Abnormal OB (All Trimesters) Flashcards

Question

Twin to Twin Transfusion Syndrome

Answer 1

Same sex fetuses with shared placenta The arterial blood of donor twin pumps into venous system of recipient twin (arteriovenous anastomoses) Fetal weight discordance of =/> 20% Donor Twin: - IUGR - Oligohydramnios Receiving Twin: - Large for dates - Polyhydramnios - Hydrops - Enlarged viscera - Edema

Answer 2

Demise of one embryo in late 1st trimester/ early 2nd trimester Embryo and sac usually reabsorbed "Vanishing" sac may mimic implantation bleed or submembranous bleed

Answer 3

General term for spectrum of fetal physiologic conditions that result in an infant weighing AT OR BELOW 10th percentile for GA Growth restricted infants are born with diminished stores of fat and glycogen and are likely to be hypoglycemic

Answer 4

- Poor nurtitional status - Smoking - Multiple gestation - Drug/alcohol abuse - Severe anemia - Diabetes - Chronic renal disease - Rh sensitization - Severe chronic asthma - Under 17 or over 35 years of age - Heart disease - High altitude

Answer 5

- Placental infarcts & hemangiomas - Small placenta - Single umbilical artery - Abruptio placenta - Placental insufficiency

Answer 6

- Genetic or chromosomal defects | - Intrauterine infection

Answer 7

Growth restriction affecting entire fetus which is a result of 1st trimester fetal insult Sono findings: - All measurements more than 2 weeks below expected GA - Transcerebellar diameter consistent with dates when other parameters are less than expected - Oligohydramnios - Mature placenta earlier than expected - Low BPP score

Answer 8

"Brain sparing" Caused by placental insufficiency (most common), chromosomal abnormalities, or infection later in pregnancy Sono findings: - Decrease in AC (2 weeks behind HC) - Normal HC and FL - Oligohydramnios - Mature placenta earlier than expected (grade 3) - Absence or reversal of diastolic flow is critical

Answer 9

Large for dates, fetal weight above 4000 g or above the 90th percentile for GA Causes: - Maternal diabetes - Maternal obesity - Postterm pregnancy Sono findings: - Large AC - Decreased HC/AC ratio - Polyhydramnios - Placentomegaly

Answer 10

Abnormally decreased amount of amniotic fluid AFI below 5 cm (Below 5th percentile for GA) Causes: - Genitourinary tract abnormality (fetal) - IUGR (fetal) - Demise (fetal) - Post dates - Poor nutrition (maternal) - Placenta insufficiency (maternal) - PROM (maternal) : pre-eclampsia and eclampsia

Answer 11

Abnormally increased amount of amniotic fluid; acute or chronic; AFI above 24 cm (Above 95th percentile for GA) ESP BOOK?? - Mild: 8-12 cm - Moderate: 12-16 cm - Severe: >16 cm ``` Caused by: Maternal -gestational diabetes -Rh incompatibility -Cardiac disease -Preeclampsia -Idiopathic ``` Fetal - CNS anomaly - GI anomalies - Abdominal wall defects - Cardiac defects - Facial clefts/masses - Fetal hydrops - Twin to twin transfusion - Sacrococcygeal teratoma - Skeletal dysplasia

Answer 12

An excessive accumulation of fluid in fetal tissues and body cavities May result in: - Diffuse interstitial edema - Pleural effusion - Pericardial effusion - Ascites - Anasarca - Placentomegaly - Polyhyrdamnios Two types

Answer 13

Due to Rh isoimmunization- mother is Rh - and father is Rh + (fetus = Rh+) Maternal antibodies recognize Rh antigens on fetal RBC's as foreign and attack and destroy them which results in fetal anemia (which will in turn result in hydrops)

Answer 14

Hydrops dues to any cause other than Rh sensitization Causes: - Cardiac anomalies/arrythmias - Infection (TORCH) - Chromosomal abnormalities - Congenital hematologic disorders - Abdominal or pulmonary masses leading to venous obstruction - Twin to Twin transfusion syndrome

Answer 15

- Pericardial effusion (earliest sign) - Ascites - Fetal skin thickening (anasarca) - > 5 mm - Placental thickening (> 5 cm AP) - Pleural effusion - Hepatosplenomegaly - Polyhydramnios - Enlarged umbilical vein (> 1 cm)

Answer 16

Placental tissue encroaching upon the cervix and/or crossing internal cervical os which is caused by abnormally low implantation of blastocyst Primary cause of painless vaginal bleeding in 3rd trimester Risk factors: - AMA - Multiparity - Previous c-section - Therapeutic abortion - Closely spaced pregnancies

Answer 17

Complete/ Total Previa: - placenta completely covering internal cervical os - symmetric or asymmetric Partial Previa: -placenta partially covering internal os Marginal Previa: -placenta encroaching on but not crossing os Low Lying Placenta: -placenta in LUS within 2 cm of os

Answer 18

Fetal vessels crossing the cervical os, passing between cervix and presenting fetal part with the membranes intact Associated with velamentous insertion (Umbilical cord that inserts on the membranes)

Answer 19

Premature placental detachment (either all or part) from myometrium Risk factors: - Maternal HTN - AMA - Multiparity - Maternal vascular disease - Smoking - Maternal diabetes - Trauma - Cocaine use - Uterine leiomyomas - Placenta previa - Short umbilical cord Cinical findings: - Severe pelvic pain - Vaginal bleeding

Answer 20

Ischemic necrosis of placental villi resulting from interference with maternal blood flow to intervillous space Occurs more commonly in eclampsia/preeclampsia Sono findings: - Anechoic or hypoechoic areas seen in placenta - May be small or large - Absence of blood flow on color/spectral doppler - No flow on color/spectral doppler

Answer 21

Chorionic villi of the placenta are in direct contact with the uterine myometrium but do not invade

Answer 22

Chorionic villi of the placenta invade the uterine myometrium

Answer 23

Chorionic villi of the placenta penetrate/perforate myometrium

Answer 24

Accumulation of blood beneath the chorion Sono findings: - Appearance depends on age of hematoma - Usually decreases in size on follow up exams

Answer 25

Vascular tumor that arises from the chorionic tissue of the amniotic surface of the placenta Placental hemangioma When tumors are large (> 5cm), is when complications occur. Associated with increased MS-AFP Sono findings: - Enlarged placenta - Circular, solid Hypoechoic mass protruding from chorionic plate - Usually occur at the umbilical insertion site - Polyhydramnios - Fetal hydrops - IUGR

Answer 26

Circumvallate: - Small central chorionic ring surrounded by thickened amnion and chorion - May predispose to early separation from uterine wall, antepartum bleeding and threatened AB Circummarginate: -Central attachment of membranes without central ring

Answer 27

Succenturiate: -Accessory cotyledon with vascular connections to main placenta (connected to body of placenta) Bipartite: -Placenta divided into two lobes but united by primary vessels and membranes Annular: -Ring shaped placenta

Answer 28

Chromosomal abnormality that occurs 1:6000 births. Extra chromosome 13 Poor prognosis ***Holoprosencephaly*** (Most common marker) Sono findings: - Cleft lip/palate - IUGR - Polydactyly - Cardiac defects - Omphalocele - Renal anomalies - Absent/ small eyes - Microcephaly - Agenesis of corpus callosum

Answer 29

Chromosomal abnormality that is the second most common. Extra chromosome 18 Poor prognosis (Average lifespan of 5 days) ***Clenched fists and rocker bottom feet*** (most common markers) Sono findings: - Heart defects - Choriod plexus cysts - Micrognathia - Renal anomalies - Cleft lip and palate - Omphalocele - Enlargement of cisterna magna - Single umbilical artery - IUGR - Polyhydramnios

Answer 30

Most common chromosomal abnormality occurring 1:710 live births Extra chromosome 21 Sono findings: - Thickened nuchal fold (> 6 mm) - Heart defects - Duodenal atresia - Hyperechoic cardiac focus - Macroglossia - Micrognathia - Hyperechoic bowel - Sandal toe deformity - Clinodactyly - Low-set ears - Short stature - Small or absent nasal bones

Answer 31

Occurs in females only Chromosomal syndrome attributed to complete or partial absence of an X chromosome Occurs in 1:5000 births Not very good prognosis-high risk for in utero demise and those who do survive have ovarian dysgenesis and short stature Sono findings: - Cystic hygroma - Heart defects - Non-immune hydrops - Renal anomalies (horse shoe kidney, renal agenesis) - General lymph edema

Answer 32

Complete extra set of chromosomes -Often results in one ova being fertilized by two sperm Vast majority spontaneously abort prior to 20 weeks Sono findings: - Heart defects - Hypertelorism - Micrognathia - Microphthalmia - Ventriculomegaly - Oligohydramnios

Answer 33

The rupture of the amnion, which leads to entrapment/entanglement of the fetal parts by the "sticky" chorion. Depends on the age of injury as to how severe the defects will be. -Early entrapment may lead to severe craniofacial defects and internal malformations. -Late entrapment leads to amputations or limb restrictions. Sono findings: - Echogenic amniotic bands attached to fetus - Various fetal anomalies (at least 2) - Fetal postural deformities - Various secondary abnormalities

Answer 34

Normal karyotype Associated with Macrosomia, omphalocele and macroglossia

Answer 35

Weakened abdominal wall musculature in conjunction with massively dilated bladder, ureters and kidneys Decompression of hydronephrosis postnatally causes retraction and wrinkling of the skin, giving the appearance of a prune Associated with dilated fetal bladder, small thorax, and imperforate anus

Answer 36

Autosomal recessive condition Lethal Sono findings: - Encephalocele - IPKD - Oligohydramnios - Polydactyly

Answer 37

Group of anomalies that may occur together ``` V ertebral defects A nal atresia C ardiac anomalies T racheoesophageal fistula R enal anomalies L imb dysplasia ```

Answer 38

Rare, complex malformation caused by the failure of closure of the ventral body wall Has to have 2 or more of the following: - Limb defects - Lateral wall defects (esp. left) - Encephalocele - Exencephaly - Facial defects - Scoliosis

Answer 39

Autosomal dominant disorder that affects the ears, mandible, and palate Frequently associated with congenital heart defects - Small mandible - Micrognathia - Autosomal trisomy - Holoprosencephaly

Answer 40

Occurs in 200,000 births and more frequent in Amish community Autosomal recessive Also known as chondrodermal dysplasia Sono findings: - Limb shortening (mild to moderate) - Polydactly - Heart defects (50%) - May have narrow thorax

Answer 41

Congential disorder associated with two of the following major defects: - Cardiac defect - Abdominal wall defect - Diaphragmatic hernia - Defect of diaphragmatic pericardium - Ectopia cordis

Answer 42

Relatively small defect involving all 3 layers of the abdominal wall which allows for protrusion of the intestines into the amniotic cavity Usually to the right of the umbilicus and is not covered by a membrane Not associated with other anomalies

Answer 43

Congenital anterior abdominal wall defect in which abdominal organs (Liver, bowel, stomach) are atypically located within the umbilical cord and protrude outside the wall Develops when there is a midline defect of the abdominal muscles, fascia, and skin Covered in a membrane consisting on amnion and peritoneum Associated with: - Cardiac defects - Genitourinary defects - GI abnormalities - Chromosomal abnormalities

Answer 44

Discontinuity of esophagus and is associated with tracheoesophageal fistula 90% of time Sono findings: - Small/absent fetal stomach - Failure to demonstrate stomach on serial exams - Polyhydramnios

Answer 45

Blockage of the duodenum Associated with Trisomy 21, cardiac, urinary, and GI anomalies Sono findings: - "Double bubble" sign - dilated stomach and proximal duodenum - Polyhydramnios

Answer 46

Increased echogenicity of fetal bowel that is similar to or greater than that of adjacent bone Associated with: - Cystic fibrosis - Infection - IUGR - Chromosomal abnormalities

Answer 47

Ileus: - Impaction of thick meconium in distal ileum - Frequently associated with cystic fibrosis ``` Peritonitis: -Bowel perforation caused by bowel atresia or meconium ileus Sono findings: -Calificiations in fetal abdomen -Fetal ascites -Polyhydramnios -Presence of meconium pseudocyst ```

Answer 48

Caused by incomplete closure of the interventricular foramen and failure of the membranous part of the IV septum Sono findings: - Demonstration of an opening between the ventricles on 4 chamber view - Bidirectional flow demonstrated with color Doppler - Large defects are easier to diagnose

Answer 49

Any abnormal opening between the atria Diagnosis is difficult because of the normal patent foramen ovale Sono findings: - Relies on demonstration of echo dropout at level of the atrial septum - Prenatal diagnosis unlikely due to patent foramen ovale

Answer 50

Origins of great vessels are transposed - Aorta arises from right ventricle - Pulmonary trunk arises from left ventricle Normal 4 chamber heart view Sono findings: - Correct left-right orientation is a MUST - Images of outflow tracts demonstrate anomalous origin - Depends on demonstration of parallel orientation of outflow tracts

Answer 51

All or part of the heat is located outside of the chest cavity Sono diagnosis is made by visualization of soft tissue mass outside of the thorax exhibiting cardiac activity

Answer 52

Most common form of cyanotic heart disease Consists of four anatomical abnormalities: - VSD - Overriding aorta - Pulmonic stenosis - Right ventricular hypertrophy

Answer 53

Malformation of the tricuspid valve with low insertion Results in grossly enlarged right atrium

Answer 54

Irregular rhythm Can be due to: - Premature ventricular contractions (PVCs) - Premature atrial contractions (PACs) - Maternal caffeine intake, smoking and alcohol use

Answer 55

Heart rate greater than 180 bpm

Answer 56

Prolonged heart rate =/<100 bpm Associated with complete heart block Below 80 bpm, may be associated with fetal asphyxia Persistent bradycardia may warrant early delivery

Answer 57

May be isolated or in association with other abnormalities (esp. hydrops) Sono findings: - Anechoic fluid seen in fetal chest - Fluid contours to surrounding lung and diaphragm - Lung tissue appears echogenic

Answer 58

Results from the defective fusion/ formation of the diaphragm, allowing stomach, spleen, liver and/or colon to herniate into chest Bochdalek: - More common (85% of cases) - Left sided hernia Morgagni CDH is usually associated with other anomalies such as cardiac and brain Sono findings: - Identification of fluid filled bowel and especially stomach in chest at level of 4 chamber hear view - Heart displaced from left chest toward right - Associated with polyhydramnios

Answer 59

Unilateral condition characterized by the replacement of normal lung parenchyma by abnormal tissue (often includes visible cysts) Accounts for 25% of lung malformations 3 Types based on size of the cysts: - Type I: one or more large cysts (=/>2 cm) - Type II: multiple small cysts (<1-2 cm) - Type III: multiple small cysts, too small to be resolved by US beam so lung appears hyperechoic Sono findings: - Demonstration of non-pulsatile echogenic mass in fetal lung (solid & cystic components) - Lateral displacement of heart - Possible signs of hydrops (Most common w/ type III) - Associated polyhydramnios

Answer 60

Most common neural tube defect Congenital absence of the cerebral hemispheres and cranial vault. It occurs with failure of neural tube to close by 24 days gestation Characterized as open defect covered by angiomatous stroma, rather than skin or bone The brain stem and bony base of skull that form from other structures are present Sono findings: - Absence of cranial vault- - Bulging eyes "frog-like" face - Rudimentary brain tissue herniating from defect - Macroglossia - Polyhydramnios - Increase in fetal activity

Answer 61

Developmental abnormality in which cranium is partially or completely absent with the development of abnormal brain tissue Lethal anomaly with elevated AFP levels Sono findings: - Skull is absent - Brain is present - Lack of hyperechoic bony calvaria

Answer 62

Herniation of brain and meninges or meninges and CSF (meningocele) through a cranial defect Are associated with Meckel-Gruber Syndrome Prognosis depends on amount of brain involved an associated findings Encephaloceles are: - usually midline - Most commonly occipital - may be frontal or lateral Sono findings: - Purely cystic extracranial mass (meningocele) - Solid mass contiguous with cranium (cephalocele) - Often associated w/ hydrocephalus,and polyhydramnios

Answer 63

General term for lack of closure of the vetebral column Prognosis depends upon level and severity of lesion Usually occurs in lumbosacral region Fetuses may have: - Meningocele - Meningomyelocele: herniation of meninges and neural elements (spinal cord) thru spinal defect Sono findings: Transverse plane: -Splaying of posterior elements into "U" or "V" configuration -When sac is intact, cystic structure may be seen extending from back (small, simple cystic structure, cyst with septations and/or solid matter) Longitudinal Plane: -Splaying of parallel ossification centers -Soft tissue defect or discontinuity of skin and muscle of posterior back

Answer 64

Displacement of cerebellar vermis, fourth ventricle, medulla oblongata through foramen of magna into the upper cervical canal Associated findings of spina bifida are secondary to this Sono findings: - Compressed shape to the cerebellum - "banana sign" - Obliteration of cisterna magna - Flattening of temporal/frontal bones due to decreased intracranial pressure - "Lemon sign" - Ventriculomegaly

Answer 65

Dilation of the ventricular system secondary to an increase in the volume of CSF Sono findings: - Presence of excess fluid in lateral ventricles - "Dangling" choroid plexus - Echogenic rim of solid brain tissue - Occipital horn dilates first - Mild enlargement = 10-15 mm - Severe enlargement = >15 mm Associated findings: - Polyhydramnios - Hepatomegaly and fetal ascites - Meningomyelocele - Dandy-Walker - Encephalocele - Intracranial tumor

Answer 66

Group of disorders resulting from absent/ incomplete division of the forebrain (prosencephalon) into cerebral hemispheres and lateral ventricles Can be sporadic, due to chromosomal abnormalities (Trisomy 13 esp), or maternal infection Facial anomalies are common with this: - cyclopia with proboscis - hypoterlorism - facial clefts

Answer 67

Alobar: - Most sever form - Monoventricle - Fused thalami - Absence of falx cerebri Semi-Lobar: - Partial separation of ventricles & hemispheres with occipital lobe present - Incompletely fused thalami Lobar: - Least severe form - Normal separation of thalami, hemispheres and ventricles - Absent cavum septum pellucidum and olfactory tracts

Answer 68

Destructive disorder due to bilateral internal carotid artery occlusion/ malformation Characterized by near total lack of cerebral hemispheres with intact and normally developed meninges and skull Sono findings: - Large fluid-filled cranium - Absent cerebral tissue/ cortical mantle - Falx cerebri is present - Normal midbrain and basal ganglia - Polyhydramnios - No associated anomalies

Answer 69

Complete or partial absence of cerebellar vermis and posterior fossa cystic dilation communicating with 4th ventricle Associated with: - autosomal recessive disorders - Maternal infection - Diabetes - Exposure to alcohol and Coumadin Sono findings: - Complete/ partial agenesis of cerebellar vermis with flattened cerebellar hemispheres - Large midline cystic structure in posterior fossa - Associated with ventriculomegaly and polyhydramnios

Answer 70

Failure of callosal fibers to form normal connection May be partial or complete and is frequently associated with other anomalies Sono findings: - Absence of CSP - Elevated dilated 3rd ventricle - Widely separated frontal horns of lateral ventricles with enlarged occiptal horn - "Teardrop" shaped ventricles, displaced upward and outward

Answer 71

Small cysts within the choroid plexus are common Can be unilateral/bilateral, multiple or sinlge, large or small May be considered a normal anatomic variant

Answer 72

Defined as decreased head size (more than 3 SD below the mean) Symptom of several etiologic disturbances Cause include: - Craniosynostosis - Chromosomal abnormalities - Exposure to teratogens

Answer 73

Structural abnormality of the caudal end of the neural tube and includes a spectrum of skeletal anomalies of the lower spine and lower limbs More common in patients with diabetes Associated anomalies: - GI and GU tracts - CNS - Heart

Answer 74

Orbits placed closer together than expected

Answer 75

Orbits placed wider apart than expected

Answer 76

Midline fusion of the orbits

Answer 77

Most common congenital facial abnormality - 25% cleft lip only - 50% cleft lip and palate - 25% cleft palate only Sono findings: - Anechoic cleft extending from nostril to lip - May see tongue moving in cleft - May have association with polyhydramnios - Small stomach

Answer 78

Persistent protrusion of the tongue Polyhydramnios Associated with Beckwith-Wiedemann and Down Syndrome

Answer 79

Abnormally small jaw Small receeding chin and lower lip Associated with Trisomy 18 Polyhydramnios

Answer 80

Prominent forehead due to absent nasal bridge Associated with skeletal dysplasias and syndromes

Answer 81

Rare pharyngeal teratoma which protrudes from fetal mouth Sono appearance: - Large complex cystic and solid mass - Hyperextends neck

Answer 82

Increased soft tissue thickness at posterior aspect of the neck Slightly higher risk of chromosomal syndromes (esp. Trisomy 21) Sono findings: - Oblique axial cross-section showing CSP, 3rd ventricle, cerebellum and CM - Measurement of > 6 mm considered abnormal (measured between 15-21 weeks) - Fetal head must not be hyperextended

Answer 83

Benign developmental anomaly of the lymphatic system Associated with chromosomal abnormalities, fetal hydrops, and fetal heart failure Sono findings: - Thin walled multiseptated mass at posterior aspect of neck - May see nuchal ligament extending posteriorly (outward) - May mimic cervical teratoma, encephalocele, cervical meningomyelocele

Answer 84

Congenital absence of one or both kidneys Unilateral: -Very common -Causes no symptoms and is usually undetected until adulthood -Associated with SUA Bilateral: -Associated with Potter's syndrome Sono findings: - Severe oligohydramnios between 16-28 weeks stongly suggests renal anomalies - Absence of kidneys with "lying down" adrenal glands in renal fossa mimicking kidneys (absence of renal arteries)

Answer 85

Obstruction of kidney during its development leads to formation of cysts which replace renal parenchyma Minimal urine formation and cannot be detected early in pregnancy because cysts are not large enough to visualize Cysts may be large (up to 6 cm) and may be unilateral, bilateral or segmental Consists of: - Bilateral renal agensis - Pulmonary hypoplasia - Characteristic facies - Limb deformities - Oligohydramnios

Answer 86

Inherited disorder characterized by symmetric renal enlargement by multiple cysts These cysts cause enlargement of total renal size while compressing functioning renal tissue Sono findings: - Enlarged echogenic kidneys due to multiple interfaces of cysts - Increased kidney: AC ratio - Oligohydramnios - Small bladder - Kidneys may appear normal in early pregnancy (14-16 weeks)

Answer 87

***Most common*** Characterized by congenital obstruction of urine flow from renal pelvis into ureter Anatomic causes: - Fibrous adhesions - Bands - Kinks - Ureteral valves - Anomalous vessels Sono findings: - Hydronephrosis - Dilated renal pelvis - Thinning of renal cortex in chronic states - No hydroureter - Normal amniotic fluid level

Answer 88

Congenital folds of the urethra act as valves and obstruct urinary flow Can cause severe damage to kidneys, ureters, and bladder ***Occurs only in males*** Sono findings: - Massive bilateral hydronephrosis and hydroureter - Dilated bladder with "keyhole sign" - dilated bladder and prostatic urethra - Moderate to profound oligohyrdamnios - Bladder wall thickening - Male genitalia identified

Answer 89

- Undescended testes (normally descended into scrotum by 26-34 weeks) - Hydroceles (small are common, large warrant postnatal follow-up) Abnormal formation of the penis

Answer 90

-Hydrometrocolpos -Ovarian cysts: usually benign functional cysts that result from maternal hormone stimulation (resolve spontaneously after birth)

Answer 91

Shortening of the proximal segment of an extremity | -Humerus or femur

Answer 92

Shortening of middle segment of an extremity | -Radius/ulna, tibia/fibula

Answer 93

Shortened extremities

Answer 94

Most common lethal dysplasia Characterized by extreme micromelia (esp. rhizomelia), bowed long bones, narrow thorax with normal trunk, relatively large head Sono findings: - Cloverleaf skull (Kleeblattschadel) - Severely shortened limbs - Hypoplastic thorax - Platyspondyly - Mild hypomineralization - Polyhydramnios

Answer 95

Rare lethal form of short-limbed dysplaisa ``` Two types: Type I: -Autosomal recessive -More severe Type II: -Autosomal dominant and less severe form ``` Sono findings: - Lack of vetebral ossification - Large head, possible with decreased cranial ossification - Severely shortened limbs/ micromelia - Small chest - Polyhydramnios - Associated cleft lip/ palate, micrognathia

Answer 96

Disorder of production, secretion or function of collagen Abnormally fragile bones, which have decreased mineralization, fracture in utero, resulting in severe micromelia and irregularity of the bones Autosomal recessive Sono findings: - Presence of fractures of "thick" bones due to callus formation - Severe micromelia - Multiple rib fractures - Severe hypomineralization of the skull - Small, bell-shaped thorax

Answer 97

Lethal skeletal dysplasia characterized by short bent/ bowed bones Most commonly tibia and femurs are affected Sono findings: - "bent" long bones - Narrow thorax, and hypoplastic or absent scapulae - Associated CNS and renal anomalies

Answer 98

Rare lethal dysplasia characterized by polydactyly and extremely small thorax Death results from respiratory insufficiency

Answer 99

More than normal number of digits of the hand or foot

Answer 100

Permanent curvature of the 5th digit Associated with Trisomy 21

Answer 101

Fusion of digits, either soft tissue or bony fusion

Answer 102

Abnormal relationship between the tarsal bones and calcaneous 55% of cases are bilateral Sono findings: - Forefoot is orientated in same plane as lower leg - Persistent abnormal inversion of foot at an angle perpendicular to lower leg

Answer 103

Bottom of foot appears "rocker bottom" or convexes outward Can be associated with trisomy 21

Answer 104

Lower extremity fusion and abnormal or absent foot structures Sono findings: - Oligohydramnios - Single femur or two femurs seen side by side - Abnormal/absent foot structures - Associated with bilateral renal ageneis and skeletal abnormalities

Answer 105

Abnormal cartilage deposits at long bone epiphysis Most common form Sono findings: - Macrocrania - Micromelia - Frontal bossing - Hypoplastic thorax - Ventriculomegaly

Answer 106

Most commonly encountered umbilical cord abnormality May be caused by primary agenesis of umbilical artery or atrophy of normally formed umbilical artery Associated abnormalities include: - GU anomalies - Trisomies 18 and 13 - Cardiovascular anomalies - CNS anomalies - Omphalocele

Answer 107

Wrapping of the umbilical cord around the fetal neck Two or more complete loops of cord around the neck Color Doppler is useful to demonstrate this

Answer 108

Umbilical cord protruding through the cervix or adjacent to presenting fetal part This is an emergent situation

Answer 109

Attachment of the cord at the periphery of the placenta Cord enters directly into the edge of the placental substance

Answer 110

Attachment of the cord to the membranes rather than to the placental mass Cord travels beneath the chorion for some distance before attaching to edge of the placenta May be associated with IUGR, preterm birth and congenital anomalies

Answer 111

- Typically performed between 9-12 weeks - Can be performed either transcervically or transabdominally - Trophoblastic cells obtained with CVS are cultured and karyotyped - In cases of chromosomal abnormalities, the diagnosis is made earlier that with amniocentesis

Answer 112

``` Four components: 1) Alpha feto protein (AFP): glycoprotein produced primarily in fetal liver which crosses placenta into maternal serum -can easily be detected in routine blood test (MSAFP) Elevated MSAFP (>/= 2.0-2.5 MoM) can be associated with: -Incorrect dates -Multiple gestation -Open neural tube defects -Abdominal wall defects -Placental chorioangioma -Maternal fetal hemorrhage -Maternal hepatocellular carcinoma Decreased MSAFP associated with: -Incorrect dates -Chromosome abnormalities -Fetal demise 2) Human chorionic gonadotropin (hCG) -Elevated 2 times median value for Down Syndrome 3)Unconjugated estriol (uE3) -Tends to be lower than normal in Trisomy 21 4) Inhibin-A -Elevated with Down Syndrome ```

Answer 113

Assist in locating optimal collection site away from: - Fetus - Umbilical cord - Central placenta - Uterine vessels Typically performed around 16 weeks

Answer 114

Fetal blood is aspirated through umbilical cord

Answer 115

Hormonal and metabolic changes associated with pregnancy can result in a condition referred to as glucose intolerance of pregnancy

Answer 116

- Caudal regression syndrome - Neural tube defects - Cardiovascular malformations - Genitourinary anomalies - SUA - GI anomalies - Skeletal anomalies

Answer 117

- Respiratory distress syndrome - Hypoglycemia - IUGR - Macrosomia - Hypocalcemia - Oligo/ Polyhydramnios (depending on type of fetal anomaly present) - Thickened placenta

Answer 118

- Polyhydramnios - Pre-eclampsia - Renal dysfunction - Hypoglycemia - PVD - Postpartum hemorrhage

Answer 119

- Hypertension - Generalized edema - Proteinuria - Rapid weight gain secondary to edema

Answer 120

- HTN - Edema - Proteinuria - Convulsions - Coma - Death

Answer 121

``` Toxoplasmosis Other (syphilis) Rubella Cytomegalovirus -Herpes (genital) ```

Answer 122

Premature dilation and effacement of the uterine cervix It is the inability of the cervix to prevent the premature expulsion of uterine contents Sono findings: - Shortened cervix ( < 2.5-3 cm) prior to 34 weeks - Dilation of cervix > 2 cm in 2nd trimester - "Bulging" membranes/ "hourglass sign" are poor prognosis

Answer 123

Defined as the onset of labor before 37 weeks Causes: - Previous uterine surgery - Uterine anomalies - Maternal stress - Heavy cigarette smoking - Multiple gestations - Polyhydramnios - Antepartum bleeding - Systemic infections - May be idiopathic

Answer 124

Spontaneous rupture of membranes prior to labor Clinical sign= large passage of watery fluid from the vagina

Answer 125

Enlarges during pregnancy due to estrogen stimulation May obstruct vaginal delivery Clinical signs: - Uterus large for dates - Pain or focal tenderness - Palpable mass - Spontaneous abortion