This document provides information on antenatal radiological diagnosis and imaging. It discusses topics such as TIFFA scans performed between 13-27 weeks gestation to examine fetal anatomy. It describes common findings seen on ultrasound like choroid plexus cysts, ventriculomegaly, Arnold-Chiari malformation, Dandy-Walker malformation, and arachnoid cysts of the brain. It also discusses imaging of the face, neck, thorax, abdomen, and urogenital system, outlining key diagnostic features and management of conditions like cleft lip, congenital diaphragmatic hernia, gastroschisis, intestinal atresia, omphalocele, and echogenic dysplastic

1. ANTENATAL RADIOLOGICAL
DIAGNOSIS
DR.PRADEEP.T
Reference : CREASY & RESNIK’S Maternal and Fetal Medicine
ANTENATAL CONSULTS A guide for Neonatologists and Pediatricians
Mentor : DR.G.V. HARISH (PROFESSOR DEPT.OF PEDIATRICS, PIMS)

2. TIFFA (TARGETED IMAGING FOR FETAL
ANOMALIES SCAN)
• Period between 13 weeks 0 days to 27 weeks 6 days.
• Majority between 18-20 weeks.
• Routinely performed on all pregnant womens.
• Emphasize on fetal anatomy so named;
*FETAL ANOMALY SCAN.
*2ND TRIMESTER ANATOMY SCAN.
COMPONENTS:
• Fetal number.
• Viability.
• Presentation.
• Fetal biometry.
• Amniotic fluid.
• Placenta.

3. IMAGING OF CNS :
1.CHOROID PLEXUS CYSTS
DEFINITION
Choroid plexus cysts (CPCs) are well-demarcated, anechoic, fluid-filled structures within the choroid pl
of the lateral ventricles of the brain. They are not true cysts in the pathologic
sense. CPCs are often called “soft sonographic signs” or “markers” of aneuploidy
KEY DIAGNOSTIC FEATURES
• Unilateral or bilateral sonolucent cystic structures within the glomus of the choroid plexus
of the lateral ventricles
• Borders are well delineated.
• Size, shape, and number are variable.
• Usually small, measuring <10 mm in diameter (range,3-20 mm);
should be at least >2 mm to meet criteria.
• They regress, spontaneously disappearing during the third trimester.

4. DIFFERENTIAL DIAGNOSIS
• Ventriculomegaly
• Choroid plexus papilloma
• Intraventricular haemorrhage
• Periventricular leukomalacia.
PROGNOSIS
• The prognosis of isolated CPC is good; almost all resolve by 32 weeks.
• Isolated CPCs in fetuses with normal karyotypes do not affect
child development after birth

5. 2. VENTRICULOMEGALY : AQUEDUCTAL
STENOSIS
DEFINITION
ventriculomegaly” is when the ventricles are mildly enlarged, and “hydrocephaly” is used
when they measure >15 mm. Aqueductal stenosis (AS) results from the narrowing of the
aqueduct of Sylvius, which connects the third and fourth ventricles. VM is a common cause of
noncommunicating obstructive hydrocephaly.
KEY DIAGNOSTIC FEATURES
• Severe bilateral VM with lateral ventricles measuring >15 mm with dangling choroid plexus
and dilation of the third ventricle
• VM is usually progressive.
• Macrocephaly
• The corpus callosum may be thin or undetectable due to compression from the dilated
ventricles.
• Agenesis of the corpus callosum
• The posterior fossa structures (cerebellum, vermis, and cistern magna) are normal.
• Periventricular calcification if AS is caused by intracranial infection
• Abducted thumbs
• Male fetuses

6. NEONATAL MANAGEMENT
• Repeat head ultrasound and/or MRI to reassess in utero findings
• Serial head measurements to assess progression of the hydrocephaly
• Surgical management in cases of progressive ventriculomegaly
PROGNOSIS
• Prognosis for AS is difficult to predict. Prognosis depends on the specific cause of
the hydrocephaly and the presence of associated anomalies.
• Poorest prognosis is found among cases of X-linked AS because of the associated
anomalies

7. 3. ARNOLD-CHIARI MALFORMATION
DEFINITION
Arnold-Chiari malformation (Chiari II) is a complex congenital anomaly resulting from the
presence of open spinal defect (myelomeningocele) in which there is herniation of the
cerebellar vermis and brainstem through the foramen magnum.
KEY DIAGNOSTIC FEATURES
• Elevated maternal serum α-fetoprotein (AFP)
• Spinal findings: “U-shaped” spine, bulging mass or irregularities of the posterior contour of
the spine in the sagittal section
• Classic cranial findings: “lemon” and “banana” signs seen in >95% of cases between 16 and
24 weeks
• Ventriculomegaly or hydrocephaly
• First trimester: lack of visualization of the intracranial translucency (IT) on ultrasound

9. 4. DANDY-WALKER MALFORMATION
DEFINITION
The term Dandy-Walker malformation (DWM) refers to a spectrum of malformations that
include enlargement of the posterior fossa with an elevated cerebellar tentorium, dilation
of the fourth ventricle, and malformed cerebellar vermis
KEY DIAGNOSTIC FEATURES
• Large cistern magna that communicates with the fourth ventricle
• Absent or hypoplastic vermis
• Cerebellar hemispheres with varying degrees of dysplasia
• Ventriculomegaly

10. PROGNOSIS
• Motor deficits such as delayed motor development, hypotonia, and ataxia, MR
• Intrauterine fetal demise
• 80% develop hydrocephaly by 3 month

11. 6.ARACHNOID CYSTS
DEFINITION
Arachnoid cysts are collections of cerebrospinal fluid (CSF) on the brain surface; they can be
congenital (primary) or secondary (acquired). The CSF is located within the layers of the
arachnoid membrane, which may or may not communicate
with the subarachnoid space. These cysts are usually benign, congenital, space-occupying
lesions.

12. ANTENATAL MANAGEMENT
• Anatomic survey, fetal echocardiography, genetic counseling and karyotype
• Serial scans to monitor cyst and fetal head size; large cysts can cause mass effect and
result in hydrocephaly and macrocephaly.
• Cysts may resolve in utero.
• Consider MRI to look for other brain anomalies such as heterotopias.
• Asymptomatic cysts may be serially followed without surgical treatment.
• Symptomatic cysts (weakness, lethargy, seizures, developmental delay) and those causing
macrocephaly, hydrocephaly, or increased intracranial pressure can be surgically treated by
cystoperitoneal shunt or cyst fenestration

13. IMAGING OF FACE AND NECK
:
1.CLEFT LIP AND CLEFT
PALATE
DEFINITION
• Common malformation that typically
runs between the nostrils and may involve the
central part of the posterior palate.
• Linear defect extending from upper lip
to the nostril
 Four types
• Type 1: Unilateral cleft lip (CL), no cleft
palate (CP)
• Type 2: Unilateral CL, with CP
• Type 3: Bilateral CL/CP
• Type 4: Midline CL/CP

14. KEY DIAGNOSTIC FEATURES
• Typically not detectable until about 18 weeks.
 Unilateral CL with or without CP:
• Most cases of CL are left-sided and unilateral.
• Obliquely aligned gap in the lip extends to the nose.
• A gap between the maxilla and palate may be present.
 Bilateral CL with or without CP:
• Central mass protrudes below the nose.
• Profile view may show an infranasal, premaxillary mass.
• Standard view of the lips may be difficult to obtain.
Midline CL and CP:
• Absent central maxilla and upper lip
• Deformed nose, possibly even absent and replaced by a proboscis. The nose may also be small or have a single
nostril.

15. NEONATAL MANAGEMENT
Timing of repair depends on the nature of anatomic malformation.
• CL usually repaired at 2-3 months
• CP usually repaired at 9-18 months
• If defects are wide, repair is often delayed, requiring increased use of
presurgical nasal alveolar molding.
Multidisciplinary approach:
• Plastic, maxillofacial surgery
• ENT, speech therapy, audiology
• Orthodontics, dentistry
• Feeding evaluation, nutrition consultation
• Psychological support

16. IMAGING OF THORAX :
1.CONGENITAL DIAPHRAGMATIC HERNIA
KEY DIAGNOSTIC FEATURES
• Major finding is a thoracic mass accompanied by mediastinal shift.
• In left-sided CDH, the stomach appears as a cystic mass and is not seen
in its normal position; liver is herniated in 50%.
• In almost all right-sided CDHs, the liver herniates; liver and lung have
similar echogenicities, so a discrete mass is not always seen; diagnosis is
suspected because of a mediastinal shift to the left. Doppler can show hepatic
vascularity; gallbladder may be seen; MRI may be useful.
• Abdominal circumference may be small, and the abdomen may appear
scaphoid.

18. 2. CCAM (CONGENITAL CYSTIC
ADENOMATOID MALFORMATION)
KEY DIAGNOSTIC FEATURES
• CCAM classified as
microcystic (<5 mm).
macrocystic (>5 mm).

19. IMAGING OF ABDOMEN :
1.GASTROSCHISIS
DEFINITION
Gastroschisis is a full-thickness paraumbilical defect through
which bowel herniates. In distinction to an omphalocele, the
bowels are not enveloped by a membrane.
KEY DIAGNOSTIC FEATURES
• Multiple loops of bowel are seen floating freely in the amniotic fluid, with a typical cauliflower
appearance.
• Abdominal wall defect is typically located to the right of the abdominal cord insertion.
• Intra and extraabdominal dilated loops of bowel may be seen late in pregnancy.
• Maternal serum α-fetoprotein is elevated

20. ANTENATAL MANAGEMENT
• Serial ultrasound examinations to monitor fetal growth, amniotic fluid, and
worsening bowel distention
• Data about whether bowel dilation is a poor prognostic sign or an
indication for immediate delivery are inconsistent.
• Doppler assessment of umbilical and cerebral artery flow
• Fetal echocardiogram to confirm normal anatomy
• Fetal nonstress or biophysical profile testing (or both), twice weekly,
beginning at 32-34 weeks

21. 2. INTESTINAL ARESIA
DEFINITION
Intestinal atresia is complete obstruction of the bowel lumen
produce a distended proximal gastrointestinal tract.

22. KEY DIAGNOSTIC FEATURES
• Bowel loops greater than 7 mm suggest obstruction.
• Duodenal atresia produces the classic echolucent “doublebubble,” which
represents the dilated stomach and proximal duodenum.
• Polyhydramnios is typical in cases of duodenal atresia and is particularly marked in
the third trimester.
• Jejunoileal atresia produces multiple dilated loops of bowel with increased proximal
peristalsis.

23. 3. OMPHALOCELE
DEFINITION
Omphalocele is a midline ventral wall defect, with bowel or liver (or both) herniating
through the base of the umbilicus and covered by a membrane consisting of
peritoneum and amnion.
KEY DIAGNOSTIC FEATURES
• Midline mass is seen at the base of the umbilical cord, with the liver and bowel
herniating from the abdominal cavity, surrounded by a smooth, limiting membrane
• The umbilical cord passes through the mass and inserts on the membranes. This key
feature distinguishes omphalocele from gastroschisis in cases of ruptured omphalocele sac.
• Ascites may be seen in the omphalocele sac.
• The absence of liver in the omphalocele sac is strongly associated with aneuploidy.
• Maternal serum α-fetoprotein is not uniformly elevated with omphalocele

24. • C-section is recommended for large (<5cm) omphalocele.
ANTENATAL MANAGEMENT
• Amniocentesis is recommended because of the high risk of aneuploidy.
• Fetal echocardiogram to confirm normal anatomy
• Serial ultrasound examinations to monitor fetal growth, amniotic fluid, and worsening fetal
condition
• Fetal nonstress or biophysical profile testing (or both), twice weekly, at 32-34 weeks

25. 4. OESOPHAGEAL ATRESIA AND
TRACHEO-ESOPHAGEAL FISTULA
• Oesophageal atresia is a congenital, anatomical interruption of the
oesophagus resulting in a lack of direct communication from the pharynx
to the stomach.
• It is the most common congenital anomaly affecting the oesophagus.
• More than 90% have an associated tracheo-oesophageal fistula.
• In the most common form, the upper oesophagus ends as a blind pouch and a fistula
connects the trachea to the distal oesophagus,
Other associated findings include:
◗ renal anomalies, including the Potter deformation sequence
(oligohydramnios, renal anomalies, pulmonary hypoplasia)
◗ aneuploidy (trisomies 18, 21, 13);
◗ Feingold syndrome (microcephaly, limb anomalies, oesophageal atresia,
duodenal atresia, developmental delay);
◗ other atresias of the gastrointestinal tract

27. MANAGEMENT—ANTENATAL
• The antenatal diagnosis is based on the combined ultrasound findings of
polyhydramnios and a small or absent stomach pouch/bubble.
• A H-type, or type E, fistula is very difficult to diagnose antenatally.
• The antenatal management is basically that of polyhydramnios and any associated
anomalies. There is no specific treatment of the oesophageal atresia antenatally.
• Amniocentesis should be considered for karyotype.
• Fetal echocardiogram is recommended to assess cardiac structure and function.
• Serial ultrasound examinations to monitor fetal growth, amniotic fluid, and worsening
fetal condition (e.g., hydrops fetalis)
• Amnioreduction may be indicated to reduce the risk of preterm delivery or relieve
maternal respiratory compromise.
• Fetal nonstress or biophysical profile testing (or both), twice weekly, beginning at 32-34
weeks

28. UROGENITAL IMAGING :
1.ECHOGENIC DYSPLASTIC KIDNEY
DEFINITION
Echogenic dysplastic kidneys appear abnormally bright on ultrasound, indicative of
abnormal renal parenchyma and suggesting abnormal function.
KEY DIAGNOSTIC FEATURES
ADPKD ARPKD OBSTRUCTIVE CYSTIC
DYSPLASIA
• Enlarged echogenic
• Normal bladder
• Normal amniotic fluid
• One or both parents with
renal cysts
• Massive echogenic kidneys
• Small or absent bladder.
• Oligohydramnios
• Small echogenic kidneys
• Oligohydramnios.
• Early USG may show
bladder, ureter,kidney

29. ANTENATAL MANAGEMENT
• Amniocentesis should be considered, if associated with genetic markers.
• TORCH - titers if other findings indicate possible intrauterine infection
• Fetal echocardiogram to rule out associated congenital heart defects.
• Consider termination if ARPKD or anhydramnios is suspected.
• Serial ultrasound examinations to monitor fetal growth, amniotic fluid, and fetal condition
• Fetal nonstress or biophysical profile testing (or both), twice weekly, beginning at 32-34 weeks

30. 2.URETEROCELE
DEFINITION
Ureterocele is a cystic dilation of the ureter within the fetal bladder with
obstruction of the ureter at the ureterovesical junction, causing a dilated ureter
and hydronephrosis.
KEY DIAGNOSTIC FEATURES
• Dilated ureter and kidney with obstructed ureterocele
• Approximately 80% of ureteroceles are associated with a duplicated renal
collecting system .
• 10% of ureteroceles are bilateral, producing a complex multiseptated-
appearing bladder.
classification of ureteroceles:
• Intravesical (25%): ureterocele inserts entirely in the bladder
• Ectopic (75%): ureterocele located distal to the trigone,
inserting into the bladder neck,
urethra (cecoureterocele), or
elsewhere in the pelvis

31. ANTENATAL MANAGEMENT
• Consider in utero therapy to preserve renal function if there is bladder outlet
obstruction with severe oligohydramnios.
• Vesico amniotic shunting
• Fetal cystoscopy with laser ureterocele incision
• Serial ultrasound examinations to monitor fetal growth, amniotic fluid.
• Amniotic fluid assessment at least weekly, beginning at 32-34 weeks

32. 3.RENAL AGENISIS
DEFINITION
Renal agenesis is a developmental anomaly consisting of congenital absence of one
or both kidneys; the lack of both kidneys is incompatible with extrauterine life.
UNILATERAL RENAL AGENESIS:
• Unilateral empty renal fossa
• Compensatory contralateral renal hypertrophy
• Amniotic fluid typically normal but oligohydramnios if
contralateral multicystic dysplastic kidney.
• Color Doppler imaging confirms unilateral renal artery
present
• Absent bladder
• Bilateral empty renal fossae
• Fetal discoid adrenal glands can be
confused for fetal kidneys.
• Color Doppler imaging confirms
bilaterally absent renal arteries
KEY DIAGNOSTIC FEATURES
BILATERAL RENAL AGENESIS:
• Severe oligohydramnios or
anhydramnios after 16 weeks’GA

33. ANTENATAL MONITORING
• Consider termination with confirmed diagnosis of bilateral renal agenesis.
• With unilateral renal agenesis, serial ultrasound examinations are necessary to
fetal growth, contralateral kidney, and amniotic fluid.
• Consider at least weekly amniotic fluid assessment after 32-34 weeks

34. NEURAL TUBE DEFECTS:
DEFINITION
Open neural tube defect is an embryologic defect of the formation of the
posterior vertebral arches of the spine, exposing the neural elements.
KEY DIAGNOSTIC FEATURES
• Open neural tube defects (ONTD) appears on sagittal-view ultrasound
as an overlying cystic mass.
ONTD is classified by the appearance of tissues overlying the bony defect:
• Myelomeningocele—sac containing spinal cord or other neural elements
• Meningocele—sac containing only protruding meninges and CSF.
• Myeloschisis—wide splaying of the vertebral arch with no visible covering (neural
tube completely exposed).
• Lesion level is defined as the highest vertebral level at which dysraphism is
visualized.
• 3D and MRI imaging may be helpful in determining lesion level.

35. ANTENATAL MANAGEMENT
• Amniocentesis should be considered for karyotyping;
• Fetal echocardiogram is recommended to assess cardiac structure and function.
• Serial ultrasound examinations to monitor fetal growth, amniotic fluid.
• Fetal nonstress or biophysical profile testing (or both), twice weekly,at 32-34 weeks
• Fetoscopic in utero treatment reduces need for cerebral ventricular shunt placement and improves
motor function, but it increases preterm delivery.

36. SINGLE UMBILICAL ARTERY
DEFINITION
The normal human umbilical cord contains two arteries but
only a single vein due to early atrophy of the left umbilical vein.
In single umbilical artery (SUA), also called a two-vessel cord,
there is only one artery and one vein.
KEY DIAGNOSTIC FEATURES
• Two umbilical arteries are most accurately visualized with color Doppler imaging
of the fetal bladder. Umbilical arteries are seen on both sides of the fetal urinary
bladder.
• Coexistent structural anomalies may be found in up to 30% of fetuses with SUA
and can include cardiac, gastrointestinal, and renal defects.

37. ANTENATAL MONITORING
• Detailed search for coexisting structural anomalies
• Consider amniocentesis for karyotype particularly if other anomalies are present
• Serial growth assessment in the third trimester
• Antenatal biophysical testing if anomalies are present.

38. FIRST TRIMESTER SCANNING :
NUCHAL TRANSLUCENCY
DEFINITION
Nuchal translucency (NT) is the sonographic measurement of the subcutaneous fluid
collection between the soft tissue of the cervical spine and the skin in a fetus. The
measurement is generally taken between 11 and 13 gestational weeks and is used, to
assess the risk of aneuploidy
IMAGING
• Gestational age requirement for performing NT varies slightly between laboratories, but
generally it is a crown-rump length of 45-84 mm, corresponding to
11-13 gestational weeks.

39. NASAL BONE
DEFINITION
The absence of the fetal nasal bone between 11 and 13 weeks can be used as a
marker for aneuploidy
ANTENATAL SIGNIFICANCE
• Increased nuchal translucency
• Combining NT and serum biochemistry values results in a detection rate of 90% for
Down syndrome (DS)
• The characteristics of the NB vary with gestational age.
• Absent NB alone for detecting trisomy 21 is 65%.

40. INVASIVE PROCEDURES:
CHRONIC VILLOUS
SAMPLING (CVS)
AMNIOCENTESIS CORDOCENTESIS (PUBS)
Percutaneous umbilical cord
blood sampling.
1. TIME Transcervical (10-13 weeks)
Transabdominal (>12 weeks-
term)
16-18 weeks
(early 12-14 weeks)
18-20 weeks
2. MATERIAL FOR STUDY Trophoblast cells 15-30 ml of amniotic fluid Fetal WBCs
3. RESULT Culture 10-14 days Culture 3-4 weeks 24-48 hrs
4. RISKS 3-5 % fetal loss, infection,
bleeding,
Limb reduction defects.
0.5% fetal loss, clubfoot,
maternal infection, PT
labour.
1-2% fetal loss, infection,
PROM
5.ACCURACY Accurate Highly accurate Highly accurate
6. INDICATIONS Chromosomal abnormalities,
Parents known carriers of
genetic disorder.
Detects chromosomal
defects(downs), cystic
fibrosis, muscular dystrophy,
SCA.
Detects fetal malformations,
infections (TORCH), fetal
anemia
7. TERMINATION OF
PREGNANCY
Safe as in 1st trimester 2nd trimester - risky 2nd trimester- risky

41. FETAL MRI
THOUGH SONOGRAPHY IS THE MAIN IMAGING TOOL IN ANTENATAL IMAGING MRI HAS:
• Superior tissue contrast.
• A large field of view.
• Relative operator independence.
TECHNIQUE :
• Mother should be fasting for 4hours before imaging.
• Supine position, but left lateral decubitus position maybe helpful.
• A body array coil is wrapped around maternal abdomen to improve spatial resolution.

42. SAFETY OF MRI IN THE OBSTETRICAL
PATIENT
MATERNAL RISKS 1ST TRIMESTER 2ND AND 3RD
TRIMESTER
• Same as for non-
pregnant women
• Prolonged supine
positioning of gravid
uterus can lead to
hypotension due to
compression of IVC.
• This can be avoided
by lateral decubitus
position.
• Usually done for
maternal indications
not for prenatal
diagnosis.
• High acoustic noise
may be concern for
mother and fetus.
• Typically performed
by 1.5 Tesla.
• Artefacts may be
more pronounced
due to large amount
of amniotic fluid, and
increased abdominal
girth.

43. INTRA UTERINE FETAL SURGERY
INDICATIONS :
• In conditions which interfere with the normal development of the fetus.
• Which when corrected will allow normal development of the fetus.
CONTRAINDICATIONS :
• Severe affliction or pain.
• Life threatening abnormalities.
• Chromosomal and genetic conditions

44. TYPES OF SURGERY
1. Open surgery
2. Fetal endoscopic surgery
3. Fetal image guided surgery (FIGS)
* Ultrasound image guided procedure.
* Needle / trocar-cannula shunt introduced
4. Ex-utero intrapartum treatment procedure (EXIT).

45. OPEN SURGERY
• Uterus is opened similar to LSCS.
• special stapling device to prevent bleeding and amniotic fluid leak.
• Intra operative sonography to locate placenta and to determine
the surface anatomy of the fetus.
• Fetal part is exteriorized.
• Fetal surgery.
INDICATIONS :
• Congenital cystic adenomatoid malformation of lung (Lobectomy).
• Sacro-coccygeal teratoma resection.
• Meningo myelocele repair.

46. FETAL ENDOSCOPIC SURGERY
(FETENDO)
• Fetoscopic access to the fetus.
• Real time visualization of the fetus.
• It is a combination of endoscopy and sonography.
• Less invasive.
• Less risk of amniotic leak.
• Less risk of preterm labour.
INDICATIONS :
• Congenital diaphragmatic hernia ( balloon occlusion of trachea).
• Twin to twin transfusion syndrome (laser coagulation of vessels).
• Neural tube defects.
• Amniotic band division.

47. FIGS (FETAL IMAGE GUIDED SURGERY)
• Least invasive
• Least risk of amniotic leak
• Least risk of preterm labour
DIAGNOSTIC :
• Chorion villous sampling.
• Amniocentesis.
• Cordocentesis.
• Fetal skin biopsy.
THERAPEUTIC :
• RFA (Radio frequency ablation) of anomalous twins.
• Cord cauterization of twins.
• Vesical/ pleural shunts.
• Balloon dilation of aortic stenosis.

48. EXIT (EX-UTERO INTRAPARTUM
TREATMENT PROCEDURE
• It is the intervention that occurs at the time of delivery.
• Primarily used in cases where baby airway require surgical intervention.
• It starts as a routine LSCS but under GA.
• Head of the baby is delivered, but the placenta is insitu.
• The baby gets oxygen from placenta
• Bronchoscopy of fetal airway
• Endotracheal intubation attempted
• Cord is cut and baby delivered.
INDICATIONS :
• Congenital high airway obstruction syndrome.
• Pulmonary sequestration.
• Congenital cystic adenomatoid malformation.

49. RISKS ASSOCIATED WITH INTRAUTERINE
SURGERIES.
MATERNAL RISKS FETAL RISKS
• Tocolytic therapy cause pulmonary
edema
• Subsequent delivery by LSCS.
• Amniotic fluid leak.
• Intra uterine infection.
• Maternal mirror syndrome in “fetal
Hydrops”
• Chorioamniotic membrane separation.
• Prematurity
• Intra uterine infection
• Intestinal atresia
• Renal agenesis.
• Premature closure of ductus arteriosus.
• CNS injury due to maternal hypoxia or
fetal circulatory disturbance.

50. INDICATIONS :
THORACIC INDICATIONS : ( hypertense T2
)
1. CCAM (congenital cystic adenomatoid
malformations )
* characterized by abnormal branching of
immature bronchioles and lack of alveolar
development resulting in a mass.
*CCAMS communicate with tracheobronchial tree.
2. Bronchopulmonary sequestrations :
*Non functioning pulmonary tissue ( left more
common than right)
3. Bronchial atresia.
4. Congenital diaphragmatic hernia.
5. Foregut duplication cysts.

51. COVID-19 RECENT UPDATES:
STATISTICS (28/07/2020)
Overall cases in India Last week (21/07-28/07)
1. Confirmed cases 14,49,731 2,62,706
2. Active cases 4,96,988 87,877
3. Total deaths 33,425 4,744
Overall cases in
Telangana
Last week (21/07-28/07)
1. Confirmed cases 57,142 9,437
2. Active cases 13,753 2,862
3. Total deaths 480 51

52. GI INDICATIONS :
1. Esophageal atresia
2. Duodenal atresia.
3. Small bowel atresia.
• Development of GI system occurs in 1st trimester, while functioning begins in 2nd trimester.
• Meconium is produced after 13 weeks of gestation.
• Meconium has T1 bright signal. >20 weeks of GA meconium in colon & rectum show high T1.
• Other bowl parts show low T1.

53. GU SYSTEM INDICATION:
1. Polycystic kidney disease.
2. Multicystic dysplastic kidney.
3. Ureteropelvic junction obstruction.
4. Posterior urethral valves (male fetus).
ANTERIOR ABDOMINAL WALL
DEFECTS
1. Gastroschisis
2. omphaloceles.
CNS indications :
1. Ventriculomegaly
2. Agenesis of corpus callosum
3. Posterior fossa abnormalities.
4. Malformations of cerebral cortex.
5. Myelomeningocele.

54. CORONAVIRUS (COVID-19) DRUGS LATEST
UPDATES
ITOLIZUMAB NOT PART OF INDIA’S TREATMENT
PROTOCOL; MAVRILIMUMAB SHOWS PROMISEItolizumab not part of treatment protocol, says Centre
 Weeks after the Drug Controller General of India approved Itolizumab for
emergency use in Covid-19 treatment, the Union Health Ministry has said the
drug has not been included in the national treatment protocol.
 According to a statement issued by the Health Ministry, the National Task Force
on Covid-19 contended there was “very little evidence in favour of this
medicine”.
 In trials, the drug has been shown to be effective in preventing cardio-renal
complications in Covid-19 patients

55.  Remdesivir has proven successful at shortening the recovery time for
patients and Favipiravir has shown clinical improvement of up to 88% in mild
to moderate cases.
 single intravenous dose (6 mg/kg)
Mavrilimumab shown to improve clinical outcomes
 Even though various studies are still underway, early results have
shown some patients treated with mavrilimumab did not need
mechanical ventilation.
 According to a study published in The Lancet Rheumatology.
Mavrilimumab, a granulocyte-macrophage colony-stimulating
factor (GM-CSF) receptor inhibitor, has also shown to improve
clinical outcomes in patients with Covid-19 pneumonia and
systemic hyperinflammation.
 World Health Organisation are running trials on several drugs. So far, only
Dexamethasone has shown life-saving results against Covid-19.

56. COVID-19 VACCINE : INDIA AT THE CENTRE OF
VACCINE AND MODERNA’S PHASE III TRIALS
MODERNA
(mRNA-1273)
ASTRAZENECA
(ChAdOx1 nCOV-19)
VACCINE CANDIDATES US-based Biotech company Oxford university and British drug
company AstraZeneca
HOW DO VACCINES WORK Using mRNA technology, involves
injecting genetic instructions to human
cells for creating proteins to fight virus.
Made of genetically – engineered
virus which generates immune
response against virus.
SAFETY 1. No serious toxicity reported
2. Systemic adverse effects were mild to
moderate
3. Participants had fatigue, headache ,
myalgia
1. No serious adverse effects
2. Fatigue and headache were
commonly reported
3. Reaction on day1 of vaccination
was reduced with paracetamol.
IMMUNE RESPONSE 100mcg/dose ellicts high neutralization
and T-cell response
Cell-mediated T-cell response
peaked at day14.

57. THANK YOU