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DMST 244 OBGYN 1 > Module 11.1 Fetal spinal pathology > Flashcards

Module 11.1 Fetal spinal pathology Flashcards

1
Q

Each vertebra will develop how many ossification centers?

A

Three

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2
Q

The centrum forms the ______ portion of the vertebral body

A

Central

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3
Q

The two neural processes will form what 5 things?

A
  1. Peduncles
  2. Transverse processes
  3. Laminae
  4. Spinous process
  5. Posterolateral part of the lateral body
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4
Q

Ossification is not complete until which weeks?

A

18 weeks

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5
Q

Potentially a small spinal bifida could be missed prior to what week?

A

18

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6
Q

How many will be at risk for NTD?

A

1/1000

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7
Q

What increases risk of NTD? 4

A
  1. Valproic acid
  2. Maternal diabetes
  3. Folic acid deficiency
  4. History of spinal defects
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8
Q

In terms of spinal bifida, Defects in the boney structure of the spinal canal may result in the herniation of what contents? 3

A
  1. Meninges
  2. CSF
  3. Neural tissue
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9
Q

What are other forms of NTD? 2

A
  1. Encephalocele: Brain herniation through defect in skull
  2. Anencephaly: Missing all brain and skull
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10
Q

What does this picture demonstrate?

A

Encephalocele

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11
Q

What does these two images demonstrate?

A
  1. Left normal spine
  2. Right Spina bifida occulta
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12
Q

What does these two pictures demonstrate?

A
  1. Left Spina bifida with meningocele
  2. Spina bifida with myelomeningocele
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13
Q

What is spinal bifida occulta? what does it involve? What might we see?

A
  1. Involves only the deepest layers
  2. May only see skin dimple or patch of hair on the skin
  3. Closed defect
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14
Q

How many spinal bifida cases are occult?

A

15-20%

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15
Q

What is involved with Spina bifida aperta? What kind of defect is it? And what are the percentage of cases?

A
  1. Involves all layers from dura to skin
  2. Open defect
  3. 80-85% of cases
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16
Q

Which is the most intense case of spina bifida?

A

Myelomeningocele with meningocele coming in second

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17
Q

What does meningocele contain?

A

Meninges and CSF

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18
Q

What does myelomeningocele contain? 3

A
  1. Meninges
  2. CSG
  3. Neural tissue
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19
Q

When is screening done for spina bifida? What is abnormal?

A

1.16 weeks
2. AFP is elevated

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20
Q

What are other causes of elevated MS AFP? 6

A
  1. Abdominal wall defects
  2. Multiple fata pregnancies
  3. Fetal death
  4. Urinary obstruction
  5. Cystic hygroma
  6. Incorrect dates
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21
Q

What is the most common location for NTD?

A

Lumbosacral spine

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22
Q

What is NTD usually associated with? 6

A
  1. Meckel gruber syndrome
  2. Encephalocele
  3. Polycystic kidneys
  4. Polydactyly
  5. Trisomy 18
  6. Triploidy
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23
Q

What is spinal dysraphism?

A

Abnormal closure of the spine

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24
Q

What is rachischisis? What is it another name for?

A
  1. Another name for spinal dysraphism
  2. Failure of fusion of the vertebral arches
25
Q

What are radiological landmarks for NTDs? 3

A
  1. t12 most distal rib
  2. L5 superior margin of iliac wing
  3. S4 most caudal ossification center in 2nd trimester
26
Q

What are some other systems affected by NTD?

A

lefts (clubfoot, hip dislocation)

27
Q

Legs are affected by NTD how? 2

A
  1. Imbalance of muscular activity due to nerve involvement
  2. Nerves exposed to amniotic fluid results in damage to these nerves
28
Q

What should look for on U/S for NTD? 5

A
  1. Obliterated cisterna magna
  2. Banana sign with cerebellum
  3. Lemon sign
  4. Splayed laminae
  5. Protruding mass or cyst
29
Q

What does this image demonstrate?

A

Spinal NTD

30
Q

Where is the best plane to do an assessment of meningocele?

A

Transverse

31
Q

When assess Meningocele what must we ensure we do?

A

Assessment of the skin surface away from the uterine wall

32
Q

What is the prognoses of NTD? 2

A
  1. Depends on location
  2. More superior = greater disability
33
Q

What is Iniencephaly?

A

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

34
Q

What is iniencephaly also known as?

A

Star gazing position

35
Q

What cerebral condition can inencephaly also be associated with?

A

Anencephaly

36
Q

What are some segmentation errors of iniencephaly?

A

Shortens neck and head becomes dorsiflexed

37
Q

What is scoliosis?

A

Lateral curvature of the spine

38
Q

What kyphosis?

A

Exaggerated curvature of the spine in the sagittal plane

39
Q

What does this image demonstrate?

40
Q

What is the VACTERL sequence?

A

Vertebral
Anal
Cardiovascular
Tracheo- Esophageal
Renal
Limb

41
Q

What is VACTERL sequence often associated with ?

A

Caudal regression

42
Q

What is the prognosis of VACTERL sequence?

A

Depends on severity and extent of involvement

43
Q

What is caudal regression?

A

Range of anomalies of the spine

44
Q

What maternal condition increases the risk of caudal regression?

A

Maternal diabetes

45
Q

What is sirenomelia?

A
  1. Absence of sacrum
  2. Fusion of legs
  3. Rectal atresia
  4. Renal dysgenesis or agenesis
  5. Oligohydraminos
46
Q

What is the prognosis of sirenomelia?

A
  1. All die in infancy
47
Q

What is the most severe form of caudal regression?

A

Sirenomelia (mermaids syndrome)

48
Q

What is a sacrococcygeal teratoma? What elements does it contain?

A
  1. Mass adjacent to distal spine
  2. Contains elements of many tissues
49
Q

How rare is sacrococcygeal teratoma?

A

1/ 35,0000 births (very rare)

50
Q

Teratomas can arise from what areas? 4

A
  1. Sacrum
  2. Coccyx
  3. Brain
  4. Gonads
51
Q

What are four types of sacrococcygeal teratomas?

A

By location
1. External mass predominant 47%
2. External mass with internal components 34%
3. Internal mass predominant with smaller external component 5%
4. Presacral mass (internal only) 10%

52
Q

What is this an image of?

A

Type 1 Sacrococcygeal Teratoma

53
Q

What is this an image of?

A

Type 2 Sacrococcygeal teratoma

54
Q

What is this an image of?

A

Type 3 Sacrococcygeal teratoma

55
Q

What is this an image of?

A

Type four sacrococcygeal teratoma

56
Q

What is this an image of?

A

Sacral teratoma

57
Q

What is the prognosis of sacral teratoma? What of a solid one? What happens if it is >4.5 cm?

A
  1. Depends on size of mass and severity of structure displacement
  2. Solid mass has a malignant tendency
  3. If >4.5 cm C section is indicated
58
Q

What is the DDX for sacral teratoma? 3

A
  1. Rectal duplication
  2. Anterior myelomeningocele
  3. Sarcoma

DMST 244 OBGYN 1 (22 decks)

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