Morphological ultrasound

#KnowledgeIsSuccess and there are 3 main ultrasounds to perform during pregnancy:

  • 12 weeks: First trimester screening.
  • 20 weeks: Morphological study.
  • 28 weeks: Fetal echocardiography.

In this video we share with you a complete morphological study in which Dr. Carlos Monsalve checks that all the bone structure, organs and morphological details are in order.

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Hola, muy buenos días. Hoy les vamos a presentar un estudio que es muy importante en el embarazo, que es el estudio morfológico, bueno, el día de hoy hubo una paciente con nosotros que nos permitió grabar su estudio morfológico, es decir, mientras yo revisaba a todo su bebé que anatómicamente no tuviera ningún defecto ella nos permitió hacer esta grabación de ese estudio que les vamos a compartir. Es una paciente que ya estuvo con nosotros hace dos años, que atendimos a su primer bebé por parto, que todos salió muy bien y ahora nuevamente deposita la confianza en nosotros y viene a que le atendamos su segundo embarazo, en este segundo embarazo ya hicimos el screening del primer trimestre y ahora ya tiene 19 semanas con 4 días y entonces es el momento ideal para hacer el estudio morfológico o estructural.

Es un estudio que nos va a servir para ver qué anatómicamente un bebé no tenga ningún defecto. Vamos a revisar todo su desarrollo óseo, cerebro, cara, órganos, manos, pies, dedos. Entonces es un estudio que lo recomendamos siempre porque las va a dejar muy tranquilas en su seguimiento del embarazo, ya van a estar tranquilas el resto del embarazo que anatómicamente su bebé no tiene ningún defecto y claro si hubiera algo, bueno nos podemos preparar para ese nacimiento y tener las mejores armas para atender a su bebé si tuvieran algún problemita. Este morfológico que hicimos fue de un solo bebé pero les vamos a compartir en las redes sociales una liga donde tenemos morfológico de gemelitos e incluso morfológico de trillizos, que estos acaban de nacer apenas el día de ayer entonces, puede ser muy interesante para ustedes. Muchísimas gracias.

Morphological ultrasound consultation begins

Here we are going to start to do the ultrasound, we are going to do the morphological ultrasound. and the first thing we are seeing… Wait, wait! Sorry, you guys edit. Is your baby. You can already see his shape. If you look, you can already see a little bit there. What you have here is the head, on this side is the head, an eye, the nose, the mouth that is covered by these little hands. They have a little hand here in front of their mouth and here the other little hand, this is an eye, the other eye, the nose and here the mouth. Do you come out? arm and the other arm. And here is his heart, this one that moves is his heart that is here beating. Okay? The buttocks were down here.

Have I already told you about sex? Throw him out already. Okay. We can continue seeing it Look: Pompi, leg over here, booty, leg over here and here in the middle… The pilín, child, there’s the pilín. Does it come out? The male genitalia: The penis and the bag of testicles that you see there. Super good! It is very clear that he is a boy. I’m going to put it, a boy. It looks very clear, it doesn’t hide it. These little bubbles that you see here are part of the umbilical cord. Everything we see black on the ultrasound is water, it has a very good amount of liquid. What you see here is the placenta, all of this is the placenta. What am I seeing? That it is implanted, that there are no bruises, that there are no detachments and that it is not a low placenta, I apply a little pressure down here, this black thing here is your bladder, this is the exit, where we try to see the cervical os to see that it is well closed. This is your baby’s head, although you feel it low, it is up and here it is completely closed – Wow, that’s good – And the placenta is anterior, that is, it is not a low placenta, it is a placenta that is well positioned, okay? We are going to start the study and the first thing we are going to do is listen to your baby’s little heart here. Does it already have a name? – No – Ok, you still have time, there is time to search for the name.

It’s already moved, that’s why you lose the microphone there. I hit it again. It is a heart that beats strongly, has a good rhythm and now has a heart rate of 145, which is normal. Between 120 and 160. Ok.

Measurements, limbs and weight

Let’s start by first measuring all of your baby’s bones. There’s the face looking towards us. This is the little head seen from above, what would be the crown. We start by looking at the bones of the skull, this is the line that divides the brain into its two halves and here we first measure the head, from one temple to the other. A temple and the circumference of the head. Head circumference Does it come out? BPD 46.6, Head circumference 167.5. One arm here and the other little arm here… Exactly how you are, look, here he is holding on. We see first this is the arm that goes from the shoulder to the elbow, this is the bone of the arm, the humerus, from the shoulder to the elbow Humerus of 30.1 Normal humerus 30.1 and then from the elbow towards the wrist you will see these two little lines that are the ulna and radius at the same level at the elbow, at the same level at the wrist. But look how it moves, I stay still and there is your baby moving. and here he shows us the other elbow, the forearm, the same bones, the ulna and the radius, and from the elbow to the shoulder the other humerus and here the hands, we start by seeing this little hand… He is moving it. It is always important to see that a baby moves his entire body, that he moves his limbs, OK? Let it not be rigid for so long, so if it is moving, this type of illness is ruled out.

It continues from the shoulder to the elbow, from the elbow to the wrist and here is this little hand. This is the thumb and then from there you can see the other little fingers, look. It looks very clear 1, 2, 3, 4 and 5, they are the knuckles, now we are going to give him time and we will see how he opens them, he looks and he already lowered his hand towards me. Here we measure the radius and ulna, so that they are at the same level at the elbow and at the same level at the wrist. Radius and ulna 27.1, good. And the other hand is on this side, there you will start to see it and the little fingers too, we increase it and here you see the knuckles: 1, 2, 3, 4 and the chubby one 5 and here are the ones on this other hand 1, 2, 3, 4, the fifth from behind. 5 little fingers on each hand! Arm, forearm and hands fine.

Here you start to see the column. Cervical spine, thoracic spine, lumbar spine and here at the end in the tailbone where the spine closes. Here we see the tummy, the chest wall, the abdominal wall and this is the entrance of the umbilical cord through the navel, which is now going to turn color. We are seeing that the abdominal wall is well closed. We make a small slice at the level of the stomach, as we remember everything black is water, this black circle here is the stomach, which when seeing it full tells us that the liquid that is swallowed passes without any difficulty through the neck and reaches the stomach, You always have to see it plump, and precisely that level is where we make the cut to measure the abdominal circumference. Here we measure the abdominal circumference in the tummy. Abdominal circumference 137.5, good. We reach the pelvis here and here we are going to see.

He stands with his legs wide apart, with zero modesty, look, complete, one bare leg and his butt, because he already knows that I already know! I already saw it. We are also going to measure his bones. The leg bone, femur 30.7 that has a good relationship with the humerus. From the knee… We get to the knee and from the knee towards the foot these two little lines will look the same, here the calf and here the little foot. This is the calf and here you will see its 2 little lines that are at the same level on the knee and at the same level on the ankle, which are the tibia and fibula. He has a 27.9 fibula and here the sole of his foot, if you see it’s as if we were looking from the side, lower his calf and here his ankle – Aha, yes, it looks very good! – It is following the line of the leg, that tells me that it is not deviated either inward or outward, it is in a good position. Here’s the other sole of the foot… I already saw his toes! Right now we are going to tell you and here is the other little leg, which is like a frog, with its legs separated.

The other thigh comes here, the knee, maybe the tibia and the fibula are here, and here the foot also follows the line of the leg. So his feet are well accommodated and here we are going to see the little toes. He already put one foot together here and the other here, here we see the little prints of his fingers. When he puts all his fingers together he looks at what it looks like. Many fingers. 1, 2, 3, 4 and 5 It’s as if we were seeing it from the front – Yes, I am seeing them! – and the other little fingers 1, 2, 3, 4 and the chubby one here 5. On this side they are the first ones we saw – Aha, if I saw them, he is doing it like this – He already made them small. 1, 2, 3, 4 and 5. 5 little toes on each foot. Normal thigh, leg and foot.

Go up a little further here, right? Yes, you see, your baby reaches the height of the navel – Ahh – In week 20, which is the middle of the pregnancy, it reaches approximately the height of the navel, so look, it’s up to here. You who feel that your tummy is low look to where your baby is. If you see here is the butt, and knee here, butt and knee here, it is important to see that the knees are at the same level, that is, the legs are even. But he looks where I’m looking at him – Yes, I already saw – Here by the navel and your baby is here, here is the head, it already occupies all this space and has good space. -Yes and the liquid is fine-Right now your baby weighs 288 grams and corresponds to 19 weeks and 3 days, you are 19 weeks and 4 days so she is growing perfectly. Right now I’m going to take it in profile, it looks pretty there, right? – Yes, he is moving his little mouth – Right now he is still too small for 4D, he still looks very skinny, he doesn’t have that much flesh, 4D is recommended from week 24 onwards, he looks better, because if we put him on right now, look, he goes away Let’s see how very skinny. – No, it looks a lot like an alien – Right now it still doesn’t look so pretty, they look prettier after week 24, but you can already see the shape. The amount of fluid, as I had told you at first, looks good, maximum lacuna we are going to measure… Maximum lacuna 45, it should not be less than 20 nor more than 80, anterior placenta grade 0 well, this is the umbilical cord , here you see a thicker line and then two thin ones are two arteries and a vein.

Umbilical cord and organs

The cord has to have two arteries and a vein, when an artery is missing there can be problems with development and growth, here I am seeing that it has two arteries and a vein. Does it come out? Now we are going to start checking his organs, we are going to start with the brain. This is the little head seen from above. The bones of the skull, the line that divides the brain into its two halves, this little line comes here and is interrupted, it becomes like a little black box and then it continues, this little black box tells me that there is a structure that communicates the two hemispheres, which is the cavum, corpus pellucidum. Then it continues and you see a kind of arrowhead that is black, this is the area of the thalami. It is important to see because in the back we are going to see like a little peanut or an 8, which is the cerebellum, what you see here.

It is very important to see the cerebellum because seeing that it has this shape attached here with the thalami will also rule out spina bifida problems. When the spine is open, this structure collapses and loses that shape and now measures very closely in relation to the weeks of gestation, which measures 19.8 – Órale – On the sides of the line that divides the brain you can see these gray stripes that are the choroid plexuses, in them we see that there are no cysts, that there are no tumors, it looks normal. Liquid will form in front and behind these structures, what you have to see is that there is not too much liquid. Anterior lateral ventricle 2.4, very good, it should not be greater than 10 and in the back, posterior lateral ventricle 5.4, which should not be greater than 12, this is what we call hydrocephalus, there is not much water in the brain, so that is being discarded. Here we are at the level of the cerebellum, and behind you can also see a black space, that is the posterior fossa and fluid is also formed here, here it should not be greater than 8 in these weeks and it is 5.8, posterior fossa good. And behind you can see that other space which is the nape fold, what we measure in week 12 is now the nuchal fold which should not be greater than 6. In babies with Down syndrome or chromosomal problems this is very common. chubby and has a 2.9 which is normal. This little mountain is one of the first convolutions of the brain, they are the Silvio fissures, here we see the base of the skull that looks normal, it is the ventricle here, the calcarine fissures and what we can see now inside his little head looks good.

Let’s see, he looked he was getting a little bit looking in, down. This is the orbit of one eye and here the orbit of the other, we see that inside this orbit you will see a little white circle on the outside and black on the inside. Have you seen it yet? It is the ball of the eye, the lens, and seeing it black inside also rules out problems with congenital cataracts, it looks normal, here is this one that is the furthest away, this one is in front, and here is the other one. He has both lenses well. Here he is looking towards us and we are going to measure right now the distance between his eyes to see that they are neither too far apart, nor too close together, nor too small. BOD 30.3, DIO 8.7 and DO 8.4 well, it is a good, normal relationship. We get here, he looks now he has raised his forearm and hand again above the face, but what we are going to see now is the tip of the nose. Let’s look at this part here from bottom to top, ok, the little mouth. This is the tip of the nose, these are the nostrils, this little white line is the upper lip, the lower lip and the chin. There you can see his little hands here on the sides, I’m seeing that he doesn’t have facial clefts, what was previously the cleft lip, OK? It looks normal and this is the cleft palate that looks good, look, it’s looking down, it’s turning. Lip good, nostrils good.

There it turned inwards a little bit, that is, it turned looking downwards, we looked at the spine up here where you see the cervical spine, the dorsal spine, the lumbar spine and here at the end at the coccyx where its spine closes and we see that There are no deviations, there are no malformations and your spine is well closed. It looks perfect there. – Wow, what a good shot – It’s already started to spin again, to do this study you always have to give the babies time, they are going to move. See that thing that looks like a “u”? It is the jaw seen from the bottom up that looks normal, The jaw, here the oropharynx and the palate. A cleft palate can be missed, but a cleft palate can be seen. Oropharynx good, jaw good. Oral well… His little face. Here I put it a little to the side and what you see here is the nasal bone. There is his nasal bone that measures 4, now you should not measure less than 2.5, the same for babies with Down syndrome who are flatter, it takes longer to ossify and that nasal bone can become smaller, it should not be in these weeks for below 2.5 Ok? It looks perfect and there it is. He is opening his mouth. We continue, we go towards the neck and here we measure the heart.

Heart and blood flow

We like to do the heart study around week 28 because it is larger and you can see heart disease better, but right now I see that it is forming well. This is a small slice at the level of the thorax, where the beating heart is here, we first see the tip of the heart towards the left side and we see the 4 chambers, there are the 2 ventricles and the 2 atria – Wow! – We put colors on it and this is to see how the blood passes through the heart valves, where we see that there are no sudden changes in color, which tells us that these valves open and close correctly.

It is important to see this week the exit of the great vessels, this is the exit of the pulmonary artery and this one that goes down, that crosses or is going to cross the pulmonary artery. Pulmonary artery up and crosses the aorta. It comes and crosses and forms the arch of the aorta. This one that comes down here is the exit of the aorta and this one that goes up is the exit of the pulmonary one. Large glasses output well. Here we see the heart and stomach from below. Heart and stomach below the heart. This is where the diaphragm is, it is the muscle that separates the thorax from the abdomen, we can rule out diaphragmatic losses or problems here or a diaphragm defect from this moment. Well, we go towards the abdomen, we see here the stomach and this little black circle that you see down here is the bladder, which, seeing it plump, tells me that at least one of the two kidneys is working well and right now I am going to check that it has its two kidneys.

We are going to look at his back, here you can see the spine and the ribs and then down here you are going to see here a little bean with a black center, this is a kidney, everything that you see here is a kidney and this one go up here, he has another kidney, does he come out? We are looking at his 2 kidneys. And what is painted here are the renal arteries, which confirms that what I am seeing are the kidneys. In the kidneys we see that they are present, that there is no fluid or too much fluid because there should always be a little fluid and that there are no cysts or tumors, it looks normal. Two well-seen kidneys. We continue in a cross section here, here is the stomach and here you will see a kind of black coma, the colors are blood vessels, this one that is not painted is the gallbladder, all this here is the liver when we see the gallbladder biliary tract we assume that the bile duct is formed, without it one would not be able to live outside. I can’t see the bile duct, but I can see the gallbladder, there it is. And what we see here in this other cut is the entry of the umbilical cord through the navel and the abdominal wall well closed from above, below, and we see that there are no large hernias, a small one could escape, but a large one could. we see it. And right here around the bladder, if I also use the Doppler to see the circulation, these two will be painted that confirm the umbilical arteries, which before exiting through the navel pass here around the bladder, there are its two arteries.

The morphological ultrasound concludes

Well, your baby is wonderful! Anatomically we do not see any defects, there are things that we see later, in week 28 we review the morphology of the heart in more depth. We can already evaluate many times in week 28 the descent of the testicles, evaluate well the opening of the anus that at the moment cannot yet be seen and see some more things such as the intestine, or more things.

But size and weight is perfect, it corresponds perfectly to the weeks of pregnancy that you are, and it doesn’t come out, I already saw that it is very closed. Here is the face. What comes out here is an ear, this little beak, it’s your baby’s little ear and the one on this side is covered here with this hand, right there it’s covered. If you move it, we can see you again. – It’s just loaded like this – Yes, it’s loaded, look, here’s the hand. Part of the pavilion could be seen here, but the truth is that it is well covered. This here is the pinna of the other ear. Look, he’s back on his feet, he’s already turned around.

He already finished, he already fulfilled, he already showed himself and we already saw that everything is very well with your baby. – Yes, thank you Doctor – Congratulations! And it doesn’t come out.

“The morphological ultrasound gives mothers the assurance that their baby is fine for the rest of the pregnancy and if we detect something wrong, we can correct it or prepare for birth with all the necessary specialists.”

Dr. Carlos Monsalve
Dr. Carlos Monsalve
Specialist in gynecology and obstetrics

Perinatology, invasive techniques and obstetric ultrasound.
Hospital Universitario La Fe, Valencia, España.

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