3. Skrining USG Trimester I_dr. Vaulinne Basyir, SpOG(K)
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Transcript of 3. Skrining USG Trimester I_dr. Vaulinne Basyir, SpOG(K)
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SKRINING ULTRASONOGRAFI
TRIMESTER PERTAMA
Oleh :Vaulinne Basyir, dr., SpOG(K)
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SKRINING TRIMESTER 11. Kantung kehamilan (Gestational Sac)
Ukuran Lokasi
Intrauterin Ekstrauterin
Yolk sac Blighted ova
2. Fetal pole Ukuran (CRL) Pulsasi
3. Embrio Ukuran Gerak Anatomi Jumlah Amnionitas & korionisitas
4. Kelainan
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IDENTIFIKASI KANTUNG KEHAMILAN
(GESTATIONAL SAC) Vaginal transducer
Ukuran 2-3 mm ~ 4 - 5 minggu usia kehamilan
Bentuk : gumpalan cairan kecil yang dikelilingi jaringan hiperekogenik
Ukuran : mean sac diameter (MSD)
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Mean sac diameter (MSD)
Normal : bertambah 1,13 mm/hr
Abnormal : pertambahan 0,6 – 0,7 mm/hr
MSD & cardiac activity MSD 16 mm cardiac
activity (+) Jarak pemeriksaan
USG ke 2 12 hari sejak ditemukan
MSD 4 mm pada USG ke-1
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KEHAMILAN EKTOPIK(EKSTRAUTERIN)
Identifikasi dgn TV setelah minggu ke-5,5
Kantung kehamilan diluar uterus (kehamilan ekstrauterin)
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USG kehamilan ektopik:1. Ukuran uterus sedikit membesar2. Massa kompleks pada cavum Douglas3. Cairan bebas pada cavum Douglas4. Massa kompleks pada daerah adneksa5. Gambaran Ring of Fire pada daerah
adneksa (Doppler)
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IDENTIFIKASI YOLK SAC Transvaginal :
Awal deteksi kehamilan minggu ke-5 (MSD, 5mm) Transabdominal :
Awal deteksi kehamilan minggu ke-7 (MSD, 20mm) Ukuran bertambah pada minggu ke 5 –10
CRL 30-45mm
Minggu kehamilan
Diameter sonografi (mm±SD)
5 3.01 ± 0.75
6 2.99 ± 0.73
7 3.99 ± 0.86
8 4.72 ± 0.64
9 5.22 ± 0.63
10 5.89 ± 0.56
11 5.35 ± 0.87
12 4.34 ± 0.62
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IDENTIFIKASI BLIGHTED OVA Volume kantung kehamilan > 2,5 cc
tapi tidak tampak fetal pole Diameter kantung > 2 cm tidak
tampak fetal pole Catatan : bila kantung utuh dan tidak
ada perdarahan, sebaiknya USG diulang 1-2 minggu
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IDENTIFIKASI FETAL POLE
CRL ≥ 5 mm, pulsasi jantung sudah dapat dideteksi
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IDENTIFIKASI EMBRIO
Crown-rump length (CRL) Jarak terjauh dalam garis lurus dari kranial
sampai kaudal
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CRL (mm)Robinson &
Fleming (minggu)
Hadlock(minggu) CRL (mm)
Robinson & Fleming(minggu)
Hadlock(minggu)
2 5.7 5.7 29 9.9 9.7
3 5.9 5.9 30 10 9.9
4 6.1 6.1 31 10.1 10
5 6.3 6.2 32 10.2 10.1
6 6.5 6.4 33 10.3 10.2
7 6.7 6.6 34 10.4 10.3
8 6.9 6.7 35 10.5 10.4
9 7 6.9 36 10.6 10.5
10 7.2 7.1 37 10.7 10.6
11 7.4 7.2 38 10.8 10.7
12 7.5 7.4 39 10.9 10.8
13 7.7 7.5 40 11 10.9
14 7.9 7.7 41 11.1 11
15 8 7.9 42 11.2 11.1
16 8.2 8 43 11.3 11.2
17 8.3 8.1 44 11.4 11.2
18 8.5 8.3 45 11.4 11.3
19 8.6 8.4 46 11.5 11.4
20 8.7 8.6 47 11.6 11.5
21 8.9 8.7 48 11.7 11.6
22 9 8.9 49 11.8 11.7
23 9.1 9 50 11.9 11.7
24 9.3 9.1 51 11.9 11.8
25 9.4 9.2 52 12 11.9
26 9.5 9.4 53 12.1 12
27 9.6 9.5 54 12.2 12
28 9.7 9.6 55 12.3 12.1
Pengukuran CRL dengan konversi usia kehamilan
Rumus praktis :GA (minggu) = 6,5 + CRL
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AKTIVITAS JANTUNG
Awal deteksi pulsasi TV minggu ke-6 TA minggu ke-7
Usia kehamilan (minggu)
Rerata denyut jantung
(bpm ± SD)
5-5.95 101.2 ± 8.7
6-6.95 124.5 ± 12.1
7-7.95 128.0 ± 11.7
8-8.95 144.3 ± 19.5
9-9.95 138.7 ± 12.4
10-10.95 136.9 ± 10.9
11-11.95 139.8 ± 18.9
12-12.95 137.3 ± 12.9
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DESKRIPSI PERKEMBANGAN SONOANATOMIK
Minggu ke-4,5 Kantung kehamilan (2
mm) 5 minggu 0-6 hari (CRL
0-3 mm) Yolk sac
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6 minggu 0-6 hari (CRL 4-8 mm) Embryonic pole, yolk
sac
7 minggu 0-6 hari (CRL 9-14 mm)
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o 8 minggu 0-6 hari (CRL 15-22 mm)
o 9 minggu 0-6 hari (CRL 23-31 mm)
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KEHAMILAN MULTIPEL Kehamilan kembar dizigotik /
multizigotikDari dua telur (di) atau lebih (multi).Masing-masing memiliki korion dan amnion, namun plasenta mungkin terpisah atau tumbuh menjadi satu (2 amnion, 2 korion, 2 atau 1 plasenta)
Kehamilan kembar monozigotikTerjadi dari satu telur. Plasenta dan selaput janin tergantung pada usia saat terjadi segmentasi
Diamnionik Dikorionik : tebal selaput ≥ 2 mm
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KELAINAN PADA TRIMESTER 1
1. Kantung kehamilan (rongga korion) Jika ukuran rongga korion > 10 mm (jika
tanpa yolk sac) atau ukuran > 20 mm (tanpa embrio) abnormal
2. Yolk sac Jika yolk sac < 3 mm (minggu ke-6 sampai
10) dan > 7 mm (sebelum minggu ke-9), bentuk iregular abnormal
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3. Haematoma subkorion Massa hipoekoik
berbentuk bulan sabit disamping kantung kehamilan, embrio baik
4. Denyut jantungEmbrio dengan
CRL ≥ 6 mm tanpa aktivitas jantung suspek intrauterine
embryonic/fetal death
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TROPHOBLASTIC DISEASE
1. MolaUterus dipenuhi
dengan kista dan area ekogenik beragam ukuran dan bentuk tanpa embrio
2. Koriokarsinoma Tampak seperti mola.
Tumor primer berukuran kecil, < 8 mm
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NT SCREENING Nuchal translucency : lapisan
cairan tipis pada daerah posterior nuchal
Peningkatan ketebalan NT berhubungan dengan anomali struktur (major cardiac defects, skeletal dysplasias, fetal akinesia, diaphragmatic hernia)
Usia kehamilan 11 minggu ≥ 2mmUsia kehamilan 13 minggu ≥ 2.8mm
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PRINSIP
Semakin Tebal NT, semakin tinggi risiko kecacatan
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NT yang menebal bila berlanjut pada trimester II&III akan bermanifestasi sebagai kistik higroma.
75% kistik higroma dengan sel kromosom.
60-70% janin trisomi 21 tanpa nasal bone. 2% pada kromosom normal
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CARA PENGUKURAN Usia 11 – 13 +6 hari Ukuran CRL : 45 - 84 mm Lebih banyak kondisi abnormal
dapat dideteksi Janin tidak terlalu banyak
pergerakan
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POTONGAN GAMBAR Kepala janin Bagian atas thorak Posisi supine Tidak ada ekstensi berlebihan Tidak ada fleksi berlebihan Batas kulit dan janin dibedakan Pengukuran pada ketebalan
maksimum
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POTONGAN GAMBAR
Kaliper ditempatkan pada garis yang terlihat jelas pada kulit atau jaringan lunak, dan tidak pada bagian dalam cairan.
Berulang kali diambil rata-rata atau hasil yang paling optimal.
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KOMPLIKASI Kantung tanpa embrio / yolk sac
Kehamilan normal (normal IUP) Kehamilan abnormal (abnormal IUP) Pseudogestational sac (kehamilan ektopik)
Kantung dengan embrio Tidak ada denyut jantung
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KRITERIA KANTUNG ABNORMAL Ukuran :
Tidak ada double decidua sac saat MSD ≥10 mm Tidak ada yolk sac saat MSD ≥20 mm Tidak ada embrio saat MSD ≥25 mm
Pertumbuhan MSD normal = 1.13 mm/hr MSD abnormal = 0.70 mm/hr
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ANOMALI JANIN
Holoprosencephaly
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Encephaloceles
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Anencephaly
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Omphalocele Gastroschisis
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TERIMA KASIH