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Ob / Gyn 2 > Fetal Spine Pathology > Flashcards

Fetal Spine Pathology Flashcards

1
Q

Each vertebra will develop from

A

Three ossification centres

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2
Q

What forms the central portion of the vertebral body

A

Centrum

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3
Q

What will the 2 neural processes form

A 
Pedicles
Transverse processes 
Laminae
Spinous process 
Posterolateral part to the vertebral body
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4
Q

When is the ossification of the laminae complete

A

18weeks

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5
Q

What could be missed potentially if a fetus is scanned before 18weeks

A

Spina bifida

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6
Q

What increases the risk of NTD

A 
Valproate acid
Folic acid deficiency 
History of spinal defect 
-previous pregnancy 
-Fx of NTD
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7
Q

What is a spina bifida

A

Defect in the structure of the spinal canal that may result in the herniation of its contents

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8
Q

What are the contents contained in a spina bifida

A

Meninges
CSF
Neural tissue

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9
Q

A spina bifida is a

A

NTD

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10
Q

What are other NTD

A

Encephalocele

Anencephaly

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11
Q

What are the different variations of Spina Bifida

A

Spina bifida occulta

Spina bifida aperta

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12
Q

What does a spina bifida occulta involve

A

Only the deeper layers

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13
Q

What may only be seen in a spina bifida occulta

A

A skin dimple or patch of hair on the skin

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14
Q

Is a spina bifida occulta a open or closed defect

A

Closed

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15
Q

What layers does a spina bifida aperta involve

A

All layers- from dura to skin

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16
Q

Is spina bifida aperta a open or closed defect

A

Open

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17
Q

What are the 2 types of spina bifida aperta

A

Meningocele

Myelomeningocele

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18
Q

What is a meningocele

A

Only meninges protrude with CSF

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19
Q

What is a myelomeningocele

A

Protrusion that contains meninges, CSF and neural tissue

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20
Q

AFP is produced by the

A

Fetal liver

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21
Q

When is the quad screen done

A

At week 16

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22
Q

What does AFP cross

A

Placenta

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23
Q

What must be considered for the levels of AFP

A

Gestational age, since the levels vary with age

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24
Q

MS AFP is elevated with what

A

NTD that are not covered by skin

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25
Q

What causes the MS AFP to be elevated

A 
Abdominal wall defects 
Multifetal pregnancies
Fetal death 
Urinary obstruction 
Cystic hygroma 
Incorrect dates
26
Q

What is the most common reason AFP will be elevated

A

Incorrect dates

27
Q

NTE usually occur where

A

In the lumbrosacral spine

28
Q

What is a NTD associated with

A

Meckel grub are syndrome
Trisomy 18
Triploidy

29
Q

What is Spinal dysraphism

A

Abnormal closure of the spine

Also called rachischisis

30
Q

What does rachischisis mean

A

Spinal dysraphism, or failure of fusion of the vertebral arches

31
Q

The level of the NTD corresponds to which landmarks

A

T-12 most distal rib
L-5 superior margin of iliac wing
S-4 most caudal ossification center in 2nd trimester

32
Q

The higher the defect the neural tube what will happens to the fetus

A

The more defects it will have

33
Q

What is also effected when there is a NTD

A

Legs

34
Q

What will happen to the legs with a NTD

A

Clubfoot and hip dislocation ebcause of an imbalance of muscular activity due to nerve involvement or impairment of neural tube defect

35
Q

What is the US appearance of a NTD

A

Splayed laminae

Protruding mass or cyst

36
Q

When there is a NTD what should also be looked

A

Arnold chiari II malformation

Ventriculomegaly

37
Q

Assessment of the spine is best done in what plane

A

Transverse

38
Q

What is the prognosis of a NTD

A

Dependant on location and extent

39
Q

What is iniencephaly

A

Special case of dysraphism involving the back of the cranium and c-spine

40
Q

What does inien refer to

A

Nape of the neck

41
Q

What causes iniencephaly

A

Segmentation error of the upper spine that shortens the neck and the head becomes dorsiflexed

42
Q

What is iniencephaly known as

A

Star gazing position

43
Q

What can iniencephaly be associated with

A

Anencephaly

44
Q

What is scoliosis

A

Lateral curvature of the spine

45
Q

What is kyphosis

A

Exaggerated curvature of the spine in the Sagittal plane

46
Q

What would you expect to see in the brain with iniencephaly

A

Hydrocephalus

47
Q

What are scoliosis and kyphosis associated with

A

Amniotic band syndrome
Skeletal dysplasia
VACTERL
Caudal regression syndrome

48
Q

Who had a increased risk for having a fetus with caudal regression

A

Mother with maternal diabetes

49
Q

What is caudal regression

A

Range of anomalies of the spine from absence of part of the sacrum to absence of lumbar spine

50
Q

What is sirenomelia

A 
Absence of sacrum 
Fusion of the legs
Rectal atresia
Renal dysgenesis or agenesis 
Oligohydraminos
51
Q

What is the prognosis for sirenomelia

A

Fatal, all die in infancy

52
Q

What is the most severe form of caudal regression

A

Sirenomelia

53
Q

What does a sacrococcygeal teratoma contain

A

Elements of many tissues

54
Q

Where can teratomas arise from

A

Sacrum or coccyx
Brain
Gonads

55
Q

What are the four types of sacrococcygeal teratomas

A

External mass predominant
Eternal mass with internal components
Internal mass predominant with smaller external component
Presacral mass

56
Q

What is the appearance of sacrococcygeal teratoma on US

A

Mass in rump or buttocks area adjacent to spine

Displaces the pelvic structures and may compress the ureters causing hydronephrosis

57
Q

If there is AV shunting from sacrococcygeal teratoma what might be seen

A

Heart failure

58
Q

What is the echotexture of a sacrococcygeal teratoma

A

85% are solid/mixed
15% cystic
Possible to see calcifications

59
Q

If a sacrococcygeal teratoma has a solid or mixed echotexture, is it benign or malignant

A

Malignant

60
Q

What is the prognosis of of a sacrococcygeal teratoma

A

It is dependant on size of mass and severity of structure displacement

61
Q

If the mass is >4.5cm that what would be warranted at delivery

A

C-section

62
Q

What is a DDX for a sacrococcygeal teratoma

A

Rectal duplication
Anterior myelomeningocele
Sarcoma

Ob / Gyn 2 (8 decks)

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