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OB/GYN 303 > Module 5.1: Fetal Spinal Pathology > Flashcards

Module 5.1: Fetal Spinal Pathology Flashcards

1
Q

What does each vertebra develop?

A

Three ossification centres:

  • One centrum
  • Two neural processes
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2
Q

What is the centrum?

A

The central ossification centre of the vertebral body

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3
Q

What do the neural processes of the vertebra form?

A
  • Pedicles
  • Transverse processes
  • Laminae
  • Spinous processes (between the two neural processes)
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4
Q

Where do the neural processes form?

A

Posterolateral to the vertebral body

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5
Q

When is ossification complete?

A

18 weeks

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6
Q

At what time could a spina bifida likely be missed on US?

A

Before ossification at 18 weeks

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7
Q

How common are neural tube defects?

A

1/1000 births

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8
Q

What factors increase the risk of neural tube defects?

A
  1. Valproic acid (seizure medication)
  2. Maternal diabetes
  3. Folic acid deficiency
  4. History of spinal defects (Prev. Pregnancy or family history)
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9
Q

What is spina bifida?

A

Herniation of spinal canal contents

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10
Q

What may tissues may be herniated from spina bifida?

A
  1. Meninges
  2. CSF
  3. Neural tissue
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11
Q

What is Spina Bifida Occulta?

A

A closed defect where only the deeper layers are effected and only a dimple or patch of hair may be seen on the skin.

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12
Q

How common is Spina Bifida Occulta?

A

15-20% of spina bifida cases

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13
Q

What is Spina Bifida Aperta?

A

An open defect involving all the layers from dura to the skin.

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14
Q

How common is Spina Bifida Aperta?

A

80-85 % of SB cases

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15
Q

What are the two types of Spina Bifida Aperta?

A
  1. Meningocele

2. Myelomeningocele

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16
Q

What is meningocele?

A

SB where only the meninges and CSF herniate.

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17
Q

What is myelomeningocele?

A

SB where the meninges, CSF and neural tissue herniate.

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18
Q

What is MS AFP?

A

Maternal Serum Alpha Fetal-Protein

“Quad screen” maternal blood test that measures the level of AFP in the blood to screen for abnormalities

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19
Q

When is the quad-screen done?

A

16 weeks

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20
Q

What is AFP?

A

AFP is a normal protein that is produced by the fetal liver, it crosses over the placenta and can be detected in the maternal blood. The level increases with gestational age.

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21
Q

What conditions can cause AFP to be elevated? (7)

A
  1. NTD aperta
  2. Abdominal wall defects
  3. Urinary obstruction
  4. Cystic hygroma
  5. Fetal death
  6. Multifetal pregnancy
  7. Incorrect dates
22
Q

Where are the NTD landmarks?

A

T-12 (Distal rib)

L-5 (superior margin of iliac wing)

S-4 (caudal ossification center in 2nd trimester)

23
Q

Where is the most caudal ossification center?

A

S-4

24
Q

Where is the most distal rib?

A

T-12

25
Q

What sonographic features can indicate a spinal defect?

A
  1. Splayed laminae
  2. Protruding mass or cyst
  3. Arnold Chiari II
  4. Ventriculomegaly
  5. Obliterated cisterna magna
  6. Banana sign cerebellum
  7. Lemon sign (SB)
26
Q

What is Spinal Dysraphism?

A

The incomplete fusion of the spine

27
Q

How is the spine best assessed?

A

Trans

28
Q

How does the location of a meningocele affect the prognosis?

A

The more superior in the spine the greater the disability

29
Q

What is Iniencephaly?

A

A special case of dysraphism involving the back of the cranium and c-spine where segmentation errors of the upper spine shortens the neck and the head becomes dorsiflexed.

30
Q

What does Inien refer to?

A

The nape of the neck

31
Q

What is Iniencephaly also know as?

A

Star gazing position

32
Q

What is scoliosis?

A

Lateral curvature of the spine

33
Q

What is exaggerated curvature of the spine in the sagittal plane called?

A

Kyphosis

34
Q

What are Scoliosis and Kyphosis associated with?

A
  1. Amniotic band syndrome
  2. Skeletal dysplasia
  3. VACTERAL
  4. Caudal regression syndrome
35
Q

What is caudal regression syndrome?

A

A range of anomalies of the spine ranging from an absence of part of the sacrum to absence of the lumbar spine.

36
Q

What increases the risk of caudal regression?

A

Maternal diabetes

37
Q

What is mermaid syndrome called?

A

Sirenomelia

38
Q

What are the characteristics of sirenomelia?

A
  • Absence of sacrum
  • Fusion of legs
  • Rectal atresia
  • Renal dysgenesis or agenesis
  • Oligohydramnios
39
Q

What is the prognosis of sirenomelia?

A

Death in infancy

40
Q

What is the most severe form of caudal regression?

A

Sirenomelia

41
Q

What does VACTERAL stand for?

A 
Verebral (dysraphism)
Anal (atresia) 
Cardiovascular
Tracheo-Esophageal (fistula)
Renal
Limb (radial ray)
42
Q

What is VACTERAL often associated with? (4)

A
  1. Caudal regression (sirenomelia)
  2. Spina Bifida
  3. Congenital scoliosis
  4. Hemi vertebrae
43
Q

What is a sacrococcygeal teratoma?

A

An external tumour containing elements of many tissues usually located at the base of the coccyx

44
Q

How common are teratomas?

A

1/35000 births (rare)

45
Q

Where can teratomas arise from?

A
  1. Sacrum or coccyx
  2. Brain
  3. Gonads
46
Q

What are the four types of Sacrococcygeal Teratomas and how common are they?

A

Type 1: External mass predominant (47%)

Type 2: External mass with internal components (34%)

Type 3: Predominant Internal Mass with smaller external portion (5%)

Type 4: Presacral mass, internal only (10%)

47
Q

How do Sacrococcygeal Teratomas appear on US?

A

Mass in rump or buttocks area

48
Q

Why is the echo texture of a Sacrococcygeal Teratomas important?

A

solid/mixed = malignant tendancy

Cystic = benign

49
Q

How often are Sacrococcygeal Teratomas malignant or benign?

A 
85% = malignant
15% = benign
50
Q

What conditions may Sacrococcygeal Teratomas cause?

A
  1. Hydronephrosis due to compressed ureters
  2. Displacement of pelvis structures
  3. AV shunting = heart failure
51
Q

When would a cesarean section be warranted in the case of a Sacrococcygeal Teratoma?

A

If the Sacrococcygeal Teratoma was greater than 4.5 cm.

52
Q

What is the DDX of a Sacrococcygeal Teratoma?

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

OB/GYN 303 (21 decks)

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