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DMS 150 OB/GYN > Chapter 28 Neonatal And Pediatric Pelvis > Flashcards

Chapter 28 Neonatal And Pediatric Pelvis Flashcards

0
Q

Surface epithelium gives rise to ________ ________ ________or _________ _________.

A

secondary sex cords; cortical cords

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1
Q

Primary sex cords converge to form network of canals called the ______ _______.

A

rete ovarii

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2
Q

Oogonia multiply rapidly by ________.

A

mitosis

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3
Q

Before birth all oogonia enlarge to form what?

A

oocytes

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4
Q

________ remain in arrested state until puberty.

A

Ovaries

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5
Q

Male/female reproductive organs develop from the same source. ________ ________ grow to form primary sex cords.

A

gonadal ridges

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6
Q

By what week of gestation is the external genitalia fully formed?

A

12th week

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7
Q

_________ ________ form most of the female reproductive system.

A

Müllerian ducts

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8
Q

_________ _________ form most of the male reproductive system.

A

Wolffian ducts

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9
Q

Uterus and upper third of the vagina are derived from what?

A

The Müllerian ducts

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10
Q

Ducts elongate - internal lumens at how many weeks gestation?

A

7-12 weeks

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11
Q

Fusion of the Müllerian ducts begins _______ and progresses _______. Starts with _______ and progresses to ________.

A

caudally, cephalically; vagina, fallopian tubes

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12
Q

Fused caudal ends of the Müllerian ducts form what?

A

vagina, cervix, uterus

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13
Q

Unfused cranial ends form what?

A

Fallopian tubes

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14
Q

Fusion ________ can occur throughout the process.

A

anomalies

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15
Q

To image the pediatric pelvis you need to have the child do what?

A

Fill bladder

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16
Q

How should an infant/toddler fill their bladder?

A

have parent keep child well hydrated

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17
Q

How should you have a potty trained child fill their bladder?

A

drink 2 glasses of fluids 1 hour prior - hold bladder

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18
Q

How should you have a young teen fill their bladder?

A

drink 3-4 glasses of fluids 1 hour prior

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19
Q

What type of walls should the pediatric bladder have?

A

Smooth thin wall

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20
Q

What should the wall thickness of the bladder be when it is full?

A

1.5-3mm

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21
Q

What should the wall thickness of the bladder be when it is empty or partially filled?

A

< 5mm

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22
Q

When using bladder jets with color doppler, ureters should be dilated. True or false?

A

False. Ureters should not be dilated

23
Q

Should fluid be visualized in the neck and urethra?

A

no fluid should be visualized

24
Q

What should the newborn uterus look like?

A
  • Prominent - maternal hormones
  • Pear shaped
  • Length - 3.5 cm
  • Fundus/cervix ratio-1:2
25
Q

At 2-3 months what should the uterus look like?

A
  • Teardrop shape - tubular configuration
  • Length - 2.5-3 cm (prepuberty)
  • Fundus/cervix ratio- 1:1
  • No discernible endometrial stripe
26
Q

What should the uterus look like at age 7?

A

Begins to increase in size and take on pear shape

27
Q

What should the uterus look like at puberty/post puberty?

A
  • Dramatic changes in shape and size
  • Length 5-7 cm
  • Fundus/cervix ratio- 3:1
28
Q

To image the vagina, a _______ _______ is needed.

A

full bladder

29
Q

The vagina is a _______ structure posterior to bladder, and has continuity with ________.

A

tubular, cervix

30
Q

The vagina has a ______ central echo.

A

bright

31
Q

How should you measure the ovary?

A

Use volume measurement

32
Q

Where should you find the ovaries?

A

anywhere between lower pole kidneys to true pelvis

33
Q

What is size of the ovary up to 5 years old?

A

.75-.86 cm cubed

34
Q

What is the appearance of the ovary in neonatal?

A

heterogeneous secondary to tiny cysts

35
Q

What is the appearance of the ovary as there is an increase in age?

A

homogeneous, maybe small cysts

36
Q

Describe congenital anomalies of the uterus and ovaries.

A

Developmental abnormality, interference with blood supply or distortion of uterine cavity may cause infertility or spontaneous abortion

37
Q

Congenital anomalies occur in what percentage of females?

A

approximately .5%

38
Q

Congenital anomalies of the uterus and ovaries have a very high association with what?

A

renal anomalies

39
Q

Müllerian abnormalities include what?

A

improper fusion, incomplete development of one side, incomplete vaginal canalization

40
Q

If Müllerian anomalies are detected, what should you do?

A

You should ALWAYS check kidneys

41
Q

What are the six groups of Müllerian anomalies?

A

Class I - incomplete vaginal canalization
Class II - unicornuate uterus
Class III - uterus didelphys
Class IV - bicornuate uterus
Class V - septate uterus
Class VI - Diethylstibestrol (DES) exposure - “T” shape uterus
C

42
Q

Class I - Segmental Mullerian agenesis-incomplete vaginal canalization

A
  • transverse vaginal septum or vaginal atresia (not fully formed)
  • suspected when girl reaches puberty without menstruation
43
Q 
Class I - Vaginal atresia
hydrocolpus -
hydrometrocolpus-
hematometrocolpus-
cervix may be \_\_\_\_\_\_\_
large \_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_\_ in neonatal period or \_\_\_\_\_ at puberty
\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_.
A

hydrocolpus - fluid filled vagina
hydrometrocolpus - fluid filled vagina and uterus
hematometrocolpus - blood filled vagina and uterus
cervix may be absent
large cystic pelvic mass in neonatal period or diagnosis at puberty
imperforate hymen

44
Q

Class II

A
  • unicornuate uterus
  • complete unilateral arrest of Mullerian Ducts
  • may have small rudimentary horn if partial arrest
  • long, slender uterus (cigar shaped)
  • deviated to one side
  • frequently renal agenesis on contralateral side
  • small and laterally positioned uterus
  • infertility and pregnancy loss
45
Q

Class III

A
  • uterus didelphys
  • complete nonfusion of Müllerian ducts
  • complete duplication of uterus, cervix, and vagina
  • not usually associated with infertility problems - no treatment
  • 2 endometrial echo complexes
46
Q

Class IV

A
  • bicornuate uterus
  • partial nonfusion of the Müllerian ducts
  • duplication of uterus-common cervix
  • wide-spaced cavities - low incident of fertility complications - usually not treated
  • rudimentary cavity - at 12-16 weeks gestation, rupture of uterine cavity
  • 2 endometrial cavities visualized
47
Q

Class V

A

Septate uterus

  • 2 uterine cavities closely spaced - 1 fundus - possibly 2 cervical canals or vaginal septum
  • highest incidence of infertility problems
  • MOST COMMON UTERINE ANOMALY
48
Q

Class VI

A
  • exposure to diethylstilbestrol (DES) in utero - synthetic drug used in 1970’s during pregnancy to treat threatened and habitual abortion
  • drug causes vaginal malignancies in the daughters
  • uterus - normal shape and size
  • uterine cavity “T” shaped, irregular contour
49
Q

Ambiguous Genitalia

-hermaphroditism

A
  • True - both ovarian and testicular tissue
  • Internal and external genitalia variable
  • 46, XX karyotype, or mosaics (46, XX/46, XY)
50
Q

Ambiguous Genitalia

-Female pseudohermaphroties

A
  • 46, XX karyotype
  • increase production of androgens
  • masculinization of external genitalia (enlarged clitoris, abnormalities of urogenital sinus and partial fusion of the labia majora)
  • ultrasound used to determine presence or absence of uterus, vagina and ovaries
51
Q

Precocious Puberty

-true precocious puberty

A

ALWAYS isosexual (same sex)

  • development of secondary sexual characteristics and increasing size and activity of reproductive organs prior to normal puberty age-usually < 10 y/o
  • uterus enlarged, postpubertal configuration - 2:1 & 3:1 fundus/cervix ratio
  • ovarian volume enlarged > 1 cubic cm - functional cysts present
52
Q

Precocious pseudopuberty

A
  • maturation of secondary sexual characteristics but not reproductive organs
  • no activation of hypothalamic-pituitary-gonadal axis
  • usually associated with increase steroidal release from adrenal glands-tumors
  • should always scan the liver and adrenal glands to r/o lesion
53
Q

Pathology of the Pediatric Ovary

-Ovarian cyst

A
  • may form inutero, but spontaneously resolve
  • 3-7 mm cysts normal
  • higher incident in neonates of mothers with toxemia, diabetes, Rh isoimmunization - greater than normal release of placental chorionic gonadotropin
  • most common complications: hemorrhage, torsion
  • may rupture
  • Sono findings - anechoic structure adjacent to, or within ovary may have debris if hemorrhage
    • little or no color flow to ovary if torsion
54
Q

Pathology of the Pediatric Ovary

-Ovarian Torsion

A
  • may occur at any age
  • sudden onset of severe pain**
  • more common associated with ovarian cyst/mass
  • arterial and venous blood flow compromised (venous first)**
  • enlarged and edematous ovary
55
Q

Pathology of the Pediatric Ovary

-Ovarian Teratomas

A
  • uncommon in adolescent and neonate
  • 60% germ cell
  • benign or malignant
    • most common in pediatrics is benign mature teratoma or dermoid cyst
      • usually asymptomatic until gets very large
      • mmost frequent complication is torsion - 16-40%
56
Q

What is the sonographic appearance of ovarian teratomas?

A
  • varied-complex, heterogeneous mass
  • frequently echogenic foci with acoustic shadowing-less shadowing in neonates
  • “tip of the iceberg”

DMS 150 OB/GYN (1 decks)

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