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CHAPTER 15: Normal and Abnormal Fetal Anatomy

The ability to detect and characterize abnormalities before birth is one of the marvels of modern obstetrics. Sonography can image the fetus with remarkable precision. Components of the standard anatomic survey are listed in Table 15-1. These have been termed essential elements by the American College of Obstetricians and Gynecologists (2020) and minimal elements by the American Institute of Ultrasound in Medicine (2018). Ideally, residency training in Obstetrics and Gynecology includes education in acquisition and interpretation of these views. Resources provided by national societies assist with this endeavor (Abuhamad, 2018).

TABLE 15-1Components of Standard and Detailed Anatomic Surveys
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TABLE 15-1 Components of Standard and Detailed Anatomic Surveys
Standard Ultrasound Detailed Ultrasound, Additional Components
Head, face, and neck

  • Midline falx

  • Cavum septum pellucidum

  • Lateral ventricles

  • Choroid plexus

  • Cerebellum

  • Cisterna magna

  • Upper lip

  • Nuchal skinfold measurement, 15–20 weeks

 Head, face, and neck

  • Cranial integrity and shapea

  • Brain parenchymaa

  • Lateral ventricle wall/lining and contour

  • Third ventricle

  • Fourth ventricle

  • Corpus callosum

  • Cerebellar vermisa and lobes

  • Transverse cerebellar diameter

  • Nasal bone measurement, 15–22 weeksa

  • Profilea

  • Coronal view of lenses, nosea, lips

  • Orbits with measurement

  • Maxillaa, mandiblea, palate, tongue

  • Ear position, size

  • Necka
Thorax and heart

  • Situs

  • Heart rate (M-mode)

  • Four-chamber view of the heart

  • Left ventricular outflow tract

  • Right ventricular outflow tract

  • 3-vessel view, if feasible

  • 3-vessel trachea view, if feasible

 Thorax and heart

  • Interventricular septum

  • Superior/inferior venae cavaea

  • Aortic archa

  • Ductal arch

  • 3-vessel viewa

  • 3-vessel and trachea viewa

  • Lungsa

  • Diaphragm integritya

  • Ribs
Abdomen

  • Stomach: presence, size, and situs

  • Kidneys

  • Urinary bladder

  • Umbilical cord insertion into fetal abdomen

  • Umbilical cord vessel number

 Abdomen

  • Bowel, small and large

  • Liver

  • Gallbladder

  • Spleen

  • Renal arteries

  • Adrenal glands

  • Ventral wall integrity
Spine

  • Cervical, thoracic, lumbar, and sacral spine

 Spine

  • Shapea, curvaturea, conus medullaris

  • Integrity of spine and overlying tissuea
Extremities (presence only)

  • Arms and legs

  • Hands and feet

 Extremities

  • Architecture, position, numbera

  • Long-bone measurements

  • Fingers and toes (number, position)a
External genitalia

  • When indicated, e.g., multifetal gestation

 External genitalia

aIn addition to all standard anatomy components, these detailed ultrasound components are required by the American Institute of Ultrasound in Medicine for normal cases submitted as part of the detailed ultrasound accreditation process.

Modified from the American Institute of Ultrasound in Medicine, 2018, 2019, 2020a.

A detailed fetal anatomic survey is a specialized examination that may include more than 60 components, each determined on a case-by-case basis. It is the primary method of evaluating at-risk pregnancies and characterizing fetal abnormalities, thereby aiding consultation and delivery planning. Indications are shown in Table 14-6 and discussed further in Chapter 14 (p. 251). At Parkland hospital, the detailed survey includes, at minimum, an attempt to visualize all components required by the American Institute of Ultrasound in Medicine for normal detailed case submission ...

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