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DMS 400 OB/GYN > Class 10: U/S in 1st Trimester > Flashcards

Class 10: U/S in 1st Trimester Flashcards

1
Q

what is ovulation?

A

when an ovary releases an ovum

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2
Q

what happens if fertilization of an ovum occurs?

A

corpus luteum cyst stays & the endometrium grows

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3
Q

what happens if fertilization of an ovum doesn’t occur?

A

estrogen & progesterone levels decrease, corpus luteum regresses, and menstruation starts

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4
Q

how long does sperm remain viable in the female reproductive tract?

A

24-72 hours

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5
Q

how much sperm is considered clinical infertility?

A

less than 20 million sperm/ml

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6
Q

term for the functional maturation of sperm?

A

capacitation

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7
Q

what is the process of capacitation?

A

the process where the sperm’s glycoprotein coat is removed by substances secreted by FT & UT

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8
Q

what happens when the sperm’s glycoprotein coat is removed?

A

sperm becomes hyperactive & acrosomal reaction occurs when in contact with ovum

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9
Q

what does the acrosomal reaction do?

A

acrosome from sperm breaks down outer membrane of ovum to penetrate ovum

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10
Q

where does fertilization most commonly occur?

A

ampulla of FT

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11
Q

when does fertilization occur?

A

about 24-36 hours after ovulation

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12
Q

when does implantation occur?

A

about 6 days after ovulation

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13
Q

how many chromosomes are in a zygote?

A

46 chromosomes

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14
Q

what is a zygote?

A

sperm fertilizes an ovum, merge genetic content to make zygote

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15
Q

how many cells are in a morula cell?

A

16 cells

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16
Q

the ____ implants in the uterine cavity

A

blastocyst

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17
Q

what is the trophoblast of the blastocyst?

A

the outermost layer of cells

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18
Q

what is the outer layer of the trophoblast?

A

synctiotrophoblast

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19
Q

what is the inner layer of the trophoblast?

A

cytotrophoblast

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20
Q

what hormone does the trophoblast produce?

A

HCG

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21
Q

what does the trophoblastic tissue form to invade the endometrium?

A

chorionic villi

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22
Q

what is the fetal side of the placenta called?

A

chorionic site

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23
Q

what does the inner cell mass of the blastocele form into?

A

embryo, amnion, and yolk sac

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24
Q

what does the blastocyst become?

A

embryo

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25
Q

what is the gravid endometrium become?

A

the decidua

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26
Q

3 layers of the decidua?

A
  1. decidual basilis
  2. decidual capsularis
  3. decidual parietalis/vera
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27
Q

where is the decidua basilis?

A

the thickened endometrium at the site of implantation

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28
Q

the decidua basilis is the fetal side of the placenta. T/F?

A

false; it is the maternal side

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29
Q

what is the decidua capsularis?

A

endometrium that forms & thickens around the chorion away from the placenta

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30
Q

which decidual layer lines the gestational sac?

A

decidua capsularis

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31
Q

which decidual layer projects into the uterine lumen?

A

decidua capsularis

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32
Q

which decidual layer lines the uterine cavity?

A

decidua parietalis/vera

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33
Q

what is the double decidual sac sign?

A

the interface bw the decidua capsularis & parietalis

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34
Q

the ____ sign is a sign of viable gestation

A

decidua sac sign

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35
Q

what are the 3 fetal membranes?

A

amnion, chorion, yolk sac

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36
Q

2 functions of the yolk sac?

A
  1. provides nutrients for embryo
  2. hematopoiesis
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37
Q

how does the endometrium look like in the first trimester on US?

A

lush echogenic endometrium that represents the double decidual sac sign

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38
Q

1st US appearance of an IUP?

A

gestational sac

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39
Q

1st structure seen in the GS?

A

secondary yolk sac

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40
Q

2nd structure seen in GS?

A

embryo

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41
Q

shape of the GS on US?

A

round, oval, tear drop

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42
Q

location of the GS within the UT?

A

at the UT fundus or eccentrically placed position in mid-UT

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43
Q

what is the decidual wall thickness?

A

> 3 mm

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44
Q

what is the first lab value to be tested for pregnancy?

A

HCG levels

45
Q

what are the 2 preps for HCG levels?

A
  1. 1st IRP: 1st international reference preparation
  2. 2IS: 2nd international standard
46
Q

which prep has HCG quantities double the other?

A

1st IRP
(2)(2IS)=IRP

47
Q

the GS should be seen at 4.5 weeks (TV) from LMP when HCG reaches 2IS levels of ___ mIU/ml

A

500 mIU/ml

48
Q

The GS should be seen at 6 weeks (TA) from LMP when HCG reaches 2IS levels of ___ mIU/ml

A

1800 mIU/ml

49
Q

an unseen yolk sac TV when the MSD is ___ is abnormal

A

> 8mm

50
Q

an unseen yolk sac TA when the MSD is ___ is abnormal

A

> 20 mm

51
Q

which plane do you measure the MSD on?

A

both SAG & TRV

52
Q

MSD formula?

A

MSD=LWH/3

53
Q

the MSD is used up to ___ of gestation +/- ___

A

8 weeks +/- 2 weeks

54
Q

which measurement is the most accurate measurement in pregnancy?

A

CRL

55
Q

the CRL can be used. up to ___ of gestation

A

12 weeks

56
Q

what does the MSD measure?

A

gestational sac

57
Q

what does the CRL measure?

A

embryo

58
Q

what measurement detects cardiac activity of the fetus?

A

fetal heart motion – m-mode

59
Q

what is the vitelline duct?

A

a duct that connects the midgut & yolk sac

60
Q

what 2 structures merge to form the umbilical cord?

A

vitelline duct & allantois

61
Q

when does the heart start pumping?

A

21 days after conception

62
Q

what size is the embryo when we are able to detect cardiac activity?

A

embryo is 5+ mm

63
Q

when does herniation of the gut occur?

A

7-8 weeks

64
Q

when does the herniated gut return to the body?

A

9-10 weeks

65
Q

when is herniation of the gut abnormal?

A

after 12 weeks

66
Q

the embryo should be seen TA when MSD measures ____

A

25+ mm

67
Q

the embryo should be seen TV when MSD measures ___

A

16+mm

68
Q

what weeks is the conceptus considered an embryo?

A

1st day of LMP to week 10

69
Q

what weeks is the conceptus considered the fetus?

A

week 10 to birth

70
Q

3 ways to date the conceptus in the 1st trimester?

A
  1. patient’s LMP
  2. MSD
  3. CRL
71
Q

what is the normal order of structures seen within the early GS for the amnion, embryo, and yolk sac?

A
  1. yolk sac
  2. embryo
  3. amnion
72
Q

it may be normal to see an embryo without amnion. T/F?

A

true

73
Q

it may be normal to see amnion without an embryo. T/F?

A

false – may indicate a nonviable/anembryonic pregnancy

74
Q

what is another name for a failed IUP?

A

miscarriage

75
Q

what is considered a failed IUP?

A

a gestational sac without a yolk sac

76
Q

a GS without a yolk sac when MSD measures ____ TV is considered a miscarriage

A

> 8 mm

77
Q

a GS without a yolk sac when MSD measure ____ TA is considered a miscarriage

A

> 20 mm

78
Q

how is a blighted ovum diagnosed?

A

a GS without fetal pole or yolk sac

79
Q

another name for a blighted ovum?

A

anembryonic pregnancy

80
Q

3 clinical findings for a blighted ovum?

A
  1. vaginal bleeding
  2. low HCG levels
  3. decreasing S&S of pregnancy
81
Q

a GS without an embryo with an MSD of ___ TV is considered an anembryonic pregnancy

A

16 mm

82
Q

a GS without an embryo with an MSD of ___ TA is considered an anembryonic pregnancy

A

25 mm

83
Q

US can detect a heartbeat when an embryo is ___ mm

A

> 5mm

84
Q

what is considered an abortion/spontaneous abortion/miscarriage

A

termination of pregnancy < 20 weeks gestation

85
Q

what is a complete abortion?

A

all products of conception are expelled

86
Q

US appearance of complete abortion?

A

normal thin endo, empty UT, no corpus luteum cyst

87
Q

clinical findings of complete AB?

A

quickly declining HCG
bleeding & cramps

88
Q

what is an incomplete abortion?

A

there are still retained POC in the UT

89
Q

U/S appearance of an incomplete abortion?

A

thick, irregular endo
fluid in endo
embryonic parts with or without shadowing

90
Q

what is a missed abortion?

A

an embryo without cardiac activity (no flow w CD) and not expelled

91
Q

US appearance of GS & cervix with missed AB?

A

GS is intact & closed cx

92
Q

what is a threatened abortion?

A

patient presenting vaginal bleeding with closed cx prior 20 weeks

93
Q

a threatened abortion is clinical findings only. T/F?

A

true

94
Q

US appearance of threatened AB

A

normal appearance with intact GS & live embryo. cervix is closed

95
Q

what is the length of a normal cervix?

A

3-4 cm

96
Q

what length is considered an incompetent cervix?

A

<2.5 cm

97
Q

other names for inevitable abortion?

A

imminent abortion/abortion in progress

98
Q

what is inevitable abortion?

A

when IUP is moving towards the cervix; dilated cervix; patient has profuse bleeding

99
Q

what is a septic abortion?

A

abortion due to infection

100
Q

what is therapeutic abortion?

A

termination of pregnancy by D&C or surgical means

101
Q

difference between therapeutic vs elective abortion?

A

therapeutic is due to mom or fetus’ life in danger; elective is the mom’s choice

102
Q

what is habitual abortion?

A

repeated SAB

103
Q

lab values for all types of abortion?

A

decreasing HCG levels

104
Q

what is the most common cause off bleeding in the 1st trimester?

A

subchorionic hemorrhage

105
Q

what is another name for subchorionic hemorrhage?

A

perinatal hemorrhage

106
Q

when can a subchorionic hemorrhage occur?

A

at the time of implantationg

107
Q

where does a subchorionic hemorrhage occur?

A

between the uterine wall & GS/chorion

108
Q

S&S of subchorionic hemorrhage?

A

spotting or bleeding with or without contractions

109
Q

2 outcomes for subchorionic hemorrhage

A
  1. spontaneously regress
  2. spontaneous abortion if large hemorrhage

DMS 400 OB/GYN (21 decks)

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