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DMS 400 OB/GYN > Class 12: OB 2nd & 3rd Trimester > Flashcards

Class 12: OB 2nd & 3rd Trimester Flashcards

1
Q

the gestational period in the human usually lasts ___ days, ___ weeks, ___ months

A

280 days, 40 weeks, 9 months

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2
Q

weeks of first trimester? significance of first trimester?

A

weeks 1-12; period of organogenesis

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3
Q

weeks of 2nd trimester? significance of 2nd tri?

A

weeks 13-26; period of organ development & differentiation

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4
Q

weeks of 3rd trimester? significance of 3rd tri?

A

weeks 27-40; fetal growth & weight gain

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5
Q

what is embryonic age?

A

embryologists consider the day of conception as the first day of pregnancy

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6
Q

what is another name for gestational age?

A

menstrual age

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7
Q

what is gestational/menstrual age?

A

the first day of LMP as the 1st day of pregnancy

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8
Q

gestational age is ___ weeks more than embryonic age

A

2 weeks

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9
Q

3 structures seen in 1st trimester

A
  1. gestational sac
  2. yolk sac
  3. fetal pole with FHM
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10
Q

when can the gestational sac be seen by?

A

5 weeks from LMP (TV)

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11
Q

when can the yolk sac be seen by?

A

5.5 weeks from LMP (TV)

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12
Q

when can the fetal pole be seen by?

A

6 weeks from LMP (TV)

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13
Q

when do the amnion & chorion merge by?

A

16-17 weeks

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14
Q

the placenta can be seen as crescent echogenic area by ___ weeks

A

7-8 weeks

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15
Q

placenta can be clearly visualized by ___ week

A

12th week

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16
Q

placenta borders can be identified by ___ week

A

20th week

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17
Q

how much does the fetal pole grow each day in 1st trimester?

A

1 mm/day

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18
Q

when is the fetus most susceptible to injury?

A

1st tri

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19
Q

amniotic fluid volume increases until ___ weeks

A

36-38 weeks

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20
Q

US appearance of amniotic fluid in 1st & 2nd tri?

A

anechoic

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21
Q

US appearance of amniotic fluid in 3rd tri?

A

may contain small echogenic particles (vernix)

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22
Q

5 functions of amniotic fluid

A
  1. cushions fetus
  2. allows movement
  3. prevents adherence of amnion to embryo
  4. allows symmetrical growth
  5. maintains constant temp
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23
Q

when is most of the amniotic fluid made by the mother?

A

prior to 20 weeks

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24
Q

the amount of amniotic fluid is ___ related to ___ function

A

directly; kidney

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25
Q

normal lung development depends on the exchange of ___ within the lungs

A

amniotic fluid

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26
Q

severe oligohydramnios may lead to ____ hypoplasia

A

pulmonary hypoplasia

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27
Q

oligohydramnios is idiopathic 60% of the time. T/F?

A

false – there is usually a cause

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28
Q

what are the most common causes of oligohydramnios (3)

A
  1. PROM
  2. IUGR/FGR
  3. abnormalities in fetal genituourinary tract (blockage, no renals, no renal function)
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29
Q

polyhydramnios is idiopathic 60% of the time. T/F?

A

true

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30
Q

when may the sonographer see amniotic membrane floating in amniotic cavity?

A

after 16 weeks

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31
Q

what can floating amniotic membranes cause?

A

amniotic band syndrome

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32
Q

what is amniotic band syndrome?

A

bands/tears from amnion may entangle fetal structures and cause defects

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33
Q

what is another name for uterine contractions?

A

braxton hicks contractions

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34
Q

what are braxton hicks contractions?

A

smooth contractions of the myometrium

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35
Q

when can braxton hicks contractions occur?

A

throughout pregnancy

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36
Q

how long do uterine contractions occur?

A

about 30-45 minutes

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37
Q

U/S appearance of contractions?

A

homogenous

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38
Q

what is cervical incompetence?

A

cervical dilation prior to term

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39
Q

what is an abnormal endocervical canal length?

A

< 2.5 cm

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40
Q

what is a cerclage?

A

loop placed in cervix to hold it closed

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41
Q

what condition is considered normal in 2nd or 3rd trimester with the maternal kidneys?

A

some degree of hydronephrosis

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42
Q

which kidney is maternal hydronephrosis more common in?

A

right kidney

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43
Q

what does EDC stand for?

A

estimated date of confinement (due date)

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44
Q

how is EDC calculated?

A

by the 1st day of LMP

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45
Q

what 4 measurements are used for dating fetus in US?

A

BPD, HC, AC, FL

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46
Q

what week do the 3 primary brain vesicles start developing? what are these vesicles called?

A

~ week 6
prosencephalon
mesencephalon
rhombencephalon

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47
Q

what cystic structure can be seen in the posterior aspect of the fetus around 6-8 weeks?

A

rhombencephalon

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48
Q

what do the lateral ventricles look like around 11-12 weeks?

A

butterfly appearance

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49
Q

the choroid plexus can be seen at the ____ of the lateral ventricles

A

roof

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50
Q

function of the choroid plexus?

A

makes CSF

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51
Q

what week can the fetal head by well appreciated by?

A

12th week

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52
Q

by what week does the appearance of each brain structure remain relatively the same?

A

18th week of gestation

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53
Q

which plane do we check the contour of the skull bones?

A

long axis

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54
Q

the 4 levels to assess when checking brain development

A
  1. most superior level with IHF
  2. forebrain – lateral ventricles
  3. midbrain – thalamus, CSP, 3rd ventricle
  4. hindbrain – cerebellum, 4th ventricle, nuchal fold
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55
Q

another name for interhemispheric fissure

A

falx cerebri

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56
Q

what is the IHF/falx cerebri?

A

membrane that separates the brain into 2 hemispheres

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57
Q

the IHF ensures the separation of the ___ occured

A

cerebrum

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58
Q

the lateral ventricles shouldn’t exceed ___ mm or ___ cm

A

10 mm/1cm

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59
Q

which part of the brain is the lateral ventricle a part of?

A

forebrain

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60
Q

where is the widest diameter of the skull?

A

midbrain

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61
Q

3 midbrain landmarks?

A
  1. CSP
  2. 3rd ventricles
  3. thalami
62
Q

which direction does the apex of the thalami face?

A

occipital bone

63
Q

where is the CSP located?

A

midbrain in front of the thalamus

64
Q

where do you take the measurements for BPD & HC?

A

midbrain at the level of the thalamus, CSP & 3rd ventricle

65
Q

landmarks of the hindbrain?

A

cerebellum, 4th ventricle, nuchal fold

66
Q

the cerebellum is at the back of the cerebral ___ within the ___ fossa

A

peduncles; posterior

67
Q

what connects the cerebellar hemispheres?

A

vermis

68
Q

what is the space in the posterior fossa that is filled with CSF?

A

cisterna magna

69
Q

a normal cisterna magna may exclude almost all spinal defects. T/F?

A

true

70
Q

what is the normal measurement of the cisterna magna?

A

cisterna magna shouldn’t exceed 10 mm/1 cm

71
Q

what is the nuchal fold?

A

skin fold

72
Q

U/S appearance of occipital bone?

A

echogenic

73
Q

where are the orbits seen seen in comparison to the cerebellar plane?

A

inferior to cerebellar plane

74
Q

5 routine measurements for dating the fetus?

A
  1. BPD
  2. HC
  3. AC
  4. FL
  5. AFI
75
Q

6 nonroutine measurements for dating the fetus?

A
  1. lateral ventricles
  2. cisterna magna
  3. cerebellum
  4. orbits
  5. nuchal fold
  6. nuchal translucency
76
Q

what does the BPD assess?

A

gestational age

77
Q

what weeks is the BPD most accurate?

A

weeks 14-20

78
Q

How to place calipers for the measurements for BPD?

A

outer to inner

79
Q

landmarks for the BPD?

A

midbrain: thalamus, CSP, 3rd ventricle

80
Q

what does the HC assess?

A

gestational age

81
Q

is the HC or BPD more accurate? why?

A

HC bc it isn’t affected by head shape

82
Q

where do you take the measurements for HC?

A

outer to outer with ellipse or caliper button

83
Q

what are the 2 variations in head shape?

A
  1. brachycephaly
  2. dolichocephaly
84
Q

what is brachycephaly?

A

a more rounded head shape

85
Q

what is dolichocephaly?

A

more elongated head shape

86
Q

why was the cephalic index (CI) created?

A

it helps determine a normal fetal head size regardless of variations in fetal head shape

87
Q

formula for CI?

A

CI = BPD/OFD x 100

88
Q

what is a normal cephalic index range?

A

75-85%

89
Q

what is considered brachycephaly in regards to the CI?

A

over 85-90%

90
Q

what is considered dolichocephaly in regards to the CI?

A

< 70%

91
Q

the cerebellum measurement can be used up to ___ weeks of gestation

A

24 weeks

92
Q

the cerebellum measurement correlates with fetal ___ from ____ weeks of gestational age

A

fetal age from 16-24 weeks

93
Q

for the cerebellum measurement, the imaging plane is ___ & ___ to the BPD level

A

parallel & inferior

94
Q

U/S appearance of cerebellar hemispheres?

A

2 hypoechoic hemispheres

95
Q

U/S appearance of vermis?

A

hyperechoic

96
Q

the ___brain is anterior to vermis

A

midbrain

97
Q

normal measurement of nuchal fold at the level of the cerebellum shouldn’t exceed ___

A

6 mm

98
Q

a nuchal fold measuring 6 mm or more may indicate ___

A

down’s syndrome

99
Q

the lateral ventricles can be clearly identified by which week of gestation?

A

16th week

100
Q

how do you measure the OFD?

A

from midpoint of frontal to midpoint of occipital

101
Q

how do you measure the cisterna magna?

A

from outer of vermis to the inner of occipital bone (ONLY CM)

102
Q

both the NT & nuchal fold rule out ___ abnormalities

A

chromosomal

103
Q

which trimester is the NT measured in?

A

1st trimester

104
Q

which plane is NT measured?

A

sagittal/long axis

105
Q

if the NT is equal to or greater than ___, it can indicate ___ abnromality

A

3 mm; chromosomal abnormalities

106
Q

which trimester is the nuchal fold measured in?

A

2nd tri

107
Q

what plane is the nuchal fold measured in?

A

transverse or cross-section

108
Q

the nuchal fold is measured at the level of the ____

A

cerebellum

109
Q

how do you measure the nuchal fold?

A

from outer occipital bone to the outer skin

110
Q

normal measurement for nuchal fold?

A

less than 6 mm

111
Q

if the nuchal fold measures 6mm or greater, this can indicate what 4 conditions?

A
  1. chromosomal abnl
  2. fetal demise
  3. skeletal dysplasia
  4. fetal hydrops
112
Q

2 measurements for the orbits

A
  1. OOD/binocular distance
  2. IOD/interocular distance
113
Q

what does the OOD measure?

A

gestational age

114
Q

when do you measure OOD?

A

when unable to get BPD or HC

115
Q

what does IOD rule out?

A

hyper/hypotelorism

116
Q

best plane to image cleft lip?

A

sagittal

117
Q

most common fetal neck mass?

A

cystic hygroma

118
Q

the vertebrae can be well visualized by ___ weeks of gestation

A

16

119
Q

what is the preferred plane to image the spine? SAG or COR?

A

SAG

120
Q

how does the spine look on U/S in TRV?

A

3 highly echogenic ossification centers

121
Q

U/S appearance of the fetal spine in SAG?

A

railroad sign – 2 curvilinear lines extending from cervical spine to sacrum

122
Q

U/S appearance of fetal spine in COR?

A

3 parallel lines that can be imaged from cervical spine to lumbar sacral region

123
Q

define fetal presentation

A

the fetal part closest to the cervix

124
Q

3 types of fetal presentation

A
  1. cephalic
  2. breech
  3. other
125
Q

define fetal lie

A

the long axis orientation of the fetus

126
Q

3 types of fetal lie

A
  1. longitudinal
  2. transverse
  3. oblique
127
Q

U/S appearance of fetal lungs?

A

solid masses between fetal heart and ribs

128
Q

U/S appearance of fetal lungs in early fetal life compared to liver?

A

lungs are iso/hypoechoic to liver

129
Q

U/S appearance of fetal lungs later in fetal life compared to liver

A

hyperechoic to liver

130
Q

lung maturity is determined by ____

A

amniocentesis

131
Q

what ratio is checked with amniocentesis to determine lung maturity?

A

lecithin-sphingomyelin ratio

132
Q

an LS ratio of ___ indicates mature lungs

A

2+

133
Q

what is the fetal heart rate after the 1st tri?

A

120-160 BPM

134
Q

what is the most important view for the fetal heart?

A

4 chamber view

135
Q

what percentage of all abnormalities can be ruled out with the 4th chamber view?

A

65%

136
Q

the fetal diaphragm can be seen in ___ of fetuses by ___ weeks

A

1/2 of fetuses by 20 weeks

137
Q

the fetal kidneys are seen by ___ weeks

A

15-16 weeks

138
Q

the fetal stomach should be documented by ___ weeks

A

20 weeks

139
Q

U/S appearance of fetal kidneys in early vs later gestation

A

kidneys are hypoechoic in early gestation & look similar to adult kidneys in later gestation

140
Q

which measurement does fetal weight rely on the most?

A

AC

141
Q

what is the standard measurement for dating the fetus after 12-15 weeks?

A

AC

142
Q

landmarks for AC?

A

stomach
ossification centers of spine
portal sinus

143
Q

how to measure AC?

A

outer to outer using ellipse

144
Q

how many vessels are in the umbilical cord?

A

3 – 1 umbilical vein & 2 spiral arteries

145
Q

which vessel brings oxygen & nutrient rich blood to the fetus?

A

umbilical vein

146
Q

what do the umbilical arteries do?

A

carry nutrient poor & O2 poor blood away from fetus to the placenta

147
Q

which trimester is the fetal bowel seen?

A

3rd tri

148
Q

the fetal urinary bladder can be seen by ___ weeks

A

20 weeks

149
Q

seeing the UB ensures the ____ of at least ___

A

presence; 1 kidney

150
Q

how to measure femur length?

A

measure only diaphysis of bone

151
Q

when is femur length more accurate in dating?

A

late pregnancy

152
Q

fetal genitalia can be best identified after ___ weeks

A

20

DMS 400 OB/GYN (21 decks)

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