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OB GYNE 4 > 8 Doppler > Flashcards

8 Doppler Flashcards

1
Q

What is Doppler assessing?

A

fetal and maternal circulation

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2
Q

Doppler uses ___ and ___ assessment for flow patterns and measurements and referenced to gestational age

A

Qualitative - Not measured loss D flow, reversal, notching

and Quantitative

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3
Q

Methods

A
  1. CW (non stress test)
  2. PW (velocities that produce F shifts < 1/2 PRF)
  3. Color - to locate, direction, MCA on C of W
  4. Power - when direction not needed, pick up very small vessels
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4
Q

Most fetal blood investigated is less than

A

1m/sec

so we are successful with PW

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5
Q

Doppler can cause____. Color doppler adds little extra energy where PW adds alot (Dr. Zwiebel)

A

Bioeffects

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6
Q

Diastolic velocities ____ as term approaches due to ____placental resistance (larger placenta vessels)

A

Increases; decreased

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7
Q

Semiquantitative Analysis is used because it is

A

angle independent*

bc it is difficult to control angle of incidence

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8
Q

What is PI (pulsatility index)

A

PI= S-D/mean velocity

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9
Q

What is RI (resistive index)

A

RI= S-D/S

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10
Q

What is the fav Ratio outcome we use now and why?

A

PI because it will continue to show change (have value) even when diastolic flow is zero

Unlike RI when D flow 0 RI =1

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11
Q

As impedance increases the pulsatility of flow velocity ______?

A

increases

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12
Q

How many waveforms should be measured and averaged to avoid error?

A
  1. (need this)
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13
Q

3 Factors that will affect outcome blood flow in diastole for measurement

A

Tachycardia and Bradycardia
Fetal breathing.
AVOID DOPPLER DURING FETAL BREATHING. (too many different PSV)

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14
Q

During embryonic period normal to have ___ resistance flow with ____ end diastolic flow

A

HIGH; ABSENT

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15
Q

Towards end of 1st Trimester end diastolic flow____

A

appears

small vessel

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16
Q

As pregnancy progresses the end diastolic velocity ____.

A

Increases

due to vessel enlargement

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17
Q

THE easiest vessel to. asses is the?

A

Umbilical artery (2 arteries in the cord, 1 is the vein=maternal)

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18
Q

Umbilical arteries are____

A

pulsatile

bc fetal heart pumping blood back into the placenta

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19
Q

Next most common vessel is the ?

A

MCA prox to transducer

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20
Q

Third most common

A

Ductus Venousus

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21
Q

Other vessels assessed

A

Umbilical vein
Fetal aorta - rare
Fetal IVC - rare

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22
Q

What does the PI, RU and S/D ratio do with increasing gestational age?

A

decreases because the diastolic flow is increasing

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23
Q

Ratios are higher if measured at the ___ ___ of the cord

A

fetal end

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24
Q

It is recommended to measure ____ cord

A

mid

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25
Q

With twins measure the fetal artery just outside the ____ ___ so you don’t mix them up

A

fetal abdomen

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26
Q

Abnormal findings is decreased or absent diastolic flow causing increased RI & PI In the _______ artery

A

umbilical

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27
Q

_____ of ______flow in the umbilical artery is severe can cause death (too much pressure on fetal heart)

A

Reversed; diastolic

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28
Q

RI >___ is abnormal from ___weeks onward

A
  1. 72 ; 26 weeks

* must use gestational age when reference a value

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29
Q

Indications for doing doppler

A 
Small for gestational age
IUGR
need umbilical artery doppler
Mom have HTN
IDDM (mom type 1, prior too)
TTTS (monochoionic, 1 donor, 1 receipt)
poor growth in both twins due to placental insuff.
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30
Q

Umbilical ARTERY Doppler Normally = Forward flow through ___ phases of the cardiac cycle

A

ALL

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31
Q

Umbilical ARTERY Absent ______flow is ABNORMAL and means the blood is stoping when the babies heart is relaxing. As well as _____ flow, opposite direction, severe destress.

A

Diastolic; reversed

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32
Q

With the fetal aorta you are sampling the ?

A

descending aorta, just about diaphragm

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33
Q

Appearance of the aorta is similar to the ____ artery but changes are noticed in aorta 1st. Decreased, absent or reversed diastolic flow same indications.

A

umbilical

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34
Q

What artery is used to assess brain sparing with IUGR fetuses?

A

MCA

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35
Q

What is poor perfusion called when baby shunt blood to head but body isn’t growing at rate it should be, kidneys, less fluid, oligo?

A

Brain-sparing effect

36
Q

CU ratio = ?

A

MCA PI/Umbilical Artery PI

37
Q

With Anemia there will be ____ systolic velocity due to ____viscosity of blood (bc of decreased hematocrit)

A

Increased; decreased *
(blood is runnier)
*The PSV will increase with gestation

38
Q

With Anemia what artery is looked at?

A

MCA for IMMUNE HYDROPS (Rh- incompatibility babies, mom sensitized from 1st pregnancy, can’t have any transfer of blood, bc has antibodies)

39
Q

And amnocentesis is required and possible blood transfusion if MCA measures?

A

> 1 m/sec

40
Q

Explain how to Measure MCA? (5)

A 
Angle slightly caudal from BPD
Measure MCA closest to transducer
Must have MCA flow parallel with sound beam
**0 Degree angulation
Sample at prox segment MCA
41
Q

What are we looking for with MCA sample in immune hydrops?

A

PSV

*if not 0 = peaks are not seen well.

42
Q

When fetal head is low or trouble with MCA what should you do?

A

give fetus a rest

pressure on head can cause distress abnormal waveform

43
Q

The umbilical VEIN during embryonic period is?

A

pulsatile

44
Q

The umbilical VEIN from 2nd trimester on should be?

A

NON pulsatile

*if pulsatile CHF? (tricuspid regurg)

45
Q

The umbilical vein can be sampled in fetal __ or ___

A

abdomen or cord

46
Q

Where is the Ductus Venosus is located

A

connector bw LPV and IVC

47
Q

Ductus Venosus flow is?

A

biphasic

48
Q

ABNORMAL Ductus Venosus is

A

flow go below the baseline

49
Q

Ductus Venosus measurment is used with?

A

TTTS - recipient twin too much blood see blood below the baseline with TR.

50
Q

Ductus Venosus is the regulator of?

A

oxygen to fetus

half blood returning from placenta is directed thru DV

51
Q

Ductus Venosus scanning protocol

A

Level of AC
Color of the umbilical vein
sweep posterior towards fetal spine
locate TURBULENT flow vessel (due to narrow lumen)

52
Q

S wave = systolic peak
D-rapid filling of ventricles
A=?

A

Atrial contraction

53
Q

What is abnormal Ductus Venosus waveform?

A

A wave reversal

54
Q

IVC is what type of waveform?

A

Triphasic close to heart

Biphasic further away

55
Q

Where should we measure IVC?

A

below diaphragm (away from heart)

56
Q

PI ____ with fetal hypoxia/asphyxia (low oxygen)

A

Increases

57
Q

IUGR- hypoxia/asphyxia waveform will show?

A

REVERSED flow in umbilical artery
INCREASED DIASTOLIC flow in MCA
IUGR indicates that the placental resistance is rising

58
Q

Abnormal value of ____ is abnormal in 1st trimester and may predict placental insufficiency or Pre-eclampsia

A

PAPP-A

59
Q

_____ in the uterine artery is abnormal

A

notching

60
Q

Doppler in Gynecology is?

A

EV

61
Q

When to use Doppler in Gynecology

A

Persistant trophoblastic disease
Neoplasia or tumors
AV fistulas

62
Q

Uterine Artery doppler abnormalities can cause low resistance flow and cause

A 
uterine fibroid (leiomyoma)
or endo cancer
63
Q

Arcuate vessels after baby can?

A

calcify

64
Q

Endo carcinoma always use

A

Doppler with EV

65
Q

With Endo polyps use color doppler to?

A

look for feeding vessel (stalk)

66
Q

Ovarian Doppler with EV to look for? and you must use?

A

Torsion; spectral as well!

67
Q

With an ovarian neoplasm you will see increased?

A

diastolic flow

68
Q

What can look like neoplasm flow and be mistaken for mass?

A

CLC

69
Q

Ovarian Doppler varies with _____cycle so need to know what cycle they’re in.

A

menstrual

70
Q

Ovary with dominant follicle ?

A

PI and RI decreased and increased flow in ovary

71
Q

ovary without dominant follicle?

A

low or absent diastolic flow

changes with pregnancy

72
Q

Ovarian Doppler Malignant lesions tend to have more of a ?

A

Central flow

73
Q

Ovarian Doppler Benign lesions tend to have more of a ?

A

Peripheral flow

74
Q

Perfect world pelvic US performed on day __ to __ to avoid confounding ovarian and endometrial findings, when we see large CLC

A

5-9

75
Q

Paraovarian cysts may have a

A

papillae

more suggestive of ovarian cancer

76
Q

Cogwheel sign is with ?

A

PID

77
Q

Granulosa cell tumor produces hormones causes?

A

thickened endometrium

78
Q

High distolic flow, low resistive flow = ___tumor

A

malignant (lots of flow)

79
Q

Use power doppler small ___ and low ___

A

ROI (box); PRF

80
Q

Inflammation of vein caused by clot, rare and associated with Postpartum, malignancies, PID is called?

A

Postpartum Ovarian Vein Thrombophlebitis

*INCREASE RISK WITH C-SECTION PTs

81
Q

What is Virchow’s Triad?

A
  1. Hypercoagulability in pregnancy
  2. Venous stasis
  3. Vessel damage due to UT expanding and contracting
82
Q

In Postpartum Ovarian Vein Thrombophlebitis

What ovarian vein occurs more frequently ?

A

Right 80-90%

can use CT, MRI and US

83
Q

Postpartum Ovarian Vein Thrombophlebitis

Sonography appears as?

A

tubular hypoechoic structure LACKING color

assess IVC for clot invasion

84
Q

DDX for Postpartum Ovarian Vein Thrombophlebitis

A

Appendicitis
fibroids
neprolithiasis
Tubo-ovarian abscess

85
Q

Pelvic congestion symptoms and associations?

A

unknown cause
Chronic dull ache, pain.
associated with multiple babies and LE varices

86
Q

Pelvic congestion appearance

A

multiple tubular structures, dilated pelvic veins, color seen.

OB GYNE 4 (11 decks)

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