This was a 26 year old lady seen around 32 weeks of gestation sent for 2nd opinion of open neural tube defect.Earlier scan done around 18 weeks was reported as normal.

The following picture shows the lumbar meningo myelocele.

3 d showing 2 views

the following  images are 3 d reconstruction.

3d reconstruction

3d live reconstruction

the conventional markers are not very helpful – lemon sign not made out

lemon sign not made out as the GA is around 32 weeks

banana sign is not so clear; but cerebellar shape is changed – boomerang

BPD and HC less than 2.3%tile is a subtle marker to look at the spine closely

BPD and HC are <2.3%tile and this could be an important marker to look carefully at the spine

COMMENT :

This again illustrates the need to pick up open neural tubal defects earlier , when the lemon and banana sign are much easier to appreciate .

Appreciation of internal translucency in the 1st trimester needs a learning curve , in which all obstetrics practicing sonologists should invest .

Microcephaly  could be an important marker in the late 2nd and 3rd trimester scans.