DMS333WI2021: Fetal Skeleton

Week 9: Forum/Discussion Board

This is the normal fetal spine. It is normal because all ossification centers are present and in the correct anatomical location, there is asymmetry between all vertebra, the spine shows slight convex and concave shape, the sacrum is pointed posteriorly and present.

Figure 9 from Preliminary experience with Advanced Volume Contrast Imaging ( VCI ) and Omniview in obstetric and gynecologic ultrasound | Semantic Scholar

Here is an abnormal spine that is demonstration a hemivertebrae. This is a condition where half of the vertebra in the spine does not form. The cause of a hemivertebrae is unknown however some suggest its probable cause is lack of blood supply to the vertebrae. Sonographic assessment will demonstrate a "kink" in the spine which makes the contour look off. You may also notice a wedge shaped vertebra only on a single side. Hemivertebrae can express itself as kyphosis, scoliosis and lordosis

The Clinical Value of Prenatal 3D Ultrasonic Diagnosis on Fetus Hemivertebra Deformity- A Preliminary Study. - Abstract - Europe PMC

What is the difference between scoliosis and kyphosis? How do you treat it? - Quora

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Hi Allison,

These pictures are incredible and I appreciate that you included a representative image in all three scan planes, its really helpful to see it this why while were still getting this concept down! The spine is one of my favorite images to see when I observe OB, something about the shape and symmetry is so appealing to the eye. Apparently a hemivertebrae can be corrected surgically in infancy by removing it and then fusing the superior and inferior vertebrae together! Do you think this condition could be caused by a malformation in the mesoderm or maybe from an outside factor like maternal teratogens? I remember in your presentation you mentioned the importance of Folate during pregnancy, especially for the development of the spine, do you think a lack of folate could be the responsible?

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Hey Chrishawna,

After researching it more. I it seems to be unknown why hemivertebraes occur. One source said it could be due to a lack of blood supply to the vertebra so it never fully proliferates because it isn't being fed enough to grow. Another said it could be congenital, which corresponds to what Dr. Wilson has said about family history playing a large role in skeletal dysplasias. Also I believe any teratogens can cause any malformation with a fetus.

As for folate. Folate is really important for the cell proliferation process ( dividing, folding & fusing) of the neural tube. The neural tube is formed by the ectoderm whereas the vertebrae is formed by the mesoderm. So for folate I think it is beneficial for the neural tube not necessarily the spine formation.

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Awesome job Allison!! Thank you for the clarification on the folate, I knew it was important, but couldn't remember for what exactly! :)

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Folic acid may prevent neural tube defectsPamela Egan Youth for Health: #folicacidPH 2019 to highlight the role of Folic acid in healthy and planned pregnancies

Great post Allison! Crishawna I was also a bit fuzzy on the folate association. I liked these images, I think spina bifida is the one Michelle mentioned in class? It's incredible these can be prevented with taking enough folate, I found this page from the CDC very informative regarding it's importance in pregnant women, and I liked that it points out neural tube defects occur in the first few weeks of pregnancy, so it's important to take folate before!

https://www.cdc.gov/ncbddd/folicacid/features/folic-acid-helps-prevent-some-birth-defects.html#:~:text=CDC%20urges%20all%20women%20of,are%20anencephaly%20and%20spina%20bifida.

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Zuly,

These are great! Yes my mind was blown when I found out the neural tube forms in 2-4 days in the 5th week of pregnancy. Some women may not even know they are pregnant yet!!! Folate can decrease NTD by 70%. So Folate, Folate, Folate!! Also another random fact is that folate is better to have than the synthetic version aka folic acid. Apparently some women with certain gene mutation (MTHFR) can't actually absorb folic acid so they must take folate!

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Zuly & Allison,

You two are killing it!! I had always heard you should start taking prenatal prior to trying to conceive and this makes perfect sense. I was also wondering if folate and folic acid were the same, great research ladies!! :)

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Scoliosis

Also I really liked this picture and forgot to attach it!

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This is great! I love these kind of graphics.

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Hi Allison,

I liked your pictures and can see the differentiation from the normal vertebra compared to a hemivertebrae. However, I remember Dr. WIlson showing the image in lecture that was super discrete and difficult to point out which makes me scared. I also did not know that kyphosis and scoliosis is apart of hemivertebrae.

Prenatal diagnosis and assessment of congenital spinal anomalies: Review for prenatal counseling

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Hey Candee,

Yes it can totally be discrete! So many little bones that need to be perfectly shaped and in the proper location! This is why it is so important to scan the spine in all 3 scanning planes. In this image below you can see the coronal scan plane (lateral hemivertebra) can show different pathologies than the sagittal (Dorsal hemivertebra).

Dedicated to the mission of bringing free or low-cost educational materials and information to the global ultrasound community.

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Hey Allison,

This response was great. I really appreciated how the normal images broke down the 3 ossification centers. I am still struggling with the fetal spine. I think I can tell if something is abnormal, like if it shaped weird. I am still confused on if we should just be looking if the spine appears abnormal in sagittal view or is there something we should be counting as well. Also how obtaining the views of the vertebral body vs posterior processes are different.

Nice work!

This site has some spine anatomy. It as discusses lordosis, kyphosis, and scoliosis.

https://courses.lumenlearning.com/nemcc-ap/chapter/the-vertebral-column/

Also here is a nice fetal spine depicting intact skin really well.

normal 2nd trimester ultrasound how to

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