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Ob/Gyne > Module 7.2 : Detailed Scan > Flashcards

Module 7.2 : Detailed Scan Flashcards

1
Q

overall sagittal sweep

A
  • sag plane to the other sweep from cervix to fundus of uterus to assess th position of fundus
  • image sag fundus/cervix pic
  • check for fetal heart motion
  • check for number of fetus
  • assess for presence of amniotic fluid
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2
Q

overall transverse sweep

A
  • transverse sweep along the lateral aspect of the uterus to include adnexa
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3
Q

overall transverse assessment

A 
- fibroids 
   \+ document in 2 planes 
   \+ measure in 3 dimensions 
   \+ doppler 
- assess for adnexal masses usually arising from ovary 
   \+ corpus luteal cyst
   \+ dermoid cyst 
      - two planes 3 dimensions
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4
Q

need to establish

A
  • viable fetus
  • fetal lie
  • fetal number
  • placental localization
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5
Q

placenta

A
  • look at placenta position
  • asses placental texture
  • decide if placenta is low or not
    + placenta previa = placenta over cervix
    + LOWER PLACENTAL EDGE SHOULD BE A MINIMUM OF 2 CM AWAY FROM INTERNAL OS OF CERVIX
  • document cervix length measure
  • document and measure placental edge to internal is
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6
Q

what to start with in OB scanning

A
  • start with whatever is up
  • if fetus with back up anterior start with spine and kidneys
  • if fetus laying with chest up always start with heart and face profile
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7
Q

cranium

A
  • asses head shape
  • high on fetal head or cephalic on the fetus the head the shape is round
  • at BPD level fetal had more oval
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8
Q

cranial images

A
  • BPD, OFD, HC
  • ventricular image
  • bilateral choroid image
  • cerebellar image
  • orbital image
  • nose lip image
  • profile
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9
Q

BPD assesses

A
  • cavum septum pellucidi
  • third ventricle
  • ambient cistern
  • falx cerebri
  • shape
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10
Q

ventricular image

A 
- assesses the dependent ventricle 
   \+ ventricle farthest from transducer
- measure ventricular atrium size
  \+ upper normal is 10mm
- assess echo texture of dependent choroid
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11
Q

bilateral choroid image

A
  • assess echo texture of both choroid together
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12
Q

cerebellar image / posterior fossa

A 
- used to assess the cerebellar shape and size 
   \+ if vermis is present
- presence and size of cisterna magna
   \+ what is upper limit of normal 10mm
- nuchal fold thickness 
   \+ 10mm
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13
Q

orbital image

A 
- assess for
   \+ hyper telorism = to far
   \+ hypoterlorism = to close
- size of orbits 
   \+ micropthalmia (small eyes)
- seeing lenses on the eyes rules out 
   \+ anopthalima (no eyes)
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14
Q

nose lip image

A
  • image skims the nose and slip
  • rule out
    + cleft lip and abnormal nostrils
  • want 2 nostrils and septum between
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15
Q

profile

A
  • line up forehead nose and chin on image
  • assess chin
    + micrognathia (small mandible)
    + retrognathia (receding chin)
  • assess nasal bone
    + present >2.5mm
    + absent or hypoplastic
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16
Q

ossification

A
  • anterior ossification center is the vertebral body
  • posterior ossifications laminar junction
  • THESE ARE ONLY VISIBLE AREAS OF THE FETAL SPINE ON ULTRASOUND
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17
Q

spinal ossification

A
  • as the gestational age increases the lamina ossifies into a linear structure rather than circular
  • ossification is not complete until 18 weeks gestation
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18
Q

spine

A
  • must be viewed in 2 planes
    + trans and sag
  • if you can not view in a sag plan than coronal acceptable
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19
Q

imaging spine

A
  • one image at distal end to include sacrum
  • on image at cephalic end to include cervical spine into cranium
  • include as many vertebral ossifications in image as possible
  • MOST IMPORTANT IS TO SWEEP THROUGH SPINE IN TRANSVERSE
  • only image taken in trans is at lumbosacral junction (spina bifida)
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20
Q

trans spine at sacrum

A
  • ideal image include both iliac crests and all 3 ossifications centers
  • transducer directly over spine
  • fetal bladder included as well
  • looking for herniation
  • should see amniotic fluid behind spine
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21
Q

abdominal circumference (AC)

A
  • assesses presence of stomach and position of organs
  • is the stomach on the left side
  • should only see one stomach bubble
  • the GB may be seen
    + do not confuse with stomach
    + ovoid looking on right side
22
Q

what is a good AC

A
  • umbilical vein runs in the falciform ligament and becomes ligamentum teres after birth
  • confluence of umbilical vein and left portal vein
  • referred to as portal sinus
23
Q

heart

A
  • 4 chamber view
  • assess the size of all chambers and valve placement
  • M-MODE ADN MEASURE THE FETAL HEART RATE
  • could do chest circumference if needed
24
Q

heart size and placement

A
  • size of heart should be 1/3 of chest

- toward the left 45’

25
Q

outflow images

A
  • done to rule out great vessel abnormalities
  • RVOT
  • LVOT
  • not lung tissue around the heart
26
Q

LVOT

A
  • should see valve in aortic sinus

- probe more cephalic

27
Q

RVOT

A
  • need to take long axis

- should see branches

28
Q

3 vessel view

A
  • see SVC, aortic arch and pulmonary artery
29
Q

cine clip 6-12 seconds

A
  • beginning at fetal stomach in trans
  • sweeping cephalic
  • demonstrate
    + stomach
    + 4 chamber
    + LVOT
    + RVOT
    + 3 vessel view
30
Q

fetal heart cine clip

A
  • fetal heart in horizontal plane
  • while performing the cine clip LVOT should appear with and change to probe plane
  • RVOT should follow
  • 3 vessel should be just superior to RVOT
31
Q

longitudinal image of abdomen and chest

A
  • assess location of stomach in relation to diaphragm
  • assess echotexture of lungs compared to liver
    + should be isoechoic to lung sin 2nd semester
    + slightly increased echogenicoty to liver in 3rd trimester
32
Q

longitudinal abd and chest image

A
  • heart
  • diaphragm (hypo echoic)
  • stomach
    + look for diaphragmatic hernia
33
Q

bowel

A
  • small bowel appears as cluster of rings bordered by large bowel
  • colon (large bowel) in 3rd trimester may contain meconium particles and appear hypo echoic and prominent
  • LARGE BOWEL 17mm DIAMTER AT TERM
  • hyper echoic bowel may be trisomy 21 or CF
34
Q

kidneys

A
  • located on either side of spine
  • lack of distinction in 2nd trimester
  • renal pelvis hypo echoic and minimally dilated up to 3mm
  • over 5mm is the upper limit
  • 3rd trimester calyces are well seen
  • kidneys relate to gestational age
35
Q

kidney images

A
  • spine in middle
  • freeze over renal pelvis
  • longitudinal images are included if any abnormality is detected in kidney
    + hydronephrosis
    + renal cysts
36
Q

adrenals

A
  • superior and medial to kidneys
  • hypo echoic with echogenic centres
  • do not confuse adrenals with kidneys
37
Q

bladder

A
  • anehoic structure between iliac crests
  • should fill and empty every 20 minutes
  • always see a little urine
  • just slide down from kidneys
38
Q

umbilical arteries at bladder

A
  • 2 arteries at this level
  • identify right and left umbilical arteries around the bladder
  • document this view
  • add color doppler or power doppler
  • deoxygenated blood in the arteries
  • soft marker for aniploidy
39
Q

umbilical cord

A
  • 2 arteries 1 vein
  • image cord in a trans plane to document all three vessles
  • image cord insertion into fetal abdomen wall defects
    +omphalocele (liver out body)
  • also image cord into placenta
    + cord should insert into placenta more than 3 cm away for edge of planets
40
Q

genitalia

A
  • can be seen if fetus is lying face up with legs seperated
  • important to document in twins and sex linked syndromes
  • labia can be swollen and look like scrotum
  • testicle do not descend until 28 weeks gestation
  • scrotum can be tucked up between legs
41
Q

girls

A
  • hamburger sign
42
Q

boy

A
  • sticks and berries

- turtle

43
Q

bones

A
  • all bones can be assessed on ultrasound
  • routinely femur is measured
  • humerus also measured at second rimester detail scan
44
Q

upper limbs

A
  • forearm
    + radius and ulna
    + ulna is medial (thinner and longer)
    + radius is lateral (shorter and thicker)
  • take and image with and open hand if you see
  • right and left
45
Q

lower limbs

A
  • tibia and fibula should be imaged with the foot pointing in the correct direction
  • should not see all toes and tie/fib in same image
  • tibia>fibula
  • not arch of foot
46
Q

rt and lt ankle image

A
  • rule out club foot

- rocker bottom feet

47
Q

long bones

A
  • with certain syndromes or chromosomal abnormalities required to measure all long bones
  • femur
  • tibia
  • fibula
  • humerus
  • radius
  • ulna
  • right and left sides
    and clavicles
48
Q

amniotic fluid

A
  • and AFI is not performed at the detailed 18 week assessment
  • a subjective assessment observed
    + subjectively decreased
    + subjectively increased
  • amniotic fluid volume increases until 34 weeks than slowly diminishes
  • fluid is produced by fetal urinary system
    + to lesser extents by the umbilical cord, lungs, skin in early pregnancy
49
Q

vernix

A
  • skin cells floating in the fluid

- waxy substance that protects baby frombein surrounded by fluid

50
Q

supine hypotension

A
  • mother may feel hot or light headed nauseous or faint
  • ROLL ON HER SIDE
    + left side is best
    + if twins then left then right
  • roll away from you

Ob/Gyne (24 decks)

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