🧠早期腦部結構異常 - 第一孕期🧠
太久沒有學術文章,過年前碰到傷心的案例,藉此整理一下早期超音波。
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胎兒的中樞神經異常發生率約1%。
第二孕期(20-24週)的異常篩檢很重要,不過近期開始流行把異常篩檢時程往前,也就是越來越強調第一孕期超音波的重要性。
以往的第一孕期超音波,大致上就看寶寶頭臀徑(看寶寶大小是否符合生長),是否有明顯頸部透明帶過厚,確定心跳ok,行有餘力還會看看四肢是否有發育,還有沒有明顯腹部或腦部異常。
第一孕期會最仔細看超音波的時候就是在做 #第一孕期唐氏症篩檢(頸部透明帶)時。此時應該要能看得到的結構,包含 #顱骨、 #大腦中線 還有 #脈絡叢及側腦室(此時的側腦室應該要被脈絡叢填滿)。
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如果依據這樣的超音波掃描下來,可以檢驗出大部分嚴重腦部異常:
✔️無腦/顱畸形(acrania)
✔️前腦無裂畸形(holoprosencephaly)
✔️嚴重神經管缺損(neural tube defect)
🔎當然腦膨出(encephalocele)或後顱窩畸形(posterior fossa malformation)有時並不是那麼容易判斷,甚至需要幾次超音波的追蹤。
✏️在掃瞄NT的切面,自從大師Rabih Chaoui在2009年提出intracranial translucency ( #IT,也就是第四腦室)的觀念,之後也有文獻提出量測腦幹厚度(#BS)及腦幹到枕骨的距離(#BSOB)比例,對於判斷神經管缺損及後顱窩畸形(嚴重如Dandy-Walker)有所幫助,比例通常是1:1。
📖文獻可參考:
Assessment of intracranial translucency (IT) in the detection of spina bifida at the 11-13-week scan
First‐trimester fetal neurosonography: technique and diagnostic potential
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🔎另外看到一個表格整理得還不錯跟大家分享一下(照片的第二張,有各種腦部異常的超音波直接和間接徵象可供參考)
1️⃣Open spina bifida
🔎直接徵象: 脊椎側彎或型態異常、背部出現凸出(Myelomeningocele)
🔎間接徵象: BS/BSOB比例、腦幹過寬、腦室大池消失、小頭症、IT消失
2️⃣Dandy-Walker malformation
🔎直接徵象: 後顱窩擴大
🔎間接徵象: IT消失、BSOB變寬
3️⃣Agenesis of corpus callosum
🔎間接徵象: Pericallosal artery消失
4️⃣Holoprosencephaly
🔎間接徵象: 脈絡叢囊腫異常(butterfly sign消失)
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早期的超音波也可以看很多喔!
雖然很多結構異常還是需要等到後期大一點再追蹤,才能判斷較準確的預後與諮詢;不過如果可以在早期就先偵測到這些非常嚴重甚至致死的異常,早點接受終止妊娠,或許可以降低對於心理和身體上的傷害。
#早期超音波
#第一孕期篩檢
#nuchaltranslucency
#intracranialtranslucency
#早期腦部異常篩檢
neural tube 在 9bulan10hari Facebook 的最佳解答
JANGAN SKIP MAKAN ASID FOLIK KETIKA HAMIL, KESANNYA KEPADA ANAK NANTI.
Hari ni mommy dah makan asid folik ke belum?
Jangan ambil sambil lewa je ttg pengambilan asid folik ni ya, walaupun pil tu kecil je tapi kesannya besar kepada anak yang dikandung.
Kenapa asid folik penting untuk ibu hamil?
Menurut Dr Zubaidi Hj Ahmad, vitamin B9 amat diperlukan dalam membina sel-sel baru dalam tubuh. Ia tersangatlah penting dalam membina DNA yang baru dan membaiki DNA yang rosak dalam sel.
Bukan tu je, asid Folik membantu perkembangan otak dan spinal cord. Dalam masa 12 minggu pertama kehamilan, otak dan sistem saraf bayi terbentuk dan berkembang dengan pesat. Suka atau tidak, telanlah dengan niat untuk kebaikan anak.
Ada ibu yang tak berapa suka makan ubat, kalau anda fikirkan kandungan dan sayangkan anak.. makanlah. Suami, tolonglah ingatkan isteri ya kalau dia lupa nak makan.
Bahaya tau kalau tak amalkan masa awal2 mengandung.
Terdapat beberapa kajian menunjukkan asid folik membantu dalam mengurangkan risiko kecacatan saraf bayi seperti sipina bifida dan neural tube defect.
Spina bifida berlaku apabila pelindung yang melitupi saraf tunjang bayi tidak tertutup dengan sempurna. Ini boleh menyebabkan kerosakan saraf kekal.
Komplikasi akibat tak ambil asid folik juga boleh berlaku kepada ibu hamil.
Ibu boleh mengalami anemia akibat kekurang folate, dimana sel darah merah menjadi terlalu banyak (megaloblastic).
Selain masalah kecacatan tiub saraf, pengambilan asid folik juga penting bagi mengurangkan risiko terhadap sumbing (cleft lip / cleft palate) pada bayi yang dilahirkan.
Menurut BabyCenter, keperluan asid folik bagi ibu mengandung adalah kira-kira 400-600 microgram sehari.
Mommy juga boleh menambah kandungan asid folik dengan makanan yang berkhasiat, contohnya kekacang, sayuran berdaun hijau, avokado, bijirin penuh, dan buah-buahan sitrus.
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DON ' T SKIP TO EAT FOLLOW FOLIC ACID WHEN PREGNANT, THE EFFECTION IS TO THE CHILD
Have mommy eaten folic acid today?
Don't just take it while going through the recruitment of this folic acid, although the pill is small but the effect is big on the children who are pregnant.
Why is folic acid important for pregnant women?
According to Dr Zubaidi Hj Ahmad, vitamin B9 is much needed in building new cells in the body. It's very important in building new DNA and repairing damaged DNA in cells.
Not only that, Folik acid helps brain development and spinal cord. Within the first 12 weeks of pregnancy, brain and nervous system formed and developed rapidly. Like it or not, swallow it with intention for the good of the child.
There are mothers who don't like to take medicine, if you think about the content and love your children.. eat. Husband, please remind your wife if she forgets to eat.
It's dangerous if you don't practice it during your early pregnancy.
There are several studies showing folic acid helps in reducing the risk of baby nerve disability such as sipina bifida and neural tube defect.
Spina bifida occurs when the protector covering the nerve of the baby's tunnel is not perfectly covered. This can cause permanent nerve damage.
Complications due to not taking folic acid can also happen to pregnant mothers.
Mothers can have anemia due to lack of folate, where red blood cells become too much (megaloblastic).
In addition to nerve tube disability problems, folic acid intake is also important to reduce the risk of sumbing (cleft lip / cleft palate) in born babies.
According to BabyCenter, the requirement of folic acid for pregnant mothers is about 400-600 micrograms a day.
Mommy can also add folic acid content with nutritious food, e.g. peanuts, green leafed vegetables, avocado, full cereal, and citrus fruits.
Copyrights 9 months10 days please SHARE ❤️❤️Translated
neural tube 在 王姿允醫師。我的無齡秘笈。 Facebook 的最佳解答
又一個4+2R寶寶🥰
從我開始使用「4+2R代謝飲食法」幫忙調整代謝跟腸道菌相後,已經有很多「三寶」不小心跑出來,或是很多原本被告知困難受孕者,在飲食當中意外懷孕,所以我後來習慣在衛教時多一條警語:
「極易中獎,麻煩無計畫著請認真避孕😆」
昨天本來要安排一位維持期受試者做身體組成檢查,但近日她主訴有噁心不適感,以防萬一去檢查一下,發現已懷孕7週左右。由於這位女性的第一個寶寶是透過體外受精 (in vitro fertilization,IVF)做試管來的, 在孕期還有妊娠糖尿病(GDM)的問題,所以完全沒料到二寶會來的那麼容易😁☺️
這位女性在為期兩個月的R2為主的飲食後,BMI從33.8減少到27.9,體重減少13.6%(共11.8kg,其中9kg純脂肪,內臟脂肪VAT下降5kg),胰島素抗性顯著改善。
英國一項包含 287,213 次懷孕資料的分析,發現與正常體重者相較, #過重與肥胖者有較高的機會罹患各種孕期併發症或不良結果,包括妊娠糖尿病、子癇前症 、緊急剖腹產、產後出血感染、子宮內胎兒死亡等等。
而根據統合分析的研究結果,與 #正常體重者相較,過重、肥胖、重度肥胖者 #罹患孕期糖尿病的風險比分別為 2.14、3.56 及 8.56,至於 #胎兒死產的風險,過重者是體重正常者的 1.47 倍,肥胖者則高達 2.07 倍。 #胎兒出現神經管缺陷的機會,在過重者是 1.22 倍,肥胖者為 1.70 倍,重度肥胖者則為 3.11 倍。
而過重及肥胖女性透過減重,可 #增加自然懷孕率且增加人工生殖 (assisted reproductive technology, ART) 之成功率。一項研究指出,BMI > 25的女性,如果減重超過 10%,後來受孕成功及寶寶順利出生的機率,都比減重小於 10% 的人多了34 %🌸
這位受試者很開心,覺得是加入計畫意外的禮物🎁,接下來轉為孕期體重管理,希望藉由健康飲食介入,讓她的孕產程都能更平安順利🙏
Reference:
1. Kort JD, Winget C, Kim SH, Lathi RB. A retrospective cohort study to evaluate the impact of meaningful weight loss on fertility outcomes in an overweight population with infertility. Fertil Steril. 2014;101(5):1400-1403.
2. Rasmussen SA, Chu SY, Kim SY, Schmid CH, Lau J. Maternal obesity and risk of neural tube defects: a metaanalysis. Am J Obstet Gynecol 2008;198:611-9.
3. Best D, Avenell A, Bhattacharya S. How effective are weight-loss interventions for improving fertility in women and men who are overweight or obese? A systematic review and meta-analysis of the evidence. Hum Reprod Update 2017;23:681-705.
4. Sim K, Partridge S, Sainsbury A. Does weight loss in overweight or obese women improve fertility treatment outcomes? A systematic review. Obes Rev
2014;15:839-50.
#減重10趴也可透過降低胰島素抗性改善多囊性卵巢
#減重10趴484現省30萬🤣🤣🤣
neural tube 在 Embryology, Neural Tube - StatPearls - NCBI Bookshelf 的相關結果
The neural tube formation during gestational development is a complicated morphogenic process that requires various cell signaling and ... ... <看更多>
neural tube 在 Neural Tube - an overview | ScienceDirect Topics 的相關結果
Neural tube defects (NTDs) are common birth defects resulting from failure of the neural epithelium (primordium of the brain and spinal cord) to form a tube ... ... <看更多>
neural tube 在 Neural tube - Wikipedia 的相關結果
In the developing chordate (including vertebrates), the neural tube is the embryonic precursor to the central nervous system, which is made up of the brain ... ... <看更多>