Fine ultrasound

Fine ultrasound image of a child in the fourth month of pregnancy

Fine ultrasound is the sonographic examination within the scope of prenatal diagnosis , i.e. an examination of the unborn child using a particularly high-resolution ultrasound device . The terms sonographic detailed diagnosis , organ screening and malformation ultrasound are used synonymously .

This ultrasound examination can only be carried out by specially qualified doctors, to whom the pregnant woman may be referred by her gynecologist if the latter cannot carry out the examination himself.

In Germany, the fine ultrasound examination is only paid for as a regular service by the health insurance companies in some federal states (e.g. Mecklenburg-Western Pomerania ), in most of them a separate prescription is required by the responsible gynecologist, which is carried out based on the presence of risk factors or indications of malformations .

Statements

By means of the fine ultrasound, which can be carried out between the 19th and 22nd week of pregnancy, it is theoretically possible to determine or exclude some developmental disorders and some physical peculiarities in the child. In many cases, so-called sonographic soft markers are recognized with fine ultrasound or can be assessed more closely or largely excluded.

Chromosomal peculiarities (e.g. Down syndrome , Edwards syndrome , Pätau syndrome ) can not be diagnosed. Only the combination of various physical abnormalities (see also: Softmarker ) can indicate certain chromosome peculiarities, so that an amniocentesis can be considered for an almost 100 percent reliable diagnosis.

Examined organ systems

Certain organs or organ structures of the unborn child are examined using ultrasound . Particular attention is paid to the possible lack of organ anlage, malformations of the organs and the timely development of the organs.

In particular:

• the face: special features would be e.g. B. cleft lip and palate , an unusually small or large interpupillary distance or an unusual facial profile, e.g. B. by an underdeveloped (= hypoplastic) nasal bone ,
• the head : special features would be e.g. B. hydrocephaly (= an accumulation of cerebral fluid due to a drainage disorder), microcephaly (= a head that is too small), anencephaly (= a neural tube malformation, characterized by the absence of parts of the bony skull, meninges, scalp and parts of the brain), Holoprosencephaly (= a developmental disorder of the forebrain and face), an encephalocele (= brain fracture), enlarged cerebral chambers ( ventricles ) or plexus cysts in the brain
• the spine : a special feature would be e.g. B. a form of spina bifida aperta (= obstruction of the spinal canal)
• the extremities : special features would be e.g. B. a shortened thigh bone (= femur) or a shortened humerus (= humerus), an underdeveloped (= hypoplastic) or missing (= aplastic) middle phalanx of the fifth finger , a special position of the fingers (e.g. bends or overlays), a form of congenital hand or foot malformations (= dysmelia ) or multiple fingers (= polydactyly )
• the belly: a specialty would be e.g. B. an omphalocele (= umbilical cord break or the umbilical cord on the baby is sack-like inflated and abdominal organs protrude through the navel), a laparoschisis (= abdominal wall gap), a gastroschisis (= malformation of the abdominal wall usually located to the right of the navel with prolapse of intestinal loops) a diaphragmatic hernia
• the gastrointestinal tract: special features would be e.g. B. Obstructions or blockages such as an intestinal obstruction ( duodenal stenosis , double-bubble phenomenon)
• the kidneys and the lower urinary tract : special features would be e.g. B. cysts , a Potter syndrome (depending on the severity, differentiated into the types Potter I, II, III, IV) or malformations in the kidney area (e.g. horseshoe kidney , water sac kidney , urinary stasis kidney , renal pelvic enlargement )
• the heart : special features would be e.g. B. Heart defects or white spots (= golf ball phenomenon )

Assessment of the pictures

How the ultrasound images of the fine ultrasound can be assessed or what and how much can be seen on them also depends on the quality of the examination equipment, the experience of the examining doctor, amount of amniotic fluid (little amniotic fluid = poor sound conduction), the child's position, the week of pregnancy, the strength the mother's abdominal wall, scars, etc.

It can be helpful to consider an examination with 3D ultrasound or 4D ultrasound so that any special features found can be assessed more precisely or the prenatal and postnatal treatment of the child can be optimally planned.

Chromosomal peculiarities cannot be diagnosed using ultrasound. Nevertheless, physical cues and other sonographic soft markers can sometimes be recognized and thus "the ultrasound examination [...] also becomes the rail for prenatal diagnostic invasive measures such as amniotic fluid puncture , chorionic villus sampling and chordocentesis ".

The Center for Technology Assessment in Switzerland examined the psychological effects of prenatal sonography in a study. The study participants assessed the diagnosis as positive, but also reported considerable psychological stress on the parents due to the previously reported abnormalities, although most of the children were later born healthy.

literature

• Michael Entezami, Mathias Albig, Adam Gasiorek-Wiens, Rolf Becker: Sonographic malformation diagnostics - teaching atlas of fetal ultrasound examination. 2002, ISBN 3-1312-9651-8
• Rolf Becker, Walter Fuhrmann, Wolfgang Holzgreve u. a .: Prenatal diagnosis and therapy - human genetic counseling, etiology and pathogenesis of malformations, invasive, non-invasive and sonographic diagnosis as well as therapy in utero. 1995, ISBN 3-8047-1357-2

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !

Individual evidence

1. ↑ Peter Kollertz, Martina English: Ultrasound Feindiagnostik. In: www.mein-gyn.de. mein-gyn group practice Dr. Rolf and Martina Englisch und Kollegen, April 20, 2020, accessed on June 4, 2020 . 
2. ↑ Barbara Maier: Ethics in Gynecology and Obstetrics: Decisions based on clinical case studies. Springer, 2013. ISBN 9783642583438 . P. 128
3. ↑ TA-SWISS (L. Götzmann et al.), 2001: Psychosocial aspects of ultrasound examination in pregnancy. TA / 40, ISBN 3-908194-24-5
4. ↑ Barbara Maier: Ethics in Gynecology and Obstetrics: Decisions based on clinical case studies. Springer, 2013. ISBN 9783642583438 . P. 124