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   👉🏼 Speakers: Dr Alok Varshney, Dr. Shilpa Satarkar, Dr Jiten Kumar
👉🏼 24 hours of Extensive learning from Eminent Speakers
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1Fetal Biometry & Mid-Trimester Anomaly Scan (ISUOG Guidelines)

20 + 2 Planes Approach — The Right Way to Do TIFFA

📘 What This Lecture Covers

This lecture provides a complete, practical, ISUOG-compliant approach to performing and reporting a mid-trimester anomaly scan (TIFFA) with emphasis on fetal biometry, anatomy, and neurosonography, focusing on what to see, how to see it, and how not to miss anomalies.

🔹 Core Concepts & Guidelines

• Objectives of mid-trimester anomaly scan (TIFFA)
• Global guidelines overview:
  • ISUOG
  • AIUM
  • ICRI / SFM (India)
• Importance of institutional protocols & checklist-based scanning
• Medicolegal importance of documentation & image storage
• ALARA principle and equipment requirements

🔹 ISUOG 20 + 2 Planes Concept

• Philosophy of 2 sweeps + 20 planes
• Systematic yet opportunistic scanning approach
• How a single plane evaluates multiple organs
• How one organ must be evaluated in multiple planes
• Role of survey sweep vs review sweep
• Detection of ~65 fetal anomalies using this approach

🔹 Fetal Biometry (Correct Technique & Pitfalls)

• Biparietal diameter (BPD) & head circumference (HC)
  • Correct transthalamic plane
  • Leading-edge vs outer-to-outer techniques
• Abdominal circumference (AC)
  • Portal sinus & stomach as key landmarks
• Femur length (FL)
  • Correct insonation angle
  • Avoiding foreshortening errors
• Estimated fetal weight (EFW)
  • ISUOG-recommended Hadlock formula
• Common biometry errors & their clinical impact

🔹 Detailed Plane-Wise Anatomical Evaluation

Spine (Sagittal, Coronal & Whole-Body Coronal)

• Open & closed neural tube defects
• Sacral agenesis
• Spinal curvature anomalies
• Sacrococcygeal teratoma

Fetal Brain & CNS

• Transventricular, transthalamic & transcerebellar planes
• Ventricular measurement technique
• CSP importance
• Posterior fossa evaluation
• Lemon & banana signs
• Embryology-based understanding of CNS malformations

🔹 Embryology Applied to Ultrasound

• Neural tube formation & closure
• Dorsal vs ventral induction defects
• Primary & secondary neurulation
• Cerebral vesicle development
• Neuronal proliferation, migration & organization
• Embryological basis of:
  • ACC
  • Holoprosencephaly
  • Cortical malformations
  • Posterior fossa anomalies

🔹 Fetal Neurosonography

• Screening vs detailed neurosonography
• ISUOG Part 1 & Part 2 CNS guidelines
• Indications for fetal neurosonography
• Transabdominal vs transvaginal neurosonography
• Multiplanar evaluation:
  • Axial
  • Coronal
  • Sagittal & parasagittal
• Role of cine loops & 3D volume acquisition
• Gestational age–dependent appearance of:
  • Corpus callosum
  • Vermis
  • Cortical sulcation

🔹 Fetal Thorax & Heart

• Establishing fetal situs
• Four-chamber view (standard & lateral)
• LVOT & RVOT evaluation
• Five-chamber view
• Three-vessel trachea (3VT) view
• Lung echogenicity & mediastinal shift
• Screening-level detection of major cardiac anomalies

🔹 Fetal Abdomen

• Stomach & abdominal situs
• Gallbladder evaluation
• Cord insertion plane
• Anterior abdominal wall defects
• Ascites & hydrops screening

🔹 Renal & Urinary Tract

• Kidney evaluation in axial, sagittal & coronal planes
• Renal pelvis measurement
• Hydronephrosis grading concepts
• Renal agenesis & cystic kidney diseases
• Urinary bladder & umbilical artery assessment
• Detection of single umbilical artery

🔹 Limbs & Skeletal System

• Long bone measurements
• Evaluation of all 12 long bones
• Limb alignment & mineralization
• Detection of:
  • Skeletal dysplasias
  • Limb reduction defects
  • Talipes
  • Arthrogryposis
• Importance of movement assessment

🔹 Fetal Face & Neck

• Coronal facial plane
• Orbits & lens evaluation
• Median sagittal facial profile
• Nasal bone measurement
• Detection of:
  • Cleft lip & palate
  • Micrognathia / retrognathia
  • Hypertelorism / hypotelorism
  • Facial markers of aneuploidy

🔹 Placenta, Cord & Cervix

• Placental location & morphology
• Retroplacental complex evaluation
• Cord insertion types
• Cervical length assessment
• Membranes & synechiae

🔹 Reporting, Checklists & Clinical Decision-Making

• ISUOG-recommended CNS & TIFFA checklists
• How to report a normal screening scan
• When to escalate to advanced imaging
• Importance of follow-up & referral to higher centers
• Avoiding false reassurance & overdiagnosis

🎯 Who Should Attend

• Radiologists
• Fetal Medicine Specialists
• Obstetricians & Sonologists
• Postgraduate residents
• Anyone performing TIFFA scans

🌟 Outcome of This Lecture

• Confidence in ISUOG-compliant TIFFA scanning
• Ability to systematically rule out major anomalies
• Improved reporting quality & medicolegal safety
• Strong embryology-based understanding of fetal anomalies
• Clear differentiation between screening vs diagnostic evaluation
  
  
   

  2.Fetal Medicine Evaluation of fetal spine: 1. Normal spine 2. Dysraphic anomalies 3. Non-dysraphic anomalies

  From Normal Anatomy to Complex Dysraphism — A Complete Practical Approach

  🔹 What this lecture covers

  Systematic approach to fetal spine evaluation
  • Spine assessment as an integral part of fetal CNS evaluation
  • When and how to evaluate spine in first trimester, mid-trimester, and late pregnancy
  • Role of transabdominal vs transvaginal ultrasound
  • Importance of sagittal, axial, and coronal planes
  • Use of 3D ultrasound, surface rendering, skeletal mode & OmniView
    
    🔹 Normal Fetal Spine
• Normal sagittal, axial, and coronal spine anatomy
• True mid-sagittal vs off-midline sagittal views
• Identification of vertebral bodies, pedicles, neural arches
• Axial three ossification center (triangle) concept
• Normal sacral tapering and spinal curvature
• Skin–spine relationship and its clinical importance
• Normal spinal cord, conus medullaris level, CSF relationships
  
  🔹 Embryology of the Fetal Spine
• Gastrulation and mesodermal development
• Primary neurulation vs secondary neurulation
• Neural tube closure sequence and timing
• Role of notochord, somites, and chondrification centers
• Embryological basis of spinal and multisystem anomalies
• Understanding embryology to predict associated defects
  
  🔹 Non-Dysraphic Vertebral Anomalies
• Formation defects (hemivertebra, wedge vertebra)
• Segmentation defects (block vertebra)
• Butterfly vertebra and persistent notochord
• Imaging features in sagittal, axial, coronal, and 3D planes
• Congenital scoliosis and spinal deformity patterns
• Association with systemic anomalies (VACTERL)
  
  🔹 Open Neural Tube Defects (ONTD)
• Acrania–exencephaly–anencephaly sequence
• First-trimester diagnosis of open neural tube defects
• First-trimester cranial markers (crash sign, absent IT, brainstem changes)
• Direct spinal signs of open spina bifida
• Indirect cranial signs:
  • Lamon sign
  • Banana sign
  • Chiari II malformation
  • Ventriculomegaly and hydrocephalus
• Myelomeningocele vs meningocele
• Pathophysiology of CSF leak and brain changes
  
  🔹 Closed Spinal Dysraphism
• Difference between open and closed dysraphism
• Simple vs complex closed dysraphic states
• Lipomeningocele, lipomyelomeningocele
• Simple meningocele, myelocystocele, terminal myelocystocele
• Lesions with and without subcutaneous mass
• Skin stigmata and subtle diagnostic clues
• Importance of skin–spine distance
• Role of high-resolution TVS and 3D ultrasound
  
  🔹 Tethered Cord
• Definition and embryological basis
• Normal ascent of conus medullaris
• Antenatal diagnosis of tethered cord
• Low-lying conus criteria
• Conus–ossification distance concepts
• Anterior displacement of CSF as a key diagnostic sign
• Functional implications: bladder, bowel, and lower limb dysfunction
  
  🔹 Complex Spinal Dysraphism
• Diastematomyelia (split cord malformation)
• Fibrous vs bony septum
• Widened spinal canel and bony spur identification
• Cord splitting and associated scoliosis
• Role of coronal and axial imaging
  
  🔹 Caudal Regression Sequence
• Embryological basis (secondary neurulation defect)
• Strong association with maternal diabetes
• Sacral and lumbosacral agenesis
• Lower limb, gastrointestinal, and genitourinary anomalies
• Antenatal diagnosis and prognosis
  
  🔹 Segmental Spinal Dysgenesis
• Segmental agenesis or dysgenesis of spine
• Severe spinal curvature and gibbous deformity
• Asymmetric ribs and vertebral anomalies
• Association with limb-body wall complex, VACTERL, and amniotic band syndrome
• First-trimester and mid-trimester diagnostic clues
  
  🔹 Systemic Associations & Syndromic Evaluation
• VACTERL association and mesodermal origin
• When to expand evaluation beyond the spine
• Importance of complete fetal anatomical survey
  
  🔹 Counseling & Prognosis
• Determining level of spinal defect
• Predicting motor outcome and ambulation
• Bladder and bowel function implications
• Hydrocephalus progression and follow-up strategy
• Limitations of fetal movement assessment
• Importance of structured parental counseling
• Recurrence risk and role of preconceptional folic acid
  
  🔹 Clinical Take-Home Framework
• How to scan the spine systematically in every trimester
• How to differentiate normal, dysraphic, and non-dysraphic anomalies
• How embryology guides diagnosis and counseling
• How imaging findings translate into prognosis and nenatal management