I. Horseshoe inversion foot Definition: Horseshoe inversion foot refers to the palm of the foot from the ankle to deviate from the midline, turned to the inside, and fixed in this position. Diagnostic points: 1. It is the most common congenital deformity of the foot. The incidence is about 1:250-1000, slightly more unilateral than bilateral, and twice as common in males as in females. 2, Intrauterine ultrasound sonogram shows both calf and foot on the longitudinal position of the calf. Jiang Xiaoqing, Department of Obstetrics and Gynaecology, Jiangsu Maternal and Child Health Hospital, Jiangsu Province, China. 3. Clinical manifestations include pronation and pronation of the forefoot, high arching of the middle foot, and inversion of the hindfoot in the form of a horseshoe, and in severe cases, the heel of the foot becomes small and there is a fold of skin on top of it. 4.It can be combined with tibial internal rotation and calf triceps atrophy. 5, Most often seen in some syndromes such as trisomy 18 and dyskinesia fetal malformation. Description of the main points: 1. The forefoot is inwardly turned, the midfoot is highly arched, and the hindfoot is inwardly turned in the horseshoe, and in severe cases, the heel becomes small and there is a skin fold above it. 2, may be combined with tibial internal rotation and calf triceps atrophy. Requirements: 1. Orthopantomogram: full view of both lower limbs below the abdomen. 2. 2. Side view film: full view of single foot. Definition: one or more extra fingers (toes) or finger (toe)-like growths on hands or feet. Diagnostic points: 1, can be unilateral or bilateral. According to the site is divided into pre-axial type (radial or tibial) and post-axial type (ulnar or fibular), post-axial type is more common. The post-axial type is more common. It can be combined with syndactyly or broken fingers (toes) at the same time. 2.Single polydactyly is mostly autosomal dominant, and can be one of the symptoms of many syndromes such as trisomy 13. 3, clinically divided into: ① simple soft tissue, with or without ring-shaped depression tissue connected to the surrounding tissues; ② complete shape of the fingers (toes), often only one or two knuckles, can be with the palm (metatarsal) bone constitutes the joints or foliated bony connections; ③ more than the remaining fingers (toes), the appearance of nearly normal, there is a fingernail (toes), and there is a certain development of poor palm (metatarsal) bone. Multiple fingers (toes) and normal fingers (toes) are sometimes of the same size, and it is difficult to distinguish them from the exterior, and the extra fingers (toes) may be smaller, and branching fingers (toes) may also be formed. 4, easy to diagnose clinically, intrauterine ultrasound can show one or more extra fingers (toes) on the hand or foot, and X-ray examination can clarify the bone and joint abnormalities. Description of the main points: 1, simple soft tissue, with or without ring-shaped depression tissue connected to the surrounding tissues; 2, the appearance of the more complete finger (toe), often only one or two knuckles, and can be formed with the palm (metatarsal) bone joints or foliated bony joints; 3, the extra fingers (toes), the appearance of the near-normal, with fingernails, and a certain degree of poorly developed metacarpal (metatarsal) bone. The extra fingers (toes) and normal fingers (toes) are sometimes of the same size, which is difficult to distinguish from the appearance, and the extra fingers (toes) may also be smaller, and may also form branching fingers (toes). Requirements: 1. Orthopantomogram: unilateral or bilateral unfolding of the hands or feet of polydactyly (toes). Third, and fingers (toes) Definition: fingers (toes) and fingers (toes) between the excess skin connected to the skin, soft tissue or bone tissue connected to the common. Diagnostic points: 1, common in the 2nd and 3rd fingers. 2, Clinical manifestations: soft tissue and fingers (toes), light only a thin layer of skin webbing; more serious when more fingers (toes) skin or subcutaneous soft tissue connected, while the finger (toe) nails are separated; severe cases of the fingers (toes) merge, some bone segmentation incomplete and articular deformity, or the end of the finger (toes) bone and nail fusion. Intrauterine ultrasound can be used to see if the fingers can be separated when the fetal hand is unfolded during fetal movement, but sometimes the ultrasound still fails to make a diagnosis. x-ray examination may reveal bone deformities. 4.There is often a family history of this disease, which is autosomal dominant. Description of key points: 1, soft tissue and fingers (toes), light only a thin layer of skin webbing; 2, more serious when more fingers (toes) skin or subcutaneous soft tissue connected, and finger (toe) nail separation; 3, serious cases of fingers (toes) combined, some of the bone segmentation incomplete and articular deformity, or the end of the knuckle finger (toes) and nail fusion of bone. Requirements for radiographs: Orthopantomogram: unilateral or bilateral photographs of the hand or foot with fingers (toes). Limb shortening Definition: also known as limb loss. One or more limbs are completely or partially absent or severely hypoplastic. Diagnostic Points: The severity of the deformity varies and can involve one, two or four limbs. 1, lateral limb loss: also known as amputation deformity. The distal end of the limb is completely or partially missing, and the proximal end is basically normal. According to the site of occurrence, it is divided into: complete or partial absence of upper arm (thigh), forearm (calf), wrist (tarsus), palm (metatarsus) and fingers (toes). Missing fingers (toes) belong to this category. 2, longitudinal limb loss: the longitudinal column of long bones on the radial (tibial) or ulnar (fibular) side of the limb is partially or completely absent or severely underdeveloped, or the central longitudinal column of the hand (foot) is absent, forming a split hand (foot). Radial hypoplasia or agenesis is the most common, often accompanied by thumb agenesis. 3, intermediate limb deficiency: also known as “seal deformity”. The distal end of the limb is basically normal, the middle long bone is missing, and the hand (foot) is often deformed. Clinically can be divided into: ① complete seal hand (foot), the entire upper arm (thigh), forearm (calf) is completely missing, the hand (or foot) directly attached to the trunk; ② proximal seal hand (foot), the upper arm (thigh) is missing, the forearm (calf) is directly attached to the trunk; ③ distal seal hand (foot), the forearm (calf) is missing, the hand (foot) is directly attached to the upper arm (thigh) end. 4.Mixed type: simultaneous presence of the above types of deformities. 5.Limb loss can exist alone or be one of the manifestations of some syndromes. It is associated with autosomal dominant or autosomal recessive inheritance and exposure to certain drugs during early pregnancy. Description of key points: 1, lateral limb loss: all or part of the distal limb is missing, and the proximal end is basically normal. It can be categorized into: complete or partial absence of upper arm (thigh), forearm (calf), wrist (tarsus), palm (metatarsus), fingers (toes). Missing fingers (toes) belong to this category. 2, longitudinal limb deficiency: the longitudinal column of long bones on the radial (tibial) side or ulnar (fibular) side of the limb is partially or completely absent or severely underdeveloped, or the central longitudinal column of the hand (foot) is absent, resulting in the formation of a split hand (foot), which is often accompanied by the thumb is absent. 3, intermediate limb deficiency: also known as “seal deformity”. The distal end of the limb is basically normal, the middle long bone is missing, and the hand (foot) is often deformed. Can be divided into: ① complete seal hand (foot), the entire upper arm (thigh), forearm (calf) is completely missing, hand (or foot) directly attached to the trunk; ② proximal seal hand (foot), the upper arm (thigh) is missing, the forearm (calf) is directly attached to the trunk; ③ distal seal hand (foot), the forearm (calf) is missing, the hand (foot) is directly attached to the upper arm (thigh) end. 4.Mixed type: the simultaneous presence of the above types of deformity. Requirements for filming: 1. Orthopantomograms: including whole body and partial photographs of the shortened limb. 2.Lateral position film: localized photographs of the shortened limb. Diaphragmatic hernia Definition: refers to the entry of abdominal contents into the thoracic cavity through a fissure or defect in the diaphragm. Incidence rate of newborns 1:2000 to 1:3000. Diagnostic points: 1, diaphragmatic developmental defects, according to its location is divided into the thoraco-abdominal hiatus posterior lateral hernia, parastomal hernia, diaphragmatic expansion and esophageal hiatal hernia, of which the left side of the thoraco-abdominal hiatus hernia is the most common. 2. Stomach, intestines and spleen can be herniated into the thoracic cavity, which can be accompanied by one or both lungs dysplasia, and the heart is extruded to the right side of the thoracic cavity. 3. Intrauterine ultrasound diagnosis: (1) Sonogram shows occupying lesions in the thoracic cavity, which are more common on the left side. (2) A large number of abdominal organs enter the thoracic cavity, and abdominal circumference reduction may occur. (3) Severe fetal mediastinal displacement may cause fetal hydrops. (4) It should be differentiated from other thoracic cystic lesions. 4, Thoracoabdominal frontal X-ray shows the disappearance of the left diaphragmatic shadow, the thoracic cavity with intestinal tubes and gastric vesicles, etc. 5, the prognosis is related to the time of diaphragmatic hernia, the amount of organs herniated into the thoracic cavity, the degree of pulmonary insufficiency, and the combination of malformations. Describe the main points: 1, the newborn abdomen is flat, the birth of the “boat-shaped abdomen”, dyspnea, bruises. 2, chest and abdomen X-ray of the front and side. The chest and abdominal X-ray showed the disappearance of the left diaphragm, the presence of intestinal tubes and gastric vesicles in the thoracic cavity, and so on. In the right thoracoabdominal hiatal hernia, the liver and so on enter into the right thoracic cavity, which can also cause the above symptoms. Requirements: Orthopantomogram: full-body photograph of the newborn. V. Umbilical bulge Definition: A defect in the midline of the abdominal wall, including muscle, fascia and skin, with the contents of the abdominal cavity protruding into the umbilical cord and the surface covered with peritoneum and amniotic membrane. Incidence 1:4000 to 1:5800. Diagnostic points: 1, according to the abdominal wall umbilical defect diameter <2,5cm, 2,5-5,0cm or >5cm is divided into type I, II and III. 2, at birth, it can be seen in the front and back of the umbilical cord, which is the most important part of the abdominal wall. 2.At birth, the muscles and skin around the umbilical cord in the midline can be seen in the defect, resulting in the peritoneum and abdominal organs through the defect out of the body, the surface of the herniated material is covered by the inner peritoneum and the outer layer of amniotic membrane composed of translucent capsule membrane, abdominal organs (intestines and liver, etc.) can be seen through the film, so it is known as “glassy abdomen”. 3. After birth, the thin capsule is easy to rupture, and should be differentiated from the cleft abdominal deformity, in which the umbilical cord is inserted into the abdominal wall in a normal way. Intrauterine ultrasound shows a mass in the anterior abdominal wall, which contains simple intestinal tubes or simple liver echoes. 5.Umbilical dilatation can occur alone, or it can be one of the manifestations of some syndromes, such as umbilical dilatation-giant tongue-giant body syndrome (Beck-with-Widedmann, EMG syndrome), 13-trisomy syndrome. 6, Some maternal blood AFP value is elevated. Description of key points: 1, the newborn midline umbilical cord around the muscle and skin defect, resulting in the peritoneum and abdominal organs through the defect bulging out of the body, the surface of the herniated material has an inner layer of peritoneum and the outer layer of amniotic membrane composed of a semi-transparent capsule membrane cover, abdominal organs (intestinal tubes and the liver, etc.) can be seen through the film. 2, after birth, the thin sac membrane is easy to rupture, should be differential diagnosis with cleft abdominal deformity, the latter umbilical cord inserted into the abdominal wall at the normal. Requirements for filming: 1. Orthopantomogram: the whole body of the newborn is photographed in a frontal view, trying not to break the sac membrane, focusing on the root of the umbilical cord and the hernia sac content of the image. 2. 2, lateral film: focus on the umbilical root and hernia sac content of the image. VI. Hiatus Abdominis Definition: refers to a full-layer defect of the abdominal wall next to the umbilicus, accompanied by protrusion of abdominal viscera. The incidence rate is 1:10,000 to 1:150,000. Diagnostic points: 1. Most of them are disseminated, and there are few chromosomal abnormalities. 2. 2, the whole layer of the abdominal wall next to the umbilicus is defective, the umbilical cord is normal where it connects to the abdominal wall, the defect is mostly on the right side, and the defect tends to be small, mostly between 2-4 cm. 3, longitudinal defects in the abdominal wall on the side of the normal umbilical cord, the stomach, large and small intestines, and occasionally the bladder or uterus are expanded out of the body through this defect, with no hernia sac covering, and no liver expansion. Expanded intestinal wall hypertrophy, edema, adhesion, intestinal tube purple color, no peristalsis, a few cases of intestinal tube has been necrosis. It is often combined with intestinal malrotation, atresia and other malformations. 4, intrauterine ultrasound often located in the umbilical root of the right abdominal wall defect, gap is small, the protruding material is mostly intestinal tubes, the official cavity can be mildly dilated. When a large number of intestinal tube protrusion, fetal abdominal circumference can become smaller. 5, Maternal blood AFP value is elevated. 6, need to be differentiated from umbilical bulge, body tip abnormality and cloacal exstrophy, the latter two are huge abdominal wall defects. Description of the main points: 1, in the normal umbilical cord on the side of the abdominal wall has about 2-3 cm longitudinal defect, the stomach, large and small intestines, and occasionally the bladder or uterus through the defect out of the body, no hernia sac cover, no liver bulging. 2.The bulging intestinal wall is hypertrophied, edematous, adherent, the intestinal tube is purplish in color, there is no intestinal peristalsis, and the intestinal tube is necrotic in a few cases. Often combined with malrotation, atresia and other deformities. 3, Abdominal defect and umbilical cord between the narrow normal skin, the side of the rectus abdominis muscle underdevelopment, umbilical cord and umbilical cord is normal. The right ventral cleft is more common than the left, and single ventral cleft deformity is more common. Requirements: Orthopantomograph: full body photograph of the newborn, focusing on the relationship between the root of the umbilical cord and the location of the cleft abdomen, the abdominal bulge should not be retracted. Definition: dorsiflexion and valgus of the whole foot to the front and outside. Diagnostic points: 1, dorsal and lateral (ankle side) soft tissue mild tension caused by toe flexion and inversion restrictions. 2, the heel is in the valgus position, the heel is in the valgus position. 2. The heel is in the valgus position. 3, in the anterior lateral foot abnormal position often have deeper skin folds, subcutaneous tissue reduction. 4, may be accompanied by flat feet, knee extension contracture, oblique neck, etc., the tibia and fibula appear bent in severe cases. 5, intrauterine by the influence of fetal posture, foot ectropion is difficult to diagnose with ultrasound imaging. The heel of the foot is in the valgus position. 2, in the anterior lateral position of the foot abnormal often have deeper skin folds, subcutaneous tissue is reduced. Requirements: Orthopantomogram: the whole body including the deformed part of the foot in the valgus position.