الفهرس 
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Abstract
Background: High Risk Pregnancy (HRP) is a condition where the mother, the developing fetus or both are at an increased risk for complications during or after pregnancy and birth. Congenital anomalies are one of the leading causes of fetal and child mortality in developed and developing countries. Most major fetal anomalies can be diagnosed in the first trimester, On the other hand, the performance of a second trimester scan as a screening tool is generally considered less reliable as intervention is more inaccessible for religious and legal reasons. Aim of the work: We designed this study aiming to detect congenital anomalies using CRL and EV earlier than anatomical scan. Patients and Methods: Study included 100 pregnant women with gestational age 7-14 weeks with one or more of risk factors such as DM, HTN, obesity, history of previous fetal congenital anomalies, consanguine marriage, and thyroid dysfunction. We excluded 8 cases from the study as they had early miscarriage before anatomical scan. 6 cases out of the remaining 92 cases had termination of pregnancy after anatomical scan because of congenital anomalies detected at primary scan. We performed 2 scans the first at 7-14 weeks and the second at 18-22 weeks. All scans were carried out by Prof Dr Hend shalaby using commercial US machine. EV was calculated fast and accurate by VOCAL technique in vivo with narrow error. The results of our study showed that CRL and EV was sensitive to detect congenital anomalies in the first trimester also we noticed that the larger EV is associated with congenital anomalies. Results: Consanguinity was mostly a causative factor for congenital anomalies followed by maternal medical illness as diabetes mellitus. Congenital anomalies recorded 12% of high risk pregnancies, more than 50% of anomalies diagnosed at first trimester as cystic hygroma, omphalocele, increase NT and trisomy 18. Conclusions: We recommend performing these measurements on larger sample size to detect more structural congenital anomalies in future studies that will mostly strengthen the relationship between congenital anomalies and EV. Routine First trimester anomaly scan for high-risk pregnancies may help as an appropriate intervention and proper management of congenital anomalies. An embryo of GA 7_10 weeks of gestation is too small for investigation because all structures are not completely formed yet so, a targeted scan for anomalies at 11–13 weeks of gestation is recommended.