O&G Flashcards by Kim Lam

Empty sac

Normal early IUP
Anembryonic gestation
Ectopic pregnancy (pseudogestational sac)

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Causes of first trimester bleeding

Pregnancy related:

Normal IUP
Abortion
Ectopic
GTD
Subchorionic haemorrhage

Unrelated to pregnancy

Polyp
Cancer
Vaginal ulcers

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Echogenic central cavity

Normal pregnancy
Ectopic pregnancy with decidual reaction
Abortion (retained products)

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Complex intrauterine mass

Missed abortion with placental hydropic degeneration
Foetal demise with retained tissue
Molar pregnancy
Degenerated uterine fibroid
Endometrial carcinoma

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Elevated AFP

Foetal abnormalities
- NTD, abdominal wall defects, cystic hygroma, GIT obstruction, atresia, liver disease, renal disease

Incorrect dates
Multiple gestation
Foetal demise
Low birth weight
Placental abnormalities

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Low AFP

Down syndrome
Trisomy 18
Incorrect dates

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Diffusely enlarged placenta (>4cm thick)

Hydrops
Maternal diabetes
Maternal anaemia
TORCH
Intraplacental haematoma
Molar change/partial mole

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Three typical findings of ectopic pregnancy

Complex adnexal mass
Free pelvic fluid
Tubal ring

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Abnormal placental echotexture

Partial mole
Hydropic placenta
Haemorrhage or abruption
Chorioangioma
Venous lakes, fibrin, interval loud thrombosis etc

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Solitary umbilical artery

Trisomy 13 or 18
Structural anomalies (holopresencephaly, skeletal dysplasia, hydrocephalus, omphalocele, hydrothorax, diaphragmatic hernia)

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Third trimester bleeding

Placenta praevia
Placental abruption
Cervical lesions
Idiopathic

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Pleural effusion - foetal chest

Unilateral: CHD, sequestration, CCAM
Bilateral: hydrops, pulmonary lymphangiectasia
Uni or bilateral: idiopathic, infection, chromosomal anomalies

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Absent stomach bubble

Oligohydramnios
Swallowing abnormality (CNS defect)
Oesophageal atresia
CDH
Situs
Risk of chromosomal abnormalities (trisomy 18)

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Double bubble

Ladd’s bands
Annular pancreas
Duodenal atresia
Stenosis of the duodenum

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Dilated bowel

Atresia
Stenosis
Volvulus
Meconium ileus
Enteric duplication
Hirschsprung's

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Echogenic bowel

Normal variant during 2nd trimester
Cystic fibrosis
Down syndrome
IUGR
CMV

Abdominal calcification

Bowel related
- meconium peritonitis, meconium ileus, atresia, volvulus

Other organs
- renal, liver (TORCH), neuroblastoma, teratoma, foetal gallstones

Hydronephrosis

PUJ obstruction
UVJ obstruction (primary megaureter)
Duplex collecting system
Bladder outlet obstruction
Prune belly
Caudal regression
Maternal drugs
Ectopic ureterocoele

Foetal hydronephrosis

Follow up if > 7mm after 32 weeks

> 10mm always pathological

Cystic abdominal structures

Hydronephrosis
Fluid filled dilated bowel
Ascites
Meconium pseudocyst
Cysts eg Mesenteric, urachal, duplication, ovarian, choledochal

Ascites

Hydrops
Urine ascites
Meconium peritonitis
Infection
Pseudo ascites

Causes of thickened endometrium

Early pregnancy
Ectopic pregnancy
RPOC
Anovulatory cycles
Tamoxifen
HRT

Risk factors for endometrial carcinoma

HRT
Tamoxifen
Age
Family history
Past history of unopposed oestrogen exposure
Hypertension
Obesity and diabetes

Staging of endometrial carcinoma

Limited to body of uterus
Cervical stromal involvement
Local or regional spread of tumour
3a. Invades body of uterus and/or adnexae
3b. Vaginal or parametrial involvement
Rectum, bladder or distant metastasis

Cervical cancer staging

1. Confined to cervix 2. Beyond cervix, not to pelvic sidewall or lower third of vagina 3. Lower third of vagina 4. Extension beyond pelvis or involvement of bladder/rectum

Causes of polyhydramnios

Maternal: diabetes, HTN, maternal CHF Foetal: CNS lesions, proximal GIT obstruction (oesophageal/duodenal/jejunal atresia), abdominal wall defects, chest masses, CVD abnormalities, twin-twin transfusion, hydrops Idiopathic (65%) Mild > 11cm pocket Moderate 12-15 Severe > 16

Causes of oligohydramnios

``` Drugs Renal abnormalities IUGR Premature rupture of membranes Chromosomal anomalies (18, 13) ```

Ovarian cancer staging

1. Tumour limited to ovaries 2. Involves both ovaries with pelvic extension 3. Peritoneal implants outside the pelvis or retroperitoneal lymph node metastasis 4. Distant metastases including liver parenchyma

Causes of IUGR

Maternal - HTN, diabetes, renal, cardiac, SLE, smoking, alcohol, drugs, infection Multiple gestation Placental insufficiency

Causes of foetal hydrops

Immune Non immune - chromosome - cardiac - in utero infection - foetal tumours - metabolic (gaucher) - skeletal dysplasias - high output flow states eg vein of Galen malformation - thoracic abnormalities causing venous ovstruction

Nuchal translucency

> 3mm 11-14 weeks gestation | > 6mm 16-20 weeks gestation

Features of trisomy 21

``` Cardiac defects Ventriculomegaly Duodenal atresia Pyelectasis Hyperechoic bowel Omphalocele Short femora and humeri ```

Features of Turner Syndrome

Short stature Ovarian dysgenesis Congenital lymphedema Cystic hygroma

Trisomy 18

Cystic hygroma Growth restriction Abnormal extremities (clenched hands and overlapping digits) Choroid plexus cysts

Trisomy 13

Holopresencephaly Cleft lip and palate Polydactyly Renal and cardiac anomalies (Patau syndrome)