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DMST 244 Obstetrics and Gyn Sonography 1 > Module 8 Fetal brain and heart > Flashcards

Module 8 Fetal brain and heart Flashcards

1
Q

The heart tube begins to develop from the mesoderm at which week and is fully formed by when?

A

Develops at the 5th week and is fully formed by the 10th week

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2
Q

The heart tube is routinely valued from when to when?

A

From 18 weeks to term (40 weeks)

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3
Q

When is the best time to evaluate the fetal heart?

A

18-24 weeks

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4
Q

How does the heart sit in the chest? What is the heart position within the fetus in terms of midline? How is the apex angled? How much of the chest does it occupy? Which side is it on?

A
  1. Sits complete horizontal in the fetal chest
  2. Located to the left of midline
  3. The apex points about 45 degrees to the left
  4. Occupies 1/3 of the chest
  5. Located to the left of midline
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5
Q

The two atria of the fetal heart lie how compared to the 2 ventricles ?

A

They sit posterior

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6
Q

Which chamber of the fetal heart is the most posterior?

A

Left atrium

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7
Q

Which chamber is the most anterior?

A

Right ventricle

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8
Q

What are the valves of the fetal heart?

A
  1. Two atria ventricular valves
  2. Two semi lunar valves between the ventricles and circulatory system
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9
Q

Where are the two atria ventricular valves located? What are they?

A
  1. Between the atria and ventricles
  2. Mitral and tricuspid
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10
Q

Where are the two semi lunar valves located in the fetal heart?

A

Between the ventricles and circulatory system.
Consists of
1. Aortic valve and pulmonary valve

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11
Q

What is the mitral valve also know as? How many cusps does it have? What does it do?

A
  1. Bicuspid valve
  2. Contains 2 cusps
  3. Passes blood from left atrium to the left ventricle
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12
Q

How many cusps does the tricuspid valve have?

A
  1. 3 cusps
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13
Q

What is blood flow in the tricuspid valve?

A

Passes blood from the right atrium to the right ventricle

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14
Q

The mitral and tricuspid do what together? And how do they lay in terms of each other?

A

They open and close together and are situated at the same level in the heart

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15
Q

The aortic valve contains how many cusps?

A

3 cusps

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16
Q

What does the aortic valve do?

A

Passes oxygenated blood from the left ventricle into the aorta to be distributed to the rest of the body

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17
Q

The pulmonary valve has how many cusps?

A

3

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18
Q

What does the pulmonary valve do?

A

Passes deoxygenated blood (postnatal) from the right ventricle to the pulmonary artery to be oxygenated by the lungs

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19
Q

How does the pulmonary artery sit in terms of position to the aorta?

A

It is more anterior and superior

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20
Q

Which artery bifurcates?

A

Pulmonary artery

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21
Q

What are the routine images of the heart? 5

A
  1. Four chamber heart
  2. Left outflow tract
  3. Right outflow tract
  4. Heart axis/ situs
  5. Fetal heart M mode
    +/- cine clip
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22
Q

At 19 weeks the fetal heart is the size similar to what?

A

An almond

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23
Q

What does the fetal 4 chamber heart show?

A

All four chamber with septum

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24
Q

What is the moderator band?

A

The thick muscle of the moderator band makes the right ventricular chamber look smaller than the left

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25
Q

The moderator band is used to prove what?

A

Which chamber is the right ventricle in abnormal hearts

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26
Q

What does the RVOT demonstrate?

A

The right ventricle with the pulmonary artery

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27
Q

Do the LVOT and RVOT cross each other in the fetal heart?

A

Yes

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28
Q

What is the normal fetal heart rate?

A

120-160

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29
Q

During first trimester what heart rate is concerning?

A

Under 100

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30
Q

In early pregnancies the heart may actually stop for how long?

A

A few seconds when you scan. IF this happens during a scan, move away and return to the heart at a later time.

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31
Q

What is the heart rate of the fetal heart during the third trimester?

A

Up to 180

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32
Q

What is Bradycardia in the 2nd and 3rd semester? What is tachycardia?

A

Under 100 is bradycardia and over 200 is tachycardia

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33
Q

When getting the cine clip of the fetus where should we start? And why? Where do we go from the start?

A

Start at the level of the AC to demonstrate the fetal stomach to confirm citrus. Then we slowly sweep cephalic on the fetus

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34
Q

What do we demonstrate during cine clips of the fetus? 5

A
  1. Stomach
  2. 4 chamber view
  3. LVOT
  4. RVOT
  5. 3 vessel view
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35
Q

When getting a fetal heart M mode of the fetus, how many beats are usually measured?

A

1 beat

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36
Q

What comprises of the fetal circulation? 3

A
  1. Ductus venous
  2. Foramen ovale
  3. Ductus arteriosis
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37
Q

What does the ductus arteriosis do?

A

Shunts blood from the pulmonary artery to the aortic arch to bypass the lungs during fetal life

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38
Q

What does the ductus arteriosis do after delivery ?

A

It closes

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39
Q

What is the fetal foramen ovale? What does it do?

A
  1. Opening between atria
  2. Brings blood from the right atrium to the left atrium
  3. Helps bypass the lungs
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40
Q

The foramen ovale flap opens into what?

A

The left atrium

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41
Q

What are some additional images we can take for the fetal heart? 4

A
  1. Short axis (circle and sausage)
  2. SVC - IVC with the right atrium
  3. Aortic arch
  4. Pulmonary veins with the left atrium
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42
Q

What does the short axis view of the fetal heart demonstrate? 4

A
  1. The right and left atria
  2. The right ventricle
  3. Pulmonary artery
  4. Ductus arteriosis all circling the aorta
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43
Q

What does the IVC and the SVC do?

A

They bring deoxygenated blood back from the body to the right atrium

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44
Q

What are the three vessels at the aortic arch?

A
  1. Brachiocephalic artery
  2. Left common carotid artery
  3. Left subclavian artery
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45
Q

What does the duct Ao arch look like?

A

A hockey stick

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46
Q

Where is the ductal arch?

A

Where the right ventricle with the ductus joins the aorta

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47
Q

What does the pulmonary veins do?

A

They bring oxygenated blood from the lungs to the left atrium in newborns

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48
Q

How many pulmonary veins are there?

A

4

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49
Q

On the ultrasound how many pulmonary veins will you see?

A

2 of them

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50
Q

The central nervous system (CMS) develops from what? And when?

A

A thickened area of the ectoderm in a process called neurulation at 4.5 LMP

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51
Q

During the formation of a neural plate, the neural tube closes where? And progresses where?

A

Starts around the middle and progresses to cranial and Cephalic ends

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52
Q

When does the cranial end and the caudal end of the neural tube close?

A

Cranial closes at 38 LMP and the caudal closes at 40 LMP

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53
Q

The neural tube differentiates into how many vesicles when?

A

It differentiates into three primary vesicles by the end of the 6th week
1. Prosencephalon
2. Mesencephalon
3. Rhombencephalon

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54
Q

What does the prosencephalon consist of?

A

The forebrain

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55
Q

What does the prosencephalon divide into? 2

A
  1. Telencephalon
  2. Diencephalon
56
Q

What does the telencephalon consist of?

A

Cerebral hemispheres

57
Q

What does the diencephalon consist of?

A

Thalamus and hypothalamus

58
Q

What does the telencephalon: Cerebrum do?

A

Learned behaviour and personality

59
Q

What does the cerebrum consist of? 5

A
  1. Two frontal lobes: personality, voluntary motion
  2. Two parietal lobes: Peripheral sensory
  3. Two temporal lobes: Smell, taste and hearing
  4. Two occipital lobes: vision
  5. Two lobes called the insula: motor and sensory function organs
60
Q

What is the diencephalon (thalamus)? What is it made up of?

A
  1. It is made up of grey matter
  2. Main relay center for sensory impulses from the right side of the body go through the thalamus to the left cerebral hemisphere
61
Q

What is the mesencephalon? What does it consist of? What is the smallest portion of the brain? Where is it located?

A
  1. Consist of mid brain
  2. Smallest portion of the brain
  3. Located anterior to aqueduct Sylvius
62
Q

What does the mesencephalon create?

A

The cerebral peduncles

63
Q

What does the rhombencephalon divide into? And what does it consist of? 2

A

Consist of the hindbrain and divides into the
1. Cerebellum and pons (Metencephalon)
2. Medulla oblongata (Melencephalon)

64
Q

What does the pons connect? Where is it located?

A
  1. Located between the midbrain and medulla oblongata
  2. Connects the cerebrum to the cerebellum
65
Q

What does the medulla oblongata do? Where did it extend from?

A
  1. Extends from pons to the spinal cord
  2. Regulates heart rate and respiratory rhythm and blood pressure
66
Q

Where is the Rhombencephalon: cerebellum located? 2

A
  1. Beneath the occipital lobes of the cerebrum in the posterior fossa.
  2. Posterior to the pons and medulla oblongata
67
Q

What are the two lateral hemispheres of the Rhombencephalon: cerebellum separated by?

A

Cerebella’s vermin’s and Falx cerebelli

68
Q

What is the cerebella vermis function? What is its echogenicity?

A

The cerebella’s vermis is brightly echogenic and functions in the coordination of movement

69
Q

What are the ventricles? What is it continuous with?

A
  1. Four connecting cavities within the cerebral hemispheres and the brain stem
  2. Continuous with the spinal cord cavity
70
Q

All the cavities of the ventricles contain what?

A

CSF and choroid plexus

71
Q

What is the ventricular system structure of the fetal brain? 7

A
  1. Lateral ventricles
  2. Foramen of Munro
  3. 3rd ventricle
  4. Aqueduct of Sylvius
  5. 4th ventricle
  6. Foramen of magendie
  7. Spinal cord
72
Q

The magendi is which aspect of the ventricles? What does it connect too?

A
  1. Fourth aspect of the 4th ventricle
  2. Connects the spinal cord
73
Q

What is the luschka? What does it communicate with?

A
  1. Lateral aspect of the 4th ventricle
  2. Communicates with the menigies of the brain
74
Q

The Luschka allows for CSF into what?

A

The subarachnoid space of the meninges

75
Q

What are the largest of the ventricles?

A

Lateral ventricles

76
Q

Where is the Lateral ventricles located?

A

In the cerebral hemispheres

77
Q

Each of the lateral ventricles has what?

A

A body and three horns

78
Q

What are the three horns of the lateral ventricles?

A
  1. Anterior (frontal) horn
  2. Posterior (occipital) horn
  3. Inferior (temporal) horn
79
Q

The junction of the body, occipital, and temporal horns forms what?

A

Trigone or atria of the ventricle

80
Q

What does the 3rd ventricles look like? Where are they located? and What do they communicate with?

A
  1. Thin
  2. Located between the thalami and inferior to the corpus callosum
  3. Communicates with the lateral ventricles via the foramen of Monro (interventricular foramen)
  4. Communicates with the 4th ventricle via the aqueduct of sylvius (cerebral aqueduct)
81
Q

Where is the 4th ventricle located? What is it anterior to?

A
  1. Located within the brain stem
  2. Anterior to the cerebellum
82
Q

What is the 4th ventricle continuous with?

A

The central canal of the spinal cord via the foramen of magendie

83
Q

What does the 4th ventricle communicate with laterally?

A

Subarachnoid space of the meninges vis the foramen of luschka

84
Q

What does the choroid plexus do?

A

Produces CSF

85
Q

Where is the choroid plexus located? Comparison to the 4th and 3rd ventricles?

A
  1. In the body of the lateral ventricles
  2. The roof of the 3rd ventricle
  3. Superior side walls of the 4th ventricle
86
Q

What is the corpus callosum?

A

A bridge of white matter nerve fibers that connect the right and left cerebral hemispheres

87
Q

Where is the corpus callosum located?

A

Found deep in the longitudinal fissure

88
Q

In what view do we see the corpus callosum in utero?3

A
  1. Profile view
  2. Midline sagittal
  3. seen in neonates while scanning over the anterior fontanelle
89
Q

What re the 4 parts from front to back of the corpus callosum?

A
  1. Rostrum
  2. Genu
  3. Body
  4. Splenium
90
Q

What does the red arrows point towards?

A

The corpus callosum

91
Q

What does the images point towards?

A

The top one is the Corpus callosum and the bottom one in the vermis

92
Q

What happens if the corpus callosum is missing? Would the pericallosal artery be normal? What about the lateral ventricles? What would this do to the guru later in pregnancy?

A
  1. CSP will not be visualized as it is absent
  2. The pericallosal artery is abnormal
  3. Lateral ventricles are teardrop shaped
  4. Later in pregnancy the gyri appear in a sunburst pattern
93
Q

What does this image tell us?

A

Normal corpus callosum

94
Q

What does these images demonstrate?

A

Abnormal corpus callosums

95
Q

What are the meninges? What does it surround?

A
  1. Protective areas of the brain
  2. Surrounds the brain, all the convolutions and grooves (gyri and sulci)
96
Q

From inner to outer what are the layers of the meninges? 3

A
  1. Pia matter
  2. Arachnoid mater
  3. Dura matter
97
Q

What is the Cavum Septi Pellucidi? 2

A
  1. Structure that separates the anterior horns of the lateral ventricles
  2. Important landmark for BPD where the cranium is measured
98
Q

Where is the Cavum Septi Pellucidi located in relation to the thalamus?

A

Anterior and slightly superior to the thalamus

99
Q

What does the arrows point towards?

A

The left is the Cavum septi Pellucidi and the right is the fornix

100
Q

Where is the cavum vergae found?

A

Found at the posterior tip of the septi pellucidi

101
Q

Is the cavum vergae seen on prenatal ultrasounds?

A

No

102
Q

When does the cavum vergae close?

A

Around 26 weeks

103
Q

What does the sulci pattern allow? 2

A
  1. More cerebral cortex, gray matter to develop
  2. As well as increases the surface area of the brain
104
Q

What is the Gyri?

A

Convolutions of the cerebral surface

105
Q

What is the sulci?

A

Grooves in the cerebral hemisphers

106
Q

Where is the cisterna magna located?

A

Between the cerebellum and the occipital bone

107
Q

What does the cisterna magna contain?

A

CSF

108
Q

Can the Cisterna magna be visualized in the normal fetus?

A

Yes

109
Q

What does a fetus with spina bifida do to the cisterna magna?

A

Makes it absent

110
Q

What is the normal measurements of the cisterna magna?

A

> 1cm

111
Q

Sometimes linear echoes can be seen within the cisterna magna? These are what?

A

These are the dura folds and they attach to the falx cerebelli. They are seen in the cisterna magna

112
Q

What does this arrow point towards?

A

Cisterna magna

113
Q

What is the falx cerebri?

A

A double layer of dura mater that separates the cerebral hemisphers

114
Q

The falx cerebri runs within what?

A

The longitudinal fissure (Interhemispheric fissure)

115
Q

What is the tentorium?

A

Dura mater that separates the occipital lobes of the cerebrum from the cerebellum

116
Q

When is the tentorium best seen in neonates?

A

On neonatal cranial ultrasound studies

117
Q

What is the circle of willis?

A

A cerebral ring of communicating arteries

118
Q

The brain receives arterial blood from what two main pairs of vessels?

A
  1. Internal carotid arteries
  2. Vertebral arteries
119
Q

What does each colour represent?

A

Red: LV
Pink: LA
Yellow: RV
Blue: Aov

120
Q

What does each of the colors indicate?

A

Red: RA
Blue: RV
Pink: PA

121
Q

What does this image demonstrate?

A

Pulmonary artery

122
Q

What is this an image of?

A

Situs image of a baby that is Cephalic maternal right

123
Q

What is this an image of?

A

Situs image of the stomach on the left and apex to the left

124
Q

What is this an image of?

A

LVOT

125
Q

What is this an image of?

A

Three chamber view

126
Q

What does this image demonstrate?

A

How 3 vessel view should be measured

127
Q

What does these two images represent?

A

Left: Normal heart beat
Right: Tachycardia

128
Q

What does this image demonstrate?

A

Ductus arteriosis

129
Q

What does each of these images demonstrate?

A

Ductus arteriosis

130
Q

What does this image demonstrate?

A

Foramen ovale

131
Q

What does this image demonstrate?

A

Ductal arch

132
Q

What does the red arrow point towards?

A

Pulmonary veins

133
Q

Label the image

A

Red: Prosencephalon
Blue: Mesencephalon
Purple: Rhombencephalon

134
Q

What is this a measurement of?

A

Rhombencephalon

135
Q

Label the structures

A

DMST 244 Obstetrics and Gyn Sonography 1 (22 decks)

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