This document provides guidance on performing an ultrasound examination of the fetus in the second and third trimesters of pregnancy. It details the standard views and measurements that should be obtained, including images of the head, heart, abdomen, limbs and other structures. Potential abnormalities are also listed for each structure. Fetal echocardiography is important for detecting congenital cardiac defects, which occur in 2-6.5% of live births and can have serious consequences if not identified prenatally.

1. ULTRASOUND EXAMINATION OF THE 2nd & 3rd TRIMESTER PREGNANCY.
Dr/ ABD ALLAH NAZEER. MD.

2. BASIC HARD COPY IMAGES:
A morphology series should include the following minimum images:
cervix length
Placenta and placenta to cervix distance
BPD, HC, AC, FL
Ventricles and choroids
Cerebellum, NF, Cisterna Magna
nose and lips, eyes and orbits
Palate and mandible
spine (sagittal, coronal and transverse)
Pelvis, arms, hands, fingers, legs,feet,toes
Diaphragm and stomach shown on left side
kidneys with PUJ measurement and bladder
cord insertion and 2 umbilical arteries
Heart- 4 chamber,LVOT,RVOT,PAV,Aortic arch and ductal arch (in B
mode and colour)
heart rate

3. IMAGES TO CHECK GROWTH
Biparietal Diameter and Head Circumference (BPD AND HC):
The fetal head measurement must be taken in a cross sectional approach to
include the skull, thalamus, septum pellucidum and it must be symmetrical. The
fetus's head should be imaged laterally through the parietal bone. The
measurement is from the outer edge to the inner edge of the cranium .
*Note: The cerebellum must NEVER be seen in this image or the probe is too
caudal which can give an inaccurate size of the fetal head.
Abdominal Circumference (AC):
The abdominal circumference is taken with a transverse image to include the
stomach, portal vein and the spine in a true transverse plane. The ribs may or may
not be seen but must be symmetrical if included. It should be a circle at 18-20
weeks and no compression by external forces. It is best taken with the baby supine
or lateral because if the baby is prone then the rib shadows make it difficult to
check the correct level. The measurement must be taken around the waist on the
edge of the skin layer.
*Note: The kidneys should not be seen in the AC image or the plane is too caudal.
Femur Length (FL):
The femur bone must only be imaged when it is parallel to the probe as it will not
be foreshortened. The lateral edge of the shaft is measured from the greater
trochanter to the lateral femoral condyle.

4. ULTRASOUND 18-20 WEEKS - Normal (MORPHOLOGY SCAN)
HEAD ULTRASOUND
The correct plane for the measurement of
the head circumference (HC) and bi-parietal
diameter (BPD)must include the cavum
septum pellucidum, thalamus and choroid
plexus in the atrium of the lateral ventricles.
BPD: Measure outer table of the
skull to the inner table.
HC: Measure around the outer
table of the skull.

5. The correct plane for measuring the
nuchal fold is to have cavum septum
pellucidum (CSP) and the cerebellar
hemispheres in the image.
The cerebellar diameter should approximately
equal the weeks of gestation. (EG
19weeks=19mm).
Normal cisterna magna is less than 10mm.
A normal nuchal fold is less than 6mm
(between 17-20weeks).

6. The LATERAL VENTRICLES should be less than
10mm in diameter (best measured at the
occipital horn). The CHOROID PLEXII should be
homogeneous. Small, and sometimes multiple,
choroid plexus cysts are a common finding on
high resolution equipment. They are of
doubtful significance as an isolated finding.
PROFILE - ensure the mandible is
appropriate size, nasal bone is present
and there is a normal face/head shape.

7. FACE: Ensure there is symmetry with
a normal inter-orbital distance.
NOSE & LIPS: From the 'face' image, rotate the
probe to visualize the nose and lips front on.
2 distinctly separate nodules and in intact
hypoechoic upper lip should be seen. 2 distinctly
septate nostrils and an intact hypoechoic top lip.

8. ABDOMINAL ULTRASOUND
AC- ABDOMINAL CIRCUMFERENCE.
The Abdominal Circumference must include the
portal section from the umbilical vein, the stomach
and a true cross section of the spine with 3
ossification centers. It should be circular in shape.

9. First, confirm that the organs are
correctly sited right vs left.
An axial plane through the chest and
upper abdomen shows the heart and
stomach on the same side (which has
been proven to be the left).
In a coronal plane, confirm the presence
and position of heart, stomach and
bladder. Also check the diaphragm. Ensure
that there is no herniation of abdominal
contents into the thorax.

10. FETAL KIDNEYS
Confirm the presence and position of both
kidneys. Be cautious not to mistake the
adrenal glands which are quite large. Look
for the anechoic renal pelvis. The renal
pelvis TS diameter should be less than 5mm.
The kidneys must be measured in a sagittal
or coronal plane. Utilize colour/power
Doppler to confirm renal arteries and help
identify the kidneys in a larger patient.

11. UMBILICAL CORD
Cord insertion
Ensure the abdominal wall around the cord insertion
is intact and that no bowel has herniated into the
cord. Use power Doppler to confirm the presence of
2 umbilical arteries forking around the bladder. (Be
careful not to slip into a more coronal plane and
mistake the iliac arteries.)
There is an obvious penis identified at 18-
20 weeks. Shown on the mouseover is the
3 parallel white stripes of the external
genitalia of the female vulva.

12. FETAL SPINE
CORONAL SPINE
Check for any scoliosis.
Cervico-thoracic spine: Check the ribs for
symmetry. Lumbar/sacral spine: In coronal,
visualize the sacral taper and pelvic bones.
SAGITTAL SPINE
Ensure there is a uniform, intact
posterior skin edge.

13. TRANSVERSE SPINE
The 3 ossification centers of the spine should
be visible from neck to the lumbo-sacral
junction. A smooth intact skin line should be
visible throughout. Beware overlying cord
mimicking a meningocele.
CORONAL SPINE

14. FETAL LIMBS:
Femur Length
The Femur length should only be measured when
the femur is horizontal (beam is perpendicular)
and shadows evenly- at least from both ends.

15. Lower limbs
Confirm the presence and equal size
of the tibia and fibula bilaterally.
The foot should be perpendicular
to the tibia and fibula.

16. Upper limbs. 5 fingers/knuckles on each side.

17. The echogenic mucous plug is readily
visible in the cervix. Measure the length
of the cervix. It should be at least 30mm,
and contain no fluid.
Uterine contraction
Beware of uterine contractions
mimicking a low lying placenta.

18. PLACENTA
Placental bed: Locate the placenta (anterior
V's posterior or lateral)
Ensure there is a myometrial rim of 3mm or
more under the placenta (otherwise
suspect placenta percreta/accreta).
The placenta tip must be greater
than 3cm from the internal os.

19. LIQUOR and AFI
Greater than the 95th centile
=Polyhydramnios. Less than
the 5th centile =Oligohydramnios.
Amniotic Fluid index (AFI), Measure the
deepest vertical pocket (with no fetal content)
in each quadrant and add them together.

20. UMBILICAL ARTERY RESISTIVE INDEX:
Measure the Systolic-Diastolic (SD) ratio
or the resistive index of the umbilical
artery. Both of these are different forms
of the same information. Umbilical Artery Doppler.

21. MIDDLE CEREBRAL ARTERY DOPPLER:
MCA Doppler
Middle cerebral artery Doppler gives an
indication of the "Brain sparing effect“.
Measure the pulsatility index. Another useful
ratio is: MCA RI / UA RI < 1 (normally > 1).

22. DUCTUS VENOSUS:
Ductus venosus Doppler: Oxygen rich blood from
the maternal circulation enters to the fetus via the
Umbilical vein. The umbilical vein ascends the fetal
abdomen and drains into the left portal vein and
the IVC via Ductus venosus. DV is being flagged as a
potentially earlier predictor of adverse pregnancy
outcome than Umbilical artery Doppler's.
Ductus venosus Doppler is recognizable as a
small high velocity structure laying superiorly in
the liver, adjacent to the IVC. Should be constant
forward flow throughout the cardiac cycle.

23. MOST COMMON ABNORMALITIES TO LOOK FOR WHEN IMAGING THE FOLLOWING STRUCTURES
Profile, nasal bone, nose/lips, mandible, palate, orbits.
Cleft lip and palate, Cystic hygroma, Exophthalmos, Proptosis, Prominent
eyes, Hypotelorism, Microphthalmia, Anophthalmia, Facial asymmetry,
Macroglossia, Micrognathia
Nasal bone absence or hypoplastic
Head, BPD, HC, CBM, NSF, CM, Ventricles
Choroids plexus cysts(CPC)
Agenesis of the corpus callosum:
Dandy-Walker cyst
Echogenic brain focus or foci
Encephalocele, Holoprosencephaly, Intracranial cyst, Clover leaf skull,
Macrocephaly, Microcephaly
Ventriculomegaly
Arnold Chiari malformation
Dandy-Walker malformation, Arachnoid cysts, Intracranial bleed,
Posterior fossa cyst
Vein of Galen aneurysm
Anencephaly, Aqueductal stenosis, Intracranial teratomas

24. Heart,4chamber,LVOT,RVOT,heart beat
Bradycardia, Tachycardia
Heart axis towards the left
Enlarged heart, Ventricular septal defect (VSD), Atrial septal defect (ASD),
Coarctation of the aorta, Double outlet right ventricle
Hypoplastic left heart syndrome, Hypoplastic right heart syndrome
Single ventricle, Tetralogy of Fallot
Cardiac rhabdomyoma, Ebstein's anomaly
Endocardial cushion defect (atrioventricular canal)
Ectopia cordis (pentralogy of Cantrell)
Common arterial truncus
Premature atrial contractions
Transposition of the great arteries
Bright echoes in the heart
Left/right heart enlargement
Right atrial enlargement
Pericardial effusion
Small chest, Pleural effusion

25. Chest cavity
Pericardial effusion, Small chest, Enlarged heart, Pleural effusion, Cystic masses
Cystadenomatoid malformations, Diaphragmatic hernia, Chest wall hematoma
Pericardial cyst, Tracheal atresia, Mediastinal teratoma, hemothorax
Diaphragm,liver,GB,bowelDiaphragmatic hernia
Anal atresia, Duodenal atresia
Gastrointestinal atresia or stenosis
Gastroschisis, Omphalocele, Meconium cyst, Meconium ileus, Umbilical hernia
Tracheoesophageal atresia or fistula/esophageal atresia
Ascites, Midgut volvulus, Small bowel atresia, Meconium peritonitis
Dilated stomach, Dilated duodenum, Dilated bowel
Echogenic mass
Adrenal hemorrhage
Hepatic tumour
Neuroblastoma
Ovarian cyst with hemorrhage
Echogenic bowel
Cystic fibrosis
Intragut or intrabdominal bleed
Calcification, Gallstones, Teratoma

26. Kidneys and Adrenals
Hydronephrosis
Ectopic ureter
Infantile polycystic kidney disease
Multicystic dysplastic kidney
Posterior urethral valves
Reflux (<6mm PUJ)
Ureterocele, Ectopic ureter
Pelvo-uretero junction obstruction
Ureterovesical junction obstruction
Horseshoe kidney, Pelvic kidney, Renal agenesis
Ureterocele
Adrenal hematoma, Adrenal mass
Cord and insertion, Omphalocele, Gastroschisis
Umbilical hernia
One umbilical artery

27. Bladder and Gender
Absent bladder, Renal agenesis, Bladder exostrophy, Dilated bladder
Spine coronal, trans Spina bifida
Myelomeningocele, Myeloschisis, Meningocele
Cystic masses
Solid masses-Sacrococcygeal teratoma
Lower limbs Rocker-bottom feet
Polydactyly
Achondroplasia, Achondrogemesis
Absent digits, Absent limbs
Bowing
Clinodactyly, Club foot
Fractures
Joint contractures
Mesomelic shortness
Muscle wasting
Rhizomelic shortening, Limb shortening.

28. Upper limb
Polydactyly
Achondroplasia
Achondrogemesis
Absent digits
Absent limbs
Abnormal thumb
Bowing
Clenched hands
Clinodactyly
Fractures
Joint contractures
Mesomelic shortness
Muscle wasting
Radial hypoplasia
Rhizomelic shortening
Short limbs
Limb shortening

42. Vein of Galen aneurysm.

43. MICROCEPHALY.

44. Anencephaly.

45. Anencephaly

47. Fetal Hydrocephalus Ultrasound.

48. Ultrasound image choroid
plexus papilloma.
Color Doppler image
choroid plexus papilloma.

49. Congenital cardiac disease is seen in 2–6.5 of 1000 live births and
is a major cause of morbidity and mortality, with half of these cases being
lethal or requiring surgical correction. Environmental, genetic, and
chromosomal abnormalities are believed to be causes of congenital
cardiac defects, with a higher incidence among infants with affected
siblings or mother. Extra-cardiac abnormalities are associated with 25%
of these cases.
Detection of cardiac anomalies can be challenging and is typically done
by fetal cardiac ultrasound performed between 18 and 22 weeks.
Transvaginal scan can detect anomalies even at 12–13 weeks. Detailed
fetal echocardiography is performed in high-risk cases, which could be a
result of fetal (extra-cardiac anomalies, increased nuchal translucency,
hydrops, or polyhydramnios), maternal (teratogen exposure, metabolic
disorders, congenital heart defect, folic acid deficiency, or autoantibodies),
or familial (sibling or father with congenital heart defect and Mendelian
syndromes) factors. Detection of anomalies alters the obstetric course and
outcome, including reassurance, termination, fetal therapy, mode of
delivery, and postnatal referral to a tertiary care center with advanced
expertise in management of these patients.

50. Standard cardiac view. A, Basic four-chamber view, which shows right ventricle
(RV), left ventricle (LV), right atrium (RA), and left atrium (LA). Interventricular
septum (arrow) is also seen in this view that is acquired perpendicular to
ultrasound beam. Interatrial septum (arrowhead) is visualized.

51. Extended cardiac views. A, Left
ventricular outflow tract view
shows left ventricle (LV), which
gives origin to ascending aorta
(AO). Right ventricular (RV)
outflow tract and left atrium
(LA) are also seen.
Extended cardiac view.
B, Right ventricular outflow
tract view shows RV, giving
origin to main pulmonary
artery (PA). AO is seen as
circular structure and is
perpendicular to PA.
Extended cardiac view.
C, Further superiorly, right
pulmonary artery (RPA)
and left pulmonary artery
(LPA) are seen.

52. A, Aortic arch can be seen giving off branches to head
and neck and continuing as descending thoracic aorta
(DTA). DA = ductus arteriosus.
B, DA connects pulmonary artery (PA) to DTA.
C, Superior vena cava (SVC) and inferior vena cava (IVC)
open into morphologic right atrium (RA). RV = right ventricle.
D, Pulmonary veins (arrows) open into morphologic
left atrium (LA). LV = left ventricle

53. Ventricular septal defect. Four-chamber view shows small defect
(arrow) in inlet portion of interventricular septum (arrowhead). LA =
left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.

54. Atrioventricular canal defect. Four-chamber view shows large defect in inlet part of
interventricular septum (arrows) and complete absence of inter-atrial septum (arrowheads),
with free communication of all cardiac chambers, consistent with atrioventricular septal defect.
LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.

55. Tetralogy of Fallot. Outflow tract view shows aorta (AO) overriding ventricular septal
defect (arrows). Pulmonary artery was visualized separately (not shown). These findings
are consistent with tetralogy of Fallot. LV = left ventricle, RV = right ventricle.

56. Truncus arteriosus. A, Outflow tract view
shows common arterial trunk (straight arrow)
originating from left ventricle (LV) and right
ventricle (RV), overlying small ventricular
septal defect (arrowhead). In addition, there
is small pericardial effusion (curved arrow).
Truncus arteriosus. B, Doppler in outflow
tract shows common arterial trunk (straight
arrow) originating from ventricles.
Admixture of flow is seen in ventricular
septal defect (arrowhead). Curved arrow
indicates small pericardial effusion.

57. D-transposition of great arteries. Outflow view shows aorta (AO)
and pulmonary artery (PA) parallel to each other, with AO
originating from right ventricle (RV) and PA from left ventricle (LV).

58. Double outlet right ventricle. Right ventricular outlet view shows aorta (AO) and
pulmonary artery (PA) originating from right ventricle (RV). LV = left ventricle.

59. Right-sided abnormalities. A, Four-chamber
view shows small right ventricle (RV), with
normal sized left ventricle (LV), consistent
with hypoplastic right heart syndrome. LA =
left atrium, RA = right atrium.
Right-sided abnormalities. B, Four-chamber
view show thickened leaflets of tricuspid
valve (arrows), with restricted opening,
consistent with tricuspid stenosis.

60. Hypoplastic left heart syndrome. Four-chamber view shows small left ventricle (LV)
and left atrium (LA), associated with ventricular septal defect (VSD) consistent with
hypoplastic left heart syndrome. RA = right atrium, RV = right ventricle.

61. Hypoplastic aorta. A, Axial image shows
normal size of pulmonary artery (arrow)
with severe hypoplasia of aorta
(arrowhead). DA = ductus arteriosus, RV =
right ventricle.
Hypoplastic aorta. B, Another axial image
shows severe hypoplasia of aorta
(arrowhead). In addition, there is
ventricular septal defect (arrows) that
allows flow from left ventricle (LV) to RV.

62. Aortic stenosis. Doppler through aortic valve reveals increased systolic velocity (arrow),
with maximal velocity of 218 cm/s, indicative of severe aortic stenosis. LV = left ventricle.

63. Pulmonary stenosis. Color Doppler through pulmonary valve
reveals increased systolic velocity, with maximal velocity of
240 cm/s, indicative of severe pulmonary stenosis.

64. Ebstein anomaly. Four-chamber view shows apical displacement of tricuspid valve
(arrow) from level of annulus (arrowhead) with severe dilation of right atrium
(RA), consistent with Ebstein anomaly. A and B indicate measurement of right
atrium, LA = left atrium, LV = left ventricle, RV = right ventricle.

65. Pentalogy of Cantrell. A, Sagittal
ultrasound through uterus shows
defect in chest wall (curved arrows)
with heart lying outside thoracic
cavity (arrow).
Pentalogy of Cantrell. B, Patient also
had omphalocele (arrow) and
diaphragmatic hernia (arrowhead)
consistent with pentalogy of Cantrell.

66. Cardiac rhabdomyoma. Four-chamber view shows echogenic mass (arrow) attached to
interventricular septum, in patient with tuberous sclerosis, consistent with rhabdomyoma.
LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.

67. Dilated cardiomyopathy. Axial view through fetal thorax shows severely dilated heart with
dilation of all chambers. In addition, there is pleural effusion (arrowhead) and diaphragmatic
hernia (curved arrow). LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.

68. Hypertrophic cardiomyopathy. Four-chamber view shows severe
hypertrophy (arrows) of left ventricle (LV) and right ventricle (RV).
There is also moderate pericardial effusion (arrowhead).

69. Endocardial fibroelastosis. Four-chamber views show increased echogenicity
(arrows) within myocardium of left ventricle (LV) and right ventricle (RV) in patient
with endocardial fibroelastosis. LA = left atrium, RA = right atrium.

70. Echogenic intracardiac foci. Four-chamber view shows echogenic focus (arrow) within
myocardium. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.

71. Fetal arrhythmia. A, M-mode Doppler images
show premature atrial contraction (arrow)
with subsequent early ventricular contraction
(arrowhead).
Fetal arrhythmia. B, M-Mode Doppler
images show supraventricular tachycardia–
atrial heart rate (arrowhead) is fast as well
as ventricular heart rate (arrow).

115. Abdominal wall defects.

118. URINARY TRACT ABNORMALITIES
The frequency of urinary abnormalities is approximately 7:1000 newborns,
and the recurrence risk is 8% to 10%. The etiology of urinary tract
abnormalities should extend beyond the apparent site of the lesion. For
example, dilation of the ureteropelvic junction (UPJ) may result either from
obstruction at the upper ureter or from pathology at a more caudad level.
This includes increased intraluminal pressure secondary to reflux at the level
of the vesicoureteral junction resulting in dilation of the UPJ. Similarly, a
posterior urethral valve (PUV) will dilate the UPJ and even produce
hydronephrosis. Thus, in discussing urinary tract abnormalities, it is
reasonable to start with the urethra and proceed cephalad.
Posterior Urethral Valve
Most PUVs are partial, such that the resulting bladder dilation is not severe.
The ureters may only be slightly dilated, and if present, hydronephrosis is
moderate. In the severe form, however, the pathophysiology is severe and
may resemble the findings in agenesis of the urethra. In complete PUV, the
bladder is markedly dilated. The ureters also are convoluted and large.
Hydronephrosis is severe. Oligohydramnios prevents appropriate pulmonary
development and leads to pulmonary hypoplasia.

119. Longitudinal echogram showing some enlargement of the bladder (
arrow) in a fetus with a partial posterior urethral valve. Ureters are
not dilated, and there is no evidence of hydronephrosis.

120. Cross-section of fetal abdomen at level of kidneys ( spine anterior ) show both kidneys. The
left (LT) kidney shows dilation of the ureteropelvic junction (UPJ), but no hydronephrosis is
present. B. The fetal spine is tot he left of the echogram and the kidney above the spine
also shows dilation of the UPJ, the anteroposterior diameter (calipers) measuring 8 mm. C.
The fetal spine is on the right lower side of the echogram. The kidney above the spine
shows more severe UPJ (calipers) , with extension to the calyces.

121. Longitudinal echogram of fetus, showing kidney (within tracing) with extensive
hydronephrosis. Many dilated calyces are communicating with the renal pelvis, a
finding that differentiates hydronephrosis from multicystic kidney.

122. Infantile polycystic renal disease, Cross-section of fetal abdomen at level of
kidneys (spine anterior, arrow) shows both kidneys. The areas on each side of the
spine are filled with a uniform echopattern, and no kidneys are seen. B. Color
Doppler of aorta in a fetus with renal agenesis fails to outline renal arteries

123. Cross-section of fetal abdomen at level of kidneys (spine anterior) shows
both kidneys. Note pyelectasis of right kidney (anteroposterior diameter =
6.4 mm). The left kidney is enlarged and uniformly cystic, with no
apparent renal cortical tissue, which is characteristic of multicystic kidney.

124. EXTERNALLY VISIBLE BODY DEFECTS AND SKELETAL ABNORMALITIES
Cleft Lip and Palate
It is now possible to image the fetal nose area and upper lip to rule out cleft lip. Cleft
lip alone is genetically different from the combination of a cleft lip and palate and is
more likely to occur in female infants (sex ratio, 2:1). Importantly, both conditions may
be components of genetic, chromosomal, or other syndromes.
Cystic hygroma. Echogram of nostrils (single arrow shows left)
nostril and upper lip (double arrows).

125. Fetal hydrops. Cross-section of fetal neck, showing very large cystic
hygromas extending toward the right side of the echogram.

126. Small sacrococcygeal teratoma (+,X) noted anterior to the fetal spine.
This could be readily palpated in a rectal examination in the neonate.

127. Fetal limb abnormalities can be detected on sonography before 15
weeks’ gestational age and are often associated with serious congenital
conditions, especially trisomy 18. Transabdominal sonography alone can show
most of these abnormalities, although transvaginal and 3-dimensional
sonography can provide additional information. Targeted evaluation of fetal limbs
during sonography before 15 weeks should be considered in high-risk populations.
Club hand on transabdominal 2- and 3-dimensional sonography in a fetus with suspected
trisomy 18 at a gestational age of 13 weeks 1 day. A, Two-dimensional sonogram showing
the shortened forearm (short arrow) and abnormal hand positioning (long arrow). B,
Three-dimensional sonogram showing the club hand and its structural relationship to the
entire fetus, which may be important for the patient to understand the anomaly.

128. Transabdominal 2-dimensional sonogram showing a single lower extremity with
a single femur (long arrow) in the proximal portion of the lower extremity
and 2 bones in the lower limb (short arrows). Note that the foot is absent

129. Absent right lower extremity with the membrane attached to an otherwise normal left leg
in a fetus with suspected amniotic band syndrome at a gestational age of 13 weeks 5 days.
Membrane attachment to an isolated or unilaterally missing extremity, in the absence of
any other congenital anomaly, serves as criterion for suspicion of amniotic band syndrome.
A, Transabdominal 2-dimensional sonogram showing the normal left (LT) leg for
comparison. B, Transabdominal 2-dimensional sonogram showing the absent right leg (RT
LE) bud. Only the iliac bones (arrows) are seen. C, Two-dimensional sonogram showing the
membrane (arrow) wrapped around the otherwise normal-appearing left leg.

130. Abnormal left hand with a normal ulna and absent radius in a fetus with an unknown
diagnosis at a gestational age of 12 weeks 4 days. A, Transvaginal 2-dimensional
sonogram showing the normal right hand for comparison. B, The abnormal left hand
(arrow) is more apparent on a transvaginal 2-dimensional sonogram when seen in
comparison to the opposite normal hand. Notice that only 1 bone is seen in the forearm.

131. Overlapping fingers and clenched hands in a fetus with trisomy 18 at a gestational
age of 14 weeks 4 days. A, Transvaginal 2-dimensional sonogram showing a
clenched hand (arrow). L indicates left. B, Transvaginal 2-dimensional sonogram
of the fetal hand showing the overlapping first digit (arrows).

133. Abnormal findings of fetal bones: (A and B) Bowed femur in the case of
campomelic dysplasia, (C and D) fractured femur in the case of
osteogenesis imperfecta type IV. Fracture and reossification affect the
sonographic penetration, and the deformity is observed in radiograph

134. Thanatophoric dysplasia: (A to C) Micromelic shortening of femur, humerus with
mild angulation and lower limbs, (D) undersized thorax compared with the
abdomen, (E and F) micromelic shortening of upper and lower limbs with normal
ossification, no fracture and puppet posture in 3D ultrasound and 3D-CT scan

135. Thank You.