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Obstetrics & Gynecolgy 1 > Mod 5 > Flashcards

Mod 5 Flashcards

1
Q

Pregnancy is dated by

A

Weeks from first day of the last menstrual period or LMP

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2
Q

Pregnancy

A

40 completed weeks gestation
280 days
3 trimesters

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3
Q

1st trimester

A 
From 0-13 weeks +6 days LMP
Confirms:
pregnancy
Pregnancy location
Size of embryo agrees with LMP dating 
Number of embryos 
Viability- fetal heart beat with M-mode
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4
Q

Embryo

A

Conceptus is called this from conception up to 10 weeks LMP

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5
Q

Fetus

A

After 10 weeks LMP embryo is renamed to this

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6
Q

Sonography uses this date

A

LMP

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7
Q

Embryologist use this date

A

Conception date

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8
Q

What do Sonographers measure when determining due date

A

Crown Rump Length - CRL

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9
Q

Ovulation

A

Occurs at day 14 in the ideal cycle
LH must surge for it to occur
Ovum is ejected from follicle, propelled towards Fallopian tube
Lives for 12-24 hours

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10
Q

Sperm

A 
200-500 million sperm deposited near cervix 
300-500 reach ovum 
100 million/ml is the normal count 
20 million or less is considered sterile
Survives usually for 24hrs 
- can survive up to 72hrs
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11
Q

Fertilization

A

Sperm passes through zona pellucida
Sperm head enlarges to become male pronucleus
Ovum completes its second meiotic division to become female pronucleus
Both pronucleo fuse and chromosomes intermingle

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12
Q

Zygote

A

Union of the sperm and ovum

Also called conceptus

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13
Q

Morula

A

Cluster of cells
Remains the same size but cells become smaller and smaller with each division
12-16 blastomeres

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14
Q

Blastocyst

A

Secretions cross the zona pellucida entering the morula forming a fluid cavity
Enters the uterus 6-7 days after fertilization

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15
Q

How long does the ovum travel and where does it eventually get fertilized

A

Travels about 24-36 hrs to a Pilar portion of Fallopian tube

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16
Q

Implantation occurs

A

Complete by 11-12 days post ovulation or 9-12 days post fertilization
Suppose to implant on the posterior portion of the uterus on the endometrium fundus

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17
Q

Celvage

A

Rapid cell decision without a change in the size of original zygote

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18
Q

Blastomeres

A

Two daughter cells

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19
Q

What are the two parts that the zygote separates into after fluid goes into zygote

A

Trophoblasts

Embryoblasts

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20
Q

Trophoblast

A

Outer cell to become placenta and chorion

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21
Q

Chorion

A

Responsible for fetal tissue

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22
Q

Embryoblast

A

Inner cell mass forms:
Embryo
Yolk sac
Amnion

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23
Q

What happens when the zona pellucida disappears

A

Blastocyst implants in the uterus

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24
Q

After implantation

A

Blastocyst is imbedded in endometrial epithelium

Trophoblasts differentiates into syncytiotrophoblast and cytotrophoblast

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25
Q

Syncytiotrophoblast

A

Produces hCG

Erodes the endometrial stromatolites and blastocyst sinks into endometrium

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26
Q

Lacunae

A

Eroded space of endometrium

Become the intervillous spaces of the placenta

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27
Q

Cytotrophoblast

A

Produces fingerlike projections that extend into the forming lacunae network

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28
Q

Primary chorionic villi

A

Fingerlike projections of the cytotrophoblast
Two types are:
Chorion frondosum
Smooth chorion/ chorion laeve

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29
Q

Chorion frondosum

A

Villi directly at the implantation site

Early placenta

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30
Q

Smooth Chorion/ chorion laeve

A

All the remaining villi around the gestational sac

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31
Q

Decidua cells in endometrium increase in size and content for implantation due to which hormone

A

Progesterone

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32
Q

What is the cause and the result of the endometrium undergoing a decidua reaction

A

Ectopic pregnancy

Result is the formation of a pseudo sac

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33
Q

What kind of reaction can occur in a bicoruate uterus

A

Decidua reaction

Gives the appearance that this is twins as the non pregnant horn response to the increase in hCG

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34
Q

Decidua basalis

A

Part of the decidua underlying the conceptus
Eventually becomes the maternal side of the placenta
Thickens layer where implantation occurs

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35
Q

Decidua capsularis

A

Part that covers the gestational sac

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36
Q

Decidua parietalis

A

All remaining decidua

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37
Q

Double decidual sign

A

Sonographic descriptor
Opposed layers of the decidua parietalis and capsularis can be identified on early u/s

This should be always be tried to rule out pseudo sacs

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38
Q

Prior to fusion of decidua Vera and capsularis what exists and what happens to it during implantation

A

Potential space between the two layers

Blood can collect in this space if their is bleeding during implantation

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39
Q

Amniotic cavity

A

Formed by the small spaces that occur between the inner cell mass and the trophoblast
Occurs by day 9

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40
Q

Blastocyst cavity is renamed to what when the amniotic cavity is visualized and can you see it on ultrasound

A

No viable on ultrasound

Now called the primitive yolk sac

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41
Q

Double bleb sign

A

Represent the early amnion and yolk sac

Only seen on EV at around 5 1/2 weeks

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42
Q

Embyro consists of what two layers

A

Epibalst

Hypoblast

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43
Q

Epiblast

A

Gives rise to nearly all the cells in the embryo

Also forms the amniotic membrane which houses the amniotic fluid

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44
Q

Hypoblast

A

Contributes to the formation of the primitive ectoderm

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45
Q

Bilaminar disc

A

Embryonic disc
Occurs around 4 weeks LMP
What the inner cell mass becomes

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46
Q

What is happening to the inner cell mass when implantation is occurring

A

It is changing

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47
Q

Trilaminar disc

A

At 5 weeks LMP

When gastrulation occurs

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48
Q

Gastrulation

A

Formation of the three layers

Endoderm
Ectoderm
Mesoderm

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49
Q

Endoderm

A

1st layer to differentiate
Inner layer
Linings of GI and respiratory tract

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50
Q

Ectoderm

A

2nd layer to differentiate
Outer layer
Forms CNS
Surface ectoderm ex: hair, skin, teeth and nails

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51
Q

Mesoderm

A

3rd layer to differentiate
Middle layer
Generally forms muscle and bone

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52
Q

Neurulation

A

Begins at 3 weeks after conception, 5 weeks LMP

Formation of neural plate, neural folds and neural tube

53
Q

Neural tube

A

Closes around day 40 LMP

Starts closing in the middle than progresses to the caudal and cephalic ends

54
Q

Visualizing the embryo on ultrasound

A

Decidua basalis amd chorion frondosum appear as thickened area along gestational sac

55
Q

Embryonic pole

A

Develops in close proximity to chorion frondosum

56
Q

Secondary yolk sac

A

Seen on ultrasound from 5 weeks to 10-12 weeks LMP

Occurs when the head and tail of the embryo fold in and incorporate part of the primitive yolk sac

57
Q

Yolk sac

A 
Provides nutrients prior to circulation
Hematopoiesis starts here
Forms vessels from allantois
Formation of digestive tract occurs here
Development of sex glands occur here
58
Q

Allantois

A

Diverticulum of the yolk sac
Forms umbilical vessels
Involved in the formation of urinary bladder

59
Q

Gestational sac grows how much a day

A

1.1mm

60
Q

How much does the embryo grow everyday for the first 8 weeks

A

1-2mm

61
Q

What is the upper limit of normal for the yolk sac before 10 weeks

A

6mm

62
Q

Gestational sac sizes

A

Mean age- mean sac diameter
6weeks- 1.5cm
7weeks- 2cm
8weeks- 3cm

63
Q

Qualitative pregnancy test

A 
By urine
Takes 2 mins @ home
Can detect at 4weeks LMP
Must meet threshold to get a positive
Negative does not exclude pregnancy 
 -either too early or diluted urine sample
64
Q

Quantitative pregnancy test

A 
By blood 
Tests the beta sub unit of HCG 
Takes 8hrs and is very sensitive 
Negative by this method excludes pregnancy
Will show positive 23 days LMP
Plateau at 8 weeks
65
Q

EV scanning gestation sac sizes

A

4 weeks- 2-3mm
5 weeks- 5-6mm, yolk sac*2-3mm
6 weeks- CRL 3-4mm, FH seen
7 weeks- CRL 12-14mm

66
Q

What are the three different units for beta hCG

A

FIRP
SIS
TIS

67
Q

FIRP

A

First international reference preparation

68
Q

SIS

A

Second international standard
Values are 1/2 FIRP
Oldest method

69
Q

TIS

A

Third international standard

Values are the same as the FIRP

70
Q

What should be considered if the the hCG is at or greater than the discriminatory zone

A

Ectopic pregnancy if no IUP is visualized

71
Q

What is the discrimatory zone for hCG

A

500-1000 mIU/ml IS EV

1000-2000 mIU/ml IRP EV

72
Q

If the CRL of the embryo is 5mm or greater by EV what should be detected

A

Fetal heart motion

73
Q

What happens to beta hCG levels in a normal IUP until 8 weeks gestation

A

They should double every 48 hrs

74
Q

High beta hCG indicates

A 
Multiple fetuses
Hydatigiform moles
Choriocarinoma
Tetatomas
Gonadotropin producing tumors
75
Q

Low beta hCG indicates

A

Ectopic
Missed abortion, fetal demise
Inaccurate dates

76
Q

Pseudocyesis

A

A condition where a women feels pregnant
Symptoms of
: nausea, bloating, full feeling in pelvis

Pregnancy test is negative, ultrasound is normal non gravid uterus, no IUP detetected in endometrium

These symptoms can be created psychologically

77
Q

Early OB protocol

A

Sag midline uterus
Trx vag, Cx, fundus
Mean sac diameter if no embryo is identified
If embyro is seen measure CRL 3 times
Document yolk sac if seen
M-mode heart rate if motion seen
Document maternal ovaries
Document hematoma near gestational sac if identified
Document free fluid in two planes if seen
If at 12-14 week do CRL and BPD
EV scanning all pregnancies under 7 weeks gestation

78
Q

Haploid

A

A single set of unpaired chromosomes (23)

A cell with 46 chromosomes divides into 2 new cells, each with 23 each with 23 chromosomes by meiosis

79
Q

Diploid

A

Paired chromosomes

Organism with 46 chromosomes (23 pairs)

80
Q

Triploid

A

3 complete chromosomes sets

69 chromosomes

81
Q

Trisomy

A

Condition where there is one extra chromosome present in each cell additional to the normal diploid

82
Q

Trisomy 21

A

An extra chromosome on chromosome 21

Results in Down syndrome

83
Q

What is the karyotype now for Down syndrome

A

47 xx or xy

84
Q

Karyotype

A

How chromosomes are expressed in a diagram
Chromosome set of an individual
Described in terms of both the number and the structure of the chromosomes

85
Q

Mitosis

A

Process of nuclear division where cellular material is equally divided between both daughter cells
All cells except gamete cells

86
Q

Gamete cells

A

Sex cells

87
Q

Meiosis

A

Process that reduces the number of chromosomes in gametes to half

88
Q

Chromosomes

A

Threadlike nucleoprotein structure within the nucleus of a cell that contains DNA

89
Q

DNA

A

Double stranded nucleus acid that is a constituent of chromosomes
Contains hereditary information coded in specific sequences

90
Q

Gene

A

Hereditary unit that carries hereditary traits
For self reproducing
Arrangement of DNA in a chromosome

91
Q

Karyotype

A

chromosome set of an individual
discribed in terms of both the number and the stucture
represntation of chromosomes set in a diagram

92
Q

endovaginal scan when necessary when no what is seen

A

embryo

embryonic heart beat

93
Q

why is ultrasound used for obsetrical cases

A

determines viabilty, dating and number of embryos

94
Q

why is dating important

A

certain testing in pregancy is performed at specific times in a pregnancy so that certain milestones of the pregancy are accuratley documented for that gestational age

95
Q

inccurate dates can be caused by what factors

A

longer or shorter menstrual cycles

96
Q

what can inaccuate dates lead to

A

false positive or negative values

97
Q

1st trimester screen involves what

A

nuchal translucency

maternal bood work

98
Q

what is the only definitve test for a 1st trimemster abnormal screen

A

amniocentesis

99
Q

in the 1st trimester screen anything over what value is concidered in the risk assesment range

A

3mL

100
Q

what does a nuchal translucency sca asses for

A 
chromosomal abnormalities
heart abnormalities
lung abnormalities
skeletal abnormalities
congential infections
blood disorders
metabolic disorders
101
Q

why is the 18 week scan the most important

A

assess all the structures of the fetus

102
Q

can the 18 week scan be pushed back and if so till when and why

A

yes till 20 weeks enables the heart to be better visualized

103
Q

18 week detailed scan involves the measurement of what structures

A 
head 
spine
fetal abdomen
fetal chest
femur length
humerus length
ankle veiw 
open hands
placenta
umbilical cord
maternal structures
104
Q

what are the measurements and structures of the head that are veiwed in a 18 week detailed screen

A 
BPD
HC
cavum septum pellucidum
cerebeller diameter
ventricular diameter
nuchal fold
cisterna magna
orbits
nasal bone
nose/lips
profile
105
Q

what are the measurements and structures of the fetal abdomen that are veiwed in a 18 week detailed screen

A 
AC
stomach
kidneys
bowel
diaphragm
bladder
106
Q

what are the measurements and structures of the fetal chest that are veiwed in a 18 week detailed screen

A

lungs

heart

107
Q

what are the measurements and structures of the fetal heart that are veiwed in a 18 week detailed screen

A 
4 chamber 
LT outflow
RT outflow
3 vessel view
m-mode for heart rate
108
Q

what are the measurements and structures of the placenta that are veiwed in a 18 week detailed screen

A

location

thickness

109
Q

what are the measurements and structures of the maternal structures that are veiwed in a 18 week detailed screen

A

cervix

uterus

110
Q

in a 3rd trimester screen are the anatomy images reassesed if they are normal

A

no

111
Q

after 12-16 weeks what is the amniotic fluid comprised of

A

fetal urine

112
Q

a 3rd trimester screen is monitoring what

A

fetal well being- how well the placenta is working and if the fetus is safe in utero

113
Q

what is assesed in a 3rd trimester screen

A

biometry for growth of fetus: BDP, HC, AC, FL
fetal heart rate- m-mode
biophysical profile: fetal well being and placental function
placenta: growth and grade

114
Q

fetal well being encompasses what

A

fetal movement
fetal tone
amniotic fluid
fetal breathing movements

115
Q

doppler is needed in 3rd trimester screen if

A

fetal growth is lagging
amniotic fluid is low
maternal reasons

116
Q

what are the maternal reasons for doppler to be used in the 3rd trimester screen

A

high blood pressure

gestational diabetes

117
Q

what are vessels samples that are taken in a 3rd trimester screen

A

umbilical artery
middle cerebral artery of fetus
ductus venosus

118
Q

what is the maternal blood work taken at the 1st trimeseter screen (+ Nuchal)

A

PAPPA

hCG

119
Q

what does the hCG level blood test assist with during a 1st trimester screen

A

nuchal translucency results to validate a problem

120
Q

what is the maternal blood work taken at 16 weeks gestation

A

triple screen

quad screen

121
Q

what is then maternal blood work taken at 24-28 weeks gestation

A

glucose tolerance screen

122
Q

what is the glucose tolerance screen testing for

A

gestational diabetes

123
Q

does gestational go away and if so when

A

yes but only when the placenta goes away

124
Q

what is the time frame that gestational diabetes can impair a mother for

A

3-5 years

125
Q

what can gestational dibetes develop into

A

type 2 diabetes

126
Q

what does a routine obsetrical doctor visit entail

A

mom’s: weight, blood pressure and urine
uterine fundal height measurement
postion of the baby by palpation
fetal heart beat rate recorded with doppler

127
Q

how often does a pregant patient have a routine doctors visit

A

monthly at the beginning of the pregnancy
every 2 weeks if normal until around 36 weeks
weekly if normal till term

128
Q

post dates require what

A

ultrasounds to cheack fetal well being and growth

Obstetrics & Gynecolgy 1 (8 decks)

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