan in a further eight cases. During the first phase of the study,\ 34 830 fetuses were examined. In this group, there )Tj 0 -1.564 TD (were 31 cases of anencephaly but the diagnosis was made at the early sca\ n in only 23 \(74%\) of the cases)Tj 8.9195 0 0 8.9195 636.0507 44.46 Tm (29)Tj 11.1493 0 0 11.1493 647.3963 41.6058 Tm (. Subsequently, the )Tj -54.739 -1.383 Td (sonographers from the participating centers were informed of the differe\ nt diagnostic features of anencephaly in the first )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(31 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 836 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 443.511 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (compared to the second trimester and they were instructed to specificall\ y look for and record the presence or absence of )Tj 0 -1.473 TD (acrania at the early scan. In the second phase of the study, 20 407 fetu\ ses were examined and all 16 cases of anencephaly )Tj 0 -1.564 TD (were diagnosed at the early scan)Tj 8.9195 0 0 8.9195 223.091 552.0009 Tm (29)Tj 11.1493 0 0 11.1493 234.4366 549.1467 Tm (.)Tj -17.7 -1.847 Td (These findings demonstrate that anencephaly can be reliably diagnosed at\ the routine 11\22614-week ultrasound scan, provided )Tj 0 -1.473 TD (the sonographic features for this condition are specifically searched fo\ r. )Tj 9.4902 0 0 9.4902 37.098 482.3558 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 458.438 Tm (Encephalocele)Tj /TT0 1 Tf 0 -2.867 TD (This is a cranial defect with protrusion of meninges \(meningocele\) and\ brain \(encephalocele\). In about 75% of cases, the lesion )Tj 0 -1.473 TD (is occipital but alternative sites include the frontoethmoidal and parie\ tal regions. It is often associated with microcephaly, )Tj T* (hydrocephaly, spina bifida and Meckel\226Gruber syndrome.)Tj 0 -1.937 TD (A prerequisite for the diagnosis of encephalocele \(in contrast to nucha\ l cystic hygroma\) is the demonstration of an associated )Tj 0 -1.473 TD (bony defect in the skull and, therefore, the diagnosis may not be possib\ le before the onset of cranial ossification at about 10 )Tj T* (weeks of gestation. However, van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. have reported that, at least in some cases, the first sign for possibl\ e )Tj 0 -1.564 TD (encephalocele is enlargement of the rhombencephalic cavity from about 9 \ weeks)Tj 8.9195 0 0 8.9195 491.9792 324.5945 Tm (30)Tj 11.1493 0 0 11.1493 503.3248 321.7403 Tm (.)Tj -41.817 -1.847 Td (Bronshtein and Zimmer described a case of occipital encephalocele that w\ as first seen at 13 weeks as an empty occipital sac )Tj T* (measuring 8 x 9 mm)Tj 8.9195 0 0 8.9195 154.1548 286.5674 Tm (31)Tj 11.1493 0 0 11.1493 165.5003 283.7132 Tm (. At 14 weeks, the sac remained of the same size and was filled with bra\ in tissue. At 15 and 16 weeks, )Tj -11.517 -1.383 Td (repeated examinations demonstrated complete resolution of the defect and\ the maternal serum a-fetoprotein was normal. At )Tj 0 -1.473 TD (19 weeks, there was recurrence of the encephalocele and this persisted u\ ntil 24 weeks when the pregnancy was terminated; )Tj T* (pathological examination confirmed the diagnosis of encephalocele.)Tj 0 -2.028 TD (van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a fetus at 11 weeks of gestation with two translucent areas \ in the occipital region)Tj 8.9195 0 0 8.9195 688.4748 215.6896 Tm (32)Tj 11.1493 0 0 11.1493 699.8204 212.8353 Tm (. A repeat )Tj -59.441 -1.383 Td (scan at 13 weeks demonstrated a bony defect and protrusion of the brain.\ The diagnosis of occipital encephalocele was made )Tj 0 -1.473 TD (and this was confirmed by pathological examination after termination of \ the pregnancy.)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(32 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 837 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 242.698 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 265.7254944 0 0 265.7254944 267.4509735 319.0980377 cm /Im0 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 227.3333 295.8047 Tm (Figure 10)Tj /TT1 1 Tf ( - Encephalocele in a 12-week fetus)Tj /TT0 1 Tf -17.062 -3.424 Td (Meckel\226Gruber syndrome)Tj /TT1 1 Tf 0 -2.867 TD (This is a lethal, autosomal recessive condition characterized by the tri\ ad of encephalocele, bilateral polycystic kidneys and )Tj 0 -1.473 TD (polydactyly.)Tj 0 -2.028 TD (Pachi )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. described the sonographic features of the syndrome in a high-risk preg\ nancy at 13 weeks of gestation)Tj 8.9195 0 0 8.9195 678.7192 189.4828 Tm (33)Tj 11.1493 0 0 11.1493 690.0647 186.6286 Tm (. There was )Tj -58.566 -1.383 Td (an occipital bony defect accompanied by encephalocele and abnormally enl\ arged kidneys. Pathological examination, after )Tj 0 -1.473 TD (termination at 13 weeks, detected all three features of the syndrome. Se\ pulveda )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. examined nine high-risk pregnancies at )Tj 0 -1.564 TD (11\22613 weeks and correctly diagnosed the four affected fetuses by the \ presence of the characteristic triad of the syndrome)Tj 8.9195 0 0 8.9195 725.6467 140.2068 Tm (34)Tj 11.1493 0 0 11.1493 736.9922 137.3526 Tm (. )Tj -62.775 -1.383 Td (Similarly, van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. examined five high-risk pregnancies and correctly identified the three\ affected fetuses at 11\226)Tj T* (14 weeks)Tj 8.9195 0 0 8.9195 90.0239 107.3561 Tm (30)Tj 11.1493 0 0 11.1493 101.3694 104.5019 Tm (.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 105.4278 104.5019 Tm ( )Tj /TT1 1 Tf -7.2 -1.84 Td ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(33 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 838 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 173.843 363.647 224.314 225.176 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 363.647 224.314 225.176 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 215.6862793 0 0 174.2745056 178.1568604 389.0980377 cm /Im0 Do Q q 215.6862793 0 0 216.5490265 406.784317 367.9607849 cm /Im1 Do Q q 215.6862793 0 0 270.9019623 178.1568604 83.6862793 cm /Im2 Do Q q 215.6862793 0 0 271.7647095 406.784317 83.2548981 cm /Im3 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 261.644 59.9616 Tm (Courtesy form Zurita \251 2001 - )Tj 0 0 0.4 rg (www.thefetus.net)Tj 0 0 0 rg 9.4902 0 0 9.4902 37.098 38.719 Tm ( )Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(34 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 839 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 569.954 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 302.105 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 253.647 18 293.333 190.869 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 1 1 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 577.3026 Tm (Screening studies)Tj 0 0 0 rg /TT1 1 Tf -0.542 -1.8 Td (An ultrasound screening study for fetal abnormalities at 12\22614 weeks \ of gestation, involving 1632 pregnancies correctly )Tj 0 -1.473 TD (identified the one case of Meckel\226Gruber syndrome; there was an occip\ ital bony defect with a small encephalocele at 12 weeks )Tj 0 -1.564 TD (and enlarged cystic kidneys at 13 weeks)Tj 8.9195 0 0 8.9195 264.3881 526.2295 Tm (35)Tj 11.1493 0 0 11.1493 275.7337 523.3753 Tm (. The parents chose to continue with the pregnancy and at 15 weeks there\ was )Tj -21.404 -1.383 Td (enlargement of the encephalocele. Serial scans from 18 weeks demonstrate\ d the presence of anhydramnios, making )Tj T* (visualization of the fetal abnormalities difficult. The diagnosis was co\ nfirmed after delivery at 37 weeks and neonatal death)Tj 8.9195 0 0 8.9195 729.3594 493.3789 Tm (36)Tj 11.1493 0 0 11.1493 740.7049 490.5246 Tm (. )Tj -63.108 -1.383 Td (Sepulveda )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. detected the triad of the syndrome in a 13-week fetus during screening\ for chromosomal abnormalities by )Tj T* (measurement of fetal nuchal translucency thickness in 21 477 pregnancies\ )Tj 8.9195 0 0 8.9195 457.9626 460.5282 Tm (34)Tj 11.1493 0 0 11.1493 469.3082 457.674 Tm (.)Tj -38.766 -1.847 Td (These findings suggest that the phenotypic expression of the syndrome is\ evident from at least 11 weeks of gestation. )Tj 0 -1.473 TD (Consequently, all affected cases could potentially be diagnosed by the e\ arly scan, provided that systematic examination of both )Tj 0 -1.473 TD (the skull/brain and the renal fossae is carried out routinely. Indeed, t\ he diagnosis is likely to be easier at 11\22614 weeks, when)Tj ( )Tj 0 -1.473 TD (the amniotic fluid is normal, than during the second trimester when the \ presence of the associated oligohydramnios could easily )Tj T* (cause encephalocele and certainly polydactyly to be missed. Additionally\ , at 11\22614 weeks, the fingers are easier to examine )Tj 0 -1.473 TD (because they are invariably extended, whereas in the second trimester th\ e hands are often clenched. )Tj 0 -1.315 TD ( )Tj /TT3 1 Tf 0 -2.086 TD (Hydrocephalus)Tj /TT1 1 Tf 0 -4.592 TD (Congenital hydrocephalus has a birth prevalence of about 2 per 1000. Alt\ hough the underlying cause may be chromosomal )Tj 0 -1.2 TD (abnormalities, genetic syndromes, fetal infection or brain hemorrhage, m\ any cases have no clear-cut etiology and are probably )Tj T* (due to a combination of genetic and environmental factors. Antenatal son\ ographic diagnosis is based on the demonstration of )Tj T* (dilated lateral cerebral ventricles.)Tj 9.4902 0 0 9.4902 225.1313 225.6997 Tm ( )Tj -19.813 -1.147 Td ( )Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(35 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 840 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 253.647 380.902 293.333 213.098 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 205.094 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 112.648 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 208.784317 270.9019623 385.215683 cm /Im0 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 257.9608 361.9224 Tm (Dilated lateral cerebral ventricules 13+2 wees)Tj 9.4902 0 0 9.4902 37.098 342.4052 Tm ( )Tj 11.1493 0 0 11.1493 37.098 329.7818 Tm (In normal fetuses, the outline of the lateral ventricles, the echogenic \ choroid plexi and the mid-line echo are visible by )Tj 0 -1.473 TD (ultrasound from 9 weeks of gestation; at 10\22611 weeks, the third and f\ ourth ventricles become visible and, at 12 weeks, the )Tj 0 -1.564 TD (cerebellum and thalamii can be seen)Tj 8.9195 0 0 8.9195 243.0706 298.7785 Tm (18,37)Tj 11.1493 0 0 11.1493 269.0084 295.9243 Tm (. The transverse diameter of the choroid plexus increases from 2 mm at 1\ 0 weeks to )Tj -20.8 -1.473 Td (about 5 mm at 13 weeks)Tj 8.9195 0 0 8.9195 177.468 282.3532 Tm (7)Tj 11.1493 0 0 11.1493 183.1408 279.499 Tm (. The lateral ventricle diameter to hemisphere diameter ratio decreases \ with gestation from 72% at )Tj -13.099 -1.473 Td (12 weeks, 67% at 13 weeks and 61% at 14 weeks)Tj 8.9195 0 0 8.9195 322.6544 265.9279 Tm (38)Tj 11.1493 0 0 11.1493 334 263.0737 Tm (. The transverse cerebellar diameter increases linearly with gestation f\ rom )Tj -26.63 -1.473 Td (about 6 mm at 10 weeks to 12 mm at 14 weeks)Tj 8.9195 0 0 8.9195 308.1492 249.5025 Tm (7,10)Tj 11.1493 0 0 11.1493 328.4142 246.6483 Tm (. )Tj 1 1 0 rg /TT1 1 Tf -25.587 -2.388 Td (Screening studies)Tj 0 0 0 rg /TT0 1 Tf -0.542 -2.48 Td (Ventriculomegaly usually develops after the 14th week of gestation. In a\ screening study involving ultrasound examinations at )Tj 0 -1.473 TD (11\22614 weeks of gestation and again at 18\22620 weeks in 3991 patients\ , there were eight cases of ventriculomegaly \(two were )Tj 0 -1.564 TD (associated with spina bifida\); only two were diagnosed at the early sca\ n and the other six at 18\22620 weeks)Tj 8.9195 0 0 8.9195 635.7051 161.3698 Tm (26)Tj 11.1493 0 0 11.1493 647.0506 158.5156 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 651.109 158.5156 Tm ( )Tj /TT3 1 Tf 11.1493 0 0 11.1493 37.098 127.5753 Tm (Dandy\226Walker malformation)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(36 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 841 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 437.532 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 319.17 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 32.784 135.107 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.8865 Tm (This condition, which complicates about 10% of cases with hydrocephalus,\ is characterized by complete or partial absence of )Tj 0 -1.473 TD (the cerebellar vermis and cystic dilatation of the fourth ventricle. The\ Dandy\226Walker complex is a non-specific end-point of )Tj T* (chromosomal abnormalities \(usually trisomy 18 or 13 and triploidy\), mo\ re than 50 genetic syndromes, congenital infection or )Tj T* (teratogens such as warfarin, but it can also be an isolated finding.)Tj 0 -1.937 TD (Ulm )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 14-week fetus with an apparently isolated Dandy\226Walker m\ alformation but fetal karyotyping )Tj 0 -1.564 TD (demonstrated triploidy)Tj 8.9195 0 0 8.9195 164.5125 491.4307 Tm (39)Tj 11.1493 0 0 11.1493 175.858 488.5765 Tm (.)Tj 9.4902 0 0 9.4902 37.098 471.1147 Tm ( )Tj 1 1 0 rg /TT2 1 Tf 11.1493 0 0 11.1493 43.1373 452.4597 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf -0.542 -2.48 Td (In a screening study involving ultrasound examinations at 11\22614 weeks\ of gestation and again at 18\22620 weeks in 3991 )Tj 0 -1.564 TD (patients, there was one case of the Dandy\226Walker malformation and thi\ s was not diagnosed in the first-trimester scan)Tj 8.9195 0 0 8.9195 704.5187 410.2332 Tm (26)Tj 11.1493 0 0 11.1493 715.8643 407.3789 Tm (. In )Tj -60.88 -1.383 Td (another screening study for chromosomal abnormalities by fetal nuchal tr\ anslucency in 1473 pregnancies, there was one case )Tj 0 -1.564 TD (of Dandy-Walker malformation and this was correctly diagnosed in the fir\ st-trimester scan)Tj 8.9195 0 0 8.9195 545.6074 377.3825 Tm (27)Tj 11.1493 0 0 11.1493 556.953 374.5282 Tm (.)Tj 9.4902 0 0 9.4902 37.098 357.0665 Tm ( )Tj /TT3 1 Tf 11.1493 0 0 11.1493 37.098 334.0977 Tm (Hydranencephaly)Tj /TT0 1 Tf 0 -2.867 TD (This is a lethal, sporadic condition characterized by absence of the cer\ ebral hemispheres with preservation of the mid-brain and)Tj ( )Tj 0 -1.473 TD (cerebellum. It is thought to result from widespread vascular occlusion o\ f the internal carotid arteries or their branches, )Tj T* (prolonged severe hydrocephalus, an overwhelming infection, or defects in\ embryogenesis. About 1% of infants thought to have )Tj T* (hydrocephalus are later found to have hydranencephaly.)Tj 0 -1.937 TD (Lin )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 12-week fetus with a large head, small hemispheres and a fl\ uid-filled intracranial cavity with no mid-line )Tj 0 -1.564 TD (echo)Tj 8.9195 0 0 8.9195 63.377 216.6796 Tm (40)Tj 11.1493 0 0 11.1493 74.7225 213.8254 Tm (. A repeat scan at 18 weeks demonstrated a cystic fetal head with no cer\ ebral hemispheres and falx; the brain could be )Tj -3.375 -1.383 Td (seen protruding into the cystic cavity. Unlike alobar holoprosencephaly,\ there was no rim of cortex present. The pregnancy was )Tj 0 -1.473 TD (terminated and pathological examination confirmed the diagnosis.)Tj /TT4 1 Tf 9.4902 0 0 9.4902 409.0394 181.9815 Tm ( )Tj /TT3 1 Tf 11.1493 0 0 11.1493 37.098 150.0344 Tm (Holoprosencephaly)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(37 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 842 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 118.196 483.84 m 682.431 483.84 l 681.569 482.977 l 119.059 482.977 l h f 118.196 483.84 m 118.196 193.891 l 119.059 194.754 l 119.059 482.977 l h f 0.313 0.313 0.313 rg 682.431 483.84 m 682.431 193.891 l 681.569 194.754 l 681.569 482.977 l h f 118.196 193.891 m 682.431 193.891 l 681.569 194.754 l 119.059 194.754 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 126.824 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 125.961 476.075 m 396.863 476.075 l 396 475.213 l 126.824 475.213 l h f 125.961 476.075 m 125.961 256.938 l 126.824 257.801 l 126.824 475.213 l h f 0.949 0.945 0.935 rg 396.863 476.075 m 396.863 256.938 l 396 257.801 l 396 475.213 l h f 125.961 256.938 m 396.863 256.938 l 396 257.801 l 126.824 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 404.627 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 403.765 476.075 m 674.667 476.075 l 673.804 475.213 l 404.627 475.213 l h f 403.765 476.075 m 403.765 256.938 l 404.627 257.801 l 404.627 475.213 l h f 0.949 0.945 0.935 rg 674.667 476.075 m 674.667 256.938 l 673.804 257.801 l 673.804 475.213 l h f 403.765 256.938 m 674.667 256.938 l 673.804 257.801 l 404.627 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 125.961 250.036 m 396.863 250.036 l 396 249.173 l 126.824 249.173 l h f 125.961 250.036 m 125.961 201.656 l 126.824 202.519 l 126.824 249.173 l h f 0.949 0.945 0.935 rg 396.863 250.036 m 396.863 201.656 l 396 202.519 l 396 249.173 l h f 125.961 201.656 m 396.863 201.656 l 396 202.519 l 126.824 202.519 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 403.765 250.036 m 674.667 250.036 l 673.804 249.173 l 404.627 249.173 l h f 403.765 250.036 m 403.765 201.656 l 404.627 202.519 l 404.627 249.173 l h f 0.949 0.945 0.935 rg 674.667 250.036 m 674.667 201.656 l 673.804 202.519 l 673.804 249.173 l h f 403.765 201.656 m 674.667 201.656 l 673.804 202.519 l 404.627 202.519 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5727 Tm (Holoprosencephaly, with a birth prevalence of about 1 in 10 000, is char\ acterized by a spectrum of cerebral abnormalities )Tj 0 -1.473 TD (resulting from incomplete cleavage of the forebrain. There are three typ\ es according to the degree of forebrain cleavage. The )Tj T* (alobar type, which is the most severe, is characterized by a monoventric\ ular cavity and fusion of the thalami. In the semilobar )Tj T* (type, there is partial segmentation of the ventricles and cerebral hemis\ pheres posteriorly with incomplete fusion of the thalami)Tj (. )Tj T* (In lobar holoprosencephaly, there is normal separation of the ventricles\ and thalami but absence of the septum pellucidum. The )Tj T* (first two types are often accompanied by facial abnormalities. )Tj ET q 258.8235321 0 0 208.784317 131.1372528 262.114624 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 262.114624 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 131.1373 233.8638 Tm (Alobar type)Tj /TT0 1 Tf ( -monoventricular cavity and )Tj T* (fusion of the thalami at 11+2 weeks)Tj 9.4902 0 0 9.4902 335.259 217.4385 Tm ( )Tj 11.1493 0 0 11.1493 408.9412 233.8638 Tm (Increased Nucal Transluncency \(white )Tj T* (arrows\) at 11+2 weeks - trissomy 13. )Tj 9.4902 0 0 9.4902 37.098 186.0288 Tm ( )Tj 11.1493 0 0 11.1493 37.098 172.3985 Tm (Toth )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. observed a floating membranous structure in place of the skull of an 1\ 1-week fetus)Tj 8.9195 0 0 8.9195 567.8392 175.2528 Tm (41)Tj 11.1493 0 0 11.1493 579.1847 172.3985 Tm (. At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 843 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 453.14 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 349.463 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 32.784 203.288 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 581.9973 Tm (karyotype was trisomy 18)Tj 8.9195 0 0 8.9195 182.9312 584.8515 Tm (45)Tj 11.1493 0 0 11.1493 194.2767 581.9973 Tm (. Wong )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported three cases of alobar holoprocencephaly \(single ventricle an\ d fused thalami\) )Tj -14.098 -1.473 Td (at 10\22613 weeks; there was one case each of trisomy 18, triploidy and \ mosaic 18p deletion and duplication)Tj 8.9195 0 0 8.9195 636.6974 568.4262 Tm (46)Tj 11.1493 0 0 11.1493 648.0429 565.572 Tm (.)Tj -54.797 -1.937 Td (Snijders )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported on the sonographic features of 46 trisomy 13 fetuses at 10\226\ 14 weeks of gestation)Tj 8.9195 0 0 8.9195 633.1965 546.8244 Tm (47)Tj 11.1493 0 0 11.1493 644.5421 543.9702 Tm (. In 76% there was )Tj -54.483 -1.383 Td (increased nuchal translucency thickness, 64% were tachycardic, 24% had h\ oloprosencephaly and 10% had exomphalos. There )Tj 0 -1.473 TD (was no significant difference in nuchal translucency thickness between t\ hose with and those without holoprosencephaly or )Tj 0 -1.564 TD (exomphalos)Tj 8.9195 0 0 8.9195 104.295 497.5484 Tm (47)Tj 11.1493 0 0 11.1493 115.6405 494.6942 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 119.6989 494.6942 Tm ( )Tj /TT3 1 Tf ( )Tj 1 1 0 rg /TT4 1 Tf 11.1493 0 0 11.1493 43.1373 468.0676 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 443.5522 Tm ( )Tj 11.1493 0 0 11.1493 37.098 431.5724 Tm (In a screening study involving ultrasound examinations at 11\22614 weeks\ of gestation and again at 18\22620 weeks in 3991 )Tj 0 -1.29 TD (patients, there was one case of holoprosencephaly and this was not diagn\ osed in the first-trimester scan)Tj 8.9195 0 0 8.9195 626.362 420.0407 Tm (26)Tj 11.1493 0 0 11.1493 637.7075 417.1865 Tm (. Another screening )Tj -53.87 -1.2 Td (study for fetal abnormalities at 12\22614 weeks of gestation, involving \ 1632 pregnancies, correctly identified the one case of )Tj 0 -1.29 TD (holoprosencephaly)Tj 8.9195 0 0 8.9195 141.5449 392.2755 Tm (35)Tj 11.1493 0 0 11.1493 152.8904 389.4213 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 156.9488 389.4213 Tm ( )Tj /TT0 1 Tf ( )Tj /TT5 1 Tf 11.1493 0 0 11.1493 37.098 364.3907 Tm (Iniencephaly)Tj /TT3 1 Tf 9.4902 0 0 9.4902 37.098 335.3022 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 37.098 321.04 Tm (This is a rare malformation of unknown etiology, characterized by cervic\ al dysraphism and occipital \(inion\) defect with or )Tj 0 -1.473 TD (without an encephalocele.)Tj 0 -1.937 TD (Sherer )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of iniencephaly in a 13-week fetus; there was a\ crania, persistently hyperextended head )Tj 0 -1.564 TD (and spinal dysraphism)Tj 8.9195 0 0 8.9195 162.8066 268.435 Tm (48)Tj 11.1493 0 0 11.1493 174.1522 265.5807 Tm (. After termination, pathological examination demonstrated complete cran\ iorachischisis with )Tj -12.293 -1.383 Td (hyperextended cervical vertebrae.)Tj /TT5 1 Tf 0 -2.865 TD (Spina bifida)Tj /TT0 1 Tf 0 -2.867 TD (In spina bifida, there is failure of closure of the neural tube, which n\ ormally occurs by the 6th week of gestation. In the spin)Tj (e of )Tj 0 -1.473 TD (normal fetuses, there are three ossification centers, two pedicles and t\ he spinal body, and these are present from the 10th )Tj 0 -1.473 TD (week of gestation, allowing ultrasonographic visualization of the neural\ canal from this gestation. Braithwaite )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. assessed )Tj 0 -1.473 TD (the fetal anatomy at 12\22613 weeks of gestation, by a combination of tr\ ansabdominal and transvaginal sonography, and they )Tj 0 -1.564 TD (reported successful examination of the vertebrae and overlying skin in b\ oth the transverse and coronal planes in all cases)Tj 8.9195 0 0 8.9195 722.9485 122.3988 Tm (49)Tj 11.1493 0 0 11.1493 734.2941 119.5446 Tm (.)Tj -62.533 -1.847 Td (In the 1980s, the main method of screening for open spina bifida was by \ maternal serum a-fetoprotein at around 16 weeks of )Tj 0 -1.473 TD (gestation and the method of diagnosis was amniocentesis and measurement \ of amniotic fluid a-fetoprotein and acetyl )Tj 0 -1.564 TD (cholinesterase. Although it was possible to diagnose the condition by ul\ trasonographic examination of the spine)Tj 8.9195 0 0 8.9195 664.8383 67.9463 Tm (50)Tj 11.1493 0 0 11.1493 676.1838 65.0921 Tm (, the )Tj -57.321 -1.473 Td (sensitivity of this test was low)Tj 8.9195 0 0 8.9195 206.0103 51.521 Tm (51)Tj 11.1493 0 0 11.1493 217.3558 48.6667 Tm (. However, the observation, that spina bifida was associated with scallo\ ping of the frontal bones )Tj -16.168 -1.473 Td (\(the \221lemon\222 sign\) \()Tj 0 0 0.4 rg (Figure 11)Tj 0 0 0 rg (\), and caudal displacement of the cerebellum \(the \221banana\222 sign\)\ )Tj 8.9195 0 0 8.9195 562.1976 35.0956 Tm (52)Tj 11.1493 0 0 11.1493 573.5432 32.2414 Tm (, has led to the replacement of )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(39 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 844 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 130.706 284.932 267.451 27.608 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 284.932 267.451 27.608 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 130.706 31.284 267.451 27.608 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 31.284 267.451 27.608 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (biochemical assessment with ultrasonography, both for screening and for \ diagnosis of this abnormality.)Tj 9.4902 0 0 9.4902 37.098 564.5356 Tm ( )Tj 38.955 -2.009 Td ( )Tj ET q 258.8235321 0 0 208.784317 135.0196075 321.1668243 cm /Im0 Do Q q 258.8235321 0 0 208.784317 406.784317 321.1668243 cm /Im1 Do Q 1 1 1 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 144.1692 295.0729 Tm (Banana sign and cisterna magna < 2,0mm)Tj 32.277 0 Td (Lemon sign)Tj ET q 258.8235321 0 0 208.784317 135.0196075 67.5197601 cm /Im2 Do Q q 258.8235321 0 0 208.784317 406.784317 67.5197601 cm /Im3 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 184.435 41.4258 Tm (U-shaped spine \(transverse\))Tj 23.242 0 Td (early dilatation of the ventricules)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(40 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 845 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 130.706 339.882 267.451 27.608 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 339.882 267.451 27.608 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 38.824 78.106 722.98 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 208.784317 135.0196075 376.1176453 cm /Im0 Do Q q 258.8235321 0 0 208.784317 406.784317 376.1176453 cm /Im1 Do Q 1 1 1 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 151.0539 350.0237 Tm (spine lombar sacral defect \(longitudinal\))Tj 27.554 0 Td (mielomeningocele \(coronal\) )Tj 0 0 0 rg /TT1 1 Tf -20.803 -2.863 Td (Figure 11)Tj /TT0 1 Tf ( - Case Spina bifida + lemmon sign - 13 + 6 weeks)Tj 9.4902 0 0 9.4902 37.098 295.7844 Tm ( )Tj 11.1493 0 0 11.1493 37.098 283.161 Tm (In the 1990s, improvements in the quality of ultrasound equipment have l\ ed to the diagnosis of spina bifida during the first )Tj 0 -1.473 TD (trimester of pregnancy. Blumenfeld )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described the evolution of the cranial and cerebellar signs of spina b\ ifida in an )Tj 0 -1.564 TD (affected fetus that was scanned at 10, 12 and 15 weeks of gestation)Tj 8.9195 0 0 8.9195 422.8869 252.1577 Tm (53)Tj 11.1493 0 0 11.1493 434.2324 249.3035 Tm (. In the first scan, there was a sacral irregularity but the )Tj -35.62 -1.383 Td (cerebellum appeared normal; at 12 weeks, the banana sign was detected an\ d, at 15 weeks, when the diagnosis of sacral )Tj 0 -1.473 TD (meningocele was made, the lemon sign was identified. Sebire )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described that, in three cases of lumbosacral spina bifida )Tj 0 -1.564 TD (diagnosed at 12\22614 weeks of gestation, there was an associated lemon \ sign)Tj 8.9195 0 0 8.9195 465.7894 202.8817 Tm (54)Tj 11.1493 0 0 11.1493 477.135 200.0275 Tm (. Similarly, Bernard and colleagues reported the )Tj -39.468 -1.473 Td (diagnosis of spina bifida in a 12-week fetus with narrowing of the front\ al bones and flattening of the occiput)Tj 8.9195 0 0 8.9195 644.7472 186.4564 Tm (55)Tj 11.1493 0 0 11.1493 656.0927 183.6022 Tm (.)Tj -55.519 -1.847 Td (These findings demonstrate that, at least in some cases of spina bifida,\ the characteristic lemon and banana signs are present )Tj 0 -1.473 TD (from the first trimester of pregnancy. However, the prevalence of these \ signs at the 11\22614-week scan remains to be )Tj 0 -1.473 TD (determined.)Tj 9.4902 0 0 9.4902 37.098 111.6879 Tm ( )Tj 1 1 0 rg /TT3 1 Tf 11.1493 0 0 11.1493 43.1373 93.0329 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 68.5175 Tm ( )Tj 11.1493 0 0 11.1493 37.098 56.5378 Tm (In a screening study involving ultrasound examinations at 11\22614 weeks\ of gestation and 18\22620 weeks in 3991 patients, there )Tj 0 -1.29 TD (were six cases of spina bifida \(including one with associated exencepha\ ly\) and five of these were diagnosed at the early scan)Tj 8.9195 0 0 8.9195 741.0773 45.006 Tm (26)Tj 11.1493 0 0 11.1493 752.4229 42.1518 Tm (. )Tj -64.159 -1.29 Td (In two other screening studies involving 1632 pregnancies at 12\22614 we\ eks)Tj 8.9195 0 0 8.9195 458.8546 30.62 Tm (35)Tj 11.1493 0 0 11.1493 470.2001 27.7658 Tm ( and 1473 pregnancies at 10\22614 weeks)Tj 8.9195 0 0 8.9195 691.6145 30.62 Tm (27)Tj 11.1493 0 0 11.1493 702.96 27.7658 Tm (, )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(41 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 846 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 552.575 735.059 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.6479 Tm (respectively, there were two cases of spina bifida \(one in each\) and t\ hese were not diagnosed in the first-trimester scan.)Tj 9.4902 0 0 9.4902 717.6861 583.6479 Tm ( )Tj 1 1 1 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 559.9234 Tm (CARDIAC DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.187 TD (Abnormalities of the heart and great arteries are the most common congen\ ital defects and the birth prevalence is 5\22610 per )Tj 0 -1.473 TD (1000. In general, about half are either lethal or require surgery and ha\ lf are asymptomatic. The first two groups are referred t)Tj (o )Tj T* (as major. Specialist echocardiography at around 20 weeks of gestation ca\ n identify most of the major cardiac defects, but the )Tj T* (main challenge in prenatal diagnosis is to identify the high-risk group \ for referral to specialist centers. Currently, screening)Tj ( is )Tj 0 -1.473 TD (based on examination of the four-chamber view of the heart at the 20-wee\ k scan, but this identifies only 26% of the major )Tj 0 -1.564 TD (cardiac defects)Tj 8.9195 0 0 8.9195 120.9744 455.2606 Tm (56)Tj 11.1493 0 0 11.1493 132.3199 452.4064 Tm (.)Tj -8.541 -1.937 Td (Examination of the four-chamber view of the heart can now be carried out\ at the 11\22614-week scan \()Tj 0 0 0.4 rg (Table 2)Tj 0 0 0 rg (\))Tj 8.9195 0 0 8.9195 650.4333 433.6588 Tm (57\22660)Tj 11.1493 0 0 11.1493 678.7972 430.8046 Tm (. At 12\22613 )Tj -57.555 -1.47 Td (weeks of gestation, the four-chamber view can be examined successfully b\ y transabdominal ultrasound in 76% of the cases and )Tj 0 -1.564 TD (transvaginally in 95%)Tj 8.9195 0 0 8.9195 159.7294 399.8345 Tm (49)Tj 11.1493 0 0 11.1493 171.075 396.9803 Tm (. Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported that the diameters of the two ventricles were similar and inc\ reased linearly )Tj -12.017 -1.383 Td (with gestation from about 1.5 mm at 11 weeks to 3 mm at 14 weeks; the di\ ameter of the heart was about one-third that of the )Tj 0 -1.564 TD (chest and the ratio did not change with gestation)Tj 8.9195 0 0 8.9195 313.4563 366.9838 Tm (58)Tj 11.1493 0 0 11.1493 324.8018 364.1296 Tm (. In contrast, Blaas )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. examined the ratio of the heart diameter to that of )Tj -25.805 -1.473 Td (the abdomen and reported a decrease with gestation from 51% at 8 weeks t\ o 42% at 12 weeks)Tj 8.9195 0 0 8.9195 577.3607 350.5585 Tm (11)Tj 11.1493 0 0 11.1493 588.7063 347.7043 Tm (.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 592.7646 347.7043 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 147.098 322.587 Tm (Table 2)Tj /TT0 1 Tf ( - Studies reporting on the proportion of cases where the four-chamber v\ iew of )Tj 0 -1.201 TD (the heart was successfully visualized by ultrasonography at 10\22614 wee\ ks of gestation)Tj ET 0.5 0.5 0.5 rg 147.098 291.517 m 147.098 293.242 l 653.529 293.242 l 652.667 292.38 l 147.961 292.38 l 147.961 292.38 l h f 0.875 0.875 0.875 rg 653.529 293.242 m 653.529 291.517 l 147.098 291.517 l 147.961 292.38 l 652.667 292.38 l 652.667 292.38 l h f 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 147.098 269.0863 Tm (Author)Tj 15.625 0 Td (10 weeks)Tj 6.953 0 Td (11 weeks)Tj 7.625 0 Td (12 weeks)Tj 6.604 0 Td (13 and 14 weeks)Tj ET 0.5 0.5 0.5 rg 147.098 250.961 m 147.098 252.687 l 653.529 252.687 l 652.667 251.824 l 147.961 251.824 l 147.961 251.824 l h f 0.875 0.875 0.875 rg 653.529 252.687 m 653.529 250.961 l 147.098 250.961 l 147.961 251.824 l 652.667 251.824 l 652.667 251.824 l h f 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 147.098 226.2298 Tm (Dolkart & Reimers 1991)Tj 8.9195 0 0 8.9195 281.7261 229.084 Tm ( 57)Tj 11.1493 0 0 11.1493 338.1507 226.7332 Tm (0/8)Tj 4.831 0 Td (3/10 \(30%\) )Tj 7.625 0 Td (9/10 \(90%\))Tj 7.885 0 Td (24/24 \(100%\) )Tj -37.476 -1.877 Td (Bronshetein et.al, 1992 )Tj 8.9195 0 0 8.9195 283.0417 208.6588 Tm (58)Tj 11.1493 0 0 11.1493 335.1181 206.308 Tm (-----)Tj 5.103 0 Td (3/18 \(16%\))Tj 7.625 0 Td (9/25 \(36%\))Tj 8.203 0 Td (66/72 \(90%\))Tj -37.794 -2.432 Td (Johnson et al. 1992 )Tj 8.9195 0 0 8.9195 261.6016 182.0474 Tm (59)Tj 11.1493 0 0 11.1493 332.6429 186.3862 Tm (7/26 )Tj -0.271 -1.2 Td (\(27%\) )Tj 6.906 1.2 Td (19/33 )Tj 0.047 -1.2 Td (\(58%\) )Tj 5.95 0.6 Td (36/51 \(71%\) )Tj 8.203 0 Td (73/100 \(73%\) )Tj -37.476 -2.987 Td (Gembruch et al. 1993)Tj 8.9195 0 0 8.9195 269.8521 149.2498 Tm (60)Tj 11.1493 0 0 11.1493 281.1976 146.3956 Tm ( )Tj 4.836 0.045 Td (-----)Tj 6.413 0.6 Td (12/15 )Tj 0.047 -1.2 Td (\(80%\) )Tj 5.95 0.6 Td (28/30 \(93%\) )Tj 8.203 0 Td (66/66 \(100%\) )Tj ET 0.5 0.5 0.5 rg 147.098 123.378 m 147.098 125.104 l 653.529 125.104 l 652.667 124.241 l 147.961 124.241 l 147.961 124.241 l h f 0.875 0.875 0.875 rg 653.529 125.104 m 653.529 123.378 l 147.098 123.378 l 147.961 124.241 l 652.667 124.241 l 652.667 124.241 l h f 0 0 0 rg BT /TT0 1 Tf 9.4902 0 0 9.4902 37.098 105.1629 Tm ( )Tj 11.1493 0 0 11.1493 37.098 92.5394 Tm (Dolkart and Reimers reported that the earliest defined cardiac structure\ s visible were the mitral and tricuspid valves; at 10 )Tj 0 -1.564 TD (weeks, they were seen in 25% of the cases, at 12 weeks in 90% and at 13\226\ 14 weeks in all cases)Tj 8.9195 0 0 8.9195 584.552 77.9615 Tm (57)Tj 11.1493 0 0 11.1493 595.8976 75.1073 Tm (. The five-chamber, aortic )Tj -50.12 -1.383 Td (arch and ductus arteriosus views were first seen in some fetuses from 12\ weeks but, in the majority, only at 14 weeks. The )Tj 0 -1.473 TD (aortic root in short-axis projection and the left ventricle in long-axis\ view could be imaged in 70% and 40% of fetuses, )Tj 0 -1.564 TD (respectively by 12 weeks. Aortic and pulmonary valves were first visuali\ zed at 12 weeks in 20% of the cases)Tj 8.9195 0 0 8.9195 649.4634 28.6855 Tm (57)Tj 11.1493 0 0 11.1493 660.8089 25.8313 Tm (. Johnson )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(42 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 847 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (reported that the proportion of cases in which a full cardiac anatomic s\ urvey \(four-chamber, aorta, pulmonary artery and )Tj 0 -1.564 TD (pulmonary veins\) was possible was 0% at 10\22611 weeks, 31% at 12 weeks\ , 43% at 13 weeks and 46% at 14 weeks)Tj 8.9195 0 0 8.9195 689.9242 568.4262 Tm (59)Tj 11.1493 0 0 11.1493 701.2698 565.572 Tm (. )Tj -59.571 -1.383 Td (Gembruch )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. visualized the four-chamber view as well as the origin and double cros\ sing of the aorta and pulmonary trunk in )Tj T* (67% of cases at 11 weeks, 80% at 12 weeks and 100% at 13\22614 weeks)Tj 8.9195 0 0 8.9195 445.4531 535.5755 Tm (60)Tj 11.1493 0 0 11.1493 456.7986 532.7213 Tm (.)Tj -37.644 -1.847 Td (There are several case reports on the sonographic diagnosis of cardiac d\ efects at 11\22614 weeks of gestation. Gembruch )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. )Tj 0 -1.473 TD (reported an 11-week fetus with persistent bradycardia \(60 bpm\), increa\ sed nuchal translucency, complete atrioventricular canal )Tj 0 -1.473 TD (defect and complete heart block; the pregnancy was terminated and pathol\ ogical examination demonstrated situs inversus )Tj 0 -1.564 TD (visceralis totalis and confirmed the septal defect)Tj 8.9195 0 0 8.9195 308.6398 464.6977 Tm (61)Tj 11.1493 0 0 11.1493 319.9853 461.8435 Tm (. DeVore )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. examined a 14-week fetus with persistent bradycardia \(70 )Tj -25.373 -1.383 Td (bpm\) and found ventricular septal defect, ventricular wall hypertrophy,\ dilated aortic root, pericardial effusion, ascites and s)Tj (itus )Tj T* (inversus of the stomach; pathological examination after intrauterine dea\ th at 16 weeks confirmed the ultrasound findings)Tj 8.9195 0 0 8.9195 721.3319 431.847 Tm (62)Tj 11.1493 0 0 11.1493 732.6774 428.9928 Tm (. )Tj -62.388 -1.383 Td (Bronshtein )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the ultrasound findings in a 13-week fetus with ventricular s\ eptal defect and overriding aorta, )Tj T* (suggesting the diagnosis of tetralogy of Fallot)Tj 8.9195 0 0 8.9195 293.577 398.9964 Tm (63)Tj 11.1493 0 0 11.1493 304.9226 396.1421 Tm (. In addition, there was increased nuchal translucency thickness and )Tj -24.022 -1.383 Td (exomphalos, and cytogenetic analysis demonstrated trisomy 18. Pathologic\ al examination after intrauterine death at 17 weeks )Tj 0 -1.473 TD (confirmed the diagnosis of tetralogy of Fallot. In another case of exomp\ halos at 13 weeks, pericardial effusion and ventricular )Tj T* (septal defect were identified; the fetal karyotype was normal. At 18 wee\ ks, hydrocephalus and oligohydramnios were also )Tj T* (noted and pathological examination after intrauterine death at 21 weeks \ confirmed the ultrasound findings and in addition, )Tj 0 -1.564 TD (there was a double-outlet right ventricle and absence of the ductus arte\ riosus)Tj 8.9195 0 0 8.9195 475.0545 316.8697 Tm (63)Tj 11.1493 0 0 11.1493 486.4001 314.0154 Tm (.)Tj -40.299 -1.937 Td (Achiron )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the sonographic findings in eight fetuses with cardiac defect\ s diagnosed at 10\22612 weeks of gestation)Tj 8.9195 0 0 8.9195 734.9787 295.2678 Tm (64)Tj 11.1493 0 0 11.1493 746.3242 292.4136 Tm (. )Tj -63.612 -1.383 Td (In seven of the cases, there was increased nuchal translucency thickness\ and pericardial effusion; the fetal karyotype was )Tj 0 -1.473 TD (normal in seven and one had Turner syndrome. There was one case of tachy\ cardia, one of ectopia cordis in association with )Tj T* (exomphalos, one with a giant right atrium that, in subsequent pathologic\ al examination after termination of pregnancy, was )Tj T* (diagnosed as Uhl disease, two cases with atrioventricular septal defects\ and three cases with ventricular septal defects; )Tj 0 -1.564 TD (pathological examination in the latter group showed tetralogy of Fallot \ in two and persistent truncus arteriosus in the third)Tj 8.9195 0 0 8.9195 726.9177 213.1411 Tm (64)Tj 11.1493 0 0 11.1493 738.2632 210.2869 Tm (.)Tj -62.889 -1.847 Td (Bronshtein )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the results of an ultrasound screening study involving 81 fet\ uses at 12 weeks, 341 at 13 weeks and )Tj T* (980 at 14 weeks)Tj 8.9195 0 0 8.9195 130.2395 175.114 Tm (65)Tj 11.1493 0 0 11.1493 141.585 172.2598 Tm (. Five fetuses with cardiac defects were identified, including one with \ a small left ventricle and pericardial )Tj -9.372 -1.383 Td (effusion at 11 weeks, one with ventricular septal defect, dilated left v\ entricle and pericardial effusion at 12 weeks that was )Tj 0 -1.473 TD (subsequently diagnosed as tetralogy of Fallot, one with ventricular sept\ al defect and overriding aorta at 13 weeks, one with )Tj T* (dextrocardia at 14 weeks that was subsequently found to also have a vent\ ricular septal defect, and another with a single atrium )Tj T* (and single ventricle at 14 weeks.)Tj 0 -1.937 TD (Gembruch )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the results of ultrasound screening in 15 fetuses at 11 weeks\ , 30 at 12 weeks, 51 at 13 weeks and 11 )Tj 0 -1.564 TD (at 14 weeks)Tj 8.9195 0 0 8.9195 105.042 71.3855 Tm (60)Tj 11.1493 0 0 11.1493 116.3876 68.5313 Tm (. There were ten fetuses with cardiac anomalies and, in nine of these, t\ he diagnosis was correctly made at the 11\226)Tj -7.112 -1.383 Td (14-week scan; in one case, complete atrioventricular septal defect with \ double- outlet right ventricle was not detected at 12 )Tj 0 -1.473 TD (weeks but was correctly diagnosed at 21 weeks. The defects identified we\ re: five cases with complete atrioventricular septal )Tj T* (defect, including one with dextrocardia and two with atrioventricular he\ art block; there was one case of single ventricle and )Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(43 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 848 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 579.8367 Tm (common atrium that was subsequently, at the 20-week scan, also found to \ have dextrocardia, malposition of the great arteries )Tj 0 -1.473 TD (and situs inversus visceralis; one case of perimembranous ventricular se\ ptal defect; one case with suspected single ventricle )Tj T* (and hypoplasia of the aorta that was subsequently found at postmortem ex\ amination to have hypoplastic left heart, hypoplasia )Tj T* (of the ascending aorta and the aortic arch, right-sided isomerism of the\ atria and asplenia; one case of hypoplastic left heart,)Tj ( )Tj T* (hypoplastic aorta and left ventricular endocardial fibroelastosis. In ei\ ght of the ten cases with cardiac defects, there was )Tj T* (increased nuchal translucency thickness; the fetal karyotype was normal \ in six cases, trisomy 21 in two, trisomy 18 in one and )Tj 0 -1.564 TD (Turner syndrome in one)Tj 8.9195 0 0 8.9195 172.0383 483.1321 Tm (60)Tj 11.1493 0 0 11.1493 183.3838 480.2779 Tm (.)Tj 9.4902 0 0 9.4902 37.098 462.8161 Tm ( )Tj 11.1493 0 0 11.1493 37.098 450.1926 Tm (Abnormalities of the heart and great arteries are the most common congen\ ital defects and the birth prevalence is 5\22610 per )Tj 0 -1.473 TD (1000. In general, about half are either lethal or require surgery and ha\ lf are asymptomatic. The first two groups are referred t)Tj (o )Tj T* (as major. Specialist echocardiography at around 20 weeks of gestation ca\ n identify most of the major cardiac defects, but the )Tj T* (main challenge in prenatal diagnosis is to identify the high-risk group \ for referral to specialist centers. Currently, screening)Tj ( is )Tj T* (based on examination of the four-chamber view of the heart at the 20-wee\ k scan, but this identifies only 26% of the major )Tj 0 -1.564 TD (cardiac defects)Tj 8.9195 0 0 8.9195 120.9744 369.9134 Tm (56)Tj 11.1493 0 0 11.1493 132.3199 367.0592 Tm (.)Tj -8.541 -1.937 Td (Examination of the four-chamber view of the heart can now be carried out\ at the 11\22614-week scan \()Tj 0 0 0.4 rg (Table 2)Tj 0 0 0 rg (\))Tj 8.9195 0 0 8.9195 650.4333 348.3116 Tm (57\22660)Tj 11.1493 0 0 11.1493 678.7972 345.4574 Tm (. At 12\22613 )Tj -57.555 -1.47 Td (weeks of gestation, the four-chamber view can be examined successfully b\ y transabdominal ultrasound in 76% of the cases and )Tj 0 -1.564 TD (transvaginally in 95%)Tj 8.9195 0 0 8.9195 159.7294 314.4873 Tm (49)Tj 11.1493 0 0 11.1493 171.075 311.6331 Tm (. Bronshtein )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported that the diameters of the two ventricles were similar and inc\ reased linearly )Tj -12.017 -1.383 Td (with gestation from about 1.5 mm at 11 weeks to 3 mm at 14 weeks; the di\ ameter of the heart was about one-third that of the )Tj 0 -1.564 TD (chest and the ratio did not change with gestation)Tj 8.9195 0 0 8.9195 313.4563 281.6366 Tm (58)Tj 11.1493 0 0 11.1493 324.8018 278.7824 Tm (. In contrast, Blaas )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. examined the ratio of the heart diameter to that of )Tj -25.805 -1.473 Td (the abdomen and reported a decrease with gestation from 51% at 8 weeks t\ o 42% at 12 weeks)Tj 8.9195 0 0 8.9195 577.3607 265.2113 Tm (11)Tj 11.1493 0 0 11.1493 588.7063 262.3571 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 592.7646 262.3571 Tm ( )Tj /TT3 1 Tf 11.1493 0 0 11.1493 147.098 237.2398 Tm (Table 2)Tj /TT0 1 Tf ( - Studies reporting on the proportion of cases where the four-chamber v\ iew of )Tj 0 -1.201 TD (the heart was successfully visualized by ultrasonography at 10\22614 wee\ ks of gestation)Tj ET 0.5 0.5 0.5 rg 147.098 206.17 m 147.098 207.895 l 653.529 207.895 l 652.667 207.032 l 147.961 207.032 l 147.961 207.032 l h f 0.875 0.875 0.875 rg 653.529 207.895 m 653.529 206.17 l 147.098 206.17 l 147.961 207.032 l 652.667 207.032 l 652.667 207.032 l h f 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 147.098 183.7391 Tm (Author)Tj 15.625 0 Td (10 weeks)Tj 6.953 0 Td (11 weeks)Tj 7.625 0 Td (12 weeks)Tj 6.604 0 Td (13 and 14 weeks)Tj ET 0.5 0.5 0.5 rg 147.098 165.614 m 147.098 167.34 l 653.529 167.34 l 652.667 166.477 l 147.961 166.477 l 147.961 166.477 l h f 0.875 0.875 0.875 rg 653.529 167.34 m 653.529 165.614 l 147.098 165.614 l 147.961 166.477 l 652.667 166.477 l 652.667 166.477 l h f 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 147.098 140.8826 Tm (Dolkart & Reimers 1991)Tj 8.9195 0 0 8.9195 281.7261 143.7368 Tm ( 57)Tj 11.1493 0 0 11.1493 338.1507 141.3859 Tm (0/8)Tj 4.831 0 Td (3/10 \(30%\) )Tj 7.625 0 Td (9/10 \(90%\))Tj 7.885 0 Td (24/24 \(100%\) )Tj -37.476 -1.877 Td (Bronshetein et.al, 1992 )Tj 8.9195 0 0 8.9195 283.0417 123.3116 Tm (58)Tj 11.1493 0 0 11.1493 335.1181 120.9608 Tm (-----)Tj 5.103 0 Td (3/18 \(16%\))Tj 7.625 0 Td (9/25 \(36%\))Tj 8.203 0 Td (66/72 \(90%\))Tj -37.794 -2.432 Td (Johnson et al. 1992 )Tj 8.9195 0 0 8.9195 261.6016 96.7002 Tm (59)Tj 11.1493 0 0 11.1493 332.6429 101.039 Tm (7/26 )Tj -0.271 -1.2 Td (\(27%\) )Tj 6.906 1.2 Td (19/33 )Tj 0.047 -1.2 Td (\(58%\) )Tj 5.95 0.6 Td (36/51 \(71%\) )Tj 8.203 0 Td (73/100 \(73%\) )Tj -37.476 -2.987 Td (Gembruch et al. 1993)Tj 8.9195 0 0 8.9195 269.8521 63.9026 Tm (60)Tj 11.1493 0 0 11.1493 281.1976 61.0484 Tm ( )Tj 4.836 0.045 Td (-----)Tj 6.413 0.6 Td (12/15 )Tj 0.047 -1.2 Td (\(80%\) )Tj 5.95 0.6 Td (28/30 \(93%\) )Tj 8.203 0 Td (66/66 \(100%\) )Tj ET 0.5 0.5 0.5 rg 147.098 38.031 m 147.098 39.757 l 653.529 39.757 l 652.667 38.894 l 147.961 38.894 l 147.961 38.894 l h f 0.875 0.875 0.875 rg 653.529 39.757 m 653.529 38.031 l 147.098 38.031 l 147.961 38.894 l 652.667 38.894 l 652.667 38.894 l h f 0 0 0 rg BT /TT0 1 Tf 9.4902 0 0 9.4902 37.098 19.8157 Tm ( )Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(44 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 849 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (Dolkart and Reimers reported that the earliest defined cardiac structure\ s visible were the mitral and tricuspid valves; at 10 )Tj 0 -1.564 TD (weeks, they were seen in 25% of the cases, at 12 weeks in 90% and at 13\226\ 14 weeks in all cases)Tj 8.9195 0 0 8.9195 584.552 568.4262 Tm (57)Tj 11.1493 0 0 11.1493 595.8976 565.572 Tm (. The five-chamber, aortic )Tj -50.12 -1.383 Td (arch and ductus arteriosus views were first seen in some fetuses from 12\ weeks but, in the majority, only at 14 weeks. The )Tj 0 -1.473 TD (aortic root in short-axis projection and the left ventricle in long-axis\ view could be imaged in 70% and 40% of fetuses, )Tj 0 -1.564 TD (respectively by 12 weeks. Aortic and pulmonary valves were first visuali\ zed at 12 weeks in 20% of the cases)Tj 8.9195 0 0 8.9195 649.4634 519.1502 Tm (57)Tj 11.1493 0 0 11.1493 660.8089 516.296 Tm (. Johnson )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. )Tj -55.942 -1.383 Td (reported that the proportion of cases in which a full cardiac anatomic s\ urvey \(four-chamber, aorta, pulmonary artery and )Tj T* (pulmonary veins\) was possible was 0% at 10\22611 weeks, 31% at 12 weeks\ , 43% at 13 weeks and 46% at 14 weeks)Tj 8.9195 0 0 8.9195 689.9242 486.2995 Tm (59)Tj 11.1493 0 0 11.1493 701.2698 483.4453 Tm (. )Tj -59.571 -1.383 Td (Gembruch )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. visualized the four-chamber view as well as the origin and double cros\ sing of the aorta and pulmonary trunk in )Tj T* (67% of cases at 11 weeks, 80% at 12 weeks and 100% at 13\22614 weeks)Tj 8.9195 0 0 8.9195 445.4531 453.4488 Tm (60)Tj 11.1493 0 0 11.1493 456.7986 450.5946 Tm (.)Tj -37.644 -1.847 Td (There are several case reports on the sonographic diagnosis of cardiac d\ efects at 11\22614 weeks of gestation. Gembruch )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. )Tj 0 -1.473 TD (reported an 11-week fetus with persistent bradycardia \(60 bpm\), increa\ sed nuchal translucency, complete atrioventricular canal )Tj 0 -1.473 TD (defect and complete heart block; the pregnancy was terminated and pathol\ ogical examination demonstrated situs inversus )Tj 0 -1.564 TD (visceralis totalis and confirmed the septal defect)Tj 8.9195 0 0 8.9195 308.6398 382.571 Tm (61)Tj 11.1493 0 0 11.1493 319.9853 379.7168 Tm (. DeVore )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. examined a 14-week fetus with persistent bradycardia \(70 )Tj -25.373 -1.383 Td (bpm\) and found ventricular septal defect, ventricular wall hypertrophy,\ dilated aortic root, pericardial effusion, ascites and s)Tj (itus )Tj T* (inversus of the stomach; pathological examination after intrauterine dea\ th at 16 weeks confirmed the ultrasound findings)Tj 8.9195 0 0 8.9195 721.3319 349.7203 Tm (62)Tj 11.1493 0 0 11.1493 732.6774 346.8661 Tm (. )Tj -62.388 -1.383 Td (Bronshtein )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the ultrasound findings in a 13-week fetus with ventricular s\ eptal defect and overriding aorta, )Tj T* (suggesting the diagnosis of tetralogy of Fallot)Tj 8.9195 0 0 8.9195 293.577 316.8697 Tm (63)Tj 11.1493 0 0 11.1493 304.9226 314.0154 Tm (. In addition, there was increased nuchal translucency thickness and )Tj -24.022 -1.383 Td (exomphalos, and cytogenetic analysis demonstrated trisomy 18. Pathologic\ al examination after intrauterine death at 17 weeks )Tj 0 -1.473 TD (confirmed the diagnosis of tetralogy of Fallot. In another case of exomp\ halos at 13 weeks, pericardial effusion and ventricular )Tj T* (septal defect were identified; the fetal karyotype was normal. At 18 wee\ ks, hydrocephalus and oligohydramnios were also )Tj T* (noted and pathological examination after intrauterine death at 21 weeks \ confirmed the ultrasound findings and in addition, )Tj 0 -1.564 TD (there was a double-outlet right ventricle and absence of the ductus arte\ riosus)Tj 8.9195 0 0 8.9195 475.0545 234.743 Tm (63)Tj 11.1493 0 0 11.1493 486.4001 231.8887 Tm (.)Tj -40.299 -1.937 Td (Achiron )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the sonographic findings in eight fetuses with cardiac defect\ s diagnosed at 10\22612 weeks of gestation)Tj 8.9195 0 0 8.9195 734.9787 213.1411 Tm (64)Tj 11.1493 0 0 11.1493 746.3242 210.2869 Tm (. )Tj -63.612 -1.383 Td (In seven of the cases, there was increased nuchal translucency thickness\ and pericardial effusion; the fetal karyotype was )Tj 0 -1.473 TD (normal in seven and one had Turner syndrome. There was one case of tachy\ cardia, one of ectopia cordis in association with )Tj T* (exomphalos, one with a giant right atrium that, in subsequent pathologic\ al examination after termination of pregnancy, was )Tj T* (diagnosed as Uhl disease, two cases with atrioventricular septal defects\ and three cases with ventricular septal defects; )Tj 0 -1.564 TD (pathological examination in the latter group showed tetralogy of Fallot \ in two and persistent truncus arteriosus in the third)Tj 8.9195 0 0 8.9195 726.9177 131.0145 Tm (64)Tj 11.1493 0 0 11.1493 738.2632 128.1602 Tm (.)Tj -62.889 -1.847 Td (Bronshtein )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the results of an ultrasound screening study involving 81 fet\ uses at 12 weeks, 341 at 13 weeks and )Tj T* (980 at 14 weeks)Tj 8.9195 0 0 8.9195 130.2395 92.9873 Tm (65)Tj 11.1493 0 0 11.1493 141.585 90.1331 Tm (. Five fetuses with cardiac defects were identified, including one with \ a small left ventricle and pericardial )Tj -9.372 -1.383 Td (effusion at 11 weeks, one with ventricular septal defect, dilated left v\ entricle and pericardial effusion at 12 weeks that was )Tj 0 -1.473 TD (subsequently diagnosed as tetralogy of Fallot, one with ventricular sept\ al defect and overriding aorta at 13 weeks, one with )Tj T* (dextrocardia at 14 weeks that was subsequently found to also have a vent\ ricular septal defect, and another with a single atrium )Tj T* (and single ventricle at 14 weeks.)Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(45 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 850 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 170.842 722.98 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 579.8367 Tm (Gembruch )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the results of ultrasound screening in 15 fetuses at 11 weeks\ , 30 at 12 weeks, 51 at 13 weeks and 11 )Tj 0 -1.564 TD (at 14 weeks)Tj 8.9195 0 0 8.9195 105.042 565.2588 Tm (60)Tj 11.1493 0 0 11.1493 116.3876 562.4046 Tm (. There were ten fetuses with cardiac anomalies and, in nine of these, t\ he diagnosis was correctly made at the 11\226)Tj -7.112 -1.383 Td (14-week scan; in one case, complete atrioventricular septal defect with \ double- outlet right ventricle was not detected at 12 )Tj 0 -1.473 TD (weeks but was correctly diagnosed at 21 weeks. The defects identified we\ re: five cases with complete atrioventricular septal )Tj T* (defect, including one with dextrocardia and two with atrioventricular he\ art block; there was one case of single ventricle and )Tj T* (common atrium that was subsequently, at the 20-week scan, also found to \ have dextrocardia, malposition of the great arteries )Tj T* (and situs inversus visceralis; one case of perimembranous ventricular se\ ptal defect; one case with suspected single ventricle )Tj T* (and hypoplasia of the aorta that was subsequently found at postmortem ex\ amination to have hypoplastic left heart, hypoplasia )Tj 0 -1.473 TD (of the ascending aorta and the aortic arch, right-sided isomerism of the\ atria and asplenia; one case of hypoplastic left heart,)Tj ( )Tj 0 -1.473 TD (hypoplastic aorta and left ventricular endocardial fibroelastosis. In ei\ ght of the ten cases with cardiac defects, there was )Tj T* (increased nuchal translucency thickness; the fetal karyotype was normal \ in six cases, trisomy 21 in two, trisomy 18 in one and )Tj 0 -1.564 TD (Turner syndrome in one)Tj 8.9195 0 0 8.9195 172.0383 401.0054 Tm (60)Tj 11.1493 0 0 11.1493 183.3838 398.1512 Tm (.)Tj -13.121 -1.689 Td ( )Tj 0 -1.158 TD (In a study of 29 154 chromosomally normal, singleton pregnancies, 56% of\ major abnormalities of the heart and great arteries )Tj 0 -1.564 TD (were found in the subgroup with nuchal translucency above the 95th centi\ le)Tj 8.9195 0 0 8.9195 464.8529 351.8289 Tm (66)Tj 11.1493 0 0 11.1493 476.1985 348.9747 Tm (. Therefore, measurement of nuchal translucency )Tj -39.384 -1.383 Td (thickness at 11\22614 weeks may constitute the most effective method of \ screening for cardiac defects.)Tj 0 -1.937 TD (In patients with increased nuchal translucency, it is now possible to un\ dertake detailed cardiac scanning in early pregnancy. A )Tj 0 -1.473 TD (specialist scan from 14 weeks can effectively reassure the majority of p\ arents that there is no major cardiac defect. In the )Tj 0 -1.473 TD (cases with a major defect, the early scan can either lead to the correct\ diagnosis or at least raise suspicions so that follow-u)Tj (p )Tj T* (scans are carried out. The scans can be performed either transvaginally \ or transabdominally. However, more important than )Tj 0 -1.473 TD (the actual route for such a scan is the need to use high-quality equipme\ nt and, in particular, with facilities for color Doppler)Tj ( )Tj 0 -1.473 TD (examination. At 14 weeks, the gray scale alone is not sufficient for acc\ urate examination of the heart and it is necessary also )Tj (to )Tj T* (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 0 rg /TT2 1 Tf 0.542 -2.478 Td (Screening studies \226 relation to nuchal translucency thickness)Tj 0 0 0 rg /TT0 1 Tf -0.542 -2.322 Td ( )Tj 0 -1.158 TD (In a study of 29 154 chromosomally normal, singleton pregnancies, 56% of\ major abnormalities of the heart and great arteries )Tj 0 -1.564 TD (were found in the subgroup with nuchal translucency above the 95th centi\ le)Tj 8.9195 0 0 8.9195 464.8529 132.393 Tm (66)Tj 11.1493 0 0 11.1493 476.1985 129.5388 Tm (. Therefore, measurement of nuchal translucency )Tj -39.384 -1.383 Td (thickness at 11\22614 weeks may constitute the most effective method of \ screening for cardiac defects.)Tj 0 -1.937 TD (In patients with increased nuchal translucency, it is now possible to un\ dertake detailed cardiac scanning in early pregnancy. A )Tj 0 -1.473 TD (specialist scan from 14 weeks can effectively reassure the majority of p\ arents that there is no major cardiac defect. In the )Tj 0 -1.473 TD (cases with a major defect, the early scan can either lead to the correct\ diagnosis or at least raise suspicions so that follow-u)Tj (p )Tj T* (scans are carried out. The scans can be performed either transvaginally \ or transabdominally. However, more important than )Tj 0 -1.473 TD (the actual route for such a scan is the need to use high-quality equipme\ nt and, in particular, with facilities for color Doppler)Tj ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(46 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 851 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 527.927 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 430.089 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (examination. At 14 weeks, the gray scale alone is not sufficient for acc\ urate examination of the heart and it is necessary also )Tj (to )Tj 0 -1.473 TD (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (ABDOMINAL WALL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.129 TD (Sonographically, the stomach is identified as a sonolucent cystic struct\ ure in the upper left quadrant of the abdomen. It is fir)Tj (st )Tj 0 -1.29 TD (visualized at 8\2269 weeks and it is seen in all cases by 12\22613 weeks\ )Tj 8.9195 0 0 8.9195 410.7675 500.0039 Tm (11,18,49)Tj 11.1493 0 0 11.1493 451.2976 497.1497 Tm (. At 8\22610 weeks, of gestation, all fetuses demonstrate )Tj -37.15 -1.2 Td (herniation of the midgut that is visualized as a hyperechogenic mass in \ the base of the umbilical cord; retraction into the )Tj 0 -1.29 TD (abdominal cavity occurs at 10\22612 weeks and it is completed by 11 week\ s and 5 days)Tj 8.9195 0 0 8.9195 516.0506 472.2387 Tm (11,67,68)Tj 11.1493 0 0 11.1493 556.5806 469.3845 Tm (.)Tj /TT1 1 Tf -46.593 -2.186 Td (Exomphalos)Tj /TT0 1 Tf 0 -2.867 TD (This is a sporadic abnormality with a birth prevalence of about 1 in 400\ 0. Prenatal diagnosis by ultrasound is based on the )Tj 0 -1.473 TD (demonstration of the mid-line anterior abdominal wall defect, the hernia\ ted sac with its visceral contents and the umbilical cor)Tj (d )Tj T* (insertion at the apex of the sac \()Tj 0 0 0.4 rg (Figure 12)Tj 0 0 0 rg (\). Occasionally, there is an associated failure in the cephalic embryon\ ic fold, resulting )Tj T* (in the pentalogy of Cantrell \(omphalocele, anterior diaphragmatic herni\ a, sternal cleft, ectopia cordis and cardiac defects\) or )Tj 0 -1.473 TD (failure of the caudal fold, in which case the omphalocele may be associa\ ted with exstrophy of the bladder or cloaca, imperforate)Tj ( )Tj 0 -1.473 TD (anus, colonic atresia and sacral vertebral defects. Fetal exomphalos is \ associated with chromosomal defects, usually trisomy )Tj T* (18, in about 30% of cases at mid-gestation and in 15% of neonates.)Tj 0 -1.938 TD (Schmidt and Kubli described a case of exomphalos at 13 weeks as an echog\ enic tumor at the umbilicus; the fetus was )Tj 0 -1.564 TD (subsequently found to have trisomy 18)Tj 8.9195 0 0 8.9195 257.0741 278.3221 Tm (19)Tj 11.1493 0 0 11.1493 268.4197 275.4679 Tm (. Brown )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver at 10 weeks, but\ )Tj -20.748 -1.383 Td (retrospective examinations of the sonograms obtained at 6\2269 weeks did\ not reveal any abnormality; the diagnosis was )Tj 0 -1.564 TD (confirmed after delivery)Tj 8.9195 0 0 8.9195 171.492 245.4715 Tm (69)Tj 11.1493 0 0 11.1493 182.8375 242.6172 Tm (. Similarly, Pagliano )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver and bowel in a 1\ 0-)Tj -13.072 -1.473 Td (week fetus; the pregnancy was terminated and the diagnosis was confirmed\ )Tj 8.9195 0 0 8.9195 466.3246 229.0461 Tm (70)Tj 11.1493 0 0 11.1493 477.6702 226.1919 Tm (. Heydanus )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of )Tj -39.516 -1.383 Td (exomphalos in three fetuses at 12\22614 weeks; in one there was an assoc\ iated ectopia cordis and hydrops and the pregnancy )Tj 0 -1.473 TD (was terminated, in the second there was an associated two-vessel cord an\ d intrauterine death occurred and, in the third with )Tj 0 -1.564 TD (isolated exomphalos, there was an infant death)Tj 8.9195 0 0 8.9195 304.0908 179.7701 Tm (71)Tj 11.1493 0 0 11.1493 315.4364 176.9159 Tm (.)Tj 9.4902 0 0 9.4902 37.098 159.4541 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(47 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 852 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 242.155 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 197.568634 270.9019623 387.7254944 cm /Im0 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 270.902 364.4322 Tm (Figure 12)Tj /TT1 1 Tf ( - Exomphalos in a 13-week fetus)Tj 9.4902 0 0 9.4902 37.098 344.9074 Tm ( )Tj 11.1493 0 0 11.1493 37.098 331.9209 Tm (van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the findings of 14 cases with exomphalos diagnosed at 11\2261\ 4 weeks of gestation)Tj 8.9195 0 0 8.9195 680.6703 334.7751 Tm (68)Tj 11.1493 0 0 11.1493 692.0159 331.9209 Tm (. In eight )Tj -58.741 -1.2 Td (cases, there was increased nuchal translucency thickness \(3.5\22610 mm\)\ and seven of these had chromosomal abnormalities, )Tj 0 -1.2 TD (mainly trisomy 18. The contents of the exomphalos were bowel only in the\ chromosomally abnormal group and liver as well as )Tj 0 -1.2 TD (bowel in those with a normal karyotype. In the chromosomally normal grou\ p, there were four with other defects, such as )Tj 0 -1.2 TD (tetralogy of Fallot and Meckel\226Gruber syndrome; only three infants we\ re liveborn.)Tj 9.4902 0 0 9.4902 500.029 278.4042 Tm ( )Tj -48.78 -1.147 Td ( )Tj 1 1 0 rg /TT3 1 Tf 11.1493 0 0 11.1493 43.1373 249.5032 Tm (Screening studies)Tj 0 0 0 rg /TT1 1 Tf -0.542 -1.8 Td (An ultrasound screening study of 622 high-risk pregnancies at 10\22613 w\ eeks correctly diagnosed the two cases of )Tj 0 -1.564 TD (exomphalos)Tj 8.9195 0 0 8.9195 104.295 214.8555 Tm (25)Tj 11.1493 0 0 11.1493 115.6405 212.0013 Tm (. In two other screening studies of low-risk patients, involving 1632 pr\ egnancies at 12\22614 weeks)Tj 8.9195 0 0 8.9195 661.1322 214.8555 Tm (35)Tj 11.1493 0 0 11.1493 672.4778 212.0013 Tm ( and 1473 )Tj -56.988 -1.473 Td (pregnancies at 10\22614 weeks)Tj 8.9195 0 0 8.9195 197.6706 198.4302 Tm (27)Tj 11.1493 0 0 11.1493 209.0161 195.576 Tm (, respectively, there were four cases of exomphalos \(two in each\) and \ they were all diagnosed in )Tj -15.42 -1.383 Td (the first-trimester scan.)Tj 0 -1.937 TD (In a screening study for chromosomal abnormalities by assessment of feta\ l nuchal translucency thickness at 10\22614 weeks of )Tj 0 -1.473 TD (gestation, there were 15 726 pregnancies with a minimum gestation of 11 \ weeks and 4 days and, in this group, there were 18 )Tj 0 -1.564 TD (cases of exomphalos)Tj 8.9195 0 0 8.9195 153.6084 127.5524 Tm (72)Tj 11.1493 0 0 11.1493 164.954 124.6981 Tm (. In seven cases, the karyotype was normal, in nine there was trisomy 18\ , in one trisomy 13 and in one )Tj -11.468 -1.383 Td (triploidy. Furthermore, in the total group, the prevalence of exomphalos\ in fetuses with trisomy 18 was 23%, in those with )Tj 0 -1.473 TD (trisomy 13 it was 9%, in those with triploidy it was 13% and in those wi\ th no evidence of these chromosomal defects it was )Tj T* (0.045%. This study demonstrated that both the prevalence of exomphalos a\ nd the associated risk for chromosomal defects )Tj 0 -1.564 TD (increase with maternal age and decrease with gestational age)Tj 8.9195 0 0 8.9195 385.1575 61.851 Tm (72)Tj 11.1493 0 0 11.1493 396.5031 58.9968 Tm (.)Tj /TT4 1 Tf 9.4902 0 0 9.4902 400.5614 58.9968 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(48 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 853 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 561.653 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 373.701 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 305.559 735.059 23.122 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 167.845 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5804 Tm (Gastroschisis)Tj /TT1 1 Tf 0 -2.867 TD (This is a sporadic defect with a birth prevalence of about 1 in 4000. Ev\ isceration of the intestine occurs through a small )Tj 0 -1.473 TD (abdominal wall defect located just lateral and usually to the right of a\ n intact umbilical cord. Prenatal diagnosis by ultrasoun)Tj (d is )Tj T* (based on the demonstration of the normally situated umbilicus and the he\ rniated loops of intestine, which are free-floating. )Tj T* (Associated chromosomal abnormalities are rare.)Tj 0 -1.937 TD (Surprisingly, although the incidence of gastroschisis in ultrasound stud\ ies during the second trimester of pregnancy is similar )Tj (to )Tj 0 -1.473 TD (that of exomphalos, there is a sparsity of reports on first-trimester di\ agnosis. Kushnir )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a 13-week fetus with a )Tj T* (free-floating cauliflower-shaped mass protruding through the fetal abdom\ en and to the right of a normally inserted umbilical )Tj 0 -1.564 TD (cord; the diagnosis was confirmed after delivery at term)Tj 8.9195 0 0 8.9195 353.9952 426.3116 Tm (73)Tj 11.1493 0 0 11.1493 365.3407 423.4574 Tm (. Similarly, Guzman reported a 12-week fetus with gastroschisis; )Tj -29.441 -1.473 Td (there was spontaneous rupture of membranes and intrauterine death at 22 \ weeks)Tj 8.9195 0 0 8.9195 499.1036 409.8862 Tm (74)Tj 11.1493 0 0 11.1493 510.4492 407.032 Tm (.)Tj 1 1 0 rg /TT3 1 Tf -41.914 -2.33 Td (Screening studies)Tj 0 0 0 rg /TT1 1 Tf 9.4902 0 0 9.4902 37.098 364.1126 Tm ( )Tj 11.1493 0 0 11.1493 37.098 352.1329 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there was one 11-week fetus with gastroschisis, )Tj 0 -1.29 TD (encephalocele and kyphoscoliosis; the pregnancy was terminated)Tj 8.9195 0 0 8.9195 404.8472 340.6012 Tm (25)Tj 11.1493 0 0 11.1493 416.1928 337.7469 Tm (.)Tj 9.4902 0 0 9.4902 420.2512 337.7469 Tm ( )Tj 1 1 1 rg /TT0 1 Tf 12.0784 0 0 12.0784 37.098 313.1604 Tm (URINARY TRACT DEFECTS)Tj 0 0 0 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 290.2827 Tm ( )Tj 0 -1.158 TD (The fetal kidneys and adrenals can first be visualized by transabdominal\ ultrasound at 9 weeks and they are seen in all cases )Tj 0 -1.564 TD (from 12 weeks)Tj 8.9195 0 0 8.9195 120.2497 262.7968 Tm (18)Tj 11.1493 0 0 11.1493 131.5952 259.9426 Tm (. The renal echogenicity is high at 9 weeks but decreases with gestation\ ; the adrenals appear as translucent )Tj -8.476 -1.473 Td (structures with an echodense cortex)Tj 8.9195 0 0 8.9195 241.0303 246.3715 Tm (18)Tj 11.1493 0 0 11.1493 252.3758 243.5172 Tm (. The fetal bladder can be visualized in about 80% of fetuses at 11 week\ s and in more )Tj -19.309 -1.473 Td (than 90% by 13 weeks)Tj 8.9195 0 0 8.9195 166.7312 229.9461 Tm (75)Tj 11.1493 0 0 11.1493 178.0768 227.0919 Tm (. At 12\22613 weeks, the fetal kidneys can be visualized in 99% of the c\ ases, by using both )Tj -12.645 -1.473 Td (transabdominal and transvaginal sonography)Tj 8.9195 0 0 8.9195 290.6225 213.5208 Tm (49)Tj 11.1493 0 0 11.1493 301.968 210.6666 Tm (.)Tj 9.4902 0 0 9.4902 37.098 193.2048 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 175.1935 Tm (Bilateral Renal Agenesis)Tj /TT1 1 Tf -0.542 -1.8 Td (This sporadic condition, with a birth prevalence of about 1 in 4000, is \ usually diagnosed in the second trimester of pregnancy )Tj 0 -1.473 TD (by the findings of anhydramnios, absence of the urinary bladder and fail\ ure to identify the fetal kidneys; the differential )Tj 0 -1.473 TD (diagnosis is preterm prelabor rupture of membranes and severe uteroplace\ ntal insufficiency that may also present with )Tj T* (oligohydramnios.)Tj 0 -1.937 TD (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the prenatal diagnosis of bilateral renal agenesis at 14 week\ s of gestation in five fetuses; in all cases, )Tj 0 -1.473 TD (there were hypoechogenic masses in the renal beds, that were subsequentl\ y found at pathological examination to be enlarged )Tj 0 -1.564 TD (adrenals)Tj 8.9195 0 0 8.9195 84.7725 53.2427 Tm (76)Tj 11.1493 0 0 11.1493 96.1181 50.3884 Tm (. The amniotic fluid volume was normal in all cases at 14 weeks. In two \ cases, a cystic structure suggestive of the )Tj -5.294 -1.383 Td (fetal bladder was temporarily detected in the fetal pelvis but this disa\ ppeared by 16\22617 weeks.)Tj /TT0 1 Tf ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(49 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 854 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 569.562 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 38.824 361.275 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 169.414 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 59.275 735.059 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 576.9104 Tm (Infantile polycystic kidney disease)Tj /TT1 1 Tf -0.542 -1.8 Td (This an autosomal recessive condition with a birth prevalence of about 1\ in 50 000. It is subdivided into perinatal, neonatal, )Tj 0 -1.473 TD (infantile and juvenile types, on the basis of the age of onset of the cl\ inical presentation and the degree of renal involvement.)Tj ( )Tj 0 -1.473 TD (Prenatal diagnosis by ultrasound is confined to the perinatal and probab\ ly the neonatal types and is based on the )Tj T* (demonstration of bilaterally enlarged and homogeneously hyperechogenic k\ idneys. While there is often associated )Tj T* (oligohydramnios, this is not found invariably. These sonographic appeara\ nces, however, may not become apparent until 26 )Tj T* (weeks of gestation, and therefore serial scans should be performed for e\ xclusion of the diagnosis.)Tj 0 -1.937 TD (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a case of infantile polycystic kidney disease; at 11 and 15 w\ eeks, the kidneys and bladder looked )Tj 0 -1.564 TD (normal, but at 28 weeks there was oligohydramnios with bilaterally enlar\ ged and diffusely hyperechogenic kidneys)Tj 8.9195 0 0 8.9195 682.6883 438.5342 Tm (77)Tj 11.1493 0 0 11.1493 694.0339 435.68 Tm (. )Tj -58.922 -1.383 Td (Retrospective examination of the videotapes taken from the early scans d\ emonstrated that the kidneys were of increased )Tj 0 -1.473 TD (echogenicity and increased length from as early as 12 weeks.)Tj /TT0 1 Tf 0.542 -2.478 Td (Multicystic dysplastic kidney disease)Tj /TT1 1 Tf -0.542 -2.48 Td (In this sporadic condition, which may be unilateral or bilateral, the co\ llecting tubules and nephrons are dysplastic. The )Tj 0 -1.473 TD (collecting tubules become cystic and the diameter of the cysts determine\ s the size of the kidneys, which may be large and )Tj T* (multicystic or small, shrunken and hyperechogenic. Occasionally, only on\ e of a small number of adjacent collecting tubules is )Tj T* (involved so that only a segment of the kidney is abnormal. With bilatera\ l involvement, there is associated absence of the )Tj T* (bladder and oligohydramnios.)Tj 0 -1.937 TD (Cullen )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a case that at 11 weeks demonstrated hyperechoic kidneys with\ no obvious dilatation of the bladder; )Tj 0 -1.564 TD (ultrasound examination in the newborn, after delivery at term, confirmed\ the diagnosis of cystic dysplastic kidneys)Tj 8.9195 0 0 8.9195 683.6583 246.673 Tm (25)Tj 11.1493 0 0 11.1493 695.0039 243.8187 Tm (. )Tj -59.009 -1.383 Td (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a case with a unilateral multicystic kidney diagnosed at 12 w\ eeks during routine ultrasound )Tj 0 -1.564 TD (examination; the fetal karyotype was normal)Tj 8.9195 0 0 8.9195 290.3103 213.8223 Tm (78)Tj 11.1493 0 0 11.1493 301.6558 210.9681 Tm (. Ultrasound examination of the newborn confirmed the antenatal diagnosi\ s.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 730.5814 210.9681 Tm ( )Tj 1 1 0 rg /TT4 1 Tf 11.1493 0 0 11.1493 43.1373 184.3415 Tm (Screening studies)Tj 0 0 0 rg /TT1 1 Tf -0.542 -2.48 Td (In a screening study involving ultrasound examinations at 11\22614 weeks\ of gestation and at 18\22620 weeks in 3991 patients, )Tj 0 -1.473 TD (there were three cases of unilateral multicystic dysplastic kidneys and \ none was detected at the early scan; two were diagnosed )Tj 0 -1.564 TD (at 18\22620 weeks and the third was detected at 31 weeks)Tj 8.9195 0 0 8.9195 352.8691 125.6896 Tm (26)Tj 11.1493 0 0 11.1493 364.2147 122.8353 Tm (. In another screening study involving 1632 pregnancies at 12\22614 )Tj -29.34 -1.473 Td (weeks, there was one case with unilateral multicystic kidneys and this w\ as correctly identified in the first-trimester scan)Tj 8.9195 0 0 8.9195 712.825 109.2642 Tm (35)Tj 11.1493 0 0 11.1493 724.1705 106.41 Tm (.)Tj /TT0 1 Tf ( )Tj /TT1 1 Tf 9.4902 0 0 9.4902 37.098 88.9482 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 37.098 66.6232 Tm (Hydronephrosis)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(50 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 855 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 232.078 287.529 336.471 206.196 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 223.672 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 106.598 735.059 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 577.4518 Tm (Varying degrees of pelvicalyceal dilatation are found in about 1% of fet\ uses. Mild hydronephrosis or pyelectasia may be due to )Tj 0 -1.2 TD (relaxation of smooth muscle of the urinary tract by the high levels of c\ irculating maternal hormones, or maternal\226fetal )Tj T* (overhydration. In the majority of cases, the condition remains stable or\ resolves in the neonatal period. In about 20% of cases,)Tj ( )Tj 0 -1.2 TD (there may be an underlying ureteropelvic junction obstruction or vesicou\ reteric reflux that requires postnatal follow-up and )Tj 0 -1.2 TD (possible surgery. Moderate or severe pelvicalyceal dilatation is usually\ progressive and, in more than 50% of cases, surgery is )Tj T* (necessary during the first 2 years of life)Tj 9.4902 0 0 9.4902 261.244 510.5558 Tm (. )Tj -23.619 -1.147 Td ( )Tj ET q 258.8235321 0 0 197.568634 270.9019623 291.8425293 cm /Im0 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 259.6427 268.5492 Tm (Mild hydronephrosis or pyelectasia at 13-14weeks)Tj 9.4902 0 0 9.4902 37.098 249.0321 Tm ( )Tj 1 1 0 rg /TT1 1 Tf 11.1493 0 0 11.1493 43.1373 231.0208 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf -0.542 -1.8 Td (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there were two cases of hydronephrosis and )Tj 0 -1.473 TD (exomphalos and they were both detected at the first scan; one pregnancy \ was terminated and the other resulted in a livebirth )Tj 0 -1.564 TD (with cloacal defect as well as the exomphalos)Tj 8.9195 0 0 8.9195 292.6405 179.9478 Tm (25)Tj 11.1493 0 0 11.1493 303.986 177.0936 Tm (. In a screening study involving ultrasound examinations at 11\22614 wee\ ks of )Tj -23.938 -1.383 Td (gestation and at 18\22620 weeks in 3991 low-risk patients, there were fo\ ur cases of hydronephrosis and only one of these was )Tj T* (diagnosed at the early scan)Tj 8.9195 0 0 8.9195 191.9956 147.0971 Tm (26)Tj 11.1493 0 0 11.1493 203.3411 144.2429 Tm (.)Tj /TT2 1 Tf ( )Tj -14.911 -2.717 Td (Megacystis)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(51 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 856 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 124.235 207.584 273.922 217.412 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 207.584 273.922 217.412 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.4943 Tm (Sebire )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. examined transabdominally 300 pregnancies at 10\22614 weeks of gestati\ on and reported a significant increase in )Tj 0 -1.473 TD (bladder length with crown\226rump length \()Tj 0 0 0.4 rg (Figure 13)Tj 0 0 0 rg (\), but, within this gestational age range, none of the measurements was\ )Tj 0 -1.564 TD (more than 6 mm)Tj 8.9195 0 0 8.9195 131.8896 545.4911 Tm (79)Tj 11.1493 0 0 11.1493 143.2351 542.6368 Tm (. The fetal bladder was always visualized if the crown\226rump length wa\ s more than 67 mm, but not in 9% of )Tj -9.52 -1.383 Td (those with a crown\226rump length of 38\22667 mm.)Tj 0 -1.937 TD (Bulic )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. described a 14-week fetus with megacystis \(bladder length 50 mm\) and\ oligohydramnios; pathological examination )Tj 0 -1.473 TD (after termination at 15 weeks showed urethral atresia, hypertrophic blad\ der, dysplastic kidneys and absence of abdominal )Tj 0 -1.564 TD (musculature)Tj 8.9195 0 0 8.9195 106.2907 474.6132 Tm (80)Tj 11.1493 0 0 11.1493 117.6363 471.759 Tm (. In another 11-week fetus, there was megacystis \(20 mm\); at 14 weeks \ there was enlargement of the bladder )Tj -7.224 -1.383 Td (and oligohydramnios. Pathological examination after termination demonstr\ ated urethral atresia, severe megacystis but normal )Tj T* (kidneys)Tj 8.9195 0 0 8.9195 79.8111 441.7626 Tm (80)Tj 11.1493 0 0 11.1493 91.1566 438.9083 Tm (. )Tj ET q 258.8235321 0 0 208.784317 131.784317 211.8974304 cm /Im0 Do Q q 258.8235321 0 0 197.568634 410.0196075 217.5052795 cm /Im1 Do Q BT /TT2 1 Tf 11.1493 0 0 11.1493 128.549 181.9145 Tm (Figure 13a)Tj /TT0 1 Tf ( - Megacystis in a 12-13 week )Tj 0 -1.201 TD (fetus \(>18 mm diameter\))Tj /TT2 1 Tf 24.955 1.801 Td (Figure 13b - )Tj /TT0 1 Tf (Megacystis in a 12-13 week )Tj T* (fetus + color doppler showing single umbilical )Tj 0 -1.2 TD (artery)Tj 9.4902 0 0 9.4902 37.098 142.321 Tm ( )Tj 11.1493 0 0 11.1493 37.098 128.6907 Tm (Stiller reported an 11-week fetus with megacystis \(10 mm\) but normal k\ idneys and amniotic fluid)Tj 8.9195 0 0 8.9195 587.3059 131.545 Tm (81)Tj 11.1493 0 0 11.1493 598.6514 128.6907 Tm (. At 13 weeks, there was )Tj -50.367 -1.383 Td (enlargement of the bladder \(30 mm\) and bilateral hydronephrosis with r\ educed amniotic fluid; the pregnancy was terminated.)Tj 0 -1.937 TD (Drugan )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 12-week fetus with megacystis \(18 mm\); at 14 weeks there \ was further enlargement of the bladder )Tj 0 -1.564 TD (with normal kidneys but oligohydramnios)Tj 8.9195 0 0 8.9195 268.9147 77.0925 Tm (82)Tj 11.1493 0 0 11.1493 280.2603 74.2383 Tm (. Vesicoamniotic shunting was carried out and the pregnancy continued no\ rmally; a )Tj -21.81 -1.383 Td (male infant with mild prune-belly and moderate renal function \(40\22650\ %\) was born at 35 weeks.)Tj 0 -2.028 TD (Zimmer and Bronshtein reported an 11-week fetus with megacystis \(13 mm\)\ and two umbilical cord cysts)Tj 8.9195 0 0 8.9195 633.9324 39.0653 Tm (83)Tj 11.1493 0 0 11.1493 645.2779 36.2111 Tm (. At 12 weeks, the )Tj -54.549 -1.383 Td (bladder increased \(30 mm\) and there was evidence of hydronephrosis; at\ 13 weeks there was intrauterine death. In another 12-)Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(52 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 857 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 253.028 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 580.3672 Tm (week fetus, there was megacystis \(46 mm\), bilateral hydronephrosis, in\ creased nuchal translucency and talipes. Chorionic villus )Tj 0 -1.473 TD (sampling showed Turner mosaicism and the pregnancy was terminated.)Tj 0 -1.937 TD (Yoshida )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(45 mm\) and decreased amnio\ tic fluid volume; follow-up scans )Tj 0 -1.564 TD (demonstrated resolution of the megacystis and normalization of the amnio\ tic fluid volume)Tj 8.9195 0 0 8.9195 543.2103 527.7622 Tm (84)Tj 11.1493 0 0 11.1493 554.5559 524.9079 Tm (. At 28 weeks, tetralogy of Fallot )Tj -46.412 -1.383 Td (was diagnosed. Investigations after delivery at 38 weeks confirmed the c\ ardiac defect and, in addition, demonstrated vaginal )Tj 0 -1.473 TD (atresia, imperforate anus, recto-urethral fistula, bilateral vesicourete\ ral reflux, unilateral renal hypoplasia, hypoplasia of )Tj T* (abdominal muscles, scoliosis and bilateral talipes. The karyotype was no\ rmal female. The suggested diagnosis was VACTERL-)Tj T* (like association.)Tj 0 -1.937 TD (Fried )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(30 mm\); a repeat scan 2 da\ ys later demonstrated urinary ascites with a )Tj 0 -1.564 TD (thick-walled deflated bladder and the pregnancy was terminated)Tj 8.9195 0 0 8.9195 399.7186 424.0336 Tm (85)Tj 11.1493 0 0 11.1493 411.0641 421.1794 Tm (. The fetal karyotype was 46,XY.)Tj -33.542 -1.847 Td (Hoshino )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 10 weeks but, a\ t 12 weeks, there was megacystis \(40 )Tj 0 -1.473 TD (mm\) with normal amniotic fluid volume; at 13 weeks, the diameter of the\ bladder increased to 54 mm, there was bilateral )Tj 0 -1.564 TD (hydronephrosis and the amniotic fluid volume was reduced)Tj 8.9195 0 0 8.9195 368.5451 369.5812 Tm (86)Tj 11.1493 0 0 11.1493 379.8906 366.7269 Tm (.)Tj -30.746 -1.847 Td (Cazorla )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 8 weeks but, at\ 13 weeks, there was megacystis \(33 )Tj 0 -1.564 TD (mm\) and reduced amniotic fluid volume; the fetal karyotype was 46,XY)Tj 8.9195 0 0 8.9195 439.5662 331.554 Tm (87)Tj 11.1493 0 0 11.1493 450.9118 328.6998 Tm (. At 16 weeks, the fetus developed generalized edema )Tj -37.116 -1.383 Td (and the pregnancy was terminated. Pathological examination revealed uret\ hral atresia, megacystis, hydronephrosis and )Tj 0 -1.473 TD (atrophied abdominal muscles.)Tj 9.4902 0 0 9.4902 37.098 278.3873 Tm ( )Tj 1 1 0 rg /TT2 1 Tf 11.1493 0 0 11.1493 43.1373 260.3761 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 243.4395 Tm ( )Tj 11.1493 0 0 11.1493 37.098 230.8161 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there were two cases with urethral obstruction )Tj 0 -1.564 TD (presenting as megacystis at 11 and 13 weeks of gestation)Tj 8.9195 0 0 8.9195 364.2972 216.2382 Tm (25)Tj 11.1493 0 0 11.1493 375.6427 213.3839 Tm (. In a screening study for chromosomal abnormalities by )Tj -30.365 -1.473 Td (assessment of fetal nuchal translucency thickness, 24 492 singleton preg\ nancies were examined)Tj 8.9195 0 0 8.9195 580.3264 199.8128 Tm (79)Tj 11.1493 0 0 11.1493 591.672 196.9586 Tm (. Megacystis was present in )Tj -49.741 -1.383 Td (15 fetuses \(prevalence of 1 in 1633\) and, in these cases, the longitud\ inal bladder diameter was 8\22632 mm. There were three )Tj 0 -1.473 TD (cases with chromosomal abnormalities and two of these had increased nuch\ al translucency thickness. In the chromosomally )Tj T* (normal group with mild-to-moderate megacystis \(longitudinal bladder dia\ meter of 8\22612 mm\), the majority of fetuses had )Tj T* (spontaneous resolution without any obvious adverse effects on renal deve\ lopment and function. In those with severe )Tj T* (megacystis \(minimum longitudinal bladder diameter of 17 mm\), there was\ evolution to obstructive uropathy and renal )Tj 0 -1.564 TD (dysplasia)Tj 8.9195 0 0 8.9195 88.7194 101.2608 Tm (79)Tj 11.1493 0 0 11.1493 100.0649 98.4066 Tm (.)Tj -5.648 -1.847 Td (Extensive animal studies have demonstrated that obstructive uropathy cau\ ses renal dysplasia and the degree of renal damage )Tj 0 -1.564 TD (is related both to the onset and duration of the obstruction)Tj 8.9195 0 0 8.9195 368.4893 63.2337 Tm (88,89)Tj 11.1493 0 0 11.1493 394.4271 60.3794 Tm (. Furthermore, such studies have shown that renal damage can )Tj -32.049 -1.383 Td (be reduced by intrauterine surgery to by-pass the obstruction. However, \ the data from vesico\226amniotic shunting in human )Tj 0 -1.473 TD (fetuses with obstructive uropathy have not provided conclusive evidence \ that such interventions are beneficial, possibly )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(53 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 858 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 511.502 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 278.262 722.98 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (because, by mid-gestation, when surgery is usually undertaken, irreversi\ ble renal damage may have already occurred. The )Tj 0 -1.473 TD (extent to which first-trimester diagnosis of megacystis and vesico\226am\ niotic shunting could prevent the subsequent )Tj T* (development of renal damage remains to be determined.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (SKELETAL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.029 TD ( )Tj 0 -1.158 TD (Limb buds are first seen by ultrasound at about the 8th week of gestatio\ n, the femur and humerus are seen from 9 weeks, tibia/)Tj 0 -1.473 TD (fibula and radius/ulna from 10 weeks and digits of hands and feet from 1\ 1 weeks; all long bones are consistently seen from 11 )Tj 0 -1.564 TD (weeks)Tj 8.9195 0 0 8.9195 71.9174 452.314 Tm (14,18,90,91)Tj 11.1493 0 0 11.1493 127.0396 449.4598 Tm (. Body movements \(wiggling\) are seen at 9 weeks and, by 11 weeks, limb\ s move about readily)Tj 8.9195 0 0 8.9195 662.6084 452.314 Tm (18,90)Tj 11.1493 0 0 11.1493 688.5462 449.4598 Tm (. The length )Tj -58.429 -1.383 Td (of the humerus, radius/ulna, femur and tibia/fibula are similar at 11\226\ 14 weeks and increase linearly with gestation from about )Tj T* (6 mm at 11 weeks to 13 mm at 14 weeks; the femur to foot ratio is 0.85)Tj 8.9195 0 0 8.9195 449.1101 419.4633 Tm (92)Tj 11.1493 0 0 11.1493 460.4556 416.6091 Tm (.)Tj -37.972 -1.847 Td (Skeletal dysplasias are found in about 1 per 4000 births; about 25% of a\ ffected fetuses are stillborn and about 30% die in the )Tj 0 -1.473 TD (neonatal period. The most common dysplasias are thanatophoric dysplasia,\ osteogenesis imperfecta, achondroplasia, )Tj 0 -1.473 TD (achondrogenesis and asphyxiating thoracic dysplasia. Several case report\ s have described the prenatal diagnosis of a wide )Tj 0 -1.473 TD (range of skeletal defects in the first trimester of pregnancy and they a\ re usually associated with increased nuchal translucency)Tj ( )Tj T* (thickness \(see Chapter 2\).)Tj /TT2 1 Tf 9.4902 0 0 9.4902 185.7631 330.3127 Tm ( )Tj /TT0 1 Tf -15.665 -1.946 Td ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 43.1373 293.1891 Tm (Caudal regression syndrome)Tj /TT0 1 Tf 9.4902 0 0 9.4902 37.098 268.6737 Tm ( )Tj 11.1493 0 0 11.1493 37.098 256.694 Tm (This rare, sporadic syndrome presents with varying degrees of vertebral \ anomalies from partial sacral agenesis to complete )Tj 0 -1.2 TD (absence of the lumbosacral spine. Sirenomelia is the extreme form, with \ variable fusion and hypoplasia of the lower extremities )Tj T* (and genitourinary, gastrointestinal, cardiovascular and central nervous \ system abnormalities. It is 250 times more common in )Tj 0 -1.2 TD (poorly controlled diabetic mothers than in the general population.)Tj 9.4902 0 0 9.4902 406.5085 216.5564 Tm ( )Tj -38.926 -1.147 Td ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(54 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 859 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.8 rg 32.784 61.27 735.059 23.122 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 208.784317 132.8627472 385.215683 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 385.215683 cm /Im1 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 132.8627 356.9649 Tm (Although on superficial examination this )Tj 0 -1.473 TD (image might pass for normal, note that on )Tj T* (the caudal side of the image \(on the right, )Tj T* (since the ribs can be seen on the left side of )Tj T* (the image\) the spine terminates without the )Tj T* (usual landmark of the iliac wings and )Tj T* (sacrum.)Tj 9.4902 0 0 9.4902 177.906 258.4129 Tm ( )Tj 11.1493 0 0 11.1493 408.9412 324.1142 Tm (The lack of sacrum allows the iliac wings to )Tj T* (be approximated, giving them a \223shield\224 like )Tj T* (appearance.)Tj 9.4902 0 0 9.4902 477.9109 291.2635 Tm ( )Tj 11.1493 0 0 11.1493 278.2342 219.5562 Tm (courtesy Phillipe Jeanty - www.thefetus.net)Tj 9.4902 0 0 9.4902 37.098 195.0816 Tm ( )Tj 11.1493 0 0 11.1493 37.098 182.0951 Tm (Baxi )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. performed serial ultrasound scans in a patient that originally present\ ed in diabetic ketoacidotic coma)Tj 8.9195 0 0 8.9195 663.9798 184.9493 Tm (93)Tj 11.1493 0 0 11.1493 675.3253 182.0951 Tm (. At 9 weeks, )Tj -57.244 -1.2 Td (the crown\226rump length was shorter by a week than expected from the me\ nstrual age. At 11 weeks, there was a protuberence )Tj 0 -1.2 TD (of the lower spine and no normal movements of the thighs were seen. At 1\ 4 weeks, the femora were fixed in a \221frog-leg\222 )Tj 0 -1.2 TD (position and were never seen moving independently from each other. At 17\ weeks, shortening and kyphosis of the lower spine )Tj 0 -1.2 TD (were observed. Pathological examination after termination of the pregnan\ cy confirmed the diagnosis of caudal regression )Tj T* (syndrome.)Tj 9.4902 0 0 9.4902 96.5908 115.1991 Tm ( )Tj -6.269 -2.338 Td ( )Tj 1 1 0 rg /TT2 1 Tf 12.0784 0 0 12.0784 37.098 68.8714 Tm (Chapter 4 - References)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(55 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 860 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 9.4902 0 0 9.4902 55.4366 577.7752 Tm (1. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 577.7752 Tm (Moore GW, Hutchins GM, O\222Rahilly R. The estimated age of staged human\ embryos and early fetuses. )Tj /TT2 1 Tf (Am J Obstet Gynecol)Tj /TT1 1 Tf ( )Tj 0 -1.473 TD (1981;139:500\2266)Tj /TT0 1 Tf 9.4902 0 0 9.4902 55.4366 539.748 Tm (2. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 539.748 Tm (O\222Rahilly R, M\374ller F. )Tj /TT2 1 Tf (Developmental Stages in Human Embryos)Tj /TT1 1 Tf (. Washington DC: Carnegie Institute Publ, 1987)Tj /TT0 1 Tf 9.4902 0 0 9.4902 55.4366 518.1462 Tm (3. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 518.1462 Tm (Timor-Tritsch IE, Peisner DB, Raju S. Sonoembryology: an organ-oriented \ approach using a high-frequency vaginal probe. )Tj /TT2 1 Tf (J Clin )Tj T* (Ultrasound)Tj /TT1 1 Tf ( 1990;18:286\22698)Tj /TT0 1 Tf 9.4902 0 0 9.4902 55.4366 480.1191 Tm (4. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 480.1191 Tm (O\222Rahilly R, M\374ller F. )Tj /TT2 1 Tf (The Embryonic Human Brain. An Atlas of Developmental Stages)Tj /TT1 1 Tf (. New York: Wiley-Liss, 1994)Tj /TT0 1 Tf 9.4902 0 0 9.4902 55.4366 458.5173 Tm (5. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 458.5173 Tm (Blumenfeld Z, Rottem S, Elgali S, Timor-Tritsch IE. Transvaginal sonogra\ phic assessment of early embryological development. In T)Tj (imor-)Tj T* (Tritsch IE, Rottem S, eds. )Tj /TT2 1 Tf (Transvaginal Sonography)Tj /TT1 1 Tf (, London: Heinemann Medical Books, 1988:87\226108)Tj /TT0 1 Tf 9.4902 0 0 9.4902 55.4366 420.4901 Tm (6. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 420.4901 Tm (Bree RL, Marn CS. Transvaginal sonography in the first trimester: embryo\ logy, anatomy, and hCG correlation. )Tj /TT2 1 Tf (Sem Ultrasound, CT, MR)Tj /TT1 1 Tf ( )Tj T* (1990;11:12\22621)Tj /TT0 1 Tf 9.4902 0 0 9.4902 55.4366 382.463 Tm (7. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 382.463 Tm (Blaas HG, Eik-Nes SH, Kiserud T, Hellevik LR. Early development of the f\ orebrain and midbrain: a longitudinal ultrasound study f)Tj (rom 7 to )Tj T* (12 weeks of gestation. )Tj /TT2 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1994;4: 183\22692)Tj /TT0 1 Tf 9.4902 0 0 9.4902 55.4366 344.4358 Tm (8. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 344.4358 Tm (Wisser J, Dirschedl P. Embryonic heart rate in dated human embryos. )Tj /TT2 1 Tf (Early Hum Dev)Tj /TT1 1 Tf ( 1994;37: 107\22615)Tj /TT0 1 Tf 9.4902 0 0 9.4902 55.4366 322.834 Tm (9. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 322.834 Tm (Wisser J, Dirschedl P, Krone S. Estimation of gestational age by transva\ ginal sonographic measurements of greatest embryonic len)Tj (gth in )Tj T* (dated human embryos. )Tj /TT2 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1994;4: 457\22662)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 284.8069 Tm (10. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 284.8069 Tm (Blaas HG, Eik-Nes SH, Kiserud T, Hellevik LR. Early development of the h\ indbrain: a longitudinal ultrasound study from 7 to 12 w)Tj (eeks of )Tj T* (gestation. )Tj /TT2 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1995;5:151\22660)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 246.7797 Tm (11. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 246.7797 Tm (Blaas HG, Eik-Nes SH, Kiserud T, Hellevik LR. Early development of the h\ indbrain: a longitudinal ultrasound study from 7 to 12 w)Tj (eeks of )Tj T* (gestation. )Tj /TT2 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1995;6:240\2269)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 208.7526 Tm (12. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 208.7526 Tm (Blaas HG, Eik-Nes SH, Berg S, Torp H. In-vivo three-dimensional ultrasou\ nd reconstructions of embryos and early fetuses. )Tj /TT2 1 Tf (Lancet)Tj /TT1 1 Tf ( )Tj T* (1998;352:1182\2266)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 170.7254 Tm (13. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 170.7254 Tm (Blaas HG, Eik-Nes SH, Bremnes JB. Embryonic growth. A longitudinal biome\ tric ultrasound study. )Tj /TT2 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1998;12:346\226)Tj T* (54)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 132.6983 Tm (14. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 132.6983 Tm (van Zalen-Sprock RM, van Brons JTJ, van Vugt JMG, van Harten HJ, van Gij\ n HP. Ultrasonographic and radiologic visualization of t)Tj (he )Tj T* (developing embryonic skeleton. )Tj /TT2 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1997;9:392\2267)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 94.6711 Tm (15. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 94.6711 Tm (Campbell S, Holt EM, Johnson FD. Anencephaly: early ultrasonic diagnosis\ and active management. )Tj /TT2 1 Tf (Lancet)Tj /TT1 1 Tf ( 1972;2:1226\2267)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 73.0693 Tm (16. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 73.0693 Tm (Warkany J. Anencephaly. In Warkany J, ed. )Tj /TT2 1 Tf (Congenital Malformations)Tj /TT1 1 Tf (. Chicago: Yearbook Publishers, 1971:189\226200)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 51.4675 Tm (17. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 51.4675 Tm (O\222 Rahilly R, Gardner E. The initial appearance of ossification in st\ aged human embryos. )Tj /TT2 1 Tf (Am J Anat)Tj /TT1 1 Tf ( 1974;134:291\226308)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 29.8657 Tm (18. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 29.8657 Tm (Green JJ, Hobbins JC. Abdominal ultrasound examination of the first trim\ ester fetus. )Tj /TT2 1 Tf (Am J Obstet Gynecol)Tj /TT1 1 Tf ( 1988;159:165\22675)Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(56 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 861 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 583.8144 Tm (19. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 583.8144 Tm (Schmidt W, Kubli F. Early diagnosis of severe congenital malformations b\ y ultrasonography. )Tj /TT2 1 Tf (J Perinat Med)Tj /TT1 1 Tf ( 1982;10:233\22641)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 562.2126 Tm (20. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 562.2126 Tm (Johnson A, Losure TA, Weiner S. Early diagnosis of anencephaly. )Tj /TT2 1 Tf (J Clin Ultrasound)Tj /TT1 1 Tf ( 1985;13:503\2265)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 540.6108 Tm (21. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 540.6108 Tm (Rottem S, Bronshtein M, Thaler I, Brandes JM. First trimester transvagin\ al sonographic diagnosis of fetal anomalies. )Tj /TT2 1 Tf (Lancet)Tj /TT1 1 Tf ( 1989;1:444\2265)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 519.009 Tm (22. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 519.009 Tm (Kennedy KA, Flick KJ, Thurmond AS. First-trimester diagnosis of exenceph\ aly. )Tj /TT2 1 Tf (Am J Obstet Gynecol)Tj /TT1 1 Tf ( 1990;162:461\2263)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 497.4072 Tm (23. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 497.4072 Tm (Bronshtein M, Ornoy A. Acrania: anencephaly resulting from secondary deg\ eneration of a closed neural tube: two cases in the same)Tj ( family. )Tj /TT2 1 Tf 0 -1.473 TD (J Clin Ultrasound)Tj /TT1 1 Tf ( 1991;19:230\2264)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 459.38 Tm (24. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 459.38 Tm (Goldstein RB, Filly RA, Callen PW. Sonography of anencephaly: pitfalls i\ n early diagnosis. )Tj /TT2 1 Tf (J Clin Ultrasound)Tj /TT1 1 Tf ( 1989;17:397\226402)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 437.7782 Tm (25. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 437.7782 Tm (Cullen MT, Green J, Whetham J, Salafia C, Gabrielli S, Hobbins JC. Trans\ vaginal ultrasonographic detection of congenital anomali)Tj (es in the )Tj T* (first trimester. )Tj /TT2 1 Tf (Am J Obstet Gynecol)Tj /TT1 1 Tf ( 1990;163:466\22676)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 399.7511 Tm (26. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 399.7511 Tm (Hernadi L, Torocsik M. Screening for fetal anomalies in the 12th week of\ pregnancy by transvaginal sonography in an unselected )Tj T* (population. )Tj /TT2 1 Tf (Prenat Diagn)Tj /TT1 1 Tf ( 1997;17:753\2269)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 361.7239 Tm (27. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 361.7239 Tm (Pajkrt E, van Lith JMM, Mol BWJ, Bleker OP, Bilardo CM. Screening for Do\ wn\222s syndrome by fetal nuchal translucency measurement i)Tj (n a )Tj T* (general obstetric population. )Tj /TT2 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1998;12:163\2269)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 323.6968 Tm (28. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 323.6968 Tm (Chatzipapas IK, Whitlow BJ, Economides DL. The \221Mickey Mouse\222 sign\ and the diagnosis of anencephaly in early pregnancy. )Tj /TT2 1 Tf (Ultrasound )Tj T* (Obstet Gynecol)Tj /TT1 1 Tf ( 1998;13:196\2269)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 285.6696 Tm (29. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 285.6696 Tm (Johnson SP, Sebire NJ, Snijders RJM, Tunkel S, Nicolaides KH. Ultrasound\ screening for anencephaly at 10\22614 weeks of gestation. )Tj /TT2 1 Tf T* (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1197;9:14\22616)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 247.6425 Tm (30. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 247.6425 Tm (van Zalen-Sprock RM, van Vugt JMG, van Geijn HP. First-trimester sonogra\ phic detection of neurodevelopmental abnormalities in so)Tj (me )Tj T* (single-gene disorders. )Tj /TT2 1 Tf (Prenat Diagn)Tj /TT1 1 Tf ( 1996;16:199\226202)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 209.6153 Tm (31. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 209.6153 Tm (Bronshtein M, Zimmer EZ. Transvaginal sonographic follow-up on the forma\ tion of fetal cephalocele at 13\22619 weeks\222 gestation. )Tj /TT2 1 Tf (Obstet )Tj T* (Gynecol)Tj /TT1 1 Tf ( 1991;78:528\22630)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 171.5882 Tm (32. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 171.5882 Tm (van Zalen-Sprock M, van Vugt JMG, van der Harten HJ, van Geijn HP. Cepha\ locele and cystic hygroma: diagnosis and differentiation)Tj ( in the )Tj T* (first trimester of pregnancy with transvaginal sonography. Report of two\ cases. )Tj /TT2 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1992;2:289\22692)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 133.561 Tm (33. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 133.561 Tm (Pachi A, Giancotti A, Torcia F, de Prosperi V, Maggi E. Meckel\226Gruber\ syndrome: ultrasonographic diagnosis at 13 weeks\222 gestatio)Tj (nal age )Tj T* (in an at-risk case. )Tj /TT2 1 Tf (Prenat Diagn)Tj /TT1 1 Tf ( 1989;9:187\22690)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 95.5339 Tm (34. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 95.5339 Tm (Sepulveda W, Sebire NJ, Souka A, Snijders RJM, Nicolaides KH. Diagnosis \ of the Meckel\226Gruber syndrome at eleven to fourteen week)Tj (s\222 )Tj T* (gestation. )Tj /TT2 1 Tf (Am J Obstet Gynecol)Tj /TT1 1 Tf ( 1997;176:316\22619)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 57.5067 Tm (35. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 57.5067 Tm (Economides DL, Braithwaite JM. First trimester ultrasonographic diagnosi\ s of fetal structural abnormalities in a low risk popula)Tj (tion. )Tj /TT2 1 Tf (Br J )Tj T* (Obstet Gynaecol)Tj /TT1 1 Tf ( 1998;105:53\2267)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 19.4796 Tm (36. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 19.4796 Tm (Braithwaite J, Economides DL. First-trimester diagnosis of Meckel\226Gru\ ber syndrome by transabdominal sonography in a low-risk cas)Tj (e. )Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(57 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 862 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 71.6078 579.0542 Tm (Prenat Diagn)Tj /TT1 1 Tf ( 1995;15:1168\22670)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 557.4524 Tm (37. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 557.4524 Tm (Timor-Tritsch IE, Monteagudo A, Warren WB. Transvaginal sonographic defi\ nition of the central nervous system in the first and ea)Tj (rly )Tj 0 -1.473 TD (second trimesters. )Tj /TT0 1 Tf (Am J Obstet Gynecol)Tj /TT1 1 Tf ( 1991;164:497\226503)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 519.4253 Tm (38. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 519.4253 Tm (Kushnir U, Shalev J, Bronshtein M, Bider D, Lipitz S, Nebel L, Mashiach \ S, Ben-Rafael Z. Fetal intracranial anatomy in the first)Tj ( trimester of )Tj T* (pregnancy: transvaginal ultrasonographic evaluation. )Tj /TT0 1 Tf (Neuroradiology)Tj /TT1 1 Tf ( 1989;31:222\2265)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 481.3981 Tm (39. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 481.3981 Tm (Ulm B, Ulm MR, Deutinger J, Bernaschek G. Dandy\226Walker malformation d\ iagnosed before 21 weeks of gestation: associated )Tj T* (malformations and chromosomal abnormalities. )Tj /TT0 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1997;10:167\22670)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 443.371 Tm (40. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 443.371 Tm (Lin Y, Chang F, Liu C. Antenatal detection of hydranencephaly at 12 week\ s, menstrual age. )Tj /TT0 1 Tf (J Clin Ultrasound)Tj /TT1 1 Tf ( 1992;20:62\2264)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 421.7692 Tm (41. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 421.7692 Tm (Toth Z, Csecsei K, Szeifert G, Torok O, Papp Z. Early prenatal diagnosis\ of cyclopia associated with holoprosencephaly. )Tj /TT0 1 Tf (J Clin Ultrasound)Tj /TT1 1 Tf ( )Tj T* (1986;14:550\2263)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 383.742 Tm (42. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 383.742 Tm (Bronshtein M, Wiener Z. Early transvaginal sonographic diagnosis of alob\ ar holoprosencephaly. )Tj /TT0 1 Tf (Prenat Diagn)Tj /TT1 1 Tf ( 1991;11:459\22662)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 362.1402 Tm (43. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 362.1402 Tm (Gonzalez-Gomez F, Salamanca A, Padilla MC, Camara M, Sabatel RM. Alobar \ holoprosencephalic embryo detected via transvaginal )Tj T* (sonography. )Tj /TT0 1 Tf (Eur J Obstet Gynecol Reprod Bio)Tj /TT1 1 Tf (l 1992;47:266\22670)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 324.1131 Tm (44. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 324.1131 Tm (Sakala EP, Gaio KL. Fundal uterine leiomyoma obscuring first trimester t\ ransabdominal sonographic diagnosis of fetal holoprosenc)Tj (ephaly. )Tj /TT0 1 Tf T* (J Reprod Med)Tj /TT1 1 Tf ( 1993;38:400\2262)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 286.0859 Tm (45. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 286.0859 Tm (Turner CD, Silva S, Jeanty P. Prenatal diagnosis of alobar holoprosencep\ haly at 10 weeks of gestation. )Tj /TT0 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( )Tj T* (1999;13:360\2262)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 248.0588 Tm (46. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 248.0588 Tm (Wong HS, Lam YH, Tang MHY, Cheung LWK, Ng LKL, Yan KW. First-trimester u\ ltrasound diagnosis of holoprosencephaly: three case )Tj T* (reports. )Tj /TT0 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1999;13:356\2269)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 210.0316 Tm (47. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 210.0316 Tm (Snijders RJM, Sebire NJ, Nayar R, Souka A, Nicolaides KH. Increased nuch\ al translucency in trisomy 13 fetuses at 10\22614 weeks of )Tj T* (gestation. )Tj /TT0 1 Tf (Am J Med Genet)Tj /TT1 1 Tf ( 1999;in press)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 172.0045 Tm (48. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 172.0045 Tm (Sherer DM, Hearn-Stebbins B, Harvey W, Metlay LA, Abramowicz JS. Endovag\ inal sonographic diagnosis of iniencephaly apertus and )Tj T* (craniorachischisis at 13 weeks, menstrual age. )Tj /TT0 1 Tf (J Clin Ultrasound)Tj /TT1 1 Tf ( 1993;21:124\2267)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 133.9773 Tm (49. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 133.9773 Tm (Braithwaite JM, Armstrong MA, Economides DL. Assessment of fetal anatomy\ at 12 to 13 weeks of gestation by transabdominal and )Tj T* (transvaginal sonography. )Tj /TT0 1 Tf (Br J Obstet Gynaecol)Tj /TT1 1 Tf ( 1996;103:82\2265)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 95.9502 Tm (50. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 95.9502 Tm (Campbell S, Pryse-Davies J, Coltard TM, )Tj /TT0 1 Tf (et al)Tj /TT1 1 Tf (. Ultrasound in the diagnosis of spina bifida. )Tj /TT0 1 Tf (Lancet)Tj /TT1 1 Tf ( 1975;1:1065\2266)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 74.3484 Tm (51. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 74.3484 Tm (Roberts CJ, Evans KT, Hibbard BM, Laurence KM, Roberts EE, Robertson IB.\ Diagnostic effectiveness of ultrasound in detection of )Tj (neural )Tj T* (tube defect: the South Wales experience of 2509 scans \(1977\2261982\) i\ n high-risk mothers. )Tj /TT0 1 Tf (Lancet)Tj /TT1 1 Tf ( 1983;ii:1068\2269)Tj /TT2 1 Tf 9.4902 0 0 9.4902 49.4008 36.3212 Tm (52. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 36.3212 Tm (Nicolaides KH, Campbell S, Gabbe SG, Guidetti R. Ultrasound screening fo\ r spina bifida: cranial and cerebellar signs. )Tj /TT0 1 Tf (Lancet)Tj /TT1 1 Tf ( 1986;2:72\2264)Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(58 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 863 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 583.8144 Tm (53. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 583.8144 Tm (Blumenfeld Z, Siegler E, Bronshtein M. The early diagnosis of neural tub\ e defects. )Tj /TT2 1 Tf (Prenat Diagn)Tj /TT1 1 Tf ( 1993;13:863\22671)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 562.2126 Tm (54. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 562.2126 Tm (Sebire NJ, Noble PL, Thorpe-Beeston JG, Snijders RJM, Nicolaides KH. Pre\ sence of the \221lemon sign\222 in fetuses with spina bifida a)Tj (t the 10\226)Tj 0 -1.473 TD (14-week scan. )Tj /TT2 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1997;10:403\2265)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 524.1855 Tm (55. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 524.1855 Tm (Bernard JP, Suarez B, Rambaud C, Muller F, Ville Y. Prenatal diagnosis o\ f neural tube defect before 12 weeks\222 gestation: direct )Tj (and )Tj T* (indirect ultrasonographic semeiology. )Tj /TT2 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1997;10:406\2269)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 486.1583 Tm (56. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 486.1583 Tm (Tegnander E, Eik-Nes SH, Johansen OJ, Linker DT. Prenatal detection of h\ eart defects at the routine fetal examination at 18 week)Tj (s in a )Tj T* (non-selected poulation. )Tj /TT2 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1995; 5:372\22680)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 448.1312 Tm (57. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 448.1312 Tm (Dolkart LA, Reimers FT. Transvaginal fetal echocardiography in early pre\ gnancy: normative data. )Tj /TT2 1 Tf (Am J Obstet Gynecol)Tj /TT1 1 Tf ( 1991;165:688\22691)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 426.5293 Tm (58. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 426.5293 Tm (Bronshtein M, Siegler E, Eshcoli Z, Zimmer EZ. Transvaginal ultrasound m\ easurements of the fetal heart at 11 to 17 weeks of gest)Tj (ation. )Tj /TT2 1 Tf T* (Am J Perinat)Tj /TT1 1 Tf ( 1992;9:38\22642)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 388.5022 Tm (59. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 388.5022 Tm (Johnson P, Sharland G, Maxwell D, Allan L. The role of transvaginal sono\ graphy in the early detection of congenital heart diseas)Tj (e. )Tj /TT2 1 Tf T* (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1992;2:248\22651)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 350.4751 Tm (60. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 350.4751 Tm (Gembruch U, Knopfle G, Bald R, Hansmann M. Early diagnosis of fetal cong\ enital heart disease by transvaginal echocardiography. )Tj /TT2 1 Tf T* (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1993;3:310\22617)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 312.4479 Tm (61. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 312.4479 Tm (Gembruch U, Knopfle G, Chatterjee M, Bald R, Hansmann M. First-trimester\ diagnosis of fetal congenital heart disease by transvag)Tj (inal two-)Tj T* (dimensional and Doppler echocardiography. )Tj /TT2 1 Tf (Obstet Gynecol)Tj /TT1 1 Tf ( 1990;75:496\2268)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 274.4207 Tm (62. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 274.4207 Tm (DeVore GR, Steiger GR, Larson EJ. Fetal echocardiography: the prenatal d\ iagnosis of a ventricular septal defect in a 14-week fet)Tj (us with )Tj T* (pulmonary artery hypoplasia. )Tj /TT2 1 Tf (Obstet Gynecol)Tj /TT1 1 Tf ( 1987;69:494\2267)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 236.3936 Tm (63. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 236.3936 Tm (Bronshtein M, Siegler E, Yoffe N, Zimmer EZ. Prenatal diagnosis of ventr\ icular septal defect and overriding aorta at 14 weeks\222 g)Tj (estation, )Tj T* (using transvaginal sonography. )Tj /TT2 1 Tf (Prenat Diagn)Tj /TT1 1 Tf ( 1990;10:697\226702)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 198.3665 Tm (64. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 198.3665 Tm (Achiron R, Rotstein Z, Lipitz S, Mashiach S, Hegesh J. First-trimester d\ iagnosis of fetal congenital heart disease by transvagin)Tj (al )Tj T* (ultrasonography. )Tj /TT2 1 Tf (Obstet Gynecol)Tj /TT1 1 Tf ( 1994;84:69\22672)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 160.3393 Tm (65. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 160.3393 Tm (Bronshtein M, Zimmer EZ, Milo S, Ho SY, Lorber A, Gerlis M. Fetal cardia\ c abnormalities detected by transvaginal sonography at 1)Tj (2\22616 )Tj T* (weeks\222 gestation. )Tj /TT2 1 Tf (Obstet Gynecol)Tj /TT1 1 Tf ( 1991;78:374\2268)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 122.3121 Tm (66. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 122.3121 Tm (Hyett JA, Perdu M, Sharland GK, Snijders RJM, Nicolaides KH. Using fetal\ nuchal translucency to screen for major congenital card)Tj (iac )Tj T* (defects at 10\22614 weeks of gestation: population based cohort study. )Tj /TT2 1 Tf (Br Med J)Tj /TT1 1 Tf ( 1999:318:81\2265)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 84.285 Tm (67. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 84.285 Tm (Timor-Tritsch IE, Warren W, Peisner DB, Pirrone E. First-trimester midgu\ t herniation: a high frequency transvaginal sonographic )Tj (study. )Tj /TT2 1 Tf (Am )Tj T* (J Obstet Gynecol)Tj /TT1 1 Tf ( 1989;161:831\2263)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 46.2579 Tm (68. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 46.2579 Tm (van Zalen-Sprock RM, van Vugt JMG, van Geijn HP. First-trimester sonogra\ phy of physiological midgut herniation and early diagnos)Tj (is of )Tj T* (omphalocele. )Tj /TT2 1 Tf (Prenat Diagn)Tj /TT1 1 Tf ( 1997;17:511\22618)Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(59 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 864 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 582.6456 Tm (69. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 582.6456 Tm (Brown DL, Emerson DS, Shulman LP, Carson SA. Sonographic diagnosis of om\ phalocele during the 10)Tj 8.9195 0 0 8.9195 582.8488 585.4998 Tm (th)Tj 11.1493 0 0 11.1493 590.2876 582.6456 Tm ( week of gestation. )Tj /TT2 1 Tf (Am J Radiol)Tj /TT1 1 Tf ( )Tj -46.521 -1.368 Td (1989;153:825\2266)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 545.7873 Tm (70. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 545.7873 Tm (Pagliano M, Mossetti M, Ragno P. Echographic diagnosis of omphalocele in\ the first trimester of pregnancy. )Tj /TT2 1 Tf (J Clin Ultrasound)Tj /TT1 1 Tf ( 1990;18:658\226)Tj 0 -1.473 TD (60)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 507.7601 Tm (71. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 507.7601 Tm (Heydanus R, Raats AM, Tibboel D, Lost FJ, Wladimiroff JW. Prenatal diagn\ osis of fetal abdominal wall defects: a retrospective an)Tj (alysis of )Tj T* (44 cases. )Tj /TT2 1 Tf (Prenat Diagn)Tj /TT1 1 Tf ( 1996;16:411\22617)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 469.733 Tm (72. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 469.733 Tm (Snijders RJM, Sebire NJ, Souka A, Santiago C, Nicolaides KH. Fetal exomp\ halos and chromosomal defects: relationship to maternal )Tj (age )Tj T* (and gestation. )Tj /TT2 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1995;6:250\2265)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 431.7058 Tm (73. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 431.7058 Tm (Kushnir O, Izquierdo L, Vigil D, Curet LB. Early transvaginal diagnosis \ of gastroschisis. )Tj /TT2 1 Tf (J Clin Ultrasound)Tj /TT1 1 Tf ( 1990;18:194\2267)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 410.104 Tm (74. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 410.104 Tm (Guzman ER. Early prenatal diagnosis of gastroschisis with transvaginal s\ onography. )Tj /TT2 1 Tf (Am J Obstet Gynecol)Tj /TT1 1 Tf ( 1990;162:1253\2264)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 388.5022 Tm (75. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 388.5022 Tm (Rosati P, Guariglia L. Transvaginal sonographic assessment of the fetal \ urinary tract in early pregnancy. )Tj /TT2 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( )Tj T* (1996;7:95\226100)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 350.4751 Tm (76. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 350.4751 Tm (Bronshtein M, Amit A, Achiron R, Noy I, Blumenfeld Z. The early prenatal\ sonographic diagnosis of renal agenesis: techniques and)Tj ( possible )Tj T* (pitfalls. )Tj /TT2 1 Tf (Prenat Diagn)Tj /TT1 1 Tf ( 1994;14:291\2267)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 312.4479 Tm (77. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 312.4479 Tm (Bronshtein M, Bar-Hava I, Blumenfeld Z. Clues and pitfalls in the early \ prenatal diagnosis of \221late onset\222 infantile polycystic )Tj (kidney. )Tj /TT2 1 Tf (Prenat )Tj T* (Diagn)Tj /TT1 1 Tf ( 1992;12:293\2268)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 274.4207 Tm (78. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 274.4207 Tm (Bronshtein M, Yoffe N, Brandes JM, Blumenfeld Z. First and early second-\ trimester diagnosis of fetal urinary tract anomalies usi)Tj (ng )Tj T* (transvaginal sonography. )Tj /TT2 1 Tf (Prenat Diagn)Tj /TT1 1 Tf ( 1990;10:653\22666)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 236.3936 Tm (79. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 236.3936 Tm (Sebire NJ, von Kaisenberg C, Rubio C, Snijders RJM, Nicolaides KH. Fetal\ megacystis at 10\22614 weeks of gestation. )Tj /TT2 1 Tf (Ultrasound Obstet )Tj T* (Gynecol)Tj /TT1 1 Tf ( 1996;8: 387\22690)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 198.3665 Tm (80. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 198.3665 Tm (Bulic M, Podobnik M, Korenic B, Bistricki J. First-trimester diagnosis o\ f low obstructive uropathy: an indicator of initial rena)Tj (l function in the )Tj T* (fetus. )Tj /TT2 1 Tf (J Clin Ultrasound)Tj /TT1 1 Tf ( 1987;15:537\22641)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 160.3393 Tm (81. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 160.3393 Tm (Stiller R. Early ultrasonic appearance of fetal bladder outlet obstructi\ on. )Tj /TT2 1 Tf (Am J Obstet Gynecol)Tj /TT1 1 Tf ( 1989;160:584\2265)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 138.7375 Tm (82. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 138.7375 Tm (Drugan A, Zador IE, Bhatia RK, Sacks AJ, Evans M. First trimester diagno\ sis and early in utero treatment of obstructive uropathy)Tj (. )Tj /TT2 1 Tf (Acta )Tj T* (Obstet Gynecol Scand)Tj /TT1 1 Tf ( 1989;68:645\2269)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 100.7103 Tm (83. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 100.7103 Tm (Zimmer EZ, Bronshtein M. Fetal intra-abdominal cysts detected in the fir\ st and early second trimester by transvaginal sonography)Tj (. )Tj /TT2 1 Tf (J Clin )Tj T* (Ultrasound)Tj /TT1 1 Tf ( 1991;19:564\2267)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 62.6832 Tm (84. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 62.6832 Tm (Yoshida M, Matsumura M, Shintaku Y, Yura Y, Kanamori T, Matsushita K, No\ nogaki T, Hayashi M, Tauchi K. Prenatally diagnosed fema)Tj (le )Tj T* (Prune-belly syndrome associated with tetralogy of Fallot. )Tj /TT2 1 Tf (Gynecol Obstet Invest)Tj /TT1 1 Tf ( 1995;39:141\2264)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 24.6561 Tm (85. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 24.6561 Tm (Fried S, Appelman Z, Caspi B. The origin of ascites in prune belly syndr\ ome \226 early sonographic evidence. )Tj /TT2 1 Tf (Prenat Diagn)Tj /TT1 1 Tf ( 1995;15:876\2267)Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(60 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 865 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /Article <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 579.0542 Tm (86. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 579.0542 Tm (Hoshino T, Ihara Y, Shirane H, Ota T. Prenatal diagnosis of prune belly \ syndrome at 12 weeks of pregnancy: case report and revie)Tj (w of the )Tj 0 -1.473 TD (literature. )Tj /TT2 1 Tf (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1998;12:362\2266)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 541.0271 Tm (87. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 541.0271 Tm (Cazorla E, Ruiz F, Abad A, Monleon J. Prune belly syndrome: early antena\ tal diagnosis. )Tj /TT2 1 Tf (Eur J Obstet Gynecol)Tj /TT1 1 Tf ( 1997;72:31\2263)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 519.4253 Tm (88. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 519.4253 Tm (Harrison MR, Nakayama DK, Noall R, De Lorimer AA. Correction of congenit\ al hydronephrosis in utero. II. Decompression reverses t)Tj (he )Tj T* (effect of obstruction on the fetal lung and urinary tract. )Tj /TT2 1 Tf (J Pediatr Surg)Tj /TT1 1 Tf ( 1982;17:965\22674)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 481.3981 Tm (89. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 481.3981 Tm (Glick PL, Harrison MR, Adzick NS, Noall RA, Villa RL. Correction of cong\ enital hydronephrosis in utero. IV. In utero decompressi)Tj (on )Tj T* (prevents renal dysplasia. )Tj /TT2 1 Tf (J Pediatr Surg)Tj /TT1 1 Tf ( 1984;19:649\22657)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 443.371 Tm (90. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 443.371 Tm (Timor-Tritsch IE, Farine D, Rosen M. A close look at early embryonic dev\ elopment with the high-frequency transvaginal transducer)Tj (. )Tj /TT2 1 Tf (Am J )Tj T* (Obstet Gynecol)Tj /TT1 1 Tf ( 1988;159:676\22681)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 405.3438 Tm (91. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 405.3438 Tm (Timor-Tritsch IE, Monteagudo A, Peisner DB. High-frequency transvaginal \ sonographic examination for the potential malformation )Tj T* (assessment of the 9-week to 14-week fetus. )Tj /TT2 1 Tf (J Clin Ultrasound)Tj /TT1 1 Tf ( 1992;20:231\2268)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 367.3167 Tm (92. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 367.3167 Tm (Zorzoli A, Kusterman E, Carvelli E, Corso FE, Fogliani R, Aimi G, Nicoli\ ni U. Measurements of fetal limb bones in early pregnanc)Tj (y. )Tj /TT2 1 Tf T* (Ultrasound Obstet Gynecol)Tj /TT1 1 Tf ( 1994;4:29\22633)Tj /TT0 1 Tf 9.4902 0 0 9.4902 49.4008 329.2895 Tm (93. )Tj /TT1 1 Tf 11.1493 0 0 11.1493 71.6078 329.2895 Tm (Baxi L, Warren W, Collins M, Timor-Tritsch IE. Early detection of caudal\ regression syndrome with transvaginal scanning. )Tj /TT2 1 Tf (Obstet Gynecol)Tj /TT1 1 Tf ( )Tj T* (1990;75:485\2269)Tj 0.4 0.4 0.4 rg /TT3 1 Tf 23.44 -7.609 Td (The 11-14-week scan )Tj -17.381 -1.2 Td (Copyright \251 2001 by KH Nicolaides, NJ Sebire, RJM Snijders, RLS Ximen\ es & G. 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The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 239.712 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 247.6078491 135.0196075 337.6862793 cm /Im0 Do Q 0 0 0 rg BT /TT0 1 Tf 9.4902 0 0 9.4902 406.7843 458.3727 Tm ( )Tj 11.1493 0 0 11.1493 135.0196 314.3929 Tm (Coronal section showing the implantation )Tj 0 -1.2 TD (\(fundus+left corno\), normal decidual )Tj T* (reaction )Tj 9.4902 0 0 9.4902 406.7843 301.5588 Tm ( )Tj 0 0 1 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 254.6389 Tm (6 weeks \(crown\226rump length 4\2268 mm\))Tj ET EMC /Annot <>BDC 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 222.6739 Tm (The embryonic pole, yolk sac and heart activity )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 307.2346 222.6739 Tm (are now always present. )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 448.2842 222.6739 Tm (The heart rate increases to 130 bpm. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 661.9048 222.6739 Tm (At the end of )Tj -56.04 -1.473 Td (week 6, )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 85.1069 206.2509 Tm (the first sign of the rhombencephalic cavity )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 332.5881 206.2509 Tm (appears as a tiny hypoechogenic area in the cranial pole of the embryo. \ )Tj -26.503 -1.473 Td (The amniotic cavity can be seen surrounded by a thin membrane around the\ embryo.)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(4 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1045 0 obj<> endobj 1046 0 obj<>/Type/XObject/BBox[81.5142 203.523 332.255 217.821]/FormType 1>>stream 1 1 0 rg 0.8411 w 85.1068 203.9433 m 81.9349 207.1151 81.9349 214.2285 85.1068 217.4003 c 328.6628 217.4003 l 331.8347 214.2285 331.8347 207.1151 328.6628 203.9433 c f endstream endobj 1047 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 250.741 14.2986]/FormType 1>>stream /Form Do endstream endobj 1048 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 250.742 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1049 0 obj<>>> endobj 1050 0 obj<>6]/P 208 0 R/S/Annot/Pg 246 0 R>> endobj 1051 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 445.644 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 132 570.2982 Tm (Uterus \(longitudinal view\) with identification )Tj 0 -1.473 TD (of the Gestational Sac \(5,0mm mean )Tj T* (diameter\) and color doppler maping of the )Tj T* (uterine vessels, trophobastic flow \(TF\) and )Tj T* (peri-endometrial flow.)Tj 9.4902 0 0 9.4902 256.1923 504.5969 Tm ( )Tj 11.1493 0 0 11.1493 409.8039 554.0488 Tm (Uterus \(longitudinal view\) with identification )Tj 0 -1.2 TD (of the Gestational Sac \(5,0mm mean )Tj T* (diameter\) and color doppler energy maping )Tj 0 -1.2 TD (of the uterine vessels )Tj 0 0 1 rg /TT1 1 Tf -33.429 -4.784 Td (5 weeks)Tj 0 0 0 rg /TT0 1 Tf 0 -2.867 TD (The yolk sac is first visible at 5 weeks and it )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 289.3023 428.608 Tm (is always present by 5 weeks and 4 days. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 527.0945 428.608 Tm (There are lacunary structures at the site )Tj -43.949 -1.473 Td (of implantation. The embryonic pole appears adjacent to the yolk sac, so\ on showing cardiac activity. Since the connecting stalk )Tj 0 -1.473 TD (is short, the embryonic pole is found near the wall. At the end of week \ 5, the )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 475.0942 395.7622 Tm (heart rate is about 100 bpm.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 637.5782 395.7583 Tm ( )Tj ET EMC /Article <>BDC q 258.8235321 0 0 197.568634 135.0196075 173.3484192 cm /Im0 Do Q q 258.8235321 0 0 208.784317 406.784317 167.7405701 cm /Im1 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 177.4667 144.4473 Tm (Longitudinal view of the uterus )Tj -3.563 -1.2 Td (Gestational Sac + Yolk Sac \(embryionic pole )Tj 8.566 -1.2 Td (not visible\))Tj 15.565 1.8 Td (end of the week 5 and visualization of the )Tj 0 -1.2 TD (embryo)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(3 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1052 0 obj<> endobj 1053 0 obj<>/Type/XObject/BBox[471.501 393.034 641.165 407.332]/FormType 1>>stream 1 1 0 rg 0.8411 w 475.0935 393.4544 m 471.9217 396.6263 471.9217 403.7397 475.0935 406.9115 c 637.5723 406.9115 l 640.7442 403.7397 640.7442 396.6263 637.5723 393.4544 c f endstream endobj 1054 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 169.664 14.2986]/FormType 1>>stream /Form Do endstream endobj 1055 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 169.664 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1056 0 obj<>>> endobj 1057 0 obj<>3]/P 208 0 R/S/Annot/Pg 253 0 R>> endobj 1058 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 404.22 735.059 30.229 re f EMC EMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 37.098 512.097 m 340.784 512.097 l 339.059 510.371 l 38.824 510.371 l h f 37.098 512.097 m 37.098 436.175 l 38.824 437.9 l 38.824 510.371 l h f 0.313 0.313 0.313 rg 340.784 512.097 m 340.784 436.175 l 339.059 437.9 l 339.059 510.371 l h f 37.098 436.175 m 340.784 436.175 l 339.059 437.9 l 38.824 437.9 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 38.824 510.371 m 76.784 510.371 l 75.922 509.508 l 39.686 509.508 l h f 38.824 510.371 m 38.824 474.136 l 39.686 474.998 l 39.686 509.508 l h f 0.949 0.945 0.935 rg 76.784 510.371 m 76.784 474.136 l 75.922 474.998 l 75.922 509.508 l h f 38.824 474.136 m 76.784 474.136 l 75.922 474.998 l 39.686 474.998 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 77.647 474.998 260.549 34.51 re f 0.457 0.449 0.431 rg 76.784 510.371 m 339.059 510.371 l 338.196 509.508 l 77.647 509.508 l h f 76.784 510.371 m 76.784 474.136 l 77.647 474.998 l 77.647 509.508 l h f 0.949 0.945 0.935 rg 339.059 510.371 m 339.059 474.136 l 338.196 474.998 l 338.196 509.508 l h f 76.784 474.136 m 339.059 474.136 l 338.196 474.998 l 77.647 474.998 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 38.824 474.136 m 76.784 474.136 l 75.922 473.273 l 39.686 473.273 l h f 38.824 474.136 m 38.824 437.9 l 39.686 438.763 l 39.686 473.273 l h f 0.949 0.945 0.935 rg 76.784 474.136 m 76.784 437.9 l 75.922 438.763 l 75.922 473.273 l h f 38.824 437.9 m 76.784 437.9 l 75.922 438.763 l 39.686 438.763 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 77.647 438.763 260.549 34.51 re f 0.457 0.449 0.431 rg 76.784 474.136 m 339.059 474.136 l 338.196 473.273 l 77.647 473.273 l h f 76.784 474.136 m 76.784 437.9 l 77.647 438.763 l 77.647 473.273 l h f 0.949 0.945 0.935 rg 339.059 474.136 m 339.059 437.9 l 338.196 438.763 l 338.196 473.273 l h f 76.784 437.9 m 339.059 437.9 l 338.196 438.763 l 77.647 438.763 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 135.0196 573.6708 Tm (Figure 1c)Tj /TT1 1 Tf ( - Embryo at 6 weeks \(crown\226)Tj 0 -1.473 TD (rump length 5 mm\). Embryo cardiac ativity )Tj T* (with a heart rate of 126 bpm.)Tj 9.4902 0 0 9.4902 301.7131 540.8201 Tm ( )Tj 11.072 1.423 Td ( )Tj -38.955 -4.278 Td ( )Tj ET q 34.5098114 0 0 34.5098114 39.6862793 474.9984894 cm /Im0 Do Q q 258.8235321 0 0 21.568634 78.5098114 481.4690857 cm /Im1 Do Q q 34.5098114 0 0 34.5098114 39.6862793 438.7631989 cm /Im0 Do Q q 258.8235321 0 0 21.568634 78.5098114 445.2337799 cm /Im2 Do Q 0 0 1 rg BT /TT2 1 Tf 11.1493 0 0 11.1493 37.098 419.1475 Tm (7 weeks \(crown\226rump length 9\22614 mm\))Tj 0 0 0 rg 0 -2.866 TD (External form)Tj /TT1 1 Tf 0 -1.938 TD (The embryonic body appears as a triangle in the sagittal section. The si\ des consist of \(1\) the back, \(2\) the roof of the )Tj 0 -1.473 TD (rhombencephalon, and \(3\) the frontal part of the head, the base of the\ umbilical cord, and the embryonic tail. The embryonic )Tj T* (body is slender in the coronal plane. The limbs are short, paddle-shaped\ outgrowths.)Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Central nervous system)Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 419.1475 Tm 0 -11.625 TD (The hypoechogenic brain cavities )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 227.1155 289.5369 Tm (can be identified, including the separated cerebral hemispheres. The lat\ eral ventricles are )Tj -17.043 -1.473 Td (shaped like small, round vesicles. The cavity of the diencephalon \(futu\ re third ventricle\) runs posteriorly. In the smallest )Tj 0 -1.473 TD (embryos, the medial telencephalon forms a continuous cavity between the \ lateral ventricles. The future foramina of Monro are )Tj T* (wide during week 7. In the sagittal plane, the height of the cavity of t\ he diencephalon is slightly greater than that of the )Tj T* (mesencephalon \(future Sylvian aqueduct\). Thus, the wide border between\ the cavities of the diencephalon and the )Tj T* (mesencephalon is indicated. The curved tube-like mesencephalic cavity li\ es anteriorly, its rostral part pointing caudally. It )Tj 0 -1.473 TD (straightens considerably during the following weeks. By week 8, it is re\ gularly identified. The relatively broad and shallow )Tj 0 -1.473 TD (rhombencephalic cavity is always visible from 7 weeks onwards. It then h\ as a well-defined rhombic shape in the cranial pole of )Tj T* (the embryo.)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(6 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1059 0 obj<> endobj 1060 0 obj<>/Type/XObject/BBox[33.5055 286.809 226.783 301.107]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.098 287.2292 m 33.9262 290.401 33.9262 297.5144 37.098 300.6862 c 223.1904 300.6862 l 226.3622 297.5144 226.3622 290.401 223.1904 287.2292 c f endstream endobj 1061 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 193.278 14.2986]/FormType 1>>stream /Form Do endstream endobj 1062 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 193.278 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1063 0 obj<>>> endobj 1064 0 obj<>6]/P 208 0 R/S/Annot/Pg 253 0 R>> endobj 1065 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 404.22 735.059 30.229 re f EMC EMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 37.098 512.097 m 340.784 512.097 l 339.059 510.371 l 38.824 510.371 l h f 37.098 512.097 m 37.098 436.175 l 38.824 437.9 l 38.824 510.371 l h f 0.313 0.313 0.313 rg 340.784 512.097 m 340.784 436.175 l 339.059 437.9 l 339.059 510.371 l h f 37.098 436.175 m 340.784 436.175 l 339.059 437.9 l 38.824 437.9 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 38.824 510.371 m 76.784 510.371 l 75.922 509.508 l 39.686 509.508 l h f 38.824 510.371 m 38.824 474.136 l 39.686 474.998 l 39.686 509.508 l h f 0.949 0.945 0.935 rg 76.784 510.371 m 76.784 474.136 l 75.922 474.998 l 75.922 509.508 l h f 38.824 474.136 m 76.784 474.136 l 75.922 474.998 l 39.686 474.998 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 77.647 474.998 260.549 34.51 re f 0.457 0.449 0.431 rg 76.784 510.371 m 339.059 510.371 l 338.196 509.508 l 77.647 509.508 l h f 76.784 510.371 m 76.784 474.136 l 77.647 474.998 l 77.647 509.508 l h f 0.949 0.945 0.935 rg 339.059 510.371 m 339.059 474.136 l 338.196 474.998 l 338.196 509.508 l h f 76.784 474.136 m 339.059 474.136 l 338.196 474.998 l 77.647 474.998 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 38.824 474.136 m 76.784 474.136 l 75.922 473.273 l 39.686 473.273 l h f 38.824 474.136 m 38.824 437.9 l 39.686 438.763 l 39.686 473.273 l h f 0.949 0.945 0.935 rg 76.784 474.136 m 76.784 437.9 l 75.922 438.763 l 75.922 473.273 l h f 38.824 437.9 m 76.784 437.9 l 75.922 438.763 l 39.686 438.763 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 77.647 438.763 260.549 34.51 re f 0.457 0.449 0.431 rg 76.784 474.136 m 339.059 474.136 l 338.196 473.273 l 77.647 473.273 l h f 76.784 474.136 m 76.784 437.9 l 77.647 438.763 l 77.647 473.273 l h f 0.949 0.945 0.935 rg 339.059 474.136 m 339.059 437.9 l 338.196 438.763 l 338.196 473.273 l h f 76.784 437.9 m 339.059 437.9 l 338.196 438.763 l 77.647 438.763 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 135.0196 573.6708 Tm (Figure 1c)Tj /TT1 1 Tf ( - Embryo at 6 weeks \(crown\226)Tj 0 -1.473 TD (rump length 5 mm\). 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In the sagittal plane, the height of the cavity of t\ he diencephalon is slightly greater than that of the )Tj T* (mesencephalon \(future Sylvian aqueduct\). Thus, the wide border between\ the cavities of the diencephalon and the )Tj T* (mesencephalon is indicated. The curved tube-like mesencephalic cavity li\ es anteriorly, its rostral part pointing caudally. It )Tj 0 -1.473 TD (straightens considerably during the following weeks. By week 8, it is re\ gularly identified. The relatively broad and shallow )Tj 0 -1.473 TD (rhombencephalic cavity is always visible from 7 weeks onwards. 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In the smallest )Tj -44.714 -1.473 Td (embryos, the medial telencephalon forms a continuous cavity between the \ lateral ventricles. The future foramina of Monro are )Tj 0 -1.473 TD (wide during week 7. In the sagittal plane, the height of the cavity of t\ he diencephalon is slightly greater than that of the )Tj T* (mesencephalon \(future Sylvian aqueduct\). Thus, the wide border between\ the cavities of the diencephalon and the )Tj T* (mesencephalon is indicated. The curved tube-like mesencephalic cavity li\ es anteriorly, its rostral part pointing caudally. It )Tj T* (straightens considerably during the following weeks. By week 8, it is re\ gularly identified. The relatively broad and shallow )Tj 0 -1.473 TD (rhombencephalic cavity is always visible from 7 weeks onwards. 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The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 98.353 428.513 m 702.275 428.513 l 700.549 426.787 l 100.078 426.787 l h f 98.353 428.513 m 98.353 352.591 l 100.078 354.317 l 100.078 426.787 l h f 0.313 0.313 0.313 rg 702.275 428.513 m 702.275 352.591 l 700.549 354.317 l 700.549 426.787 l h f 98.353 352.591 m 702.275 352.591 l 700.549 354.317 l 100.078 354.317 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 100.078 426.787 m 138.039 426.787 l 137.176 425.925 l 100.941 425.925 l h f 100.078 426.787 m 100.078 390.552 l 100.941 391.415 l 100.941 425.925 l h f 0.949 0.945 0.935 rg 138.039 426.787 m 138.039 390.552 l 137.176 391.415 l 137.176 425.925 l h f 100.078 390.552 m 138.039 390.552 l 137.176 391.415 l 100.941 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 138.902 391.415 260.549 34.51 re f 0.457 0.449 0.431 rg 138.039 426.787 m 400.314 426.787 l 399.451 425.925 l 138.902 425.925 l h f 138.039 426.787 m 138.039 390.552 l 138.902 391.415 l 138.902 425.925 l h f 0.949 0.945 0.935 rg 400.314 426.787 m 400.314 390.552 l 399.451 391.415 l 399.451 425.925 l h f 138.039 390.552 m 400.314 390.552 l 399.451 391.415 l 138.902 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 1 1 1 rg 401.176 391.415 36.235 34.51 re f 0.457 0.449 0.431 rg 400.314 426.787 m 438.275 426.787 l 437.412 425.925 l 401.176 425.925 l h f 400.314 426.787 m 400.314 390.552 l 401.176 391.415 l 401.176 425.925 l h f 0.949 0.945 0.935 rg 438.275 426.787 m 438.275 390.552 l 437.412 391.415 l 437.412 425.925 l h f 400.314 390.552 m 438.275 390.552 l 437.412 391.415 l 401.176 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 439.137 391.415 260.549 34.51 re f 0.457 0.449 0.431 rg 438.275 426.787 m 700.549 426.787 l 699.686 425.925 l 439.137 425.925 l h f 438.275 426.787 m 438.275 390.552 l 439.137 391.415 l 439.137 425.925 l h f 0.949 0.945 0.935 rg 700.549 426.787 m 700.549 390.552 l 699.686 391.415 l 699.686 425.925 l h f 438.275 390.552 m 700.549 390.552 l 699.686 391.415 l 439.137 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 100.078 390.552 m 138.039 390.552 l 137.176 389.689 l 100.941 389.689 l h f 100.078 390.552 m 100.078 354.317 l 100.941 355.179 l 100.941 389.689 l h f 0.949 0.945 0.935 rg 138.039 390.552 m 138.039 354.317 l 137.176 355.179 l 137.176 389.689 l h f 100.078 354.317 m 138.039 354.317 l 137.176 355.179 l 100.941 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 138.902 355.179 260.549 34.51 re f 0.457 0.449 0.431 rg 138.039 390.552 m 400.314 390.552 l 399.451 389.689 l 138.902 389.689 l h f 138.039 390.552 m 138.039 354.317 l 138.902 355.179 l 138.902 389.689 l h f 0.949 0.945 0.935 rg 400.314 390.552 m 400.314 354.317 l 399.451 355.179 l 399.451 389.689 l h f 138.039 354.317 m 400.314 354.317 l 399.451 355.179 l 138.902 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 1 1 1 rg 401.176 355.179 36.235 34.51 re f 0.457 0.449 0.431 rg 400.314 390.552 m 438.275 390.552 l 437.412 389.689 l 401.176 389.689 l h f 400.314 390.552 m 400.314 354.317 l 401.176 355.179 l 401.176 389.689 l h f 0.949 0.945 0.935 rg 438.275 390.552 m 438.275 354.317 l 437.412 355.179 l 437.412 389.689 l h f 400.314 354.317 m 438.275 354.317 l 437.412 355.179 l 401.176 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 439.137 355.179 260.549 34.51 re f 0.457 0.449 0.431 rg 438.275 390.552 m 700.549 390.552 l 699.686 389.689 l 439.137 389.689 l h f 438.275 390.552 m 438.275 354.317 l 439.137 355.179 l 439.137 389.689 l h f 0.949 0.945 0.935 rg 700.549 390.552 m 700.549 354.317 l 699.686 355.179 l 699.686 389.689 l h f 438.275 354.317 m 700.549 354.317 l 699.686 355.179 l 439.137 355.179 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 132.4314 571.3178 Tm (Figure 3a)Tj /TT1 1 Tf ( - Embryo at 7+5 weeks \(crown\226)Tj 0 -1.473 TD (rump length 14 mm\). Sagittal section )Tj T* (through )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 180.3957 538.472 Tm (the \221triangular\222 body demonstrating )Tj 11.1493 0 0 11.1493 132.4314 571.3178 Tm 0 -4.419 TD (the shallow cavity of the rhomben-cephalon )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 132.4314 505.6261 Tm (\(Rh\), the curved tube-like mesencephalon )Tj 0 -1.473 TD (\(Mes\), the diencephalon \(Di\) and the )Tj T* (umbilical cord \(U\))Tj 9.4902 0 0 9.4902 232.4296 472.7658 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 409.3725 554.8925 Tm (Figure 3b)Tj /TT1 1 Tf ( - Embryo at 7+5 weeks \(crown\226)Tj T* (rump length 14 mm\). Coronal section )Tj T* (through the head and body demonstrating )Tj T* (the shallow cavity of the rhomben-cephalon )Tj T* (\(Rh\), choroid plexus \(CP\))Tj 9.4902 0 0 9.4902 552.0393 489.1911 Tm ( )Tj -54.26 -5.131 Td ( )Tj ET q 34.5098114 0 0 34.5098114 100.9411774 391.4147797 cm /Im0 Do Q q 258.8235321 0 0 21.568634 138.9019623 397.885376 cm /Im1 Do Q q 34.5098114 0 0 34.5098114 401.1764679 391.4147797 cm /Im0 Do Q q 258.8235321 0 0 21.568634 440 397.885376 cm /Im2 Do Q q 34.5098114 0 0 34.5098114 100.9411774 355.1794891 cm /Im0 Do Q q 258.8235321 0 0 21.568634 138.9019623 361.6500702 cm /Im3 Do Q q 34.5098114 0 0 34.5098114 401.1764679 355.1794891 cm /Im0 Do Q q 258.8235321 0 0 21.568634 440 361.6500702 cm /Im4 Do Q BT /TT1 1 Tf 9.4902 0 0 9.4902 37.098 344.7286 Tm ( )Tj /TT2 1 Tf 11.1493 0 0 11.1493 37.098 332.1128 Tm (Heart)Tj /TT1 1 Tf 0 -1.938 TD (The heart can be recognized as a beating, large and bright structure bel\ ow the embryonic head at 7 weeks. The heart rate )Tj 0 -1.473 TD (increases from 130 bpm to 160 bpm. Details of the heart anatomy are not \ visible, but the atrial and ventricular compartments )Tj 0 -1.473 TD (can sometimes be distinguished by the reciprocal movements of the walls.\ )Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Intestinal tract)Tj /TT1 1 Tf 0 -1.938 TD (The short umbilical cord shows a large celomic cavity at its insertion, \ where the primary intestinal loop can be identified. The)Tj ( )Tj 0 -1.473 TD (first sign of herniation of the gut occurs during week 7 as a thickening\ of the cord and showing a slight echogenic area at the )Tj T* (abdominal insertion. Within a few days, this echogenic structure becomes\ more distinct.)Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Extra-embryonic structures)Tj /TT1 1 Tf 0 -1.938 TD (The amniotic cavity becomes visible at the beginning of week 7. The mean\ diameter of the amniotic cavity is almost the same )Tj 0 -1.473 TD (as the corresponding crown\226rump length.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 272.1592 141.9694 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(8 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1123 0 obj<> endobj 1124 0 obj<>/Type/XObject/BBox[128.839 519.321 382.98 550.042]/FormType 1>>stream HD 1 {O {_''ߗ #18iyk >$c 2+(/йsVh W䬷w.):M[kLk*B.Wڷ,ٯl쉿䬷wvGP? endstream endobj 1125 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 254.142 30.7215]/FormType 1>>stream /Form Do endstream endobj 1126 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 254.142 30.7218]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1127 0 obj<>>> endobj 1128 0 obj<>6]/P 208 0 R/S/Annot/Pg 261 0 R>> endobj 1129 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 98.353 428.513 m 702.275 428.513 l 700.549 426.787 l 100.078 426.787 l h f 98.353 428.513 m 98.353 352.591 l 100.078 354.317 l 100.078 426.787 l h f 0.313 0.313 0.313 rg 702.275 428.513 m 702.275 352.591 l 700.549 354.317 l 700.549 426.787 l h f 98.353 352.591 m 702.275 352.591 l 700.549 354.317 l 100.078 354.317 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 100.078 426.787 m 138.039 426.787 l 137.176 425.925 l 100.941 425.925 l h f 100.078 426.787 m 100.078 390.552 l 100.941 391.415 l 100.941 425.925 l h f 0.949 0.945 0.935 rg 138.039 426.787 m 138.039 390.552 l 137.176 391.415 l 137.176 425.925 l h f 100.078 390.552 m 138.039 390.552 l 137.176 391.415 l 100.941 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 138.902 391.415 260.549 34.51 re f 0.457 0.449 0.431 rg 138.039 426.787 m 400.314 426.787 l 399.451 425.925 l 138.902 425.925 l h f 138.039 426.787 m 138.039 390.552 l 138.902 391.415 l 138.902 425.925 l h f 0.949 0.945 0.935 rg 400.314 426.787 m 400.314 390.552 l 399.451 391.415 l 399.451 425.925 l h f 138.039 390.552 m 400.314 390.552 l 399.451 391.415 l 138.902 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 1 1 1 rg 401.176 391.415 36.235 34.51 re f 0.457 0.449 0.431 rg 400.314 426.787 m 438.275 426.787 l 437.412 425.925 l 401.176 425.925 l h f 400.314 426.787 m 400.314 390.552 l 401.176 391.415 l 401.176 425.925 l h f 0.949 0.945 0.935 rg 438.275 426.787 m 438.275 390.552 l 437.412 391.415 l 437.412 425.925 l h f 400.314 390.552 m 438.275 390.552 l 437.412 391.415 l 401.176 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 439.137 391.415 260.549 34.51 re f 0.457 0.449 0.431 rg 438.275 426.787 m 700.549 426.787 l 699.686 425.925 l 439.137 425.925 l h f 438.275 426.787 m 438.275 390.552 l 439.137 391.415 l 439.137 425.925 l h f 0.949 0.945 0.935 rg 700.549 426.787 m 700.549 390.552 l 699.686 391.415 l 699.686 425.925 l h f 438.275 390.552 m 700.549 390.552 l 699.686 391.415 l 439.137 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 100.078 390.552 m 138.039 390.552 l 137.176 389.689 l 100.941 389.689 l h f 100.078 390.552 m 100.078 354.317 l 100.941 355.179 l 100.941 389.689 l h f 0.949 0.945 0.935 rg 138.039 390.552 m 138.039 354.317 l 137.176 355.179 l 137.176 389.689 l h f 100.078 354.317 m 138.039 354.317 l 137.176 355.179 l 100.941 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 138.902 355.179 260.549 34.51 re f 0.457 0.449 0.431 rg 138.039 390.552 m 400.314 390.552 l 399.451 389.689 l 138.902 389.689 l h f 138.039 390.552 m 138.039 354.317 l 138.902 355.179 l 138.902 389.689 l h f 0.949 0.945 0.935 rg 400.314 390.552 m 400.314 354.317 l 399.451 355.179 l 399.451 389.689 l h f 138.039 354.317 m 400.314 354.317 l 399.451 355.179 l 138.902 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 1 1 1 rg 401.176 355.179 36.235 34.51 re f 0.457 0.449 0.431 rg 400.314 390.552 m 438.275 390.552 l 437.412 389.689 l 401.176 389.689 l h f 400.314 390.552 m 400.314 354.317 l 401.176 355.179 l 401.176 389.689 l h f 0.949 0.945 0.935 rg 438.275 390.552 m 438.275 354.317 l 437.412 355.179 l 437.412 389.689 l h f 400.314 354.317 m 438.275 354.317 l 437.412 355.179 l 401.176 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 439.137 355.179 260.549 34.51 re f 0.457 0.449 0.431 rg 438.275 390.552 m 700.549 390.552 l 699.686 389.689 l 439.137 389.689 l h f 438.275 390.552 m 438.275 354.317 l 439.137 355.179 l 439.137 389.689 l h f 0.949 0.945 0.935 rg 700.549 390.552 m 700.549 354.317 l 699.686 355.179 l 699.686 389.689 l h f 438.275 354.317 m 700.549 354.317 l 699.686 355.179 l 439.137 355.179 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 132.4314 571.3178 Tm (Figure 3a)Tj /TT1 1 Tf ( - Embryo at 7+5 weeks \(crown\226)Tj 0 -1.473 TD (rump length 14 mm\). Sagittal section )Tj T* (through )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 180.3957 538.472 Tm (the \221triangular\222 body demonstrating )Tj 11.1493 0 0 11.1493 132.4314 571.3178 Tm 0 -4.419 TD (the shallow cavity of the rhomben-cephalon )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 132.4314 505.6261 Tm (\(Rh\), )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 165.3442 505.6261 Tm (the curved tube-like mesencephalon )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 132.4314 489.2032 Tm (\(Mes\), the diencephalon \(Di\) and the )Tj 0 -1.473 TD (umbilical cord \(U\))Tj 9.4902 0 0 9.4902 232.4296 472.7658 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 409.3725 554.8925 Tm (Figure 3b)Tj /TT1 1 Tf ( - Embryo at 7+5 weeks \(crown\226)Tj T* (rump length 14 mm\). Coronal section )Tj T* (through the head and body demonstrating )Tj T* (the shallow cavity of the rhomben-cephalon )Tj T* (\(Rh\), choroid plexus \(CP\))Tj 9.4902 0 0 9.4902 552.0393 489.1911 Tm ( )Tj -54.26 -5.131 Td ( )Tj ET q 34.5098114 0 0 34.5098114 100.9411774 391.4147797 cm /Im0 Do Q q 258.8235321 0 0 21.568634 138.9019623 397.885376 cm /Im1 Do Q q 34.5098114 0 0 34.5098114 401.1764679 391.4147797 cm /Im0 Do Q q 258.8235321 0 0 21.568634 440 397.885376 cm /Im2 Do Q q 34.5098114 0 0 34.5098114 100.9411774 355.1794891 cm /Im0 Do Q q 258.8235321 0 0 21.568634 138.9019623 361.6500702 cm /Im3 Do Q q 34.5098114 0 0 34.5098114 401.1764679 355.1794891 cm /Im0 Do Q q 258.8235321 0 0 21.568634 440 361.6500702 cm /Im4 Do Q BT /TT1 1 Tf 9.4902 0 0 9.4902 37.098 344.7286 Tm ( )Tj /TT2 1 Tf 11.1493 0 0 11.1493 37.098 332.1128 Tm (Heart)Tj /TT1 1 Tf 0 -1.938 TD (The heart can be recognized as a beating, large and bright structure bel\ ow the embryonic head at 7 weeks. The heart rate )Tj 0 -1.473 TD (increases from 130 bpm to 160 bpm. Details of the heart anatomy are not \ visible, but the atrial and ventricular compartments )Tj 0 -1.473 TD (can sometimes be distinguished by the reciprocal movements of the walls.\ )Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Intestinal tract)Tj /TT1 1 Tf 0 -1.938 TD (The short umbilical cord shows a large celomic cavity at its insertion, \ where the primary intestinal loop can be identified. The)Tj ( )Tj 0 -1.473 TD (first sign of herniation of the gut occurs during week 7 as a thickening\ of the cord and showing a slight echogenic area at the )Tj T* (abdominal insertion. Within a few days, this echogenic structure becomes\ more distinct.)Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Extra-embryonic structures)Tj /TT1 1 Tf 0 -1.938 TD (The amniotic cavity becomes visible at the beginning of week 7. The mean\ diameter of the amniotic cavity is almost the same )Tj 0 -1.473 TD (as the corresponding crown\226rump length.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 272.1592 141.9694 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(8 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1130 0 obj<> endobj 1131 0 obj<>/Type/XObject/BBox[179.847 502.898 373.124 517.196]/FormType 1>>stream 1 1 0 rg 0.8411 w 183.4393 503.3184 m 180.2674 506.4902 180.2674 513.6035 183.4393 516.7754 c 369.5316 516.7754 l 372.7035 513.6035 372.7035 506.4902 369.5316 503.3184 c f endstream endobj 1132 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 193.278 14.2985]/FormType 1>>stream /Form Do endstream endobj 1133 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 193.278 14.2988]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1134 0 obj<>>> endobj 1135 0 obj<>9]/P 208 0 R/S/Annot/Pg 261 0 R>> endobj 1136 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 98.353 428.513 m 702.275 428.513 l 700.549 426.787 l 100.078 426.787 l h f 98.353 428.513 m 98.353 352.591 l 100.078 354.317 l 100.078 426.787 l h f 0.313 0.313 0.313 rg 702.275 428.513 m 702.275 352.591 l 700.549 354.317 l 700.549 426.787 l h f 98.353 352.591 m 702.275 352.591 l 700.549 354.317 l 100.078 354.317 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 100.078 426.787 m 138.039 426.787 l 137.176 425.925 l 100.941 425.925 l h f 100.078 426.787 m 100.078 390.552 l 100.941 391.415 l 100.941 425.925 l h f 0.949 0.945 0.935 rg 138.039 426.787 m 138.039 390.552 l 137.176 391.415 l 137.176 425.925 l h f 100.078 390.552 m 138.039 390.552 l 137.176 391.415 l 100.941 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 138.902 391.415 260.549 34.51 re f 0.457 0.449 0.431 rg 138.039 426.787 m 400.314 426.787 l 399.451 425.925 l 138.902 425.925 l h f 138.039 426.787 m 138.039 390.552 l 138.902 391.415 l 138.902 425.925 l h f 0.949 0.945 0.935 rg 400.314 426.787 m 400.314 390.552 l 399.451 391.415 l 399.451 425.925 l h f 138.039 390.552 m 400.314 390.552 l 399.451 391.415 l 138.902 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 1 1 1 rg 401.176 391.415 36.235 34.51 re f 0.457 0.449 0.431 rg 400.314 426.787 m 438.275 426.787 l 437.412 425.925 l 401.176 425.925 l h f 400.314 426.787 m 400.314 390.552 l 401.176 391.415 l 401.176 425.925 l h f 0.949 0.945 0.935 rg 438.275 426.787 m 438.275 390.552 l 437.412 391.415 l 437.412 425.925 l h f 400.314 390.552 m 438.275 390.552 l 437.412 391.415 l 401.176 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 439.137 391.415 260.549 34.51 re f 0.457 0.449 0.431 rg 438.275 426.787 m 700.549 426.787 l 699.686 425.925 l 439.137 425.925 l h f 438.275 426.787 m 438.275 390.552 l 439.137 391.415 l 439.137 425.925 l h f 0.949 0.945 0.935 rg 700.549 426.787 m 700.549 390.552 l 699.686 391.415 l 699.686 425.925 l h f 438.275 390.552 m 700.549 390.552 l 699.686 391.415 l 439.137 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 100.078 390.552 m 138.039 390.552 l 137.176 389.689 l 100.941 389.689 l h f 100.078 390.552 m 100.078 354.317 l 100.941 355.179 l 100.941 389.689 l h f 0.949 0.945 0.935 rg 138.039 390.552 m 138.039 354.317 l 137.176 355.179 l 137.176 389.689 l h f 100.078 354.317 m 138.039 354.317 l 137.176 355.179 l 100.941 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 138.902 355.179 260.549 34.51 re f 0.457 0.449 0.431 rg 138.039 390.552 m 400.314 390.552 l 399.451 389.689 l 138.902 389.689 l h f 138.039 390.552 m 138.039 354.317 l 138.902 355.179 l 138.902 389.689 l h f 0.949 0.945 0.935 rg 400.314 390.552 m 400.314 354.317 l 399.451 355.179 l 399.451 389.689 l h f 138.039 354.317 m 400.314 354.317 l 399.451 355.179 l 138.902 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 1 1 1 rg 401.176 355.179 36.235 34.51 re f 0.457 0.449 0.431 rg 400.314 390.552 m 438.275 390.552 l 437.412 389.689 l 401.176 389.689 l h f 400.314 390.552 m 400.314 354.317 l 401.176 355.179 l 401.176 389.689 l h f 0.949 0.945 0.935 rg 438.275 390.552 m 438.275 354.317 l 437.412 355.179 l 437.412 389.689 l h f 400.314 354.317 m 438.275 354.317 l 437.412 355.179 l 401.176 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 439.137 355.179 260.549 34.51 re f 0.457 0.449 0.431 rg 438.275 390.552 m 700.549 390.552 l 699.686 389.689 l 439.137 389.689 l h f 438.275 390.552 m 438.275 354.317 l 439.137 355.179 l 439.137 389.689 l h f 0.949 0.945 0.935 rg 700.549 390.552 m 700.549 354.317 l 699.686 355.179 l 699.686 389.689 l h f 438.275 354.317 m 700.549 354.317 l 699.686 355.179 l 439.137 355.179 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 132.4314 571.3178 Tm (Figure 3a)Tj /TT1 1 Tf ( - Embryo at 7+5 weeks \(crown\226)Tj 0 -1.473 TD (rump length 14 mm\). Sagittal section )Tj T* (through )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 180.3957 538.472 Tm (the \221triangular\222 body demonstrating )Tj 11.1493 0 0 11.1493 132.4314 571.3178 Tm 0 -4.419 TD (the shallow cavity of the rhomben-cephalon )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 132.4314 505.6261 Tm (\(Rh\), )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 165.3442 505.6261 Tm (the curved tube-like mesencephalon )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 132.4314 489.2032 Tm (\(Mes\), the diencephalon \(Di\) and the )Tj 0 -1.473 TD (umbilical cord \(U\))Tj 9.4902 0 0 9.4902 232.4296 472.7658 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 409.3725 554.8925 Tm (Figure 3b)Tj /TT1 1 Tf ( - Embryo at 7+5 weeks \(crown\226)Tj T* (rump length 14 mm\). Coronal section )Tj T* (through the head and body demonstrating )Tj T* (the shallow cavity of the rhomben-cephalon )Tj T* (\(Rh\), choroid plexus \(CP\))Tj 9.4902 0 0 9.4902 552.0393 489.1911 Tm ( )Tj -54.26 -5.131 Td ( )Tj ET q 34.5098114 0 0 34.5098114 100.9411774 391.4147797 cm /Im0 Do Q q 258.8235321 0 0 21.568634 138.9019623 397.885376 cm /Im1 Do Q q 34.5098114 0 0 34.5098114 401.1764679 391.4147797 cm /Im0 Do Q q 258.8235321 0 0 21.568634 440 397.885376 cm /Im2 Do Q q 34.5098114 0 0 34.5098114 100.9411774 355.1794891 cm /Im0 Do Q q 258.8235321 0 0 21.568634 138.9019623 361.6500702 cm /Im3 Do Q q 34.5098114 0 0 34.5098114 401.1764679 355.1794891 cm /Im0 Do Q q 258.8235321 0 0 21.568634 440 361.6500702 cm /Im4 Do Q BT /TT1 1 Tf 9.4902 0 0 9.4902 37.098 344.7286 Tm ( )Tj /TT2 1 Tf 11.1493 0 0 11.1493 37.098 332.1128 Tm (Heart)Tj /TT1 1 Tf 0 -1.938 TD (The heart can be recognized as a beating, large and bright structure bel\ ow the embryonic head at 7 weeks. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 646.6302 310.5055 Tm (The heart rate )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 294.0825 Tm (increases from 130 bpm to 160 bpm. Details of the heart anatomy are not \ visible, but the atrial and ventricular compartments )Tj 0 -1.473 TD (can sometimes be distinguished by the reciprocal movements of the walls.\ )Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Intestinal tract)Tj /TT1 1 Tf 0 -1.938 TD (The short umbilical cord shows a large celomic cavity at its insertion, \ where the primary intestinal loop can be identified. The)Tj ( )Tj 0 -1.473 TD (first sign of herniation of the gut occurs during week 7 as a thickening\ of the cord and showing a slight echogenic area at the )Tj 0 -1.473 TD (abdominal insertion. Within a few days, this echogenic structure becomes\ more distinct.)Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Extra-embryonic structures)Tj /TT1 1 Tf 0 -1.938 TD (The amniotic cavity becomes visible at the beginning of week 7. The mean\ diameter of the amniotic cavity is almost the same )Tj 0 -1.473 TD (as the corresponding crown\226rump length.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 272.1592 141.9694 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(8 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1137 0 obj<> endobj 1138 0 obj<>/Type/XObject/BBox[643.037 307.777 730.697 322.075]/FormType 1>>stream 1 1 0 rg 0.8411 w 646.6292 308.1977 m 643.4573 311.3696 643.4573 318.4829 646.6292 321.6548 c 727.1046 321.6548 l 730.2764 318.4829 730.2764 311.3696 727.1046 308.1977 c f endstream endobj 1139 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 87.6606 14.2986]/FormType 1>>stream /Form Do endstream endobj 1140 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 87.6609 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1141 0 obj<>>> endobj 1142 0 obj<>11]/P 208 0 R/S/Annot/Pg 261 0 R>> endobj 1143 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 98.353 428.513 m 702.275 428.513 l 700.549 426.787 l 100.078 426.787 l h f 98.353 428.513 m 98.353 352.591 l 100.078 354.317 l 100.078 426.787 l h f 0.313 0.313 0.313 rg 702.275 428.513 m 702.275 352.591 l 700.549 354.317 l 700.549 426.787 l h f 98.353 352.591 m 702.275 352.591 l 700.549 354.317 l 100.078 354.317 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 100.078 426.787 m 138.039 426.787 l 137.176 425.925 l 100.941 425.925 l h f 100.078 426.787 m 100.078 390.552 l 100.941 391.415 l 100.941 425.925 l h f 0.949 0.945 0.935 rg 138.039 426.787 m 138.039 390.552 l 137.176 391.415 l 137.176 425.925 l h f 100.078 390.552 m 138.039 390.552 l 137.176 391.415 l 100.941 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 138.902 391.415 260.549 34.51 re f 0.457 0.449 0.431 rg 138.039 426.787 m 400.314 426.787 l 399.451 425.925 l 138.902 425.925 l h f 138.039 426.787 m 138.039 390.552 l 138.902 391.415 l 138.902 425.925 l h f 0.949 0.945 0.935 rg 400.314 426.787 m 400.314 390.552 l 399.451 391.415 l 399.451 425.925 l h f 138.039 390.552 m 400.314 390.552 l 399.451 391.415 l 138.902 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 1 1 1 rg 401.176 391.415 36.235 34.51 re f 0.457 0.449 0.431 rg 400.314 426.787 m 438.275 426.787 l 437.412 425.925 l 401.176 425.925 l h f 400.314 426.787 m 400.314 390.552 l 401.176 391.415 l 401.176 425.925 l h f 0.949 0.945 0.935 rg 438.275 426.787 m 438.275 390.552 l 437.412 391.415 l 437.412 425.925 l h f 400.314 390.552 m 438.275 390.552 l 437.412 391.415 l 401.176 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 439.137 391.415 260.549 34.51 re f 0.457 0.449 0.431 rg 438.275 426.787 m 700.549 426.787 l 699.686 425.925 l 439.137 425.925 l h f 438.275 426.787 m 438.275 390.552 l 439.137 391.415 l 439.137 425.925 l h f 0.949 0.945 0.935 rg 700.549 426.787 m 700.549 390.552 l 699.686 391.415 l 699.686 425.925 l h f 438.275 390.552 m 700.549 390.552 l 699.686 391.415 l 439.137 391.415 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 100.078 390.552 m 138.039 390.552 l 137.176 389.689 l 100.941 389.689 l h f 100.078 390.552 m 100.078 354.317 l 100.941 355.179 l 100.941 389.689 l h f 0.949 0.945 0.935 rg 138.039 390.552 m 138.039 354.317 l 137.176 355.179 l 137.176 389.689 l h f 100.078 354.317 m 138.039 354.317 l 137.176 355.179 l 100.941 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 138.902 355.179 260.549 34.51 re f 0.457 0.449 0.431 rg 138.039 390.552 m 400.314 390.552 l 399.451 389.689 l 138.902 389.689 l h f 138.039 390.552 m 138.039 354.317 l 138.902 355.179 l 138.902 389.689 l h f 0.949 0.945 0.935 rg 400.314 390.552 m 400.314 354.317 l 399.451 355.179 l 399.451 389.689 l h f 138.039 354.317 m 400.314 354.317 l 399.451 355.179 l 138.902 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 1 1 1 rg 401.176 355.179 36.235 34.51 re f 0.457 0.449 0.431 rg 400.314 390.552 m 438.275 390.552 l 437.412 389.689 l 401.176 389.689 l h f 400.314 390.552 m 400.314 354.317 l 401.176 355.179 l 401.176 389.689 l h f 0.949 0.945 0.935 rg 438.275 390.552 m 438.275 354.317 l 437.412 355.179 l 437.412 389.689 l h f 400.314 354.317 m 438.275 354.317 l 437.412 355.179 l 401.176 355.179 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 439.137 355.179 260.549 34.51 re f 0.457 0.449 0.431 rg 438.275 390.552 m 700.549 390.552 l 699.686 389.689 l 439.137 389.689 l h f 438.275 390.552 m 438.275 354.317 l 439.137 355.179 l 439.137 389.689 l h f 0.949 0.945 0.935 rg 700.549 390.552 m 700.549 354.317 l 699.686 355.179 l 699.686 389.689 l h f 438.275 354.317 m 700.549 354.317 l 699.686 355.179 l 439.137 355.179 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 132.4314 571.3178 Tm (Figure 3a)Tj /TT1 1 Tf ( - Embryo at 7+5 weeks \(crown\226)Tj 0 -1.473 TD (rump length 14 mm\). Sagittal section )Tj T* (through )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 180.3957 538.472 Tm (the \221triangular\222 body demonstrating )Tj 11.1493 0 0 11.1493 132.4314 571.3178 Tm 0 -4.419 TD (the shallow cavity of the rhomben-cephalon )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 132.4314 505.6261 Tm (\(Rh\), )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 165.3442 505.6261 Tm (the curved tube-like mesencephalon )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 132.4314 489.2032 Tm (\(Mes\), the diencephalon \(Di\) and the )Tj 0 -1.473 TD (umbilical cord \(U\))Tj 9.4902 0 0 9.4902 232.4296 472.7658 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 409.3725 554.8925 Tm (Figure 3b)Tj /TT1 1 Tf ( - Embryo at 7+5 weeks \(crown\226)Tj T* (rump length 14 mm\). Coronal section )Tj T* (through the head and body demonstrating )Tj T* (the shallow cavity of the rhomben-cephalon )Tj T* (\(Rh\), choroid plexus \(CP\))Tj 9.4902 0 0 9.4902 552.0393 489.1911 Tm ( )Tj -54.26 -5.131 Td ( )Tj ET q 34.5098114 0 0 34.5098114 100.9411774 391.4147797 cm /Im0 Do Q q 258.8235321 0 0 21.568634 138.9019623 397.885376 cm /Im1 Do Q q 34.5098114 0 0 34.5098114 401.1764679 391.4147797 cm /Im0 Do Q q 258.8235321 0 0 21.568634 440 397.885376 cm /Im2 Do Q q 34.5098114 0 0 34.5098114 100.9411774 355.1794891 cm /Im0 Do Q q 258.8235321 0 0 21.568634 138.9019623 361.6500702 cm /Im3 Do Q q 34.5098114 0 0 34.5098114 401.1764679 355.1794891 cm /Im0 Do Q q 258.8235321 0 0 21.568634 440 361.6500702 cm /Im4 Do Q BT /TT1 1 Tf 9.4902 0 0 9.4902 37.098 344.7286 Tm ( )Tj /TT2 1 Tf 11.1493 0 0 11.1493 37.098 332.1128 Tm (Heart)Tj /TT1 1 Tf 0 -1.938 TD (The heart can be recognized as a beating, large and bright structure bel\ ow the embryonic head at 7 weeks. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 646.6302 310.5055 Tm (The heart rate )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 294.0825 Tm (increases from 130 bpm to 160 bpm. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 250.4066 294.0825 Tm (Details of the heart anatomy are not visible, but the atrial and ventric\ ular compartments )Tj -19.132 -1.473 Td (can sometimes be distinguished by the reciprocal movements of the walls.\ )Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Intestinal tract)Tj /TT1 1 Tf 0 -1.938 TD (The short umbilical cord shows a large celomic cavity at its insertion, \ where the primary intestinal loop can be identified. The)Tj ( )Tj 0 -1.473 TD (first sign of herniation of the gut occurs during week 7 as a thickening\ of the cord and showing a slight echogenic area at the )Tj 0 -1.473 TD (abdominal insertion. Within a few days, this echogenic structure becomes\ more distinct.)Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Extra-embryonic structures)Tj /TT1 1 Tf 0 -1.938 TD (The amniotic cavity becomes visible at the beginning of week 7. The mean\ diameter of the amniotic cavity is almost the same )Tj 0 -1.473 TD (as the corresponding crown\226rump length.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 272.1592 141.9694 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(8 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1144 0 obj<> endobj 1145 0 obj<>/Type/XObject/BBox[33.5055 291.354 250.075 305.652]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.098 291.7747 m 33.9262 294.9466 33.9262 302.06 37.098 305.2318 c 246.4823 305.2318 l 249.6541 302.06 249.6541 294.9466 246.4823 291.7747 c f endstream endobj 1146 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 216.569 14.2986]/FormType 1>>stream /Form Do endstream endobj 1147 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 216.57 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1148 0 obj<>>> endobj 1149 0 obj[1148 0 R 1152 0 R 1156 0 R 1159 0 R 1163 0 R 1166 0 R] endobj 1150 0 obj<>3]/P 208 0 R/S/Annot/Pg 273 0 R>> endobj 1151 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 139.48 140.808 267.451 244.157 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 1 1 1 rg 411.245 140.808 249.903 244.157 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 9.4902 0 0 9.4902 37.098 581.9383 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 569.3225 Tm (Central nervous system)Tj /TT0 1 Tf 0 -1.938 TD (The brain cavities are easily seen as large \221holes\222 in the embryon\ ic head. The hemispheres enlarge, developing via thick round )Tj 0 -1.473 TD (slices originating antero-caudally from the third ventricle into a cresc\ ent shape. The choroid plexus in the lateral ventricles )Tj T* (becomes visible as tiny echogenic areas. The future foramina of Monro be\ come more accentuated during week 8. The third )Tj T* (ventricle is still relatively wide, as is the mesencephalic cavity. 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Sagittal )Tj 0 -1.2 TD (section vascularization and the umbilical )Tj 0 -1.2 TD (cord.)Tj 9.4902 0 0 9.4902 37.098 149.5883 Tm ( )Tj /TT2 1 Tf 11.1493 0 0 11.1493 37.098 136.9725 Tm (Heart)Tj /TT1 1 Tf 0 -1.938 TD (The heart rate has increased to 160 bpm. Occasionally it is possible to \ identify the atrial and ventricular walls moving )Tj 0 -1.473 TD (reciprocally as early as at the end of week 8. The atrial compartment ap\ pears wider than the ventricular compartment, and the )Tj 0 -1.473 TD (heart covers about 50% of the transverse thoracic area. A kind of four-c\ hamber view of the heart can then be obtained, where )Tj T* (the atrial compartment is wider than the ventricular part.)Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Intestinal tract)Tj /TT1 1 Tf 0 -1.938 TD (There is no sign of the stomach during week 7. 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The arrow points at the )Tj 0 -1.473 TD (choroid plexus of the rhombencephalon)Tj 9.4902 0 0 9.4902 637.4411 398.2273 Tm ( )Tj ET q 258.8235321 0 0 196.7058868 143.7937317 166.0784302 cm /Im1 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 415.5584 280.8414 Tm (Figure 6a)Tj /TT1 1 Tf ( - Embryo at 8+5 weeks )Tj 0 -1.201 TD (\(crown\226rump length 20 mm\). Sagittal )Tj 0 -1.2 TD (section vascularization and the umbilical )Tj T* (cord.)Tj 9.4902 0 0 9.4902 37.098 149.5883 Tm ( )Tj /TT2 1 Tf 11.1493 0 0 11.1493 37.098 136.9725 Tm (Heart)Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 136.9725 Tm 0 -1.938 TD (The heart rate has increased to 160 bpm. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 275.3474 115.3652 Tm (Occasionally it is possible to identify the atrial and ventricular walls\ moving )Tj -21.369 -1.473 Td (reciprocally as early as at the end of week 8. The atrial compartment ap\ pears wider than the ventricular compartment, and the )Tj 0 -1.473 TD (heart covers about 50% of the transverse thoracic area. A kind of four-c\ hamber view of the heart can then be obtained, where )Tj T* (the atrial compartment is wider than the ventricular part.)Tj /TT0 1 Tf ( )Tj /TT2 1 Tf 0 -1.937 TD (Intestinal tract)Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 22.8929 Tm (There is no sign of the stomach during week 7. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 306.0304 22.8929 Tm (In some cases, it is possible to recognize the fluid-filled stomach as a\ small )Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(12 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1216 0 obj<> endobj 1217 0 obj<>/Type/XObject/BBox[33.5055 20.1645 305.698 34.4629]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.098 20.5852 m 33.9262 23.757 33.9262 30.8704 37.098 34.0422 c 302.1053 34.0422 l 305.2772 30.8704 305.2772 23.757 302.1053 20.5852 c f endstream endobj 1218 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 272.193 14.2986]/FormType 1>>stream /Form Do endstream endobj 1219 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 272.193 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1220 0 obj<>>> endobj 1221 0 obj[1220 0 R 1224 0 R 1228 0 R 1231 0 R 1235 0 R 1238 0 R 1242 0 R 1245 0 R] endobj 1222 0 obj<>3]/P 208 0 R/S/Annot/Pg 286 0 R>> endobj 1223 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 535.584 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 582.4581 Tm (hypoechogenic area on the left side of the upper abdomen below the heart\ )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 461.7191 582.4581 Tm (at the end of week 8.)Tj ET EMC /Article <>BDC 0 0 1 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 550.5154 Tm (9 weeks \(crown\226rump length 23\22631 mm\))Tj 0 0 0 rg /TT2 1 Tf 0 -2.866 TD (External form)Tj /TT0 1 Tf 0 -1.938 TD (The body develops an ellipsoid shape with a large head. The soles of the\ feet touch in the mid-line at the end of the week. At )Tj 0 -1.473 TD (the same time, it is possible to obtain acceptable images of the profile\ ; thus, it should be possible to examine the mouth. The )Tj 0 -1.473 TD (ventral body wall is well defined.)Tj /TT1 1 Tf ( )Tj ET q 258.8235321 0 0 208.784317 270.9019623 236.0784302 cm /Im0 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 270.902 212.1414 Tm (Figure 7 - )Tj /TT0 1 Tf (Embryo at 9-10 weeks \(crown\226)Tj 0 -1.473 TD (rump length 30 mm\). 3D scan showing the )Tj T* (external form of the fetal body \(upper and )Tj T* (lower limbs\).)Tj 9.4902 0 0 9.4902 37.098 135.7693 Tm ( )Tj /TT2 1 Tf 11.1493 0 0 11.1493 37.098 123.1535 Tm (Central nervous system)Tj /TT0 1 Tf 0 -1.938 TD (The lateral ventricles are always visible. They are best seen in the par\ asagittal plane, where the C-shape becomes apparent. )Tj 0 -1.473 TD (The cortex is smooth and hypoechogenic. The bright choroid plexuses of t\ he lateral ventricles are regularly detectable at 9 )Tj 0 -1.473 TD (weeks 4 days. They show rapid growth, similar to the hemispheres, and so\ on fill most of the ventricular cavities. The width of )Tj T* (the diencephalic cavity narrows gradually, while the width of the mesenc\ ephalon remains wide. A distinct border \(\221isthmus )Tj T* (prosencephali\222\) has developed between the cavity of the mesencephalo\ n and the third ventricle. The wall of the diencephalon, )Tj T* (initially very thin, thickens considerably starting from week 8 to 9. Th\ e isthmus rhombencephali is always distinct. The cavity )Tj (of )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(13 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1224 0 obj<> endobj 1225 0 obj<>/Type/XObject/BBox[458.126 579.73 585.622 594.028]/FormType 1>>stream 1 1 0 rg 0.8411 w 461.7182 580.1504 m 458.5463 583.3223 458.5463 590.4356 461.7182 593.6074 c 582.03 593.6074 l 585.2018 590.4356 585.2018 583.3223 582.03 580.1504 c f endstream endobj 1226 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 127.497 14.2985]/FormType 1>>stream /Form Do endstream endobj 1227 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 127.497 14.2988]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1228 0 obj<>>> endobj 1229 0 obj<>6]/P 208 0 R/S/Annot/Pg 286 0 R>> endobj 1230 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 535.584 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 582.4581 Tm (hypoechogenic area on the left side of the upper abdomen below the heart\ )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 461.7191 582.4581 Tm (at the end of week 8.)Tj ET EMC /Article <>BDC 0 0 1 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 550.5154 Tm (9 weeks \(crown\226rump length 23\22631 mm\))Tj 0 0 0 rg /TT2 1 Tf 0 -2.866 TD (External form)Tj /TT0 1 Tf 0 -1.938 TD (The body develops an ellipsoid shape with a large head. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 355.6783 496.9541 Tm (The soles of the feet touch in the mid-line at the end of the week. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 730.3062 496.9541 Tm (At )Tj -62.175 -1.473 Td (the same time, it is possible to obtain acceptable images of the profile\ ; thus, it should be possible to examine the mouth. The )Tj 0 -1.473 TD (ventral body wall is well defined.)Tj /TT1 1 Tf ( )Tj ET q 258.8235321 0 0 208.784317 270.9019623 236.0784302 cm /Im0 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 270.902 212.1414 Tm (Figure 7 - )Tj /TT0 1 Tf (Embryo at 9-10 weeks \(crown\226)Tj 0 -1.473 TD (rump length 30 mm\). 3D scan showing the )Tj T* (external form of the fetal body \(upper and )Tj T* (lower limbs\).)Tj 9.4902 0 0 9.4902 37.098 135.7693 Tm ( )Tj /TT2 1 Tf 11.1493 0 0 11.1493 37.098 123.1535 Tm (Central nervous system)Tj /TT0 1 Tf 0 -1.938 TD (The lateral ventricles are always visible. They are best seen in the par\ asagittal plane, where the C-shape becomes apparent. )Tj 0 -1.473 TD (The cortex is smooth and hypoechogenic. The bright choroid plexuses of t\ he lateral ventricles are regularly detectable at 9 )Tj 0 -1.473 TD (weeks 4 days. They show rapid growth, similar to the hemispheres, and so\ on fill most of the ventricular cavities. The width of )Tj T* (the diencephalic cavity narrows gradually, while the width of the mesenc\ ephalon remains wide. A distinct border \(\221isthmus )Tj T* (prosencephali\222\) has developed between the cavity of the mesencephalo\ n and the third ventricle. The wall of the diencephalon, )Tj T* (initially very thin, thickens considerably starting from week 8 to 9. Th\ e isthmus rhombencephali is always distinct. The cavity )Tj (of )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(13 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1231 0 obj<> endobj 1232 0 obj<>/Type/XObject/BBox[352.085 494.226 729.972 508.524]/FormType 1>>stream 1 1 0 rg 0.8411 w 355.6777 494.6464 m 352.5058 497.8183 352.5058 504.9316 355.6777 508.1035 c 726.3798 508.1035 l 729.5516 504.9316 729.5516 497.8183 726.3798 494.6464 c f endstream endobj 1233 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 377.887 14.2986]/FormType 1>>stream /Form Do endstream endobj 1234 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 377.888 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1235 0 obj<>>> endobj 1236 0 obj<>9]/P 208 0 R/S/Annot/Pg 286 0 R>> endobj 1237 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 535.584 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 582.4581 Tm (hypoechogenic area on the left side of the upper abdomen below the heart\ )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 461.7191 582.4581 Tm (at the end of week 8.)Tj ET EMC /Article <>BDC 0 0 1 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 550.5154 Tm (9 weeks \(crown\226rump length 23\22631 mm\))Tj 0 0 0 rg /TT2 1 Tf 0 -2.866 TD (External form)Tj /TT0 1 Tf 0 -1.938 TD (The body develops an ellipsoid shape with a large head. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 355.6783 496.9541 Tm (The soles of the feet touch in the mid-line at the end of the week. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 730.3062 496.9541 Tm (At )Tj -62.175 -1.473 Td (the same time, it is possible to obtain acceptable images of the profile\ ; thus, it should be possible to examine the mouth. The )Tj 0 -1.473 TD (ventral body wall is well defined.)Tj /TT1 1 Tf ( )Tj ET q 258.8235321 0 0 208.784317 270.9019623 236.0784302 cm /Im0 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 270.902 212.1414 Tm (Figure 7 - )Tj /TT0 1 Tf (Embryo at 9-10 weeks \(crown\226)Tj T* (rump length 30 mm\). 3D scan showing the )Tj T* (external form of the fetal body \(upper and )Tj T* (lower limbs\).)Tj 9.4902 0 0 9.4902 37.098 135.7693 Tm ( )Tj /TT2 1 Tf 11.1493 0 0 11.1493 37.098 123.1535 Tm (Central nervous system)Tj /TT0 1 Tf 0 -1.938 TD (The lateral ventricles are always visible. They are best seen in the par\ asagittal plane, where the C-shape becomes apparent. )Tj 0 -1.473 TD (The cortex is smooth and hypoechogenic. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 274.6227 85.1232 Tm (The bright choroid plexuses )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 433.7789 85.1232 Tm (of the lateral ventricles are regularly detectable at 9 )Tj -35.579 -1.473 Td (weeks 4 days. They show rapid growth, similar to the hemispheres, and so\ on fill most of the ventricular cavities. The width of )Tj T* (the diencephalic cavity narrows gradually, while the width of the mesenc\ ephalon remains wide. A distinct border \(\221isthmus )Tj T* (prosencephali\222\) has developed between the cavity of the mesencephalo\ n and the third ventricle. The wall of the diencephalon, )Tj T* (initially very thin, thickens considerably starting from week 8 to 9. Th\ e isthmus rhombencephali is always distinct. The cavity )Tj (of )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(13 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1238 0 obj<> endobj 1239 0 obj<>/Type/XObject/BBox[271.029 82.3948 433.446 96.6932]/FormType 1>>stream 1 1 0 rg 0.8411 w 274.622 82.8155 m 271.4501 85.9874 271.4501 93.1007 274.622 96.2726 c 429.8533 96.2726 l 433.0252 93.1007 433.0252 85.9874 429.8533 82.8155 c f endstream endobj 1240 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 162.417 14.2986]/FormType 1>>stream /Form Do endstream endobj 1241 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 162.417 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1242 0 obj<>>> endobj 1243 0 obj<>12]/P 208 0 R/S/Annot/Pg 286 0 R>> endobj 1244 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 32.784 535.584 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 582.4581 Tm (hypoechogenic area on the left side of the upper abdomen below the heart\ )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 461.7191 582.4581 Tm (at the end of week 8.)Tj ET EMC /Article <>BDC 0 0 1 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 550.5154 Tm (9 weeks \(crown\226rump length 23\22631 mm\))Tj 0 0 0 rg /TT2 1 Tf 0 -2.866 TD (External form)Tj /TT0 1 Tf 0 -1.938 TD (The body develops an ellipsoid shape with a large head. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 355.6783 496.9541 Tm (The soles of the feet touch in the mid-line at the end of the week. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 730.3062 496.9541 Tm (At )Tj -62.175 -1.473 Td (the same time, it is possible to obtain acceptable images of the profile\ ; thus, it should be possible to examine the mouth. The )Tj 0 -1.473 TD (ventral body wall is well defined.)Tj /TT1 1 Tf ( )Tj ET q 258.8235321 0 0 208.784317 270.9019623 236.0784302 cm /Im0 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 270.902 212.1414 Tm (Figure 7 - )Tj /TT0 1 Tf (Embryo at 9-10 weeks \(crown\226)Tj T* (rump length 30 mm\). 3D scan showing the )Tj T* (external form of the fetal body \(upper and )Tj T* (lower limbs\).)Tj 9.4902 0 0 9.4902 37.098 135.7693 Tm ( )Tj /TT2 1 Tf 11.1493 0 0 11.1493 37.098 123.1535 Tm (Central nervous system)Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 101.5462 Tm (The lateral ventricles )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 158.5809 101.5462 Tm (are always visible. They are best seen in the parasagittal plane, where \ the C-shape becomes apparent. )Tj -10.896 -1.473 Td (The cortex is smooth and hypoechogenic. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 274.6227 85.1232 Tm (The bright choroid plexuses )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 433.7789 85.1232 Tm (of the lateral ventricles are regularly detectable at 9 )Tj -35.579 -1.473 Td (weeks 4 days. They show rapid growth, similar to the hemispheres, and so\ on fill most of the ventricular cavities. The width of )Tj T* (the diencephalic cavity narrows gradually, while the width of the mesenc\ ephalon remains wide. A distinct border \(\221isthmus )Tj T* (prosencephali\222\) has developed between the cavity of the mesencephalo\ n and the third ventricle. The wall of the diencephalon, )Tj T* (initially very thin, thickens considerably starting from week 8 to 9. Th\ e isthmus rhombencephali is always distinct. The cavity )Tj (of )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(13 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1245 0 obj<> endobj 1246 0 obj<>/Type/XObject/BBox[33.5055 98.8177 158.248 113.116]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.098 99.2384 m 33.9262 102.4103 33.9262 109.5236 37.098 112.6955 c 154.6559 112.6955 l 157.8277 109.5236 157.8277 102.4103 154.6559 99.2384 c f endstream endobj 1247 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 124.743 14.2986]/FormType 1>>stream /Form Do endstream endobj 1248 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 124.743 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1249 0 obj<>>> endobj 1250 0 obj[1249 0 R 1253 0 R 1257 0 R 1260 0 R 1264 0 R 1267 0 R 1271 0 R 1276 0 R 1294 0 R 1297 0 R 1301 0 R 1304 0 R 1308 0 R 1311 0 R] endobj 1251 0 obj<>2]/P 208 0 R/S/Annot/Pg 292 0 R>> endobj 1252 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 130.706 236.86 267.451 212.235 re f EMC EMC EMC /Annot <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 578.9921 Tm (the mesencephalon remains relatively large, especially the posterior par\ t. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 455.2859 578.9921 Tm (The height and the width are about the same size. )Tj -37.508 -1.473 Td (During weeks 8 and 9, the rhombic fossa becomes deeper due to the progre\ ssive flexure of the pons. The lateral corners of the )Tj 0 -1.473 TD (rhombencephalic cavity, called the lateral recesses, are easily identifi\ ed at weeks 7 and 8. During this period, the distance )Tj T* (between these recesses increases \(rhombencephalon width\). Later, durin\ g weeks 9 and 10, the lateral recesses often become )Tj T* (covered by the enlarging cerebellar hemispheres. Thus, only the central \ part of the hypoechogenic fourth ventricle, which is )Tj T* (divided by the choroid plexuses, is visible. The choroid plexuses of the\ fourth ventricle are bright landmarks, dividing the )Tj 0 -1.473 TD (ventricle into rostral and caudal compartments. The cerebellar hemispher\ es are easily detectable. The primordia of cerebellar )Tj 0 -1.473 TD (hemispheres are clearly separated in the mid-line during the embryonic p\ eriod.)Tj ET q 258.8235321 0 0 157.8823547 135.0196075 264.0361938 cm /Im0 Do Q q 258.8235321 0 0 203.6078491 406.784317 241.1734467 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 135.0196 217.2364 Tm (Figure 7a )Tj /TT0 1 Tf (- Embryo at 9+4 weeks \(crown\226)Tj 0 -1.473 TD (rump length 28 mm\). Sagittal section )Tj T* (demonstrating the relatively large head and )Tj T* (the cavities of the diencephalon \(Di\), )Tj T* (mesencephalon \(Mes\) and rhombencephalon )Tj T* (\(Rh\). The arrow points at the genital )Tj T* (tubercle, but at this stage it is not possible )Tj 0 -1.473 TD (to differentiate between male and female )Tj 0 -1.473 TD (gender)Tj 9.4902 0 0 9.4902 174.0199 85.8337 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 406.7843 192.5984 Tm (Figura 7b)Tj /TT0 1 Tf ( - Embryo at 9+4 weeks \(crown\226)Tj 0 -1.473 TD (rump length 28 mm\). Sagittal section )Tj T* (demonstrating the relatively large head and )Tj T* (the cavities of the diencephalon \(Di\), )Tj T* (mesencephalon \(Mes\), rhombencephalon )Tj T* (\(Rh\) and umbilical cord \(U\).)Tj 9.4902 0 0 9.4902 564.3242 110.4717 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 55.6121 Tm ( )Tj /TT2 1 Tf 0 -1.937 TD (Heart)Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(14 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1253 0 obj<> endobj 1254 0 obj<>/Type/XObject/BBox[33.5055 576.264 454.953 590.562]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.098 576.6844 m 33.9262 579.8562 33.9262 586.9696 37.098 590.1414 c 451.3605 590.1414 l 454.5324 586.9696 454.5324 579.8562 451.3605 576.6844 c f endstream endobj 1255 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 421.448 14.2986]/FormType 1>>stream /Form Do endstream endobj 1256 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 421.448 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1257 0 obj<>>> endobj 1258 0 obj<>5]/P 208 0 R/S/Annot/Pg 292 0 R>> endobj 1259 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 130.706 236.86 267.451 212.235 re f EMC EMC EMC /Annot <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 578.9921 Tm (the mesencephalon remains relatively large, especially the posterior par\ t. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 455.2859 578.9921 Tm (The height and the width are about the same size. )Tj -37.508 -1.473 Td (During weeks 8 and 9, the rhombic fossa becomes deeper due to the progre\ ssive flexure of the pons. The lateral corners of the )Tj 0 -1.473 TD (rhombencephalic cavity, called )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 213.4577 546.1463 Tm (the lateral recesses, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 330.6258 546.1463 Tm (are easily identified at weeks 7 and 8. During this period, the distance\ )Tj -26.327 -1.473 Td (between these recesses increases \(rhombencephalon width\). Later, durin\ g weeks 9 and 10, the lateral recesses often become )Tj T* (covered by the enlarging cerebellar hemispheres. Thus, only the central \ part of the hypoechogenic fourth ventricle, which is )Tj T* (divided by the choroid plexuses, is visible. The choroid plexuses of the\ fourth ventricle are bright landmarks, dividing the )Tj T* (ventricle into rostral and caudal compartments. The cerebellar hemispher\ es are easily detectable. 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Sagittal section )Tj T* (demonstrating the relatively large head and )Tj T* (the cavities of the diencephalon \(Di\), )Tj T* (mesencephalon \(Mes\), rhombencephalon )Tj T* (\(Rh\) and umbilical cord \(U\).)Tj 9.4902 0 0 9.4902 564.3242 110.4717 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 55.6121 Tm ( )Tj /TT2 1 Tf 0 -1.937 TD (Heart)Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(14 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1260 0 obj<> endobj 1261 0 obj<>/Type/XObject/BBox[209.865 543.418 330.293 557.716]/FormType 1>>stream 1 1 0 rg 0.8411 w 213.4573 543.8386 m 210.2854 547.0104 210.2854 554.1237 213.4573 557.2956 c 326.7003 557.2956 l 329.8721 554.1237 329.8721 547.0104 326.7003 543.8386 c f endstream endobj 1262 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 120.428 14.2986]/FormType 1>>stream /Form Do endstream endobj 1263 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 120.428 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1264 0 obj<>>> endobj 1265 0 obj<>8]/P 208 0 R/S/Annot/Pg 292 0 R>> endobj 1266 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 130.706 236.86 267.451 212.235 re f EMC EMC EMC /Annot <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 578.9921 Tm (the mesencephalon remains relatively large, especially the posterior par\ t. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 455.2859 578.9921 Tm (The height and the width are about the same size. )Tj -37.508 -1.473 Td (During weeks 8 and 9, the rhombic fossa becomes deeper due to the progre\ ssive flexure of the pons. The lateral corners of the )Tj 0 -1.473 TD (rhombencephalic cavity, called )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 213.4577 546.1463 Tm (the lateral recesses, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 330.6258 546.1463 Tm (are easily identified at weeks 7 and 8. During this period, the distance\ )Tj -26.327 -1.473 Td (between these recesses increases \(rhombencephalon width\). Later, durin\ g weeks 9 and 10, the lateral recesses often become )Tj T* (covered by the enlarging cerebellar hemispheres. 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Sagittal section )Tj T* (demonstrating the relatively large head and )Tj T* (the cavities of the diencephalon \(Di\), )Tj T* (mesencephalon \(Mes\) and rhombencephalon )Tj T* (\(Rh\). The arrow points at the genital )Tj T* (tubercle, but at this stage it is not possible )Tj 0 -1.473 TD (to differentiate between male and female )Tj 0 -1.473 TD (gender)Tj 9.4902 0 0 9.4902 174.0199 85.8337 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 406.7843 192.5984 Tm (Figura 7b)Tj /TT0 1 Tf ( - Embryo at 9+4 weeks \(crown\226)Tj 0 -1.473 TD (rump length 28 mm\). 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Thus, only the central \ part of the hypoechogenic fourth ventricle, which is )Tj T* (divided by the choroid plexuses, is visible. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 278.2798 496.8775 Tm (The choroid plexuses of the fourth ventricle are bright landmarks, divid\ ing the )Tj -21.632 -1.473 Td (ventricle into rostral and caudal compartments. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 308.1934 480.4546 Tm (The cerebellar hemispheres )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 466.8369 480.4546 Tm (are easily detectable. The primordia of cerebellar )Tj -38.544 -1.473 Td (hemispheres are clearly separated in the mid-line during the embryonic p\ eriod.)Tj ET q 258.8235321 0 0 157.8823547 135.0196075 264.0361938 cm /Im0 Do Q q 258.8235321 0 0 203.6078491 406.784317 241.1734467 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 135.0196 217.2364 Tm (Figure 7a )Tj /TT0 1 Tf (- Embryo at 9+4 weeks \(crown\226)Tj 0 -1.473 TD (rump length 28 mm\). Sagittal section )Tj T* (demonstrating the relatively large head and )Tj T* (the cavities of the diencephalon \(Di\), )Tj T* (mesencephalon \(Mes\) and rhombencephalon )Tj T* (\(Rh\). The arrow points at the genital )Tj T* (tubercle, but at this stage it is not possible )Tj 0 -1.473 TD (to differentiate between male and female )Tj 0 -1.473 TD (gender)Tj 9.4902 0 0 9.4902 174.0199 85.8337 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 406.7843 192.5984 Tm (Figura 7b)Tj /TT0 1 Tf ( - Embryo at 9+4 weeks \(crown\226)Tj 0 -1.473 TD (rump length 28 mm\). 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At this stage, the midgut herniation presents as a large\ hyperechogenic mass. The stomach can be detected in )Tj T* (75% of the embryos before 10 weeks.)Tj ET q 258.8235321 0 0 208.784317 270.9019623 278.9321289 cm /Im0 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 270.902 254.9951 Tm (Figure 7c - )Tj /TT0 1 Tf (Embryo at 9+4 weeks \(crown\226)Tj 0 -1.473 TD (rump length 28 mm\). 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At this stage, the midgut herniation presents as a large\ hyperechogenic mass. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 577.9286 523.3776 Tm (The stomach can be detected in )Tj -48.508 -1.473 Td (75% of the embryos before 10 weeks.)Tj ET EMC /Article <>BDC q 258.8235321 0 0 208.784317 270.9019623 278.9321289 cm /Im0 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 270.902 254.9951 Tm (Figure 7c - )Tj /TT0 1 Tf (Embryo at 9+4 weeks \(crown\226)Tj 0 -1.473 TD (rump length 28 mm\). 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The lateral corners of the )Tj 0 -1.473 TD (rhombencephalic cavity, called )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 213.4577 546.1463 Tm (the lateral recesses, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 330.6258 546.1463 Tm (are easily identified at weeks 7 and 8. During this period, the distance\ )Tj -26.327 -1.473 Td (between these recesses increases \(rhombencephalon width\). Later, durin\ g weeks 9 and 10, the lateral recesses often become )Tj T* (covered by the enlarging cerebellar hemispheres. Thus, only the central \ part of the hypoechogenic fourth ventricle, which is )Tj T* (divided by the choroid plexuses, is visible. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 278.2798 496.8775 Tm (The choroid plexuses of the fourth ventricle are bright landmarks, divid\ ing the )Tj -21.632 -1.473 Td (ventricle into rostral and caudal compartments. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 308.1934 480.4546 Tm (The cerebellar hemispheres )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 466.8369 480.4546 Tm (are easily detectable. The primordia of cerebellar )Tj -38.544 -1.473 Td (hemispheres are clearly separated in the mid-line during the embryonic p\ eriod.)Tj ET q 258.8235321 0 0 157.8823547 135.0196075 264.0361938 cm /Im0 Do Q q 258.8235321 0 0 203.6078491 406.784317 241.1734467 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 135.0196 217.2364 Tm (Figure 7a )Tj /TT0 1 Tf (- Embryo at 9+4 weeks \(crown\226)Tj 0 -1.473 TD (rump length 28 mm\). Sagittal section )Tj T* (demonstrating the relatively large head and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 135.0196 217.2364 Tm 0 -4.419 TD (the cavities of the diencephalon \(Di\), )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 135.0196 151.5447 Tm (mesencephalon \(Mes\) and rhombencephalon )Tj 0 -1.473 TD (\(Rh\). The arrow points at the genital )Tj T* (tubercle, but at this stage it is not possible )Tj T* (to differentiate between male and female )Tj T* (gender)Tj 9.4902 0 0 9.4902 174.0199 85.8337 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 406.7843 192.5984 Tm (Figura 7b)Tj /TT0 1 Tf ( - Embryo at 9+4 weeks \(crown\226)Tj T* (rump length 28 mm\). Sagittal section )Tj T* (demonstrating the relatively large head and )Tj T* (the cavities of the diencephalon \(Di\), )Tj T* (mesencephalon \(Mes\), rhombencephalon )Tj T* (\(Rh\) and umbilical cord \(U\).)Tj 9.4902 0 0 9.4902 564.3242 110.4717 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 55.6121 Tm ( )Tj /TT2 1 Tf 0 -1.937 TD (Heart)Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(14 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1297 0 obj<> endobj 1298 0 obj<>/Type/XObject/BBox[131.427 165.239 346.758 179.538]/FormType 1>>stream 1 1 0 rg 0.8411 w 135.0196 165.6599 m 131.8478 168.8318 131.8478 175.9451 135.0196 179.117 c 343.1652 179.117 l 346.3371 175.9451 346.3371 168.8318 343.1652 165.6599 c f endstream endobj 1299 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 215.331 14.2986]/FormType 1>>stream /Form Do endstream endobj 1300 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 215.331 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1301 0 obj<>>> endobj 1302 0 obj<>15]/P 208 0 R/S/Annot/Pg 292 0 R>> endobj 1303 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 130.706 236.86 267.451 212.235 re f EMC EMC EMC /Annot <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 578.9921 Tm (the mesencephalon remains relatively large, especially the posterior par\ t. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 455.2859 578.9921 Tm (The height and the width are about the same size. )Tj -37.508 -1.473 Td (During weeks 8 and 9, the rhombic fossa becomes deeper due to the progre\ ssive flexure of the pons. The lateral corners of the )Tj 0 -1.473 TD (rhombencephalic cavity, called )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 213.4577 546.1463 Tm (the lateral recesses, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 330.6258 546.1463 Tm (are easily identified at weeks 7 and 8. During this period, the distance\ )Tj -26.327 -1.473 Td (between these recesses increases \(rhombencephalon width\). Later, durin\ g weeks 9 and 10, the lateral recesses often become )Tj T* (covered by the enlarging cerebellar hemispheres. Thus, only the central \ part of the hypoechogenic fourth ventricle, which is )Tj T* (divided by the choroid plexuses, is visible. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 278.2798 496.8775 Tm (The choroid plexuses of the fourth ventricle are bright landmarks, divid\ ing the )Tj -21.632 -1.473 Td (ventricle into rostral and caudal compartments. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 308.1934 480.4546 Tm (The cerebellar hemispheres )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 466.8369 480.4546 Tm (are easily detectable. The primordia of cerebellar )Tj -38.544 -1.473 Td (hemispheres are clearly separated in the mid-line during the embryonic p\ eriod.)Tj ET q 258.8235321 0 0 157.8823547 135.0196075 264.0361938 cm /Im0 Do Q q 258.8235321 0 0 203.6078491 406.784317 241.1734467 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 135.0196 217.2364 Tm (Figure 7a )Tj /TT0 1 Tf (- Embryo at 9+4 weeks \(crown\226)Tj 0 -1.473 TD (rump length 28 mm\). Sagittal section )Tj T* (demonstrating the relatively large head and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 135.0196 217.2364 Tm 0 -4.419 TD (the cavities of the diencephalon \(Di\), )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 135.0196 151.5447 Tm (mesencephalon \(Mes\) )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 261.8876 151.5447 Tm (and rhombencephalon )Tj -11.379 -1.473 Td (\(Rh\). The arrow points at the genital )Tj 0 -1.473 TD (tubercle, but at this stage it is not possible )Tj T* (to differentiate between male and female )Tj T* (gender)Tj 9.4902 0 0 9.4902 174.0199 85.8337 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 406.7843 192.5984 Tm (Figura 7b)Tj /TT0 1 Tf ( - Embryo at 9+4 weeks \(crown\226)Tj T* (rump length 28 mm\). Sagittal section )Tj T* (demonstrating the relatively large head and )Tj T* (the cavities of the diencephalon \(Di\), )Tj T* (mesencephalon \(Mes\), rhombencephalon )Tj T* (\(Rh\) and umbilical cord \(U\).)Tj 9.4902 0 0 9.4902 564.3242 110.4717 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 55.6121 Tm ( )Tj /TT2 1 Tf 0 -1.937 TD (Heart)Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(14 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1304 0 obj<> endobj 1305 0 obj<>/Type/XObject/BBox[131.427 148.816 261.555 163.115]/FormType 1>>stream 1 1 0 rg 0.8411 w 135.0196 149.237 m 131.8478 152.4088 131.8478 159.5222 135.0196 162.694 c 257.9624 162.694 l 261.1343 159.5222 261.1343 152.4088 257.9624 149.237 c f endstream endobj 1306 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 130.128 14.2986]/FormType 1>>stream /Form Do endstream endobj 1307 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 130.128 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1308 0 obj<>>> endobj 1309 0 obj<>17]/P 208 0 R/S/Annot/Pg 292 0 R>> endobj 1310 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 130.706 236.86 267.451 212.235 re f EMC EMC EMC /Annot <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 578.9921 Tm (the mesencephalon remains relatively large, especially the posterior par\ t. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 455.2859 578.9921 Tm (The height and the width are about the same size. )Tj -37.508 -1.473 Td (During weeks 8 and 9, the rhombic fossa becomes deeper due to the progre\ ssive flexure of the pons. The lateral corners of the )Tj 0 -1.473 TD (rhombencephalic cavity, called )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 213.4577 546.1463 Tm (the lateral recesses, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 330.6258 546.1463 Tm (are easily identified at weeks 7 and 8. During this period, the distance\ )Tj -26.327 -1.473 Td (between these recesses increases \(rhombencephalon width\). Later, durin\ g weeks 9 and 10, the lateral recesses often become )Tj T* (covered by the enlarging cerebellar hemispheres. Thus, only the central \ part of the hypoechogenic fourth ventricle, which is )Tj T* (divided by the choroid plexuses, is visible. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 278.2798 496.8775 Tm (The choroid plexuses of the fourth ventricle are bright landmarks, divid\ ing the )Tj -21.632 -1.473 Td (ventricle into rostral and caudal compartments. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 308.1934 480.4546 Tm (The cerebellar hemispheres )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 466.8369 480.4546 Tm (are easily detectable. The primordia of cerebellar )Tj -38.544 -1.473 Td (hemispheres are clearly separated in the mid-line during the embryonic p\ eriod.)Tj ET q 258.8235321 0 0 157.8823547 135.0196075 264.0361938 cm /Im0 Do Q q 258.8235321 0 0 203.6078491 406.784317 241.1734467 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 135.0196 217.2364 Tm (Figure 7a )Tj /TT0 1 Tf (- Embryo at 9+4 weeks \(crown\226)Tj 0 -1.473 TD (rump length 28 mm\). Sagittal section )Tj T* (demonstrating the relatively large head and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 135.0196 217.2364 Tm 0 -4.419 TD (the cavities of the diencephalon \(Di\), )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 135.0196 151.5447 Tm (mesencephalon \(Mes\) )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 261.8876 151.5447 Tm (and rhombencephalon )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 135.0196 135.1218 Tm (\(Rh\). The arrow points at the genital )Tj 0 -1.473 TD (tubercle, but at this stage it is not possible )Tj T* (to differentiate between male and female )Tj T* (gender)Tj 9.4902 0 0 9.4902 174.0199 85.8337 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 406.7843 192.5984 Tm (Figura 7b)Tj /TT0 1 Tf ( - Embryo at 9+4 weeks \(crown\226)Tj T* (rump length 28 mm\). 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T\ he esophagus can be identified as an echogenic )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(18 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1383 0 obj<> endobj 1384 0 obj<>/Type/XObject/BBox[127.797 104.233 588.39 118.532]/FormType 1>>stream 1 1 0 rg 0.8411 w 131.3895 104.6539 m 128.2177 107.8258 128.2177 114.9391 131.3895 118.111 c 584.7971 118.111 l 587.969 114.9391 587.969 107.8258 584.7971 104.6539 c f endstream endobj 1385 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 460.593 14.2986]/FormType 1>>stream /Form Do endstream endobj 1386 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 460.593 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1387 0 obj<>>> endobj 1388 0 obj<>9]/P 208 0 R/S/Annot/Pg 325 0 R>> endobj 1389 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 455.961 407.49 155.294 182.039 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 189.373 386.346 262.275 16.83 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 455.961 386.346 155.294 16.83 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 455.961 199.993 155.294 182.039 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 189.373 165.47 262.275 30.209 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 455.961 165.47 155.294 30.209 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 178.5882416 191.0980377 409.215683 cm /Im0 Do Q q 124.2352905 0 0 163.9215698 471.4901886 416.5490265 cm /Im1 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 235.775 391.0988 Tm (slice at thalamo level \(sagital\))Tj 20.865 0 Td (thalamo level \(coronal\))Tj ET q 258.8235321 0 0 178.5882416 191.0980377 201.7188568 cm /Im2 Do Q q 124.2352905 0 0 163.9215698 471.4901886 209.0521851 cm /Im3 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 219.0789 176.9124 Tm (slice at posterior fossalevel \(sagital\))Tj 22.978 0.6 Td (posterior fossa level )Tj 2.944 -1.2 Td (\(coronal\))Tj /TT1 1 Tf -42.244 -2.263 Td (Heart)Tj /TT0 1 Tf 0 -1.938 TD (At 10 weeks, the moving valves and the interventricular septum can be id\ entified. )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 503.2188 123.3846 Tm (The heart rate slows down to 165 bpm )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 724.8669 123.3846 Tm (at the )Tj -61.687 -1.473 Td (end of week 11. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 131.3897 106.9617 Tm (The ventricles, atria, septa, valves, veins and outflow tracts become id\ entifiable.)Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.1 85.3655 Tm (Intestinal tract)Tj /TT0 1 Tf 0 -1.938 TD (Midgut herniation has its maximal extension at the beginning of week 10 \ and returns into the abdominal cavity during weeks )Tj 0 -1.473 TD (10\22611. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 80.5377 47.3352 Tm (The gut retracts into the abdominal cavity between 10 weeks 4 days and 1\ 1 weeks 5 days. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 596.6057 47.3352 Tm (Fetuses which are older than )Tj -50.183 -1.473 Td (11 weeks 5 days usually do not demonstrate any sign of the herniation. T\ he esophagus can be identified as an echogenic )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(18 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1390 0 obj<> endobj 1391 0 obj<>/Type/XObject/BBox[76.9453 44.6068 596.272 58.9052]/FormType 1>>stream 1 1 0 rg 0.8411 w 80.5378 45.0275 m 77.366 48.1994 77.366 55.3127 80.5378 58.4845 c 592.6799 58.4845 l 595.8518 55.3127 595.8518 48.1994 592.6799 45.0275 c f endstream endobj 1392 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 519.327 14.2986]/FormType 1>>stream /Form Do endstream endobj 1393 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 519.328 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1394 0 obj<>>> endobj 1395 0 obj<>12]/P 208 0 R/S/Annot/Pg 325 0 R>> endobj 1396 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 455.961 407.49 155.294 182.039 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 189.373 386.346 262.275 16.83 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 455.961 386.346 155.294 16.83 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 455.961 199.993 155.294 182.039 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.8 0.8 0.8 rg 189.373 165.47 262.275 30.209 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 455.961 165.47 155.294 30.209 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 178.5882416 191.0980377 409.215683 cm /Im0 Do Q q 124.2352905 0 0 163.9215698 471.4901886 416.5490265 cm /Im1 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 235.775 391.0988 Tm (slice at thalamo level \(sagital\))Tj 20.865 0 Td (thalamo level \(coronal\))Tj ET q 258.8235321 0 0 178.5882416 191.0980377 201.7188568 cm /Im2 Do Q q 124.2352905 0 0 163.9215698 471.4901886 209.0521851 cm /Im3 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 219.0789 176.9124 Tm (slice at posterior fossalevel \(sagital\))Tj 22.978 0.6 Td (posterior fossa level )Tj 2.944 -1.2 Td (\(coronal\))Tj /TT1 1 Tf -42.244 -2.263 Td (Heart)Tj /TT0 1 Tf 0 -1.938 TD (At 10 weeks, the moving valves and the interventricular septum can be id\ entified. )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 503.2188 123.3846 Tm (The heart rate slows down to 165 bpm )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 724.8669 123.3846 Tm (at the )Tj -61.687 -1.473 Td (end of week 11. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 131.3897 106.9617 Tm (The ventricles, atria, septa, valves, veins and outflow tracts become id\ entifiable.)Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.1 85.3655 Tm (Intestinal tract)Tj /TT0 1 Tf 0 -1.938 TD (Midgut herniation has its maximal extension at the beginning of week 10 \ and returns into the abdominal cavity during weeks )Tj 0 -1.473 TD (10\22611. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 80.5377 47.3352 Tm (The gut retracts into the abdominal cavity between 10 weeks 4 days and 1\ 1 weeks 5 days. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 596.6057 47.3352 Tm (Fetuses which are older than )Tj -50.183 -1.473 Td (11 weeks 5 days usually do not demonstrate any sign of the herniation. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 445.1201 30.9123 Tm (The esophagus can be identified )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 629.931 30.9123 Tm (as an echogenic )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(18 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1397 0 obj<> endobj 1398 0 obj<>/Type/XObject/BBox[441.527 28.1839 629.598 42.4823]/FormType 1>>stream 1 1 0 rg 0.8411 w 445.1195 28.6045 m 441.9476 31.7764 441.9476 38.8897 445.1195 42.0616 c 626.0053 42.0616 l 629.1772 38.8897 629.1772 31.7764 626.0053 28.6045 c f endstream endobj 1399 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 188.071 14.2986]/FormType 1>>stream /Form Do endstream endobj 1400 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 188.071 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1401 0 obj<>>> endobj 1402 0 obj<>3]/P 208 0 R/S/Annot/Pg 345 0 R>> endobj 1403 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - 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Embryo at 10 weeks \(crown\226rump length 32 )Tj 0 -1.473 TD (mm\). Horizontal section through the abdomen )Tj T* (demonstrating the umbilical cord. The arrows show the )Tj T* (extension of the physiological midgut herniation)Tj 9.4902 0 0 9.4902 497.1915 273.1459 Tm ( )Tj -48.481 -2.855 Td ( )Tj ET q 34.5098114 0 0 34.5098114 39.6862793 207.3242798 cm /Im1 Do Q q 258.8235321 0 0 21.568634 78.5098114 213.7948761 cm /Im2 Do Q BT /TT0 1 Tf 9.4902 0 0 9.4902 343.3725 233.9715 Tm ( )Tj 0 0 1 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 187.7086 Tm (Fetal growth from 7 to 12 weeks)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(19 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1404 0 obj<> endobj 1405 0 obj<>/Type/XObject/BBox[367.973 580.276 754.735 594.574]/FormType 1>>stream 1 1 0 rg 0.8411 w 371.5652 580.6964 m 368.3934 583.8682 368.3934 590.9815 371.5652 594.1534 c 751.1426 594.1534 l 754.3145 590.9815 754.3145 583.8682 751.1426 580.6964 c f endstream endobj 1406 0 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21.568634 78.5098114 300.3921509 cm /Im3 Do Q BT /TT0 1 Tf 9.4902 0 0 9.4902 37.098 276.4825 Tm ( )Tj 1 1 1 rg /TT1 1 Tf 12.0784 0 0 12.0784 37.098 252.3464 Tm (CENTRAL NERVOUS SYSTEM DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 229.8942 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 206.6202 Tm (Acrania/exencephaly/anencephaly)Tj /TT0 1 Tf 0 -2.187 TD (Prenatal ultrasonographic diagnosis of anencephaly during the second and\ third trimesters of pregnancy is based on the )Tj 0 -1.564 TD (demonstration of an absent cranial vault and cerebral hemispheres)Tj 8.9195 0 0 8.9195 413.9451 167.6588 Tm (15)Tj 11.1493 0 0 11.1493 425.2906 164.8046 Tm (. Animal studies have shown that, in the absence of the )Tj -34.818 -1.473 Td (cranial vault, there is progressive degeneration of the exposed cerebral\ tissue to anencephaly)Tj 8.9195 0 0 8.9195 564.5947 151.2335 Tm (16)Tj 11.1493 0 0 11.1493 575.9403 148.3792 Tm (.)Tj -48.33 -1.847 Td (In normal human fetuses, there is histological evidence that )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 379.1998 127.7864 Tm (the onset of ossification of the cranial vault is at 10 weeks )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 710.6461 127.7864 Tm (of )Tj -60.412 -1.564 Td (gestation)Tj 8.9195 0 0 8.9195 88.8643 113.2063 Tm (17)Tj 11.1493 0 0 11.1493 100.2099 110.3521 Tm ( and that, ultrasonographically by 11 weeks, there is hyperechogenicity \ of the skull in comparison to the underlying )Tj -5.661 -1.473 Td (tissues)Tj 8.9195 0 0 8.9195 75.6747 96.781 Tm (18)Tj 11.1493 0 0 11.1493 87.0202 93.9267 Tm (. Ultrasound reports have demonstrated that in the human, as in animal s\ tudies, there is progression from acrania to )Tj -4.478 -1.473 Td (exencephaly and finally anencephaly \()Tj 0 0 0.4 rg (Table 1)Tj 0 0 0 rg (\))Tj 8.9195 0 0 8.9195 298.3378 80.3556 Tm (19\22623)Tj 11.1493 0 0 11.1493 326.7017 77.5014 Tm (. In the first trimester, the pathognomonic feature is acrania, the brai\ n )Tj -25.975 -1.47 Td (being either entirely normal or at varying degrees of distortion and dis\ ruption.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 477.9199 61.1092 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(28 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1658 0 obj<> endobj 1659 0 obj<>/Type/XObject/BBox[375.607 125.058 710.313 139.356]/FormType 1>>stream 1 1 0 rg 0.8411 w 379.1992 125.4787 m 376.0273 128.6506 376.0273 135.7639 379.1992 138.9357 c 706.7203 138.9357 l 709.8922 135.7639 709.8922 128.6506 706.7203 125.4787 c f endstream endobj 1660 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 334.706 14.2986]/FormType 1>>stream /Form Do endstream endobj 1661 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 334.707 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1662 0 obj<>>> endobj 1663 0 obj<>6]/P 208 0 R/S/Annot/Pg 521 0 R>> endobj 1664 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 130.706 344.824 267.451 22.431 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 344.824 267.451 22.431 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.6 rg 32.784 244.745 735.059 23.122 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 199.272 735.059 22.007 re f EMC EMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 37.098 331.02 m 340.784 331.02 l 339.059 329.294 l 38.824 329.294 l h f 37.098 331.02 m 37.098 291.333 l 38.824 293.059 l 38.824 329.294 l h f 0.313 0.313 0.313 rg 340.784 331.02 m 340.784 291.333 l 339.059 293.059 l 339.059 329.294 l h f 37.098 291.333 m 340.784 291.333 l 339.059 293.059 l 38.824 293.059 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 38.824 329.294 m 76.784 329.294 l 75.922 328.431 l 39.686 328.431 l h f 38.824 329.294 m 38.824 293.059 l 39.686 293.922 l 39.686 328.431 l h f 0.949 0.945 0.935 rg 76.784 329.294 m 76.784 293.059 l 75.922 293.922 l 75.922 328.431 l h f 38.824 293.059 m 76.784 293.059 l 75.922 293.922 l 39.686 293.922 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 77.647 293.922 260.549 34.51 re f 0.457 0.449 0.431 rg 76.784 329.294 m 339.059 329.294 l 338.196 328.431 l 77.647 328.431 l h f 76.784 329.294 m 76.784 293.059 l 77.647 293.922 l 77.647 328.431 l h f 0.949 0.945 0.935 rg 339.059 329.294 m 339.059 293.059 l 338.196 293.922 l 338.196 328.431 l h f 76.784 293.059 m 339.059 293.059 l 338.196 293.922 l 77.647 293.922 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 208.784317 135.0196075 375.8823547 cm /Im0 Do Q q 258.8235321 0 0 208.784317 406.784317 375.8823547 cm /Im1 Do Q 1 1 1 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 221.1107 352.3767 Tm (Cervical Length)Tj 24.375 0 Td (Cervical Length)Tj 0 0 0 rg 9.4902 0 0 9.4902 37.098 332.6472 Tm ( )Tj ET q 34.5098114 0 0 34.5098114 39.6862793 293.9215698 cm /Im2 Do Q q 258.8235321 0 0 21.568634 78.5098114 300.3921509 cm /Im3 Do Q BT /TT0 1 Tf 9.4902 0 0 9.4902 37.098 276.4825 Tm ( )Tj 1 1 1 rg /TT1 1 Tf 12.0784 0 0 12.0784 37.098 252.3464 Tm (CENTRAL NERVOUS SYSTEM DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 229.8942 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 206.6202 Tm (Acrania/exencephaly/anencephaly)Tj /TT0 1 Tf 0 -2.187 TD (Prenatal ultrasonographic diagnosis of anencephaly during the second and\ third trimesters of pregnancy is based on the )Tj 0 -1.564 TD (demonstration of an absent cranial vault and cerebral hemispheres)Tj 8.9195 0 0 8.9195 413.9451 167.6588 Tm (15)Tj 11.1493 0 0 11.1493 425.2906 164.8046 Tm (. Animal studies have shown that, in the absence of the )Tj -34.818 -1.473 Td (cranial vault, there is progressive degeneration of the exposed cerebral\ tissue to anencephaly)Tj 8.9195 0 0 8.9195 564.5947 151.2335 Tm (16)Tj 11.1493 0 0 11.1493 575.9403 148.3792 Tm (.)Tj -48.33 -1.847 Td (In normal human fetuses, there is histological evidence that )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 379.1998 127.7864 Tm (the onset of ossification of the cranial vault is at 10 weeks )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 710.6461 127.7864 Tm (of )Tj -60.412 -1.564 Td (gestation)Tj 8.9195 0 0 8.9195 88.8643 113.2063 Tm (17)Tj 11.1493 0 0 11.1493 100.2099 110.3521 Tm ( and that, )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 159.2901 110.3521 Tm (ultrasonographically by 11 weeks, there is hyperechogenicity of the skul\ l )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 572.7733 110.3521 Tm (in comparison to the underlying )Tj -48.046 -1.473 Td (tissues)Tj 8.9195 0 0 8.9195 75.6747 96.781 Tm (18)Tj 11.1493 0 0 11.1493 87.0202 93.9267 Tm (. Ultrasound reports have demonstrated that in the human, as in animal s\ tudies, there is progression from acrania to )Tj -4.478 -1.473 Td (exencephaly and finally anencephaly \()Tj 0 0 0.4 rg (Table 1)Tj 0 0 0 rg (\))Tj 8.9195 0 0 8.9195 298.3378 80.3556 Tm (19\22623)Tj 11.1493 0 0 11.1493 326.7017 77.5014 Tm (. In the first trimester, the pathognomonic feature is acrania, the brai\ n )Tj -25.975 -1.47 Td (being either entirely normal or at varying degrees of distortion and dis\ ruption.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 477.9199 61.1092 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(28 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1665 0 obj<> endobj 1666 0 obj<>/Type/XObject/BBox[155.697 107.624 572.44 121.922]/FormType 1>>stream 1 1 0 rg 0.8411 w 159.29 108.0444 m 156.1182 111.2162 156.1182 118.3296 159.29 121.5014 c 568.8474 121.5014 l 572.0192 118.3296 572.0192 111.2162 568.8474 108.0444 c f endstream endobj 1667 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 416.743 14.2986]/FormType 1>>stream /Form Do endstream endobj 1668 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 416.743 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1669 0 obj<>>> endobj 1670 0 obj[1669 0 R 1673 0 R 1677 0 R 1680 0 R 1684 0 R 1687 0 R 1691 0 R 1694 0 R 1698 0 R 1701 0 R] endobj 1671 0 obj<>3]/P 208 0 R/S/Annot/Pg 576 0 R>> endobj 1672 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 443.511 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (compared to the second trimester and they were instructed to specificall\ y look for and record the presence or absence of )Tj 0 -1.473 TD (acrania at the early scan. In the second phase of the study, 20 407 fetu\ ses were examined and all 16 cases of anencephaly )Tj 0 -1.564 TD (were diagnosed at the early scan)Tj 8.9195 0 0 8.9195 223.091 552.0009 Tm (29)Tj 11.1493 0 0 11.1493 234.4366 549.1467 Tm (.)Tj -17.7 -1.847 Td (These findings demonstrate that )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 223.1758 528.5539 Tm (anencephaly can be reliably diagnosed at the routine 11\22614-week ultra\ sound scan, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 694.9584 528.5539 Tm (provided )Tj -59.005 -1.473 Td (the sonographic features for this condition are specifically searched fo\ r. )Tj 9.4902 0 0 9.4902 37.098 482.3558 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 458.438 Tm (Encephalocele)Tj /TT0 1 Tf 0 -2.867 TD (This is a cranial defect with protrusion of meninges \(meningocele\) and\ brain \(encephalocele\). In about 75% of cases, the lesion )Tj 0 -1.473 TD (is occipital but alternative sites include the frontoethmoidal and parie\ tal regions. It is often associated with microcephaly, )Tj T* (hydrocephaly, spina bifida and Meckel\226Gruber syndrome.)Tj 0 -1.937 TD (A prerequisite for the diagnosis of encephalocele \(in contrast to nucha\ l cystic hygroma\) is the demonstration of an associated )Tj 0 -1.473 TD (bony defect in the skull and, therefore, the diagnosis may not be possib\ le before the onset of cranial ossification at about 10 )Tj T* (weeks of gestation. However, van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. have reported that, at least in some cases, the first sign for possibl\ e )Tj 0 -1.564 TD (encephalocele is enlargement of the rhombencephalic cavity from about 9 \ weeks)Tj 8.9195 0 0 8.9195 491.9792 324.5945 Tm (30)Tj 11.1493 0 0 11.1493 503.3248 321.7403 Tm (.)Tj -41.817 -1.847 Td (Bronshtein and Zimmer described a case of occipital encephalocele that w\ as first seen at 13 weeks as an empty occipital sac )Tj T* (measuring 8 x 9 mm)Tj 8.9195 0 0 8.9195 154.1548 286.5674 Tm (31)Tj 11.1493 0 0 11.1493 165.5003 283.7132 Tm (. At 14 weeks, the sac remained of the same size and was filled with bra\ in tissue. At 15 and 16 weeks, )Tj -11.517 -1.383 Td (repeated examinations demonstrated complete resolution of the defect and\ the maternal serum a-fetoprotein was normal. At )Tj 0 -1.473 TD (19 weeks, there was recurrence of the encephalocele and this persisted u\ ntil 24 weeks when the pregnancy was terminated; )Tj T* (pathological examination confirmed the diagnosis of encephalocele.)Tj 0 -2.028 TD (van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a fetus at 11 weeks of gestation with two translucent areas \ in the occipital region)Tj 8.9195 0 0 8.9195 688.4748 215.6896 Tm (32)Tj 11.1493 0 0 11.1493 699.8204 212.8353 Tm (. A repeat )Tj -59.441 -1.383 Td (scan at 13 weeks demonstrated a bony defect and protrusion of the brain.\ The diagnosis of occipital encephalocele was made )Tj 0 -1.473 TD (and this was confirmed by pathological examination after termination of \ the pregnancy.)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(32 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1673 0 obj<> endobj 1674 0 obj<>/Type/XObject/BBox[219.583 525.826 694.625 540.124]/FormType 1>>stream 1 1 0 rg 0.8411 w 223.1754 526.2462 m 220.0036 529.4181 220.0036 536.5314 223.1754 539.7032 c 691.0323 539.7032 l 694.2042 536.5314 694.2042 529.4181 691.0323 526.2462 c f endstream endobj 1675 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 475.042 14.2985]/FormType 1>>stream /Form Do endstream endobj 1676 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 475.042 14.2988]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1677 0 obj<>>> endobj 1678 0 obj<>6]/P 208 0 R/S/Annot/Pg 576 0 R>> endobj 1679 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 443.511 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (compared to the second trimester and they were instructed to specificall\ y look for and record the presence or absence of )Tj 0 -1.473 TD (acrania at the early scan. In the second phase of the study, 20 407 fetu\ ses were examined and all 16 cases of anencephaly )Tj 0 -1.564 TD (were diagnosed at the early scan)Tj 8.9195 0 0 8.9195 223.091 552.0009 Tm (29)Tj 11.1493 0 0 11.1493 234.4366 549.1467 Tm (.)Tj -17.7 -1.847 Td (These findings demonstrate that )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 223.1758 528.5539 Tm (anencephaly can be reliably diagnosed at the routine 11\22614-week ultra\ sound scan, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 694.9584 528.5539 Tm (provided )Tj -59.005 -1.473 Td (the sonographic features for this condition are specifically searched fo\ r. )Tj 9.4902 0 0 9.4902 37.098 482.3558 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 458.438 Tm (Encephalocele)Tj /TT0 1 Tf 0 -2.867 TD (This is a cranial defect with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 194.1249 426.473 Tm (protrusion of meninges \(meningocele\) and brain \(encephalocele\). )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 566.6232 426.473 Tm (In about 75% of cases, the lesion )Tj -47.494 -1.473 Td (is occipital but alternative sites include the frontoethmoidal and parie\ tal regions. It is often associated with microcephaly, )Tj 0 -1.473 TD (hydrocephaly, spina bifida and Meckel\226Gruber syndrome.)Tj 0 -1.937 TD (A prerequisite for the diagnosis of encephalocele \(in contrast to nucha\ l cystic hygroma\) is the demonstration of an associated )Tj 0 -1.473 TD (bony defect in the skull and, therefore, the diagnosis may not be possib\ le before the onset of cranial ossification at about 10 )Tj T* (weeks of gestation. However, van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. have reported that, at least in some cases, the first sign for possibl\ e )Tj 0 -1.564 TD (encephalocele is enlargement of the rhombencephalic cavity from about 9 \ weeks)Tj 8.9195 0 0 8.9195 491.9792 324.5945 Tm (30)Tj 11.1493 0 0 11.1493 503.3248 321.7403 Tm (.)Tj -41.817 -1.847 Td (Bronshtein and Zimmer described a case of occipital encephalocele that w\ as first seen at 13 weeks as an empty occipital sac )Tj 0 -1.564 TD (measuring 8 x 9 mm)Tj 8.9195 0 0 8.9195 154.1548 286.5674 Tm (31)Tj 11.1493 0 0 11.1493 165.5003 283.7132 Tm (. At 14 weeks, the sac remained of the same size and was filled with bra\ in tissue. At 15 and 16 weeks, )Tj -11.517 -1.383 Td (repeated examinations demonstrated complete resolution of the defect and\ the maternal serum a-fetoprotein was normal. At )Tj 0 -1.473 TD (19 weeks, there was recurrence of the encephalocele and this persisted u\ ntil 24 weeks when the pregnancy was terminated; )Tj T* (pathological examination confirmed the diagnosis of encephalocele.)Tj 0 -2.028 TD (van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a fetus at 11 weeks of gestation with two translucent areas \ in the occipital region)Tj 8.9195 0 0 8.9195 688.4748 215.6896 Tm (32)Tj 11.1493 0 0 11.1493 699.8204 212.8353 Tm (. A repeat )Tj -59.441 -1.383 Td (scan at 13 weeks demonstrated a bony defect and protrusion of the brain.\ The diagnosis of occipital encephalocele was made )Tj 0 -1.473 TD (and this was confirmed by pathological examination after termination of \ the pregnancy.)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(32 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1680 0 obj<> endobj 1681 0 obj<>/Type/XObject/BBox[190.532 423.745 566.29 438.043]/FormType 1>>stream 1 1 0 rg 0.8411 w 194.1246 424.1652 m 190.9528 427.3371 190.9528 434.4504 194.1246 437.6223 c 562.6972 437.6223 l 565.8691 434.4504 565.8691 427.3371 562.6972 424.1652 c f endstream endobj 1682 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 375.758 14.2986]/FormType 1>>stream /Form Do endstream endobj 1683 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 375.758 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1684 0 obj<>>> endobj 1685 0 obj<>9]/P 208 0 R/S/Annot/Pg 576 0 R>> endobj 1686 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 443.511 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (compared to the second trimester and they were instructed to specificall\ y look for and record the presence or absence of )Tj 0 -1.473 TD (acrania at the early scan. In the second phase of the study, 20 407 fetu\ ses were examined and all 16 cases of anencephaly )Tj 0 -1.564 TD (were diagnosed at the early scan)Tj 8.9195 0 0 8.9195 223.091 552.0009 Tm (29)Tj 11.1493 0 0 11.1493 234.4366 549.1467 Tm (.)Tj -17.7 -1.847 Td (These findings demonstrate that )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 223.1758 528.5539 Tm (anencephaly can be reliably diagnosed at the routine 11\22614-week ultra\ sound scan, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 694.9584 528.5539 Tm (provided )Tj -59.005 -1.473 Td (the sonographic features for this condition are specifically searched fo\ r. )Tj 9.4902 0 0 9.4902 37.098 482.3558 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 458.438 Tm (Encephalocele)Tj /TT0 1 Tf 0 -2.867 TD (This is a cranial defect with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 194.1249 426.473 Tm (protrusion of meninges \(meningocele\) and brain \(encephalocele\). )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 566.6232 426.473 Tm (In about 75% of cases, the lesion )Tj -47.494 -1.473 Td (is occipital but alternative sites include the frontoethmoidal and parie\ tal regions. It is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 519.5508 410.05 Tm (often associated with microcephaly, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 393.6271 Tm (hydrocephaly, spina bifida and Meckel\226Gruber syndrome.)Tj 0 -1.937 TD (A prerequisite for the diagnosis of encephalocele \(in contrast to nucha\ l cystic hygroma\) is the demonstration of an associated )Tj 0 -1.473 TD (bony defect in the skull and, therefore, the diagnosis may not be possib\ le before the onset of cranial ossification at about 10 )Tj T* (weeks of gestation. However, van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. have reported that, at least in some cases, the first sign for possibl\ e )Tj 0 -1.564 TD (encephalocele is enlargement of the rhombencephalic cavity from about 9 \ weeks)Tj 8.9195 0 0 8.9195 491.9792 324.5945 Tm (30)Tj 11.1493 0 0 11.1493 503.3248 321.7403 Tm (.)Tj -41.817 -1.847 Td (Bronshtein and Zimmer described a case of occipital encephalocele that w\ as first seen at 13 weeks as an empty occipital sac )Tj T* (measuring 8 x 9 mm)Tj 8.9195 0 0 8.9195 154.1548 286.5674 Tm (31)Tj 11.1493 0 0 11.1493 165.5003 283.7132 Tm (. At 14 weeks, the sac remained of the same size and was filled with bra\ in tissue. At 15 and 16 weeks, )Tj -11.517 -1.383 Td (repeated examinations demonstrated complete resolution of the defect and\ the maternal serum a-fetoprotein was normal. At )Tj 0 -1.473 TD (19 weeks, there was recurrence of the encephalocele and this persisted u\ ntil 24 weeks when the pregnancy was terminated; )Tj T* (pathological examination confirmed the diagnosis of encephalocele.)Tj 0 -2.028 TD (van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a fetus at 11 weeks of gestation with two translucent areas \ in the occipital region)Tj 8.9195 0 0 8.9195 688.4748 215.6896 Tm (32)Tj 11.1493 0 0 11.1493 699.8204 212.8353 Tm (. A repeat )Tj -59.441 -1.383 Td (scan at 13 weeks demonstrated a bony defect and protrusion of the brain.\ The diagnosis of occipital encephalocele was made )Tj 0 -1.473 TD (and this was confirmed by pathological examination after termination of \ the pregnancy.)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(32 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1687 0 obj<> endobj 1688 0 obj<>/Type/XObject/BBox[515.958 407.322 724.075 421.62]/FormType 1>>stream 1 1 0 rg 0.8411 w 519.5503 407.7423 m 516.3784 410.9142 516.3784 418.0276 519.5503 421.1994 c 720.4824 421.1994 l 723.6543 418.0276 723.6543 410.9142 720.4824 407.7423 c f endstream endobj 1689 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 208.117 14.2986]/FormType 1>>stream /Form Do endstream endobj 1690 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 208.118 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1691 0 obj<>>> endobj 1692 0 obj<>11]/P 208 0 R/S/Annot/Pg 576 0 R>> endobj 1693 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 443.511 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (compared to the second trimester and they were instructed to specificall\ y look for and record the presence or absence of )Tj 0 -1.473 TD (acrania at the early scan. In the second phase of the study, 20 407 fetu\ ses were examined and all 16 cases of anencephaly )Tj 0 -1.564 TD (were diagnosed at the early scan)Tj 8.9195 0 0 8.9195 223.091 552.0009 Tm (29)Tj 11.1493 0 0 11.1493 234.4366 549.1467 Tm (.)Tj -17.7 -1.847 Td (These findings demonstrate that )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 223.1758 528.5539 Tm (anencephaly can be reliably diagnosed at the routine 11\22614-week ultra\ sound scan, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 694.9584 528.5539 Tm (provided )Tj -59.005 -1.473 Td (the sonographic features for this condition are specifically searched fo\ r. )Tj 9.4902 0 0 9.4902 37.098 482.3558 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 458.438 Tm (Encephalocele)Tj /TT0 1 Tf 0 -2.867 TD (This is a cranial defect with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 194.1249 426.473 Tm (protrusion of meninges \(meningocele\) and brain \(encephalocele\). )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 566.6232 426.473 Tm (In about 75% of cases, the lesion )Tj -47.494 -1.473 Td (is occipital but alternative sites include the frontoethmoidal and parie\ tal regions. It is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 519.5508 410.05 Tm (often associated with microcephaly, )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 393.6271 Tm (hydrocephaly, spina bifida and Meckel\226Gruber syndrome.)Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 372.0309 Tm (A prerequisite for the diagnosis of encephalocele \(in contrast to nucha\ l cystic hygroma\) is the demonstration of an associated )Tj 0 -1.473 TD (bony defect in the skull and, therefore, the diagnosis may not be possib\ le before the onset of cranial ossification at about 10 )Tj T* (weeks of gestation. However, van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. have reported that, at least in some cases, the first sign for possibl\ e )Tj 0 -1.564 TD (encephalocele is enlargement of the rhombencephalic cavity from about 9 \ weeks)Tj 8.9195 0 0 8.9195 491.9792 324.5945 Tm (30)Tj 11.1493 0 0 11.1493 503.3248 321.7403 Tm (.)Tj -41.817 -1.847 Td (Bronshtein and Zimmer described a case of occipital encephalocele that w\ as first seen at 13 weeks as an empty occipital sac )Tj T* (measuring 8 x 9 mm)Tj 8.9195 0 0 8.9195 154.1548 286.5674 Tm (31)Tj 11.1493 0 0 11.1493 165.5003 283.7132 Tm (. At 14 weeks, the sac remained of the same size and was filled with bra\ in tissue. At 15 and 16 weeks, )Tj -11.517 -1.383 Td (repeated examinations demonstrated complete resolution of the defect and\ the maternal serum a-fetoprotein was normal. At )Tj 0 -1.473 TD (19 weeks, there was recurrence of the encephalocele and this persisted u\ ntil 24 weeks when the pregnancy was terminated; )Tj T* (pathological examination confirmed the diagnosis of encephalocele.)Tj 0 -2.028 TD (van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a fetus at 11 weeks of gestation with two translucent areas \ in the occipital region)Tj 8.9195 0 0 8.9195 688.4748 215.6896 Tm (32)Tj 11.1493 0 0 11.1493 699.8204 212.8353 Tm (. A repeat )Tj -59.441 -1.383 Td (scan at 13 weeks demonstrated a bony defect and protrusion of the brain.\ The diagnosis of occipital encephalocele was made )Tj 0 -1.473 TD (and this was confirmed by pathological examination after termination of \ the pregnancy.)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(32 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1694 0 obj<> endobj 1695 0 obj<>/Type/XObject/BBox[33.5055 390.899 363.763 405.197]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.098 391.3194 m 33.9262 394.4912 33.9262 401.6046 37.098 404.7764 c 360.1708 404.7764 l 363.3427 401.6046 363.3427 394.4912 360.1708 391.3194 c f endstream endobj 1696 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 330.258 14.2986]/FormType 1>>stream /Form Do endstream endobj 1697 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 330.258 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1698 0 obj<>>> endobj 1699 0 obj<>14]/P 208 0 R/S/Annot/Pg 576 0 R>> endobj 1700 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 443.511 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (compared to the second trimester and they were instructed to specificall\ y look for and record the presence or absence of )Tj 0 -1.473 TD (acrania at the early scan. In the second phase of the study, 20 407 fetu\ ses were examined and all 16 cases of anencephaly )Tj 0 -1.564 TD (were diagnosed at the early scan)Tj 8.9195 0 0 8.9195 223.091 552.0009 Tm (29)Tj 11.1493 0 0 11.1493 234.4366 549.1467 Tm (.)Tj -17.7 -1.847 Td (These findings demonstrate that )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 223.1758 528.5539 Tm (anencephaly can be reliably diagnosed at the routine 11\22614-week ultra\ sound scan, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 694.9584 528.5539 Tm (provided )Tj -59.005 -1.473 Td (the sonographic features for this condition are specifically searched fo\ r. )Tj 9.4902 0 0 9.4902 37.098 482.3558 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 37.098 458.438 Tm (Encephalocele)Tj /TT0 1 Tf 0 -2.867 TD (This is a cranial defect with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 194.1249 426.473 Tm (protrusion of meninges \(meningocele\) and brain \(encephalocele\). )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 566.6232 426.473 Tm (In about 75% of cases, the lesion )Tj -47.494 -1.473 Td (is occipital but alternative sites include the frontoethmoidal and parie\ tal regions. It is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 519.5508 410.05 Tm (often associated with microcephaly, )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 393.6271 Tm (hydrocephaly, spina bifida and Meckel\226Gruber syndrome.)Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 372.0309 Tm (A prerequisite for the diagnosis of encephalocele \(in contrast to nucha\ l cystic hygroma\) is the demonstration of an associated )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 355.608 Tm (bony defect in the skull )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 172.2388 355.608 Tm (and, therefore, the diagnosis may not be possible before the onset of cr\ anial ossification at about 10 )Tj -12.121 -1.473 Td (weeks of gestation. However, van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. have reported that, at least in some cases, the first sign for possibl\ e )Tj 0 -1.564 TD (encephalocele is enlargement of the rhombencephalic cavity from about 9 \ weeks)Tj 8.9195 0 0 8.9195 491.9792 324.5945 Tm (30)Tj 11.1493 0 0 11.1493 503.3248 321.7403 Tm (.)Tj -41.817 -1.847 Td (Bronshtein and Zimmer described a case of occipital encephalocele that w\ as first seen at 13 weeks as an empty occipital sac )Tj T* (measuring 8 x 9 mm)Tj 8.9195 0 0 8.9195 154.1548 286.5674 Tm (31)Tj 11.1493 0 0 11.1493 165.5003 283.7132 Tm (. At 14 weeks, the sac remained of the same size and was filled with bra\ in tissue. At 15 and 16 weeks, )Tj -11.517 -1.383 Td (repeated examinations demonstrated complete resolution of the defect and\ the maternal serum a-fetoprotein was normal. At )Tj 0 -1.473 TD (19 weeks, there was recurrence of the encephalocele and this persisted u\ ntil 24 weeks when the pregnancy was terminated; )Tj T* (pathological examination confirmed the diagnosis of encephalocele.)Tj 0 -2.028 TD (van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a fetus at 11 weeks of gestation with two translucent areas \ in the occipital region)Tj 8.9195 0 0 8.9195 688.4748 215.6896 Tm (32)Tj 11.1493 0 0 11.1493 699.8204 212.8353 Tm (. A repeat )Tj -59.441 -1.383 Td (scan at 13 weeks demonstrated a bony defect and protrusion of the brain.\ The diagnosis of occipital encephalocele was made )Tj 0 -1.473 TD (and this was confirmed by pathological examination after termination of \ the pregnancy.)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(32 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1701 0 obj<> endobj 1702 0 obj<>/Type/XObject/BBox[33.5055 352.88 171.906 367.178]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.098 353.3003 m 33.9262 356.4721 33.9262 363.5855 37.098 366.7573 c 168.3138 366.7573 l 171.4857 363.5855 171.4857 356.4721 168.3138 353.3003 c f endstream endobj 1703 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 138.401 14.2986]/FormType 1>>stream /Form Do endstream endobj 1704 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 138.401 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1705 0 obj<>>> endobj 1706 0 obj[1705 0 R 1709 0 R 1713 0 R 1716 0 R 1720 0 R 1723 0 R] endobj 1707 0 obj<>3]/P 208 0 R/S/Annot/Pg 579 0 R>> endobj 1708 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 242.698 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 265.7254944 0 0 265.7254944 267.4509735 319.0980377 cm /Im0 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 227.3333 295.8047 Tm (Figure 10)Tj /TT1 1 Tf ( - Encephalocele in a 12-week fetus)Tj /TT0 1 Tf -17.062 -3.424 Td (Meckel\226Gruber syndrome)Tj /TT1 1 Tf 0 -2.867 TD (This is a )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 87.2312 225.6645 Tm (lethal, autosomal recessive condition )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 298.6777 225.6645 Tm (characterized by the triad of encephalocele, bilateral polycystic kidney\ s and )Tj -23.461 -1.473 Td (polydactyly.)Tj 0 -2.028 TD (Pachi )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. described the sonographic features of the syndrome in a high-risk preg\ nancy at 13 weeks of gestation)Tj 8.9195 0 0 8.9195 678.7192 189.4828 Tm (33)Tj 11.1493 0 0 11.1493 690.0647 186.6286 Tm (. There was )Tj -58.566 -1.383 Td (an occipital bony defect accompanied by encephalocele and abnormally enl\ arged kidneys. Pathological examination, after )Tj 0 -1.473 TD (termination at 13 weeks, detected all three features of the syndrome. Se\ pulveda )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. examined nine high-risk pregnancies at )Tj 0 -1.564 TD (11\22613 weeks and correctly diagnosed the four affected fetuses by the \ presence of the characteristic triad of the syndrome)Tj 8.9195 0 0 8.9195 725.6467 140.2068 Tm (34)Tj 11.1493 0 0 11.1493 736.9922 137.3526 Tm (. )Tj -62.775 -1.383 Td (Similarly, van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. examined five high-risk pregnancies and correctly identified the three\ affected fetuses at 11\226)Tj T* (14 weeks)Tj 8.9195 0 0 8.9195 90.0239 107.3561 Tm (30)Tj 11.1493 0 0 11.1493 101.3694 104.5019 Tm (.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 105.4278 104.5019 Tm ( )Tj /TT1 1 Tf -7.2 -1.84 Td ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(33 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1709 0 obj<> endobj 1710 0 obj<>/Type/XObject/BBox[83.6387 222.936 298.345 237.234]/FormType 1>>stream 1 1 0 rg 0.8411 w 87.2312 223.3567 m 84.0594 226.5286 84.0594 233.6419 87.2312 236.8138 c 294.7525 236.8138 l 297.9244 233.6419 297.9244 226.5286 294.7525 223.3567 c f endstream endobj 1711 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 214.706 14.2986]/FormType 1>>stream /Form Do endstream endobj 1712 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 214.707 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1713 0 obj<>>> endobj 1714 0 obj<>6]/P 208 0 R/S/Annot/Pg 579 0 R>> endobj 1715 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 242.698 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 265.7254944 0 0 265.7254944 267.4509735 319.0980377 cm /Im0 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 227.3333 295.8047 Tm (Figure 10)Tj /TT1 1 Tf ( - Encephalocele in a 12-week fetus)Tj /TT0 1 Tf -17.062 -3.424 Td (Meckel\226Gruber syndrome)Tj /TT1 1 Tf 0 -2.867 TD (This is a )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 87.2312 225.6645 Tm (lethal, autosomal recessive condition )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 298.6777 225.6645 Tm (characterized by the triad of )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 461.6248 225.6645 Tm (encephalocele, bilateral polycystic kidneys and )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.1039 209.2415 Tm (polydactyly.)Tj 0 -2.028 TD (Pachi )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. described the sonographic features of the syndrome in a high-risk preg\ nancy at 13 weeks of gestation)Tj 8.9195 0 0 8.9195 678.7192 189.4828 Tm (33)Tj 11.1493 0 0 11.1493 690.0647 186.6286 Tm (. There was )Tj -58.566 -1.383 Td (an occipital bony defect accompanied by encephalocele and abnormally enl\ arged kidneys. Pathological examination, after )Tj 0 -1.473 TD (termination at 13 weeks, detected all three features of the syndrome. 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There was )Tj -58.566 -1.383 Td (an occipital bony defect accompanied by encephalocele and abnormally enl\ arged kidneys. Pathological examination, after )Tj 0 -1.473 TD (termination at 13 weeks, detected all three features of the syndrome. Se\ pulveda )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. examined nine high-risk pregnancies at )Tj 0 -1.564 TD (11\22613 weeks and correctly diagnosed the four affected fetuses by the \ presence of the characteristic triad of the syndrome)Tj 8.9195 0 0 8.9195 725.6467 140.2068 Tm (34)Tj 11.1493 0 0 11.1493 736.9922 137.3526 Tm (. )Tj -62.775 -1.383 Td (Similarly, van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. examined five high-risk pregnancies and correctly identified the three\ affected fetuses at 11\226)Tj T* (14 weeks)Tj 8.9195 0 0 8.9195 90.0239 107.3561 Tm (30)Tj 11.1493 0 0 11.1493 101.3694 104.5019 Tm (.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 105.4278 104.5019 Tm ( )Tj /TT1 1 Tf -7.2 -1.84 Td ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(33 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1723 0 obj<> endobj 1724 0 obj<>/Type/XObject/BBox[33.5114 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100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 569.954 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 302.105 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 253.647 18 293.333 190.869 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 1 1 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 577.3026 Tm (Screening studies)Tj 0 0 0 rg /TT1 1 Tf -0.542 -1.8 Td (An ultrasound screening study for fetal abnormalities at 12\22614 weeks \ of gestation, involving 1632 pregnancies correctly )Tj 0 -1.473 TD (identified the one case of Meckel\226Gruber syndrome; there was )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n BT /TT1 1 Tf 11.1493 0 0 11.1493 394.0392 540.8109 Tm (an occipital bony defect with a small encephalocele )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 685.1474 540.8109 Tm (at 12 weeks )Tj -58.125 -1.564 Td (and enlarged cystic kidneys at 13 weeks)Tj 8.9195 0 0 8.9195 264.3881 526.2295 Tm (35)Tj 11.1493 0 0 11.1493 275.7337 523.3753 Tm (. The parents chose to continue with the pregnancy and at 15 weeks there\ was )Tj -21.404 -1.383 Td (enlargement of the encephalocele. Serial scans from 18 weeks demonstrate\ d the presence of anhydramnios, making )Tj 0 -1.564 TD (visualization of the fetal abnormalities difficult. The diagnosis was co\ nfirmed after delivery at 37 weeks and neonatal death)Tj 8.9195 0 0 8.9195 729.3594 493.3789 Tm (36)Tj 11.1493 0 0 11.1493 740.7049 490.5246 Tm (. )Tj -63.108 -1.383 Td (Sepulveda )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. detected the triad of the syndrome in a 13-week fetus during screening\ for chromosomal abnormalities by )Tj T* (measurement of fetal nuchal translucency thickness in 21 477 pregnancies\ )Tj 8.9195 0 0 8.9195 457.9626 460.5282 Tm (34)Tj 11.1493 0 0 11.1493 469.3082 457.674 Tm (.)Tj -38.766 -1.847 Td (These findings suggest that the phenotypic expression of the syndrome is\ evident from at least 11 weeks of gestation. )Tj 0 -1.473 TD (Consequently, all affected cases could potentially be diagnosed by the e\ arly scan, provided that systematic examination of both )Tj T* (the skull/brain and the renal fossae is carried out routinely. Indeed, t\ he diagnosis is likely to be easier at 11\22614 weeks, when)Tj ( )Tj T* (the amniotic fluid is normal, than during the second trimester when the \ presence of the associated oligohydramnios could easily )Tj 0 -1.473 TD (cause encephalocele and certainly polydactyly to be missed. Additionally\ , at 11\22614 weeks, the fingers are easier to examine )Tj 0 -1.473 TD (because they are invariably extended, whereas in the second trimester th\ e hands are often clenched. )Tj 0 -1.315 TD ( )Tj /TT3 1 Tf 0 -2.086 TD (Hydrocephalus)Tj /TT1 1 Tf 0 -4.592 TD (Congenital hydrocephalus has a birth prevalence of about 2 per 1000. Alt\ hough the underlying cause may be chromosomal )Tj 0 -1.2 TD (abnormalities, genetic syndromes, fetal infection or brain hemorrhage, m\ any cases have no clear-cut etiology and are probably )Tj T* (due to a combination of genetic and environmental factors. 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A repeat scan at 18 weeks demonstrated a cystic fetal head with no cer\ ebral hemispheres and falx; the brain could be )Tj -3.375 -1.383 Td (seen protruding into the cystic cavity. Unlike alobar holoprosencephaly,\ there was no rim of cortex present. 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A repeat scan at 18 weeks demonstrated a cystic fetal head with no cer\ ebral hemispheres and falx; the brain could be )Tj -3.375 -1.383 Td (seen protruding into the cystic cavity. Unlike alobar holoprosencephaly,\ there was no rim of cortex present. 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At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1862 0 obj<> endobj 1863 0 obj<>/Type/XObject/BBox[208.79 231.135 344.392 245.434]/FormType 1>>stream 1 1 0 rg 0.8411 w 212.3821 231.5561 m 209.2103 234.7279 209.2103 241.8413 212.3821 245.0131 c 340.7994 245.0131 l 343.9712 241.8413 343.9712 234.7279 340.7994 231.5561 c f endstream endobj 1864 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 135.602 14.2986]/FormType 1>>stream /Form Do endstream endobj 1865 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 135.603 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1866 0 obj<>>> endobj 1867 0 obj<>6]/P 208 0 R/S/Annot/Pg 623 0 R>> endobj 1868 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 118.196 483.84 m 682.431 483.84 l 681.569 482.977 l 119.059 482.977 l h f 118.196 483.84 m 118.196 193.891 l 119.059 194.754 l 119.059 482.977 l h f 0.313 0.313 0.313 rg 682.431 483.84 m 682.431 193.891 l 681.569 194.754 l 681.569 482.977 l h f 118.196 193.891 m 682.431 193.891 l 681.569 194.754 l 119.059 194.754 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 126.824 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 125.961 476.075 m 396.863 476.075 l 396 475.213 l 126.824 475.213 l h f 125.961 476.075 m 125.961 256.938 l 126.824 257.801 l 126.824 475.213 l h f 0.949 0.945 0.935 rg 396.863 476.075 m 396.863 256.938 l 396 257.801 l 396 475.213 l h f 125.961 256.938 m 396.863 256.938 l 396 257.801 l 126.824 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 404.627 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 403.765 476.075 m 674.667 476.075 l 673.804 475.213 l 404.627 475.213 l h f 403.765 476.075 m 403.765 256.938 l 404.627 257.801 l 404.627 475.213 l h f 0.949 0.945 0.935 rg 674.667 476.075 m 674.667 256.938 l 673.804 257.801 l 673.804 475.213 l h f 403.765 256.938 m 674.667 256.938 l 673.804 257.801 l 404.627 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 125.961 250.036 m 396.863 250.036 l 396 249.173 l 126.824 249.173 l h f 125.961 250.036 m 125.961 201.656 l 126.824 202.519 l 126.824 249.173 l h f 0.949 0.945 0.935 rg 396.863 250.036 m 396.863 201.656 l 396 202.519 l 396 249.173 l h f 125.961 201.656 m 396.863 201.656 l 396 202.519 l 126.824 202.519 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 403.765 250.036 m 674.667 250.036 l 673.804 249.173 l 404.627 249.173 l h f 403.765 250.036 m 403.765 201.656 l 404.627 202.519 l 404.627 249.173 l h f 0.949 0.945 0.935 rg 674.667 250.036 m 674.667 201.656 l 673.804 202.519 l 673.804 249.173 l h f 403.765 201.656 m 674.667 201.656 l 673.804 202.519 l 404.627 202.519 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5727 Tm (Holoprosencephaly, with a birth prevalence of about 1 in 10 000, is char\ acterized by a spectrum of cerebral abnormalities )Tj 0 -1.473 TD (resulting from incomplete cleavage of the forebrain. There are three typ\ es according to the degree of forebrain cleavage. The )Tj T* (alobar type, which is the most severe, is characterized by a monoventric\ ular cavity and fusion of the thalami. In the semilobar )Tj T* (type, there is partial segmentation of the ventricles and cerebral hemis\ pheres posteriorly with incomplete fusion of the thalami)Tj (. )Tj T* (In lobar holoprosencephaly, there is normal separation of the ventricles\ and thalami but absence of the septum pellucidum. The )Tj T* (first two types are often accompanied by facial abnormalities. )Tj ET q 258.8235321 0 0 208.784317 131.1372528 262.114624 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 262.114624 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 131.1373 233.8638 Tm (Alobar type)Tj /TT0 1 Tf ( -)Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 212.3822 233.8638 Tm (monoventricular cavity )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 344.7244 233.8638 Tm (and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 131.1373 217.4409 Tm (fusion of the thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 251.1039 217.4409 Tm (at 11+2 weeks)Tj 9.4902 0 0 9.4902 335.259 217.4385 Tm ( )Tj 11.1493 0 0 11.1493 408.9412 233.8638 Tm (Increased Nucal Transluncency \(white )Tj 0 -1.473 TD (arrows\) at 11+2 weeks - trissomy 13. )Tj 9.4902 0 0 9.4902 37.098 186.0288 Tm ( )Tj 11.1493 0 0 11.1493 37.098 172.3985 Tm (Toth )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. observed a floating membranous structure in place of the skull of an 1\ 1-week fetus)Tj 8.9195 0 0 8.9195 567.8392 175.2528 Tm (41)Tj 11.1493 0 0 11.1493 579.1847 172.3985 Tm (. At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1869 0 obj<> endobj 1870 0 obj<>/Type/XObject/BBox[127.545 214.712 250.772 229.011]/FormType 1>>stream 1 1 0 rg 0.8411 w 131.1373 215.1331 m 127.9654 218.305 127.9654 225.4184 131.1373 228.5902 c 247.1791 228.5902 l 250.351 225.4184 250.351 218.305 247.1791 215.1331 c f endstream endobj 1871 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 123.227 14.2986]/FormType 1>>stream /Form Do endstream endobj 1872 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 123.227 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1873 0 obj<>stream HS[0R9*BI"Pbmo:mgæ|{sL_D/{Jjh H@UO1xՁpW endstream endobj 1874 0 obj[/Indexed/DeviceRGB 255 1875 0 R] endobj 1875 0 obj<>stream HJQFo=kߪ] L ĤPt0")hYsr/K>kK^͐.,x.1ϊgTrͦ陣nfØv3'0- MEFAs څ;S%Fh/3 `\^dAcTSil/I endstream endobj 1876 0 obj<>stream H0- "޻n׸?NW=;rgBZ0676@j\* ?ڢ@ʤ"P0|%L@Zb+4R'04 7M8~M쟿Ĵ$0UQ,V9Ϯ0 Zl/,Ot 6Ԫ)D,`i%g)D0@kgI ,QW4ģ:@POʜUwP(`2׀bWeUAy1n}OjMZ&VI[_IL@S:Dp}x;'66\߾k4bȭ{ceJy;j<Z}PK>pz%'{S%8!ﭻ`O_툄Tە/sJO`Up5iV)FvU:Yv(6u=})ED'7P/G H]N~.2ԵLH ](H`v endstream endobj 1877 0 obj<>/ColorSpace<>/ProcSet[/PDF/ImageC/ImageI]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H**BK 4T043U0ɹ\ .\`` endstream endobj 1878 0 obj<>/ProcSet[/PDF]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H*wSp 0 ) endstream endobj 1879 0 obj<>>> endobj 1880 0 obj<>stream HS[0R9*BI"Pbmo:mgæ|{sL_D/{Jjh H@UO1xՁpW endstream endobj 1881 0 obj[/Indexed/DeviceRGB 255 1882 0 R] endobj 1882 0 obj<>stream HJQFo=kߪ] L ĤPt0")hYsr/K>kK^͐.,x.1ϊgTrͦ陣nfØv3'0- MEFAs څ;S%Fh/3 `\^dAcTSil/I endstream endobj 1883 0 obj<>stream H0- "޻n׸?NW=;rgBZ0676@j\* ?ڢ@ʤ"P0|%L@Zb+4R'04 7M8~M쟿Ĵ$0UQ,V9Ϯ0 Zl/,Ot 6Ԫ)D,`i%g)D0@kgI ,QW4ģ:@POʜUwP(`2׀bWeUAy1n}OjMZ&VI[_IL@S:Dp}x;'66\߾k4bȭ{ceJy;j<Z}PK>pz%'{S%8!ﭻ`O_툄Tە/sJO`Up5iV)FvU:Yv(6u=})ED'7P/G H]N~.2ԵLH ](H`v endstream endobj 1884 0 obj<>/ColorSpace<>/ProcSet[/PDF/ImageC/ImageI]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H**BK 4T043U0ɹ\ .\`` endstream endobj 1885 0 obj<>/ProcSet[/PDF]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H*wSp 0 ) endstream endobj 1886 0 obj<> endobj 1887 0 obj<>>> endobj 1888 0 obj<>9]/P 208 0 R/S/Annot/Pg 623 0 R>> endobj 1889 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 118.196 483.84 m 682.431 483.84 l 681.569 482.977 l 119.059 482.977 l h f 118.196 483.84 m 118.196 193.891 l 119.059 194.754 l 119.059 482.977 l h f 0.313 0.313 0.313 rg 682.431 483.84 m 682.431 193.891 l 681.569 194.754 l 681.569 482.977 l h f 118.196 193.891 m 682.431 193.891 l 681.569 194.754 l 119.059 194.754 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 126.824 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 125.961 476.075 m 396.863 476.075 l 396 475.213 l 126.824 475.213 l h f 125.961 476.075 m 125.961 256.938 l 126.824 257.801 l 126.824 475.213 l h f 0.949 0.945 0.935 rg 396.863 476.075 m 396.863 256.938 l 396 257.801 l 396 475.213 l h f 125.961 256.938 m 396.863 256.938 l 396 257.801 l 126.824 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 404.627 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 403.765 476.075 m 674.667 476.075 l 673.804 475.213 l 404.627 475.213 l h f 403.765 476.075 m 403.765 256.938 l 404.627 257.801 l 404.627 475.213 l h f 0.949 0.945 0.935 rg 674.667 476.075 m 674.667 256.938 l 673.804 257.801 l 673.804 475.213 l h f 403.765 256.938 m 674.667 256.938 l 673.804 257.801 l 404.627 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 125.961 250.036 m 396.863 250.036 l 396 249.173 l 126.824 249.173 l h f 125.961 250.036 m 125.961 201.656 l 126.824 202.519 l 126.824 249.173 l h f 0.949 0.945 0.935 rg 396.863 250.036 m 396.863 201.656 l 396 202.519 l 396 249.173 l h f 125.961 201.656 m 396.863 201.656 l 396 202.519 l 126.824 202.519 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 403.765 250.036 m 674.667 250.036 l 673.804 249.173 l 404.627 249.173 l h f 403.765 250.036 m 403.765 201.656 l 404.627 202.519 l 404.627 249.173 l h f 0.949 0.945 0.935 rg 674.667 250.036 m 674.667 201.656 l 673.804 202.519 l 673.804 249.173 l h f 403.765 201.656 m 674.667 201.656 l 673.804 202.519 l 404.627 202.519 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5727 Tm (Holoprosencephaly, with a birth prevalence of )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 298.5602 576.5727 Tm (about 1 in 10 000, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 406.7642 576.5727 Tm (is characterized by a spectrum of cerebral abnormalities )Tj -33.156 -1.473 Td (resulting from incomplete cleavage of the forebrain. There are three typ\ es according to the degree of forebrain cleavage. The )Tj 0 -1.473 TD (alobar type, which is the most severe, is characterized by a monoventric\ ular cavity and fusion of the thalami. In the semilobar )Tj T* (type, there is partial segmentation of the ventricles and cerebral hemis\ pheres posteriorly with incomplete fusion of the thalami)Tj (. )Tj T* (In lobar holoprosencephaly, there is normal separation of the ventricles\ and thalami but absence of the septum pellucidum. The )Tj T* (first two types are often accompanied by facial abnormalities. )Tj ET q 258.8235321 0 0 208.784317 131.1372528 262.114624 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 262.114624 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 131.1373 233.8638 Tm (Alobar type)Tj /TT0 1 Tf ( -)Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 212.3822 233.8638 Tm (monoventricular cavity )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 344.7244 233.8638 Tm (and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 131.1373 217.4409 Tm (fusion of the thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 251.1039 217.4409 Tm (at 11+2 weeks)Tj 9.4902 0 0 9.4902 335.259 217.4385 Tm ( )Tj 11.1493 0 0 11.1493 408.9412 233.8638 Tm (Increased Nucal Transluncency \(white )Tj 0 -1.473 TD (arrows\) at 11+2 weeks - trissomy 13. )Tj 9.4902 0 0 9.4902 37.098 186.0288 Tm ( )Tj 11.1493 0 0 11.1493 37.098 172.3985 Tm (Toth )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. observed a floating membranous structure in place of the skull of an 1\ 1-week fetus)Tj 8.9195 0 0 8.9195 567.8392 175.2528 Tm (41)Tj 11.1493 0 0 11.1493 579.1847 172.3985 Tm (. At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1890 0 obj<> endobj 1891 0 obj<>/Type/XObject/BBox[326.832 573.844 406.432 588.143]/FormType 1>>stream 1 1 0 rg 0.8411 w 330.4243 574.265 m 327.2525 577.4368 327.2525 584.5501 330.4243 587.722 c 402.8393 587.722 l 406.0112 584.5501 406.0112 577.4368 402.8393 574.265 c f endstream endobj 1892 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 79.6002 14.2986]/FormType 1>>stream /Form Do endstream endobj 1893 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 79.6005 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1894 0 obj<>>> endobj 1895 0 obj<>12]/P 208 0 R/S/Annot/Pg 623 0 R>> endobj 1896 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 118.196 483.84 m 682.431 483.84 l 681.569 482.977 l 119.059 482.977 l h f 118.196 483.84 m 118.196 193.891 l 119.059 194.754 l 119.059 482.977 l h f 0.313 0.313 0.313 rg 682.431 483.84 m 682.431 193.891 l 681.569 194.754 l 681.569 482.977 l h f 118.196 193.891 m 682.431 193.891 l 681.569 194.754 l 119.059 194.754 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 126.824 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 125.961 476.075 m 396.863 476.075 l 396 475.213 l 126.824 475.213 l h f 125.961 476.075 m 125.961 256.938 l 126.824 257.801 l 126.824 475.213 l h f 0.949 0.945 0.935 rg 396.863 476.075 m 396.863 256.938 l 396 257.801 l 396 475.213 l h f 125.961 256.938 m 396.863 256.938 l 396 257.801 l 126.824 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 404.627 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 403.765 476.075 m 674.667 476.075 l 673.804 475.213 l 404.627 475.213 l h f 403.765 476.075 m 403.765 256.938 l 404.627 257.801 l 404.627 475.213 l h f 0.949 0.945 0.935 rg 674.667 476.075 m 674.667 256.938 l 673.804 257.801 l 673.804 475.213 l h f 403.765 256.938 m 674.667 256.938 l 673.804 257.801 l 404.627 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 125.961 250.036 m 396.863 250.036 l 396 249.173 l 126.824 249.173 l h f 125.961 250.036 m 125.961 201.656 l 126.824 202.519 l 126.824 249.173 l h f 0.949 0.945 0.935 rg 396.863 250.036 m 396.863 201.656 l 396 202.519 l 396 249.173 l h f 125.961 201.656 m 396.863 201.656 l 396 202.519 l 126.824 202.519 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 403.765 250.036 m 674.667 250.036 l 673.804 249.173 l 404.627 249.173 l h f 403.765 250.036 m 403.765 201.656 l 404.627 202.519 l 404.627 249.173 l h f 0.949 0.945 0.935 rg 674.667 250.036 m 674.667 201.656 l 673.804 202.519 l 673.804 249.173 l h f 403.765 201.656 m 674.667 201.656 l 673.804 202.519 l 404.627 202.519 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5727 Tm (Holoprosencephaly, with a birth prevalence of )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 298.5602 576.5727 Tm (about 1 in 10 000, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 406.7642 576.5727 Tm (is characterized by a spectrum of cerebral abnormalities )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 560.1498 Tm (resulting from incomplete cleavage of the forebrain. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 333.4354 560.1498 Tm (There are three types according to the degree of forebrain cleavage. The\ )Tj -26.579 -1.473 Td (alobar type, which is the most severe, is characterized by a monoventric\ ular cavity and fusion of the thalami. In the semilobar )Tj 0 -1.473 TD (type, there is partial segmentation of the ventricles and cerebral hemis\ pheres posteriorly with incomplete fusion of the thalami)Tj (. )Tj T* (In lobar holoprosencephaly, there is normal separation of the ventricles\ and thalami but absence of the septum pellucidum. The )Tj T* (first two types are often accompanied by facial abnormalities. )Tj ET q 258.8235321 0 0 208.784317 131.1372528 262.114624 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 262.114624 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 131.1373 233.8638 Tm (Alobar type)Tj /TT0 1 Tf ( -)Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 212.3822 233.8638 Tm (monoventricular cavity )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 344.7244 233.8638 Tm (and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 131.1373 217.4409 Tm (fusion of the thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 251.1039 217.4409 Tm (at 11+2 weeks)Tj 9.4902 0 0 9.4902 335.259 217.4385 Tm ( )Tj 11.1493 0 0 11.1493 408.9412 233.8638 Tm (Increased Nucal Transluncency \(white )Tj 0 -1.473 TD (arrows\) at 11+2 weeks - trissomy 13. )Tj 9.4902 0 0 9.4902 37.098 186.0288 Tm ( )Tj 11.1493 0 0 11.1493 37.098 172.3985 Tm (Toth )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. observed a floating membranous structure in place of the skull of an 1\ 1-week fetus)Tj 8.9195 0 0 8.9195 567.8392 175.2528 Tm (41)Tj 11.1493 0 0 11.1493 579.1847 172.3985 Tm (. At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1897 0 obj<> endobj 1898 0 obj<>/Type/XObject/BBox[33.5055 557.421 333.103 571.72]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.098 557.842 m 33.9262 561.0139 33.9262 568.1272 37.098 571.2991 c 329.5104 571.2991 l 332.6823 568.1272 332.6823 561.0139 329.5104 557.842 c f endstream endobj 1899 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 299.598 14.2985]/FormType 1>>stream /Form Do endstream endobj 1900 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 299.598 14.2988]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1901 0 obj<>>> endobj 1902 0 obj<>15]/P 208 0 R/S/Annot/Pg 623 0 R>> endobj 1903 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 118.196 483.84 m 682.431 483.84 l 681.569 482.977 l 119.059 482.977 l h f 118.196 483.84 m 118.196 193.891 l 119.059 194.754 l 119.059 482.977 l h f 0.313 0.313 0.313 rg 682.431 483.84 m 682.431 193.891 l 681.569 194.754 l 681.569 482.977 l h f 118.196 193.891 m 682.431 193.891 l 681.569 194.754 l 119.059 194.754 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 126.824 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 125.961 476.075 m 396.863 476.075 l 396 475.213 l 126.824 475.213 l h f 125.961 476.075 m 125.961 256.938 l 126.824 257.801 l 126.824 475.213 l h f 0.949 0.945 0.935 rg 396.863 476.075 m 396.863 256.938 l 396 257.801 l 396 475.213 l h f 125.961 256.938 m 396.863 256.938 l 396 257.801 l 126.824 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 404.627 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 403.765 476.075 m 674.667 476.075 l 673.804 475.213 l 404.627 475.213 l h f 403.765 476.075 m 403.765 256.938 l 404.627 257.801 l 404.627 475.213 l h f 0.949 0.945 0.935 rg 674.667 476.075 m 674.667 256.938 l 673.804 257.801 l 673.804 475.213 l h f 403.765 256.938 m 674.667 256.938 l 673.804 257.801 l 404.627 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 125.961 250.036 m 396.863 250.036 l 396 249.173 l 126.824 249.173 l h f 125.961 250.036 m 125.961 201.656 l 126.824 202.519 l 126.824 249.173 l h f 0.949 0.945 0.935 rg 396.863 250.036 m 396.863 201.656 l 396 202.519 l 396 249.173 l h f 125.961 201.656 m 396.863 201.656 l 396 202.519 l 126.824 202.519 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 403.765 250.036 m 674.667 250.036 l 673.804 249.173 l 404.627 249.173 l h f 403.765 250.036 m 403.765 201.656 l 404.627 202.519 l 404.627 249.173 l h f 0.949 0.945 0.935 rg 674.667 250.036 m 674.667 201.656 l 673.804 202.519 l 673.804 249.173 l h f 403.765 201.656 m 674.667 201.656 l 673.804 202.519 l 404.627 202.519 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5727 Tm (Holoprosencephaly, with a birth prevalence of )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 298.5602 576.5727 Tm (about 1 in 10 000, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 406.7642 576.5727 Tm (is characterized by a spectrum of cerebral abnormalities )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 560.1498 Tm (resulting from incomplete cleavage of the forebrain. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 333.4354 560.1498 Tm (There are three types according to the degree of forebrain cleavage. The\ )Tj -26.579 -1.473 Td (alobar type, which is the most severe, is characterized by a )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 376.1261 543.7269 Tm (monoventricular cavity and fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 657.1221 543.7269 Tm (In the semilobar )Tj -55.611 -1.473 Td (type, there is partial segmentation of the ventricles and cerebral hemis\ pheres posteriorly with incomplete fusion of the thalami)Tj (. )Tj 0 -1.473 TD (In lobar holoprosencephaly, there is normal separation of the ventricles\ and thalami but absence of the septum pellucidum. The )Tj T* (first two types are often accompanied by facial abnormalities. )Tj ET q 258.8235321 0 0 208.784317 131.1372528 262.114624 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 262.114624 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 131.1373 233.8638 Tm (Alobar type)Tj /TT0 1 Tf ( -)Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 212.3822 233.8638 Tm (monoventricular cavity )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 344.7244 233.8638 Tm (and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 131.1373 217.4409 Tm (fusion of the thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 251.1039 217.4409 Tm (at 11+2 weeks)Tj 9.4902 0 0 9.4902 335.259 217.4385 Tm ( )Tj 11.1493 0 0 11.1493 408.9412 233.8638 Tm (Increased Nucal Transluncency \(white )Tj 0 -1.473 TD (arrows\) at 11+2 weeks - trissomy 13. )Tj 9.4902 0 0 9.4902 37.098 186.0288 Tm ( )Tj 11.1493 0 0 11.1493 37.098 172.3985 Tm (Toth )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. observed a floating membranous structure in place of the skull of an 1\ 1-week fetus)Tj 8.9195 0 0 8.9195 567.8392 175.2528 Tm (41)Tj 11.1493 0 0 11.1493 579.1847 172.3985 Tm (. At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1904 0 obj<> endobj 1905 0 obj<>/Type/XObject/BBox[372.533 540.998 656.789 555.297]/FormType 1>>stream 1 1 0 rg 0.8411 w 376.1255 541.4191 m 372.9536 544.591 372.9536 551.7043 376.1255 554.8762 c 653.1963 554.8762 l 656.3681 551.7043 656.3681 544.591 653.1963 541.4191 c f endstream endobj 1906 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 284.256 14.2986]/FormType 1>>stream /Form Do endstream endobj 1907 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 284.256 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1908 0 obj<>>> endobj 1909 0 obj<>18]/P 208 0 R/S/Annot/Pg 623 0 R>> endobj 1910 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 118.196 483.84 m 682.431 483.84 l 681.569 482.977 l 119.059 482.977 l h f 118.196 483.84 m 118.196 193.891 l 119.059 194.754 l 119.059 482.977 l h f 0.313 0.313 0.313 rg 682.431 483.84 m 682.431 193.891 l 681.569 194.754 l 681.569 482.977 l h f 118.196 193.891 m 682.431 193.891 l 681.569 194.754 l 119.059 194.754 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 126.824 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 125.961 476.075 m 396.863 476.075 l 396 475.213 l 126.824 475.213 l h f 125.961 476.075 m 125.961 256.938 l 126.824 257.801 l 126.824 475.213 l h f 0.949 0.945 0.935 rg 396.863 476.075 m 396.863 256.938 l 396 257.801 l 396 475.213 l h f 125.961 256.938 m 396.863 256.938 l 396 257.801 l 126.824 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 404.627 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 403.765 476.075 m 674.667 476.075 l 673.804 475.213 l 404.627 475.213 l h f 403.765 476.075 m 403.765 256.938 l 404.627 257.801 l 404.627 475.213 l h f 0.949 0.945 0.935 rg 674.667 476.075 m 674.667 256.938 l 673.804 257.801 l 673.804 475.213 l h f 403.765 256.938 m 674.667 256.938 l 673.804 257.801 l 404.627 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 125.961 250.036 m 396.863 250.036 l 396 249.173 l 126.824 249.173 l h f 125.961 250.036 m 125.961 201.656 l 126.824 202.519 l 126.824 249.173 l h f 0.949 0.945 0.935 rg 396.863 250.036 m 396.863 201.656 l 396 202.519 l 396 249.173 l h f 125.961 201.656 m 396.863 201.656 l 396 202.519 l 126.824 202.519 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 403.765 250.036 m 674.667 250.036 l 673.804 249.173 l 404.627 249.173 l h f 403.765 250.036 m 403.765 201.656 l 404.627 202.519 l 404.627 249.173 l h f 0.949 0.945 0.935 rg 674.667 250.036 m 674.667 201.656 l 673.804 202.519 l 673.804 249.173 l h f 403.765 201.656 m 674.667 201.656 l 673.804 202.519 l 404.627 202.519 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5727 Tm (Holoprosencephaly, with a birth prevalence of )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 298.5602 576.5727 Tm (about 1 in 10 000, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 406.7642 576.5727 Tm (is characterized by a spectrum of cerebral abnormalities )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 560.1498 Tm (resulting from incomplete cleavage of the forebrain. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 333.4354 560.1498 Tm (There are three types according to the degree of forebrain cleavage. The\ )Tj -26.579 -1.473 Td (alobar type, which is the most severe, is characterized by a )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 376.1261 543.7269 Tm (monoventricular cavity and fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 657.1221 543.7269 Tm (In the semilobar )Tj -55.611 -1.473 Td (type, there is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 115.879 527.3039 Tm (partial segmentation of the ventricles and cerebral hemispheres posterio\ rly with incomplete fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 510.881 Tm (In lobar holoprosencephaly, there is normal separation of the ventricles\ and thalami but absence of the septum pellucidum. The )Tj 0 -1.473 TD (first two types are often accompanied by facial abnormalities. )Tj ET q 258.8235321 0 0 208.784317 131.1372528 262.114624 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 262.114624 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 131.1373 233.8638 Tm (Alobar type)Tj /TT0 1 Tf ( -)Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 212.3822 233.8638 Tm (monoventricular cavity )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 344.7244 233.8638 Tm (and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 131.1373 217.4409 Tm (fusion of the thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 251.1039 217.4409 Tm (at 11+2 weeks)Tj 9.4902 0 0 9.4902 335.259 217.4385 Tm ( )Tj 11.1493 0 0 11.1493 408.9412 233.8638 Tm (Increased Nucal Transluncency \(white )Tj 0 -1.473 TD (arrows\) at 11+2 weeks - trissomy 13. )Tj 9.4902 0 0 9.4902 37.098 186.0288 Tm ( )Tj 11.1493 0 0 11.1493 37.098 172.3985 Tm (Toth )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. observed a floating membranous structure in place of the skull of an 1\ 1-week fetus)Tj 8.9195 0 0 8.9195 567.8392 175.2528 Tm (41)Tj 11.1493 0 0 11.1493 579.1847 172.3985 Tm (. At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1911 0 obj<> endobj 1912 0 obj<>/Type/XObject/BBox[112.287 524.576 758.994 538.874]/FormType 1>>stream 1 1 0 rg 0.8411 w 115.8791 524.9963 m 112.7073 528.1681 112.7073 535.2815 115.8791 538.4533 c 755.4016 538.4533 l 758.5735 535.2815 758.5735 528.1681 755.4016 524.9963 c f endstream endobj 1913 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 646.708 14.2986]/FormType 1>>stream /Form Do endstream endobj 1914 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 646.708 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1915 0 obj<>>> endobj 1916 0 obj<>21]/P 208 0 R/S/Annot/Pg 623 0 R>> endobj 1917 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 118.196 483.84 m 682.431 483.84 l 681.569 482.977 l 119.059 482.977 l h f 118.196 483.84 m 118.196 193.891 l 119.059 194.754 l 119.059 482.977 l h f 0.313 0.313 0.313 rg 682.431 483.84 m 682.431 193.891 l 681.569 194.754 l 681.569 482.977 l h f 118.196 193.891 m 682.431 193.891 l 681.569 194.754 l 119.059 194.754 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 126.824 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 125.961 476.075 m 396.863 476.075 l 396 475.213 l 126.824 475.213 l h f 125.961 476.075 m 125.961 256.938 l 126.824 257.801 l 126.824 475.213 l h f 0.949 0.945 0.935 rg 396.863 476.075 m 396.863 256.938 l 396 257.801 l 396 475.213 l h f 125.961 256.938 m 396.863 256.938 l 396 257.801 l 126.824 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 404.627 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 403.765 476.075 m 674.667 476.075 l 673.804 475.213 l 404.627 475.213 l h f 403.765 476.075 m 403.765 256.938 l 404.627 257.801 l 404.627 475.213 l h f 0.949 0.945 0.935 rg 674.667 476.075 m 674.667 256.938 l 673.804 257.801 l 673.804 475.213 l h f 403.765 256.938 m 674.667 256.938 l 673.804 257.801 l 404.627 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 125.961 250.036 m 396.863 250.036 l 396 249.173 l 126.824 249.173 l h f 125.961 250.036 m 125.961 201.656 l 126.824 202.519 l 126.824 249.173 l h f 0.949 0.945 0.935 rg 396.863 250.036 m 396.863 201.656 l 396 202.519 l 396 249.173 l h f 125.961 201.656 m 396.863 201.656 l 396 202.519 l 126.824 202.519 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 403.765 250.036 m 674.667 250.036 l 673.804 249.173 l 404.627 249.173 l h f 403.765 250.036 m 403.765 201.656 l 404.627 202.519 l 404.627 249.173 l h f 0.949 0.945 0.935 rg 674.667 250.036 m 674.667 201.656 l 673.804 202.519 l 673.804 249.173 l h f 403.765 201.656 m 674.667 201.656 l 673.804 202.519 l 404.627 202.519 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5727 Tm (Holoprosencephaly, with a birth prevalence of )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 298.5602 576.5727 Tm (about 1 in 10 000, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 406.7642 576.5727 Tm (is characterized by a spectrum of cerebral abnormalities )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 560.1498 Tm (resulting from incomplete cleavage of the forebrain. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 333.4354 560.1498 Tm (There are three types according to the degree of forebrain cleavage. The\ )Tj -26.579 -1.473 Td (alobar type, which is the most severe, is characterized by a )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 376.1261 543.7269 Tm (monoventricular cavity and fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 657.1221 543.7269 Tm (In the semilobar )Tj -55.611 -1.473 Td (type, there is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 115.879 527.3039 Tm (partial segmentation of the ventricles and cerebral hemispheres posterio\ rly with incomplete fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 510.881 Tm (In lobar holoprosencephaly, there is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 243.572 510.881 Tm (normal separation of the ventricles and thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 514.1992 510.881 Tm (but absence of the septum pellucidum. The )Tj -42.792 -1.473 Td (first two types are often accompanied by facial abnormalities. )Tj ET q 258.8235321 0 0 208.784317 131.1372528 262.114624 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 262.114624 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 131.1373 233.8638 Tm (Alobar type)Tj /TT0 1 Tf ( -)Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 212.3822 233.8638 Tm (monoventricular cavity )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 344.7244 233.8638 Tm (and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 131.1373 217.4409 Tm (fusion of the thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 251.1039 217.4409 Tm (at 11+2 weeks)Tj 9.4902 0 0 9.4902 335.259 217.4385 Tm ( )Tj 11.1493 0 0 11.1493 408.9412 233.8638 Tm (Increased Nucal Transluncency \(white )Tj 0 -1.473 TD (arrows\) at 11+2 weeks - trissomy 13. )Tj 9.4902 0 0 9.4902 37.098 186.0288 Tm ( )Tj 11.1493 0 0 11.1493 37.098 172.3985 Tm (Toth )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. observed a floating membranous structure in place of the skull of an 1\ 1-week fetus)Tj 8.9195 0 0 8.9195 567.8392 175.2528 Tm (41)Tj 11.1493 0 0 11.1493 579.1847 172.3985 Tm (. At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1918 0 obj<> endobj 1919 0 obj<>/Type/XObject/BBox[239.979 508.153 513.866 522.451]/FormType 1>>stream 1 1 0 rg 0.8411 w 243.5715 508.5733 m 240.3996 511.7451 240.3996 518.8585 243.5715 522.0303 c 510.2736 522.0303 l 513.4454 518.8585 513.4454 511.7451 510.2736 508.5733 c f endstream endobj 1920 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 273.887 14.2986]/FormType 1>>stream /Form Do endstream endobj 1921 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 273.888 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1922 0 obj<>>> endobj 1923 0 obj<>24]/P 208 0 R/S/Annot/Pg 623 0 R>> endobj 1924 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 118.196 483.84 m 682.431 483.84 l 681.569 482.977 l 119.059 482.977 l h f 118.196 483.84 m 118.196 193.891 l 119.059 194.754 l 119.059 482.977 l h f 0.313 0.313 0.313 rg 682.431 483.84 m 682.431 193.891 l 681.569 194.754 l 681.569 482.977 l h f 118.196 193.891 m 682.431 193.891 l 681.569 194.754 l 119.059 194.754 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 126.824 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 125.961 476.075 m 396.863 476.075 l 396 475.213 l 126.824 475.213 l h f 125.961 476.075 m 125.961 256.938 l 126.824 257.801 l 126.824 475.213 l h f 0.949 0.945 0.935 rg 396.863 476.075 m 396.863 256.938 l 396 257.801 l 396 475.213 l h f 125.961 256.938 m 396.863 256.938 l 396 257.801 l 126.824 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 404.627 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 403.765 476.075 m 674.667 476.075 l 673.804 475.213 l 404.627 475.213 l h f 403.765 476.075 m 403.765 256.938 l 404.627 257.801 l 404.627 475.213 l h f 0.949 0.945 0.935 rg 674.667 476.075 m 674.667 256.938 l 673.804 257.801 l 673.804 475.213 l h f 403.765 256.938 m 674.667 256.938 l 673.804 257.801 l 404.627 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 125.961 250.036 m 396.863 250.036 l 396 249.173 l 126.824 249.173 l h f 125.961 250.036 m 125.961 201.656 l 126.824 202.519 l 126.824 249.173 l h f 0.949 0.945 0.935 rg 396.863 250.036 m 396.863 201.656 l 396 202.519 l 396 249.173 l h f 125.961 201.656 m 396.863 201.656 l 396 202.519 l 126.824 202.519 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 403.765 250.036 m 674.667 250.036 l 673.804 249.173 l 404.627 249.173 l h f 403.765 250.036 m 403.765 201.656 l 404.627 202.519 l 404.627 249.173 l h f 0.949 0.945 0.935 rg 674.667 250.036 m 674.667 201.656 l 673.804 202.519 l 673.804 249.173 l h f 403.765 201.656 m 674.667 201.656 l 673.804 202.519 l 404.627 202.519 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5727 Tm (Holoprosencephaly, with a birth prevalence of )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 298.5602 576.5727 Tm (about 1 in 10 000, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 406.7642 576.5727 Tm (is characterized by a spectrum of cerebral abnormalities )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 560.1498 Tm (resulting from incomplete cleavage of the forebrain. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 333.4354 560.1498 Tm (There are three types according to the degree of forebrain cleavage. The\ )Tj -26.579 -1.473 Td (alobar type, which is the most severe, is characterized by a )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 376.1261 543.7269 Tm (monoventricular cavity and fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 657.1221 543.7269 Tm (In the semilobar )Tj -55.611 -1.473 Td (type, there is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 115.879 527.3039 Tm (partial segmentation of the ventricles and cerebral hemispheres posterio\ rly with incomplete fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 510.881 Tm (In lobar holoprosencephaly, there is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 243.572 510.881 Tm (normal separation of the ventricles and thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 514.1992 510.881 Tm (but )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 536.5201 510.881 Tm (absence of the septum pellucidum. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 736.7728 510.881 Tm (The )Tj -62.755 -1.473 Td (first two types are often accompanied by facial abnormalities. )Tj ET q 258.8235321 0 0 208.784317 131.1372528 262.114624 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 262.114624 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 131.1373 233.8638 Tm (Alobar type)Tj /TT0 1 Tf ( -)Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 212.3822 233.8638 Tm (monoventricular cavity )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 344.7244 233.8638 Tm (and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 131.1373 217.4409 Tm (fusion of the thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 251.1039 217.4409 Tm (at 11+2 weeks)Tj 9.4902 0 0 9.4902 335.259 217.4385 Tm ( )Tj 11.1493 0 0 11.1493 408.9412 233.8638 Tm (Increased Nucal Transluncency \(white )Tj 0 -1.473 TD (arrows\) at 11+2 weeks - trissomy 13. )Tj 9.4902 0 0 9.4902 37.098 186.0288 Tm ( )Tj 11.1493 0 0 11.1493 37.098 172.3985 Tm (Toth )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. observed a floating membranous structure in place of the skull of an 1\ 1-week fetus)Tj 8.9195 0 0 8.9195 567.8392 175.2528 Tm (41)Tj 11.1493 0 0 11.1493 579.1847 172.3985 Tm (. At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1925 0 obj<> endobj 1926 0 obj<>/Type/XObject/BBox[532.928 508.153 736.44 522.451]/FormType 1>>stream 1 1 0 rg 0.8411 w 536.5201 508.5733 m 533.3483 511.7451 533.3483 518.8585 536.5201 522.0303 c 732.8478 522.0303 l 736.0197 518.8585 736.0197 511.7451 732.8478 508.5733 c f endstream endobj 1927 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 203.513 14.2986]/FormType 1>>stream /Form Do endstream endobj 1928 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 203.513 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1929 0 obj<>>> endobj 1930 0 obj<>27]/P 208 0 R/S/Annot/Pg 623 0 R>> endobj 1931 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 118.196 483.84 m 682.431 483.84 l 681.569 482.977 l 119.059 482.977 l h f 118.196 483.84 m 118.196 193.891 l 119.059 194.754 l 119.059 482.977 l h f 0.313 0.313 0.313 rg 682.431 483.84 m 682.431 193.891 l 681.569 194.754 l 681.569 482.977 l h f 118.196 193.891 m 682.431 193.891 l 681.569 194.754 l 119.059 194.754 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 126.824 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 125.961 476.075 m 396.863 476.075 l 396 475.213 l 126.824 475.213 l h f 125.961 476.075 m 125.961 256.938 l 126.824 257.801 l 126.824 475.213 l h f 0.949 0.945 0.935 rg 396.863 476.075 m 396.863 256.938 l 396 257.801 l 396 475.213 l h f 125.961 256.938 m 396.863 256.938 l 396 257.801 l 126.824 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 404.627 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 403.765 476.075 m 674.667 476.075 l 673.804 475.213 l 404.627 475.213 l h f 403.765 476.075 m 403.765 256.938 l 404.627 257.801 l 404.627 475.213 l h f 0.949 0.945 0.935 rg 674.667 476.075 m 674.667 256.938 l 673.804 257.801 l 673.804 475.213 l h f 403.765 256.938 m 674.667 256.938 l 673.804 257.801 l 404.627 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 125.961 250.036 m 396.863 250.036 l 396 249.173 l 126.824 249.173 l h f 125.961 250.036 m 125.961 201.656 l 126.824 202.519 l 126.824 249.173 l h f 0.949 0.945 0.935 rg 396.863 250.036 m 396.863 201.656 l 396 202.519 l 396 249.173 l h f 125.961 201.656 m 396.863 201.656 l 396 202.519 l 126.824 202.519 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 403.765 250.036 m 674.667 250.036 l 673.804 249.173 l 404.627 249.173 l h f 403.765 250.036 m 403.765 201.656 l 404.627 202.519 l 404.627 249.173 l h f 0.949 0.945 0.935 rg 674.667 250.036 m 674.667 201.656 l 673.804 202.519 l 673.804 249.173 l h f 403.765 201.656 m 674.667 201.656 l 673.804 202.519 l 404.627 202.519 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5727 Tm (Holoprosencephaly, with a birth prevalence of )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 298.5602 576.5727 Tm (about 1 in 10 000, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 406.7642 576.5727 Tm (is characterized by a spectrum of cerebral abnormalities )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 560.1498 Tm (resulting from incomplete cleavage of the forebrain. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 333.4354 560.1498 Tm (There are three types according to the degree of forebrain cleavage. The\ )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 543.7269 Tm (alobar type, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 108.5205 543.7269 Tm (which is the most severe, is characterized by a )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 376.1261 543.7269 Tm (monoventricular cavity and fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 657.1221 543.7269 Tm (In the semilobar )Tj -55.611 -1.473 Td (type, there is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 115.879 527.3039 Tm (partial segmentation of the ventricles and cerebral hemispheres posterio\ rly with incomplete fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 510.881 Tm (In lobar holoprosencephaly, there is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 243.572 510.881 Tm (normal separation of the ventricles and thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 514.1992 510.881 Tm (but )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 536.5201 510.881 Tm (absence of the septum pellucidum. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 736.7728 510.881 Tm (The )Tj -62.755 -1.473 Td (first two types are often accompanied by facial abnormalities. )Tj ET q 258.8235321 0 0 208.784317 131.1372528 262.114624 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 262.114624 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 131.1373 233.8638 Tm (Alobar type)Tj /TT0 1 Tf ( -)Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 212.3822 233.8638 Tm (monoventricular cavity )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 344.7244 233.8638 Tm (and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 131.1373 217.4409 Tm (fusion of the thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 251.1039 217.4409 Tm (at 11+2 weeks)Tj 9.4902 0 0 9.4902 335.259 217.4385 Tm ( )Tj 11.1493 0 0 11.1493 408.9412 233.8638 Tm (Increased Nucal Transluncency \(white )Tj 0 -1.473 TD (arrows\) at 11+2 weeks - trissomy 13. )Tj 9.4902 0 0 9.4902 37.098 186.0288 Tm ( )Tj 11.1493 0 0 11.1493 37.098 172.3985 Tm (Toth )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. observed a floating membranous structure in place of the skull of an 1\ 1-week fetus)Tj 8.9195 0 0 8.9195 567.8392 175.2528 Tm (41)Tj 11.1493 0 0 11.1493 579.1847 172.3985 Tm (. At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1932 0 obj<> endobj 1933 0 obj<>/Type/XObject/BBox[33.0851 540.578 108.609 555.717]/FormType 1>>stream 1 0 0 RG 0.8411 w 37.0982 547.1864 m 104.5959 547.1864 l S endstream endobj 1934 0 obj<>>> endobj 1935 0 obj<>30]/P 208 0 R/S/Annot/Pg 623 0 R>> endobj 1936 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 118.196 483.84 m 682.431 483.84 l 681.569 482.977 l 119.059 482.977 l h f 118.196 483.84 m 118.196 193.891 l 119.059 194.754 l 119.059 482.977 l h f 0.313 0.313 0.313 rg 682.431 483.84 m 682.431 193.891 l 681.569 194.754 l 681.569 482.977 l h f 118.196 193.891 m 682.431 193.891 l 681.569 194.754 l 119.059 194.754 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 126.824 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 125.961 476.075 m 396.863 476.075 l 396 475.213 l 126.824 475.213 l h f 125.961 476.075 m 125.961 256.938 l 126.824 257.801 l 126.824 475.213 l h f 0.949 0.945 0.935 rg 396.863 476.075 m 396.863 256.938 l 396 257.801 l 396 475.213 l h f 125.961 256.938 m 396.863 256.938 l 396 257.801 l 126.824 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 404.627 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 403.765 476.075 m 674.667 476.075 l 673.804 475.213 l 404.627 475.213 l h f 403.765 476.075 m 403.765 256.938 l 404.627 257.801 l 404.627 475.213 l h f 0.949 0.945 0.935 rg 674.667 476.075 m 674.667 256.938 l 673.804 257.801 l 673.804 475.213 l h f 403.765 256.938 m 674.667 256.938 l 673.804 257.801 l 404.627 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 125.961 250.036 m 396.863 250.036 l 396 249.173 l 126.824 249.173 l h f 125.961 250.036 m 125.961 201.656 l 126.824 202.519 l 126.824 249.173 l h f 0.949 0.945 0.935 rg 396.863 250.036 m 396.863 201.656 l 396 202.519 l 396 249.173 l h f 125.961 201.656 m 396.863 201.656 l 396 202.519 l 126.824 202.519 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 403.765 250.036 m 674.667 250.036 l 673.804 249.173 l 404.627 249.173 l h f 403.765 250.036 m 403.765 201.656 l 404.627 202.519 l 404.627 249.173 l h f 0.949 0.945 0.935 rg 674.667 250.036 m 674.667 201.656 l 673.804 202.519 l 673.804 249.173 l h f 403.765 201.656 m 674.667 201.656 l 673.804 202.519 l 404.627 202.519 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5727 Tm (Holoprosencephaly, with a birth prevalence of )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 298.5602 576.5727 Tm (about 1 in 10 000, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 406.7642 576.5727 Tm (is characterized by a spectrum of cerebral abnormalities )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 560.1498 Tm (resulting from incomplete cleavage of the forebrain. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 333.4354 560.1498 Tm (There are three types according to the degree of forebrain cleavage. The\ )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 543.7269 Tm (alobar type, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 108.5205 543.7269 Tm (which is the most severe, is characterized by a )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 376.1261 543.7269 Tm (monoventricular cavity and fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 657.1221 543.7269 Tm (In the semilobar )Tj -55.611 -1.473 Td (type, there is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 115.879 527.3039 Tm (partial segmentation of the ventricles and cerebral hemispheres posterio\ rly with incomplete fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 510.881 Tm (In )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 52.7739 510.881 Tm (lobar holoprosencephaly, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 197.3582 510.881 Tm (there is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 243.572 510.881 Tm (normal separation of the ventricles and thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 514.1992 510.881 Tm (but )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 536.5201 510.881 Tm (absence of the septum pellucidum. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 736.7728 510.881 Tm (The )Tj -62.755 -1.473 Td (first two types are often accompanied by facial abnormalities. )Tj ET q 258.8235321 0 0 208.784317 131.1372528 262.114624 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 262.114624 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 131.1373 233.8638 Tm (Alobar type)Tj /TT0 1 Tf ( -)Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 212.3822 233.8638 Tm (monoventricular cavity )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 344.7244 233.8638 Tm (and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 131.1373 217.4409 Tm (fusion of the thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 251.1039 217.4409 Tm (at 11+2 weeks)Tj 9.4902 0 0 9.4902 335.259 217.4385 Tm ( )Tj 11.1493 0 0 11.1493 408.9412 233.8638 Tm (Increased Nucal Transluncency \(white )Tj 0 -1.473 TD (arrows\) at 11+2 weeks - trissomy 13. )Tj 9.4902 0 0 9.4902 37.098 186.0288 Tm ( )Tj 11.1493 0 0 11.1493 37.098 172.3985 Tm (Toth )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. observed a floating membranous structure in place of the skull of an 1\ 1-week fetus)Tj 8.9195 0 0 8.9195 567.8392 175.2528 Tm (41)Tj 11.1493 0 0 11.1493 579.1847 172.3985 Tm (. At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1937 0 obj<> endobj 1938 0 obj<>/Type/XObject/BBox[48.7609 507.732 197.446 522.872]/FormType 1>>stream 1 0 0 RG 0.8411 w 52.774 514.3406 m 193.4331 514.3406 l S endstream endobj 1939 0 obj<>>> endobj 1940 0 obj<> endobj 1941 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 118.196 483.84 m 682.431 483.84 l 681.569 482.977 l 119.059 482.977 l h f 118.196 483.84 m 118.196 193.891 l 119.059 194.754 l 119.059 482.977 l h f 0.313 0.313 0.313 rg 682.431 483.84 m 682.431 193.891 l 681.569 194.754 l 681.569 482.977 l h f 118.196 193.891 m 682.431 193.891 l 681.569 194.754 l 119.059 194.754 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 126.824 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 125.961 476.075 m 396.863 476.075 l 396 475.213 l 126.824 475.213 l h f 125.961 476.075 m 125.961 256.938 l 126.824 257.801 l 126.824 475.213 l h f 0.949 0.945 0.935 rg 396.863 476.075 m 396.863 256.938 l 396 257.801 l 396 475.213 l h f 125.961 256.938 m 396.863 256.938 l 396 257.801 l 126.824 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 404.627 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 403.765 476.075 m 674.667 476.075 l 673.804 475.213 l 404.627 475.213 l h f 403.765 476.075 m 403.765 256.938 l 404.627 257.801 l 404.627 475.213 l h f 0.949 0.945 0.935 rg 674.667 476.075 m 674.667 256.938 l 673.804 257.801 l 673.804 475.213 l h f 403.765 256.938 m 674.667 256.938 l 673.804 257.801 l 404.627 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 125.961 250.036 m 396.863 250.036 l 396 249.173 l 126.824 249.173 l h f 125.961 250.036 m 125.961 201.656 l 126.824 202.519 l 126.824 249.173 l h f 0.949 0.945 0.935 rg 396.863 250.036 m 396.863 201.656 l 396 202.519 l 396 249.173 l h f 125.961 201.656 m 396.863 201.656 l 396 202.519 l 126.824 202.519 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 403.765 250.036 m 674.667 250.036 l 673.804 249.173 l 404.627 249.173 l h f 403.765 250.036 m 403.765 201.656 l 404.627 202.519 l 404.627 249.173 l h f 0.949 0.945 0.935 rg 674.667 250.036 m 674.667 201.656 l 673.804 202.519 l 673.804 249.173 l h f 403.765 201.656 m 674.667 201.656 l 673.804 202.519 l 404.627 202.519 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5727 Tm (Holoprosencephaly, with a birth prevalence of )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 298.5602 576.5727 Tm (about 1 in 10 000, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 406.7642 576.5727 Tm (is characterized by a spectrum of cerebral abnormalities )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 560.1498 Tm (resulting from incomplete cleavage of the forebrain. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 333.4354 560.1498 Tm (There are three types according to the degree of forebrain cleavage. The\ )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 543.7269 Tm (alobar type, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 108.5205 543.7269 Tm (which is the most severe, is characterized by a )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 376.1261 543.7269 Tm (monoventricular cavity and fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 657.1221 543.7269 Tm (In the )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 694.8179 543.7269 Tm (semilobar )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 527.3039 Tm (type, there is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 115.879 527.3039 Tm (partial segmentation of the ventricles and cerebral hemispheres posterio\ rly with incomplete fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 510.881 Tm (In )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 52.7739 510.881 Tm (lobar holoprosencephaly, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 197.3582 510.881 Tm (there is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 243.572 510.881 Tm (normal separation of the ventricles and thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 514.1992 510.881 Tm (but )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 536.5201 510.881 Tm (absence of the septum pellucidum. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 736.7728 510.881 Tm (The )Tj -62.755 -1.473 Td (first two types are often accompanied by facial abnormalities. )Tj ET q 258.8235321 0 0 208.784317 131.1372528 262.114624 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 262.114624 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 131.1373 233.8638 Tm (Alobar type)Tj /TT0 1 Tf ( -)Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 212.3822 233.8638 Tm (monoventricular cavity )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 344.7244 233.8638 Tm (and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 131.1373 217.4409 Tm (fusion of the thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 251.1039 217.4409 Tm (at 11+2 weeks)Tj 9.4902 0 0 9.4902 335.259 217.4385 Tm ( )Tj 11.1493 0 0 11.1493 408.9412 233.8638 Tm (Increased Nucal Transluncency \(white )Tj 0 -1.473 TD (arrows\) at 11+2 weeks - trissomy 13. )Tj 9.4902 0 0 9.4902 37.098 186.0288 Tm ( )Tj 11.1493 0 0 11.1493 37.098 172.3985 Tm (Toth )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. observed a floating membranous structure in place of the skull of an 1\ 1-week fetus)Tj 8.9195 0 0 8.9195 567.8392 175.2528 Tm (41)Tj 11.1493 0 0 11.1493 579.1847 172.3985 Tm (. At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1942 0 obj<> endobj 1943 0 obj<>/Type/XObject/BBox[690.805 540.578 704.64 555.717]/FormType 1>>stream 1 0 0 RG 0.8411 w 694.8179 547.1865 m 700.6266 547.1865 l S endstream endobj 1944 0 obj<>/Type/XObject/BBox[690.805 540.578 704.64 555.717]/FormType 1>>stream 1 0 0 RG 0.8411 w 694.8179 547.1865 m 700.6266 547.1865 l S endstream endobj 1945 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 118.196 483.84 m 682.431 483.84 l 681.569 482.977 l 119.059 482.977 l h f 118.196 483.84 m 118.196 193.891 l 119.059 194.754 l 119.059 482.977 l h f 0.313 0.313 0.313 rg 682.431 483.84 m 682.431 193.891 l 681.569 194.754 l 681.569 482.977 l h f 118.196 193.891 m 682.431 193.891 l 681.569 194.754 l 119.059 194.754 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 126.824 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 125.961 476.075 m 396.863 476.075 l 396 475.213 l 126.824 475.213 l h f 125.961 476.075 m 125.961 256.938 l 126.824 257.801 l 126.824 475.213 l h f 0.949 0.945 0.935 rg 396.863 476.075 m 396.863 256.938 l 396 257.801 l 396 475.213 l h f 125.961 256.938 m 396.863 256.938 l 396 257.801 l 126.824 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 404.627 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 403.765 476.075 m 674.667 476.075 l 673.804 475.213 l 404.627 475.213 l h f 403.765 476.075 m 403.765 256.938 l 404.627 257.801 l 404.627 475.213 l h f 0.949 0.945 0.935 rg 674.667 476.075 m 674.667 256.938 l 673.804 257.801 l 673.804 475.213 l h f 403.765 256.938 m 674.667 256.938 l 673.804 257.801 l 404.627 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 125.961 250.036 m 396.863 250.036 l 396 249.173 l 126.824 249.173 l h f 125.961 250.036 m 125.961 201.656 l 126.824 202.519 l 126.824 249.173 l h f 0.949 0.945 0.935 rg 396.863 250.036 m 396.863 201.656 l 396 202.519 l 396 249.173 l h f 125.961 201.656 m 396.863 201.656 l 396 202.519 l 126.824 202.519 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 403.765 250.036 m 674.667 250.036 l 673.804 249.173 l 404.627 249.173 l h f 403.765 250.036 m 403.765 201.656 l 404.627 202.519 l 404.627 249.173 l h f 0.949 0.945 0.935 rg 674.667 250.036 m 674.667 201.656 l 673.804 202.519 l 673.804 249.173 l h f 403.765 201.656 m 674.667 201.656 l 673.804 202.519 l 404.627 202.519 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5727 Tm (Holoprosencephaly, with a birth prevalence of )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 298.5602 576.5727 Tm (about 1 in 10 000, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 406.7642 576.5727 Tm (is characterized by a spectrum of cerebral abnormalities )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 560.1498 Tm (resulting from incomplete cleavage of the forebrain. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 333.4354 560.1498 Tm (There are three types according to the degree of forebrain cleavage. 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At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1946 0 obj<>>> endobj 1947 0 obj<>35]/P 208 0 R/S/Annot/Pg 623 0 R>> endobj 1948 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 118.196 483.84 m 682.431 483.84 l 681.569 482.977 l 119.059 482.977 l h f 118.196 483.84 m 118.196 193.891 l 119.059 194.754 l 119.059 482.977 l h f 0.313 0.313 0.313 rg 682.431 483.84 m 682.431 193.891 l 681.569 194.754 l 681.569 482.977 l h f 118.196 193.891 m 682.431 193.891 l 681.569 194.754 l 119.059 194.754 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 126.824 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 125.961 476.075 m 396.863 476.075 l 396 475.213 l 126.824 475.213 l h f 125.961 476.075 m 125.961 256.938 l 126.824 257.801 l 126.824 475.213 l h f 0.949 0.945 0.935 rg 396.863 476.075 m 396.863 256.938 l 396 257.801 l 396 475.213 l h f 125.961 256.938 m 396.863 256.938 l 396 257.801 l 126.824 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 404.627 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 403.765 476.075 m 674.667 476.075 l 673.804 475.213 l 404.627 475.213 l h f 403.765 476.075 m 403.765 256.938 l 404.627 257.801 l 404.627 475.213 l h f 0.949 0.945 0.935 rg 674.667 476.075 m 674.667 256.938 l 673.804 257.801 l 673.804 475.213 l h f 403.765 256.938 m 674.667 256.938 l 673.804 257.801 l 404.627 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 125.961 250.036 m 396.863 250.036 l 396 249.173 l 126.824 249.173 l h f 125.961 250.036 m 125.961 201.656 l 126.824 202.519 l 126.824 249.173 l h f 0.949 0.945 0.935 rg 396.863 250.036 m 396.863 201.656 l 396 202.519 l 396 249.173 l h f 125.961 201.656 m 396.863 201.656 l 396 202.519 l 126.824 202.519 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 403.765 250.036 m 674.667 250.036 l 673.804 249.173 l 404.627 249.173 l h f 403.765 250.036 m 403.765 201.656 l 404.627 202.519 l 404.627 249.173 l h f 0.949 0.945 0.935 rg 674.667 250.036 m 674.667 201.656 l 673.804 202.519 l 673.804 249.173 l h f 403.765 201.656 m 674.667 201.656 l 673.804 202.519 l 404.627 202.519 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5727 Tm (Holoprosencephaly, with a birth prevalence of )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 298.5602 576.5727 Tm (about 1 in 10 000, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 406.7642 576.5727 Tm (is characterized by a spectrum of cerebral abnormalities )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 560.1498 Tm (resulting from incomplete cleavage of the forebrain. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 333.4354 560.1498 Tm (There are three types according to the degree of forebrain cleavage. 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At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1949 0 obj<> endobj 1950 0 obj<>/Type/XObject/BBox[690.805 540.578 753.418 555.717]/FormType 1>>stream 1 0 0 RG 0.8411 w 694.8179 547.1865 m 749.4048 547.1865 l S endstream endobj 1951 0 obj<>>> endobj 1952 0 obj<>37]/P 208 0 R/S/Annot/Pg 623 0 R>> endobj 1953 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.801 0.801 0.801 rg 118.196 483.84 m 682.431 483.84 l 681.569 482.977 l 119.059 482.977 l h f 118.196 483.84 m 118.196 193.891 l 119.059 194.754 l 119.059 482.977 l h f 0.313 0.313 0.313 rg 682.431 483.84 m 682.431 193.891 l 681.569 194.754 l 681.569 482.977 l h f 118.196 193.891 m 682.431 193.891 l 681.569 194.754 l 119.059 194.754 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 126.824 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 125.961 476.075 m 396.863 476.075 l 396 475.213 l 126.824 475.213 l h f 125.961 476.075 m 125.961 256.938 l 126.824 257.801 l 126.824 475.213 l h f 0.949 0.945 0.935 rg 396.863 476.075 m 396.863 256.938 l 396 257.801 l 396 475.213 l h f 125.961 256.938 m 396.863 256.938 l 396 257.801 l 126.824 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0 rg 404.627 257.801 269.176 217.412 re f 0.457 0.449 0.431 rg 403.765 476.075 m 674.667 476.075 l 673.804 475.213 l 404.627 475.213 l h f 403.765 476.075 m 403.765 256.938 l 404.627 257.801 l 404.627 475.213 l h f 0.949 0.945 0.935 rg 674.667 476.075 m 674.667 256.938 l 673.804 257.801 l 673.804 475.213 l h f 403.765 256.938 m 674.667 256.938 l 673.804 257.801 l 404.627 257.801 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 125.961 250.036 m 396.863 250.036 l 396 249.173 l 126.824 249.173 l h f 125.961 250.036 m 125.961 201.656 l 126.824 202.519 l 126.824 249.173 l h f 0.949 0.945 0.935 rg 396.863 250.036 m 396.863 201.656 l 396 202.519 l 396 249.173 l h f 125.961 201.656 m 396.863 201.656 l 396 202.519 l 126.824 202.519 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.457 0.449 0.431 rg 403.765 250.036 m 674.667 250.036 l 673.804 249.173 l 404.627 249.173 l h f 403.765 250.036 m 403.765 201.656 l 404.627 202.519 l 404.627 249.173 l h f 0.949 0.945 0.935 rg 674.667 250.036 m 674.667 201.656 l 673.804 202.519 l 673.804 249.173 l h f 403.765 201.656 m 674.667 201.656 l 673.804 202.519 l 404.627 202.519 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5727 Tm (Holoprosencephaly, with a birth prevalence of )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 298.5602 576.5727 Tm (about 1 in 10 000, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 406.7642 576.5727 Tm (is characterized by a spectrum of cerebral abnormalities )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 560.1498 Tm (resulting from incomplete cleavage of the forebrain. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 333.4354 560.1498 Tm (There are three types according to the degree of forebrain cleavage. The\ )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 543.7269 Tm (alobar type, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 108.5205 543.7269 Tm (which is the most severe, is characterized by a )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 376.1261 543.7269 Tm (monoventricular cavity and fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 657.1221 543.7269 Tm (In the )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 694.8179 543.7269 Tm (semilobar )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 527.3039 Tm (type, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 69.6651 527.3039 Tm (there is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 115.879 527.3039 Tm (partial segmentation of the ventricles and cerebral hemispheres posterio\ rly with incomplete fusion of the thalami. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 510.881 Tm (In )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 52.7739 510.881 Tm (lobar holoprosencephaly, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 197.3582 510.881 Tm (there is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 243.572 510.881 Tm (normal separation of the ventricles and thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 514.1992 510.881 Tm (but )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 536.5201 510.881 Tm (absence of the septum pellucidum. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 736.7728 510.881 Tm (The )Tj -62.755 -1.473 Td (first two types are often accompanied by facial abnormalities. )Tj ET q 258.8235321 0 0 208.784317 131.1372528 262.114624 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 262.114624 cm /Im1 Do Q BT /TT1 1 Tf 11.1493 0 0 11.1493 131.1373 233.8638 Tm (Alobar type)Tj /TT0 1 Tf ( -)Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 212.3822 233.8638 Tm (monoventricular cavity )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 344.7244 233.8638 Tm (and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 131.1373 217.4409 Tm (fusion of the thalami )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 251.1039 217.4409 Tm (at 11+2 weeks)Tj 9.4902 0 0 9.4902 335.259 217.4385 Tm ( )Tj 11.1493 0 0 11.1493 408.9412 233.8638 Tm (Increased Nucal Transluncency \(white )Tj 0 -1.473 TD (arrows\) at 11+2 weeks - trissomy 13. )Tj 9.4902 0 0 9.4902 37.098 186.0288 Tm ( )Tj 11.1493 0 0 11.1493 37.098 172.3985 Tm (Toth )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. observed a floating membranous structure in place of the skull of an 1\ 1-week fetus)Tj 8.9195 0 0 8.9195 567.8392 175.2528 Tm (41)Tj 11.1493 0 0 11.1493 579.1847 172.3985 Tm (. At 12 weeks, they noted )Tj -48.621 -1.383 Td (acrania and a floating, balloon-like, membranous brain substance. At 16 \ weeks, the diagnosis of acrania and holoprosencephaly )Tj 0 -1.564 TD (with cyclops was made and these findings were confirmed at postmortem ex\ amination after termination at 18 weeks)Tj 8.9195 0 0 8.9195 694.5735 142.4021 Tm (41)Tj 11.1493 0 0 11.1493 705.9191 139.5479 Tm (. )Tj -59.988 -1.383 Td (Bronshtein and Weiner described a case of alobar holoprosencephaly durin\ g routine ultrasound examination at 14 weeks; there )Tj T* (were a single cerebral ventricle, fused thalami and a crescent-shaped fr\ ontal cortex)Tj 8.9195 0 0 8.9195 507.4322 109.5514 Tm (42)Tj 11.1493 0 0 11.1493 518.7777 106.6972 Tm (. The fetal karyotype was normal. )Tj -43.203 -1.473 Td (Gonzalez-Gomez )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described a 10-week fetus with a single ventricular cavity, absence of\ the orbits and mid-facial cleft)Tj 8.9195 0 0 8.9195 729.1476 93.1261 Tm (43)Tj 11.1493 0 0 11.1493 740.4931 90.2718 Tm (. )Tj -63.089 -1.383 Td (The karyotype was normal. Pathological examination after termination at \ 11 weeks demonstrated alobar holoprosencephaly, )Tj T* (anophthalmia, arrhinia and facial cleft)Tj 8.9195 0 0 8.9195 250.117 60.2754 Tm (43)Tj 11.1493 0 0 11.1493 261.4625 57.4212 Tm (. Sakala and Gaio diagnosed alobar holoprosencephaly in a 13-week fetus \ with absent )Tj -20.124 -1.473 Td (falx, large single ventricle and fused thalami; the karyotype was 69,XXY\ )Tj 8.9195 0 0 8.9195 443.4462 43.8501 Tm (44)Tj 11.1493 0 0 11.1493 454.7917 40.9958 Tm (. Turner )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported a case of alobar )Tj -37.464 -1.383 Td (holoprosencephaly \(single ventricle and fused thalami\), exomphalos and\ increased nuchal translucency at 10 weeks; the )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(38 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1954 0 obj<> endobj 1955 0 obj<>/Type/XObject/BBox[33.0849 524.155 65.6952 539.294]/FormType 1>>stream 1 0 0 RG 0.8411 w 37.098 530.7635 m 61.6821 530.7635 l S endstream endobj 1956 0 obj<>>> endobj 1957 0 obj<>3]/P 208 0 R/S/Annot/Pg 636 0 R>> endobj 1958 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 453.14 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 349.463 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 32.784 203.288 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 581.9973 Tm (karyotype was trisomy 18)Tj 8.9195 0 0 8.9195 182.9312 584.8515 Tm (45)Tj 11.1493 0 0 11.1493 194.2767 581.9973 Tm (. Wong )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported three cases of alobar holoprocencephaly \(single ventricle an\ d fused thalami\) )Tj -14.098 -1.473 Td (at 10\22613 weeks; there was one case each of trisomy 18, triploidy and \ mosaic 18p deletion and duplication)Tj 8.9195 0 0 8.9195 636.6974 568.4262 Tm (46)Tj 11.1493 0 0 11.1493 648.0429 565.572 Tm (.)Tj -54.797 -1.937 Td (Snijders )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported on the sonographic features of 46 trisomy 13 fetuses at 10\226\ 14 weeks of gestation)Tj 8.9195 0 0 8.9195 633.1965 546.8244 Tm (47)Tj 11.1493 0 0 11.1493 644.5421 543.9702 Tm (. In 76% there was )Tj -54.483 -1.383 Td (increased nuchal translucency thickness, 64% were tachycardic, 24% had h\ oloprosencephaly and 10% had exomphalos. There )Tj 0 -1.473 TD (was no significant difference in nuchal translucency thickness between t\ hose with and those without holoprosencephaly or )Tj 0 -1.564 TD (exomphalos)Tj 8.9195 0 0 8.9195 104.295 497.5484 Tm (47)Tj 11.1493 0 0 11.1493 115.6405 494.6942 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 119.6989 494.6942 Tm ( )Tj /TT3 1 Tf ( )Tj 1 1 0 rg /TT4 1 Tf 11.1493 0 0 11.1493 43.1373 468.0676 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 443.5522 Tm ( )Tj 11.1493 0 0 11.1493 37.098 431.5724 Tm (In a screening study involving ultrasound examinations at 11\22614 weeks\ of gestation and again at 18\22620 weeks in 3991 )Tj 0 -1.29 TD (patients, there was one case of holoprosencephaly and this was not diagn\ osed in the first-trimester scan)Tj 8.9195 0 0 8.9195 626.362 420.0407 Tm (26)Tj 11.1493 0 0 11.1493 637.7075 417.1865 Tm (. Another screening )Tj -53.87 -1.2 Td (study for fetal abnormalities at 12\22614 weeks of gestation, involving \ 1632 pregnancies, correctly identified the one case of )Tj T* (holoprosencephaly)Tj 8.9195 0 0 8.9195 141.5449 392.2755 Tm (35)Tj 11.1493 0 0 11.1493 152.8904 389.4213 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 156.9488 389.4213 Tm ( )Tj /TT0 1 Tf ( )Tj /TT5 1 Tf 11.1493 0 0 11.1493 37.098 364.3907 Tm (Iniencephaly)Tj /TT3 1 Tf 9.4902 0 0 9.4902 37.098 335.3022 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 37.098 321.04 Tm (This is a rare malformation of unknown etiology, characterized by )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 410.8225 321.04 Tm (cervical dysraphism and occipital \(inion\) defect with or )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 304.6171 Tm (without an encephalocele.)Tj 0 -1.937 TD (Sherer )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of iniencephaly in a 13-week fetus; there was a\ crania, persistently hyperextended head )Tj 0 -1.564 TD (and spinal dysraphism)Tj 8.9195 0 0 8.9195 162.8066 268.435 Tm (48)Tj 11.1493 0 0 11.1493 174.1522 265.5807 Tm (. After termination, pathological examination demonstrated complete cran\ iorachischisis with )Tj -12.293 -1.383 Td (hyperextended cervical vertebrae.)Tj /TT5 1 Tf 0 -2.865 TD (Spina bifida)Tj /TT0 1 Tf 0 -2.867 TD (In spina bifida, there is failure of closure of the neural tube, which n\ ormally occurs by the 6th week of gestation. In the spin)Tj (e of )Tj 0 -1.473 TD (normal fetuses, there are three ossification centers, two pedicles and t\ he spinal body, and these are present from the 10th )Tj 0 -1.473 TD (week of gestation, allowing ultrasonographic visualization of the neural\ canal from this gestation. Braithwaite )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. assessed )Tj 0 -1.473 TD (the fetal anatomy at 12\22613 weeks of gestation, by a combination of tr\ ansabdominal and transvaginal sonography, and they )Tj 0 -1.564 TD (reported successful examination of the vertebrae and overlying skin in b\ oth the transverse and coronal planes in all cases)Tj 8.9195 0 0 8.9195 722.9485 122.3988 Tm (49)Tj 11.1493 0 0 11.1493 734.2941 119.5446 Tm (.)Tj -62.533 -1.847 Td (In the 1980s, the main method of screening for open spina bifida was by \ maternal serum a-fetoprotein at around 16 weeks of )Tj 0 -1.473 TD (gestation and the method of diagnosis was amniocentesis and measurement \ of amniotic fluid a-fetoprotein and acetyl )Tj 0 -1.564 TD (cholinesterase. Although it was possible to diagnose the condition by ul\ trasonographic examination of the spine)Tj 8.9195 0 0 8.9195 664.8383 67.9463 Tm (50)Tj 11.1493 0 0 11.1493 676.1838 65.0921 Tm (, the )Tj -57.321 -1.473 Td (sensitivity of this test was low)Tj 8.9195 0 0 8.9195 206.0103 51.521 Tm (51)Tj 11.1493 0 0 11.1493 217.3558 48.6667 Tm (. However, the observation, that spina bifida was associated with scallo\ ping of the frontal bones )Tj -16.168 -1.473 Td (\(the \221lemon\222 sign\) \()Tj 0 0 0.4 rg (Figure 11)Tj 0 0 0 rg (\), and caudal displacement of the cerebellum \(the \221banana\222 sign\)\ )Tj 8.9195 0 0 8.9195 562.1976 35.0956 Tm (52)Tj 11.1493 0 0 11.1493 573.5432 32.2414 Tm (, has led to the replacement of )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(39 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1959 0 obj<> endobj 1960 0 obj<>/Type/XObject/BBox[407.23 318.312 721.778 332.61]/FormType 1>>stream 1 1 0 rg 0.8411 w 410.8221 318.7323 m 407.6502 321.9041 407.6502 329.0175 410.8221 332.1893 c 718.1855 332.1893 l 721.3574 329.0175 721.3574 321.9041 718.1855 318.7323 c f endstream endobj 1961 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 314.549 14.2986]/FormType 1>>stream /Form Do endstream endobj 1962 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 314.549 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1963 0 obj<>>> endobj 1964 0 obj<>5]/P 208 0 R/S/Annot/Pg 636 0 R>> endobj 1965 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 453.14 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 349.463 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 32.784 203.288 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 581.9973 Tm (karyotype was trisomy 18)Tj 8.9195 0 0 8.9195 182.9312 584.8515 Tm (45)Tj 11.1493 0 0 11.1493 194.2767 581.9973 Tm (. Wong )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported three cases of alobar holoprocencephaly \(single ventricle an\ d fused thalami\) )Tj -14.098 -1.473 Td (at 10\22613 weeks; there was one case each of trisomy 18, triploidy and \ mosaic 18p deletion and duplication)Tj 8.9195 0 0 8.9195 636.6974 568.4262 Tm (46)Tj 11.1493 0 0 11.1493 648.0429 565.572 Tm (.)Tj -54.797 -1.937 Td (Snijders )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported on the sonographic features of 46 trisomy 13 fetuses at 10\226\ 14 weeks of gestation)Tj 8.9195 0 0 8.9195 633.1965 546.8244 Tm (47)Tj 11.1493 0 0 11.1493 644.5421 543.9702 Tm (. In 76% there was )Tj -54.483 -1.383 Td (increased nuchal translucency thickness, 64% were tachycardic, 24% had h\ oloprosencephaly and 10% had exomphalos. There )Tj 0 -1.473 TD (was no significant difference in nuchal translucency thickness between t\ hose with and those without holoprosencephaly or )Tj 0 -1.564 TD (exomphalos)Tj 8.9195 0 0 8.9195 104.295 497.5484 Tm (47)Tj 11.1493 0 0 11.1493 115.6405 494.6942 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 119.6989 494.6942 Tm ( )Tj /TT3 1 Tf ( )Tj 1 1 0 rg /TT4 1 Tf 11.1493 0 0 11.1493 43.1373 468.0676 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 443.5522 Tm ( )Tj 11.1493 0 0 11.1493 37.098 431.5724 Tm (In a screening study involving ultrasound examinations at 11\22614 weeks\ of gestation and again at 18\22620 weeks in 3991 )Tj 0 -1.29 TD (patients, there was one case of holoprosencephaly and this was not diagn\ osed in the first-trimester scan)Tj 8.9195 0 0 8.9195 626.362 420.0407 Tm (26)Tj 11.1493 0 0 11.1493 637.7075 417.1865 Tm (. Another screening )Tj -53.87 -1.2 Td (study for fetal abnormalities at 12\22614 weeks of gestation, involving \ 1632 pregnancies, correctly identified the one case of )Tj T* (holoprosencephaly)Tj 8.9195 0 0 8.9195 141.5449 392.2755 Tm (35)Tj 11.1493 0 0 11.1493 152.8904 389.4213 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 156.9488 389.4213 Tm ( )Tj /TT0 1 Tf ( )Tj /TT5 1 Tf 11.1493 0 0 11.1493 37.098 364.3907 Tm (Iniencephaly)Tj /TT3 1 Tf 9.4902 0 0 9.4902 37.098 335.3022 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 37.098 321.04 Tm (This is a rare malformation of unknown etiology, characterized by )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 410.8225 321.04 Tm (cervical dysraphism and occipital \(inion\) defect with or )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 304.6171 Tm (without an encephalocele.)Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 283.0209 Tm (Sherer )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of iniencephaly in a 13-week fetus; there was a\ crania, persistently hyperextended head )Tj 0 -1.564 TD (and spinal dysraphism)Tj 8.9195 0 0 8.9195 162.8066 268.435 Tm (48)Tj 11.1493 0 0 11.1493 174.1522 265.5807 Tm (. After termination, pathological examination demonstrated complete cran\ iorachischisis with )Tj -12.293 -1.383 Td (hyperextended cervical vertebrae.)Tj /TT5 1 Tf 0 -2.865 TD (Spina bifida)Tj /TT0 1 Tf 0 -2.867 TD (In spina bifida, there is failure of closure of the neural tube, which n\ ormally occurs by the 6th week of gestation. In the spin)Tj (e of )Tj 0 -1.473 TD (normal fetuses, there are three ossification centers, two pedicles and t\ he spinal body, and these are present from the 10th )Tj 0 -1.473 TD (week of gestation, allowing ultrasonographic visualization of the neural\ canal from this gestation. Braithwaite )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. assessed )Tj 0 -1.473 TD (the fetal anatomy at 12\22613 weeks of gestation, by a combination of tr\ ansabdominal and transvaginal sonography, and they )Tj 0 -1.564 TD (reported successful examination of the vertebrae and overlying skin in b\ oth the transverse and coronal planes in all cases)Tj 8.9195 0 0 8.9195 722.9485 122.3988 Tm (49)Tj 11.1493 0 0 11.1493 734.2941 119.5446 Tm (.)Tj -62.533 -1.847 Td (In the 1980s, the main method of screening for open spina bifida was by \ maternal serum a-fetoprotein at around 16 weeks of )Tj 0 -1.473 TD (gestation and the method of diagnosis was amniocentesis and measurement \ of amniotic fluid a-fetoprotein and acetyl )Tj 0 -1.564 TD (cholinesterase. Although it was possible to diagnose the condition by ul\ trasonographic examination of the spine)Tj 8.9195 0 0 8.9195 664.8383 67.9463 Tm (50)Tj 11.1493 0 0 11.1493 676.1838 65.0921 Tm (, the )Tj -57.321 -1.473 Td (sensitivity of this test was low)Tj 8.9195 0 0 8.9195 206.0103 51.521 Tm (51)Tj 11.1493 0 0 11.1493 217.3558 48.6667 Tm (. However, the observation, that spina bifida was associated with scallo\ ping of the frontal bones )Tj -16.168 -1.473 Td (\(the \221lemon\222 sign\) \()Tj 0 0 0.4 rg (Figure 11)Tj 0 0 0 rg (\), and caudal displacement of the cerebellum \(the \221banana\222 sign\)\ )Tj 8.9195 0 0 8.9195 562.1976 35.0956 Tm (52)Tj 11.1493 0 0 11.1493 573.5432 32.2414 Tm (, has led to the replacement of )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(39 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1966 0 obj<> endobj 1967 0 obj<>/Type/XObject/BBox[33.5055 301.889 187.036 316.187]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.098 302.3094 m 33.9262 305.4812 33.9262 312.5946 37.098 315.7664 c 183.443 315.7664 l 186.6149 312.5946 186.6149 305.4812 183.443 302.3094 c f endstream endobj 1968 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 153.53 14.2986]/FormType 1>>stream /Form Do endstream endobj 1969 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 153.531 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1970 0 obj<>>> endobj 1971 0 obj<>8]/P 208 0 R/S/Annot/Pg 636 0 R>> endobj 1972 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 453.14 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 349.463 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 32.784 203.288 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 581.9973 Tm (karyotype was trisomy 18)Tj 8.9195 0 0 8.9195 182.9312 584.8515 Tm (45)Tj 11.1493 0 0 11.1493 194.2767 581.9973 Tm (. Wong )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported three cases of alobar holoprocencephaly \(single ventricle an\ d fused thalami\) )Tj -14.098 -1.473 Td (at 10\22613 weeks; there was one case each of trisomy 18, triploidy and \ mosaic 18p deletion and duplication)Tj 8.9195 0 0 8.9195 636.6974 568.4262 Tm (46)Tj 11.1493 0 0 11.1493 648.0429 565.572 Tm (.)Tj -54.797 -1.937 Td (Snijders )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported on the sonographic features of 46 trisomy 13 fetuses at 10\226\ 14 weeks of gestation)Tj 8.9195 0 0 8.9195 633.1965 546.8244 Tm (47)Tj 11.1493 0 0 11.1493 644.5421 543.9702 Tm (. In 76% there was )Tj -54.483 -1.383 Td (increased nuchal translucency thickness, 64% were tachycardic, 24% had h\ oloprosencephaly and 10% had exomphalos. There )Tj 0 -1.473 TD (was no significant difference in nuchal translucency thickness between t\ hose with and those without holoprosencephaly or )Tj 0 -1.564 TD (exomphalos)Tj 8.9195 0 0 8.9195 104.295 497.5484 Tm (47)Tj 11.1493 0 0 11.1493 115.6405 494.6942 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 119.6989 494.6942 Tm ( )Tj /TT3 1 Tf ( )Tj 1 1 0 rg /TT4 1 Tf 11.1493 0 0 11.1493 43.1373 468.0676 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 443.5522 Tm ( )Tj 11.1493 0 0 11.1493 37.098 431.5724 Tm (In a screening study involving ultrasound examinations at 11\22614 weeks\ of gestation and again at 18\22620 weeks in 3991 )Tj 0 -1.29 TD (patients, there was one case of holoprosencephaly and this was not diagn\ osed in the first-trimester scan)Tj 8.9195 0 0 8.9195 626.362 420.0407 Tm (26)Tj 11.1493 0 0 11.1493 637.7075 417.1865 Tm (. Another screening )Tj -53.87 -1.2 Td (study for fetal abnormalities at 12\22614 weeks of gestation, involving \ 1632 pregnancies, correctly identified the one case of )Tj T* (holoprosencephaly)Tj 8.9195 0 0 8.9195 141.5449 392.2755 Tm (35)Tj 11.1493 0 0 11.1493 152.8904 389.4213 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 156.9488 389.4213 Tm ( )Tj /TT0 1 Tf ( )Tj /TT5 1 Tf 11.1493 0 0 11.1493 37.098 364.3907 Tm (Iniencephaly)Tj /TT3 1 Tf 9.4902 0 0 9.4902 37.098 335.3022 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 37.098 321.04 Tm (This is a rare malformation of unknown etiology, characterized by )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 410.8225 321.04 Tm (cervical dysraphism and occipital \(inion\) defect with or )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 304.6171 Tm (without an encephalocele.)Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 283.0209 Tm (Sherer )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of iniencephaly in a 13-week fetus; there was a\ crania, persistently hyperextended head )Tj 0 -1.564 TD (and spinal dysraphism)Tj 8.9195 0 0 8.9195 162.8066 268.435 Tm (48)Tj 11.1493 0 0 11.1493 174.1522 265.5807 Tm (. After termination, pathological examination demonstrated complete cran\ iorachischisis with )Tj -12.293 -1.383 Td (hyperextended cervical vertebrae.)Tj /TT5 1 Tf 0 -2.865 TD (Spina bifida)Tj /TT0 1 Tf 0 -2.867 TD (In spina bifida, there is failure of closure of the neural tube, which n\ ormally occurs by the 6th week of gestation. In the spin)Tj (e of )Tj 0 -1.473 TD (normal fetuses, there are three ossification centers, two pedicles and t\ he spinal body, and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 548.691 169.8305 Tm (these are present from the 10th )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0939 153.4076 Tm (week of gestation, allowing ultrasonographic visualization of the neural\ canal from this gestation. Braithwaite )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. assessed )Tj T* (the fetal anatomy at 12\22613 weeks of gestation, by a combination of tr\ ansabdominal and transvaginal sonography, and they )Tj 0 -1.564 TD (reported successful examination of the vertebrae and overlying skin in b\ oth the transverse and coronal planes in all cases)Tj 8.9195 0 0 8.9195 722.9485 122.3988 Tm (49)Tj 11.1493 0 0 11.1493 734.2941 119.5446 Tm (.)Tj -62.533 -1.847 Td (In the 1980s, the main method of screening for open spina bifida was by \ maternal serum a-fetoprotein at around 16 weeks of )Tj 0 -1.473 TD (gestation and the method of diagnosis was amniocentesis and measurement \ of amniotic fluid a-fetoprotein and acetyl )Tj 0 -1.564 TD (cholinesterase. Although it was possible to diagnose the condition by ul\ trasonographic examination of the spine)Tj 8.9195 0 0 8.9195 664.8383 67.9463 Tm (50)Tj 11.1493 0 0 11.1493 676.1838 65.0921 Tm (, the )Tj -57.321 -1.473 Td (sensitivity of this test was low)Tj 8.9195 0 0 8.9195 206.0103 51.521 Tm (51)Tj 11.1493 0 0 11.1493 217.3558 48.6667 Tm (. However, the observation, that spina bifida was associated with scallo\ ping of the frontal bones )Tj -16.168 -1.473 Td (\(the \221lemon\222 sign\) \()Tj 0 0 0.4 rg (Figure 11)Tj 0 0 0 rg (\), and caudal displacement of the cerebellum \(the \221banana\222 sign\)\ )Tj 8.9195 0 0 8.9195 562.1976 35.0956 Tm (52)Tj 11.1493 0 0 11.1493 573.5432 32.2414 Tm (, has led to the replacement of )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(39 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1973 0 obj<> endobj 1974 0 obj<>/Type/XObject/BBox[545.097 167.102 732.845 181.4]/FormType 1>>stream 1 1 0 rg 0.8411 w 548.6896 167.5228 m 545.5177 170.6946 545.5177 177.808 548.6896 180.9798 c 729.2521 180.9798 l 732.424 177.808 732.424 170.6946 729.2521 167.5228 c f endstream endobj 1975 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 187.748 14.2986]/FormType 1>>stream /Form Do endstream endobj 1976 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 187.748 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1977 0 obj<>>> endobj 1978 0 obj<>10]/P 208 0 R/S/Annot/Pg 636 0 R>> endobj 1979 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 453.14 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 349.463 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 32.784 203.288 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 581.9973 Tm (karyotype was trisomy 18)Tj 8.9195 0 0 8.9195 182.9312 584.8515 Tm (45)Tj 11.1493 0 0 11.1493 194.2767 581.9973 Tm (. Wong )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported three cases of alobar holoprocencephaly \(single ventricle an\ d fused thalami\) )Tj -14.098 -1.473 Td (at 10\22613 weeks; there was one case each of trisomy 18, triploidy and \ mosaic 18p deletion and duplication)Tj 8.9195 0 0 8.9195 636.6974 568.4262 Tm (46)Tj 11.1493 0 0 11.1493 648.0429 565.572 Tm (.)Tj -54.797 -1.937 Td (Snijders )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported on the sonographic features of 46 trisomy 13 fetuses at 10\226\ 14 weeks of gestation)Tj 8.9195 0 0 8.9195 633.1965 546.8244 Tm (47)Tj 11.1493 0 0 11.1493 644.5421 543.9702 Tm (. In 76% there was )Tj -54.483 -1.383 Td (increased nuchal translucency thickness, 64% were tachycardic, 24% had h\ oloprosencephaly and 10% had exomphalos. 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Another screening )Tj -53.87 -1.2 Td (study for fetal abnormalities at 12\22614 weeks of gestation, involving \ 1632 pregnancies, correctly identified the one case of )Tj T* (holoprosencephaly)Tj 8.9195 0 0 8.9195 141.5449 392.2755 Tm (35)Tj 11.1493 0 0 11.1493 152.8904 389.4213 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 156.9488 389.4213 Tm ( )Tj /TT0 1 Tf ( )Tj /TT5 1 Tf 11.1493 0 0 11.1493 37.098 364.3907 Tm (Iniencephaly)Tj /TT3 1 Tf 9.4902 0 0 9.4902 37.098 335.3022 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 37.098 321.04 Tm (This is a rare malformation of unknown etiology, characterized by )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 410.8225 321.04 Tm (cervical dysraphism and occipital \(inion\) defect with or )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 304.6171 Tm (without an encephalocele.)Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 283.0209 Tm (Sherer )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of iniencephaly in a 13-week fetus; there was a\ crania, persistently hyperextended head )Tj 0 -1.564 TD (and spinal dysraphism)Tj 8.9195 0 0 8.9195 162.8066 268.435 Tm (48)Tj 11.1493 0 0 11.1493 174.1522 265.5807 Tm (. After termination, pathological examination demonstrated complete cran\ iorachischisis with )Tj -12.293 -1.383 Td (hyperextended cervical vertebrae.)Tj /TT5 1 Tf 0 -2.865 TD (Spina bifida)Tj /TT0 1 Tf 0 -2.867 TD (In spina bifida, there is failure of closure of the neural tube, which n\ ormally occurs by the 6th week of gestation. In the spin)Tj (e of )Tj 0 -1.473 TD (normal fetuses, there are three ossification centers, two pedicles and t\ he spinal body, and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 548.691 169.8305 Tm (these are present from the 10th )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0939 153.4076 Tm (week of gestation, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 144.3948 153.4076 Tm (allowing ultrasonographic visualization of the neural canal from this ge\ station. Braithwaite )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. assessed )Tj -9.624 -1.473 Td (the fetal anatomy at 12\22613 weeks of gestation, by a combination of tr\ ansabdominal and transvaginal sonography, and they )Tj 0 -1.564 TD (reported successful examination of the vertebrae and overlying skin in b\ oth the transverse and coronal planes in all cases)Tj 8.9195 0 0 8.9195 722.9485 122.3988 Tm (49)Tj 11.1493 0 0 11.1493 734.2941 119.5446 Tm (.)Tj -62.533 -1.847 Td (In the 1980s, the main method of screening for open spina bifida was by \ maternal serum a-fetoprotein at around 16 weeks of )Tj 0 -1.473 TD (gestation and the method of diagnosis was amniocentesis and measurement \ of amniotic fluid a-fetoprotein and acetyl )Tj 0 -1.564 TD (cholinesterase. Although it was possible to diagnose the condition by ul\ trasonographic examination of the spine)Tj 8.9195 0 0 8.9195 664.8383 67.9463 Tm (50)Tj 11.1493 0 0 11.1493 676.1838 65.0921 Tm (, the )Tj -57.321 -1.473 Td (sensitivity of this test was low)Tj 8.9195 0 0 8.9195 206.0103 51.521 Tm (51)Tj 11.1493 0 0 11.1493 217.3558 48.6667 Tm (. However, the observation, that spina bifida was associated with scallo\ ping of the frontal bones )Tj -16.168 -1.473 Td (\(the \221lemon\222 sign\) \()Tj 0 0 0.4 rg (Figure 11)Tj 0 0 0 rg (\), and caudal displacement of the cerebellum \(the \221banana\222 sign\)\ )Tj 8.9195 0 0 8.9195 562.1976 35.0956 Tm (52)Tj 11.1493 0 0 11.1493 573.5432 32.2414 Tm (, has led to the replacement of )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(39 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1980 0 obj<> endobj 1981 0 obj<>/Type/XObject/BBox[33.5014 150.679 144.062 164.978]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.0939 151.0999 m 33.9221 154.2717 33.9221 161.3851 37.0939 164.5569 c 140.4698 164.5569 l 143.6416 161.3851 143.6416 154.2717 140.4698 151.0999 c f endstream endobj 1982 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 110.561 14.2986]/FormType 1>>stream /Form Do endstream endobj 1983 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 110.561 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1984 0 obj<>>> endobj 1985 0 obj<>13]/P 208 0 R/S/Annot/Pg 636 0 R>> endobj 1986 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 453.14 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 349.463 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 32.784 203.288 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 581.9973 Tm (karyotype was trisomy 18)Tj 8.9195 0 0 8.9195 182.9312 584.8515 Tm (45)Tj 11.1493 0 0 11.1493 194.2767 581.9973 Tm (. Wong )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported three cases of alobar holoprocencephaly \(single ventricle an\ d fused thalami\) )Tj -14.098 -1.473 Td (at 10\22613 weeks; there was one case each of trisomy 18, triploidy and \ mosaic 18p deletion and duplication)Tj 8.9195 0 0 8.9195 636.6974 568.4262 Tm (46)Tj 11.1493 0 0 11.1493 648.0429 565.572 Tm (.)Tj -54.797 -1.937 Td (Snijders )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported on the sonographic features of 46 trisomy 13 fetuses at 10\226\ 14 weeks of gestation)Tj 8.9195 0 0 8.9195 633.1965 546.8244 Tm (47)Tj 11.1493 0 0 11.1493 644.5421 543.9702 Tm (. In 76% there was )Tj -54.483 -1.383 Td (increased nuchal translucency thickness, 64% were tachycardic, 24% had h\ oloprosencephaly and 10% had exomphalos. There )Tj 0 -1.473 TD (was no significant difference in nuchal translucency thickness between t\ hose with and those without holoprosencephaly or )Tj 0 -1.564 TD (exomphalos)Tj 8.9195 0 0 8.9195 104.295 497.5484 Tm (47)Tj 11.1493 0 0 11.1493 115.6405 494.6942 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 119.6989 494.6942 Tm ( )Tj /TT3 1 Tf ( )Tj 1 1 0 rg /TT4 1 Tf 11.1493 0 0 11.1493 43.1373 468.0676 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 443.5522 Tm ( )Tj 11.1493 0 0 11.1493 37.098 431.5724 Tm (In a screening study involving ultrasound examinations at 11\22614 weeks\ of gestation and again at 18\22620 weeks in 3991 )Tj 0 -1.29 TD (patients, there was one case of holoprosencephaly and this was not diagn\ osed in the first-trimester scan)Tj 8.9195 0 0 8.9195 626.362 420.0407 Tm (26)Tj 11.1493 0 0 11.1493 637.7075 417.1865 Tm (. Another screening )Tj -53.87 -1.2 Td (study for fetal abnormalities at 12\22614 weeks of gestation, involving \ 1632 pregnancies, correctly identified the one case of )Tj T* (holoprosencephaly)Tj 8.9195 0 0 8.9195 141.5449 392.2755 Tm (35)Tj 11.1493 0 0 11.1493 152.8904 389.4213 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 156.9488 389.4213 Tm ( )Tj /TT0 1 Tf ( )Tj /TT5 1 Tf 11.1493 0 0 11.1493 37.098 364.3907 Tm (Iniencephaly)Tj /TT3 1 Tf 9.4902 0 0 9.4902 37.098 335.3022 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 37.098 321.04 Tm (This is a rare malformation of unknown etiology, characterized by )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 410.8225 321.04 Tm (cervical dysraphism and occipital \(inion\) defect with or )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 304.6171 Tm (without an encephalocele.)Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 283.0209 Tm (Sherer )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of iniencephaly in a 13-week fetus; there was a\ crania, persistently hyperextended head )Tj 0 -1.564 TD (and spinal dysraphism)Tj 8.9195 0 0 8.9195 162.8066 268.435 Tm (48)Tj 11.1493 0 0 11.1493 174.1522 265.5807 Tm (. After termination, pathological examination demonstrated complete cran\ iorachischisis with )Tj -12.293 -1.383 Td (hyperextended cervical vertebrae.)Tj /TT5 1 Tf 0 -2.865 TD (Spina bifida)Tj /TT0 1 Tf 0 -2.867 TD (In spina bifida, there is failure of closure of the neural tube, which n\ ormally occurs by the 6th week of gestation. In the spin)Tj (e of )Tj 0 -1.473 TD (normal fetuses, there are three ossification centers, two pedicles and t\ he spinal body, and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 548.691 169.8305 Tm (these are present from the 10th )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0939 153.4076 Tm (week of gestation, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 144.3948 153.4076 Tm (allowing ultrasonographic visualization of the neural canal from this ge\ station. Braithwaite )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. assessed )Tj -9.624 -1.473 Td (the fetal anatomy at 12\22613 weeks of gestation, by a combination of tr\ ansabdominal and transvaginal sonography, and they )Tj 0 -1.564 TD (reported successful examination of the vertebrae and overlying skin in b\ oth the transverse and coronal planes in all cases)Tj 8.9195 0 0 8.9195 722.9485 122.3988 Tm (49)Tj 11.1493 0 0 11.1493 734.2941 119.5446 Tm (.)Tj -62.533 -1.847 Td (In the 1980s, the main method of screening for open spina bifida was by \ maternal serum a-fetoprotein at around 16 weeks of )Tj 0 -1.473 TD (gestation and the method of diagnosis was amniocentesis and measurement \ of amniotic fluid a-fetoprotein and acetyl )Tj 0 -1.564 TD (cholinesterase. Although it was possible to diagnose the condition by ul\ trasonographic examination of the spine)Tj 8.9195 0 0 8.9195 664.8383 67.9463 Tm (50)Tj 11.1493 0 0 11.1493 676.1838 65.0921 Tm (, the )Tj -57.321 -1.473 Td (sensitivity of this test was low)Tj 8.9195 0 0 8.9195 206.0103 51.521 Tm (51)Tj 11.1493 0 0 11.1493 217.3558 48.6667 Tm (. However, the observation, that spina bifida was associated with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 587.9142 48.6667 Tm (scalloping of the frontal bones )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0939 32.2438 Tm (\(the \221lemon\222 sign\) \()Tj 0 0 0.4 rg (Figure 11)Tj 0 0 0 rg (\), and caudal displacement of the cerebellum \(the \221banana\222 sign\)\ )Tj 8.9195 0 0 8.9195 562.1976 35.0956 Tm (52)Tj 11.1493 0 0 11.1493 573.5432 32.2414 Tm (, has led to the replacement of )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(39 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1987 0 obj<> endobj 1988 0 obj<>/Type/XObject/BBox[584.321 45.9383 761.075 60.2367]/FormType 1>>stream 1 1 0 rg 0.8411 w 587.9132 46.359 m 584.7414 49.5308 584.7414 56.6442 587.9132 59.816 c 757.4826 59.816 l 760.6545 56.6442 760.6545 49.5308 757.4826 46.359 c f endstream endobj 1989 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 176.755 14.2986]/FormType 1>>stream /Form Do endstream endobj 1990 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 176.755 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1991 0 obj<>>> endobj 1992 0 obj<>15]/P 208 0 R/S/Annot/Pg 636 0 R>> endobj 1993 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 453.14 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 349.463 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 32.784 203.288 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 581.9973 Tm (karyotype was trisomy 18)Tj 8.9195 0 0 8.9195 182.9312 584.8515 Tm (45)Tj 11.1493 0 0 11.1493 194.2767 581.9973 Tm (. Wong )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported three cases of alobar holoprocencephaly \(single ventricle an\ d fused thalami\) )Tj -14.098 -1.473 Td (at 10\22613 weeks; there was one case each of trisomy 18, triploidy and \ mosaic 18p deletion and duplication)Tj 8.9195 0 0 8.9195 636.6974 568.4262 Tm (46)Tj 11.1493 0 0 11.1493 648.0429 565.572 Tm (.)Tj -54.797 -1.937 Td (Snijders )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported on the sonographic features of 46 trisomy 13 fetuses at 10\226\ 14 weeks of gestation)Tj 8.9195 0 0 8.9195 633.1965 546.8244 Tm (47)Tj 11.1493 0 0 11.1493 644.5421 543.9702 Tm (. In 76% there was )Tj -54.483 -1.383 Td (increased nuchal translucency thickness, 64% were tachycardic, 24% had h\ oloprosencephaly and 10% had exomphalos. There )Tj 0 -1.473 TD (was no significant difference in nuchal translucency thickness between t\ hose with and those without holoprosencephaly or )Tj 0 -1.564 TD (exomphalos)Tj 8.9195 0 0 8.9195 104.295 497.5484 Tm (47)Tj 11.1493 0 0 11.1493 115.6405 494.6942 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 119.6989 494.6942 Tm ( )Tj /TT3 1 Tf ( )Tj 1 1 0 rg /TT4 1 Tf 11.1493 0 0 11.1493 43.1373 468.0676 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 443.5522 Tm ( )Tj 11.1493 0 0 11.1493 37.098 431.5724 Tm (In a screening study involving ultrasound examinations at 11\22614 weeks\ of gestation and again at 18\22620 weeks in 3991 )Tj 0 -1.29 TD (patients, there was one case of holoprosencephaly and this was not diagn\ osed in the first-trimester scan)Tj 8.9195 0 0 8.9195 626.362 420.0407 Tm (26)Tj 11.1493 0 0 11.1493 637.7075 417.1865 Tm (. Another screening )Tj -53.87 -1.2 Td (study for fetal abnormalities at 12\22614 weeks of gestation, involving \ 1632 pregnancies, correctly identified the one case of )Tj T* (holoprosencephaly)Tj 8.9195 0 0 8.9195 141.5449 392.2755 Tm (35)Tj 11.1493 0 0 11.1493 152.8904 389.4213 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 156.9488 389.4213 Tm ( )Tj /TT0 1 Tf ( )Tj /TT5 1 Tf 11.1493 0 0 11.1493 37.098 364.3907 Tm (Iniencephaly)Tj /TT3 1 Tf 9.4902 0 0 9.4902 37.098 335.3022 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 37.098 321.04 Tm (This is a rare malformation of unknown etiology, characterized by )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 410.8225 321.04 Tm (cervical dysraphism and occipital \(inion\) defect with or )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 304.6171 Tm (without an encephalocele.)Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 283.0209 Tm (Sherer )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of iniencephaly in a 13-week fetus; there was a\ crania, persistently hyperextended head )Tj 0 -1.564 TD (and spinal dysraphism)Tj 8.9195 0 0 8.9195 162.8066 268.435 Tm (48)Tj 11.1493 0 0 11.1493 174.1522 265.5807 Tm (. After termination, pathological examination demonstrated complete cran\ iorachischisis with )Tj -12.293 -1.383 Td (hyperextended cervical vertebrae.)Tj /TT5 1 Tf 0 -2.865 TD (Spina bifida)Tj /TT0 1 Tf 0 -2.867 TD (In spina bifida, there is failure of closure of the neural tube, which n\ ormally occurs by the 6th week of gestation. In the spin)Tj (e of )Tj 0 -1.473 TD (normal fetuses, there are three ossification centers, two pedicles and t\ he spinal body, and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 548.691 169.8305 Tm (these are present from the 10th )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0939 153.4076 Tm (week of gestation, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 144.3948 153.4076 Tm (allowing ultrasonographic visualization of the neural canal from this ge\ station. Braithwaite )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. assessed )Tj -9.624 -1.473 Td (the fetal anatomy at 12\22613 weeks of gestation, by a combination of tr\ ansabdominal and transvaginal sonography, and they )Tj 0 -1.564 TD (reported successful examination of the vertebrae and overlying skin in b\ oth the transverse and coronal planes in all cases)Tj 8.9195 0 0 8.9195 722.9485 122.3988 Tm (49)Tj 11.1493 0 0 11.1493 734.2941 119.5446 Tm (.)Tj -62.533 -1.847 Td (In the 1980s, the main method of screening for open spina bifida was by \ maternal serum a-fetoprotein at around 16 weeks of )Tj 0 -1.473 TD (gestation and the method of diagnosis was amniocentesis and measurement \ of amniotic fluid a-fetoprotein and acetyl )Tj 0 -1.564 TD (cholinesterase. Although it was possible to diagnose the condition by ul\ trasonographic examination of the spine)Tj 8.9195 0 0 8.9195 664.8383 67.9463 Tm (50)Tj 11.1493 0 0 11.1493 676.1838 65.0921 Tm (, the )Tj -57.321 -1.473 Td (sensitivity of this test was low)Tj 8.9195 0 0 8.9195 206.0103 51.521 Tm (51)Tj 11.1493 0 0 11.1493 217.3558 48.6667 Tm (. However, the observation, that spina bifida was associated with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 587.9142 48.6667 Tm (scalloping of the frontal bones )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0939 32.2438 Tm (\(the \221lemon\222 sign\) )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 140.3253 32.2438 Tm (\()Tj 0 0 0.4 rg (Figure 11)Tj 0 0 0 rg (\), and caudal displacement of the cerebellum \(the \221banana\222 sign\)\ )Tj 8.9195 0 0 8.9195 562.1976 35.0956 Tm (52)Tj 11.1493 0 0 11.1493 573.5432 32.2414 Tm (, has led to the replacement of )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(39 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 1994 0 obj<> endobj 1995 0 obj<>/Type/XObject/BBox[33.5014 29.5154 139.993 43.8138]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.0939 29.9361 m 33.9221 33.1079 33.9221 40.2213 37.0939 43.3931 c 136.4004 43.3931 l 139.5723 40.2213 139.5723 33.1079 136.4004 29.9361 c f endstream endobj 1996 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 106.492 14.2986]/FormType 1>>stream /Form Do endstream endobj 1997 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 106.492 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 1998 0 obj<>>> endobj 1999 0 obj<>18]/P 208 0 R/S/Annot/Pg 636 0 R>> endobj 2000 0 obj<> endobj 2001 0 obj<> endobj 2002 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 453.14 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 349.463 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 32.784 203.288 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 581.9973 Tm (karyotype was trisomy 18)Tj 8.9195 0 0 8.9195 182.9312 584.8515 Tm (45)Tj 11.1493 0 0 11.1493 194.2767 581.9973 Tm (. Wong )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported three cases of alobar holoprocencephaly \(single ventricle an\ d fused thalami\) )Tj -14.098 -1.473 Td (at 10\22613 weeks; there was one case each of trisomy 18, triploidy and \ mosaic 18p deletion and duplication)Tj 8.9195 0 0 8.9195 636.6974 568.4262 Tm (46)Tj 11.1493 0 0 11.1493 648.0429 565.572 Tm (.)Tj -54.797 -1.937 Td (Snijders )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported on the sonographic features of 46 trisomy 13 fetuses at 10\226\ 14 weeks of gestation)Tj 8.9195 0 0 8.9195 633.1965 546.8244 Tm (47)Tj 11.1493 0 0 11.1493 644.5421 543.9702 Tm (. In 76% there was )Tj -54.483 -1.383 Td (increased nuchal translucency thickness, 64% were tachycardic, 24% had h\ oloprosencephaly and 10% had exomphalos. 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Another screening )Tj -53.87 -1.2 Td (study for fetal abnormalities at 12\22614 weeks of gestation, involving \ 1632 pregnancies, correctly identified the one case of )Tj T* (holoprosencephaly)Tj 8.9195 0 0 8.9195 141.5449 392.2755 Tm (35)Tj 11.1493 0 0 11.1493 152.8904 389.4213 Tm (.)Tj /TT2 1 Tf 9.4902 0 0 9.4902 156.9488 389.4213 Tm ( )Tj /TT0 1 Tf ( )Tj /TT5 1 Tf 11.1493 0 0 11.1493 37.098 364.3907 Tm (Iniencephaly)Tj /TT3 1 Tf 9.4902 0 0 9.4902 37.098 335.3022 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 37.098 321.04 Tm (This is a rare malformation of unknown etiology, characterized by )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 410.8225 321.04 Tm (cervical dysraphism and occipital \(inion\) defect with or )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 304.6171 Tm (without an encephalocele.)Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 283.0209 Tm (Sherer )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of iniencephaly in a 13-week fetus; there was a\ crania, persistently hyperextended head )Tj 0 -1.564 TD (and spinal dysraphism)Tj 8.9195 0 0 8.9195 162.8066 268.435 Tm (48)Tj 11.1493 0 0 11.1493 174.1522 265.5807 Tm (. After termination, pathological examination demonstrated complete cran\ iorachischisis with )Tj -12.293 -1.383 Td (hyperextended cervical vertebrae.)Tj /TT5 1 Tf 0 -2.865 TD (Spina bifida)Tj /TT0 1 Tf 0 -2.867 TD (In spina bifida, there is failure of closure of the neural tube, which n\ ormally occurs by the 6th week of gestation. In the spin)Tj (e of )Tj 0 -1.473 TD (normal fetuses, there are three ossification centers, two pedicles and t\ he spinal body, and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 548.691 169.8305 Tm (these are present from the 10th )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0939 153.4076 Tm (week of gestation, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 144.3948 153.4076 Tm (allowing ultrasonographic visualization of the neural canal from this ge\ station. Braithwaite )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. assessed )Tj -9.624 -1.473 Td (the fetal anatomy at 12\22613 weeks of gestation, by a combination of tr\ ansabdominal and transvaginal sonography, and they )Tj 0 -1.564 TD (reported successful examination of the vertebrae and overlying skin in b\ oth the transverse and coronal planes in all cases)Tj 8.9195 0 0 8.9195 722.9485 122.3988 Tm (49)Tj 11.1493 0 0 11.1493 734.2941 119.5446 Tm (.)Tj -62.533 -1.847 Td (In the 1980s, the main method of screening for open spina bifida was by \ maternal serum a-fetoprotein at around 16 weeks of )Tj 0 -1.473 TD (gestation and the method of diagnosis was amniocentesis and measurement \ of amniotic fluid a-fetoprotein and acetyl )Tj 0 -1.564 TD (cholinesterase. Although it was possible to diagnose the condition by ul\ trasonographic examination of the spine)Tj 8.9195 0 0 8.9195 664.8383 67.9463 Tm (50)Tj 11.1493 0 0 11.1493 676.1838 65.0921 Tm (, the )Tj -57.321 -1.473 Td (sensitivity of this test was low)Tj 8.9195 0 0 8.9195 206.0103 51.521 Tm (51)Tj 11.1493 0 0 11.1493 217.3558 48.6667 Tm (. However, the observation, that spina bifida was associated with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 587.9142 48.6667 Tm (scalloping of the frontal bones )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0939 32.2438 Tm (\(the \221lemon\222 sign\) )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 140.3253 32.2438 Tm (\()Tj 0 0 0.4 rg (Figure 11)Tj 0 0 0 rg (\), and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 236.0421 32.2438 Tm (caudal displacement of the cerebellum \(the \221banana\222 sign\))Tj 8.9195 0 0 8.9195 562.1976 35.0956 Tm (52)Tj 11.1493 0 0 11.1493 573.5432 32.2414 Tm (, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 581.5261 32.2414 Tm (has led to the replacement of )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(39 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2003 0 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scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 130.706 339.882 267.451 27.608 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 339.882 267.451 27.608 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 38.824 78.106 722.98 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 208.784317 135.0196075 376.1176453 cm /Im0 Do Q q 258.8235321 0 0 208.784317 406.784317 376.1176453 cm /Im1 Do Q 1 1 1 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 151.0539 350.0237 Tm (spine lombar sacral defect \(longitudinal\))Tj 27.554 0 Td (mielomeningocele \(coronal\) )Tj 0 0 0 rg /TT1 1 Tf -20.803 -2.863 Td (Figure 11)Tj /TT0 1 Tf ( - Case Spina bifida + lemmon sign - 13 + 6 weeks)Tj 9.4902 0 0 9.4902 37.098 295.7844 Tm ( )Tj 11.1493 0 0 11.1493 37.098 283.161 Tm (In the 1990s, improvements in the quality of ultrasound equipment have l\ ed to the diagnosis of spina bifida during the first )Tj 0 -1.473 TD (trimester of pregnancy. Blumenfeld )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described the evolution of the cranial and cerebellar signs of spina b\ ifida in an )Tj 0 -1.564 TD (affected fetus that was scanned at 10, 12 and 15 weeks of gestation)Tj 8.9195 0 0 8.9195 422.8869 252.1577 Tm (53)Tj 11.1493 0 0 11.1493 434.2324 249.3035 Tm (. In the first scan, there was a sacral irregularity but the )Tj -35.62 -1.383 Td (cerebellum appeared normal; at 12 weeks, the banana sign was detected an\ d, at 15 weeks, when the diagnosis of sacral )Tj 0 -1.473 TD (meningocele was made, the lemon sign was identified. Sebire )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described that, in three cases of lumbosacral spina bifida )Tj 0 -1.564 TD (diagnosed at 12\22614 weeks of gestation, there was an associated lemon \ sign)Tj 8.9195 0 0 8.9195 465.7894 202.8817 Tm (54)Tj 11.1493 0 0 11.1493 477.135 200.0275 Tm (. Similarly, Bernard and colleagues reported the )Tj -39.468 -1.473 Td (diagnosis of spina bifida in a 12-week fetus with narrowing of the front\ al bones and flattening of the occiput)Tj 8.9195 0 0 8.9195 644.7472 186.4564 Tm (55)Tj 11.1493 0 0 11.1493 656.0927 183.6022 Tm (.)Tj -55.519 -1.847 Td (These findings demonstrate that, )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 227.2349 163.0094 Tm (at least in some cases of spina bifida, the characteristic lemon and ban\ ana signs are present )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0947 146.5865 Tm (from the first trimester of pregnancy. However, the prevalence of these \ signs at the 11\22614-week scan remains to be )Tj 0 -1.473 TD (determined.)Tj 9.4902 0 0 9.4902 37.098 111.6879 Tm ( )Tj 1 1 0 rg /TT3 1 Tf 11.1493 0 0 11.1493 43.1373 93.0329 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 68.5175 Tm ( )Tj 11.1493 0 0 11.1493 37.098 56.5378 Tm (In a screening study involving ultrasound examinations at 11\22614 weeks\ of gestation and 18\22620 weeks in 3991 patients, there )Tj 0 -1.29 TD (were six cases of spina bifida \(including one with associated exencepha\ ly\) and five of these were diagnosed at the early scan)Tj 8.9195 0 0 8.9195 741.0773 45.006 Tm (26)Tj 11.1493 0 0 11.1493 752.4229 42.1518 Tm (. )Tj -64.159 -1.29 Td (In two other screening studies involving 1632 pregnancies at 12\22614 we\ eks)Tj 8.9195 0 0 8.9195 458.8546 30.62 Tm (35)Tj 11.1493 0 0 11.1493 470.2001 27.7658 Tm ( and 1473 pregnancies at 10\22614 weeks)Tj 8.9195 0 0 8.9195 691.6145 30.62 Tm (27)Tj 11.1493 0 0 11.1493 702.96 27.7658 Tm (, )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(41 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2082 0 obj<> endobj 2083 0 obj<>/Type/XObject/BBox[223.642 160.281 751.421 174.579]/FormType 1>>stream 1 1 0 rg 0.8411 w 227.2345 160.7017 m 224.0627 163.8736 224.0627 170.9869 227.2345 174.1588 c 747.8281 174.1588 l 751 170.9869 751 163.8736 747.8281 160.7017 c f endstream endobj 2084 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 527.779 14.2986]/FormType 1>>stream /Form Do endstream endobj 2085 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 527.779 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2086 0 obj<>>> endobj 2087 0 obj<>5]/P 208 0 R/S/Annot/Pg 671 0 R>> endobj 2088 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 130.706 339.882 267.451 27.608 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 339.882 267.451 27.608 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 38.824 78.106 722.98 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 208.784317 135.0196075 376.1176453 cm /Im0 Do Q q 258.8235321 0 0 208.784317 406.784317 376.1176453 cm /Im1 Do Q 1 1 1 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 151.0539 350.0237 Tm (spine lombar sacral defect \(longitudinal\))Tj 27.554 0 Td (mielomeningocele \(coronal\) )Tj 0 0 0 rg /TT1 1 Tf -20.803 -2.863 Td (Figure 11)Tj /TT0 1 Tf ( - Case Spina bifida + lemmon sign - 13 + 6 weeks)Tj 9.4902 0 0 9.4902 37.098 295.7844 Tm ( )Tj 11.1493 0 0 11.1493 37.098 283.161 Tm (In the 1990s, improvements in the quality of ultrasound equipment have l\ ed to the diagnosis of spina bifida during the first )Tj 0 -1.473 TD (trimester of pregnancy. Blumenfeld )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described the evolution of the cranial and cerebellar signs of spina b\ ifida in an )Tj 0 -1.564 TD (affected fetus that was scanned at 10, 12 and 15 weeks of gestation)Tj 8.9195 0 0 8.9195 422.8869 252.1577 Tm (53)Tj 11.1493 0 0 11.1493 434.2324 249.3035 Tm (. In the first scan, there was a sacral irregularity but the )Tj -35.62 -1.383 Td (cerebellum appeared normal; at 12 weeks, the banana sign was detected an\ d, at 15 weeks, when the diagnosis of sacral )Tj 0 -1.473 TD (meningocele was made, the lemon sign was identified. Sebire )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. described that, in three cases of lumbosacral spina bifida )Tj 0 -1.564 TD (diagnosed at 12\22614 weeks of gestation, there was an associated lemon \ sign)Tj 8.9195 0 0 8.9195 465.7894 202.8817 Tm (54)Tj 11.1493 0 0 11.1493 477.135 200.0275 Tm (. Similarly, Bernard and colleagues reported the )Tj -39.468 -1.473 Td (diagnosis of spina bifida in a 12-week fetus with narrowing of the front\ al bones and flattening of the occiput)Tj 8.9195 0 0 8.9195 644.7472 186.4564 Tm (55)Tj 11.1493 0 0 11.1493 656.0927 183.6022 Tm (.)Tj -55.519 -1.847 Td (These findings demonstrate that, )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 227.2349 163.0094 Tm (at least in some cases of spina bifida, the characteristic lemon and ban\ ana signs are present )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0947 146.5865 Tm (from the first trimester of pregnancy. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 251.5628 146.5865 Tm (However, the prevalence of these signs at the 11\22614-week scan remains\ to be )Tj -19.236 -1.473 Td (determined.)Tj 9.4902 0 0 9.4902 37.098 111.6879 Tm ( )Tj 1 1 0 rg /TT3 1 Tf 11.1493 0 0 11.1493 43.1373 93.0329 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 68.5175 Tm ( )Tj 11.1493 0 0 11.1493 37.098 56.5378 Tm (In a screening study involving ultrasound examinations at 11\22614 weeks\ of gestation and 18\22620 weeks in 3991 patients, there )Tj 0 -1.29 TD (were six cases of spina bifida \(including one with associated exencepha\ ly\) and five of these were diagnosed at the early scan)Tj 8.9195 0 0 8.9195 741.0773 45.006 Tm (26)Tj 11.1493 0 0 11.1493 752.4229 42.1518 Tm (. )Tj -64.159 -1.29 Td (In two other screening studies involving 1632 pregnancies at 12\22614 we\ eks)Tj 8.9195 0 0 8.9195 458.8546 30.62 Tm (35)Tj 11.1493 0 0 11.1493 470.2001 27.7658 Tm ( and 1473 pregnancies at 10\22614 weeks)Tj 8.9195 0 0 8.9195 691.6145 30.62 Tm (27)Tj 11.1493 0 0 11.1493 702.96 27.7658 Tm (, )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(41 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2089 0 obj<> endobj 2090 0 obj<>/Type/XObject/BBox[33.5022 143.858 251.231 158.156]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.0947 144.2788 m 33.9229 147.4506 33.9229 154.564 37.0947 157.7358 c 247.638 157.7358 l 250.8099 154.564 250.8099 147.4506 247.638 144.2788 c f endstream endobj 2091 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 217.729 14.2986]/FormType 1>>stream /Form Do endstream endobj 2092 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 217.729 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2093 0 obj<>>> endobj 2094 0 obj<>3]/P 208 0 R/S/Annot/Pg 682 0 R>> endobj 2095 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 552.575 735.059 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.6479 Tm (respectively, there were two cases of spina bifida \(one in each\) and t\ hese were not diagnosed in the first-trimester scan.)Tj 9.4902 0 0 9.4902 717.6861 583.6479 Tm ( )Tj 1 1 1 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 559.9234 Tm (CARDIAC DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.187 TD (Abnormalities of the heart and great arteries are the most common congen\ ital defects and the birth prevalence is )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 680.2342 535.5399 Tm (5\22610 per )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 519.117 Tm (1000. In general, about half are either lethal or require surgery and ha\ lf are asymptomatic. The first two groups are referred t)Tj (o )Tj 0 -1.473 TD (as major. Specialist echocardiography at around 20 weeks of gestation ca\ n identify most of the major cardiac defects, but the )Tj T* (main challenge in prenatal diagnosis is to identify the high-risk group \ for referral to specialist centers. Currently, screening)Tj ( is )Tj T* (based on examination of the four-chamber view of the heart at the 20-wee\ k scan, but this identifies only 26% of the major )Tj 0 -1.564 TD (cardiac defects)Tj 8.9195 0 0 8.9195 120.9744 455.2606 Tm (56)Tj 11.1493 0 0 11.1493 132.3199 452.4064 Tm (.)Tj -8.541 -1.937 Td (Examination of the four-chamber view of the heart can now be carried out\ at the 11\22614-week scan \()Tj 0 0 0.4 rg (Table 2)Tj 0 0 0 rg (\))Tj 8.9195 0 0 8.9195 650.4333 433.6588 Tm (57\22660)Tj 11.1493 0 0 11.1493 678.7972 430.8046 Tm (. At 12\22613 )Tj -57.555 -1.47 Td (weeks of gestation, the four-chamber view can be examined successfully b\ y transabdominal ultrasound in 76% of the cases and )Tj T* (transvaginally in 95%)Tj 8.9195 0 0 8.9195 159.7294 399.8345 Tm (49)Tj 11.1493 0 0 11.1493 171.075 396.9803 Tm (. Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported that the diameters of the two ventricles were similar and inc\ reased linearly )Tj -12.017 -1.383 Td (with gestation from about 1.5 mm at 11 weeks to 3 mm at 14 weeks; the di\ ameter of the heart was about one-third that of the )Tj T* (chest and the ratio did not change with gestation)Tj 8.9195 0 0 8.9195 313.4563 366.9838 Tm (58)Tj 11.1493 0 0 11.1493 324.8018 364.1296 Tm (. In contrast, Blaas )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. examined the ratio of the heart diameter to that of )Tj -25.805 -1.473 Td (the abdomen and reported a decrease with gestation from 51% at 8 weeks t\ o 42% at 12 weeks)Tj 8.9195 0 0 8.9195 577.3607 350.5585 Tm (11)Tj 11.1493 0 0 11.1493 588.7063 347.7043 Tm (.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 592.7646 347.7043 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 147.098 322.587 Tm (Table 2)Tj /TT0 1 Tf ( - Studies reporting on the proportion of cases where the four-chamber v\ iew of )Tj 0 -1.201 TD (the heart was successfully visualized by ultrasonography at 10\22614 wee\ ks of gestation)Tj ET 0.5 0.5 0.5 rg 147.098 291.517 m 147.098 293.242 l 653.529 293.242 l 652.667 292.38 l 147.961 292.38 l 147.961 292.38 l h f 0.875 0.875 0.875 rg 653.529 293.242 m 653.529 291.517 l 147.098 291.517 l 147.961 292.38 l 652.667 292.38 l 652.667 292.38 l h f 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 147.098 269.0863 Tm (Author)Tj 15.625 0 Td (10 weeks)Tj 6.953 0 Td (11 weeks)Tj 7.625 0 Td (12 weeks)Tj 6.604 0 Td (13 and 14 weeks)Tj ET 0.5 0.5 0.5 rg 147.098 250.961 m 147.098 252.687 l 653.529 252.687 l 652.667 251.824 l 147.961 251.824 l 147.961 251.824 l h f 0.875 0.875 0.875 rg 653.529 252.687 m 653.529 250.961 l 147.098 250.961 l 147.961 251.824 l 652.667 251.824 l 652.667 251.824 l h f 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 147.098 226.2298 Tm (Dolkart & Reimers 1991)Tj 8.9195 0 0 8.9195 281.7261 229.084 Tm ( 57)Tj 11.1493 0 0 11.1493 338.1507 226.7332 Tm (0/8)Tj 4.831 0 Td (3/10 \(30%\) )Tj 7.625 0 Td (9/10 \(90%\))Tj 7.885 0 Td (24/24 \(100%\) )Tj -37.476 -1.877 Td (Bronshetein et.al, 1992 )Tj 8.9195 0 0 8.9195 283.0417 208.6588 Tm (58)Tj 11.1493 0 0 11.1493 335.1181 206.308 Tm (-----)Tj 5.103 0 Td (3/18 \(16%\))Tj 7.625 0 Td (9/25 \(36%\))Tj 8.203 0 Td (66/72 \(90%\))Tj -37.794 -2.432 Td (Johnson et al. 1992 )Tj 8.9195 0 0 8.9195 261.6016 182.0474 Tm (59)Tj 11.1493 0 0 11.1493 332.6429 186.3862 Tm (7/26 )Tj -0.271 -1.2 Td (\(27%\) )Tj 6.906 1.2 Td (19/33 )Tj 0.047 -1.2 Td (\(58%\) )Tj 5.95 0.6 Td (36/51 \(71%\) )Tj 8.203 0 Td (73/100 \(73%\) )Tj -37.476 -2.987 Td (Gembruch et al. 1993)Tj 8.9195 0 0 8.9195 269.8521 149.2498 Tm (60)Tj 11.1493 0 0 11.1493 281.1976 146.3956 Tm ( )Tj 4.836 0.045 Td (-----)Tj 6.413 0.6 Td (12/15 )Tj 0.047 -1.2 Td (\(80%\) )Tj 5.95 0.6 Td (28/30 \(93%\) )Tj 8.203 0 Td (66/66 \(100%\) )Tj ET 0.5 0.5 0.5 rg 147.098 123.378 m 147.098 125.104 l 653.529 125.104 l 652.667 124.241 l 147.961 124.241 l 147.961 124.241 l h f 0.875 0.875 0.875 rg 653.529 125.104 m 653.529 123.378 l 147.098 123.378 l 147.961 124.241 l 652.667 124.241 l 652.667 124.241 l h f 0 0 0 rg BT /TT0 1 Tf 9.4902 0 0 9.4902 37.098 105.1629 Tm ( )Tj 11.1493 0 0 11.1493 37.098 92.5394 Tm (Dolkart and Reimers reported that the earliest defined cardiac structure\ s visible were the mitral and tricuspid valves; at 10 )Tj 0 -1.564 TD (weeks, they were seen in 25% of the cases, at 12 weeks in 90% and at 13\226\ 14 weeks in all cases)Tj 8.9195 0 0 8.9195 584.552 77.9615 Tm (57)Tj 11.1493 0 0 11.1493 595.8976 75.1073 Tm (. The five-chamber, aortic )Tj -50.12 -1.383 Td (arch and ductus arteriosus views were first seen in some fetuses from 12\ weeks but, in the majority, only at 14 weeks. The )Tj 0 -1.473 TD (aortic root in short-axis projection and the left ventricle in long-axis\ view could be imaged in 70% and 40% of fetuses, )Tj 0 -1.564 TD (respectively by 12 weeks. Aortic and pulmonary valves were first visuali\ zed at 12 weeks in 20% of the cases)Tj 8.9195 0 0 8.9195 649.4634 28.6855 Tm (57)Tj 11.1493 0 0 11.1493 660.8089 25.8313 Tm (. Johnson )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(42 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2096 0 obj<> endobj 2097 0 obj<>/Type/XObject/BBox[676.641 532.811 734.466 547.11]/FormType 1>>stream 1 1 0 rg 0.8411 w 680.2334 533.2321 m 677.0616 536.404 677.0616 543.5173 680.2334 546.6891 c 730.8736 546.6891 l 734.0455 543.5173 734.0455 536.404 730.8736 533.2321 c f endstream endobj 2098 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 57.8254 14.2986]/FormType 1>>stream /Form Do endstream endobj 2099 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 57.8257 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2100 0 obj<>>> endobj 2101 0 obj<>5]/P 208 0 R/S/Annot/Pg 682 0 R>> endobj 2102 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 552.575 735.059 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.6479 Tm (respectively, there were two cases of spina bifida \(one in each\) and t\ hese were not diagnosed in the first-trimester scan.)Tj 9.4902 0 0 9.4902 717.6861 583.6479 Tm ( )Tj 1 1 1 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 559.9234 Tm (CARDIAC DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.187 TD (Abnormalities of the heart and great arteries are the most common congen\ ital defects and the birth prevalence is )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 680.2342 535.5399 Tm (5\22610 per )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 519.117 Tm (1000. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 73.4447 519.117 Tm (In general, about half are either lethal or require surgery and half are\ asymptomatic. The first two groups are referred to )Tj -3.26 -1.473 Td (as major. Specialist echocardiography at around 20 weeks of gestation ca\ n identify most of the major cardiac defects, but the )Tj 0 -1.473 TD (main challenge in prenatal diagnosis is to identify the high-risk group \ for referral to specialist centers. Currently, screening)Tj ( is )Tj T* (based on examination of the four-chamber view of the heart at the 20-wee\ k scan, but this identifies only 26% of the major )Tj 0 -1.564 TD (cardiac defects)Tj 8.9195 0 0 8.9195 120.9744 455.2606 Tm (56)Tj 11.1493 0 0 11.1493 132.3199 452.4064 Tm (.)Tj -8.541 -1.937 Td (Examination of the four-chamber view of the heart can now be carried out\ at the 11\22614-week scan \()Tj 0 0 0.4 rg (Table 2)Tj 0 0 0 rg (\))Tj 8.9195 0 0 8.9195 650.4333 433.6588 Tm (57\22660)Tj 11.1493 0 0 11.1493 678.7972 430.8046 Tm (. At 12\22613 )Tj -57.555 -1.47 Td (weeks of gestation, the four-chamber view can be examined successfully b\ y transabdominal ultrasound in 76% of the cases and )Tj T* (transvaginally in 95%)Tj 8.9195 0 0 8.9195 159.7294 399.8345 Tm (49)Tj 11.1493 0 0 11.1493 171.075 396.9803 Tm (. Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported that the diameters of the two ventricles were similar and inc\ reased linearly )Tj -12.017 -1.383 Td (with gestation from about 1.5 mm at 11 weeks to 3 mm at 14 weeks; the di\ ameter of the heart was about one-third that of the )Tj T* (chest and the ratio did not change with gestation)Tj 8.9195 0 0 8.9195 313.4563 366.9838 Tm (58)Tj 11.1493 0 0 11.1493 324.8018 364.1296 Tm (. In contrast, Blaas )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. examined the ratio of the heart diameter to that of )Tj -25.805 -1.473 Td (the abdomen and reported a decrease with gestation from 51% at 8 weeks t\ o 42% at 12 weeks)Tj 8.9195 0 0 8.9195 577.3607 350.5585 Tm (11)Tj 11.1493 0 0 11.1493 588.7063 347.7043 Tm (.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 592.7646 347.7043 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 147.098 322.587 Tm (Table 2)Tj /TT0 1 Tf ( - Studies reporting on the proportion of cases where the four-chamber v\ iew of )Tj 0 -1.201 TD (the heart was successfully visualized by ultrasonography at 10\22614 wee\ ks of gestation)Tj ET 0.5 0.5 0.5 rg 147.098 291.517 m 147.098 293.242 l 653.529 293.242 l 652.667 292.38 l 147.961 292.38 l 147.961 292.38 l h f 0.875 0.875 0.875 rg 653.529 293.242 m 653.529 291.517 l 147.098 291.517 l 147.961 292.38 l 652.667 292.38 l 652.667 292.38 l h f 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 147.098 269.0863 Tm (Author)Tj 15.625 0 Td (10 weeks)Tj 6.953 0 Td (11 weeks)Tj 7.625 0 Td (12 weeks)Tj 6.604 0 Td (13 and 14 weeks)Tj ET 0.5 0.5 0.5 rg 147.098 250.961 m 147.098 252.687 l 653.529 252.687 l 652.667 251.824 l 147.961 251.824 l 147.961 251.824 l h f 0.875 0.875 0.875 rg 653.529 252.687 m 653.529 250.961 l 147.098 250.961 l 147.961 251.824 l 652.667 251.824 l 652.667 251.824 l h f 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 147.098 226.2298 Tm (Dolkart & Reimers 1991)Tj 8.9195 0 0 8.9195 281.7261 229.084 Tm ( 57)Tj 11.1493 0 0 11.1493 338.1507 226.7332 Tm (0/8)Tj 4.831 0 Td (3/10 \(30%\) )Tj 7.625 0 Td (9/10 \(90%\))Tj 7.885 0 Td (24/24 \(100%\) )Tj -37.476 -1.877 Td (Bronshetein et.al, 1992 )Tj 8.9195 0 0 8.9195 283.0417 208.6588 Tm (58)Tj 11.1493 0 0 11.1493 335.1181 206.308 Tm (-----)Tj 5.103 0 Td (3/18 \(16%\))Tj 7.625 0 Td (9/25 \(36%\))Tj 8.203 0 Td (66/72 \(90%\))Tj -37.794 -2.432 Td (Johnson et al. 1992 )Tj 8.9195 0 0 8.9195 261.6016 182.0474 Tm (59)Tj 11.1493 0 0 11.1493 332.6429 186.3862 Tm (7/26 )Tj -0.271 -1.2 Td (\(27%\) )Tj 6.906 1.2 Td (19/33 )Tj 0.047 -1.2 Td (\(58%\) )Tj 5.95 0.6 Td (36/51 \(71%\) )Tj 8.203 0 Td (73/100 \(73%\) )Tj -37.476 -2.987 Td (Gembruch et al. 1993)Tj 8.9195 0 0 8.9195 269.8521 149.2498 Tm (60)Tj 11.1493 0 0 11.1493 281.1976 146.3956 Tm ( )Tj 4.836 0.045 Td (-----)Tj 6.413 0.6 Td (12/15 )Tj 0.047 -1.2 Td (\(80%\) )Tj 5.95 0.6 Td (28/30 \(93%\) )Tj 8.203 0 Td (66/66 \(100%\) )Tj ET 0.5 0.5 0.5 rg 147.098 123.378 m 147.098 125.104 l 653.529 125.104 l 652.667 124.241 l 147.961 124.241 l 147.961 124.241 l h f 0.875 0.875 0.875 rg 653.529 125.104 m 653.529 123.378 l 147.098 123.378 l 147.961 124.241 l 652.667 124.241 l 652.667 124.241 l h f 0 0 0 rg BT /TT0 1 Tf 9.4902 0 0 9.4902 37.098 105.1629 Tm ( )Tj 11.1493 0 0 11.1493 37.098 92.5394 Tm (Dolkart and Reimers reported that the earliest defined cardiac structure\ s visible were the mitral and tricuspid valves; at 10 )Tj 0 -1.564 TD (weeks, they were seen in 25% of the cases, at 12 weeks in 90% and at 13\226\ 14 weeks in all cases)Tj 8.9195 0 0 8.9195 584.552 77.9615 Tm (57)Tj 11.1493 0 0 11.1493 595.8976 75.1073 Tm (. The five-chamber, aortic )Tj -50.12 -1.383 Td (arch and ductus arteriosus views were first seen in some fetuses from 12\ weeks but, in the majority, only at 14 weeks. The )Tj 0 -1.473 TD (aortic root in short-axis projection and the left ventricle in long-axis\ view could be imaged in 70% and 40% of fetuses, )Tj 0 -1.564 TD (respectively by 12 weeks. Aortic and pulmonary valves were first visuali\ zed at 12 weeks in 20% of the cases)Tj 8.9195 0 0 8.9195 649.4634 28.6855 Tm (57)Tj 11.1493 0 0 11.1493 660.8089 25.8313 Tm (. Johnson )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(42 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2103 0 obj<> endobj 2104 0 obj<>/Type/XObject/BBox[33.5055 516.389 69.0544 530.687]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.098 516.8093 m 33.9262 519.9811 33.9262 527.0945 37.098 530.2663 c 65.4619 530.2663 l 68.6338 527.0945 68.6338 519.9811 65.4619 516.8093 c f endstream endobj 2105 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 35.5491 14.2986]/FormType 1>>stream /Form Do endstream endobj 2106 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 35.5494 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2107 0 obj<>>> endobj 2108 0 obj<>8]/P 208 0 R/S/Annot/Pg 682 0 R>> endobj 2109 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 552.575 735.059 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.6479 Tm (respectively, there were two cases of spina bifida \(one in each\) and t\ hese were not diagnosed in the first-trimester scan.)Tj 9.4902 0 0 9.4902 717.6861 583.6479 Tm ( )Tj 1 1 1 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 559.9234 Tm (CARDIAC DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.187 TD (Abnormalities of the heart and great arteries are the most common congen\ ital defects and the birth prevalence is )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 680.2342 535.5399 Tm (5\22610 per )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 519.117 Tm (1000. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 73.4447 519.117 Tm (In general, )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 138.9135 519.117 Tm (about half are either lethal or require surgery )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 398.4582 519.117 Tm (and half are asymptomatic. The first two groups are referred to )Tj -32.411 -1.473 Td (as major. Specialist echocardiography at around 20 weeks of gestation ca\ n identify most of the major cardiac defects, but the )Tj 0 -1.473 TD (main challenge in prenatal diagnosis is to identify the high-risk group \ for referral to specialist centers. Currently, screening)Tj ( is )Tj T* (based on examination of the four-chamber view of the heart at the 20-wee\ k scan, but this identifies only 26% of the major )Tj 0 -1.564 TD (cardiac defects)Tj 8.9195 0 0 8.9195 120.9744 455.2606 Tm (56)Tj 11.1493 0 0 11.1493 132.3199 452.4064 Tm (.)Tj -8.541 -1.937 Td (Examination of the four-chamber view of the heart can now be carried out\ at the 11\22614-week scan \()Tj 0 0 0.4 rg (Table 2)Tj 0 0 0 rg (\))Tj 8.9195 0 0 8.9195 650.4333 433.6588 Tm (57\22660)Tj 11.1493 0 0 11.1493 678.7972 430.8046 Tm (. At 12\22613 )Tj -57.555 -1.47 Td (weeks of gestation, the four-chamber view can be examined successfully b\ y transabdominal ultrasound in 76% of the cases and )Tj T* (transvaginally in 95%)Tj 8.9195 0 0 8.9195 159.7294 399.8345 Tm (49)Tj 11.1493 0 0 11.1493 171.075 396.9803 Tm (. Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported that the diameters of the two ventricles were similar and inc\ reased linearly )Tj -12.017 -1.383 Td (with gestation from about 1.5 mm at 11 weeks to 3 mm at 14 weeks; the di\ ameter of the heart was about one-third that of the )Tj T* (chest and the ratio did not change with gestation)Tj 8.9195 0 0 8.9195 313.4563 366.9838 Tm (58)Tj 11.1493 0 0 11.1493 324.8018 364.1296 Tm (. In contrast, Blaas )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. examined the ratio of the heart diameter to that of )Tj -25.805 -1.473 Td (the abdomen and reported a decrease with gestation from 51% at 8 weeks t\ o 42% at 12 weeks)Tj 8.9195 0 0 8.9195 577.3607 350.5585 Tm (11)Tj 11.1493 0 0 11.1493 588.7063 347.7043 Tm (.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 592.7646 347.7043 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 147.098 322.587 Tm (Table 2)Tj /TT0 1 Tf ( - Studies reporting on the proportion of cases where the four-chamber v\ iew of )Tj 0 -1.201 TD (the heart was successfully visualized by ultrasonography at 10\22614 wee\ ks of gestation)Tj ET 0.5 0.5 0.5 rg 147.098 291.517 m 147.098 293.242 l 653.529 293.242 l 652.667 292.38 l 147.961 292.38 l 147.961 292.38 l h f 0.875 0.875 0.875 rg 653.529 293.242 m 653.529 291.517 l 147.098 291.517 l 147.961 292.38 l 652.667 292.38 l 652.667 292.38 l h f 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 147.098 269.0863 Tm (Author)Tj 15.625 0 Td (10 weeks)Tj 6.953 0 Td (11 weeks)Tj 7.625 0 Td (12 weeks)Tj 6.604 0 Td (13 and 14 weeks)Tj ET 0.5 0.5 0.5 rg 147.098 250.961 m 147.098 252.687 l 653.529 252.687 l 652.667 251.824 l 147.961 251.824 l 147.961 251.824 l h f 0.875 0.875 0.875 rg 653.529 252.687 m 653.529 250.961 l 147.098 250.961 l 147.961 251.824 l 652.667 251.824 l 652.667 251.824 l h f 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 147.098 226.2298 Tm (Dolkart & Reimers 1991)Tj 8.9195 0 0 8.9195 281.7261 229.084 Tm ( 57)Tj 11.1493 0 0 11.1493 338.1507 226.7332 Tm (0/8)Tj 4.831 0 Td (3/10 \(30%\) )Tj 7.625 0 Td (9/10 \(90%\))Tj 7.885 0 Td (24/24 \(100%\) )Tj -37.476 -1.877 Td (Bronshetein et.al, 1992 )Tj 8.9195 0 0 8.9195 283.0417 208.6588 Tm (58)Tj 11.1493 0 0 11.1493 335.1181 206.308 Tm (-----)Tj 5.103 0 Td (3/18 \(16%\))Tj 7.625 0 Td (9/25 \(36%\))Tj 8.203 0 Td (66/72 \(90%\))Tj -37.794 -2.432 Td (Johnson et al. 1992 )Tj 8.9195 0 0 8.9195 261.6016 182.0474 Tm (59)Tj 11.1493 0 0 11.1493 332.6429 186.3862 Tm (7/26 )Tj -0.271 -1.2 Td (\(27%\) )Tj 6.906 1.2 Td (19/33 )Tj 0.047 -1.2 Td (\(58%\) )Tj 5.95 0.6 Td (36/51 \(71%\) )Tj 8.203 0 Td (73/100 \(73%\) )Tj -37.476 -2.987 Td (Gembruch et al. 1993)Tj 8.9195 0 0 8.9195 269.8521 149.2498 Tm (60)Tj 11.1493 0 0 11.1493 281.1976 146.3956 Tm ( )Tj 4.836 0.045 Td (-----)Tj 6.413 0.6 Td (12/15 )Tj 0.047 -1.2 Td (\(80%\) )Tj 5.95 0.6 Td (28/30 \(93%\) )Tj 8.203 0 Td (66/66 \(100%\) )Tj ET 0.5 0.5 0.5 rg 147.098 123.378 m 147.098 125.104 l 653.529 125.104 l 652.667 124.241 l 147.961 124.241 l 147.961 124.241 l h f 0.875 0.875 0.875 rg 653.529 125.104 m 653.529 123.378 l 147.098 123.378 l 147.961 124.241 l 652.667 124.241 l 652.667 124.241 l h f 0 0 0 rg BT /TT0 1 Tf 9.4902 0 0 9.4902 37.098 105.1629 Tm ( )Tj 11.1493 0 0 11.1493 37.098 92.5394 Tm (Dolkart and Reimers reported that the earliest defined cardiac structure\ s visible were the mitral and tricuspid valves; at 10 )Tj 0 -1.564 TD (weeks, they were seen in 25% of the cases, at 12 weeks in 90% and at 13\226\ 14 weeks in all cases)Tj 8.9195 0 0 8.9195 584.552 77.9615 Tm (57)Tj 11.1493 0 0 11.1493 595.8976 75.1073 Tm (. The five-chamber, aortic )Tj -50.12 -1.383 Td (arch and ductus arteriosus views were first seen in some fetuses from 12\ weeks but, in the majority, only at 14 weeks. The )Tj 0 -1.473 TD (aortic root in short-axis projection and the left ventricle in long-axis\ view could be imaged in 70% and 40% of fetuses, )Tj 0 -1.564 TD (respectively by 12 weeks. Aortic and pulmonary valves were first visuali\ zed at 12 weeks in 20% of the cases)Tj 8.9195 0 0 8.9195 649.4634 28.6855 Tm (57)Tj 11.1493 0 0 11.1493 660.8089 25.8313 Tm (. Johnson )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(42 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2110 0 obj<> endobj 2111 0 obj<>/Type/XObject/BBox[135.321 516.389 398.126 530.687]/FormType 1>>stream 1 1 0 rg 0.8411 w 138.9134 516.8093 m 135.7415 519.9811 135.7415 527.0945 138.9134 530.2663 c 394.533 530.2663 l 397.7049 527.0945 397.7049 519.9811 394.533 516.8093 c f endstream endobj 2112 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 262.805 14.2986]/FormType 1>>stream /Form Do endstream endobj 2113 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 262.805 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2114 0 obj<>>> endobj 2115 0 obj<>11]/P 208 0 R/S/Annot/Pg 682 0 R>> endobj 2116 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 552.575 735.059 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.6479 Tm (respectively, there were two cases of spina bifida \(one in each\) and t\ hese were not diagnosed in the first-trimester scan.)Tj 9.4902 0 0 9.4902 717.6861 583.6479 Tm ( )Tj 1 1 1 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 559.9234 Tm (CARDIAC DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.187 TD (Abnormalities of the heart and great arteries are the most common congen\ ital defects and the birth prevalence is )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 680.2342 535.5399 Tm (5\22610 per )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 519.117 Tm (1000. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 73.4447 519.117 Tm (In general, )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 138.9135 519.117 Tm (about half are either lethal or require surgery )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 398.4582 519.117 Tm (and )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 423.087 519.117 Tm (half are asymptomatic. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 556.6334 519.117 Tm (The first two groups are referred to )Tj -46.598 -1.473 Td (as major. Specialist echocardiography at around 20 weeks of gestation ca\ n identify most of the major cardiac defects, but the )Tj 0 -1.473 TD (main challenge in prenatal diagnosis is to identify the high-risk group \ for referral to specialist centers. Currently, screening)Tj ( is )Tj T* (based on examination of the four-chamber view of the heart at the 20-wee\ k scan, but this identifies only 26% of the major )Tj 0 -1.564 TD (cardiac defects)Tj 8.9195 0 0 8.9195 120.9744 455.2606 Tm (56)Tj 11.1493 0 0 11.1493 132.3199 452.4064 Tm (.)Tj -8.541 -1.937 Td (Examination of the four-chamber view of the heart can now be carried out\ at the 11\22614-week scan \()Tj 0 0 0.4 rg (Table 2)Tj 0 0 0 rg (\))Tj 8.9195 0 0 8.9195 650.4333 433.6588 Tm (57\22660)Tj 11.1493 0 0 11.1493 678.7972 430.8046 Tm (. At 12\22613 )Tj -57.555 -1.47 Td (weeks of gestation, the four-chamber view can be examined successfully b\ y transabdominal ultrasound in 76% of the cases and )Tj T* (transvaginally in 95%)Tj 8.9195 0 0 8.9195 159.7294 399.8345 Tm (49)Tj 11.1493 0 0 11.1493 171.075 396.9803 Tm (. Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported that the diameters of the two ventricles were similar and inc\ reased linearly )Tj -12.017 -1.383 Td (with gestation from about 1.5 mm at 11 weeks to 3 mm at 14 weeks; the di\ ameter of the heart was about one-third that of the )Tj T* (chest and the ratio did not change with gestation)Tj 8.9195 0 0 8.9195 313.4563 366.9838 Tm (58)Tj 11.1493 0 0 11.1493 324.8018 364.1296 Tm (. In contrast, Blaas )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. examined the ratio of the heart diameter to that of )Tj -25.805 -1.473 Td (the abdomen and reported a decrease with gestation from 51% at 8 weeks t\ o 42% at 12 weeks)Tj 8.9195 0 0 8.9195 577.3607 350.5585 Tm (11)Tj 11.1493 0 0 11.1493 588.7063 347.7043 Tm (.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 592.7646 347.7043 Tm ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 147.098 322.587 Tm (Table 2)Tj /TT0 1 Tf ( - Studies reporting on the proportion of cases where the four-chamber v\ iew of )Tj 0 -1.201 TD (the heart was successfully visualized by ultrasonography at 10\22614 wee\ ks of gestation)Tj ET 0.5 0.5 0.5 rg 147.098 291.517 m 147.098 293.242 l 653.529 293.242 l 652.667 292.38 l 147.961 292.38 l 147.961 292.38 l h f 0.875 0.875 0.875 rg 653.529 293.242 m 653.529 291.517 l 147.098 291.517 l 147.961 292.38 l 652.667 292.38 l 652.667 292.38 l h f 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 147.098 269.0863 Tm (Author)Tj 15.625 0 Td (10 weeks)Tj 6.953 0 Td (11 weeks)Tj 7.625 0 Td (12 weeks)Tj 6.604 0 Td (13 and 14 weeks)Tj ET 0.5 0.5 0.5 rg 147.098 250.961 m 147.098 252.687 l 653.529 252.687 l 652.667 251.824 l 147.961 251.824 l 147.961 251.824 l h f 0.875 0.875 0.875 rg 653.529 252.687 m 653.529 250.961 l 147.098 250.961 l 147.961 251.824 l 652.667 251.824 l 652.667 251.824 l h f 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 147.098 226.2298 Tm (Dolkart & Reimers 1991)Tj 8.9195 0 0 8.9195 281.7261 229.084 Tm ( 57)Tj 11.1493 0 0 11.1493 338.1507 226.7332 Tm (0/8)Tj 4.831 0 Td (3/10 \(30%\) )Tj 7.625 0 Td (9/10 \(90%\))Tj 7.885 0 Td (24/24 \(100%\) )Tj -37.476 -1.877 Td (Bronshetein et.al, 1992 )Tj 8.9195 0 0 8.9195 283.0417 208.6588 Tm (58)Tj 11.1493 0 0 11.1493 335.1181 206.308 Tm (-----)Tj 5.103 0 Td (3/18 \(16%\))Tj 7.625 0 Td (9/25 \(36%\))Tj 8.203 0 Td (66/72 \(90%\))Tj -37.794 -2.432 Td (Johnson et al. 1992 )Tj 8.9195 0 0 8.9195 261.6016 182.0474 Tm (59)Tj 11.1493 0 0 11.1493 332.6429 186.3862 Tm (7/26 )Tj -0.271 -1.2 Td (\(27%\) )Tj 6.906 1.2 Td (19/33 )Tj 0.047 -1.2 Td (\(58%\) )Tj 5.95 0.6 Td (36/51 \(71%\) )Tj 8.203 0 Td (73/100 \(73%\) )Tj -37.476 -2.987 Td (Gembruch et al. 1993)Tj 8.9195 0 0 8.9195 269.8521 149.2498 Tm (60)Tj 11.1493 0 0 11.1493 281.1976 146.3956 Tm ( )Tj 4.836 0.045 Td (-----)Tj 6.413 0.6 Td (12/15 )Tj 0.047 -1.2 Td (\(80%\) )Tj 5.95 0.6 Td (28/30 \(93%\) )Tj 8.203 0 Td (66/66 \(100%\) )Tj ET 0.5 0.5 0.5 rg 147.098 123.378 m 147.098 125.104 l 653.529 125.104 l 652.667 124.241 l 147.961 124.241 l 147.961 124.241 l h f 0.875 0.875 0.875 rg 653.529 125.104 m 653.529 123.378 l 147.098 123.378 l 147.961 124.241 l 652.667 124.241 l 652.667 124.241 l h f 0 0 0 rg BT /TT0 1 Tf 9.4902 0 0 9.4902 37.098 105.1629 Tm ( )Tj 11.1493 0 0 11.1493 37.098 92.5394 Tm (Dolkart and Reimers reported that the earliest defined cardiac structure\ s visible were the mitral and tricuspid valves; at 10 )Tj 0 -1.564 TD (weeks, they were seen in 25% of the cases, at 12 weeks in 90% and at 13\226\ 14 weeks in all cases)Tj 8.9195 0 0 8.9195 584.552 77.9615 Tm (57)Tj 11.1493 0 0 11.1493 595.8976 75.1073 Tm (. The five-chamber, aortic )Tj -50.12 -1.383 Td (arch and ductus arteriosus views were first seen in some fetuses from 12\ weeks but, in the majority, only at 14 weeks. The )Tj 0 -1.473 TD (aortic root in short-axis projection and the left ventricle in long-axis\ view could be imaged in 70% and 40% of fetuses, )Tj 0 -1.564 TD (respectively by 12 weeks. Aortic and pulmonary valves were first visuali\ zed at 12 weeks in 20% of the cases)Tj 8.9195 0 0 8.9195 649.4634 28.6855 Tm (57)Tj 11.1493 0 0 11.1493 660.8089 25.8313 Tm (. Johnson )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(42 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2117 0 obj<> endobj 2118 0 obj<>/Type/XObject/BBox[419.494 516.389 556.301 530.687]/FormType 1>>stream 1 1 0 rg 0.8411 w 423.087 516.8093 m 419.9152 519.9811 419.9152 527.0945 423.087 530.2663 c 552.7087 530.2663 l 555.8806 527.0945 555.8806 519.9811 552.7087 516.8093 c f endstream endobj 2119 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 136.807 14.2986]/FormType 1>>stream /Form Do endstream endobj 2120 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 136.807 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2121 0 obj<>/Encoding<>>>>> endobj 2122 0 obj<> endobj 2123 0 obj<> endobj 2124 0 obj<> endobj 2125 0 obj<>>> endobj 2126 0 obj[2125 0 R 2129 0 R 2133 0 R 2136 0 R 2146 0 R 2153 0 R] endobj 2127 0 obj<>3]/P 208 0 R/S/Annot/Pg 701 0 R>> endobj 2128 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 170.842 722.98 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 579.8367 Tm (Gembruch )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the results of ultrasound screening in 15 fetuses at 11 weeks\ , 30 at 12 weeks, 51 at 13 weeks and 11 )Tj 0 -1.564 TD (at 14 weeks)Tj 8.9195 0 0 8.9195 105.042 565.2588 Tm (60)Tj 11.1493 0 0 11.1493 116.3876 562.4046 Tm (. There were ten fetuses with cardiac anomalies and, in nine of these, t\ he diagnosis was correctly made at the 11\226)Tj -7.112 -1.383 Td (14-week scan; in one case, complete atrioventricular septal defect with \ double- outlet right ventricle was not detected at 12 )Tj 0 -1.473 TD (weeks but was correctly diagnosed at 21 weeks. The defects identified we\ re: five cases with complete atrioventricular septal )Tj T* (defect, including one with dextrocardia and two with atrioventricular he\ art block; there was one case of single ventricle and )Tj T* (common atrium that was subsequently, at the 20-week scan, also found to \ have dextrocardia, malposition of the great arteries )Tj T* (and situs inversus visceralis; one case of perimembranous ventricular se\ ptal defect; one case with suspected single ventricle )Tj 0 -1.473 TD (and hypoplasia of the aorta that was subsequently found at postmortem ex\ amination to have hypoplastic left heart, hypoplasia )Tj 0 -1.473 TD (of the ascending aorta and the aortic arch, right-sided isomerism of the\ atria and asplenia; one case of hypoplastic left heart,)Tj ( )Tj T* (hypoplastic aorta and left ventricular endocardial fibroelastosis. In ei\ ght of the ten cases with cardiac defects, there was )Tj T* (increased nuchal translucency thickness; the fetal karyotype was normal \ in six cases, trisomy 21 in two, trisomy 18 in one and )Tj 0 -1.564 TD (Turner syndrome in one)Tj 8.9195 0 0 8.9195 172.0383 401.0054 Tm (60)Tj 11.1493 0 0 11.1493 183.3838 398.1512 Tm (.)Tj -13.121 -1.689 Td ( )Tj 0 -1.158 TD (In a study of 29 154 chromosomally normal, singleton pregnancies, 56% of\ major abnormalities of the heart and great arteries )Tj 0 -1.564 TD (were found in the subgroup with nuchal translucency above the 95th centi\ le)Tj 8.9195 0 0 8.9195 464.8529 351.8289 Tm (66)Tj 11.1493 0 0 11.1493 476.1985 348.9747 Tm (. Therefore, measurement of nuchal translucency )Tj -39.384 -1.383 Td (thickness at 11\22614 weeks may constitute the most effective method of \ screening for cardiac defects.)Tj 0 -1.937 TD (In patients with increased nuchal translucency, it is now possible to un\ dertake detailed cardiac scanning in early pregnancy. A )Tj 0 -1.473 TD (specialist scan from 14 weeks can effectively reassure the majority of p\ arents that there is no major cardiac defect. In the )Tj T* (cases with a major defect, the early scan can either lead to the correct\ diagnosis or at least raise suspicions so that follow-u)Tj (p )Tj T* (scans are carried out. The scans can be performed either transvaginally \ or transabdominally. However, more important than )Tj 0 -1.473 TD (the actual route for such a scan is the need to use high-quality equipme\ nt and, in particular, with facilities for color Doppler)Tj ( )Tj 0 -1.473 TD (examination. At 14 weeks, the gray scale alone is not sufficient for acc\ urate examination of the heart and it is necessary also )Tj (to )Tj T* (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 0 rg /TT2 1 Tf 0.542 -2.478 Td (Screening studies \226 relation to nuchal translucency thickness)Tj 0 0 0 rg /TT0 1 Tf -0.542 -2.322 Td ( )Tj 0 -1.158 TD (In a study of 29 154 chromosomally normal, singleton pregnancies, )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 422.1132 146.994 Tm (56% of major abnormalities of the heart and great arteries )Tj 11.1493 0 0 11.1493 476.1985 348.9747 Tm -39.384 -19.68 Td (were found in the subgroup with nuchal translucency above the 95th centi\ le)Tj 8.9195 0 0 8.9195 464.8529 132.393 Tm (66)Tj 11.1493 0 0 11.1493 476.1985 129.5388 Tm (. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 484.1814 129.5388 Tm (Therefore, measurement of nuchal translucency )Tj -40.1 -1.383 Td (thickness at 11\22614 weeks may constitute the most effective method of \ screening for cardiac defects.)Tj 0 -1.937 TD (In patients with increased nuchal translucency, it is now possible to un\ dertake detailed cardiac scanning in early pregnancy. A )Tj 0 -1.473 TD (specialist scan from 14 weeks can effectively reassure the majority of p\ arents that there is no major cardiac defect. In the )Tj T* (cases with a major defect, the early scan can either lead to the correct\ diagnosis or at least raise suspicions so that follow-u)Tj (p )Tj T* (scans are carried out. The scans can be performed either transvaginally \ or transabdominally. However, more important than )Tj 0 -1.473 TD (the actual route for such a scan is the need to use high-quality equipme\ nt and, in particular, with facilities for color Doppler)Tj ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(46 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2129 0 obj<> endobj 2130 0 obj<>/Type/XObject/BBox[33.4824 126.791 757.865 158.564]/FormType 1>>stream HDm0 {M y MҸ8lO8D!!s1E\"$ص~KXDE I / fXُz}7K{93}Oc}h >$PB3Mb W4 8#9'z14+0:/Cd? aDtxwnݯ@K endstream endobj 2131 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 724.383 31.7733]/FormType 1>>stream /Form Do endstream endobj 2132 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 724.383 31.7736]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2133 0 obj<>>> endobj 2134 0 obj<>6]/P 208 0 R/S/Annot/Pg 701 0 R>> endobj 2135 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 170.842 722.98 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 579.8367 Tm (Gembruch )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported the results of ultrasound screening in 15 fetuses at 11 weeks\ , 30 at 12 weeks, 51 at 13 weeks and 11 )Tj 0 -1.564 TD (at 14 weeks)Tj 8.9195 0 0 8.9195 105.042 565.2588 Tm (60)Tj 11.1493 0 0 11.1493 116.3876 562.4046 Tm (. There were ten fetuses with cardiac anomalies and, in nine of these, t\ he diagnosis was correctly made at the 11\226)Tj -7.112 -1.383 Td (14-week scan; in one case, complete atrioventricular septal defect with \ double- outlet right ventricle was not detected at 12 )Tj 0 -1.473 TD (weeks but was correctly diagnosed at 21 weeks. The defects identified we\ re: five cases with complete atrioventricular septal )Tj T* (defect, including one with dextrocardia and two with atrioventricular he\ art block; there was one case of single ventricle and )Tj T* (common atrium that was subsequently, at the 20-week scan, also found to \ have dextrocardia, malposition of the great arteries )Tj T* (and situs inversus visceralis; one case of perimembranous ventricular se\ ptal defect; one case with suspected single ventricle )Tj 0 -1.473 TD (and hypoplasia of the aorta that was subsequently found at postmortem ex\ amination to have hypoplastic left heart, hypoplasia )Tj 0 -1.473 TD (of the ascending aorta and the aortic arch, right-sided isomerism of the\ atria and asplenia; one case of hypoplastic left heart,)Tj ( )Tj T* (hypoplastic aorta and left ventricular endocardial fibroelastosis. In ei\ ght of the ten cases with cardiac defects, there was )Tj T* (increased nuchal translucency thickness; the fetal karyotype was normal \ in six cases, trisomy 21 in two, trisomy 18 in one and )Tj 0 -1.564 TD (Turner syndrome in one)Tj 8.9195 0 0 8.9195 172.0383 401.0054 Tm (60)Tj 11.1493 0 0 11.1493 183.3838 398.1512 Tm (.)Tj -13.121 -1.689 Td ( )Tj 0 -1.158 TD (In a study of 29 154 chromosomally normal, singleton pregnancies, 56% of\ major abnormalities of the heart and great arteries )Tj 0 -1.564 TD (were found in the subgroup with nuchal translucency above the 95th centi\ le)Tj 8.9195 0 0 8.9195 464.8529 351.8289 Tm (66)Tj 11.1493 0 0 11.1493 476.1985 348.9747 Tm (. Therefore, measurement of nuchal translucency )Tj -39.384 -1.383 Td (thickness at 11\22614 weeks may constitute the most effective method of \ screening for cardiac defects.)Tj 0 -1.937 TD (In patients with increased nuchal translucency, it is now possible to un\ dertake detailed cardiac scanning in early pregnancy. A )Tj 0 -1.473 TD (specialist scan from 14 weeks can effectively reassure the majority of p\ arents that there is no major cardiac defect. In the )Tj T* (cases with a major defect, the early scan can either lead to the correct\ diagnosis or at least raise suspicions so that follow-u)Tj (p )Tj T* (scans are carried out. The scans can be performed either transvaginally \ or transabdominally. However, more important than )Tj 0 -1.473 TD (the actual route for such a scan is the need to use high-quality equipme\ nt and, in particular, with facilities for color Doppler)Tj ( )Tj 0 -1.473 TD (examination. At 14 weeks, the gray scale alone is not sufficient for acc\ urate examination of the heart and it is necessary also )Tj (to )Tj T* (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 0 rg /TT2 1 Tf 0.542 -2.478 Td (Screening studies \226 relation to nuchal translucency thickness)Tj 0 0 0 rg /TT0 1 Tf -0.542 -2.322 Td ( )Tj 0 -1.158 TD (In a study of 29 154 chromosomally normal, singleton pregnancies, )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 422.1132 146.994 Tm (56% of major abnormalities of the heart and great arteries )Tj 11.1493 0 0 11.1493 476.1985 348.9747 Tm -39.384 -19.68 Td (were found in the subgroup with nuchal translucency above the 95th centi\ le)Tj 8.9195 0 0 8.9195 464.8529 132.393 Tm (66)Tj 11.1493 0 0 11.1493 476.1985 129.5388 Tm (. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 484.1814 129.5388 Tm (Therefore, measurement of nuchal translucency )Tj -40.1 -1.383 Td (thickness at 11\22614 weeks may constitute the most effective method of \ screening for cardiac defects.)Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0945 92.5231 Tm (In patients with increased nuchal translucency, it is now possible to un\ dertake detailed cardiac scanning in early pregnancy. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 739.4562 92.5231 Tm (A )Tj -62.996 -1.473 Td (specialist scan from 14 weeks can effectively reassure the majority of p\ arents that there is no major cardiac defect. In the )Tj 0 -1.473 TD (cases with a major defect, the early scan can either lead to the correct\ diagnosis or at least raise suspicions so that follow-u)Tj (p )Tj T* (scans are carried out. The scans can be performed either transvaginally \ or transabdominally. However, more important than )Tj T* (the actual route for such a scan is the need to use high-quality equipme\ nt and, in particular, with facilities for color Doppler)Tj ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(46 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2136 0 obj<> endobj 2137 0 obj<>/Type/XObject/BBox[33.502 89.7947 739.122 104.093]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.0945 90.2154 m 33.9227 93.3873 33.9227 100.5006 37.0945 103.6724 c 735.5298 103.6724 l 738.7016 100.5006 738.7016 93.3873 735.5298 90.2154 c f endstream endobj 2138 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 705.62 14.2986]/FormType 1>>stream /Form Do endstream endobj 2139 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 705.621 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2140 0 obj<>stream HS[0R9*BI"Pbmo:mgæ|{sL_D/{Jjh H@UO1xՁpW endstream endobj 2141 0 obj[/Indexed/DeviceRGB 255 2142 0 R] endobj 2142 0 obj<>stream HJQFo=kߪ] L ĤPt0")hYsr/K>kK^͐.,x.1ϊgTrͦ陣nfØv3'0- MEFAs څ;S%Fh/3 `\^dAcTSil/I endstream endobj 2143 0 obj<>stream H0- "޻n׸?NW=;rgBZ0676@j\* ?ڢ@ʤ"P0|%L@Zb+4R'04 7M8~M쟿Ĵ$0UQ,V9Ϯ0 Zl/,Ot 6Ԫ)D,`i%g)D0@kgI ,QW4ģ:@POʜUwP(`2׀bWeUAy1n}OjMZ&VI[_IL@S:Dp}x;'66\߾k4bȭ{ceJy;j<Z}PK>pz%'{S%8!ﭻ`O_툄Tە/sJO`Up5iV)FvU:Yv(6u=})ED'7P/G H]N~.2ԵLH ](H`v endstream endobj 2144 0 obj<>/ColorSpace<>/ProcSet[/PDF/ImageC/ImageI]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H**BK 4T043U0ɹ\ .\`` endstream endobj 2145 0 obj<>/ProcSet[/PDF]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H*wSp 0 ) endstream endobj 2146 0 obj<>>> endobj 2147 0 obj<>stream HS[0R9*BI"Pbmo:mgæ|{sL_D/{Jjh H@UO1xՁpW endstream endobj 2148 0 obj[/Indexed/DeviceRGB 255 2149 0 R] endobj 2149 0 obj<>stream HJQFo=kߪ] L ĤPt0")hYsr/K>kK^͐.,x.1ϊgTrͦ陣nfØv3'0- MEFAs څ;S%Fh/3 `\^dAcTSil/I endstream endobj 2150 0 obj<>stream H0- "޻n׸?NW=;rgBZ0676@j\* ?ڢ@ʤ"P0|%L@Zb+4R'04 7M8~M쟿Ĵ$0UQ,V9Ϯ0 Zl/,Ot 6Ԫ)D,`i%g)D0@kgI ,QW4ģ:@POʜUwP(`2׀bWeUAy1n}OjMZ&VI[_IL@S:Dp}x;'66\߾k4bȭ{ceJy;j<Z}PK>pz%'{S%8!ﭻ`O_툄Tە/sJO`Up5iV)FvU:Yv(6u=})ED'7P/G H]N~.2ԵLH ](H`v endstream endobj 2151 0 obj<>/ColorSpace<>/ProcSet[/PDF/ImageC/ImageI]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H**BK 4T043U0ɹ\ .\`` endstream endobj 2152 0 obj<>/ProcSet[/PDF]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H*wSp 0 ) endstream endobj 2153 0 obj<> endobj 2154 0 obj<>>> endobj 2155 0 obj<>3]/P 208 0 R/S/Annot/Pg 705 0 R>> endobj 2156 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 527.927 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 430.089 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (examination. )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 113.9613 583.0041 Tm (At 14 weeks, the gray scale alone is not sufficient for accurate examina\ tion of the heart )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 611.5434 583.0041 Tm (and it is necessary also to )Tj -51.523 -1.473 Td (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (ABDOMINAL WALL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.129 TD (Sonographically, the stomach is identified as a sonolucent cystic struct\ ure in the upper left quadrant of the abdomen. It is fir)Tj (st )Tj 0 -1.29 TD (visualized at 8\2269 weeks and it is seen in all cases by 12\22613 weeks\ )Tj 8.9195 0 0 8.9195 410.7675 500.0039 Tm (11,18,49)Tj 11.1493 0 0 11.1493 451.2976 497.1497 Tm (. At 8\22610 weeks, of gestation, all fetuses demonstrate )Tj -37.15 -1.2 Td (herniation of the midgut that is visualized as a hyperechogenic mass in \ the base of the umbilical cord; retraction into the )Tj 0 -1.29 TD (abdominal cavity occurs at 10\22612 weeks and it is completed by 11 week\ s and 5 days)Tj 8.9195 0 0 8.9195 516.0506 472.2387 Tm (11,67,68)Tj 11.1493 0 0 11.1493 556.5806 469.3845 Tm (.)Tj /TT1 1 Tf -46.593 -2.186 Td (Exomphalos)Tj /TT0 1 Tf 0 -2.867 TD (This is a sporadic abnormality with a birth prevalence of about 1 in 400\ 0. Prenatal diagnosis by ultrasound is based on the )Tj 0 -1.473 TD (demonstration of the mid-line anterior abdominal wall defect, the hernia\ ted sac with its visceral contents and the umbilical cor)Tj (d )Tj T* (insertion at the apex of the sac \()Tj 0 0 0.4 rg (Figure 12)Tj 0 0 0 rg (\). Occasionally, there is an associated failure in the cephalic embryon\ ic fold, resulting )Tj 0 -1.473 TD (in the pentalogy of Cantrell \(omphalocele, anterior diaphragmatic herni\ a, sternal cleft, ectopia cordis and cardiac defects\) or )Tj 0 -1.473 TD (failure of the caudal fold, in which case the omphalocele may be associa\ ted with exstrophy of the bladder or cloaca, imperforate)Tj ( )Tj T* (anus, colonic atresia and sacral vertebral defects. Fetal exomphalos is \ associated with chromosomal defects, usually trisomy )Tj T* (18, in about 30% of cases at mid-gestation and in 15% of neonates.)Tj 0 -1.938 TD (Schmidt and Kubli described a case of exomphalos at 13 weeks as an echog\ enic tumor at the umbilicus; the fetus was )Tj 0 -1.564 TD (subsequently found to have trisomy 18)Tj 8.9195 0 0 8.9195 257.0741 278.3221 Tm (19)Tj 11.1493 0 0 11.1493 268.4197 275.4679 Tm (. Brown )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver at 10 weeks, but\ )Tj -20.748 -1.383 Td (retrospective examinations of the sonograms obtained at 6\2269 weeks did\ not reveal any abnormality; the diagnosis was )Tj T* (confirmed after delivery)Tj 8.9195 0 0 8.9195 171.492 245.4715 Tm (69)Tj 11.1493 0 0 11.1493 182.8375 242.6172 Tm (. Similarly, Pagliano )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver and bowel in a 1\ 0-)Tj -13.072 -1.473 Td (week fetus; the pregnancy was terminated and the diagnosis was confirmed\ )Tj 8.9195 0 0 8.9195 466.3246 229.0461 Tm (70)Tj 11.1493 0 0 11.1493 477.6702 226.1919 Tm (. Heydanus )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of )Tj -39.516 -1.383 Td (exomphalos in three fetuses at 12\22614 weeks; in one there was an assoc\ iated ectopia cordis and hydrops and the pregnancy )Tj 0 -1.473 TD (was terminated, in the second there was an associated two-vessel cord an\ d intrauterine death occurred and, in the third with )Tj 0 -1.564 TD (isolated exomphalos, there was an infant death)Tj 8.9195 0 0 8.9195 304.0908 179.7701 Tm (71)Tj 11.1493 0 0 11.1493 315.4364 176.9159 Tm (.)Tj 9.4902 0 0 9.4902 37.098 159.4541 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(47 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2157 0 obj<> endobj 2158 0 obj<>/Type/XObject/BBox[110.369 580.276 611.21 594.574]/FormType 1>>stream 1 1 0 rg 0.8411 w 113.9611 580.6964 m 110.7893 583.8682 110.7893 590.9815 113.9611 594.1534 c 607.6178 594.1534 l 610.7897 590.9815 610.7897 583.8682 607.6178 580.6964 c f endstream endobj 2159 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 500.842 14.2986]/FormType 1>>stream /Form Do endstream endobj 2160 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 500.842 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2161 0 obj<>>> endobj 2162 0 obj<>6]/P 208 0 R/S/Annot/Pg 705 0 R>> endobj 2163 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 527.927 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 430.089 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (examination. )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 113.9613 583.0041 Tm (At 14 weeks, the gray scale alone is not sufficient for accurate examina\ tion of the heart )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 611.5434 583.0041 Tm (and it is necessary also to )Tj -51.523 -1.473 Td (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (ABDOMINAL WALL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.129 TD (Sonographically, the stomach is identified as a sonolucent cystic struct\ ure in the upper left quadrant of the abdomen. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 702.4552 511.5371 Tm (It is first )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 497.1545 Tm (visualized at 8\2269 weeks and it is seen in all cases by 12\22613 weeks\ )Tj 8.9195 0 0 8.9195 410.7675 500.0039 Tm (11,18,49)Tj 11.1493 0 0 11.1493 451.2976 497.1497 Tm (. At 8\22610 weeks, of gestation, all fetuses demonstrate )Tj -37.15 -1.2 Td (herniation of the midgut that is visualized as a hyperechogenic mass in \ the base of the umbilical cord; retraction into the )Tj 0 -1.29 TD (abdominal cavity occurs at 10\22612 weeks and it is completed by 11 week\ s and 5 days)Tj 8.9195 0 0 8.9195 516.0506 472.2387 Tm (11,67,68)Tj 11.1493 0 0 11.1493 556.5806 469.3845 Tm (.)Tj /TT1 1 Tf -46.593 -2.186 Td (Exomphalos)Tj /TT0 1 Tf 0 -2.867 TD (This is a sporadic abnormality with a birth prevalence of about 1 in 400\ 0. Prenatal diagnosis by ultrasound is based on the )Tj 0 -1.473 TD (demonstration of the mid-line anterior abdominal wall defect, the hernia\ ted sac with its visceral contents and the umbilical cor)Tj (d )Tj T* (insertion at the apex of the sac \()Tj 0 0 0.4 rg (Figure 12)Tj 0 0 0 rg (\). Occasionally, there is an associated failure in the cephalic embryon\ ic fold, resulting )Tj 0 -1.473 TD (in the pentalogy of Cantrell \(omphalocele, anterior diaphragmatic herni\ a, sternal cleft, ectopia cordis and cardiac defects\) or )Tj 0 -1.473 TD (failure of the caudal fold, in which case the omphalocele may be associa\ ted with exstrophy of the bladder or cloaca, imperforate)Tj ( )Tj T* (anus, colonic atresia and sacral vertebral defects. Fetal exomphalos is \ associated with chromosomal defects, usually trisomy )Tj T* (18, in about 30% of cases at mid-gestation and in 15% of neonates.)Tj 0 -1.938 TD (Schmidt and Kubli described a case of exomphalos at 13 weeks as an echog\ enic tumor at the umbilicus; the fetus was )Tj 0 -1.564 TD (subsequently found to have trisomy 18)Tj 8.9195 0 0 8.9195 257.0741 278.3221 Tm (19)Tj 11.1493 0 0 11.1493 268.4197 275.4679 Tm (. Brown )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver at 10 weeks, but\ )Tj -20.748 -1.383 Td (retrospective examinations of the sonograms obtained at 6\2269 weeks did\ not reveal any abnormality; the diagnosis was )Tj T* (confirmed after delivery)Tj 8.9195 0 0 8.9195 171.492 245.4715 Tm (69)Tj 11.1493 0 0 11.1493 182.8375 242.6172 Tm (. Similarly, Pagliano )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver and bowel in a 1\ 0-)Tj -13.072 -1.473 Td (week fetus; the pregnancy was terminated and the diagnosis was confirmed\ )Tj 8.9195 0 0 8.9195 466.3246 229.0461 Tm (70)Tj 11.1493 0 0 11.1493 477.6702 226.1919 Tm (. Heydanus )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of )Tj -39.516 -1.383 Td (exomphalos in three fetuses at 12\22614 weeks; in one there was an assoc\ iated ectopia cordis and hydrops and the pregnancy )Tj 0 -1.473 TD (was terminated, in the second there was an associated two-vessel cord an\ d intrauterine death occurred and, in the third with )Tj 0 -1.564 TD (isolated exomphalos, there was an infant death)Tj 8.9195 0 0 8.9195 304.0908 179.7701 Tm (71)Tj 11.1493 0 0 11.1493 315.4364 176.9159 Tm (.)Tj 9.4902 0 0 9.4902 37.098 159.4541 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(47 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2164 0 obj<> endobj 2165 0 obj<>/Type/XObject/BBox[698.861 508.809 753.787 523.107]/FormType 1>>stream 1 1 0 rg 0.8411 w 702.4538 509.2293 m 699.282 512.4012 699.282 519.5146 702.4538 522.6864 c 750.1949 522.6864 l 753.3667 519.5146 753.3667 512.4012 750.1949 509.2293 c f endstream endobj 2166 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 54.9263 14.2986]/FormType 1>>stream /Form Do endstream endobj 2167 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 54.9266 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2168 0 obj<>>> endobj 2169 0 obj<> endobj 2170 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 527.927 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 430.089 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (examination. )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 113.9613 583.0041 Tm (At 14 weeks, the gray scale alone is not sufficient for accurate examina\ tion of the heart )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 611.5434 583.0041 Tm (and it is necessary also to )Tj -51.523 -1.473 Td (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (ABDOMINAL WALL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.129 TD (Sonographically, the stomach is identified as a sonolucent cystic struct\ ure in the upper left quadrant of the abdomen. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 702.4552 511.5371 Tm (It is first )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 497.1545 Tm (visualized at 8\2269 weeks )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 174.7585 497.1545 Tm (and it is seen in all cases by 12\22613 weeks)Tj 8.9195 0 0 8.9195 410.7675 500.0039 Tm (11,18,49)Tj 11.1493 0 0 11.1493 451.2976 497.1497 Tm (. At 8\22610 weeks, of gestation, all fetuses demonstrate )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.1011 483.7705 Tm (herniation of the midgut that is visualized as a hyperechogenic mass in \ the base of the umbilical cord; retraction into the )Tj 0 -1.29 TD (abdominal cavity occurs at 10\22612 weeks and it is completed by 11 week\ s and 5 days)Tj 8.9195 0 0 8.9195 516.0506 472.2387 Tm (11,67,68)Tj 11.1493 0 0 11.1493 556.5806 469.3845 Tm (.)Tj /TT1 1 Tf -46.593 -2.186 Td (Exomphalos)Tj /TT0 1 Tf 0 -2.867 TD (This is a sporadic abnormality with a birth prevalence of about 1 in 400\ 0. Prenatal diagnosis by ultrasound is based on the )Tj 0 -1.473 TD (demonstration of the mid-line anterior abdominal wall defect, the hernia\ ted sac with its visceral contents and the umbilical cor)Tj (d )Tj T* (insertion at the apex of the sac \()Tj 0 0 0.4 rg (Figure 12)Tj 0 0 0 rg (\). Occasionally, there is an associated failure in the cephalic embryon\ ic fold, resulting )Tj 0 -1.473 TD (in the pentalogy of Cantrell \(omphalocele, anterior diaphragmatic herni\ a, sternal cleft, ectopia cordis and cardiac defects\) or )Tj 0 -1.473 TD (failure of the caudal fold, in which case the omphalocele may be associa\ ted with exstrophy of the bladder or cloaca, imperforate)Tj ( )Tj T* (anus, colonic atresia and sacral vertebral defects. Fetal exomphalos is \ associated with chromosomal defects, usually trisomy )Tj T* (18, in about 30% of cases at mid-gestation and in 15% of neonates.)Tj 0 -1.938 TD (Schmidt and Kubli described a case of exomphalos at 13 weeks as an echog\ enic tumor at the umbilicus; the fetus was )Tj 0 -1.564 TD (subsequently found to have trisomy 18)Tj 8.9195 0 0 8.9195 257.0741 278.3221 Tm (19)Tj 11.1493 0 0 11.1493 268.4197 275.4679 Tm (. Brown )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver at 10 weeks, but\ )Tj -20.748 -1.383 Td (retrospective examinations of the sonograms obtained at 6\2269 weeks did\ not reveal any abnormality; the diagnosis was )Tj T* (confirmed after delivery)Tj 8.9195 0 0 8.9195 171.492 245.4715 Tm (69)Tj 11.1493 0 0 11.1493 182.8375 242.6172 Tm (. Similarly, Pagliano )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver and bowel in a 1\ 0-)Tj -13.072 -1.473 Td (week fetus; the pregnancy was terminated and the diagnosis was confirmed\ )Tj 8.9195 0 0 8.9195 466.3246 229.0461 Tm (70)Tj 11.1493 0 0 11.1493 477.6702 226.1919 Tm (. Heydanus )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of )Tj -39.516 -1.383 Td (exomphalos in three fetuses at 12\22614 weeks; in one there was an assoc\ iated ectopia cordis and hydrops and the pregnancy )Tj 0 -1.473 TD (was terminated, in the second there was an associated two-vessel cord an\ d intrauterine death occurred and, in the third with )Tj 0 -1.564 TD (isolated exomphalos, there was an infant death)Tj 8.9195 0 0 8.9195 304.0908 179.7701 Tm (71)Tj 11.1493 0 0 11.1493 315.4364 176.9159 Tm (.)Tj 9.4902 0 0 9.4902 37.098 159.4541 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(47 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2171 0 obj<> endobj 2172 0 obj<>/Type/XObject/BBox[171.166 494.421 760.18 508.725]/FormType 1>>stream 1 1 0 rg 0.8411 w 174.7581 494.8468 m 171.5863 498.0186 171.5863 505.132 174.7581 508.3038 c 756.5872 508.299 l 759.7591 505.1272 759.7591 498.0138 756.5872 494.8419 c f endstream endobj 2173 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 589.014 14.3034]/FormType 1>>stream /Form Do endstream endobj 2174 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 589.015 14.3037]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2175 0 obj<>/Type/XObject/BBox[171.166 494.421 760.18 508.725]/FormType 1>>stream 1 1 0 rg 0.8411 w 174.7581 494.8468 m 171.5863 498.0186 171.5863 505.132 174.7581 508.3038 c 756.5872 508.299 l 759.7591 505.1272 759.7591 498.0138 756.5872 494.8419 c f endstream endobj 2176 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 589.014 14.3034]/FormType 1>>stream /Form Do endstream endobj 2177 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 589.015 14.3037]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2178 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 527.927 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 430.089 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (examination. )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 113.9613 583.0041 Tm (At 14 weeks, the gray scale alone is not sufficient for accurate examina\ tion of the heart )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 611.5434 583.0041 Tm (and it is necessary also to )Tj -51.523 -1.473 Td (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (ABDOMINAL WALL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.129 TD (Sonographically, the stomach is identified as a sonolucent cystic struct\ ure in the upper left quadrant of the abdomen. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 702.4552 511.5371 Tm (It is first )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 497.1545 Tm (visualized at 8\2269 weeks )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 174.7585 497.1545 Tm (and it is seen in all cases by 12\22613 weeks)Tj 8.9195 0 0 8.9195 410.7675 500.0039 Tm (11,18,49)Tj 11.1493 0 0 11.1493 451.2976 497.1497 Tm (. 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Heydanus )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of )Tj -39.516 -1.383 Td (exomphalos in three fetuses at 12\22614 weeks; in one there was an assoc\ iated ectopia cordis and hydrops and the pregnancy )Tj 0 -1.473 TD (was terminated, in the second there was an associated two-vessel cord an\ d intrauterine death occurred and, in the third with )Tj 0 -1.564 TD (isolated exomphalos, there was an infant death)Tj 8.9195 0 0 8.9195 304.0908 179.7701 Tm (71)Tj 11.1493 0 0 11.1493 315.4364 176.9159 Tm (.)Tj 9.4902 0 0 9.4902 37.098 159.4541 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(47 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2179 0 obj<>>> endobj 2180 0 obj<> endobj 2181 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 527.927 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 430.089 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (examination. )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 113.9613 583.0041 Tm (At 14 weeks, the gray scale alone is not sufficient for accurate examina\ tion of the heart )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 611.5434 583.0041 Tm (and it is necessary also to )Tj -51.523 -1.473 Td (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (ABDOMINAL WALL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.129 TD (Sonographically, the stomach is identified as a sonolucent cystic struct\ ure in the upper left quadrant of the abdomen. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 702.4552 511.5371 Tm (It is first )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 497.1545 Tm (visualized at 8\2269 weeks )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 174.7585 497.1545 Tm (and it is )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 223.5479 497.1545 Tm (seen in all cases by 12\22613 weeks)Tj 8.9195 0 0 8.9195 410.7675 500.0039 Tm (11,18,49)Tj 11.1493 0 0 11.1493 451.2976 497.1497 Tm (. 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Occasionally, there is an associated failure in the cephalic embryon\ ic fold, resulting )Tj 0 -1.473 TD (in the pentalogy of Cantrell \(omphalocele, anterior diaphragmatic herni\ a, sternal cleft, ectopia cordis and cardiac defects\) or )Tj 0 -1.473 TD (failure of the caudal fold, in which case the omphalocele may be associa\ ted with exstrophy of the bladder or cloaca, imperforate)Tj ( )Tj T* (anus, colonic atresia and sacral vertebral defects. Fetal exomphalos is \ associated with chromosomal defects, usually trisomy )Tj T* (18, in about 30% of cases at mid-gestation and in 15% of neonates.)Tj 0 -1.938 TD (Schmidt and Kubli described a case of exomphalos at 13 weeks as an echog\ enic tumor at the umbilicus; the fetus was )Tj 0 -1.564 TD (subsequently found to have trisomy 18)Tj 8.9195 0 0 8.9195 257.0741 278.3221 Tm (19)Tj 11.1493 0 0 11.1493 268.4197 275.4679 Tm (. Brown )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver at 10 weeks, but\ )Tj -20.748 -1.383 Td (retrospective examinations of the sonograms obtained at 6\2269 weeks did\ not reveal any abnormality; the diagnosis was )Tj T* (confirmed after delivery)Tj 8.9195 0 0 8.9195 171.492 245.4715 Tm (69)Tj 11.1493 0 0 11.1493 182.8375 242.6172 Tm (. Similarly, Pagliano )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver and bowel in a 1\ 0-)Tj -13.072 -1.473 Td (week fetus; the pregnancy was terminated and the diagnosis was confirmed\ )Tj 8.9195 0 0 8.9195 466.3246 229.0461 Tm (70)Tj 11.1493 0 0 11.1493 477.6702 226.1919 Tm (. Heydanus )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of )Tj -39.516 -1.383 Td (exomphalos in three fetuses at 12\22614 weeks; in one there was an assoc\ iated ectopia cordis and hydrops and the pregnancy )Tj 0 -1.473 TD (was terminated, in the second there was an associated two-vessel cord an\ d intrauterine death occurred and, in the third with )Tj 0 -1.564 TD (isolated exomphalos, there was an infant death)Tj 8.9195 0 0 8.9195 304.0908 179.7701 Tm (71)Tj 11.1493 0 0 11.1493 315.4364 176.9159 Tm (.)Tj 9.4902 0 0 9.4902 37.098 159.4541 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(47 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2190 0 obj<>>> endobj 2191 0 obj<>14]/P 208 0 R/S/Annot/Pg 705 0 R>> endobj 2192 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 527.927 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 430.089 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (examination. )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 113.9613 583.0041 Tm (At 14 weeks, the gray scale alone is not sufficient for accurate examina\ tion of the heart )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 611.5434 583.0041 Tm (and it is necessary also to )Tj -51.523 -1.473 Td (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (ABDOMINAL WALL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.129 TD (Sonographically, the stomach is identified as a sonolucent cystic struct\ ure in the upper left quadrant of the abdomen. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 702.4552 511.5371 Tm (It is first )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 497.1545 Tm (visualized at 8\2269 weeks )Tj (and it is )Tj (seen in all cases by 12\22613 weeks)Tj 8.9195 0 0 8.9195 410.7675 500.0039 Tm (11,18,49)Tj 11.1493 0 0 11.1493 451.2976 497.1497 Tm (. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 459.2805 497.1497 Tm (At 8\22610 weeks, of gestation, all fetuses demonstrate )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.1011 483.7705 Tm (herniation of the midgut that is visualized as a hyperechogenic mass in \ the base of the umbilical cord; retraction into the )Tj 0 -1.29 TD (abdominal cavity occurs at 10\22612 weeks and it is completed by 11 week\ s and 5 days)Tj 8.9195 0 0 8.9195 516.0506 472.2387 Tm (11,67,68)Tj 11.1493 0 0 11.1493 556.5806 469.3845 Tm (.)Tj /TT1 1 Tf -46.593 -2.186 Td (Exomphalos)Tj /TT0 1 Tf 0 -2.867 TD (This is a sporadic abnormality with a birth prevalence of about 1 in 400\ 0. Prenatal diagnosis by ultrasound is based on the )Tj 0 -1.473 TD (demonstration of the mid-line anterior abdominal wall defect, the hernia\ ted sac with its visceral contents and the umbilical cor)Tj (d )Tj T* (insertion at the apex of the sac \()Tj 0 0 0.4 rg (Figure 12)Tj 0 0 0 rg (\). Occasionally, there is an associated failure in the cephalic embryon\ ic fold, resulting )Tj 0 -1.473 TD (in the pentalogy of Cantrell \(omphalocele, anterior diaphragmatic herni\ a, sternal cleft, ectopia cordis and cardiac defects\) or )Tj 0 -1.473 TD (failure of the caudal fold, in which case the omphalocele may be associa\ ted with exstrophy of the bladder or cloaca, imperforate)Tj ( )Tj T* (anus, colonic atresia and sacral vertebral defects. 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Similarly, Pagliano )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver and bowel in a 1\ 0-)Tj -13.072 -1.473 Td (week fetus; the pregnancy was terminated and the diagnosis was confirmed\ )Tj 8.9195 0 0 8.9195 466.3246 229.0461 Tm (70)Tj 11.1493 0 0 11.1493 477.6702 226.1919 Tm (. Heydanus )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of )Tj -39.516 -1.383 Td (exomphalos in three fetuses at 12\22614 weeks; in one there was an assoc\ iated ectopia cordis and hydrops and the pregnancy )Tj 0 -1.473 TD (was terminated, in the second there was an associated two-vessel cord an\ d intrauterine death occurred and, in the third with )Tj 0 -1.564 TD (isolated exomphalos, there was an infant death)Tj 8.9195 0 0 8.9195 304.0908 179.7701 Tm (71)Tj 11.1493 0 0 11.1493 315.4364 176.9159 Tm (.)Tj 9.4902 0 0 9.4902 37.098 159.4541 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(47 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2193 0 obj<> endobj 2194 0 obj<>/Type/XObject/BBox[33.486 494.402 459.115 509.364]/FormType 1>>stream 1 1 0 rg 0.8801 w 37.098 494.8468 m 33.9262 498.0186 33.9262 505.132 37.098 508.3038 c 455.356 508.9234 l 458.675 505.6044 458.675 498.161 455.356 494.8419 c f endstream endobj 2195 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 425.629 14.962]/FormType 1>>stream /Form Do endstream endobj 2196 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 425.63 14.9623]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2197 0 obj<>>> endobj 2198 0 obj<>17]/P 208 0 R/S/Annot/Pg 705 0 R>> endobj 2199 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 527.927 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 430.089 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (examination. )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 113.9613 583.0041 Tm (At 14 weeks, the gray scale alone is not sufficient for accurate examina\ tion of the heart )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 611.5434 583.0041 Tm (and it is necessary also to )Tj -51.523 -1.473 Td (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (ABDOMINAL WALL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.129 TD (Sonographically, the stomach is identified as a sonolucent cystic struct\ ure in the upper left quadrant of the abdomen. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 702.4552 511.5371 Tm (It is first )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 497.1545 Tm (visualized at 8\2269 weeks )Tj (and it is )Tj (seen in all cases by 12\22613 weeks)Tj 8.9195 0 0 8.9195 410.7675 500.0039 Tm (11,18,49)Tj 11.1493 0 0 11.1493 451.2976 497.1497 Tm (. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 459.2805 497.1497 Tm (At 8\22610 weeks, of gestation, all fetuses demonstrate )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.1011 483.7705 Tm (herniation of the midgut that is visualized as a hyperechogenic mass in \ the base of the umbilical cord; retraction into the )Tj 0 -1.29 TD (abdominal cavity occurs at 10\22612 weeks and it is completed by 11 week\ s and 5 days)Tj 8.9195 0 0 8.9195 516.0506 472.2387 Tm (11,67,68)Tj 11.1493 0 0 11.1493 556.5806 469.3845 Tm (.)Tj /TT1 1 Tf -46.593 -2.186 Td (Exomphalos)Tj /TT0 1 Tf 0 -2.867 TD (This is a sporadic abnormality with a birth prevalence of about )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 392.2625 413.0471 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 453.6617 413.0471 Tm (Prenatal diagnosis by ultrasound is based on the )Tj -37.362 -1.473 Td (demonstration of the mid-line anterior abdominal wall defect, the hernia\ ted sac with its visceral contents and the umbilical cor)Tj (d )Tj 0 -1.473 TD (insertion at the apex of the sac \()Tj 0 0 0.4 rg (Figure 12)Tj 0 0 0 rg (\). 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Brown )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver at 10 weeks, but\ )Tj -20.748 -1.383 Td (retrospective examinations of the sonograms obtained at 6\2269 weeks did\ not reveal any abnormality; the diagnosis was )Tj T* (confirmed after delivery)Tj 8.9195 0 0 8.9195 171.492 245.4715 Tm (69)Tj 11.1493 0 0 11.1493 182.8375 242.6172 Tm (. Similarly, Pagliano )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver and bowel in a 1\ 0-)Tj -13.072 -1.473 Td (week fetus; the pregnancy was terminated and the diagnosis was confirmed\ )Tj 8.9195 0 0 8.9195 466.3246 229.0461 Tm (70)Tj 11.1493 0 0 11.1493 477.6702 226.1919 Tm (. Heydanus )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of )Tj -39.516 -1.383 Td (exomphalos in three fetuses at 12\22614 weeks; in one there was an assoc\ iated ectopia cordis and hydrops and the pregnancy )Tj 0 -1.473 TD (was terminated, in the second there was an associated two-vessel cord an\ d intrauterine death occurred and, in the third with )Tj 0 -1.564 TD (isolated exomphalos, there was an infant death)Tj 8.9195 0 0 8.9195 304.0908 179.7701 Tm (71)Tj 11.1493 0 0 11.1493 315.4364 176.9159 Tm (.)Tj 9.4902 0 0 9.4902 37.098 159.4541 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(47 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2200 0 obj<> endobj 2201 0 obj<>/Type/XObject/BBox[388.67 410.319 453.329 424.617]/FormType 1>>stream 1 1 0 rg 0.8411 w 392.2621 410.7393 m 389.0902 413.9112 389.0902 421.0245 392.2621 424.1964 c 449.7369 424.1964 l 452.9087 421.0245 452.9087 413.9112 449.7369 410.7393 c f endstream endobj 2202 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 64.66 14.2986]/FormType 1>>stream /Form Do endstream endobj 2203 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 64.6603 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2204 0 obj<>>> endobj 2205 0 obj<>20]/P 208 0 R/S/Annot/Pg 705 0 R>> endobj 2206 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 527.927 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 430.089 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (examination. )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 113.9613 583.0041 Tm (At 14 weeks, the gray scale alone is not sufficient for accurate examina\ tion of the heart )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 611.5434 583.0041 Tm (and it is necessary also to )Tj -51.523 -1.473 Td (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (ABDOMINAL WALL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.129 TD (Sonographically, the stomach is identified as a sonolucent cystic struct\ ure in the upper left quadrant of the abdomen. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 702.4552 511.5371 Tm (It is first )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 497.1545 Tm (visualized at 8\2269 weeks )Tj (and it is )Tj (seen in all cases by 12\22613 weeks)Tj 8.9195 0 0 8.9195 410.7675 500.0039 Tm (11,18,49)Tj 11.1493 0 0 11.1493 451.2976 497.1497 Tm (. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 459.2805 497.1497 Tm (At 8\22610 weeks, of gestation, all fetuses demonstrate )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.1011 483.7705 Tm (herniation of the midgut that is visualized as a hyperechogenic mass in \ the base of the umbilical cord; retraction into the )Tj 0 -1.29 TD (abdominal cavity occurs at 10\22612 weeks and it is completed by 11 week\ s and 5 days)Tj 8.9195 0 0 8.9195 516.0506 472.2387 Tm (11,67,68)Tj 11.1493 0 0 11.1493 556.5806 469.3845 Tm (.)Tj /TT1 1 Tf -46.593 -2.186 Td (Exomphalos)Tj /TT0 1 Tf 0 -2.867 TD (This is a sporadic abnormality with a birth prevalence of about )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 392.2625 413.0471 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 453.6617 413.0471 Tm (Prenatal diagnosis by ultrasound is based on the )Tj -37.362 -1.473 Td (demonstration of the mid-line anterior abdominal wall defect, )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 386.777 396.6242 Tm (the herniated sac with its visceral contents and the umbilical cord )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.1013 380.2012 Tm (insertion at the apex of the sac \()Tj 0 0 0.4 rg (Figure 12)Tj 0 0 0 rg (\). Occasionally, there is an associated failure in the cephalic embryon\ ic fold, resulting )Tj 0 -1.473 TD (in the pentalogy of Cantrell \(omphalocele, anterior diaphragmatic herni\ a, sternal cleft, ectopia cordis and cardiac defects\) or )Tj T* (failure of the caudal fold, in which case the omphalocele may be associa\ ted with exstrophy of the bladder or cloaca, imperforate)Tj ( )Tj T* (anus, colonic atresia and sacral vertebral defects. Fetal exomphalos is \ associated with chromosomal defects, usually trisomy )Tj T* (18, in about 30% of cases at mid-gestation and in 15% of neonates.)Tj 0 -1.938 TD (Schmidt and Kubli described a case of exomphalos at 13 weeks as an echog\ enic tumor at the umbilicus; the fetus was )Tj 0 -1.564 TD (subsequently found to have trisomy 18)Tj 8.9195 0 0 8.9195 257.0741 278.3221 Tm (19)Tj 11.1493 0 0 11.1493 268.4197 275.4679 Tm (. Brown )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver at 10 weeks, but\ )Tj -20.748 -1.383 Td (retrospective examinations of the sonograms obtained at 6\2269 weeks did\ not reveal any abnormality; the diagnosis was )Tj T* (confirmed after delivery)Tj 8.9195 0 0 8.9195 171.492 245.4715 Tm (69)Tj 11.1493 0 0 11.1493 182.8375 242.6172 Tm (. Similarly, Pagliano )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver and bowel in a 1\ 0-)Tj -13.072 -1.473 Td (week fetus; the pregnancy was terminated and the diagnosis was confirmed\ )Tj 8.9195 0 0 8.9195 466.3246 229.0461 Tm (70)Tj 11.1493 0 0 11.1493 477.6702 226.1919 Tm (. Heydanus )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of )Tj -39.516 -1.383 Td (exomphalos in three fetuses at 12\22614 weeks; in one there was an assoc\ iated ectopia cordis and hydrops and the pregnancy )Tj 0 -1.473 TD (was terminated, in the second there was an associated two-vessel cord an\ d intrauterine death occurred and, in the third with )Tj 0 -1.564 TD (isolated exomphalos, there was an infant death)Tj 8.9195 0 0 8.9195 304.0908 179.7701 Tm (71)Tj 11.1493 0 0 11.1493 315.4364 176.9159 Tm (.)Tj 9.4902 0 0 9.4902 37.098 159.4541 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(47 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2207 0 obj<> endobj 2208 0 obj<>/Type/XObject/BBox[383.184 393.896 759.198 408.194]/FormType 1>>stream 1 1 0 rg 0.8411 w 386.7768 394.3164 m 383.6049 397.4883 383.6049 404.6017 386.7768 407.7735 c 755.6057 407.7735 l 758.7776 404.6017 758.7776 397.4883 755.6057 394.3164 c f endstream endobj 2209 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 376.014 14.2986]/FormType 1>>stream /Form Do endstream endobj 2210 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 376.014 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2211 0 obj<>>> endobj 2212 0 obj<>22]/P 208 0 R/S/Annot/Pg 705 0 R>> endobj 2213 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 527.927 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 430.089 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (examination. )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 113.9613 583.0041 Tm (At 14 weeks, the gray scale alone is not sufficient for accurate examina\ tion of the heart )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 611.5434 583.0041 Tm (and it is necessary also to )Tj -51.523 -1.473 Td (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (ABDOMINAL WALL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.129 TD (Sonographically, the stomach is identified as a sonolucent cystic struct\ ure in the upper left quadrant of the abdomen. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 702.4552 511.5371 Tm (It is first )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 497.1545 Tm (visualized at 8\2269 weeks )Tj (and it is )Tj (seen in all cases by 12\22613 weeks)Tj 8.9195 0 0 8.9195 410.7675 500.0039 Tm (11,18,49)Tj 11.1493 0 0 11.1493 451.2976 497.1497 Tm (. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 459.2805 497.1497 Tm (At 8\22610 weeks, of gestation, all fetuses demonstrate )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.1011 483.7705 Tm (herniation of the midgut that is visualized as a hyperechogenic mass in \ the base of the umbilical cord; retraction into the )Tj 0 -1.29 TD (abdominal cavity occurs at 10\22612 weeks and it is completed by 11 week\ s and 5 days)Tj 8.9195 0 0 8.9195 516.0506 472.2387 Tm (11,67,68)Tj 11.1493 0 0 11.1493 556.5806 469.3845 Tm (.)Tj /TT1 1 Tf -46.593 -2.186 Td (Exomphalos)Tj /TT0 1 Tf 0 -2.867 TD (This is a sporadic abnormality with a birth prevalence of about )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 392.2625 413.0471 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 453.6617 413.0471 Tm (Prenatal diagnosis by ultrasound is based on the )Tj -37.362 -1.473 Td (demonstration of the mid-line anterior abdominal wall defect, )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 386.777 396.6242 Tm (the herniated sac with its visceral contents and the umbilical cord )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.1013 380.2012 Tm (insertion at the apex of the sac )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 216.3598 380.2012 Tm (\()Tj 0 0 0.4 rg (Figure 12)Tj 0 0 0 rg (\). 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Heydanus )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of )Tj -39.516 -1.383 Td (exomphalos in three fetuses at 12\22614 weeks; in one there was an assoc\ iated ectopia cordis and hydrops and the pregnancy )Tj 0 -1.473 TD (was terminated, in the second there was an associated two-vessel cord an\ d intrauterine death occurred and, in the third with )Tj 0 -1.564 TD (isolated exomphalos, there was an infant death)Tj 8.9195 0 0 8.9195 304.0908 179.7701 Tm (71)Tj 11.1493 0 0 11.1493 315.4364 176.9159 Tm (.)Tj 9.4902 0 0 9.4902 37.098 159.4541 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(47 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2214 0 obj<> endobj 2215 0 obj<>/Type/XObject/BBox[33.5088 377.473 216.027 391.771]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.1013 377.8935 m 33.9295 381.0653 33.9295 388.1787 37.1013 391.3505 c 212.4347 391.3505 l 215.6066 388.1787 215.6066 381.0653 212.4347 377.8935 c f endstream endobj 2216 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 182.519 14.2986]/FormType 1>>stream /Form Do endstream endobj 2217 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 182.519 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2218 0 obj<>>> endobj 2219 0 obj<>25]/P 208 0 R/S/Annot/Pg 705 0 R>> endobj 2220 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 527.927 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 430.089 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (examination. )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 113.9613 583.0041 Tm (At 14 weeks, the gray scale alone is not sufficient for accurate examina\ tion of the heart )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 611.5434 583.0041 Tm (and it is necessary also to )Tj -51.523 -1.473 Td (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (ABDOMINAL WALL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.129 TD (Sonographically, the stomach is identified as a sonolucent cystic struct\ ure in the upper left quadrant of the abdomen. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 702.4552 511.5371 Tm (It is first )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 497.1545 Tm (visualized at 8\2269 weeks )Tj (and it is )Tj (seen in all cases by 12\22613 weeks)Tj 8.9195 0 0 8.9195 410.7675 500.0039 Tm (11,18,49)Tj 11.1493 0 0 11.1493 451.2976 497.1497 Tm (. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 459.2805 497.1497 Tm (At 8\22610 weeks, of gestation, all fetuses demonstrate )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.1011 483.7705 Tm (herniation of the midgut that is visualized as a hyperechogenic mass in \ the base of the umbilical cord; retraction into the )Tj 0 -1.29 TD (abdominal cavity occurs at 10\22612 weeks and it is completed by 11 week\ s and 5 days)Tj 8.9195 0 0 8.9195 516.0506 472.2387 Tm (11,67,68)Tj 11.1493 0 0 11.1493 556.5806 469.3845 Tm (.)Tj /TT1 1 Tf -46.593 -2.186 Td (Exomphalos)Tj /TT0 1 Tf 0 -2.867 TD (This is a sporadic abnormality with a birth prevalence of about )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 392.2625 413.0471 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 453.6617 413.0471 Tm (Prenatal diagnosis by ultrasound is based on the )Tj -37.362 -1.473 Td (demonstration of the mid-line anterior abdominal wall defect, )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 386.777 396.6242 Tm (the herniated sac with its visceral contents and the umbilical cord )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.1013 380.2012 Tm (insertion at the apex of the sac )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 216.3598 380.2012 Tm (\()Tj 0 0 0.4 rg (Figure 12)Tj 0 0 0 rg (\). 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Similarly, Pagliano )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver and bowel in a 1\ 0-)Tj -13.072 -1.473 Td (week fetus; the pregnancy was terminated and the diagnosis was confirmed\ )Tj 8.9195 0 0 8.9195 466.3246 229.0461 Tm (70)Tj 11.1493 0 0 11.1493 477.6702 226.1919 Tm (. Heydanus )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of )Tj -39.516 -1.383 Td (exomphalos in three fetuses at 12\22614 weeks; in one there was an assoc\ iated ectopia cordis and hydrops and the pregnancy )Tj 0 -1.473 TD (was terminated, in the second there was an associated two-vessel cord an\ d intrauterine death occurred and, in the third with )Tj 0 -1.564 TD (isolated exomphalos, there was an infant death)Tj 8.9195 0 0 8.9195 304.0908 179.7701 Tm (71)Tj 11.1493 0 0 11.1493 315.4364 176.9159 Tm (.)Tj 9.4902 0 0 9.4902 37.098 159.4541 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(47 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2221 0 obj<> endobj 2222 0 obj<>/Type/XObject/BBox[69.5656 361.05 725.316 375.348]/FormType 1>>stream 1 1 0 rg 0.8411 w 73.1582 361.4706 m 69.9863 364.6424 69.9863 371.7558 73.1582 374.9276 c 721.7231 374.9276 l 724.8949 371.7558 724.8949 364.6424 721.7231 361.4706 c f endstream endobj 2223 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 655.75 14.2986]/FormType 1>>stream /Form Do endstream endobj 2224 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 655.75 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2225 0 obj<>>> endobj 2226 0 obj<>28]/P 208 0 R/S/Annot/Pg 705 0 R>> endobj 2227 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 527.927 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 430.089 735.059 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (examination. )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 113.9613 583.0041 Tm (At 14 weeks, the gray scale alone is not sufficient for accurate examina\ tion of the heart )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 611.5434 583.0041 Tm (and it is necessary also to )Tj -51.523 -1.473 Td (use color Doppler to confirm normal forward flow to both ventricles and \ to identify the outflow tracts.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (ABDOMINAL WALL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.129 TD (Sonographically, the stomach is identified as a sonolucent cystic struct\ ure in the upper left quadrant of the abdomen. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 702.4552 511.5371 Tm (It is first )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 497.1545 Tm (visualized at 8\2269 weeks )Tj (and it is )Tj (seen in all cases by 12\22613 weeks)Tj 8.9195 0 0 8.9195 410.7675 500.0039 Tm (11,18,49)Tj 11.1493 0 0 11.1493 451.2976 497.1497 Tm (. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 459.2805 497.1497 Tm (At 8\22610 weeks, of gestation, all fetuses demonstrate )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.1011 483.7705 Tm (herniation of the midgut that is visualized as a hyperechogenic mass in \ the base of the umbilical cord; retraction into the )Tj 0 -1.29 TD (abdominal cavity occurs at 10\22612 weeks and it is completed by 11 week\ s and 5 days)Tj 8.9195 0 0 8.9195 516.0506 472.2387 Tm (11,67,68)Tj 11.1493 0 0 11.1493 556.5806 469.3845 Tm (.)Tj /TT1 1 Tf -46.593 -2.186 Td (Exomphalos)Tj /TT0 1 Tf 0 -2.867 TD (This is a sporadic abnormality with a birth prevalence of about )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 392.2625 413.0471 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 453.6617 413.0471 Tm (Prenatal diagnosis by ultrasound is based on the )Tj -37.362 -1.473 Td (demonstration of the mid-line anterior abdominal wall defect, )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 386.777 396.6242 Tm (the herniated sac with its visceral contents and the umbilical cord )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.1013 380.2012 Tm (insertion at the apex of the sac )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 216.3598 380.2012 Tm (\()Tj 0 0 0.4 rg (Figure 12)Tj 0 0 0 rg (\). Occasionally, there is an associated failure in the cephalic embryon\ ic fold, resulting )Tj -16.078 -1.473 Td (in the )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 73.1581 363.7783 Tm (pentalogy of Cantrell \(omphalocele, anterior diaphragmatic hernia, ster\ nal cleft, ectopia cordis and cardiac defects\) )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 725.649 363.7783 Tm (or )Tj -61.757 -1.473 Td (failure of the caudal fold, in which case the )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 282.6982 347.3554 Tm (omphalocele may be associated with exstrophy of the bladder or cloaca, i\ mperforate )Tj -22.028 -1.473 Td (anus, colonic atresia and sacral vertebral defects. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 319.9146 330.9325 Tm (Fetal exomphalos is associated with chromosomal defects, usually trisomy\ )Tj -25.366 -1.473 Td (18, in about 30% of cases at mid-gestation and in 15% of neonates.)Tj 0 -1.938 TD (Schmidt and Kubli described a case of exomphalos at 13 weeks as an echog\ enic tumor at the umbilicus; the fetus was )Tj 0 -1.564 TD (subsequently found to have trisomy 18)Tj 8.9195 0 0 8.9195 257.0741 278.3221 Tm (19)Tj 11.1493 0 0 11.1493 268.4197 275.4679 Tm (. Brown )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver at 10 weeks, but\ )Tj -20.748 -1.383 Td (retrospective examinations of the sonograms obtained at 6\2269 weeks did\ not reveal any abnormality; the diagnosis was )Tj T* (confirmed after delivery)Tj 8.9195 0 0 8.9195 171.492 245.4715 Tm (69)Tj 11.1493 0 0 11.1493 182.8375 242.6172 Tm (. Similarly, Pagliano )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of exomphalos containing liver and bowel in a 1\ 0-)Tj -13.072 -1.473 Td (week fetus; the pregnancy was terminated and the diagnosis was confirmed\ )Tj 8.9195 0 0 8.9195 466.3246 229.0461 Tm (70)Tj 11.1493 0 0 11.1493 477.6702 226.1919 Tm (. Heydanus )Tj /TT2 1 Tf (et al)Tj /TT0 1 Tf (. reported the diagnosis of )Tj -39.516 -1.383 Td (exomphalos in three fetuses at 12\22614 weeks; in one there was an assoc\ iated ectopia cordis and hydrops and the pregnancy )Tj 0 -1.473 TD (was terminated, in the second there was an associated two-vessel cord an\ d intrauterine death occurred and, in the third with )Tj 0 -1.564 TD (isolated exomphalos, there was an infant death)Tj 8.9195 0 0 8.9195 304.0908 179.7701 Tm (71)Tj 11.1493 0 0 11.1493 315.4364 176.9159 Tm (.)Tj 9.4902 0 0 9.4902 37.098 159.4541 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(47 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2228 0 obj<> endobj 2229 0 obj<>/Type/XObject/BBox[33.5092 328.204 761.997 358.925]/FormType 1>>stream HL10 wB/ ,ɒhdg#8j.?TDuG#$%TywiM6 M&DlO2Ci F]7HT’\2qTփ$&kց_?) endstream endobj 2230 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 728.488 30.7215]/FormType 1>>stream /Form Do endstream endobj 2231 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 728.489 30.7218]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2232 0 obj<>stream HS[0R9*BI"Pbmo:mgæ|{sL_D/{Jjh H@UO1xՁpW endstream endobj 2233 0 obj[/Indexed/DeviceRGB 255 2234 0 R] endobj 2234 0 obj<>stream HJQFo=kߪ] L ĤPt0")hYsr/K>kK^͐.,x.1ϊgTrͦ陣nfØv3'0- MEFAs څ;S%Fh/3 `\^dAcTSil/I endstream endobj 2235 0 obj<>stream H0- "޻n׸?NW=;rgBZ0676@j\* ?ڢ@ʤ"P0|%L@Zb+4R'04 7M8~M쟿Ĵ$0UQ,V9Ϯ0 Zl/,Ot 6Ԫ)D,`i%g)D0@kgI ,QW4ģ:@POʜUwP(`2׀bWeUAy1n}OjMZ&VI[_IL@S:Dp}x;'66\߾k4bȭ{ceJy;j<Z}PK>pz%'{S%8!ﭻ`O_툄Tە/sJO`Up5iV)FvU:Yv(6u=})ED'7P/G H]N~.2ԵLH ](H`v endstream endobj 2236 0 obj<>/ColorSpace<>/ProcSet[/PDF/ImageC/ImageI]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H**BK 4T043U0ɹ\ .\`` endstream endobj 2237 0 obj<>/ProcSet[/PDF]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H*wSp 0 ) endstream endobj 2238 0 obj<>>> endobj 2239 0 obj<>stream HS[0R9*BI"Pbmo:mgæ|{sL_D/{Jjh H@UO1xՁpW endstream endobj 2240 0 obj[/Indexed/DeviceRGB 255 2241 0 R] endobj 2241 0 obj<>stream HJQFo=kߪ] L ĤPt0")hYsr/K>kK^͐.,x.1ϊgTrͦ陣nfØv3'0- MEFAs څ;S%Fh/3 `\^dAcTSil/I endstream endobj 2242 0 obj<>stream H0- "޻n׸?NW=;rgBZ0676@j\* ?ڢ@ʤ"P0|%L@Zb+4R'04 7M8~M쟿Ĵ$0UQ,V9Ϯ0 Zl/,Ot 6Ԫ)D,`i%g)D0@kgI ,QW4ģ:@POʜUwP(`2׀bWeUAy1n}OjMZ&VI[_IL@S:Dp}x;'66\߾k4bȭ{ceJy;j<Z}PK>pz%'{S%8!ﭻ`O_툄Tە/sJO`Up5iV)FvU:Yv(6u=})ED'7P/G H]N~.2ԵLH ](H`v endstream endobj 2243 0 obj<>/ColorSpace<>/ProcSet[/PDF/ImageC/ImageI]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H**BK 4T043U0ɹ\ .\`` endstream endobj 2244 0 obj<>/ProcSet[/PDF]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H*wSp 0 ) endstream endobj 2245 0 obj<> endobj 2246 0 obj<>>> endobj 2247 0 obj[2246 0 R 2250 0 R 2254 0 R 2257 0 R 2261 0 R 2264 0 R 2268 0 R 2271 0 R 2275 0 R 2278 0 R] endobj 2248 0 obj<>3]/P 208 0 R/S/Annot/Pg 716 0 R>> endobj 2249 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 242.155 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 197.568634 270.9019623 387.7254944 cm /Im0 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 270.902 364.4322 Tm (Figure 12)Tj /TT1 1 Tf ( - Exomphalos in a 13-week fetus)Tj 9.4902 0 0 9.4902 37.098 344.9074 Tm ( )Tj 11.1493 0 0 11.1493 37.098 331.9209 Tm (van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the findings of 14 cases with exomphalos diagnosed at 11\2261\ 4 weeks of gestation)Tj 8.9195 0 0 8.9195 680.6703 334.7751 Tm (68)Tj 11.1493 0 0 11.1493 692.0159 331.9209 Tm (. In eight )Tj -58.741 -1.2 Td (cases, there was increased nuchal translucency thickness \(3.5\22610 mm\)\ and seven of these had chromosomal abnormalities, )Tj 0 -1.2 TD (mainly )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 78.3361 305.1626 Tm (trisomy 18. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 146.659 305.1626 Tm (The contents of the exomphalos were bowel only in the chromosomally abno\ rmal group and liver as well as )Tj -9.827 -1.2 Td (bowel in those with a normal karyotype. In the chromosomally normal grou\ p, there were four with other defects, such as )Tj 0 -1.2 TD (tetralogy of Fallot and Meckel\226Gruber syndrome; only three infants we\ re liveborn.)Tj 9.4902 0 0 9.4902 500.029 278.4042 Tm ( )Tj -48.78 -1.147 Td ( )Tj 1 1 0 rg /TT3 1 Tf 11.1493 0 0 11.1493 43.1373 249.5032 Tm (Screening studies)Tj 0 0 0 rg /TT1 1 Tf -0.542 -1.8 Td (An ultrasound screening study of 622 high-risk pregnancies at 10\22613 w\ eeks correctly diagnosed the two cases of )Tj 0 -1.564 TD (exomphalos)Tj 8.9195 0 0 8.9195 104.295 214.8555 Tm (25)Tj 11.1493 0 0 11.1493 115.6405 212.0013 Tm (. In two other screening studies of low-risk patients, involving 1632 pr\ egnancies at 12\22614 weeks)Tj 8.9195 0 0 8.9195 661.1322 214.8555 Tm (35)Tj 11.1493 0 0 11.1493 672.4778 212.0013 Tm ( and 1473 )Tj -56.988 -1.473 Td (pregnancies at 10\22614 weeks)Tj 8.9195 0 0 8.9195 197.6706 198.4302 Tm (27)Tj 11.1493 0 0 11.1493 209.0161 195.576 Tm (, respectively, there were four cases of exomphalos \(two in each\) and \ they were all diagnosed in )Tj -15.42 -1.383 Td (the first-trimester scan.)Tj 0 -1.937 TD (In a screening study for chromosomal abnormalities by assessment of feta\ l nuchal translucency thickness at 10\22614 weeks of )Tj 0 -1.473 TD (gestation, there were 15 726 pregnancies with a minimum gestation of 11 \ weeks and 4 days and, in this group, there were 18 )Tj 0 -1.564 TD (cases of exomphalos)Tj 8.9195 0 0 8.9195 153.6084 127.5524 Tm (72)Tj 11.1493 0 0 11.1493 164.954 124.6981 Tm (. In seven cases, the karyotype was normal, in nine there was trisomy 18\ , in one trisomy 13 and in one )Tj -11.468 -1.383 Td (triploidy. Furthermore, in the total group, the prevalence of exomphalos\ in fetuses with trisomy 18 was 23%, in those with )Tj 0 -1.473 TD (trisomy 13 it was 9%, in those with triploidy it was 13% and in those wi\ th no evidence of these chromosomal defects it was )Tj T* (0.045%. This study demonstrated that both the prevalence of exomphalos a\ nd the associated risk for chromosomal defects )Tj 0 -1.564 TD (increase with maternal age and decrease with gestational age)Tj 8.9195 0 0 8.9195 385.1575 61.851 Tm (72)Tj 11.1493 0 0 11.1493 396.5031 58.9968 Tm (.)Tj /TT4 1 Tf 9.4902 0 0 9.4902 400.5614 58.9968 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(48 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2250 0 obj<> endobj 2251 0 obj<>/Type/XObject/BBox[74.7437 302.434 146.327 316.733]/FormType 1>>stream 1 1 0 rg 0.8411 w 78.3363 302.8549 m 75.1644 306.0267 75.1644 313.14 78.3363 316.3119 c 142.7346 316.3119 l 145.9065 313.14 145.9065 306.0267 142.7346 302.8549 c f endstream endobj 2252 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 71.5836 14.2986]/FormType 1>>stream /Form Do endstream endobj 2253 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 71.5839 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2254 0 obj<>>> endobj 2255 0 obj<>6]/P 208 0 R/S/Annot/Pg 716 0 R>> endobj 2256 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 242.155 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 197.568634 270.9019623 387.7254944 cm /Im0 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 270.902 364.4322 Tm (Figure 12)Tj /TT1 1 Tf ( - Exomphalos in a 13-week fetus)Tj 9.4902 0 0 9.4902 37.098 344.9074 Tm ( )Tj 11.1493 0 0 11.1493 37.098 331.9209 Tm (van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the findings of 14 cases with exomphalos diagnosed at 11\2261\ 4 weeks of gestation)Tj 8.9195 0 0 8.9195 680.6703 334.7751 Tm (68)Tj 11.1493 0 0 11.1493 692.0159 331.9209 Tm (. In eight )Tj -58.741 -1.2 Td (cases, there was )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 134.8297 318.5417 Tm (increased nuchal translucency thickness \(3.5\22610 mm\) )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 442.8627 318.5417 Tm (and seven of these had chromosomal abnormalities, )Tj -36.394 -1.2 Td (mainly )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 78.3361 305.1626 Tm (trisomy 18. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 146.659 305.1626 Tm (The contents of the exomphalos were bowel only in the chromosomally abno\ rmal group and liver as well as )Tj -9.827 -1.2 Td (bowel in those with a normal karyotype. In the chromosomally normal grou\ p, there were four with other defects, such as )Tj 0 -1.2 TD (tetralogy of Fallot and Meckel\226Gruber syndrome; only three infants we\ re liveborn.)Tj 9.4902 0 0 9.4902 500.029 278.4042 Tm ( )Tj -48.78 -1.147 Td ( )Tj 1 1 0 rg /TT3 1 Tf 11.1493 0 0 11.1493 43.1373 249.5032 Tm (Screening studies)Tj 0 0 0 rg /TT1 1 Tf -0.542 -1.8 Td (An ultrasound screening study of 622 high-risk pregnancies at 10\22613 w\ eeks correctly diagnosed the two cases of )Tj 0 -1.564 TD (exomphalos)Tj 8.9195 0 0 8.9195 104.295 214.8555 Tm (25)Tj 11.1493 0 0 11.1493 115.6405 212.0013 Tm (. In two other screening studies of low-risk patients, involving 1632 pr\ egnancies at 12\22614 weeks)Tj 8.9195 0 0 8.9195 661.1322 214.8555 Tm (35)Tj 11.1493 0 0 11.1493 672.4778 212.0013 Tm ( and 1473 )Tj -56.988 -1.473 Td (pregnancies at 10\22614 weeks)Tj 8.9195 0 0 8.9195 197.6706 198.4302 Tm (27)Tj 11.1493 0 0 11.1493 209.0161 195.576 Tm (, respectively, there were four cases of exomphalos \(two in each\) and \ they were all diagnosed in )Tj -15.42 -1.383 Td (the first-trimester scan.)Tj 0 -1.937 TD (In a screening study for chromosomal abnormalities by assessment of feta\ l nuchal translucency thickness at 10\22614 weeks of )Tj 0 -1.473 TD (gestation, there were 15 726 pregnancies with a minimum gestation of 11 \ weeks and 4 days and, in this group, there were 18 )Tj 0 -1.564 TD (cases of exomphalos)Tj 8.9195 0 0 8.9195 153.6084 127.5524 Tm (72)Tj 11.1493 0 0 11.1493 164.954 124.6981 Tm (. In seven cases, the karyotype was normal, in nine there was trisomy 18\ , in one trisomy 13 and in one )Tj -11.468 -1.383 Td (triploidy. Furthermore, in the total group, the prevalence of exomphalos\ in fetuses with trisomy 18 was 23%, in those with )Tj 0 -1.473 TD (trisomy 13 it was 9%, in those with triploidy it was 13% and in those wi\ th no evidence of these chromosomal defects it was )Tj T* (0.045%. This study demonstrated that both the prevalence of exomphalos a\ nd the associated risk for chromosomal defects )Tj 0 -1.564 TD (increase with maternal age and decrease with gestational age)Tj 8.9195 0 0 8.9195 385.1575 61.851 Tm (72)Tj 11.1493 0 0 11.1493 396.5031 58.9968 Tm (.)Tj /TT4 1 Tf 9.4902 0 0 9.4902 400.5614 58.9968 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(48 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2257 0 obj<> endobj 2258 0 obj<>/Type/XObject/BBox[131.237 315.813 442.529 330.112]/FormType 1>>stream 1 1 0 rg 0.8411 w 134.8293 316.234 m 131.6575 319.4059 131.6575 326.5192 134.8293 329.691 c 438.937 329.691 l 442.1088 326.5192 442.1088 319.4059 438.937 316.234 c f endstream endobj 2259 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 311.293 14.2986]/FormType 1>>stream /Form Do endstream endobj 2260 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 311.293 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2261 0 obj<>>> endobj 2262 0 obj<>9]/P 208 0 R/S/Annot/Pg 716 0 R>> endobj 2263 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 242.155 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 197.568634 270.9019623 387.7254944 cm /Im0 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 270.902 364.4322 Tm (Figure 12)Tj /TT1 1 Tf ( - Exomphalos in a 13-week fetus)Tj 9.4902 0 0 9.4902 37.098 344.9074 Tm ( )Tj 11.1493 0 0 11.1493 37.098 331.9209 Tm (van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the findings of 14 cases with exomphalos diagnosed at 11\2261\ 4 weeks of gestation)Tj 8.9195 0 0 8.9195 680.6703 334.7751 Tm (68)Tj 11.1493 0 0 11.1493 692.0159 331.9209 Tm (. In eight )Tj -58.741 -1.2 Td (cases, there was )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 134.8297 318.5417 Tm (increased nuchal translucency thickness \(3.5\22610 mm\) )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 442.8627 318.5417 Tm (and seven of these had chromosomal abnormalities, )Tj -36.394 -1.2 Td (mainly )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 78.3361 305.1626 Tm (trisomy 18. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 146.659 305.1626 Tm (The contents of the exomphalos were bowel only in the chromosomally abno\ rmal group and liver as well as )Tj -9.827 -1.2 Td (bowel in those with a normal karyotype. In the chromosomally normal grou\ p, there were four with other defects, such as )Tj 0 -1.2 TD (tetralogy of Fallot and Meckel\226Gruber syndrome; only three infants we\ re liveborn.)Tj 9.4902 0 0 9.4902 500.029 278.4042 Tm ( )Tj -48.78 -1.147 Td ( )Tj 1 1 0 rg /TT3 1 Tf 11.1493 0 0 11.1493 43.1373 249.5032 Tm (Screening studies)Tj 0 0 0 rg /TT1 1 Tf -0.542 -1.8 Td (An ultrasound screening study of 622 high-risk pregnancies at 10\22613 w\ eeks correctly diagnosed the two cases of )Tj 0 -1.564 TD (exomphalos)Tj 8.9195 0 0 8.9195 104.295 214.8555 Tm (25)Tj 11.1493 0 0 11.1493 115.6405 212.0013 Tm (. In two other screening studies of low-risk patients, involving 1632 pr\ egnancies at 12\22614 weeks)Tj 8.9195 0 0 8.9195 661.1322 214.8555 Tm (35)Tj 11.1493 0 0 11.1493 672.4778 212.0013 Tm ( and 1473 )Tj -56.988 -1.473 Td (pregnancies at 10\22614 weeks)Tj 8.9195 0 0 8.9195 197.6706 198.4302 Tm (27)Tj 11.1493 0 0 11.1493 209.0161 195.576 Tm (, respectively, there were four cases of exomphalos \(two in each\) and \ they were all diagnosed in )Tj -15.42 -1.383 Td (the first-trimester scan.)Tj 0 -1.937 TD (In a screening study for chromosomal abnormalities by assessment of feta\ l nuchal translucency thickness at 10\22614 weeks of )Tj 0 -1.473 TD (gestation, there were 15 726 pregnancies with a minimum gestation of 11 \ weeks and 4 days and, in this group, there were 18 )Tj 0 -1.564 TD (cases of exomphalos)Tj 8.9195 0 0 8.9195 153.6084 127.5524 Tm (72)Tj 11.1493 0 0 11.1493 164.954 124.6981 Tm (. In seven cases, the karyotype was normal, in nine there was trisomy 18\ , in one trisomy 13 and in one )Tj -11.468 -1.383 Td (triploidy. Furthermore, in the total group, the prevalence of exomphalos\ in fetuses )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 505.2867 109.2786 Tm (with trisomy 18 )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 597.1012 109.2786 Tm (was 23%, in those with )Tj -50.228 -1.473 Td (trisomy 13 it was 9%, in those with triploidy it was 13% and in those wi\ th no evidence of these chromosomal defects it was )Tj 0 -1.473 TD (0.045%. This study demonstrated that both the prevalence of exomphalos a\ nd the associated risk for chromosomal defects )Tj 0 -1.564 TD (increase with maternal age and decrease with gestational age)Tj 8.9195 0 0 8.9195 385.1575 61.851 Tm (72)Tj 11.1493 0 0 11.1493 396.5031 58.9968 Tm (.)Tj /TT4 1 Tf 9.4902 0 0 9.4902 400.5614 58.9968 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(48 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2264 0 obj<> endobj 2265 0 obj<>/Type/XObject/BBox[525.318 106.55 596.768 120.849]/FormType 1>>stream 1 1 0 rg 0.8411 w 528.9108 106.9709 m 525.7389 110.1427 525.7389 117.2561 528.9108 120.4279 c 593.1754 120.4279 l 596.3473 117.2561 596.3473 110.1427 593.1754 106.9709 c f endstream endobj 2266 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 71.4499 14.2986]/FormType 1>>stream /Form Do endstream endobj 2267 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 71.4502 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2268 0 obj<>>> endobj 2269 0 obj<>12]/P 208 0 R/S/Annot/Pg 716 0 R>> endobj 2270 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 242.155 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 197.568634 270.9019623 387.7254944 cm /Im0 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 270.902 364.4322 Tm (Figure 12)Tj /TT1 1 Tf ( - Exomphalos in a 13-week fetus)Tj 9.4902 0 0 9.4902 37.098 344.9074 Tm ( )Tj 11.1493 0 0 11.1493 37.098 331.9209 Tm (van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the findings of 14 cases with exomphalos diagnosed at 11\2261\ 4 weeks of gestation)Tj 8.9195 0 0 8.9195 680.6703 334.7751 Tm (68)Tj 11.1493 0 0 11.1493 692.0159 331.9209 Tm (. In eight )Tj -58.741 -1.2 Td (cases, there was )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 134.8297 318.5417 Tm (increased nuchal translucency thickness \(3.5\22610 mm\) )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 442.8627 318.5417 Tm (and seven of these had chromosomal abnormalities, )Tj -36.394 -1.2 Td (mainly )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 78.3361 305.1626 Tm (trisomy 18. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 146.659 305.1626 Tm (The contents of the exomphalos were bowel only in the chromosomally abno\ rmal group and liver as well as )Tj -9.827 -1.2 Td (bowel in those with a normal karyotype. In the chromosomally normal grou\ p, there were four with other defects, such as )Tj 0 -1.2 TD (tetralogy of Fallot and Meckel\226Gruber syndrome; only three infants we\ re liveborn.)Tj 9.4902 0 0 9.4902 500.029 278.4042 Tm ( )Tj -48.78 -1.147 Td ( )Tj 1 1 0 rg /TT3 1 Tf 11.1493 0 0 11.1493 43.1373 249.5032 Tm (Screening studies)Tj 0 0 0 rg /TT1 1 Tf -0.542 -1.8 Td (An ultrasound screening study of 622 high-risk pregnancies at 10\22613 w\ eeks correctly diagnosed the two cases of )Tj 0 -1.564 TD (exomphalos)Tj 8.9195 0 0 8.9195 104.295 214.8555 Tm (25)Tj 11.1493 0 0 11.1493 115.6405 212.0013 Tm (. In two other screening studies of low-risk patients, involving 1632 pr\ egnancies at 12\22614 weeks)Tj 8.9195 0 0 8.9195 661.1322 214.8555 Tm (35)Tj 11.1493 0 0 11.1493 672.4778 212.0013 Tm ( and 1473 )Tj -56.988 -1.473 Td (pregnancies at 10\22614 weeks)Tj 8.9195 0 0 8.9195 197.6706 198.4302 Tm (27)Tj 11.1493 0 0 11.1493 209.0161 195.576 Tm (, respectively, there were four cases of exomphalos \(two in each\) and \ they were all diagnosed in )Tj -15.42 -1.383 Td (the first-trimester scan.)Tj 0 -1.937 TD (In a screening study for chromosomal abnormalities by assessment of feta\ l nuchal translucency thickness at 10\22614 weeks of )Tj 0 -1.473 TD (gestation, there were 15 726 pregnancies with a minimum gestation of 11 \ weeks and 4 days and, in this group, there were 18 )Tj 0 -1.564 TD (cases of exomphalos)Tj 8.9195 0 0 8.9195 153.6084 127.5524 Tm (72)Tj 11.1493 0 0 11.1493 164.954 124.6981 Tm (. In seven cases, the karyotype was normal, in nine there was trisomy 18\ , in one trisomy 13 and in one )Tj -11.468 -1.383 Td (triploidy. Furthermore, in the total group, the prevalence of exomphalos\ in fetuses )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 505.2867 109.2786 Tm (with trisomy 18 )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 597.1012 109.2786 Tm (was 23%, in those with )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.0938 92.8557 Tm (trisomy 13 )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 101.3584 92.8557 Tm (it was 9%, in those with triploidy it was 13% and in those with no evide\ nce of these chromosomal defects it was )Tj -5.764 -1.473 Td (0.045%. This study demonstrated that both the prevalence of exomphalos a\ nd the associated risk for chromosomal defects )Tj T* (increase with maternal age and decrease with gestational age)Tj 8.9195 0 0 8.9195 385.1575 61.851 Tm (72)Tj 11.1493 0 0 11.1493 396.5031 58.9968 Tm (.)Tj /TT4 1 Tf 9.4902 0 0 9.4902 400.5614 58.9968 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(48 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2271 0 obj<> endobj 2272 0 obj<>/Type/XObject/BBox[33.5016 90.1273 101.027 104.426]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.0942 90.5479 m 33.9223 93.7198 33.9223 100.8331 37.0942 104.005 c 97.4342 104.005 l 100.6061 100.8331 100.6061 93.7198 97.4342 90.5479 c f endstream endobj 2273 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 67.5253 14.2986]/FormType 1>>stream /Form Do endstream endobj 2274 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 67.5256 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2275 0 obj<>>> endobj 2276 0 obj<>15]/P 208 0 R/S/Annot/Pg 716 0 R>> endobj 2277 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 242.155 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 197.568634 270.9019623 387.7254944 cm /Im0 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 270.902 364.4322 Tm (Figure 12)Tj /TT1 1 Tf ( - Exomphalos in a 13-week fetus)Tj 9.4902 0 0 9.4902 37.098 344.9074 Tm ( )Tj 11.1493 0 0 11.1493 37.098 331.9209 Tm (van Zalen-Sprock )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the findings of 14 cases with exomphalos diagnosed at 11\2261\ 4 weeks of gestation)Tj 8.9195 0 0 8.9195 680.6703 334.7751 Tm (68)Tj 11.1493 0 0 11.1493 692.0159 331.9209 Tm (. In eight )Tj -58.741 -1.2 Td (cases, there was )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 134.8297 318.5417 Tm (increased nuchal translucency thickness \(3.5\22610 mm\) )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 442.8627 318.5417 Tm (and seven of these had chromosomal abnormalities, )Tj -36.394 -1.2 Td (mainly )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 78.3361 305.1626 Tm (trisomy 18. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 146.659 305.1626 Tm (The contents of the exomphalos were bowel only in the chromosomally abno\ rmal group and liver as well as )Tj -9.827 -1.2 Td (bowel in those with a normal karyotype. In the chromosomally normal grou\ p, there were four with other defects, such as )Tj 0 -1.2 TD (tetralogy of Fallot and Meckel\226Gruber syndrome; only three infants we\ re liveborn.)Tj 9.4902 0 0 9.4902 500.029 278.4042 Tm ( )Tj -48.78 -1.147 Td ( )Tj 1 1 0 rg /TT3 1 Tf 11.1493 0 0 11.1493 43.1373 249.5032 Tm (Screening studies)Tj 0 0 0 rg /TT1 1 Tf -0.542 -1.8 Td (An ultrasound screening study of 622 high-risk pregnancies at 10\22613 w\ eeks correctly diagnosed the two cases of )Tj 0 -1.564 TD (exomphalos)Tj 8.9195 0 0 8.9195 104.295 214.8555 Tm (25)Tj 11.1493 0 0 11.1493 115.6405 212.0013 Tm (. In two other screening studies of low-risk patients, involving 1632 pr\ egnancies at 12\22614 weeks)Tj 8.9195 0 0 8.9195 661.1322 214.8555 Tm (35)Tj 11.1493 0 0 11.1493 672.4778 212.0013 Tm ( and 1473 )Tj -56.988 -1.473 Td (pregnancies at 10\22614 weeks)Tj 8.9195 0 0 8.9195 197.6706 198.4302 Tm (27)Tj 11.1493 0 0 11.1493 209.0161 195.576 Tm (, respectively, there were four cases of exomphalos \(two in each\) and \ they were all diagnosed in )Tj -15.42 -1.383 Td (the first-trimester scan.)Tj 0 -1.937 TD (In a screening study for chromosomal abnormalities by assessment of feta\ l nuchal translucency thickness at 10\22614 weeks of )Tj 0 -1.473 TD (gestation, there were 15 726 pregnancies with a minimum gestation of 11 \ weeks and 4 days and, in this group, there were 18 )Tj 0 -1.564 TD (cases of exomphalos)Tj 8.9195 0 0 8.9195 153.6084 127.5524 Tm (72)Tj 11.1493 0 0 11.1493 164.954 124.6981 Tm (. In seven cases, the karyotype was normal, in nine there was trisomy 18\ , in one trisomy 13 and in one )Tj -11.468 -1.383 Td (triploidy. Furthermore, in the total group, the prevalence of exomphalos\ in fetuses )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 505.2867 109.2786 Tm (with trisomy 18 )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 597.1012 109.2786 Tm (was 23%, in those with )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.0938 92.8557 Tm (trisomy 13 )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 101.3584 92.8557 Tm (it was 9%, in those with )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 241.5387 92.8557 Tm (triploidy )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 291.0416 92.8557 Tm (it was 13% and in those with no evidence of these chromosomal defects it\ was )Tj -22.777 -1.473 Td (0.045%. This study demonstrated that both the prevalence of exomphalos a\ nd the associated risk for chromosomal defects )Tj T* (increase with maternal age and decrease with gestational age)Tj 8.9195 0 0 8.9195 385.1575 61.851 Tm (72)Tj 11.1493 0 0 11.1493 396.5031 58.9968 Tm (.)Tj /TT4 1 Tf 9.4902 0 0 9.4902 400.5614 58.9968 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(48 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2278 0 obj<> endobj 2279 0 obj<>/Type/XObject/BBox[237.946 90.1273 290.709 104.426]/FormType 1>>stream 1 1 0 rg 0.8411 w 241.5384 90.548 m 238.3666 93.7198 238.3666 100.8332 241.5384 104.005 c 287.1167 104.005 l 290.2886 100.8332 290.2886 93.7198 287.1167 90.548 c f endstream endobj 2280 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 52.7636 14.2986]/FormType 1>>stream /Form Do endstream endobj 2281 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 52.7639 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2282 0 obj<>>> endobj 2283 0 obj[2282 0 R 2286 0 R 2290 0 R 2293 0 R 2297 0 R 2300 0 R 2304 0 R 2307 0 R 2311 0 R 2314 0 R 2318 0 R 2321 0 R 2325 0 R 2328 0 R 2332 0 R 2335 0 R 2339 0 R 2342 0 R 2346 0 R 2349 0 R 2353 0 R 2358 0 R 2362 0 R 2365 0 R] endobj 2284 0 obj<>3]/P 208 0 R/S/Annot/Pg 719 0 R>> endobj 2285 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 561.653 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 373.701 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 305.559 735.059 23.122 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 167.845 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5804 Tm (Gastroschisis)Tj /TT1 1 Tf 0 -2.867 TD (This is a sporadic defect with a birth prevalence of about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 359.7364 544.6154 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 421.1356 544.6154 Tm (Evisceration of the intestine occurs through a small )Tj -34.445 -1.473 Td (abdominal wall defect located just lateral and usually to the right of a\ n intact umbilical cord. Prenatal diagnosis by ultrasoun)Tj (d is )Tj 0 -1.473 TD (based on the demonstration of the normally situated umbilicus and the he\ rniated loops of intestine, which are free-floating. )Tj T* (Associated chromosomal abnormalities are rare.)Tj 0 -1.937 TD (Surprisingly, although the incidence of gastroschisis in ultrasound stud\ ies during the second trimester of pregnancy is similar )Tj (to )Tj 0 -1.473 TD (that of exomphalos, there is a sparsity of reports on first-trimester di\ agnosis. Kushnir )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a 13-week fetus with a )Tj 0 -1.473 TD (free-floating cauliflower-shaped mass protruding through the fetal abdom\ en and to the right of a normally inserted umbilical )Tj 0 -1.564 TD (cord; the diagnosis was confirmed after delivery at term)Tj 8.9195 0 0 8.9195 353.9952 426.3116 Tm (73)Tj 11.1493 0 0 11.1493 365.3407 423.4574 Tm (. Similarly, Guzman reported a 12-week fetus with gastroschisis; )Tj -29.441 -1.473 Td (there was spontaneous rupture of membranes and intrauterine death at 22 \ weeks)Tj 8.9195 0 0 8.9195 499.1036 409.8862 Tm (74)Tj 11.1493 0 0 11.1493 510.4492 407.032 Tm (.)Tj 1 1 0 rg /TT3 1 Tf -41.914 -2.33 Td (Screening studies)Tj 0 0 0 rg /TT1 1 Tf 9.4902 0 0 9.4902 37.098 364.1126 Tm ( )Tj 11.1493 0 0 11.1493 37.098 352.1329 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there was one 11-week fetus with gastroschisis, )Tj 0 -1.29 TD (encephalocele and kyphoscoliosis; the pregnancy was terminated)Tj 8.9195 0 0 8.9195 404.8472 340.6012 Tm (25)Tj 11.1493 0 0 11.1493 416.1928 337.7469 Tm (.)Tj 9.4902 0 0 9.4902 420.2512 337.7469 Tm ( )Tj 1 1 1 rg /TT0 1 Tf 12.0784 0 0 12.0784 37.098 313.1604 Tm (URINARY TRACT DEFECTS)Tj 0 0 0 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 290.2827 Tm ( )Tj 0 -1.158 TD (The fetal kidneys and adrenals can first be visualized by transabdominal\ ultrasound at 9 weeks and they are seen in all cases )Tj 0 -1.564 TD (from 12 weeks)Tj 8.9195 0 0 8.9195 120.2497 262.7968 Tm (18)Tj 11.1493 0 0 11.1493 131.5952 259.9426 Tm (. The renal echogenicity is high at 9 weeks but decreases with gestation\ ; the adrenals appear as translucent )Tj -8.476 -1.473 Td (structures with an echodense cortex)Tj 8.9195 0 0 8.9195 241.0303 246.3715 Tm (18)Tj 11.1493 0 0 11.1493 252.3758 243.5172 Tm (. The fetal bladder can be visualized in about 80% of fetuses at 11 week\ s and in more )Tj -19.309 -1.473 Td (than 90% by 13 weeks)Tj 8.9195 0 0 8.9195 166.7312 229.9461 Tm (75)Tj 11.1493 0 0 11.1493 178.0768 227.0919 Tm (. At 12\22613 weeks, the fetal kidneys can be visualized in 99% of the c\ ases, by using both )Tj -12.645 -1.473 Td (transabdominal and transvaginal sonography)Tj 8.9195 0 0 8.9195 290.6225 213.5208 Tm (49)Tj 11.1493 0 0 11.1493 301.968 210.6666 Tm (.)Tj 9.4902 0 0 9.4902 37.098 193.2048 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 175.1935 Tm (Bilateral Renal Agenesis)Tj /TT1 1 Tf -0.542 -1.8 Td (This sporadic condition, with a birth prevalence of about 1 in 4000, is \ usually diagnosed in the second trimester of pregnancy )Tj 0 -1.473 TD (by the findings of anhydramnios, absence of the urinary bladder and fail\ ure to identify the fetal kidneys; the differential )Tj T* (diagnosis is preterm prelabor rupture of membranes and severe uteroplace\ ntal insufficiency that may also present with )Tj T* (oligohydramnios.)Tj 0 -1.937 TD (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the prenatal diagnosis of bilateral renal agenesis at 14 week\ s of gestation in five fetuses; in all cases, )Tj 0 -1.473 TD (there were hypoechogenic masses in the renal beds, that were subsequentl\ y found at pathological examination to be enlarged )Tj 0 -1.564 TD (adrenals)Tj 8.9195 0 0 8.9195 84.7725 53.2427 Tm (76)Tj 11.1493 0 0 11.1493 96.1181 50.3884 Tm (. The amniotic fluid volume was normal in all cases at 14 weeks. In two \ cases, a cystic structure suggestive of the )Tj -5.294 -1.383 Td (fetal bladder was temporarily detected in the fetal pelvis but this disa\ ppeared by 16\22617 weeks.)Tj /TT0 1 Tf ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(49 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2286 0 obj<> endobj 2287 0 obj<>/Type/XObject/BBox[356.144 541.887 420.803 556.185]/FormType 1>>stream 1 1 0 rg 0.8411 w 359.7361 542.3076 m 356.5643 545.4795 356.5643 552.5928 359.7361 555.7646 c 417.2109 555.7646 l 420.3828 552.5928 420.3828 545.4795 417.2109 542.3076 c f endstream endobj 2288 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 64.66 14.2985]/FormType 1>>stream /Form Do endstream endobj 2289 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 64.6603 14.2988]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2290 0 obj<>>> endobj 2291 0 obj<>6]/P 208 0 R/S/Annot/Pg 719 0 R>> endobj 2292 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 561.653 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 373.701 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 305.559 735.059 23.122 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 167.845 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5804 Tm (Gastroschisis)Tj /TT1 1 Tf 0 -2.867 TD (This is a sporadic defect with a birth prevalence of about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 359.7364 544.6154 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 421.1356 544.6154 Tm (Evisceration of the intestine occurs through a small )Tj -34.445 -1.473 Td (abdominal wall defect located just lateral and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 296.364 528.1924 Tm (usually to the right of an intact umbilical cord. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 560.2681 528.1924 Tm (Prenatal diagnosis by ultrasound is )Tj -46.924 -1.473 Td (based on the demonstration of the normally situated umbilicus and the he\ rniated loops of intestine, which are free-floating. )Tj 0 -1.473 TD (Associated chromosomal abnormalities are rare.)Tj 0 -1.937 TD (Surprisingly, although the incidence of gastroschisis in ultrasound stud\ ies during the second trimester of pregnancy is similar )Tj (to )Tj 0 -1.473 TD (that of exomphalos, there is a sparsity of reports on first-trimester di\ agnosis. Kushnir )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a 13-week fetus with a )Tj T* (free-floating cauliflower-shaped mass protruding through the fetal abdom\ en and to the right of a normally inserted umbilical )Tj 0 -1.564 TD (cord; the diagnosis was confirmed after delivery at term)Tj 8.9195 0 0 8.9195 353.9952 426.3116 Tm (73)Tj 11.1493 0 0 11.1493 365.3407 423.4574 Tm (. Similarly, Guzman reported a 12-week fetus with gastroschisis; )Tj -29.441 -1.473 Td (there was spontaneous rupture of membranes and intrauterine death at 22 \ weeks)Tj 8.9195 0 0 8.9195 499.1036 409.8862 Tm (74)Tj 11.1493 0 0 11.1493 510.4492 407.032 Tm (.)Tj 1 1 0 rg /TT3 1 Tf -41.914 -2.33 Td (Screening studies)Tj 0 0 0 rg /TT1 1 Tf 9.4902 0 0 9.4902 37.098 364.1126 Tm ( )Tj 11.1493 0 0 11.1493 37.098 352.1329 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there was one 11-week fetus with gastroschisis, )Tj 0 -1.29 TD (encephalocele and kyphoscoliosis; the pregnancy was terminated)Tj 8.9195 0 0 8.9195 404.8472 340.6012 Tm (25)Tj 11.1493 0 0 11.1493 416.1928 337.7469 Tm (.)Tj 9.4902 0 0 9.4902 420.2512 337.7469 Tm ( )Tj 1 1 1 rg /TT0 1 Tf 12.0784 0 0 12.0784 37.098 313.1604 Tm (URINARY TRACT DEFECTS)Tj 0 0 0 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 290.2827 Tm ( )Tj 0 -1.158 TD (The fetal kidneys and adrenals can first be visualized by transabdominal\ ultrasound at 9 weeks and they are seen in all cases )Tj 0 -1.564 TD (from 12 weeks)Tj 8.9195 0 0 8.9195 120.2497 262.7968 Tm (18)Tj 11.1493 0 0 11.1493 131.5952 259.9426 Tm (. The renal echogenicity is high at 9 weeks but decreases with gestation\ ; the adrenals appear as translucent )Tj -8.476 -1.473 Td (structures with an echodense cortex)Tj 8.9195 0 0 8.9195 241.0303 246.3715 Tm (18)Tj 11.1493 0 0 11.1493 252.3758 243.5172 Tm (. The fetal bladder can be visualized in about 80% of fetuses at 11 week\ s and in more )Tj -19.309 -1.473 Td (than 90% by 13 weeks)Tj 8.9195 0 0 8.9195 166.7312 229.9461 Tm (75)Tj 11.1493 0 0 11.1493 178.0768 227.0919 Tm (. At 12\22613 weeks, the fetal kidneys can be visualized in 99% of the c\ ases, by using both )Tj -12.645 -1.473 Td (transabdominal and transvaginal sonography)Tj 8.9195 0 0 8.9195 290.6225 213.5208 Tm (49)Tj 11.1493 0 0 11.1493 301.968 210.6666 Tm (.)Tj 9.4902 0 0 9.4902 37.098 193.2048 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 175.1935 Tm (Bilateral Renal Agenesis)Tj /TT1 1 Tf -0.542 -1.8 Td (This sporadic condition, with a birth prevalence of about 1 in 4000, is \ usually diagnosed in the second trimester of pregnancy )Tj 0 -1.473 TD (by the findings of anhydramnios, absence of the urinary bladder and fail\ ure to identify the fetal kidneys; the differential )Tj T* (diagnosis is preterm prelabor rupture of membranes and severe uteroplace\ ntal insufficiency that may also present with )Tj T* (oligohydramnios.)Tj 0 -1.937 TD (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the prenatal diagnosis of bilateral renal agenesis at 14 week\ s of gestation in five fetuses; in all cases, )Tj 0 -1.473 TD (there were hypoechogenic masses in the renal beds, that were subsequentl\ y found at pathological examination to be enlarged )Tj 0 -1.564 TD (adrenals)Tj 8.9195 0 0 8.9195 84.7725 53.2427 Tm (76)Tj 11.1493 0 0 11.1493 96.1181 50.3884 Tm (. The amniotic fluid volume was normal in all cases at 14 weeks. In two \ cases, a cystic structure suggestive of the )Tj -5.294 -1.383 Td (fetal bladder was temporarily detected in the fetal pelvis but this disa\ ppeared by 16\22617 weeks.)Tj /TT0 1 Tf ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(49 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2293 0 obj<> endobj 2294 0 obj<>/Type/XObject/BBox[292.771 525.464 559.935 539.762]/FormType 1>>stream 1 1 0 rg 0.8411 w 296.3636 525.8848 m 293.1917 529.0566 293.1917 536.17 296.3636 539.3418 c 556.3428 539.3418 l 559.5146 536.17 559.5146 529.0566 556.3428 525.8848 c f endstream endobj 2295 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 267.164 14.2985]/FormType 1>>stream /Form Do endstream endobj 2296 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 267.165 14.2988]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2297 0 obj<>>> endobj 2298 0 obj<>9]/P 208 0 R/S/Annot/Pg 719 0 R>> endobj 2299 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 561.653 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 373.701 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 305.559 735.059 23.122 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 167.845 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5804 Tm (Gastroschisis)Tj /TT1 1 Tf 0 -2.867 TD (This is a sporadic defect with a birth prevalence of about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 359.7364 544.6154 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 421.1356 544.6154 Tm (Evisceration of the intestine occurs through a small )Tj -34.445 -1.473 Td (abdominal wall defect located just lateral and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 296.364 528.1924 Tm (usually to the right of an intact umbilical cord. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 560.2681 528.1924 Tm (Prenatal diagnosis by ultrasound is )Tj -46.924 -1.473 Td (based on the demonstration of )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 213.5804 511.7695 Tm (the normally situated umbilicus )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 393.9093 511.7695 Tm (and the herniated loops of intestine, which are free-floating. )Tj -32.003 -1.473 Td (Associated chromosomal abnormalities are rare.)Tj 0 -1.937 TD (Surprisingly, although the incidence of gastroschisis in ultrasound stud\ ies during the second trimester of pregnancy is similar )Tj (to )Tj 0 -1.473 TD (that of exomphalos, there is a sparsity of reports on first-trimester di\ agnosis. 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Similarly, Guzman reported a 12-week fetus with gastroschisis; )Tj -29.441 -1.473 Td (there was spontaneous rupture of membranes and intrauterine death at 22 \ weeks)Tj 8.9195 0 0 8.9195 499.1036 409.8862 Tm (74)Tj 11.1493 0 0 11.1493 510.4492 407.032 Tm (.)Tj 1 1 0 rg /TT3 1 Tf -41.914 -2.33 Td (Screening studies)Tj 0 0 0 rg /TT1 1 Tf 9.4902 0 0 9.4902 37.098 364.1126 Tm ( )Tj 11.1493 0 0 11.1493 37.098 352.1329 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there was one 11-week fetus with gastroschisis, )Tj 0 -1.29 TD (encephalocele and kyphoscoliosis; the pregnancy was terminated)Tj 8.9195 0 0 8.9195 404.8472 340.6012 Tm (25)Tj 11.1493 0 0 11.1493 416.1928 337.7469 Tm (.)Tj 9.4902 0 0 9.4902 420.2512 337.7469 Tm ( )Tj 1 1 1 rg /TT0 1 Tf 12.0784 0 0 12.0784 37.098 313.1604 Tm (URINARY TRACT DEFECTS)Tj 0 0 0 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 290.2827 Tm ( )Tj 0 -1.158 TD (The fetal kidneys and adrenals can first be visualized by transabdominal\ ultrasound at 9 weeks and they are seen in all cases )Tj 0 -1.564 TD (from 12 weeks)Tj 8.9195 0 0 8.9195 120.2497 262.7968 Tm (18)Tj 11.1493 0 0 11.1493 131.5952 259.9426 Tm (. The renal echogenicity is high at 9 weeks but decreases with gestation\ ; the adrenals appear as translucent )Tj -8.476 -1.473 Td (structures with an echodense cortex)Tj 8.9195 0 0 8.9195 241.0303 246.3715 Tm (18)Tj 11.1493 0 0 11.1493 252.3758 243.5172 Tm (. The fetal bladder can be visualized in about 80% of fetuses at 11 week\ s and in more )Tj -19.309 -1.473 Td (than 90% by 13 weeks)Tj 8.9195 0 0 8.9195 166.7312 229.9461 Tm (75)Tj 11.1493 0 0 11.1493 178.0768 227.0919 Tm (. 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The amniotic fluid volume was normal in all cases at 14 weeks. In two \ cases, a cystic structure suggestive of the )Tj -5.294 -1.383 Td (fetal bladder was temporarily detected in the fetal pelvis but this disa\ ppeared by 16\22617 weeks.)Tj /TT0 1 Tf ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(49 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2300 0 obj<> endobj 2301 0 obj<>/Type/XObject/BBox[209.988 509.041 393.577 523.339]/FormType 1>>stream 1 1 0 rg 0.8411 w 213.5803 509.4617 m 210.4085 512.6336 210.4085 519.7469 213.5803 522.9188 c 389.9844 522.9188 l 393.1562 519.7469 393.1562 512.6336 389.9844 509.4617 c f endstream endobj 2302 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 183.589 14.2986]/FormType 1>>stream /Form Do endstream endobj 2303 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 183.59 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2304 0 obj<>>> endobj 2305 0 obj<>12]/P 208 0 R/S/Annot/Pg 719 0 R>> endobj 2306 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 561.653 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 373.701 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 305.559 735.059 23.122 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 167.845 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5804 Tm (Gastroschisis)Tj /TT1 1 Tf 0 -2.867 TD (This is a sporadic defect with a birth prevalence of about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 359.7364 544.6154 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 421.1356 544.6154 Tm (Evisceration of the intestine occurs through a small )Tj -34.445 -1.473 Td (abdominal wall defect located just lateral and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 296.364 528.1924 Tm (usually to the right of an intact umbilical cord. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 560.2681 528.1924 Tm (Prenatal diagnosis by ultrasound is )Tj -46.924 -1.473 Td (based on the demonstration of )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 213.5804 511.7695 Tm (the normally situated umbilicus )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 393.9093 511.7695 Tm (and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 418.5381 511.7695 Tm (the herniated loops of intestine, which are free-floating. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 495.3466 Tm (Associated chromosomal abnormalities are rare.)Tj 0 -1.937 TD (Surprisingly, although the incidence of gastroschisis in ultrasound stud\ ies during the second trimester of pregnancy is similar )Tj (to )Tj 0 -1.473 TD (that of exomphalos, there is a sparsity of reports on first-trimester di\ agnosis. 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The renal echogenicity is high at 9 weeks but decreases with gestation\ ; the adrenals appear as translucent )Tj -8.476 -1.473 Td (structures with an echodense cortex)Tj 8.9195 0 0 8.9195 241.0303 246.3715 Tm (18)Tj 11.1493 0 0 11.1493 252.3758 243.5172 Tm (. The fetal bladder can be visualized in about 80% of fetuses at 11 week\ s and in more )Tj -19.309 -1.473 Td (than 90% by 13 weeks)Tj 8.9195 0 0 8.9195 166.7312 229.9461 Tm (75)Tj 11.1493 0 0 11.1493 178.0768 227.0919 Tm (. At 12\22613 weeks, the fetal kidneys can be visualized in 99% of the c\ ases, by using both )Tj -12.645 -1.473 Td (transabdominal and transvaginal sonography)Tj 8.9195 0 0 8.9195 290.6225 213.5208 Tm (49)Tj 11.1493 0 0 11.1493 301.968 210.6666 Tm (.)Tj 9.4902 0 0 9.4902 37.098 193.2048 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 175.1935 Tm (Bilateral Renal Agenesis)Tj /TT1 1 Tf -0.542 -1.8 Td (This sporadic condition, with a birth prevalence of about 1 in 4000, is \ usually diagnosed in the second trimester of pregnancy )Tj 0 -1.473 TD (by the findings of anhydramnios, absence of the urinary bladder and fail\ ure to identify the fetal kidneys; the differential )Tj T* (diagnosis is preterm prelabor rupture of membranes and severe uteroplace\ ntal insufficiency that may also present with )Tj T* (oligohydramnios.)Tj 0 -1.937 TD (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the prenatal diagnosis of bilateral renal agenesis at 14 week\ s of gestation in five fetuses; in all cases, )Tj 0 -1.473 TD (there were hypoechogenic masses in the renal beds, that were subsequentl\ y found at pathological examination to be enlarged )Tj 0 -1.564 TD (adrenals)Tj 8.9195 0 0 8.9195 84.7725 53.2427 Tm (76)Tj 11.1493 0 0 11.1493 96.1181 50.3884 Tm (. The amniotic fluid volume was normal in all cases at 14 weeks. In two \ cases, a cystic structure suggestive of the )Tj -5.294 -1.383 Td (fetal bladder was temporarily detected in the fetal pelvis but this disa\ ppeared by 16\22617 weeks.)Tj /TT0 1 Tf ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(49 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2307 0 obj<> endobj 2308 0 obj<>/Type/XObject/BBox[414.946 509.041 736.362 523.339]/FormType 1>>stream 1 1 0 rg 0.8411 w 418.5381 509.4618 m 415.3663 512.6336 415.3663 519.747 418.5381 522.9188 c 732.7692 522.9188 l 735.941 519.747 735.941 512.6336 732.7692 509.4618 c f endstream endobj 2309 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 321.416 14.2986]/FormType 1>>stream /Form Do endstream endobj 2310 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 321.417 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2311 0 obj<>>> endobj 2312 0 obj<>14]/P 208 0 R/S/Annot/Pg 719 0 R>> endobj 2313 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 561.653 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 373.701 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 305.559 735.059 23.122 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 167.845 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5804 Tm (Gastroschisis)Tj /TT1 1 Tf 0 -2.867 TD (This is a sporadic defect with a birth prevalence of about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 359.7364 544.6154 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 421.1356 544.6154 Tm (Evisceration of the intestine occurs through a small )Tj -34.445 -1.473 Td (abdominal wall defect located just lateral and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 296.364 528.1924 Tm (usually to the right of an intact umbilical cord. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 560.2681 528.1924 Tm (Prenatal diagnosis by ultrasound is )Tj -46.924 -1.473 Td (based on the demonstration of )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 213.5804 511.7695 Tm (the normally situated umbilicus )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 393.9093 511.7695 Tm (and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 418.5381 511.7695 Tm (the herniated loops of intestine, which are free-floating. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 495.3466 Tm (Associated chromosomal abnormalities are rare.)Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 473.7504 Tm (Surprisingly, although the incidence of gastroschisis in ultrasound stud\ ies during the second trimester of pregnancy is similar )Tj (to )Tj 0 -1.473 TD (that of exomphalos, there is a sparsity of reports on first-trimester di\ agnosis. 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Similarly, Guzman reported a 12-week fetus with gastroschisis; )Tj -29.441 -1.473 Td (there was spontaneous rupture of membranes and intrauterine death at 22 \ weeks)Tj 8.9195 0 0 8.9195 499.1036 409.8862 Tm (74)Tj 11.1493 0 0 11.1493 510.4492 407.032 Tm (.)Tj 1 1 0 rg /TT3 1 Tf -41.914 -2.33 Td (Screening studies)Tj 0 0 0 rg /TT1 1 Tf 9.4902 0 0 9.4902 37.098 364.1126 Tm ( )Tj 11.1493 0 0 11.1493 37.098 352.1329 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there was one 11-week fetus with gastroschisis, )Tj 0 -1.29 TD (encephalocele and kyphoscoliosis; the pregnancy was terminated)Tj 8.9195 0 0 8.9195 404.8472 340.6012 Tm (25)Tj 11.1493 0 0 11.1493 416.1928 337.7469 Tm (.)Tj 9.4902 0 0 9.4902 420.2512 337.7469 Tm ( )Tj 1 1 1 rg /TT0 1 Tf 12.0784 0 0 12.0784 37.098 313.1604 Tm (URINARY TRACT DEFECTS)Tj 0 0 0 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 290.2827 Tm ( )Tj 0 -1.158 TD (The fetal kidneys and adrenals can first be visualized by transabdominal\ ultrasound at 9 weeks and they are seen in all cases )Tj 0 -1.564 TD (from 12 weeks)Tj 8.9195 0 0 8.9195 120.2497 262.7968 Tm (18)Tj 11.1493 0 0 11.1493 131.5952 259.9426 Tm (. The renal echogenicity is high at 9 weeks but decreases with gestation\ ; the adrenals appear as translucent )Tj -8.476 -1.473 Td (structures with an echodense cortex)Tj 8.9195 0 0 8.9195 241.0303 246.3715 Tm (18)Tj 11.1493 0 0 11.1493 252.3758 243.5172 Tm (. The fetal bladder can be visualized in about 80% of fetuses at 11 week\ s and in more )Tj -19.309 -1.473 Td (than 90% by 13 weeks)Tj 8.9195 0 0 8.9195 166.7312 229.9461 Tm (75)Tj 11.1493 0 0 11.1493 178.0768 227.0919 Tm (. 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The amniotic fluid volume was normal in all cases at 14 weeks. In two \ cases, a cystic structure suggestive of the )Tj -5.294 -1.383 Td (fetal bladder was temporarily detected in the fetal pelvis but this disa\ ppeared by 16\22617 weeks.)Tj /TT0 1 Tf ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(49 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2314 0 obj<> endobj 2315 0 obj<>/Type/XObject/BBox[33.5055 492.618 311.964 506.917]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.098 493.0388 m 33.9262 496.2107 33.9262 503.3241 37.098 506.4959 c 308.3713 506.4959 l 311.5432 503.3241 311.5432 496.2107 308.3713 493.0388 c f endstream endobj 2316 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 278.459 14.2986]/FormType 1>>stream /Form Do endstream endobj 2317 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 278.459 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2318 0 obj<>>> endobj 2319 0 obj<>17]/P 208 0 R/S/Annot/Pg 719 0 R>> endobj 2320 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 561.653 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 373.701 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 305.559 735.059 23.122 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 167.845 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5804 Tm (Gastroschisis)Tj /TT1 1 Tf 0 -2.867 TD (This is a sporadic defect with a birth prevalence of about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 359.7364 544.6154 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 421.1356 544.6154 Tm (Evisceration of the intestine occurs through a small )Tj -34.445 -1.473 Td (abdominal wall defect located just lateral and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 296.364 528.1924 Tm (usually to the right of an intact umbilical cord. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 560.2681 528.1924 Tm (Prenatal diagnosis by ultrasound is )Tj -46.924 -1.473 Td (based on the demonstration of )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 213.5804 511.7695 Tm (the normally situated umbilicus )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 393.9093 511.7695 Tm (and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 418.5381 511.7695 Tm (the herniated loops of intestine, which are free-floating. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 495.3466 Tm (Associated chromosomal abnormalities are rare.)Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 473.7504 Tm (Surprisingly, although the incidence of gastroschisis in ultrasound stud\ ies during the second trimester of pregnancy is similar )Tj (to )Tj 0 -1.473 TD (that of exomphalos, there is a sparsity of reports on first-trimester di\ agnosis. 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The amniotic fluid volume was normal in all cases at 14 weeks. 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Kushnir )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a 13-week fetus with a )Tj T* (free-floating cauliflower-shaped mass protruding through the fetal abdom\ en and to the right of a normally inserted umbilical )Tj 0 -1.564 TD (cord; the diagnosis was confirmed after delivery at term)Tj 8.9195 0 0 8.9195 353.9952 426.3116 Tm (73)Tj 11.1493 0 0 11.1493 365.3407 423.4574 Tm (. Similarly, Guzman reported a 12-week fetus with gastroschisis; )Tj -29.441 -1.473 Td (there was spontaneous rupture of membranes and intrauterine death at 22 \ weeks)Tj 8.9195 0 0 8.9195 499.1036 409.8862 Tm (74)Tj 11.1493 0 0 11.1493 510.4492 407.032 Tm (.)Tj 1 1 0 rg /TT3 1 Tf -41.914 -2.33 Td (Screening studies)Tj 0 0 0 rg /TT1 1 Tf 9.4902 0 0 9.4902 37.098 364.1126 Tm ( )Tj 11.1493 0 0 11.1493 37.098 352.1329 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there was one 11-week fetus with gastroschisis, )Tj 0 -1.29 TD (encephalocele and kyphoscoliosis; the pregnancy was terminated)Tj 8.9195 0 0 8.9195 404.8472 340.6012 Tm (25)Tj 11.1493 0 0 11.1493 416.1928 337.7469 Tm (.)Tj 9.4902 0 0 9.4902 420.2512 337.7469 Tm ( )Tj 1 1 1 rg /TT0 1 Tf 12.0784 0 0 12.0784 37.098 313.1604 Tm (URINARY TRACT DEFECTS)Tj 0 0 0 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 290.2827 Tm ( )Tj 0 -1.158 TD (The fetal kidneys and adrenals can first be visualized by transabdominal\ ultrasound at 9 weeks and they are seen in all cases )Tj 0 -1.564 TD (from 12 weeks)Tj 8.9195 0 0 8.9195 120.2497 262.7968 Tm (18)Tj 11.1493 0 0 11.1493 131.5952 259.9426 Tm (. The renal echogenicity is high at 9 weeks but decreases with gestation\ ; the adrenals appear as translucent )Tj -8.476 -1.473 Td (structures with an echodense cortex)Tj 8.9195 0 0 8.9195 241.0303 246.3715 Tm (18)Tj 11.1493 0 0 11.1493 252.3758 243.5172 Tm (. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 260.3587 243.5172 Tm (The fetal bladder can be visualized in about 80% of fetuses at 11 weeks \ and in more )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.094 227.0943 Tm (than 90% by 13 weeks)Tj 8.9195 0 0 8.9195 166.7312 229.9461 Tm (75)Tj 11.1493 0 0 11.1493 178.0768 227.0919 Tm (. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 186.0597 227.0919 Tm (At 12\22613 weeks, the fetal kidneys can be visualized in 99% of the cas\ es, )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 600.7247 227.0919 Tm (by using both )Tj -50.553 -1.473 Td (transabdominal and transvaginal sonography)Tj 8.9195 0 0 8.9195 290.6225 213.5208 Tm (49)Tj 11.1493 0 0 11.1493 301.968 210.6666 Tm (.)Tj 9.4902 0 0 9.4902 37.098 193.2048 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 175.1935 Tm (Bilateral Renal Agenesis)Tj /TT1 1 Tf -0.542 -1.8 Td (This sporadic condition, with a birth prevalence of about 1 in 4000, is \ usually diagnosed in the second trimester of pregnancy )Tj 0 -1.473 TD (by the findings of anhydramnios, absence of the urinary bladder and fail\ ure to identify the fetal kidneys; the differential )Tj T* (diagnosis is preterm prelabor rupture of membranes and severe uteroplace\ ntal insufficiency that may also present with )Tj T* (oligohydramnios.)Tj 0 -1.937 TD (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the prenatal diagnosis of bilateral renal agenesis at 14 week\ s of gestation in five fetuses; in all cases, )Tj 0 -1.473 TD (there were hypoechogenic masses in the renal beds, that were subsequentl\ y found at pathological examination to be enlarged )Tj 0 -1.564 TD (adrenals)Tj 8.9195 0 0 8.9195 84.7725 53.2427 Tm (76)Tj 11.1493 0 0 11.1493 96.1181 50.3884 Tm (. The amniotic fluid volume was normal in all cases at 14 weeks. In two \ cases, a cystic structure suggestive of the )Tj -5.294 -1.383 Td (fetal bladder was temporarily detected in the fetal pelvis but this disa\ ppeared by 16\22617 weeks.)Tj /TT0 1 Tf ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(49 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2328 0 obj<> endobj 2329 0 obj<>/Type/XObject/BBox[256.766 240.789 741.029 255.087]/FormType 1>>stream 1 1 0 rg 0.8411 w 260.3587 241.2095 m 257.1869 244.3813 257.1869 251.4947 260.3587 254.6665 c 737.4369 254.6665 l 740.6087 251.4947 740.6087 244.3813 737.4369 241.2095 c f endstream endobj 2330 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 484.263 14.2986]/FormType 1>>stream /Form Do endstream endobj 2331 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 484.264 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2332 0 obj<>>> endobj 2333 0 obj<>21]/P 208 0 R/S/Annot/Pg 719 0 R>> endobj 2334 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 561.653 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 373.701 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 305.559 735.059 23.122 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 167.845 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5804 Tm (Gastroschisis)Tj /TT1 1 Tf 0 -2.867 TD (This is a sporadic defect with a birth prevalence of about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 359.7364 544.6154 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 421.1356 544.6154 Tm (Evisceration of the intestine occurs through a small )Tj -34.445 -1.473 Td (abdominal wall defect located just lateral and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 296.364 528.1924 Tm (usually to the right of an intact umbilical cord. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 560.2681 528.1924 Tm (Prenatal diagnosis by ultrasound is )Tj -46.924 -1.473 Td (based on the demonstration of )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 213.5804 511.7695 Tm (the normally situated umbilicus )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 393.9093 511.7695 Tm (and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 418.5381 511.7695 Tm (the herniated loops of intestine, which are free-floating. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 495.3466 Tm (Associated chromosomal abnormalities are rare.)Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 473.7504 Tm (Surprisingly, although the incidence of gastroschisis in ultrasound stud\ ies during the second trimester of pregnancy is similar )Tj (to )Tj 0 -1.473 TD (that of exomphalos, there is a sparsity of reports on first-trimester di\ agnosis. Kushnir )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a 13-week fetus with a )Tj T* (free-floating cauliflower-shaped mass protruding through the fetal abdom\ en and to the right of a normally inserted umbilical )Tj 0 -1.564 TD (cord; the diagnosis was confirmed after delivery at term)Tj 8.9195 0 0 8.9195 353.9952 426.3116 Tm (73)Tj 11.1493 0 0 11.1493 365.3407 423.4574 Tm (. Similarly, Guzman reported a 12-week fetus with gastroschisis; )Tj -29.441 -1.473 Td (there was spontaneous rupture of membranes and intrauterine death at 22 \ weeks)Tj 8.9195 0 0 8.9195 499.1036 409.8862 Tm (74)Tj 11.1493 0 0 11.1493 510.4492 407.032 Tm (.)Tj 1 1 0 rg /TT3 1 Tf -41.914 -2.33 Td (Screening studies)Tj 0 0 0 rg /TT1 1 Tf 9.4902 0 0 9.4902 37.098 364.1126 Tm ( )Tj 11.1493 0 0 11.1493 37.098 352.1329 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there was one 11-week fetus with gastroschisis, )Tj 0 -1.29 TD (encephalocele and kyphoscoliosis; the pregnancy was terminated)Tj 8.9195 0 0 8.9195 404.8472 340.6012 Tm (25)Tj 11.1493 0 0 11.1493 416.1928 337.7469 Tm (.)Tj 9.4902 0 0 9.4902 420.2512 337.7469 Tm ( )Tj 1 1 1 rg /TT0 1 Tf 12.0784 0 0 12.0784 37.098 313.1604 Tm (URINARY TRACT DEFECTS)Tj 0 0 0 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 290.2827 Tm ( )Tj 0 -1.158 TD (The fetal kidneys and adrenals can first be visualized by transabdominal\ ultrasound at 9 weeks and they are seen in all cases )Tj 0 -1.564 TD (from 12 weeks)Tj 8.9195 0 0 8.9195 120.2497 262.7968 Tm (18)Tj 11.1493 0 0 11.1493 131.5952 259.9426 Tm (. The renal echogenicity is high at 9 weeks but decreases with gestation\ ; the adrenals appear as translucent )Tj -8.476 -1.473 Td (structures with an echodense cortex)Tj 8.9195 0 0 8.9195 241.0303 246.3715 Tm (18)Tj 11.1493 0 0 11.1493 252.3758 243.5172 Tm (. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 260.3587 243.5172 Tm (The fetal bladder can be visualized in about 80% of fetuses at 11 weeks \ and in more )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.094 227.0943 Tm (than 90% by 13 weeks)Tj 8.9195 0 0 8.9195 166.7312 229.9461 Tm (75)Tj 11.1493 0 0 11.1493 178.0768 227.0919 Tm (. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 186.0597 227.0919 Tm (At 12\22613 weeks, the fetal kidneys can be visualized in 99% of the cas\ es, )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 600.7247 227.0919 Tm (by using both )Tj -50.553 -1.473 Td (transabdominal and transvaginal sonography)Tj 8.9195 0 0 8.9195 290.6225 213.5208 Tm (49)Tj 11.1493 0 0 11.1493 301.968 210.6666 Tm (.)Tj 9.4902 0 0 9.4902 37.098 193.2048 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 175.1935 Tm (Bilateral Renal Agenesis)Tj /TT1 1 Tf -0.542 -1.8 Td (This sporadic condition, with a birth prevalence of about 1 in 4000, is \ usually diagnosed in the second trimester of pregnancy )Tj 0 -1.473 TD (by the findings of anhydramnios, absence of the urinary bladder and fail\ ure to identify the fetal kidneys; the differential )Tj T* (diagnosis is preterm prelabor rupture of membranes and severe uteroplace\ ntal insufficiency that may also present with )Tj T* (oligohydramnios.)Tj 0 -1.937 TD (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the prenatal diagnosis of bilateral renal agenesis at 14 week\ s of gestation in five fetuses; in all cases, )Tj 0 -1.473 TD (there were hypoechogenic masses in the renal beds, that were subsequentl\ y found at pathological examination to be enlarged )Tj 0 -1.564 TD (adrenals)Tj 8.9195 0 0 8.9195 84.7725 53.2427 Tm (76)Tj 11.1493 0 0 11.1493 96.1181 50.3884 Tm (. The amniotic fluid volume was normal in all cases at 14 weeks. In two \ cases, a cystic structure suggestive of the )Tj -5.294 -1.383 Td (fetal bladder was temporarily detected in the fetal pelvis but this disa\ ppeared by 16\22617 weeks.)Tj /TT0 1 Tf ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(49 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2335 0 obj<> endobj 2336 0 obj<>/Type/XObject/BBox[33.482 224.344 185.894 239.306]/FormType 1>>stream 1 1 0 rg 0.8801 w 37.094 224.7866 m 33.9222 227.9584 33.9222 235.0718 37.094 238.2436 c 182.1351 238.8656 l 185.4542 235.5466 185.4542 228.1032 182.1351 224.7842 c f endstream endobj 2337 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 152.413 14.962]/FormType 1>>stream /Form Do endstream endobj 2338 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 152.413 14.9623]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2339 0 obj<>>> endobj 2340 0 obj<>24]/P 208 0 R/S/Annot/Pg 719 0 R>> endobj 2341 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 561.653 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 373.701 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 305.559 735.059 23.122 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 167.845 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5804 Tm (Gastroschisis)Tj /TT1 1 Tf 0 -2.867 TD (This is a sporadic defect with a birth prevalence of about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 359.7364 544.6154 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 421.1356 544.6154 Tm (Evisceration of the intestine occurs through a small )Tj -34.445 -1.473 Td (abdominal wall defect located just lateral and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 296.364 528.1924 Tm (usually to the right of an intact umbilical cord. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 560.2681 528.1924 Tm (Prenatal diagnosis by ultrasound is )Tj -46.924 -1.473 Td (based on the demonstration of )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 213.5804 511.7695 Tm (the normally situated umbilicus )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 393.9093 511.7695 Tm (and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 418.5381 511.7695 Tm (the herniated loops of intestine, which are free-floating. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 495.3466 Tm (Associated chromosomal abnormalities are rare.)Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 473.7504 Tm (Surprisingly, although the incidence of gastroschisis in ultrasound stud\ ies during the second trimester of pregnancy is similar )Tj (to )Tj 0 -1.473 TD (that of exomphalos, there is a sparsity of reports on first-trimester di\ agnosis. Kushnir )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a 13-week fetus with a )Tj T* (free-floating cauliflower-shaped mass protruding through the fetal abdom\ en and to the right of a normally inserted umbilical )Tj 0 -1.564 TD (cord; the diagnosis was confirmed after delivery at term)Tj 8.9195 0 0 8.9195 353.9952 426.3116 Tm (73)Tj 11.1493 0 0 11.1493 365.3407 423.4574 Tm (. Similarly, Guzman reported a 12-week fetus with gastroschisis; )Tj -29.441 -1.473 Td (there was spontaneous rupture of membranes and intrauterine death at 22 \ weeks)Tj 8.9195 0 0 8.9195 499.1036 409.8862 Tm (74)Tj 11.1493 0 0 11.1493 510.4492 407.032 Tm (.)Tj 1 1 0 rg /TT3 1 Tf -41.914 -2.33 Td (Screening studies)Tj 0 0 0 rg /TT1 1 Tf 9.4902 0 0 9.4902 37.098 364.1126 Tm ( )Tj 11.1493 0 0 11.1493 37.098 352.1329 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there was one 11-week fetus with gastroschisis, )Tj 0 -1.29 TD (encephalocele and kyphoscoliosis; the pregnancy was terminated)Tj 8.9195 0 0 8.9195 404.8472 340.6012 Tm (25)Tj 11.1493 0 0 11.1493 416.1928 337.7469 Tm (.)Tj 9.4902 0 0 9.4902 420.2512 337.7469 Tm ( )Tj 1 1 1 rg /TT0 1 Tf 12.0784 0 0 12.0784 37.098 313.1604 Tm (URINARY TRACT DEFECTS)Tj 0 0 0 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 290.2827 Tm ( )Tj 0 -1.158 TD (The fetal kidneys and adrenals can first be visualized by transabdominal\ ultrasound at 9 weeks and they are seen in all cases )Tj 0 -1.564 TD (from 12 weeks)Tj 8.9195 0 0 8.9195 120.2497 262.7968 Tm (18)Tj 11.1493 0 0 11.1493 131.5952 259.9426 Tm (. The renal echogenicity is high at 9 weeks but decreases with gestation\ ; the adrenals appear as translucent )Tj -8.476 -1.473 Td (structures with an echodense cortex)Tj 8.9195 0 0 8.9195 241.0303 246.3715 Tm (18)Tj 11.1493 0 0 11.1493 252.3758 243.5172 Tm (. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 260.3587 243.5172 Tm (The fetal bladder can be visualized in about 80% of fetuses at 11 weeks \ and in more )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.094 227.0943 Tm (than 90% by 13 weeks)Tj 8.9195 0 0 8.9195 166.7312 229.9461 Tm (75)Tj 11.1493 0 0 11.1493 178.0768 227.0919 Tm (. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 186.0597 227.0919 Tm (At 12\22613 weeks, the fetal kidneys can be visualized in 99% of the cas\ es, )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 600.7247 227.0919 Tm (by using both )Tj -50.553 -1.473 Td (transabdominal and transvaginal sonography)Tj 8.9195 0 0 8.9195 290.6225 213.5208 Tm (49)Tj 11.1493 0 0 11.1493 301.968 210.6666 Tm (.)Tj 9.4902 0 0 9.4902 37.098 193.2048 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 175.1935 Tm (Bilateral Renal Agenesis)Tj /TT1 1 Tf -0.542 -1.8 Td (This sporadic condition, with a birth prevalence of about )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 356.9234 155.1248 Tm (1 in 4000, )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 418.3226 155.1248 Tm (is usually diagnosed in the second trimester of pregnancy )Tj -34.193 -1.473 Td (by the findings of anhydramnios, absence of the urinary bladder and fail\ ure to identify the fetal kidneys; the differential )Tj 0 -1.473 TD (diagnosis is preterm prelabor rupture of membranes and severe uteroplace\ ntal insufficiency that may also present with )Tj T* (oligohydramnios.)Tj 0 -1.937 TD (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the prenatal diagnosis of bilateral renal agenesis at 14 week\ s of gestation in five fetuses; in all cases, )Tj 0 -1.473 TD (there were hypoechogenic masses in the renal beds, that were subsequentl\ y found at pathological examination to be enlarged )Tj 0 -1.564 TD (adrenals)Tj 8.9195 0 0 8.9195 84.7725 53.2427 Tm (76)Tj 11.1493 0 0 11.1493 96.1181 50.3884 Tm (. The amniotic fluid volume was normal in all cases at 14 weeks. In two \ cases, a cystic structure suggestive of the )Tj -5.294 -1.383 Td (fetal bladder was temporarily detected in the fetal pelvis but this disa\ ppeared by 16\22617 weeks.)Tj /TT0 1 Tf ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(49 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2342 0 obj<> endobj 2343 0 obj<>/Type/XObject/BBox[353.33 152.396 417.99 166.695]/FormType 1>>stream 1 1 0 rg 0.8411 w 356.9227 152.817 m 353.7509 155.9889 353.7509 163.1022 356.9227 166.2741 c 414.3975 166.2741 l 417.5694 163.1022 417.5694 155.9889 414.3975 152.817 c f endstream endobj 2344 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 64.66 14.2986]/FormType 1>>stream /Form Do endstream endobj 2345 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 64.6603 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2346 0 obj<>>> endobj 2347 0 obj<>27]/P 208 0 R/S/Annot/Pg 719 0 R>> endobj 2348 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 561.653 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 373.701 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 305.559 735.059 23.122 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 167.845 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5804 Tm (Gastroschisis)Tj /TT1 1 Tf 0 -2.867 TD (This is a sporadic defect with a birth prevalence of about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 359.7364 544.6154 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 421.1356 544.6154 Tm (Evisceration of the intestine occurs through a small )Tj -34.445 -1.473 Td (abdominal wall defect located just lateral and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 296.364 528.1924 Tm (usually to the right of an intact umbilical cord. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 560.2681 528.1924 Tm (Prenatal diagnosis by ultrasound is )Tj -46.924 -1.473 Td (based on the demonstration of )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 213.5804 511.7695 Tm (the normally situated umbilicus )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 393.9093 511.7695 Tm (and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 418.5381 511.7695 Tm (the herniated loops of intestine, which are free-floating. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 495.3466 Tm (Associated chromosomal abnormalities are rare.)Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 473.7504 Tm (Surprisingly, although the incidence of gastroschisis in ultrasound stud\ ies during the second trimester of pregnancy is similar )Tj (to )Tj 0 -1.473 TD (that of exomphalos, there is a sparsity of reports on first-trimester di\ agnosis. 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Similarly, Guzman reported a 12-week fetus with gastroschisis; )Tj -29.441 -1.473 Td (there was spontaneous rupture of membranes and intrauterine death at 22 \ weeks)Tj 8.9195 0 0 8.9195 499.1036 409.8862 Tm (74)Tj 11.1493 0 0 11.1493 510.4492 407.032 Tm (.)Tj 1 1 0 rg /TT3 1 Tf -41.914 -2.33 Td (Screening studies)Tj 0 0 0 rg /TT1 1 Tf 9.4902 0 0 9.4902 37.098 364.1126 Tm ( )Tj 11.1493 0 0 11.1493 37.098 352.1329 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there was one 11-week fetus with gastroschisis, )Tj 0 -1.29 TD (encephalocele and kyphoscoliosis; the pregnancy was terminated)Tj 8.9195 0 0 8.9195 404.8472 340.6012 Tm (25)Tj 11.1493 0 0 11.1493 416.1928 337.7469 Tm (.)Tj 9.4902 0 0 9.4902 420.2512 337.7469 Tm ( )Tj 1 1 1 rg /TT0 1 Tf 12.0784 0 0 12.0784 37.098 313.1604 Tm (URINARY TRACT DEFECTS)Tj 0 0 0 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 290.2827 Tm ( )Tj 0 -1.158 TD (The fetal kidneys and adrenals can first be visualized by transabdominal\ ultrasound at 9 weeks and they are seen in all cases )Tj 0 -1.564 TD (from 12 weeks)Tj 8.9195 0 0 8.9195 120.2497 262.7968 Tm (18)Tj 11.1493 0 0 11.1493 131.5952 259.9426 Tm (. The renal echogenicity is high at 9 weeks but decreases with gestation\ ; the adrenals appear as translucent )Tj -8.476 -1.473 Td (structures with an echodense cortex)Tj 8.9195 0 0 8.9195 241.0303 246.3715 Tm (18)Tj 11.1493 0 0 11.1493 252.3758 243.5172 Tm (. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 260.3587 243.5172 Tm (The fetal bladder can be visualized in about 80% of fetuses at 11 weeks \ and in more )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.094 227.0943 Tm (than 90% by 13 weeks)Tj 8.9195 0 0 8.9195 166.7312 229.9461 Tm (75)Tj 11.1493 0 0 11.1493 178.0768 227.0919 Tm (. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 186.0597 227.0919 Tm (At 12\22613 weeks, the fetal kidneys can be visualized in 99% of the cas\ es, )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 600.7247 227.0919 Tm (by using both )Tj -50.553 -1.473 Td (transabdominal and transvaginal sonography)Tj 8.9195 0 0 8.9195 290.6225 213.5208 Tm (49)Tj 11.1493 0 0 11.1493 301.968 210.6666 Tm (.)Tj 9.4902 0 0 9.4902 37.098 193.2048 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 175.1935 Tm (Bilateral Renal Agenesis)Tj /TT1 1 Tf -0.542 -1.8 Td (This sporadic condition, with a birth prevalence of about )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 356.9234 155.1248 Tm (1 in 4000, )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 418.3226 155.1248 Tm (is usually diagnosed in the second trimester of pregnancy )Tj -34.193 -1.473 Td (by the findings of )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 138.9767 138.7018 Tm (anhydramnios, )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 226.3204 138.7018 Tm (absence of the urinary bladder and failure to identify the fetal kidneys\ ; the differential )Tj -16.972 -1.473 Td (diagnosis is preterm prelabor rupture of membranes and severe uteroplace\ ntal insufficiency that may also present with )Tj 0 -1.473 TD (oligohydramnios.)Tj 0 -1.937 TD (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the prenatal diagnosis of bilateral renal agenesis at 14 week\ s of gestation in five fetuses; in all cases, )Tj 0 -1.473 TD (there were hypoechogenic masses in the renal beds, that were subsequentl\ y found at pathological examination to be enlarged )Tj 0 -1.564 TD (adrenals)Tj 8.9195 0 0 8.9195 84.7725 53.2427 Tm (76)Tj 11.1493 0 0 11.1493 96.1181 50.3884 Tm (. The amniotic fluid volume was normal in all cases at 14 weeks. In two \ cases, a cystic structure suggestive of the )Tj -5.294 -1.383 Td (fetal bladder was temporarily detected in the fetal pelvis but this disa\ ppeared by 16\22617 weeks.)Tj /TT0 1 Tf ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(49 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2349 0 obj<> endobj 2350 0 obj<>/Type/XObject/BBox[135.384 135.973 216.121 150.272]/FormType 1>>stream 1 1 0 rg 0.8411 w 138.9769 136.3941 m 135.8051 139.566 135.8051 146.6794 138.9769 149.8512 c 212.5287 149.8512 l 215.7006 146.6794 215.7006 139.566 212.5287 136.3941 c f endstream endobj 2351 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 80.737 14.2986]/FormType 1>>stream /Form Do endstream endobj 2352 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 80.7374 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2353 0 obj<>>> endobj 2354 0 obj<>29]/P 208 0 R/S/Annot/Pg 719 0 R>> endobj 2355 0 obj<> endobj 2356 0 obj<> endobj 2357 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 561.653 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 373.701 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 305.559 735.059 23.122 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 167.845 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5804 Tm (Gastroschisis)Tj /TT1 1 Tf 0 -2.867 TD (This is a sporadic defect with a birth prevalence of about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 359.7364 544.6154 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 421.1356 544.6154 Tm (Evisceration of the intestine occurs through a small )Tj -34.445 -1.473 Td (abdominal wall defect located just lateral and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 296.364 528.1924 Tm (usually to the right of an intact umbilical cord. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 560.2681 528.1924 Tm (Prenatal diagnosis by ultrasound is )Tj -46.924 -1.473 Td (based on the demonstration of )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 213.5804 511.7695 Tm (the normally situated umbilicus )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 393.9093 511.7695 Tm (and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 418.5381 511.7695 Tm (the herniated loops of intestine, which are free-floating. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 495.3466 Tm (Associated chromosomal abnormalities are rare.)Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 473.7504 Tm (Surprisingly, although the incidence of gastroschisis in ultrasound stud\ ies during the second trimester of pregnancy is similar )Tj (to )Tj 0 -1.473 TD (that of exomphalos, there is a sparsity of reports on first-trimester di\ agnosis. 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The renal echogenicity is high at 9 weeks but decreases with gestation\ ; the adrenals appear as translucent )Tj -8.476 -1.473 Td (structures with an echodense cortex)Tj 8.9195 0 0 8.9195 241.0303 246.3715 Tm (18)Tj 11.1493 0 0 11.1493 252.3758 243.5172 Tm (. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 260.3587 243.5172 Tm (The fetal bladder can be visualized in about 80% of fetuses at 11 weeks \ and in more )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.094 227.0943 Tm (than 90% by 13 weeks)Tj 8.9195 0 0 8.9195 166.7312 229.9461 Tm (75)Tj 11.1493 0 0 11.1493 178.0768 227.0919 Tm (. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 186.0597 227.0919 Tm (At 12\22613 weeks, the fetal kidneys can be visualized in 99% of the cas\ es, )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 600.7247 227.0919 Tm (by using both )Tj -50.553 -1.473 Td (transabdominal and transvaginal sonography)Tj 8.9195 0 0 8.9195 290.6225 213.5208 Tm (49)Tj 11.1493 0 0 11.1493 301.968 210.6666 Tm (.)Tj 9.4902 0 0 9.4902 37.098 193.2048 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 175.1935 Tm (Bilateral Renal Agenesis)Tj /TT1 1 Tf -0.542 -1.8 Td (This sporadic condition, with a birth prevalence of about )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 356.9234 155.1248 Tm (1 in 4000, )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 418.3226 155.1248 Tm (is usually diagnosed in the second trimester of pregnancy )Tj -34.193 -1.473 Td (by the findings of )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 138.9767 138.7018 Tm (anhydramnios, )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 226.3204 138.7018 Tm (absence of the urinary bladder )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 402.3345 138.7018 Tm (and failure to identify the fetal kidneys; the differential )Tj -32.759 -1.473 Td (diagnosis is preterm prelabor rupture of membranes and severe uteroplace\ ntal insufficiency that may also present with )Tj 0 -1.473 TD (oligohydramnios.)Tj 0 -1.937 TD (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the prenatal diagnosis of bilateral renal agenesis at 14 week\ s of gestation in five fetuses; in all cases, )Tj 0 -1.473 TD (there were hypoechogenic masses in the renal beds, that were subsequentl\ y found at pathological examination to be enlarged )Tj 0 -1.564 TD (adrenals)Tj 8.9195 0 0 8.9195 84.7725 53.2427 Tm (76)Tj 11.1493 0 0 11.1493 96.1181 50.3884 Tm (. The amniotic fluid volume was normal in all cases at 14 weeks. In two \ cases, a cystic structure suggestive of the )Tj -5.294 -1.383 Td (fetal bladder was temporarily detected in the fetal pelvis but this disa\ ppeared by 16\22617 weeks.)Tj /TT0 1 Tf ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(49 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2358 0 obj<> endobj 2359 0 obj<>/Type/XObject/BBox[222.728 135.973 402.002 150.272]/FormType 1>>stream 1 1 0 rg 0.8411 w 226.3204 136.3941 m 223.1486 139.5659 223.1486 146.6793 226.3204 149.8511 c 398.4096 149.8511 l 401.5814 146.6793 401.5814 139.5659 398.4096 136.3941 c f endstream endobj 2360 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 179.274 14.2986]/FormType 1>>stream /Form Do endstream endobj 2361 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 179.275 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2362 0 obj<>>> endobj 2363 0 obj<>32]/P 208 0 R/S/Annot/Pg 719 0 R>> endobj 2364 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 561.653 735.059 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 373.701 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 305.559 735.059 23.122 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 167.845 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.5804 Tm (Gastroschisis)Tj /TT1 1 Tf 0 -2.867 TD (This is a sporadic defect with a birth prevalence of about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 359.7364 544.6154 Tm (1 in 4000. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 421.1356 544.6154 Tm (Evisceration of the intestine occurs through a small )Tj -34.445 -1.473 Td (abdominal wall defect located just lateral and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 296.364 528.1924 Tm (usually to the right of an intact umbilical cord. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 560.2681 528.1924 Tm (Prenatal diagnosis by ultrasound is )Tj -46.924 -1.473 Td (based on the demonstration of )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 213.5804 511.7695 Tm (the normally situated umbilicus )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 393.9093 511.7695 Tm (and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 418.5381 511.7695 Tm (the herniated loops of intestine, which are free-floating. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 495.3466 Tm (Associated chromosomal abnormalities are rare.)Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.098 473.7504 Tm (Surprisingly, although the incidence of gastroschisis in ultrasound stud\ ies during the second trimester of pregnancy is similar )Tj (to )Tj 0 -1.473 TD (that of exomphalos, there is a sparsity of reports on first-trimester di\ agnosis. Kushnir )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a 13-week fetus with a )Tj T* (free-floating cauliflower-shaped mass protruding through the fetal abdom\ en and to the right of a normally inserted umbilical )Tj 0 -1.564 TD (cord; the diagnosis was confirmed after delivery at term)Tj 8.9195 0 0 8.9195 353.9952 426.3116 Tm (73)Tj 11.1493 0 0 11.1493 365.3407 423.4574 Tm (. Similarly, Guzman reported a 12-week fetus with gastroschisis; )Tj -29.441 -1.473 Td (there was spontaneous rupture of membranes and intrauterine death at 22 \ weeks)Tj 8.9195 0 0 8.9195 499.1036 409.8862 Tm (74)Tj 11.1493 0 0 11.1493 510.4492 407.032 Tm (.)Tj 1 1 0 rg /TT3 1 Tf -41.914 -2.33 Td (Screening studies)Tj 0 0 0 rg /TT1 1 Tf 9.4902 0 0 9.4902 37.098 364.1126 Tm ( )Tj 11.1493 0 0 11.1493 37.098 352.1329 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there was one 11-week fetus with gastroschisis, )Tj 0 -1.29 TD (encephalocele and kyphoscoliosis; the pregnancy was terminated)Tj 8.9195 0 0 8.9195 404.8472 340.6012 Tm (25)Tj 11.1493 0 0 11.1493 416.1928 337.7469 Tm (.)Tj 9.4902 0 0 9.4902 420.2512 337.7469 Tm ( )Tj 1 1 1 rg /TT0 1 Tf 12.0784 0 0 12.0784 37.098 313.1604 Tm (URINARY TRACT DEFECTS)Tj 0 0 0 rg /TT1 1 Tf 11.1493 0 0 11.1493 37.098 290.2827 Tm ( )Tj 0 -1.158 TD (The fetal kidneys and adrenals can first be visualized by transabdominal\ ultrasound at 9 weeks and they are seen in all cases )Tj 0 -1.564 TD (from 12 weeks)Tj 8.9195 0 0 8.9195 120.2497 262.7968 Tm (18)Tj 11.1493 0 0 11.1493 131.5952 259.9426 Tm (. The renal echogenicity is high at 9 weeks but decreases with gestation\ ; the adrenals appear as translucent )Tj -8.476 -1.473 Td (structures with an echodense cortex)Tj 8.9195 0 0 8.9195 241.0303 246.3715 Tm (18)Tj 11.1493 0 0 11.1493 252.3758 243.5172 Tm (. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 260.3587 243.5172 Tm (The fetal bladder can be visualized in about 80% of fetuses at 11 weeks \ and in more )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.094 227.0943 Tm (than 90% by 13 weeks)Tj 8.9195 0 0 8.9195 166.7312 229.9461 Tm (75)Tj 11.1493 0 0 11.1493 178.0768 227.0919 Tm (. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 186.0597 227.0919 Tm (At 12\22613 weeks, the fetal kidneys can be visualized in 99% of the cas\ es, )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 600.7247 227.0919 Tm (by using both )Tj -50.553 -1.473 Td (transabdominal and transvaginal sonography)Tj 8.9195 0 0 8.9195 290.6225 213.5208 Tm (49)Tj 11.1493 0 0 11.1493 301.968 210.6666 Tm (.)Tj 9.4902 0 0 9.4902 37.098 193.2048 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 175.1935 Tm (Bilateral Renal Agenesis)Tj /TT1 1 Tf -0.542 -1.8 Td (This sporadic condition, with a birth prevalence of about )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 356.9234 155.1248 Tm (1 in 4000, )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 418.3226 155.1248 Tm (is usually diagnosed in the second trimester of pregnancy )Tj -34.193 -1.473 Td (by the findings of )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 138.9767 138.7018 Tm (anhydramnios, )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 226.3204 138.7018 Tm (absence of the urinary bladder )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 402.3345 138.7018 Tm (and )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 426.9634 138.7018 Tm (failure to identify the fetal kidneys; )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 629.1337 138.7018 Tm (the differential )Tj -53.101 -1.473 Td (diagnosis is preterm prelabor rupture of membranes and severe uteroplace\ ntal insufficiency that may also present with )Tj 0 -1.473 TD (oligohydramnios.)Tj 0 -1.937 TD (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported the prenatal diagnosis of bilateral renal agenesis at 14 week\ s of gestation in five fetuses; in all cases, )Tj 0 -1.473 TD (there were hypoechogenic masses in the renal beds, that were subsequentl\ y found at pathological examination to be enlarged )Tj 0 -1.564 TD (adrenals)Tj 8.9195 0 0 8.9195 84.7725 53.2427 Tm (76)Tj 11.1493 0 0 11.1493 96.1181 50.3884 Tm (. The amniotic fluid volume was normal in all cases at 14 weeks. In two \ cases, a cystic structure suggestive of the )Tj -5.294 -1.383 Td (fetal bladder was temporarily detected in the fetal pelvis but this disa\ ppeared by 16\22617 weeks.)Tj /TT0 1 Tf ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(49 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2365 0 obj<> endobj 2366 0 obj<>/Type/XObject/BBox[423.371 135.973 628.801 150.272]/FormType 1>>stream 1 1 0 rg 0.8411 w 426.9633 136.3941 m 423.7915 139.5659 423.7915 146.6793 426.9633 149.8511 c 625.2087 149.8511 l 628.3805 146.6793 628.3805 139.5659 625.2087 136.3941 c f endstream endobj 2367 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 205.431 14.2986]/FormType 1>>stream /Form Do endstream endobj 2368 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 205.431 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2369 0 obj<>>> endobj 2370 0 obj[2369 0 R 2373 0 R 2377 0 R 2380 0 R 2384 0 R 2387 0 R] endobj 2371 0 obj<>3]/P 208 0 R/S/Annot/Pg 723 0 R>> endobj 2372 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 569.562 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 38.824 361.275 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 169.414 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 59.275 735.059 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 576.9104 Tm (Infantile polycystic kidney disease)Tj /TT1 1 Tf -0.542 -1.8 Td (This an autosomal recessive condition with a birth prevalence of about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 437.5549 556.8417 Tm (1 in 50 000. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 509.9696 556.8417 Tm (It is subdivided into perinatal, neonatal, )Tj -42.413 -1.473 Td (infantile and juvenile types, on the basis of the age of onset of the cl\ inical presentation and the degree of renal involvement.)Tj ( )Tj 0 -1.473 TD (Prenatal diagnosis by ultrasound is confined to the perinatal and probab\ ly the neonatal types and is based on the )Tj T* (demonstration of bilaterally enlarged and homogeneously hyperechogenic k\ idneys. While there is often associated )Tj T* (oligohydramnios, this is not found invariably. These sonographic appeara\ nces, however, may not become apparent until 26 )Tj T* (weeks of gestation, and therefore serial scans should be performed for e\ xclusion of the diagnosis.)Tj 0 -1.937 TD (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a case of infantile polycystic kidney disease; at 11 and 15 w\ eeks, the kidneys and bladder looked )Tj 0 -1.564 TD (normal, but at 28 weeks there was oligohydramnios with bilaterally enlar\ ged and diffusely hyperechogenic kidneys)Tj 8.9195 0 0 8.9195 682.6883 438.5342 Tm (77)Tj 11.1493 0 0 11.1493 694.0339 435.68 Tm (. )Tj -58.922 -1.383 Td (Retrospective examination of the videotapes taken from the early scans d\ emonstrated that the kidneys were of increased )Tj 0 -1.473 TD (echogenicity and increased length from as early as 12 weeks.)Tj /TT0 1 Tf 0.542 -2.478 Td (Multicystic dysplastic kidney disease)Tj /TT1 1 Tf -0.542 -2.48 Td (In this sporadic condition, which may be unilateral or bilateral, the co\ llecting tubules and nephrons are dysplastic. The )Tj T* (collecting tubules become cystic and the diameter of the cysts determine\ s the size of the kidneys, which may be large and )Tj T* (multicystic or small, shrunken and hyperechogenic. Occasionally, only on\ e of a small number of adjacent collecting tubules is )Tj T* (involved so that only a segment of the kidney is abnormal. With bilatera\ l involvement, there is associated absence of the )Tj T* (bladder and oligohydramnios.)Tj 0 -1.937 TD (Cullen )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a case that at 11 weeks demonstrated hyperechoic kidneys with\ no obvious dilatation of the bladder; )Tj 0 -1.564 TD (ultrasound examination in the newborn, after delivery at term, confirmed\ the diagnosis of cystic dysplastic kidneys)Tj 8.9195 0 0 8.9195 683.6583 246.673 Tm (25)Tj 11.1493 0 0 11.1493 695.0039 243.8187 Tm (. )Tj -59.009 -1.383 Td (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a case with a unilateral multicystic kidney diagnosed at 12 w\ eeks during routine ultrasound )Tj T* (examination; the fetal karyotype was normal)Tj 8.9195 0 0 8.9195 290.3103 213.8223 Tm (78)Tj 11.1493 0 0 11.1493 301.6558 210.9681 Tm (. Ultrasound examination of the newborn confirmed the antenatal diagnosi\ s.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 730.5814 210.9681 Tm ( )Tj 1 1 0 rg /TT4 1 Tf 11.1493 0 0 11.1493 43.1373 184.3415 Tm (Screening studies)Tj 0 0 0 rg /TT1 1 Tf -0.542 -2.48 Td (In a screening study involving ultrasound examinations at 11\22614 weeks\ of gestation and at 18\22620 weeks in 3991 patients, )Tj 0 -1.473 TD (there were three cases of unilateral multicystic dysplastic kidneys and \ none was detected at the early scan; two were diagnosed )Tj 0 -1.564 TD (at 18\22620 weeks and the third was detected at 31 weeks)Tj 8.9195 0 0 8.9195 352.8691 125.6896 Tm (26)Tj 11.1493 0 0 11.1493 364.2147 122.8353 Tm (. In another screening study involving 1632 pregnancies at 12\22614 )Tj -29.34 -1.473 Td (weeks, there was one case with unilateral multicystic kidneys and this w\ as correctly identified in the first-trimester scan)Tj 8.9195 0 0 8.9195 712.825 109.2642 Tm (35)Tj 11.1493 0 0 11.1493 724.1705 106.41 Tm (.)Tj /TT0 1 Tf ( )Tj /TT1 1 Tf 9.4902 0 0 9.4902 37.098 88.9482 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 37.098 66.6232 Tm (Hydronephrosis)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(50 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2373 0 obj<> endobj 2374 0 obj<>/Type/XObject/BBox[433.962 554.113 509.637 568.412]/FormType 1>>stream 1 1 0 rg 0.8411 w 437.5541 554.5339 m 434.3822 557.7058 434.3822 564.8191 437.5541 567.991 c 506.0445 567.991 l 509.2164 564.8191 509.2164 557.7058 506.0445 554.5339 c f endstream endobj 2375 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 75.6756 14.2985]/FormType 1>>stream /Form Do endstream endobj 2376 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 75.6759 14.2988]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2377 0 obj<>>> endobj 2378 0 obj<>6]/P 208 0 R/S/Annot/Pg 723 0 R>> endobj 2379 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 569.562 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 38.824 361.275 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 169.414 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 59.275 735.059 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 576.9104 Tm (Infantile polycystic kidney disease)Tj /TT1 1 Tf -0.542 -1.8 Td (This an autosomal recessive condition with a birth prevalence of about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 437.5549 556.8417 Tm (1 in 50 000. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 509.9696 556.8417 Tm (It is subdivided into perinatal, neonatal, )Tj -42.413 -1.473 Td (infantile and juvenile types, on the basis of the age of onset of the cl\ inical presentation and the degree of renal involvement.)Tj ( )Tj 0 -1.473 TD (Prenatal diagnosis by ultrasound is confined to the perinatal and probab\ ly the neonatal types and is based on the )Tj T* (demonstration of bilaterally enlarged and homogeneously hyperechogenic k\ idneys. While there is often associated )Tj T* (oligohydramnios, this is not found invariably. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 294.6322 491.15 Tm (These sonographic appearances, however, may not become apparent until 26\ )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.0944 474.7271 Tm (weeks of gestation, and therefore serial scans should be performed for e\ xclusion of the diagnosis.)Tj 0 -1.937 TD (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a case of infantile polycystic kidney disease; at 11 and 15 w\ eeks, the kidneys and bladder looked )Tj 0 -1.564 TD (normal, but at 28 weeks there was oligohydramnios with bilaterally enlar\ ged and diffusely hyperechogenic kidneys)Tj 8.9195 0 0 8.9195 682.6883 438.5342 Tm (77)Tj 11.1493 0 0 11.1493 694.0339 435.68 Tm (. )Tj -58.922 -1.383 Td (Retrospective examination of the videotapes taken from the early scans d\ emonstrated that the kidneys were of increased )Tj 0 -1.473 TD (echogenicity and increased length from as early as 12 weeks.)Tj /TT0 1 Tf 0.542 -2.478 Td (Multicystic dysplastic kidney disease)Tj /TT1 1 Tf -0.542 -2.48 Td (In this sporadic condition, which may be unilateral or bilateral, the co\ llecting tubules and nephrons are dysplastic. The )Tj T* (collecting tubules become cystic and the diameter of the cysts determine\ s the size of the kidneys, which may be large and )Tj T* (multicystic or small, shrunken and hyperechogenic. Occasionally, only on\ e of a small number of adjacent collecting tubules is )Tj T* (involved so that only a segment of the kidney is abnormal. With bilatera\ l involvement, there is associated absence of the )Tj T* (bladder and oligohydramnios.)Tj 0 -1.937 TD (Cullen )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a case that at 11 weeks demonstrated hyperechoic kidneys with\ no obvious dilatation of the bladder; )Tj 0 -1.564 TD (ultrasound examination in the newborn, after delivery at term, confirmed\ the diagnosis of cystic dysplastic kidneys)Tj 8.9195 0 0 8.9195 683.6583 246.673 Tm (25)Tj 11.1493 0 0 11.1493 695.0039 243.8187 Tm (. )Tj -59.009 -1.383 Td (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a case with a unilateral multicystic kidney diagnosed at 12 w\ eeks during routine ultrasound )Tj T* (examination; the fetal karyotype was normal)Tj 8.9195 0 0 8.9195 290.3103 213.8223 Tm (78)Tj 11.1493 0 0 11.1493 301.6558 210.9681 Tm (. Ultrasound examination of the newborn confirmed the antenatal diagnosi\ s.)Tj /TT3 1 Tf 9.4902 0 0 9.4902 730.5814 210.9681 Tm ( )Tj 1 1 0 rg /TT4 1 Tf 11.1493 0 0 11.1493 43.1373 184.3415 Tm (Screening studies)Tj 0 0 0 rg /TT1 1 Tf -0.542 -2.48 Td (In a screening study involving ultrasound examinations at 11\22614 weeks\ of gestation and at 18\22620 weeks in 3991 patients, )Tj 0 -1.473 TD (there were three cases of unilateral multicystic dysplastic kidneys and \ none was detected at the early scan; two were diagnosed )Tj 0 -1.564 TD (at 18\22620 weeks and the third was detected at 31 weeks)Tj 8.9195 0 0 8.9195 352.8691 125.6896 Tm (26)Tj 11.1493 0 0 11.1493 364.2147 122.8353 Tm (. In another screening study involving 1632 pregnancies at 12\22614 )Tj -29.34 -1.473 Td (weeks, there was one case with unilateral multicystic kidneys and this w\ as correctly identified in the first-trimester scan)Tj 8.9195 0 0 8.9195 712.825 109.2642 Tm (35)Tj 11.1493 0 0 11.1493 724.1705 106.41 Tm (.)Tj /TT0 1 Tf ( )Tj /TT1 1 Tf 9.4902 0 0 9.4902 37.098 88.9482 Tm ( )Tj /TT0 1 Tf 11.1493 0 0 11.1493 37.098 66.6232 Tm (Hydronephrosis)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(50 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2380 0 obj<> endobj 2381 0 obj<>/Type/XObject/BBox[291.039 488.422 735.655 502.72]/FormType 1>>stream 1 1 0 rg 0.8411 w 294.6318 488.8423 m 291.46 492.0141 291.46 499.1275 294.6318 502.2993 c 732.0624 502.2993 l 735.2343 499.1275 735.2343 492.0141 732.0624 488.8423 c f endstream endobj 2382 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 444.616 14.2986]/FormType 1>>stream /Form Do endstream endobj 2383 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 444.616 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2384 0 obj<>>> endobj 2385 0 obj<>8]/P 208 0 R/S/Annot/Pg 723 0 R>> endobj 2386 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 569.562 722.98 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 38.824 361.275 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 169.414 722.98 30.229 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 32.784 59.275 735.059 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 43.1373 576.9104 Tm (Infantile polycystic kidney disease)Tj /TT1 1 Tf -0.542 -1.8 Td (This an autosomal recessive condition with a birth prevalence of about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT1 1 Tf 11.1493 0 0 11.1493 437.5549 556.8417 Tm (1 in 50 000. )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 509.9696 556.8417 Tm (It is subdivided into perinatal, neonatal, )Tj -42.413 -1.473 Td (infantile and juvenile types, on the basis of the age of onset of the cl\ inical presentation and the degree of renal involvement.)Tj ( )Tj 0 -1.473 TD (Prenatal diagnosis by ultrasound is confined to the perinatal and probab\ ly the neonatal types and is based on the )Tj T* (demonstration of bilaterally enlarged and homogeneously hyperechogenic k\ idneys. While there is often associated )Tj T* (oligohydramnios, this is not found invariably. )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 294.6322 491.15 Tm (These sonographic appearances, however, may not become apparent until 26\ )Tj ET EMC /Annot <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 37.0944 474.7271 Tm (weeks of gestation, )Tj ET EMC /Article <>BDC BT /TT1 1 Tf 11.1493 0 0 11.1493 150.2041 474.7271 Tm (and therefore serial scans should be performed for exclusion of the diag\ nosis.)Tj -10.145 -1.937 Td (Bronshtein )Tj /TT2 1 Tf (et al)Tj /TT1 1 Tf (. reported a case of infantile polycystic kidney disease; at 11 and 15 w\ eeks, the kidneys and bladder looked )Tj 0 -1.564 TD (normal, but at 28 weeks there was oligohydramnios with bilaterally enlar\ ged and diffusely hyperechogenic kidneys)Tj 8.9195 0 0 8.9195 682.6883 438.5342 Tm (77)Tj 11.1493 0 0 11.1493 694.0339 435.68 Tm (. )Tj -58.922 -1.383 Td (Retrospective examination of the videotapes taken from the early scans d\ emonstrated that the kidneys were of increased )Tj 0 -1.473 TD (echogenicity and increased length from as early as 12 weeks.)Tj /TT0 1 Tf 0.542 -2.478 Td (Multicystic dysplastic kidney disease)Tj /TT1 1 Tf -0.542 -2.48 Td (In this sporadic condition, which may be unilateral or bilateral, the co\ llecting tubules and nephrons are dysplastic. 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In about 20% of cases, )Tj -7.722 -1.2 Td (there may be an underlying ureteropelvic junction obstruction or vesicou\ reteric reflux that requires postnatal follow-up and )Tj T* (possible surgery. Moderate or severe pelvicalyceal dilatation is usually\ progressive and, in more than 50% of cases, surgery is )Tj T* (necessary during the first 2 years of life)Tj 9.4902 0 0 9.4902 261.244 510.5558 Tm (. )Tj -23.619 -1.147 Td ( )Tj ET q 258.8235321 0 0 197.568634 270.9019623 291.8425293 cm /Im0 Do Q BT /TT0 1 Tf 11.1493 0 0 11.1493 259.6427 268.5492 Tm (Mild hydronephrosis or pyelectasia at 13-14weeks)Tj 9.4902 0 0 9.4902 37.098 249.0321 Tm ( )Tj 1 1 0 rg /TT1 1 Tf 11.1493 0 0 11.1493 43.1373 231.0208 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf -0.542 -1.8 Td (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there were two cases of hydronephrosis and )Tj 0 -1.473 TD (exomphalos and they were both detected at the first scan; one pregnancy \ was terminated and the other resulted in a livebirth )Tj 0 -1.564 TD (with cloacal defect as well as the exomphalos)Tj 8.9195 0 0 8.9195 292.6405 179.9478 Tm (25)Tj 11.1493 0 0 11.1493 303.986 177.0936 Tm (. In a screening study involving ultrasound examinations at 11\22614 wee\ ks of )Tj -23.938 -1.383 Td (gestation and at 18\22620 weeks in 3991 low-risk patients, there were fo\ ur cases of hydronephrosis and only one of these was )Tj T* (diagnosed at the early scan)Tj 8.9195 0 0 8.9195 191.9956 147.0971 Tm (26)Tj 11.1493 0 0 11.1493 203.3411 144.2429 Tm (.)Tj /TT2 1 Tf ( )Tj -14.911 -2.717 Td (Megacystis)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(51 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2409 0 obj<> endobj 2410 0 obj<>/Type/XObject/BBox[33.5055 547.965 118.802 562.263]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.098 548.3857 m 33.9262 551.5576 33.9262 558.6709 37.098 561.8428 c 115.2097 561.8428 l 118.3815 558.6709 118.3815 551.5576 115.2097 548.3857 c f endstream endobj 2411 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 85.2969 14.2985]/FormType 1>>stream /Form Do endstream endobj 2412 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 85.2972 14.2988]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2413 0 obj<>>> endobj 2414 0 obj<>3]/P 208 0 R/S/Annot/Pg 735 0 R>> endobj 2415 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 124.235 207.584 273.922 217.412 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 402.471 207.584 273.922 217.412 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 576.4943 Tm (Sebire )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. examined transabdominally 300 pregnancies at 10\22614 weeks of gestati\ on and reported a significant increase in )Tj 0 -1.473 TD (bladder length with crown\226rump length \()Tj 0 0 0.4 rg (Figure 13)Tj 0 0 0 rg (\), but, within this gestational age range, none of the measurements was\ )Tj 0 -1.564 TD (more than 6 mm)Tj 8.9195 0 0 8.9195 131.8896 545.4911 Tm (79)Tj 11.1493 0 0 11.1493 143.2351 542.6368 Tm (. The fetal bladder was always visualized if the crown\226rump length wa\ s more than 67 mm, but not in 9% of )Tj -9.52 -1.383 Td (those with a crown\226rump length of 38\22667 mm.)Tj 0 -1.937 TD (Bulic )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. described a 14-week fetus with megacystis \(bladder length 50 mm\) and\ oligohydramnios; pathological examination )Tj 0 -1.473 TD (after termination at 15 weeks showed urethral atresia, hypertrophic blad\ der, dysplastic kidneys and absence of abdominal )Tj 0 -1.564 TD (musculature)Tj 8.9195 0 0 8.9195 106.2907 474.6132 Tm (80)Tj 11.1493 0 0 11.1493 117.6363 471.759 Tm (. In another 11-week fetus, there was megacystis \(20 mm\); at 14 weeks \ there was enlargement of the bladder )Tj -7.224 -1.383 Td (and oligohydramnios. Pathological examination after termination demonstr\ ated urethral atresia, severe megacystis but normal )Tj T* (kidneys)Tj 8.9195 0 0 8.9195 79.8111 441.7626 Tm (80)Tj 11.1493 0 0 11.1493 91.1566 438.9083 Tm (. )Tj ET q 258.8235321 0 0 208.784317 131.784317 211.8974304 cm /Im0 Do Q q 258.8235321 0 0 197.568634 410.0196075 217.5052795 cm /Im1 Do Q BT /TT2 1 Tf 11.1493 0 0 11.1493 128.549 181.9145 Tm (Figure 13a)Tj /TT0 1 Tf ( - Megacystis in a 12-13 week )Tj 0 -1.201 TD (fetus \(>18 mm diameter\))Tj /TT2 1 Tf 24.955 1.801 Td (Figure 13b - )Tj /TT0 1 Tf (Megacystis in a 12-13 week )Tj T* (fetus + color doppler showing )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n BT /TT0 1 Tf 11.1493 0 0 11.1493 578.3898 175.2138 Tm (single umbilical )Tj 11.1493 0 0 11.1493 128.549 181.9145 Tm 24.955 -1.801 Td (artery)Tj 9.4902 0 0 9.4902 37.098 142.321 Tm ( )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 128.6907 Tm (Stiller reported an 11-week fetus with megacystis \(10 mm\) but normal k\ idneys and amniotic fluid)Tj 8.9195 0 0 8.9195 587.3059 131.545 Tm (81)Tj 11.1493 0 0 11.1493 598.6514 128.6907 Tm (. At 13 weeks, there was )Tj -50.367 -1.383 Td (enlargement of the bladder \(30 mm\) and bilateral hydronephrosis with r\ educed amniotic fluid; the pregnancy was terminated.)Tj 0 -1.937 TD (Drugan )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 12-week fetus with megacystis \(18 mm\); at 14 weeks there \ was further enlargement of the bladder )Tj 0 -1.564 TD (with normal kidneys but oligohydramnios)Tj 8.9195 0 0 8.9195 268.9147 77.0925 Tm (82)Tj 11.1493 0 0 11.1493 280.2603 74.2383 Tm (. Vesicoamniotic shunting was carried out and the pregnancy continued no\ rmally; a )Tj -21.81 -1.383 Td (male infant with mild prune-belly and moderate renal function \(40\22650\ %\) was born at 35 weeks.)Tj 0 -2.028 TD (Zimmer and Bronshtein reported an 11-week fetus with megacystis \(13 mm\)\ and two umbilical cord cysts)Tj 8.9195 0 0 8.9195 633.9324 39.0653 Tm (83)Tj 11.1493 0 0 11.1493 645.2779 36.2111 Tm (. At 12 weeks, the )Tj -54.549 -1.383 Td (bladder increased \(30 mm\) and there was evidence of hydronephrosis; at\ 13 weeks there was intrauterine death. In another 12-)Tj ET EMC /Artifact <>BDC Q BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(52 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2416 0 obj<> endobj 2417 0 obj<>/Type/XObject/BBox[403.187 159.106 668.055 186.784]/FormType 1>>stream HL10ݧg0Djt ~p@6fFOe2gҖPFBiwᬮ,j;amj}pW3qkFK%Ξ1!Ɂݵf&&vix[ݭ m? endstream endobj 2418 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 264.868 27.6777]/FormType 1>>stream /Form Do endstream endobj 2419 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 264.868 27.678]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2420 0 obj<>stream HS[0R9*BI"Pbmo:mgæ|{sL_D/{Jjh H@UO1xՁpW endstream endobj 2421 0 obj[/Indexed/DeviceRGB 255 2422 0 R] endobj 2422 0 obj<>stream HJQFo=kߪ] L ĤPt0")hYsr/K>kK^͐.,x.1ϊgTrͦ陣nfØv3'0- MEFAs څ;S%Fh/3 `\^dAcTSil/I endstream endobj 2423 0 obj<>stream H0- "޻n׸?NW=;rgBZ0676@j\* ?ڢ@ʤ"P0|%L@Zb+4R'04 7M8~M쟿Ĵ$0UQ,V9Ϯ0 Zl/,Ot 6Ԫ)D,`i%g)D0@kgI ,QW4ģ:@POʜUwP(`2׀bWeUAy1n}OjMZ&VI[_IL@S:Dp}x;'66\߾k4bȭ{ceJy;j<Z}PK>pz%'{S%8!ﭻ`O_툄Tە/sJO`Up5iV)FvU:Yv(6u=})ED'7P/G H]N~.2ԵLH ](H`v endstream endobj 2424 0 obj<>/ColorSpace<>/ProcSet[/PDF/ImageC/ImageI]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H**BK 4T043U0ɹ\ .\`` endstream endobj 2425 0 obj<>/ProcSet[/PDF]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H*wSp 0 ) endstream endobj 2426 0 obj<>>> endobj 2427 0 obj<>stream HS[0R9*BI"Pbmo:mgæ|{sL_D/{Jjh H@UO1xՁpW endstream endobj 2428 0 obj[/Indexed/DeviceRGB 255 2429 0 R] endobj 2429 0 obj<>stream HJQFo=kߪ] L ĤPt0")hYsr/K>kK^͐.,x.1ϊgTrͦ陣nfØv3'0- MEFAs څ;S%Fh/3 `\^dAcTSil/I endstream endobj 2430 0 obj<>stream H0- "޻n׸?NW=;rgBZ0676@j\* ?ڢ@ʤ"P0|%L@Zb+4R'04 7M8~M쟿Ĵ$0UQ,V9Ϯ0 Zl/,Ot 6Ԫ)D,`i%g)D0@kgI ,QW4ģ:@POʜUwP(`2׀bWeUAy1n}OjMZ&VI[_IL@S:Dp}x;'66\߾k4bȭ{ceJy;j<Z}PK>pz%'{S%8!ﭻ`O_툄Tە/sJO`Up5iV)FvU:Yv(6u=})ED'7P/G H]N~.2ԵLH ](H`v endstream endobj 2431 0 obj<>/ColorSpace<>/ProcSet[/PDF/ImageC/ImageI]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H**BK 4T043U0ɹ\ .\`` endstream endobj 2432 0 obj<>/ProcSet[/PDF]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H*wSp 0 ) endstream endobj 2433 0 obj<> endobj 2434 0 obj<>>> endobj 2435 0 obj[2434 0 R 2438 0 R 2442 0 R 2445 0 R 2449 0 R 2452 0 R 2456 0 R 2459 0 R 2463 0 R 2466 0 R 2470 0 R 2473 0 R 2475 0 R 2478 0 R 2480 0 R 2483 0 R 2491 0 R 2498 0 R] endobj 2436 0 obj<>3]/P 208 0 R/S/Annot/Pg 752 0 R>> endobj 2437 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 253.028 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 580.3672 Tm (week fetus, there was megacystis \(46 mm\), bilateral hydronephrosis, in\ creased nuchal translucency and talipes. Chorionic villus )Tj 0 -1.473 TD (sampling showed Turner mosaicism and the pregnancy was terminated.)Tj 0 -1.937 TD (Yoshida )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(45 mm\) and decreased amnio\ tic fluid volume; follow-up scans )Tj 0 -1.564 TD (demonstrated resolution of the megacystis and normalization of the amnio\ tic fluid volume)Tj 8.9195 0 0 8.9195 543.2103 527.7622 Tm (84)Tj 11.1493 0 0 11.1493 554.5559 524.9079 Tm (. At 28 weeks, tetralogy of Fallot )Tj -46.412 -1.383 Td (was diagnosed. Investigations after delivery at 38 weeks confirmed the c\ ardiac defect and, in addition, demonstrated vaginal )Tj 0 -1.473 TD (atresia, imperforate anus, recto-urethral fistula, bilateral vesicourete\ ral reflux, unilateral renal hypoplasia, hypoplasia of )Tj T* (abdominal muscles, scoliosis and bilateral talipes. The karyotype was no\ rmal female. The suggested diagnosis was VACTERL-)Tj T* (like association.)Tj 0 -1.937 TD (Fried )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(30 mm\); a repeat scan 2 da\ ys later demonstrated urinary ascites with a )Tj 0 -1.564 TD (thick-walled deflated bladder and the pregnancy was terminated)Tj 8.9195 0 0 8.9195 399.7186 424.0336 Tm (85)Tj 11.1493 0 0 11.1493 411.0641 421.1794 Tm (. The fetal karyotype was 46,XY.)Tj -33.542 -1.847 Td (Hoshino )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 10 weeks but, a\ t 12 weeks, there was megacystis \(40 )Tj 0 -1.473 TD (mm\) with normal amniotic fluid volume; at 13 weeks, the diameter of the\ bladder increased to 54 mm, there was bilateral )Tj 0 -1.564 TD (hydronephrosis and the amniotic fluid volume was reduced)Tj 8.9195 0 0 8.9195 368.5451 369.5812 Tm (86)Tj 11.1493 0 0 11.1493 379.8906 366.7269 Tm (.)Tj -30.746 -1.847 Td (Cazorla )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 8 weeks but, at\ 13 weeks, there was megacystis \(33 )Tj T* (mm\) and reduced amniotic fluid volume; the fetal karyotype was 46,XY)Tj 8.9195 0 0 8.9195 439.5662 331.554 Tm (87)Tj 11.1493 0 0 11.1493 450.9118 328.6998 Tm (. At 16 weeks, the fetus developed generalized edema )Tj -37.116 -1.383 Td (and the pregnancy was terminated. Pathological examination revealed uret\ hral atresia, megacystis, hydronephrosis and )Tj 0 -1.473 TD (atrophied abdominal muscles.)Tj 9.4902 0 0 9.4902 37.098 278.3873 Tm ( )Tj 1 1 0 rg /TT2 1 Tf 11.1493 0 0 11.1493 43.1373 260.3761 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 243.4395 Tm ( )Tj 11.1493 0 0 11.1493 37.098 230.8161 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there were two cases with urethral obstruction )Tj 0 -1.564 TD (presenting as megacystis at 11 and 13 weeks of gestation)Tj 8.9195 0 0 8.9195 364.2972 216.2382 Tm (25)Tj 11.1493 0 0 11.1493 375.6427 213.3839 Tm (. In a screening study for chromosomal abnormalities by )Tj -30.365 -1.473 Td (assessment of fetal nuchal translucency thickness, 24 492 singleton preg\ nancies were examined)Tj 8.9195 0 0 8.9195 580.3264 199.8128 Tm (79)Tj 11.1493 0 0 11.1493 591.672 196.9586 Tm (. Megacystis was present in )Tj -49.741 -1.383 Td (15 fetuses \(prevalence of 1 in 1633\) and, in these cases, the longitud\ inal bladder diameter was 8\22632 mm. There were three )Tj 0 -1.473 TD (cases with chromosomal abnormalities and two of these had increased nuch\ al translucency thickness. In the chromosomally )Tj T* (normal group with mild-to-moderate megacystis \(longitudinal bladder dia\ meter of 8\22612 mm\), the majority of fetuses had )Tj T* (spontaneous resolution without any obvious adverse effects on renal deve\ lopment and function. In those with severe )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 591.672 196.9586 Tm -49.741 -7.275 Td (megacystis )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 103.6337 115.8474 Tm (\(minimum longitudinal bladder diameter of 17 mm\), there was evolution \ to obstructive uropathy and renal )Tj -5.968 -1.564 Td (dysplasia)Tj 8.9195 0 0 8.9195 88.7194 101.2608 Tm (79)Tj 11.1493 0 0 11.1493 100.0649 98.4066 Tm (.)Tj -5.648 -1.847 Td (Extensive animal studies have demonstrated that obstructive uropathy cau\ ses renal dysplasia and the degree of renal damage )Tj 0 -1.564 TD (is related both to the onset and duration of the obstruction)Tj 8.9195 0 0 8.9195 368.4893 63.2337 Tm (88,89)Tj 11.1493 0 0 11.1493 394.4271 60.3794 Tm (. Furthermore, such studies have shown that renal damage can )Tj -32.049 -1.383 Td (be reduced by intrauterine surgery to by-pass the obstruction. However, \ the data from vesico\226amniotic shunting in human )Tj 0 -1.473 TD (fetuses with obstructive uropathy have not provided conclusive evidence \ that such interventions are beneficial, possibly )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(53 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2438 0 obj<> endobj 2439 0 obj<>/Type/XObject/BBox[33.5022 113.119 107.226 127.417]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.0947 113.5397 m 33.9228 116.7116 33.9228 123.8249 37.0947 126.9968 c 103.6336 126.9968 l 106.8055 123.8249 106.8055 116.7116 103.6336 113.5397 c f endstream endobj 2440 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 73.7242 14.2986]/FormType 1>>stream /Form Do endstream endobj 2441 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 73.7245 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2442 0 obj<>>> endobj 2443 0 obj<>6]/P 208 0 R/S/Annot/Pg 752 0 R>> endobj 2444 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 253.028 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 580.3672 Tm (week fetus, there was megacystis \(46 mm\), bilateral hydronephrosis, in\ creased nuchal translucency and talipes. Chorionic villus )Tj 0 -1.473 TD (sampling showed Turner mosaicism and the pregnancy was terminated.)Tj 0 -1.937 TD (Yoshida )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(45 mm\) and decreased amnio\ tic fluid volume; follow-up scans )Tj 0 -1.564 TD (demonstrated resolution of the megacystis and normalization of the amnio\ tic fluid volume)Tj 8.9195 0 0 8.9195 543.2103 527.7622 Tm (84)Tj 11.1493 0 0 11.1493 554.5559 524.9079 Tm (. At 28 weeks, tetralogy of Fallot )Tj -46.412 -1.383 Td (was diagnosed. Investigations after delivery at 38 weeks confirmed the c\ ardiac defect and, in addition, demonstrated vaginal )Tj 0 -1.473 TD (atresia, imperforate anus, recto-urethral fistula, bilateral vesicourete\ ral reflux, unilateral renal hypoplasia, hypoplasia of )Tj T* (abdominal muscles, scoliosis and bilateral talipes. The karyotype was no\ rmal female. The suggested diagnosis was VACTERL-)Tj T* (like association.)Tj 0 -1.937 TD (Fried )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(30 mm\); a repeat scan 2 da\ ys later demonstrated urinary ascites with a )Tj 0 -1.564 TD (thick-walled deflated bladder and the pregnancy was terminated)Tj 8.9195 0 0 8.9195 399.7186 424.0336 Tm (85)Tj 11.1493 0 0 11.1493 411.0641 421.1794 Tm (. The fetal karyotype was 46,XY.)Tj -33.542 -1.847 Td (Hoshino )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 10 weeks but, a\ t 12 weeks, there was megacystis \(40 )Tj 0 -1.473 TD (mm\) with normal amniotic fluid volume; at 13 weeks, the diameter of the\ bladder increased to 54 mm, there was bilateral )Tj 0 -1.564 TD (hydronephrosis and the amniotic fluid volume was reduced)Tj 8.9195 0 0 8.9195 368.5451 369.5812 Tm (86)Tj 11.1493 0 0 11.1493 379.8906 366.7269 Tm (.)Tj -30.746 -1.847 Td (Cazorla )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 8 weeks but, at\ 13 weeks, there was megacystis \(33 )Tj T* (mm\) and reduced amniotic fluid volume; the fetal karyotype was 46,XY)Tj 8.9195 0 0 8.9195 439.5662 331.554 Tm (87)Tj 11.1493 0 0 11.1493 450.9118 328.6998 Tm (. At 16 weeks, the fetus developed generalized edema )Tj -37.116 -1.383 Td (and the pregnancy was terminated. Pathological examination revealed uret\ hral atresia, megacystis, hydronephrosis and )Tj 0 -1.473 TD (atrophied abdominal muscles.)Tj 9.4902 0 0 9.4902 37.098 278.3873 Tm ( )Tj 1 1 0 rg /TT2 1 Tf 11.1493 0 0 11.1493 43.1373 260.3761 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 243.4395 Tm ( )Tj 11.1493 0 0 11.1493 37.098 230.8161 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there were two cases with urethral obstruction )Tj 0 -1.564 TD (presenting as megacystis at 11 and 13 weeks of gestation)Tj 8.9195 0 0 8.9195 364.2972 216.2382 Tm (25)Tj 11.1493 0 0 11.1493 375.6427 213.3839 Tm (. In a screening study for chromosomal abnormalities by )Tj -30.365 -1.473 Td (assessment of fetal nuchal translucency thickness, 24 492 singleton preg\ nancies were examined)Tj 8.9195 0 0 8.9195 580.3264 199.8128 Tm (79)Tj 11.1493 0 0 11.1493 591.672 196.9586 Tm (. Megacystis was present in )Tj -49.741 -1.383 Td (15 fetuses \(prevalence of 1 in 1633\) and, in these cases, the longitud\ inal bladder diameter was 8\22632 mm. There were three )Tj 0 -1.473 TD (cases with chromosomal abnormalities and two of these had increased nuch\ al translucency thickness. In the chromosomally )Tj T* (normal group with mild-to-moderate megacystis \(longitudinal bladder dia\ meter of 8\22612 mm\), the majority of fetuses had )Tj T* (spontaneous resolution without any obvious adverse effects on renal deve\ lopment and function. In those with severe )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 591.672 196.9586 Tm -49.741 -7.275 Td (megacystis )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 103.6337 115.8474 Tm (\()Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 108.6955 115.8474 Tm (minimum longitudinal bladder diameter of 17 mm\), )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 401.7662 115.8474 Tm (there was evolution to obstructive uropathy and renal )Tj -32.708 -1.564 Td (dysplasia)Tj 8.9195 0 0 8.9195 88.7194 101.2608 Tm (79)Tj 11.1493 0 0 11.1493 100.0649 98.4066 Tm (.)Tj -5.648 -1.847 Td (Extensive animal studies have demonstrated that obstructive uropathy cau\ ses renal dysplasia and the degree of renal damage )Tj 0 -1.564 TD (is related both to the onset and duration of the obstruction)Tj 8.9195 0 0 8.9195 368.4893 63.2337 Tm (88,89)Tj 11.1493 0 0 11.1493 394.4271 60.3794 Tm (. Furthermore, such studies have shown that renal damage can )Tj -32.049 -1.383 Td (be reduced by intrauterine surgery to by-pass the obstruction. However, \ the data from vesico\226amniotic shunting in human )Tj 0 -1.473 TD (fetuses with obstructive uropathy have not provided conclusive evidence \ that such interventions are beneficial, possibly )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(53 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2445 0 obj<> endobj 2446 0 obj<>/Type/XObject/BBox[105.103 113.119 401.434 127.417]/FormType 1>>stream 1 1 0 rg 0.8411 w 108.6954 113.5397 m 105.5236 116.7115 105.5236 123.8249 108.6954 126.9967 c 397.8419 126.9967 l 401.0138 123.8249 401.0138 116.7115 397.8419 113.5397 c f endstream endobj 2447 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 296.332 14.2986]/FormType 1>>stream /Form Do endstream endobj 2448 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 296.332 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2449 0 obj<>>> endobj 2450 0 obj<>9]/P 208 0 R/S/Annot/Pg 752 0 R>> endobj 2451 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 253.028 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 580.3672 Tm (week fetus, there was megacystis \(46 mm\), bilateral hydronephrosis, in\ creased nuchal translucency and talipes. Chorionic villus )Tj 0 -1.473 TD (sampling showed Turner mosaicism and the pregnancy was terminated.)Tj 0 -1.937 TD (Yoshida )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(45 mm\) and decreased amnio\ tic fluid volume; follow-up scans )Tj 0 -1.564 TD (demonstrated resolution of the megacystis and normalization of the amnio\ tic fluid volume)Tj 8.9195 0 0 8.9195 543.2103 527.7622 Tm (84)Tj 11.1493 0 0 11.1493 554.5559 524.9079 Tm (. At 28 weeks, tetralogy of Fallot )Tj -46.412 -1.383 Td (was diagnosed. Investigations after delivery at 38 weeks confirmed the c\ ardiac defect and, in addition, demonstrated vaginal )Tj 0 -1.473 TD (atresia, imperforate anus, recto-urethral fistula, bilateral vesicourete\ ral reflux, unilateral renal hypoplasia, hypoplasia of )Tj T* (abdominal muscles, scoliosis and bilateral talipes. The karyotype was no\ rmal female. The suggested diagnosis was VACTERL-)Tj T* (like association.)Tj 0 -1.937 TD (Fried )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(30 mm\); a repeat scan 2 da\ ys later demonstrated urinary ascites with a )Tj 0 -1.564 TD (thick-walled deflated bladder and the pregnancy was terminated)Tj 8.9195 0 0 8.9195 399.7186 424.0336 Tm (85)Tj 11.1493 0 0 11.1493 411.0641 421.1794 Tm (. The fetal karyotype was 46,XY.)Tj -33.542 -1.847 Td (Hoshino )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 10 weeks but, a\ t 12 weeks, there was megacystis \(40 )Tj 0 -1.473 TD (mm\) with normal amniotic fluid volume; at 13 weeks, the diameter of the\ bladder increased to 54 mm, there was bilateral )Tj 0 -1.564 TD (hydronephrosis and the amniotic fluid volume was reduced)Tj 8.9195 0 0 8.9195 368.5451 369.5812 Tm (86)Tj 11.1493 0 0 11.1493 379.8906 366.7269 Tm (.)Tj -30.746 -1.847 Td (Cazorla )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 8 weeks but, at\ 13 weeks, there was megacystis \(33 )Tj T* (mm\) and reduced amniotic fluid volume; the fetal karyotype was 46,XY)Tj 8.9195 0 0 8.9195 439.5662 331.554 Tm (87)Tj 11.1493 0 0 11.1493 450.9118 328.6998 Tm (. At 16 weeks, the fetus developed generalized edema )Tj -37.116 -1.383 Td (and the pregnancy was terminated. Pathological examination revealed uret\ hral atresia, megacystis, hydronephrosis and )Tj 0 -1.473 TD (atrophied abdominal muscles.)Tj 9.4902 0 0 9.4902 37.098 278.3873 Tm ( )Tj 1 1 0 rg /TT2 1 Tf 11.1493 0 0 11.1493 43.1373 260.3761 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 243.4395 Tm ( )Tj 11.1493 0 0 11.1493 37.098 230.8161 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there were two cases with urethral obstruction )Tj 0 -1.564 TD (presenting as megacystis at 11 and 13 weeks of gestation)Tj 8.9195 0 0 8.9195 364.2972 216.2382 Tm (25)Tj 11.1493 0 0 11.1493 375.6427 213.3839 Tm (. In a screening study for chromosomal abnormalities by )Tj -30.365 -1.473 Td (assessment of fetal nuchal translucency thickness, 24 492 singleton preg\ nancies were examined)Tj 8.9195 0 0 8.9195 580.3264 199.8128 Tm (79)Tj 11.1493 0 0 11.1493 591.672 196.9586 Tm (. Megacystis was present in )Tj -49.741 -1.383 Td (15 fetuses \(prevalence of 1 in 1633\) and, in these cases, the longitud\ inal bladder diameter was 8\22632 mm. There were three )Tj 0 -1.473 TD (cases with chromosomal abnormalities and two of these had increased nuch\ al translucency thickness. In the chromosomally )Tj T* (normal group with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 144.1615 148.6933 Tm (mild-to-moderate megacystis )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 313.5194 148.6933 Tm (\(longitudinal bladder diameter of 8\22612 mm\), the majority of fetuses\ had )Tj -24.793 -1.473 Td (spontaneous resolution without any obvious adverse effects on renal deve\ lopment and function. In those with severe )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 591.672 196.9586 Tm -49.741 -7.275 Td (megacystis )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 103.6337 115.8474 Tm (\()Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 108.6955 115.8474 Tm (minimum longitudinal bladder diameter of 17 mm\), )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 401.7662 115.8474 Tm (there was evolution to obstructive uropathy and renal )Tj -32.708 -1.564 Td (dysplasia)Tj 8.9195 0 0 8.9195 88.7194 101.2608 Tm (79)Tj 11.1493 0 0 11.1493 100.0649 98.4066 Tm (.)Tj -5.648 -1.847 Td (Extensive animal studies have demonstrated that obstructive uropathy cau\ ses renal dysplasia and the degree of renal damage )Tj 0 -1.564 TD (is related both to the onset and duration of the obstruction)Tj 8.9195 0 0 8.9195 368.4893 63.2337 Tm (88,89)Tj 11.1493 0 0 11.1493 394.4271 60.3794 Tm (. Furthermore, such studies have shown that renal damage can )Tj -32.049 -1.383 Td (be reduced by intrauterine surgery to by-pass the obstruction. However, \ the data from vesico\226amniotic shunting in human )Tj 0 -1.473 TD (fetuses with obstructive uropathy have not provided conclusive evidence \ that such interventions are beneficial, possibly )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(53 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2452 0 obj<> endobj 2453 0 obj<>/Type/XObject/BBox[140.569 145.965 313.187 160.263]/FormType 1>>stream 1 1 0 rg 0.8411 w 144.1614 146.3856 m 140.9896 149.5574 140.9896 156.6708 144.1614 159.8426 c 309.5944 159.8426 l 312.7663 156.6708 312.7663 149.5574 309.5944 146.3856 c f endstream endobj 2454 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 172.618 14.2986]/FormType 1>>stream /Form Do endstream endobj 2455 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 172.619 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2456 0 obj<>>> endobj 2457 0 obj<>12]/P 208 0 R/S/Annot/Pg 752 0 R>> endobj 2458 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 253.028 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 580.3672 Tm (week fetus, there was megacystis \(46 mm\), bilateral hydronephrosis, in\ creased nuchal translucency and talipes. Chorionic villus )Tj 0 -1.473 TD (sampling showed Turner mosaicism and the pregnancy was terminated.)Tj 0 -1.937 TD (Yoshida )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(45 mm\) and decreased amnio\ tic fluid volume; follow-up scans )Tj 0 -1.564 TD (demonstrated resolution of the megacystis and normalization of the amnio\ tic fluid volume)Tj 8.9195 0 0 8.9195 543.2103 527.7622 Tm (84)Tj 11.1493 0 0 11.1493 554.5559 524.9079 Tm (. At 28 weeks, tetralogy of Fallot )Tj -46.412 -1.383 Td (was diagnosed. Investigations after delivery at 38 weeks confirmed the c\ ardiac defect and, in addition, demonstrated vaginal )Tj 0 -1.473 TD (atresia, imperforate anus, recto-urethral fistula, bilateral vesicourete\ ral reflux, unilateral renal hypoplasia, hypoplasia of )Tj T* (abdominal muscles, scoliosis and bilateral talipes. The karyotype was no\ rmal female. The suggested diagnosis was VACTERL-)Tj T* (like association.)Tj 0 -1.937 TD (Fried )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(30 mm\); a repeat scan 2 da\ ys later demonstrated urinary ascites with a )Tj 0 -1.564 TD (thick-walled deflated bladder and the pregnancy was terminated)Tj 8.9195 0 0 8.9195 399.7186 424.0336 Tm (85)Tj 11.1493 0 0 11.1493 411.0641 421.1794 Tm (. The fetal karyotype was 46,XY.)Tj -33.542 -1.847 Td (Hoshino )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 10 weeks but, a\ t 12 weeks, there was megacystis \(40 )Tj 0 -1.473 TD (mm\) with normal amniotic fluid volume; at 13 weeks, the diameter of the\ bladder increased to 54 mm, there was bilateral )Tj 0 -1.564 TD (hydronephrosis and the amniotic fluid volume was reduced)Tj 8.9195 0 0 8.9195 368.5451 369.5812 Tm (86)Tj 11.1493 0 0 11.1493 379.8906 366.7269 Tm (.)Tj -30.746 -1.847 Td (Cazorla )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 8 weeks but, at\ 13 weeks, there was megacystis \(33 )Tj T* (mm\) and reduced amniotic fluid volume; the fetal karyotype was 46,XY)Tj 8.9195 0 0 8.9195 439.5662 331.554 Tm (87)Tj 11.1493 0 0 11.1493 450.9118 328.6998 Tm (. At 16 weeks, the fetus developed generalized edema )Tj -37.116 -1.383 Td (and the pregnancy was terminated. Pathological examination revealed uret\ hral atresia, megacystis, hydronephrosis and )Tj 0 -1.473 TD (atrophied abdominal muscles.)Tj 9.4902 0 0 9.4902 37.098 278.3873 Tm ( )Tj 1 1 0 rg /TT2 1 Tf 11.1493 0 0 11.1493 43.1373 260.3761 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 243.4395 Tm ( )Tj 11.1493 0 0 11.1493 37.098 230.8161 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there were two cases with urethral obstruction )Tj 0 -1.564 TD (presenting as megacystis at 11 and 13 weeks of gestation)Tj 8.9195 0 0 8.9195 364.2972 216.2382 Tm (25)Tj 11.1493 0 0 11.1493 375.6427 213.3839 Tm (. In a screening study for chromosomal abnormalities by )Tj -30.365 -1.473 Td (assessment of fetal nuchal translucency thickness, 24 492 singleton preg\ nancies were examined)Tj 8.9195 0 0 8.9195 580.3264 199.8128 Tm (79)Tj 11.1493 0 0 11.1493 591.672 196.9586 Tm (. Megacystis was present in )Tj -49.741 -1.383 Td (15 fetuses \(prevalence of 1 in 1633\) and, in these cases, the longitud\ inal bladder diameter was 8\22632 mm. There were three )Tj 0 -1.473 TD (cases with chromosomal abnormalities and two of these had increased nuch\ al translucency thickness. In the chromosomally )Tj T* (normal group with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 144.1615 148.6933 Tm (mild-to-moderate megacystis )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 313.5194 148.6933 Tm (\()Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 318.5812 148.6933 Tm (longitudinal bladder diameter of 8\22612 mm\), )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 569.1396 148.6933 Tm (the majority of fetuses had )Tj -47.72 -1.473 Td (spontaneous resolution without any obvious adverse effects on renal deve\ lopment and function. In those with severe )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 591.672 196.9586 Tm -49.741 -7.275 Td (megacystis )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 103.6337 115.8474 Tm (\()Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 108.6955 115.8474 Tm (minimum longitudinal bladder diameter of 17 mm\), )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 401.7662 115.8474 Tm (there was evolution to obstructive uropathy and renal )Tj -32.708 -1.564 Td (dysplasia)Tj 8.9195 0 0 8.9195 88.7194 101.2608 Tm (79)Tj 11.1493 0 0 11.1493 100.0649 98.4066 Tm (.)Tj -5.648 -1.847 Td (Extensive animal studies have demonstrated that obstructive uropathy cau\ ses renal dysplasia and the degree of renal damage )Tj 0 -1.564 TD (is related both to the onset and duration of the obstruction)Tj 8.9195 0 0 8.9195 368.4893 63.2337 Tm (88,89)Tj 11.1493 0 0 11.1493 394.4271 60.3794 Tm (. Furthermore, such studies have shown that renal damage can )Tj -32.049 -1.383 Td (be reduced by intrauterine surgery to by-pass the obstruction. However, \ the data from vesico\226amniotic shunting in human )Tj 0 -1.473 TD (fetuses with obstructive uropathy have not provided conclusive evidence \ that such interventions are beneficial, possibly )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(53 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2459 0 obj<> endobj 2460 0 obj<>/Type/XObject/BBox[314.989 145.965 568.808 160.263]/FormType 1>>stream 1 1 0 rg 0.8411 w 318.5811 146.3856 m 315.4093 149.5574 315.4093 156.6708 318.5811 159.8426 c 565.2151 159.8426 l 568.3869 156.6708 568.3869 149.5574 565.2151 146.3856 c f endstream endobj 2461 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 253.819 14.2986]/FormType 1>>stream /Form Do endstream endobj 2462 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 253.819 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2463 0 obj<>>> endobj 2464 0 obj<>14]/P 208 0 R/S/Annot/Pg 752 0 R>> endobj 2465 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 253.028 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 580.3672 Tm (week fetus, there was megacystis \(46 mm\), bilateral hydronephrosis, in\ creased nuchal translucency and talipes. Chorionic villus )Tj 0 -1.473 TD (sampling showed Turner mosaicism and the pregnancy was terminated.)Tj 0 -1.937 TD (Yoshida )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(45 mm\) and decreased amnio\ tic fluid volume; follow-up scans )Tj 0 -1.564 TD (demonstrated resolution of the megacystis and normalization of the amnio\ tic fluid volume)Tj 8.9195 0 0 8.9195 543.2103 527.7622 Tm (84)Tj 11.1493 0 0 11.1493 554.5559 524.9079 Tm (. At 28 weeks, tetralogy of Fallot )Tj -46.412 -1.383 Td (was diagnosed. Investigations after delivery at 38 weeks confirmed the c\ ardiac defect and, in addition, demonstrated vaginal )Tj 0 -1.473 TD (atresia, imperforate anus, recto-urethral fistula, bilateral vesicourete\ ral reflux, unilateral renal hypoplasia, hypoplasia of )Tj T* (abdominal muscles, scoliosis and bilateral talipes. The karyotype was no\ rmal female. The suggested diagnosis was VACTERL-)Tj T* (like association.)Tj 0 -1.937 TD (Fried )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(30 mm\); a repeat scan 2 da\ ys later demonstrated urinary ascites with a )Tj 0 -1.564 TD (thick-walled deflated bladder and the pregnancy was terminated)Tj 8.9195 0 0 8.9195 399.7186 424.0336 Tm (85)Tj 11.1493 0 0 11.1493 411.0641 421.1794 Tm (. The fetal karyotype was 46,XY.)Tj -33.542 -1.847 Td (Hoshino )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 10 weeks but, a\ t 12 weeks, there was megacystis \(40 )Tj 0 -1.473 TD (mm\) with normal amniotic fluid volume; at 13 weeks, the diameter of the\ bladder increased to 54 mm, there was bilateral )Tj 0 -1.564 TD (hydronephrosis and the amniotic fluid volume was reduced)Tj 8.9195 0 0 8.9195 368.5451 369.5812 Tm (86)Tj 11.1493 0 0 11.1493 379.8906 366.7269 Tm (.)Tj -30.746 -1.847 Td (Cazorla )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 8 weeks but, at\ 13 weeks, there was megacystis \(33 )Tj T* (mm\) and reduced amniotic fluid volume; the fetal karyotype was 46,XY)Tj 8.9195 0 0 8.9195 439.5662 331.554 Tm (87)Tj 11.1493 0 0 11.1493 450.9118 328.6998 Tm (. At 16 weeks, the fetus developed generalized edema )Tj -37.116 -1.383 Td (and the pregnancy was terminated. Pathological examination revealed uret\ hral atresia, megacystis, hydronephrosis and )Tj 0 -1.473 TD (atrophied abdominal muscles.)Tj 9.4902 0 0 9.4902 37.098 278.3873 Tm ( )Tj 1 1 0 rg /TT2 1 Tf 11.1493 0 0 11.1493 43.1373 260.3761 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 243.4395 Tm ( )Tj 11.1493 0 0 11.1493 37.098 230.8161 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there were two cases with urethral obstruction )Tj 0 -1.564 TD (presenting as megacystis at 11 and 13 weeks of gestation)Tj 8.9195 0 0 8.9195 364.2972 216.2382 Tm (25)Tj 11.1493 0 0 11.1493 375.6427 213.3839 Tm (. In a screening study for chromosomal abnormalities by )Tj -30.365 -1.473 Td (assessment of fetal nuchal translucency thickness, 24 492 singleton preg\ nancies were examined)Tj 8.9195 0 0 8.9195 580.3264 199.8128 Tm (79)Tj 11.1493 0 0 11.1493 591.672 196.9586 Tm (. Megacystis was present in )Tj -49.741 -1.383 Td (15 fetuses \(prevalence of 1 in 1633\) and, in these cases, the longitud\ inal bladder diameter was 8\22632 mm. There were three )Tj 0 -1.473 TD (cases with chromosomal abnormalities and two of these had increased nuch\ al translucency thickness. In the chromosomally )Tj T* (normal group with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 144.1615 148.6933 Tm (mild-to-moderate megacystis )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 313.5194 148.6933 Tm (\()Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 318.5812 148.6933 Tm (longitudinal bladder diameter of 8\22612 mm\), )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 569.1396 148.6933 Tm (the majority of fetuses had )Tj -47.72 -1.473 Td (spontaneous resolution without any obvious adverse effects on renal deve\ lopment and function. In those with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 659.3264 132.2704 Tm (severe )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 591.672 196.9586 Tm -49.741 -7.275 Td (megacystis )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 103.6337 115.8474 Tm (\()Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 108.6955 115.8474 Tm (minimum longitudinal bladder diameter of 17 mm\), )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 401.7662 115.8474 Tm (there was evolution to obstructive uropathy and renal )Tj -32.708 -1.564 Td (dysplasia)Tj 8.9195 0 0 8.9195 88.7194 101.2608 Tm (79)Tj 11.1493 0 0 11.1493 100.0649 98.4066 Tm (.)Tj -5.648 -1.847 Td (Extensive animal studies have demonstrated that obstructive uropathy cau\ ses renal dysplasia and the degree of renal damage )Tj 0 -1.564 TD (is related both to the onset and duration of the obstruction)Tj 8.9195 0 0 8.9195 368.4893 63.2337 Tm (88,89)Tj 11.1493 0 0 11.1493 394.4271 60.3794 Tm (. Furthermore, such studies have shown that renal damage can )Tj -32.049 -1.383 Td (be reduced by intrauterine surgery to by-pass the obstruction. However, \ the data from vesico\226amniotic shunting in human )Tj 0 -1.473 TD (fetuses with obstructive uropathy have not provided conclusive evidence \ that such interventions are beneficial, possibly )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(53 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2466 0 obj<> endobj 2467 0 obj<>/Type/XObject/BBox[655.732 129.542 700.022 143.84]/FormType 1>>stream 1 1 0 rg 0.8411 w 659.3245 129.9626 m 656.1526 133.1345 656.1526 140.2478 659.3245 143.4197 c 696.429 143.4197 l 699.6009 140.2478 699.6009 133.1345 696.429 129.9626 c f endstream endobj 2468 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 44.2898 14.2986]/FormType 1>>stream /Form Do endstream endobj 2469 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 44.2901 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2470 0 obj<>>> endobj 2471 0 obj<>16]/P 208 0 R/S/Annot/Pg 752 0 R>> endobj 2472 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 253.028 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 580.3672 Tm (week fetus, there was megacystis \(46 mm\), bilateral hydronephrosis, in\ creased nuchal translucency and talipes. Chorionic villus )Tj 0 -1.473 TD (sampling showed Turner mosaicism and the pregnancy was terminated.)Tj 0 -1.937 TD (Yoshida )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(45 mm\) and decreased amnio\ tic fluid volume; follow-up scans )Tj 0 -1.564 TD (demonstrated resolution of the megacystis and normalization of the amnio\ tic fluid volume)Tj 8.9195 0 0 8.9195 543.2103 527.7622 Tm (84)Tj 11.1493 0 0 11.1493 554.5559 524.9079 Tm (. At 28 weeks, tetralogy of Fallot )Tj -46.412 -1.383 Td (was diagnosed. Investigations after delivery at 38 weeks confirmed the c\ ardiac defect and, in addition, demonstrated vaginal )Tj 0 -1.473 TD (atresia, imperforate anus, recto-urethral fistula, bilateral vesicourete\ ral reflux, unilateral renal hypoplasia, hypoplasia of )Tj T* (abdominal muscles, scoliosis and bilateral talipes. The karyotype was no\ rmal female. The suggested diagnosis was VACTERL-)Tj T* (like association.)Tj 0 -1.937 TD (Fried )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(30 mm\); a repeat scan 2 da\ ys later demonstrated urinary ascites with a )Tj 0 -1.564 TD (thick-walled deflated bladder and the pregnancy was terminated)Tj 8.9195 0 0 8.9195 399.7186 424.0336 Tm (85)Tj 11.1493 0 0 11.1493 411.0641 421.1794 Tm (. The fetal karyotype was 46,XY.)Tj -33.542 -1.847 Td (Hoshino )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 10 weeks but, a\ t 12 weeks, there was megacystis \(40 )Tj 0 -1.473 TD (mm\) with normal amniotic fluid volume; at 13 weeks, the diameter of the\ bladder increased to 54 mm, there was bilateral )Tj 0 -1.564 TD (hydronephrosis and the amniotic fluid volume was reduced)Tj 8.9195 0 0 8.9195 368.5451 369.5812 Tm (86)Tj 11.1493 0 0 11.1493 379.8906 366.7269 Tm (.)Tj -30.746 -1.847 Td (Cazorla )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 8 weeks but, at\ 13 weeks, there was megacystis \(33 )Tj T* (mm\) and reduced amniotic fluid volume; the fetal karyotype was 46,XY)Tj 8.9195 0 0 8.9195 439.5662 331.554 Tm (87)Tj 11.1493 0 0 11.1493 450.9118 328.6998 Tm (. At 16 weeks, the fetus developed generalized edema )Tj -37.116 -1.383 Td (and the pregnancy was terminated. Pathological examination revealed uret\ hral atresia, megacystis, hydronephrosis and )Tj 0 -1.473 TD (atrophied abdominal muscles.)Tj 9.4902 0 0 9.4902 37.098 278.3873 Tm ( )Tj 1 1 0 rg /TT2 1 Tf 11.1493 0 0 11.1493 43.1373 260.3761 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 243.4395 Tm ( )Tj 11.1493 0 0 11.1493 37.098 230.8161 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there were two cases with urethral obstruction )Tj 0 -1.564 TD (presenting as megacystis at 11 and 13 weeks of gestation)Tj 8.9195 0 0 8.9195 364.2972 216.2382 Tm (25)Tj 11.1493 0 0 11.1493 375.6427 213.3839 Tm (. In a screening study for chromosomal abnormalities by )Tj -30.365 -1.473 Td (assessment of fetal nuchal translucency thickness, 24 492 singleton preg\ nancies were examined)Tj 8.9195 0 0 8.9195 580.3264 199.8128 Tm (79)Tj 11.1493 0 0 11.1493 591.672 196.9586 Tm (. Megacystis was present in )Tj -49.741 -1.383 Td (15 fetuses \(prevalence of 1 in 1633\) and, in these cases, the longitud\ inal bladder diameter was 8\22632 mm. There were three )Tj 0 -1.473 TD (cases with chromosomal abnormalities and two of these had increased nuch\ al translucency thickness. In the chromosomally )Tj T* (normal group with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 144.1615 148.6933 Tm (mild-to-moderate megacystis )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 313.5194 148.6933 Tm (\()Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 318.5812 148.6933 Tm (longitudinal bladder diameter of 8\22612 mm\), )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 569.1396 148.6933 Tm (the majority of fetuses had )Tj -47.72 -1.473 Td (spontaneous resolution without any obvious adverse effects on renal deve\ lopment and function. In those with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 659.3264 132.2704 Tm (severe )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 591.672 196.9586 Tm -49.741 -7.275 Td (megacystis )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 103.6337 115.8474 Tm (\()Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 108.6955 115.8474 Tm (minimum longitudinal bladder diameter of 17 mm\), )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 401.7662 115.8474 Tm (there was evolution to obstructive uropathy and renal )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0947 98.4099 Tm (dysplasia)Tj 8.9195 0 0 8.9195 88.7194 101.2608 Tm (79)Tj 11.1493 0 0 11.1493 100.0649 98.4066 Tm (.)Tj -5.648 -1.847 Td (Extensive animal studies have demonstrated that obstructive uropathy cau\ ses renal dysplasia and the degree of renal damage )Tj 0 -1.564 TD (is related both to the onset and duration of the obstruction)Tj 8.9195 0 0 8.9195 368.4893 63.2337 Tm (88,89)Tj 11.1493 0 0 11.1493 394.4271 60.3794 Tm (. Furthermore, such studies have shown that renal damage can )Tj -32.049 -1.383 Td (be reduced by intrauterine surgery to by-pass the obstruction. However, \ the data from vesico\226amniotic shunting in human )Tj 0 -1.473 TD (fetuses with obstructive uropathy have not provided conclusive evidence \ that such interventions are beneficial, possibly )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(53 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2473 0 obj<> endobj 2474 0 obj<>/Type/XObject/BBox[397.753 112.698 708.381 127.838]/FormType 1>>stream 1 0 0 RG 0.8411 w 401.7662 119.307 m 704.3684 119.307 l S endstream endobj 2475 0 obj<>>> endobj 2476 0 obj<>18]/P 208 0 R/S/Annot/Pg 752 0 R>> endobj 2477 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 253.028 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 580.3672 Tm (week fetus, there was megacystis \(46 mm\), bilateral hydronephrosis, in\ creased nuchal translucency and talipes. Chorionic villus )Tj 0 -1.473 TD (sampling showed Turner mosaicism and the pregnancy was terminated.)Tj 0 -1.937 TD (Yoshida )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(45 mm\) and decreased amnio\ tic fluid volume; follow-up scans )Tj 0 -1.564 TD (demonstrated resolution of the megacystis and normalization of the amnio\ tic fluid volume)Tj 8.9195 0 0 8.9195 543.2103 527.7622 Tm (84)Tj 11.1493 0 0 11.1493 554.5559 524.9079 Tm (. At 28 weeks, tetralogy of Fallot )Tj -46.412 -1.383 Td (was diagnosed. Investigations after delivery at 38 weeks confirmed the c\ ardiac defect and, in addition, demonstrated vaginal )Tj 0 -1.473 TD (atresia, imperforate anus, recto-urethral fistula, bilateral vesicourete\ ral reflux, unilateral renal hypoplasia, hypoplasia of )Tj T* (abdominal muscles, scoliosis and bilateral talipes. The karyotype was no\ rmal female. The suggested diagnosis was VACTERL-)Tj T* (like association.)Tj 0 -1.937 TD (Fried )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(30 mm\); a repeat scan 2 da\ ys later demonstrated urinary ascites with a )Tj 0 -1.564 TD (thick-walled deflated bladder and the pregnancy was terminated)Tj 8.9195 0 0 8.9195 399.7186 424.0336 Tm (85)Tj 11.1493 0 0 11.1493 411.0641 421.1794 Tm (. The fetal karyotype was 46,XY.)Tj -33.542 -1.847 Td (Hoshino )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 10 weeks but, a\ t 12 weeks, there was megacystis \(40 )Tj 0 -1.473 TD (mm\) with normal amniotic fluid volume; at 13 weeks, the diameter of the\ bladder increased to 54 mm, there was bilateral )Tj 0 -1.564 TD (hydronephrosis and the amniotic fluid volume was reduced)Tj 8.9195 0 0 8.9195 368.5451 369.5812 Tm (86)Tj 11.1493 0 0 11.1493 379.8906 366.7269 Tm (.)Tj -30.746 -1.847 Td (Cazorla )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 8 weeks but, at\ 13 weeks, there was megacystis \(33 )Tj T* (mm\) and reduced amniotic fluid volume; the fetal karyotype was 46,XY)Tj 8.9195 0 0 8.9195 439.5662 331.554 Tm (87)Tj 11.1493 0 0 11.1493 450.9118 328.6998 Tm (. At 16 weeks, the fetus developed generalized edema )Tj -37.116 -1.383 Td (and the pregnancy was terminated. Pathological examination revealed uret\ hral atresia, megacystis, hydronephrosis and )Tj 0 -1.473 TD (atrophied abdominal muscles.)Tj 9.4902 0 0 9.4902 37.098 278.3873 Tm ( )Tj 1 1 0 rg /TT2 1 Tf 11.1493 0 0 11.1493 43.1373 260.3761 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 243.4395 Tm ( )Tj 11.1493 0 0 11.1493 37.098 230.8161 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there were two cases with urethral obstruction )Tj 0 -1.564 TD (presenting as megacystis at 11 and 13 weeks of gestation)Tj 8.9195 0 0 8.9195 364.2972 216.2382 Tm (25)Tj 11.1493 0 0 11.1493 375.6427 213.3839 Tm (. In a screening study for chromosomal abnormalities by )Tj -30.365 -1.473 Td (assessment of fetal nuchal translucency thickness, 24 492 singleton preg\ nancies were examined)Tj 8.9195 0 0 8.9195 580.3264 199.8128 Tm (79)Tj 11.1493 0 0 11.1493 591.672 196.9586 Tm (. Megacystis was present in )Tj -49.741 -1.383 Td (15 fetuses \(prevalence of 1 in 1633\) and, in these cases, the longitud\ inal bladder diameter was 8\22632 mm. There were three )Tj 0 -1.473 TD (cases with chromosomal abnormalities and two of these had increased nuch\ al translucency thickness. In the chromosomally )Tj T* (normal group with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 144.1615 148.6933 Tm (mild-to-moderate megacystis )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 313.5194 148.6933 Tm (\()Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 318.5812 148.6933 Tm (longitudinal bladder diameter of 8\22612 mm\), )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 569.1396 148.6933 Tm (the majority of fetuses had )Tj -47.72 -1.473 Td (spontaneous resolution without any obvious adverse effects on renal deve\ lopment and function. In those with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 659.3264 132.2704 Tm (severe )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 591.672 196.9586 Tm -49.741 -7.275 Td (megacystis )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 103.6337 115.8474 Tm (\()Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 108.6955 115.8474 Tm (minimum longitudinal bladder diameter of 17 mm\), )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 401.7662 115.8474 Tm (there was evolution to obstructive uropathy and renal )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0947 98.4099 Tm (dysplasia)Tj 8.9195 0 0 8.9195 88.7194 101.2608 Tm (79)Tj 11.1493 0 0 11.1493 100.0649 98.4066 Tm (.)Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0937 77.8138 Tm (Extensive animal studies have demonstrated that obstructive uropathy cau\ ses renal dysplasia and the degree of renal damage )Tj 0 -1.564 TD (is related both to the onset and duration of the obstruction)Tj 8.9195 0 0 8.9195 368.4893 63.2337 Tm (88,89)Tj 11.1493 0 0 11.1493 394.4271 60.3794 Tm (. Furthermore, such studies have shown that renal damage can )Tj -32.049 -1.383 Td (be reduced by intrauterine surgery to by-pass the obstruction. However, \ the data from vesico\226amniotic shunting in human )Tj 0 -1.473 TD (fetuses with obstructive uropathy have not provided conclusive evidence \ that such interventions are beneficial, possibly )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(53 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2478 0 obj<> endobj 2479 0 obj<>/Type/XObject/BBox[32.8954 95.2186 98.5915 111.061]/FormType 1>>stream 1 0 0 RG 0.8801 w 37.0947 102.1338 m 94.3922 102.1338 l S endstream endobj 2480 0 obj<>>> endobj 2481 0 obj<>21]/P 208 0 R/S/Annot/Pg 752 0 R>> endobj 2482 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.2 0.2 0.2 rg 38.824 253.028 722.98 22.007 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 580.3672 Tm (week fetus, there was megacystis \(46 mm\), bilateral hydronephrosis, in\ creased nuchal translucency and talipes. Chorionic villus )Tj 0 -1.473 TD (sampling showed Turner mosaicism and the pregnancy was terminated.)Tj 0 -1.937 TD (Yoshida )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(45 mm\) and decreased amnio\ tic fluid volume; follow-up scans )Tj 0 -1.564 TD (demonstrated resolution of the megacystis and normalization of the amnio\ tic fluid volume)Tj 8.9195 0 0 8.9195 543.2103 527.7622 Tm (84)Tj 11.1493 0 0 11.1493 554.5559 524.9079 Tm (. At 28 weeks, tetralogy of Fallot )Tj -46.412 -1.383 Td (was diagnosed. Investigations after delivery at 38 weeks confirmed the c\ ardiac defect and, in addition, demonstrated vaginal )Tj 0 -1.473 TD (atresia, imperforate anus, recto-urethral fistula, bilateral vesicourete\ ral reflux, unilateral renal hypoplasia, hypoplasia of )Tj T* (abdominal muscles, scoliosis and bilateral talipes. The karyotype was no\ rmal female. The suggested diagnosis was VACTERL-)Tj T* (like association.)Tj 0 -1.937 TD (Fried )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a 13-week fetus with megacystis \(30 mm\); a repeat scan 2 da\ ys later demonstrated urinary ascites with a )Tj 0 -1.564 TD (thick-walled deflated bladder and the pregnancy was terminated)Tj 8.9195 0 0 8.9195 399.7186 424.0336 Tm (85)Tj 11.1493 0 0 11.1493 411.0641 421.1794 Tm (. The fetal karyotype was 46,XY.)Tj -33.542 -1.847 Td (Hoshino )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 10 weeks but, a\ t 12 weeks, there was megacystis \(40 )Tj 0 -1.473 TD (mm\) with normal amniotic fluid volume; at 13 weeks, the diameter of the\ bladder increased to 54 mm, there was bilateral )Tj 0 -1.564 TD (hydronephrosis and the amniotic fluid volume was reduced)Tj 8.9195 0 0 8.9195 368.5451 369.5812 Tm (86)Tj 11.1493 0 0 11.1493 379.8906 366.7269 Tm (.)Tj -30.746 -1.847 Td (Cazorla )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. reported a fetus with normal sonographic appearance at 8 weeks but, at\ 13 weeks, there was megacystis \(33 )Tj T* (mm\) and reduced amniotic fluid volume; the fetal karyotype was 46,XY)Tj 8.9195 0 0 8.9195 439.5662 331.554 Tm (87)Tj 11.1493 0 0 11.1493 450.9118 328.6998 Tm (. At 16 weeks, the fetus developed generalized edema )Tj -37.116 -1.383 Td (and the pregnancy was terminated. Pathological examination revealed uret\ hral atresia, megacystis, hydronephrosis and )Tj 0 -1.473 TD (atrophied abdominal muscles.)Tj 9.4902 0 0 9.4902 37.098 278.3873 Tm ( )Tj 1 1 0 rg /TT2 1 Tf 11.1493 0 0 11.1493 43.1373 260.3761 Tm (Screening studies)Tj 0 0 0 rg /TT0 1 Tf 9.4902 0 0 9.4902 37.098 243.4395 Tm ( )Tj 11.1493 0 0 11.1493 37.098 230.8161 Tm (In an ultrasound screening study of 622 high-risk pregnancies at 10\2261\ 3 weeks, there were two cases with urethral obstruction )Tj 0 -1.564 TD (presenting as megacystis at 11 and 13 weeks of gestation)Tj 8.9195 0 0 8.9195 364.2972 216.2382 Tm (25)Tj 11.1493 0 0 11.1493 375.6427 213.3839 Tm (. In a screening study for chromosomal abnormalities by )Tj -30.365 -1.473 Td (assessment of fetal nuchal translucency thickness, 24 492 singleton preg\ nancies were examined)Tj 8.9195 0 0 8.9195 580.3264 199.8128 Tm (79)Tj 11.1493 0 0 11.1493 591.672 196.9586 Tm (. Megacystis was present in )Tj -49.741 -1.383 Td (15 fetuses \(prevalence of 1 in 1633\) and, in these cases, the longitud\ inal bladder diameter was 8\22632 mm. There were three )Tj 0 -1.473 TD (cases with chromosomal abnormalities and two of these had increased nuch\ al translucency thickness. In the chromosomally )Tj T* (normal group with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 144.1615 148.6933 Tm (mild-to-moderate megacystis )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 313.5194 148.6933 Tm (\()Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 318.5812 148.6933 Tm (longitudinal bladder diameter of 8\22612 mm\), )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 569.1396 148.6933 Tm (the majority of fetuses had )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0947 132.2704 Tm (spontaneous resolution )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 171.3212 132.2704 Tm (without any obvious adverse effects on renal development and function. I\ n those with )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 659.3264 132.2704 Tm (severe )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 591.672 196.9586 Tm -49.741 -7.275 Td (megacystis )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 103.6337 115.8474 Tm (\()Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 108.6955 115.8474 Tm (minimum longitudinal bladder diameter of 17 mm\), )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 401.7662 115.8474 Tm (there was evolution to obstructive uropathy and renal )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0947 98.4099 Tm (dysplasia)Tj 8.9195 0 0 8.9195 88.7194 101.2608 Tm (79)Tj 11.1493 0 0 11.1493 100.0649 98.4066 Tm (.)Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.0937 77.8138 Tm (Extensive animal studies have demonstrated that obstructive uropathy cau\ ses renal dysplasia and the degree of renal damage )Tj 0 -1.564 TD (is related both to the onset and duration of the obstruction)Tj 8.9195 0 0 8.9195 368.4893 63.2337 Tm (88,89)Tj 11.1493 0 0 11.1493 394.4271 60.3794 Tm (. Furthermore, such studies have shown that renal damage can )Tj -32.049 -1.383 Td (be reduced by intrauterine surgery to by-pass the obstruction. However, \ the data from vesico\226amniotic shunting in human )Tj 0 -1.473 TD (fetuses with obstructive uropathy have not provided conclusive evidence \ that such interventions are beneficial, possibly )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(53 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2483 0 obj<> endobj 2484 0 obj<>/Type/XObject/BBox[33.0819 129.121 171.409 144.261]/FormType 1>>stream 1 0 0 RG 0.8411 w 37.095 135.7299 m 167.3962 135.7299 l S endstream endobj 2485 0 obj<>stream HS[0R9*BI"Pbmo:mgæ|{sL_D/{Jjh H@UO1xՁpW endstream endobj 2486 0 obj[/Indexed/DeviceRGB 255 2487 0 R] endobj 2487 0 obj<>stream HJQFo=kߪ] L ĤPt0")hYsr/K>kK^͐.,x.1ϊgTrͦ陣nfØv3'0- MEFAs څ;S%Fh/3 `\^dAcTSil/I endstream endobj 2488 0 obj<>stream H0- "޻n׸?NW=;rgBZ0676@j\* ?ڢ@ʤ"P0|%L@Zb+4R'04 7M8~M쟿Ĵ$0UQ,V9Ϯ0 Zl/,Ot 6Ԫ)D,`i%g)D0@kgI ,QW4ģ:@POʜUwP(`2׀bWeUAy1n}OjMZ&VI[_IL@S:Dp}x;'66\߾k4bȭ{ceJy;j<Z}PK>pz%'{S%8!ﭻ`O_툄Tە/sJO`Up5iV)FvU:Yv(6u=})ED'7P/G H]N~.2ԵLH ](H`v endstream endobj 2489 0 obj<>/ColorSpace<>/ProcSet[/PDF/ImageC/ImageI]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H**BK 4T043U0ɹ\ .\`` endstream endobj 2490 0 obj<>/ProcSet[/PDF]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H*wSp 0 ) endstream endobj 2491 0 obj<>>> endobj 2492 0 obj<>stream HS[0R9*BI"Pbmo:mgæ|{sL_D/{Jjh H@UO1xՁpW endstream endobj 2493 0 obj[/Indexed/DeviceRGB 255 2494 0 R] endobj 2494 0 obj<>stream HJQFo=kߪ] L ĤPt0")hYsr/K>kK^͐.,x.1ϊgTrͦ陣nfØv3'0- MEFAs څ;S%Fh/3 `\^dAcTSil/I endstream endobj 2495 0 obj<>stream H0- "޻n׸?NW=;rgBZ0676@j\* ?ڢ@ʤ"P0|%L@Zb+4R'04 7M8~M쟿Ĵ$0UQ,V9Ϯ0 Zl/,Ot 6Ԫ)D,`i%g)D0@kgI ,QW4ģ:@POʜUwP(`2׀bWeUAy1n}OjMZ&VI[_IL@S:Dp}x;'66\߾k4bȭ{ceJy;j<Z}PK>pz%'{S%8!ﭻ`O_툄Tە/sJO`Up5iV)FvU:Yv(6u=})ED'7P/G H]N~.2ԵLH ](H`v endstream endobj 2496 0 obj<>/ColorSpace<>/ProcSet[/PDF/ImageC/ImageI]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H**BK 4T043U0ɹ\ .\`` endstream endobj 2497 0 obj<>/ProcSet[/PDF]>>/Type/XObject/BBox[11.0 21.0 61.0 51.0]/FormType 1>>stream H*wSp 0 ) endstream endobj 2498 0 obj<> endobj 2499 0 obj<>>> endobj 2500 0 obj[2499 0 R 2503 0 R 2507 0 R 2510 0 R 2514 0 R 2517 0 R 2521 0 R 2524 0 R 2528 0 R 2531 0 R] endobj 2501 0 obj<>3]/P 208 0 R/S/Annot/Pg 755 0 R>> endobj 2502 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 511.502 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 278.262 722.98 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (because, by mid-gestation, when surgery is usually undertaken, irreversi\ ble renal damage may have already occurred. The )Tj 0 -1.473 TD (extent to which first-trimester diagnosis of megacystis and vesico\226am\ niotic shunting could prevent the subsequent )Tj T* (development of renal damage remains to be determined.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (SKELETAL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.029 TD ( )Tj 0 -1.158 TD (Limb buds are first seen by ultrasound at about the 8th week of gestatio\ n, the femur and humerus are seen from 9 weeks, tibia/)Tj 0 -1.473 TD (fibula and radius/ulna from 10 weeks and digits of hands and feet from 1\ 1 weeks; all long bones are consistently seen from 11 )Tj 0 -1.564 TD (weeks)Tj 8.9195 0 0 8.9195 71.9174 452.314 Tm (14,18,90,91)Tj 11.1493 0 0 11.1493 127.0396 449.4598 Tm (. Body movements \(wiggling\) are seen at 9 weeks and, by 11 weeks, limb\ s move about readily)Tj 8.9195 0 0 8.9195 662.6084 452.314 Tm (18,90)Tj 11.1493 0 0 11.1493 688.5462 449.4598 Tm (. The length )Tj -58.429 -1.383 Td (of the humerus, radius/ulna, femur and tibia/fibula are similar at 11\226\ 14 weeks and increase linearly with gestation from about )Tj T* (6 mm at 11 weeks to 13 mm at 14 weeks; the femur to foot ratio is 0.85)Tj 8.9195 0 0 8.9195 449.1101 419.4633 Tm (92)Tj 11.1493 0 0 11.1493 460.4556 416.6091 Tm (.)Tj -37.972 -1.847 Td (Skeletal dysplasias are found in about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 254.6284 396.0163 Tm (1 per 4000 )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 320.2086 396.0163 Tm (births; about 25% of affected fetuses are stillborn and about 30% die in\ the )Tj -25.393 -1.473 Td (neonatal period. The most common dysplasias are thanatophoric dysplasia,\ osteogenesis imperfecta, achondroplasia, )Tj 0 -1.473 TD (achondrogenesis and asphyxiating thoracic dysplasia. Several case report\ s have described the prenatal diagnosis of a wide )Tj T* (range of skeletal defects in the first trimester of pregnancy and they a\ re usually associated with increased nuchal translucency)Tj ( )Tj T* (thickness \(see Chapter 2\).)Tj /TT2 1 Tf 9.4902 0 0 9.4902 185.7631 330.3127 Tm ( )Tj /TT0 1 Tf -15.665 -1.946 Td ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 43.1373 293.1891 Tm (Caudal regression syndrome)Tj /TT0 1 Tf 9.4902 0 0 9.4902 37.098 268.6737 Tm ( )Tj 11.1493 0 0 11.1493 37.098 256.694 Tm (This rare, sporadic syndrome presents with varying degrees of vertebral \ anomalies from partial sacral agenesis to complete )Tj 0 -1.2 TD (absence of the lumbosacral spine. Sirenomelia is the extreme form, with \ variable fusion and hypoplasia of the lower extremities )Tj T* (and genitourinary, gastrointestinal, cardiovascular and central nervous \ system abnormalities. It is 250 times more common in )Tj T* (poorly controlled diabetic mothers than in the general population.)Tj 9.4902 0 0 9.4902 406.5085 216.5564 Tm ( )Tj -38.926 -1.147 Td ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(54 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2503 0 obj<> endobj 2504 0 obj<>/Type/XObject/BBox[251.036 393.288 319.877 407.586]/FormType 1>>stream 1 1 0 rg 0.8411 w 254.6282 393.7086 m 251.4563 396.8805 251.4563 403.9938 254.6282 407.1656 c 316.284 407.1656 l 319.4558 403.9938 319.4558 396.8805 316.284 393.7086 c f endstream endobj 2505 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 68.841 14.2986]/FormType 1>>stream /Form Do endstream endobj 2506 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 68.8413 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2507 0 obj<>>> endobj 2508 0 obj<>6]/P 208 0 R/S/Annot/Pg 755 0 R>> endobj 2509 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 511.502 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 278.262 722.98 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (because, by mid-gestation, when surgery is usually undertaken, irreversi\ ble renal damage may have already occurred. The )Tj 0 -1.473 TD (extent to which first-trimester diagnosis of megacystis and vesico\226am\ niotic shunting could prevent the subsequent )Tj T* (development of renal damage remains to be determined.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (SKELETAL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.029 TD ( )Tj 0 -1.158 TD (Limb buds are first seen by ultrasound at about the 8th week of gestatio\ n, the femur and humerus are seen from 9 weeks, tibia/)Tj 0 -1.473 TD (fibula and radius/ulna from 10 weeks and digits of hands and feet from 1\ 1 weeks; all long bones are consistently seen from 11 )Tj 0 -1.564 TD (weeks)Tj 8.9195 0 0 8.9195 71.9174 452.314 Tm (14,18,90,91)Tj 11.1493 0 0 11.1493 127.0396 449.4598 Tm (. Body movements \(wiggling\) are seen at 9 weeks and, by 11 weeks, limb\ s move about readily)Tj 8.9195 0 0 8.9195 662.6084 452.314 Tm (18,90)Tj 11.1493 0 0 11.1493 688.5462 449.4598 Tm (. The length )Tj -58.429 -1.383 Td (of the humerus, radius/ulna, femur and tibia/fibula are similar at 11\226\ 14 weeks and increase linearly with gestation from about )Tj T* (6 mm at 11 weeks to 13 mm at 14 weeks; the femur to foot ratio is 0.85)Tj 8.9195 0 0 8.9195 449.1101 419.4633 Tm (92)Tj 11.1493 0 0 11.1493 460.4556 416.6091 Tm (.)Tj -37.972 -1.847 Td (Skeletal dysplasias are found in about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 254.6284 396.0163 Tm (1 per 4000 )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 320.2086 396.0163 Tm (births; about 25% of affected fetuses are stillborn and about 30% die in\ the )Tj -25.393 -1.473 Td (neonatal period. The most common dysplasias are thanatophoric dysplasia,\ osteogenesis imperfecta, achondroplasia, )Tj 0 -1.473 TD (achondrogenesis and asphyxiating thoracic dysplasia. Several case report\ s have described the prenatal diagnosis of a wide )Tj T* (range of skeletal defects in the first trimester of pregnancy and they a\ re usually associated with increased nuchal translucency)Tj ( )Tj T* (thickness \(see Chapter 2\).)Tj /TT2 1 Tf 9.4902 0 0 9.4902 185.7631 330.3127 Tm ( )Tj /TT0 1 Tf -15.665 -1.946 Td ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 43.1373 293.1891 Tm (Caudal regression syndrome)Tj /TT0 1 Tf 9.4902 0 0 9.4902 37.098 268.6737 Tm ( )Tj 11.1493 0 0 11.1493 37.098 256.694 Tm (This rare, sporadic syndrome presents with varying degrees of vertebral \ anomalies from )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 538.081 256.694 Tm (partial sacral agenesis to complete )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 243.3148 Tm (absence of the lumbosacral spine. Sirenomelia is the extreme form, with \ variable fusion and hypoplasia of the lower extremities )Tj 0 -1.2 TD (and genitourinary, gastrointestinal, cardiovascular and central nervous \ system abnormalities. 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The )Tj 0 -1.473 TD (extent to which first-trimester diagnosis of megacystis and vesico\226am\ niotic shunting could prevent the subsequent )Tj T* (development of renal damage remains to be determined.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (SKELETAL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.029 TD ( )Tj 0 -1.158 TD (Limb buds are first seen by ultrasound at about the 8th week of gestatio\ n, the femur and humerus are seen from 9 weeks, tibia/)Tj 0 -1.473 TD (fibula and radius/ulna from 10 weeks and digits of hands and feet from 1\ 1 weeks; all long bones are consistently seen from 11 )Tj 0 -1.564 TD (weeks)Tj 8.9195 0 0 8.9195 71.9174 452.314 Tm (14,18,90,91)Tj 11.1493 0 0 11.1493 127.0396 449.4598 Tm (. Body movements \(wiggling\) are seen at 9 weeks and, by 11 weeks, limb\ s move about readily)Tj 8.9195 0 0 8.9195 662.6084 452.314 Tm (18,90)Tj 11.1493 0 0 11.1493 688.5462 449.4598 Tm (. The length )Tj -58.429 -1.383 Td (of the humerus, radius/ulna, femur and tibia/fibula are similar at 11\226\ 14 weeks and increase linearly with gestation from about )Tj T* (6 mm at 11 weeks to 13 mm at 14 weeks; the femur to foot ratio is 0.85)Tj 8.9195 0 0 8.9195 449.1101 419.4633 Tm (92)Tj 11.1493 0 0 11.1493 460.4556 416.6091 Tm (.)Tj -37.972 -1.847 Td (Skeletal dysplasias are found in about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 254.6284 396.0163 Tm (1 per 4000 )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 320.2086 396.0163 Tm (births; about 25% of affected fetuses are stillborn and about 30% die in\ the )Tj -25.393 -1.473 Td (neonatal period. The most common dysplasias are thanatophoric dysplasia,\ osteogenesis imperfecta, achondroplasia, )Tj 0 -1.473 TD (achondrogenesis and asphyxiating thoracic dysplasia. Several case report\ s have described the prenatal diagnosis of a wide )Tj T* (range of skeletal defects in the first trimester of pregnancy and they a\ re usually associated with increased nuchal translucency)Tj ( )Tj T* (thickness \(see Chapter 2\).)Tj /TT2 1 Tf 9.4902 0 0 9.4902 185.7631 330.3127 Tm ( )Tj /TT0 1 Tf -15.665 -1.946 Td ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 43.1373 293.1891 Tm (Caudal regression syndrome)Tj /TT0 1 Tf 9.4902 0 0 9.4902 37.098 268.6737 Tm ( )Tj 11.1493 0 0 11.1493 37.098 256.694 Tm (This rare, sporadic syndrome presents with varying degrees of vertebral \ anomalies from )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 538.081 256.694 Tm (partial sacral agenesis to complete )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 243.3148 Tm (absence of the lumbosacral spine. )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 232.1997 243.3148 Tm (Sirenomelia is the extreme form, with variable fusion and hypoplasia of \ the lower extremities )Tj -17.499 -1.2 Td (and genitourinary, gastrointestinal, cardiovascular and central nervous \ system abnormalities. It is 250 times more common in )Tj 0 -1.2 TD (poorly controlled diabetic mothers than in the general population.)Tj 9.4902 0 0 9.4902 406.5085 216.5564 Tm ( )Tj -38.926 -1.147 Td ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(54 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2517 0 obj<> endobj 2518 0 obj<>/Type/XObject/BBox[33.5055 240.586 231.867 254.885]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.098 241.0071 m 33.9262 244.1789 33.9262 251.2923 37.098 254.4641 c 228.2747 254.4641 l 231.4465 251.2923 231.4465 244.1789 228.2747 241.0071 c f endstream endobj 2519 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 198.362 14.2986]/FormType 1>>stream /Form Do endstream endobj 2520 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 198.362 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2521 0 obj<>>> endobj 2522 0 obj<>10]/P 208 0 R/S/Annot/Pg 755 0 R>> endobj 2523 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 511.502 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 278.262 722.98 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (because, by mid-gestation, when surgery is usually undertaken, irreversi\ ble renal damage may have already occurred. The )Tj 0 -1.473 TD (extent to which first-trimester diagnosis of megacystis and vesico\226am\ niotic shunting could prevent the subsequent )Tj T* (development of renal damage remains to be determined.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (SKELETAL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.029 TD ( )Tj 0 -1.158 TD (Limb buds are first seen by ultrasound at about the 8th week of gestatio\ n, the femur and humerus are seen from 9 weeks, tibia/)Tj 0 -1.473 TD (fibula and radius/ulna from 10 weeks and digits of hands and feet from 1\ 1 weeks; all long bones are consistently seen from 11 )Tj 0 -1.564 TD (weeks)Tj 8.9195 0 0 8.9195 71.9174 452.314 Tm (14,18,90,91)Tj 11.1493 0 0 11.1493 127.0396 449.4598 Tm (. Body movements \(wiggling\) are seen at 9 weeks and, by 11 weeks, limb\ s move about readily)Tj 8.9195 0 0 8.9195 662.6084 452.314 Tm (18,90)Tj 11.1493 0 0 11.1493 688.5462 449.4598 Tm (. The length )Tj -58.429 -1.383 Td (of the humerus, radius/ulna, femur and tibia/fibula are similar at 11\226\ 14 weeks and increase linearly with gestation from about )Tj T* (6 mm at 11 weeks to 13 mm at 14 weeks; the femur to foot ratio is 0.85)Tj 8.9195 0 0 8.9195 449.1101 419.4633 Tm (92)Tj 11.1493 0 0 11.1493 460.4556 416.6091 Tm (.)Tj -37.972 -1.847 Td (Skeletal dysplasias are found in about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 254.6284 396.0163 Tm (1 per 4000 )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 320.2086 396.0163 Tm (births; about 25% of affected fetuses are stillborn and about 30% die in\ the )Tj -25.393 -1.473 Td (neonatal period. The most common dysplasias are thanatophoric dysplasia,\ osteogenesis imperfecta, achondroplasia, )Tj 0 -1.473 TD (achondrogenesis and asphyxiating thoracic dysplasia. Several case report\ s have described the prenatal diagnosis of a wide )Tj T* (range of skeletal defects in the first trimester of pregnancy and they a\ re usually associated with increased nuchal translucency)Tj ( )Tj T* (thickness \(see Chapter 2\).)Tj /TT2 1 Tf 9.4902 0 0 9.4902 185.7631 330.3127 Tm ( )Tj /TT0 1 Tf -15.665 -1.946 Td ( )Tj /TT1 1 Tf 11.1493 0 0 11.1493 43.1373 293.1891 Tm (Caudal regression syndrome)Tj /TT0 1 Tf 9.4902 0 0 9.4902 37.098 268.6737 Tm ( )Tj 11.1493 0 0 11.1493 37.098 256.694 Tm (This rare, sporadic syndrome presents with varying degrees of vertebral \ anomalies from )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 538.081 256.694 Tm (partial sacral agenesis to complete )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 243.3148 Tm (absence of the lumbosacral spine. )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 232.1997 243.3148 Tm (Sirenomelia is the extreme form, )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 421.8941 243.3148 Tm (with variable fusion and hypoplasia of the lower extremities )Tj -34.513 -1.2 Td (and genitourinary, gastrointestinal, cardiovascular and central nervous \ system abnormalities. It is 250 times more common in )Tj 0 -1.2 TD (poorly controlled diabetic mothers than in the general population.)Tj 9.4902 0 0 9.4902 406.5085 216.5564 Tm ( )Tj -38.926 -1.147 Td ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(54 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2524 0 obj<> endobj 2525 0 obj<>/Type/XObject/BBox[228.607 240.586 421.562 254.885]/FormType 1>>stream 1 1 0 rg 0.8411 w 232.1997 241.0071 m 229.0279 244.1789 229.0279 251.2923 232.1997 254.4641 c 417.9693 254.4641 l 421.1412 251.2923 421.1412 244.1789 417.9693 241.0071 c f endstream endobj 2526 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 192.955 14.2986]/FormType 1>>stream /Form Do endstream endobj 2527 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 192.955 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2528 0 obj<>>> endobj 2529 0 obj<>13]/P 208 0 R/S/Annot/Pg 755 0 R>> endobj 2530 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.4 rg 32.784 511.502 735.059 22.007 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.6 1 rg 38.824 278.262 722.98 30.229 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 583.0041 Tm (because, by mid-gestation, when surgery is usually undertaken, irreversi\ ble renal damage may have already occurred. The )Tj 0 -1.473 TD (extent to which first-trimester diagnosis of megacystis and vesico\226am\ niotic shunting could prevent the subsequent )Tj T* (development of renal damage remains to be determined.)Tj 1 1 1 rg /TT1 1 Tf 0 -2.808 TD (SKELETAL DEFECTS)Tj 0 0 0 rg /TT0 1 Tf 0 -2.029 TD ( )Tj 0 -1.158 TD (Limb buds are first seen by ultrasound at about the 8th week of gestatio\ n, the femur and humerus are seen from 9 weeks, tibia/)Tj 0 -1.473 TD (fibula and radius/ulna from 10 weeks and digits of hands and feet from 1\ 1 weeks; all long bones are consistently seen from 11 )Tj 0 -1.564 TD (weeks)Tj 8.9195 0 0 8.9195 71.9174 452.314 Tm (14,18,90,91)Tj 11.1493 0 0 11.1493 127.0396 449.4598 Tm (. Body movements \(wiggling\) are seen at 9 weeks and, by 11 weeks, limb\ s move about readily)Tj 8.9195 0 0 8.9195 662.6084 452.314 Tm (18,90)Tj 11.1493 0 0 11.1493 688.5462 449.4598 Tm (. The length )Tj -58.429 -1.383 Td (of the humerus, radius/ulna, femur and tibia/fibula are similar at 11\226\ 14 weeks and increase linearly with gestation from about )Tj T* (6 mm at 11 weeks to 13 mm at 14 weeks; the femur to foot ratio is 0.85)Tj 8.9195 0 0 8.9195 449.1101 419.4633 Tm (92)Tj 11.1493 0 0 11.1493 460.4556 416.6091 Tm (.)Tj -37.972 -1.847 Td (Skeletal dysplasias are found in about )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 254.6284 396.0163 Tm (1 per 4000 )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 320.2086 396.0163 Tm (births; about 25% of affected fetuses are stillborn and about 30% die in\ the )Tj -25.393 -1.473 Td (neonatal period. The most common dysplasias are thanatophoric dysplasia,\ osteogenesis imperfecta, achondroplasia, )Tj 0 -1.473 TD (achondrogenesis and asphyxiating thoracic dysplasia. 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It is 250 times more common in )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 37.098 216.5565 Tm (poorly controlled diabetic )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 182.5742 216.5565 Tm (mothers than in the general population.)Tj 9.4902 0 0 9.4902 406.5085 216.5564 Tm ( )Tj -38.926 -1.147 Td ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(54 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2531 0 obj<> endobj 2532 0 obj<>/Type/XObject/BBox[33.5058 213.828 182.242 228.126]/FormType 1>>stream 1 1 0 rg 0.8411 w 37.0983 214.2487 m 33.9265 217.4206 33.9265 224.5339 37.0983 227.7058 c 178.6495 227.7058 l 181.8214 224.5339 181.8214 217.4206 178.6495 214.2487 c f endstream endobj 2533 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 148.736 14.2986]/FormType 1>>stream /Form Do endstream endobj 2534 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 148.737 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2535 0 obj<>>> endobj 2536 0 obj[2535 0 R 2539 0 R 2543 0 R 2546 0 R 2550 0 R 2553 0 R] endobj 2537 0 obj<>3]/P 208 0 R/S/Annot/Pg 764 0 R>> endobj 2538 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.8 rg 32.784 61.27 735.059 23.122 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 208.784317 132.8627472 385.215683 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 385.215683 cm /Im1 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 132.8627 356.9649 Tm (Although on superficial examination this )Tj 0 -1.473 TD (image might pass for normal, note that on )Tj T* (the caudal side of the image \(on the right, )Tj T* (since the ribs can be seen on the left side of )Tj T* (the image\) the spine terminates without the )Tj T* (usual landmark of the iliac wings and )Tj 0 -1.473 TD (sacrum.)Tj 9.4902 0 0 9.4902 177.906 258.4129 Tm ( )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 408.9412 324.1142 Tm (The lack of sacrum )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 519.0517 324.1142 Tm (allows the iliac wings to )Tj -9.876 -1.473 Td (be approximated, giving them a \223shield\224 like )Tj 0 -1.473 TD (appearance.)Tj 9.4902 0 0 9.4902 477.9109 291.2635 Tm ( )Tj 11.1493 0 0 11.1493 278.2342 219.5562 Tm (courtesy Phillipe Jeanty - www.thefetus.net)Tj 9.4902 0 0 9.4902 37.098 195.0816 Tm ( )Tj 11.1493 0 0 11.1493 37.098 182.0951 Tm (Baxi )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. performed serial ultrasound scans in a patient that originally present\ ed in diabetic ketoacidotic coma)Tj 8.9195 0 0 8.9195 663.9798 184.9493 Tm (93)Tj 11.1493 0 0 11.1493 675.3253 182.0951 Tm (. At 9 weeks, )Tj -57.244 -1.2 Td (the crown\226rump length was shorter by a week than expected from the me\ nstrual age. At 11 weeks, there was a protuberence )Tj 0 -1.2 TD (of the lower spine and no normal movements of the thighs were seen. At 1\ 4 weeks, the femora were fixed in a \221frog-leg\222 )Tj T* (position and were never seen moving independently from each other. At 17\ weeks, shortening and kyphosis of the lower spine )Tj T* (were observed. Pathological examination after termination of the pregnan\ cy confirmed the diagnosis of caudal regression )Tj T* (syndrome.)Tj 9.4902 0 0 9.4902 96.5908 115.1991 Tm ( )Tj -6.269 -2.338 Td ( )Tj 1 1 0 rg /TT2 1 Tf 12.0784 0 0 12.0784 37.098 68.8714 Tm (Chapter 4 - References)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(55 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2539 0 obj<> endobj 2540 0 obj<>/Type/XObject/BBox[405.349 321.386 518.72 335.684]/FormType 1>>stream 1 1 0 rg 0.8411 w 408.9412 321.8065 m 405.7693 324.9783 405.7693 332.0916 408.9412 335.2635 c 515.1271 335.2635 l 518.2989 332.0916 518.2989 324.9783 515.1271 321.8065 c f endstream endobj 2541 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 113.371 14.2986]/FormType 1>>stream /Form Do endstream endobj 2542 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 113.371 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2543 0 obj<>>> endobj 2544 0 obj<>6]/P 208 0 R/S/Annot/Pg 764 0 R>> endobj 2545 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.8 rg 32.784 61.27 735.059 23.122 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 208.784317 132.8627472 385.215683 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 385.215683 cm /Im1 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 132.8627 356.9649 Tm (Although on superficial examination this )Tj 0 -1.473 TD (image might pass for normal, note that on )Tj T* (the caudal side of the image \(on the right, )Tj T* (since the ribs can be seen on the left side of )Tj T* (the image\) the spine terminates )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 317.7517 291.2732 Tm (without the )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 132.8627 274.8503 Tm (usual landmark of the iliac wings and )Tj T* (sacrum.)Tj 9.4902 0 0 9.4902 177.906 258.4129 Tm ( )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 408.9412 324.1142 Tm (The lack of sacrum )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 519.0517 324.1142 Tm (allows the iliac wings to )Tj -9.876 -1.473 Td (be approximated, giving them a \223shield\224 like )Tj 0 -1.473 TD (appearance.)Tj 9.4902 0 0 9.4902 477.9109 291.2635 Tm ( )Tj 11.1493 0 0 11.1493 278.2342 219.5562 Tm (courtesy Phillipe Jeanty - www.thefetus.net)Tj 9.4902 0 0 9.4902 37.098 195.0816 Tm ( )Tj 11.1493 0 0 11.1493 37.098 182.0951 Tm (Baxi )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. performed serial ultrasound scans in a patient that originally present\ ed in diabetic ketoacidotic coma)Tj 8.9195 0 0 8.9195 663.9798 184.9493 Tm (93)Tj 11.1493 0 0 11.1493 675.3253 182.0951 Tm (. At 9 weeks, )Tj -57.244 -1.2 Td (the crown\226rump length was shorter by a week than expected from the me\ nstrual age. At 11 weeks, there was a protuberence )Tj 0 -1.2 TD (of the lower spine and no normal movements of the thighs were seen. At 1\ 4 weeks, the femora were fixed in a \221frog-leg\222 )Tj T* (position and were never seen moving independently from each other. At 17\ weeks, shortening and kyphosis of the lower spine )Tj T* (were observed. Pathological examination after termination of the pregnan\ cy confirmed the diagnosis of caudal regression )Tj T* (syndrome.)Tj 9.4902 0 0 9.4902 96.5908 115.1991 Tm ( )Tj -6.269 -2.338 Td ( )Tj 1 1 0 rg /TT2 1 Tf 12.0784 0 0 12.0784 37.098 68.8714 Tm (Chapter 4 - References)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(55 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2546 0 obj<> endobj 2547 0 obj<>/Type/XObject/BBox[314.159 288.545 385.207 302.843]/FormType 1>>stream 1 1 0 rg 0.8411 w 317.7512 288.9655 m 314.5794 292.1374 314.5794 299.2507 317.7512 302.4225 c 381.6141 302.4225 l 384.7859 299.2507 384.7859 292.1374 381.6141 288.9655 c f endstream endobj 2548 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 71.0481 14.2986]/FormType 1>>stream /Form Do endstream endobj 2549 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 71.0484 14.2989]/FormType 1>>stream /R0 gs /MWFOForm Do endstream endobj 2550 0 obj<>>> endobj 2551 0 obj<>7]/P 208 0 R/S/Annot/Pg 764 0 R>> endobj 2552 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 7.7647 0 0 7.7647 18 601.1075 Tm (Diagnosis of Fetal Abnormalities - The 11-14 weeks scan)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q 0 0 0.8 rg 32.784 61.27 735.059 23.122 re f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n q 258.8235321 0 0 208.784317 132.8627472 385.215683 cm /Im0 Do Q q 258.8235321 0 0 208.784317 408.9411774 385.215683 cm /Im1 Do Q 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 132.8627 356.9649 Tm (Although on superficial examination this )Tj 0 -1.473 TD (image might pass for normal, note that on )Tj T* (the caudal side of the image \(on the right, )Tj T* (since the ribs can be seen on the left side of )Tj T* (the image\) the spine terminates )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 317.7517 291.2732 Tm (without the )Tj ET EMC /Annot <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 132.8627 274.8503 Tm (usual landmark of the iliac wings and )Tj T* (sacrum.)Tj 9.4902 0 0 9.4902 177.906 258.4129 Tm ( )Tj ET EMC Q /Annot <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 11.1493 0 0 11.1493 408.9412 324.1142 Tm (The lack of sacrum )Tj ET EMC /Article <>BDC BT /TT0 1 Tf 11.1493 0 0 11.1493 519.0517 324.1142 Tm (allows the iliac wings to )Tj -9.876 -1.473 Td (be approximated, giving them a \223shield\224 like )Tj 0 -1.473 TD (appearance.)Tj 9.4902 0 0 9.4902 477.9109 291.2635 Tm ( )Tj 11.1493 0 0 11.1493 278.2342 219.5562 Tm (courtesy Phillipe Jeanty - www.thefetus.net)Tj 9.4902 0 0 9.4902 37.098 195.0816 Tm ( )Tj 11.1493 0 0 11.1493 37.098 182.0951 Tm (Baxi )Tj /TT1 1 Tf (et al)Tj /TT0 1 Tf (. performed serial ultrasound scans in a patient that originally present\ ed in diabetic ketoacidotic coma)Tj 8.9195 0 0 8.9195 663.9798 184.9493 Tm (93)Tj 11.1493 0 0 11.1493 675.3253 182.0951 Tm (. At 9 weeks, )Tj -57.244 -1.2 Td (the crown\226rump length was shorter by a week than expected from the me\ nstrual age. At 11 weeks, there was a protuberence )Tj 0 -1.2 TD (of the lower spine and no normal movements of the thighs were seen. At 1\ 4 weeks, the femora were fixed in a \221frog-leg\222 )Tj T* (position and were never seen moving independently from each other. At 17\ weeks, shortening and kyphosis of the lower spine )Tj T* (were observed. Pathological examination after termination of the pregnan\ cy confirmed the diagnosis of caudal regression )Tj T* (syndrome.)Tj 9.4902 0 0 9.4902 96.5908 115.1991 Tm ( )Tj -6.269 -2.338 Td ( )Tj 1 1 0 rg /TT2 1 Tf 12.0784 0 0 12.0784 37.098 68.8714 Tm (Chapter 4 - References)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 7.7647 0 0 7.7647 18 8.1075 Tm (http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/cha\ pter-04-final.htm \(55 of 61\)22.8.2006 13:27:24)Tj ET EMC EMC endstream endobj 2553 0 obj<> endobj 2554 0 obj<>/Type/XObject/BBox[129.27 255.699 345.505 286.42]/FormType 1>>stream HT 1 sU -o=9q-'`g1 PuNpK8ث`UZ$\"iyi\UNg;\{}>l˜.+m]]kb nՐ9|+ 0n7? endstream endobj 2555 0 obj<>/Resources<>/ProcSet[/PDF]>>/Type/XObject/BBox[-0.000152588 -0.000152588 216.235 30.7215]/FormType 1>>stream /Form Do endstream endobj 2556 0 obj<>/ProcSet[/PDF]/ExtGState<>>>>>/Type/XObject/BBox[-0.000152588 -0.000152588 216.235 30.7218]/FormType 1>>stream /R0 gs /MWFOForm Do endstream 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00000 n 0003637487 00000 n 0003637738 00000 n 0003637851 00000 n trailer <<5D1987AB5AF4A9449F66C03AD23AFF19>]/Prev 2710456 >> startxref 3641359 %%EOF