OB 2 FINAL (PP) Flashcards
What is Menarche?
Onset of menstruation
What is Menopause?
Stop of menstruation
What is Metrorrhea?
irregular bleeding
What days does menstruation occur in the cycle?
1-4 days
What is the sonographic appearance of the endometrial canal during menstruation?
hypoechoic line
What is a corpus luteum?
small endocrine structure that develops in a ruptured ovarian follicle.
What hormones does a corpus luteum secrete?
progesterone and estrogen
What is the broad ligament?
double fold of peritoneum that covers the uterus, ovaries and fallopian tubes
what are the round ligaments?
Between layers of broad ligament In front and below fallopian tubes
What are the cardinal ligaments?
cervix support with uterosacral
continuation of the broad ligaments that extend across the pelvic floor laterally
Where is the Posterior Cul-de-sac?
between the uterus and rectum
What are other names for the posterior cul-de-sac?
pouch of douglas
rectouterine pouch
Where is the anterior cul-de-sac?
between the bladder and uterus
what is another name for the anterior cul-de-sac?
vesicouterine pouch
what is the blood supply to the vagina?
anterior uterine artery
posterior branch of internal iliac
where is the space of retzius?
Between the anterior bladder wall and pubic symphysis
what is another name for the space of retzius?
retropubic space
what is the blood supply to the ovaries?
aorta
ovarian arteries
uterine arteries
what do the ovarian veins drain into?
left vein: drains into left renal vein
right vein: drains into IVC
what is the blood supply to the fallopian tubes?
ovarian arteries and veins
where are arcuate vessels found?
along the peripheral edge of the uterus
what is the embryology of the uterus and vagina?
they both develop from the mullerian ducts between 7-12weeks
what are the 3 layers of the uterus?
perimetrium
myometrium
endometrium
what are the 2 layers of the endometrium?
zona functionalis (superficial functional layer) zona basalis (deep basil layer)
what is the songraphic appererance of the endometrium?
echogenic to hypoechoic, depending on cycle
What layer sheds during menses?
zona functionalis
What is the size of ovaries?
3x2x2
What supports the ovary posteriorly?
broad ligament via mesovarium
what is the sonographic appearance of the ovary?
homogeneous, with an echogenic medulla
what supports the ovary medially?
ovarian ligament
what supports the ovary laterally?
suspensory ligament (infundibulopelvic)
what is ovarian torsion?
complete or partial rotation of the ovary, cutting off the blood supply
what day does ovulation occur?
day 14
what is the menstrual cycle?
menstraution = 1-4days
proliferative phase = 5-14 days
secretory phase = 15-28 days
what is the ovarian cycle?
follicular phase = 1-14 days
luteal phase = 15-28 days
what is the size of a graafian follicle?
2cm
what is the rate of growth of a graafian follicle?
2-3mm per day
what is the length of the fallopian tubes?
10-12cm
what are the sections of the fallopain tube?
infundibulum
ampulla
isthums
inerstitial portion
what section of the fallopian tube is the widest?
ampulla
what are cysts in the cervix called?
nabothian cysts
what are cysts in the vagina called?
gartners duct cysts
what are the most common tumors of the uterus?
fibroids (leiomyomas)
where can fibroids form?
submucosal- endometrial cavity; irregular or heavy periods
intramural - most common site; myometrium
subserosal- peritoneal surface of uterus; pedunculate and appearing as extrauterine mass
what is adenomyosis?
nests of endometrial tissue within the myometrium
what can cause calcifications within the uterus?
fibroids and arcuate arteries
what is the size of a vaginal cuff?
2cm
who can acquire endometritis?
postpartum patients, occurs with PID too
what is the most common ovarian mass?
simple ovarian cysts
simple ovarian cysts in postmenopausal women can be what size
less than 5cm before consider malignant
what are thecomas
benign, unilateral mass seen in postmenopausal women
what pelvic organ in the most involved with metastatic disease?
ovaries
what % of postmenopausal bleeding is endometrial carcinoma?
10%
what is the most common mass during pregnancy?
corpus leutal cyst
what is another term for endometriomas?
chocolate cysts
where are endometriomas commonly located?
ovaries, cul-de-sac, retrovaginal septum, peritoneal surface of posterior wall of uterus
what is the most common benign tumor of the ovary?
dermoid
what is a mucinous cyst adenoma?
Epithelial tumor lined with mucinous elements of endodermis and bowel
Typically larger than serous cyst adenoma
Simple, septated cyst with differing echogenicity
what is a serous cyst adenomas?
2nd most common benign tumor of ovary Smaller than mucinous cystadenomas Unilateral, septated, irregular borders
what is another name for PCOS?
Stein-Leventhal syndrome
what is PCOS?
disorder with chronic anovulation
bilateral enlarged round ovaries
teens-twenties
amenorrhea, obesity, infertile, hirsutism
what is salpingitis?
infected fallopian tubes
septate uterus can cause what?
infertility
In the first trimester, testing is done to identify..
pattern of biochemical markers associated with plasma protein A (PAPP-A) and free BhCG
PAPP-A and free BhCG values are used in conjunction with an ultrasound performed between 11 and 14 weeks, what is it?
Nuchal translucency
First trimester lab values give a more accurate calculation to determine if a child has..
chromosomal abnormalities
Second trimester screening can be performed with..
maternal serum quad screen lab and a targeted ultrasound examination
What does quad screen look at?
Alpha-fetoprotein
Human chorionic gonadotropin
Unconjugated estriol
Inhibin-A
Chorionic villus sampling
Ultrasound directed biopsy of the placenta or chorionic villi that is an alternative test used to obtain a fetal karyotype by the culturing of fetal cells similar to an amniocentesis
*risk of fetal loss 1-3%
When is CVS used?
10-12 weeks
*Transcervically or transabominally
Embryoscopy
A specialized prenatal test that permits the direct viewing of the developing embryo using transcervical endoscope inserted into the extracoelomic cavity during the first trimester
Amniocentesis
First used to relieve polyhydramnios, predict Rg isoimmunization, and document fetal lung maturity.
Why is amniocentesis performed?
To determine karyotype, lung maturity, and Rh condition
Optimal collection sites for amniocentesis
Away from the fetus, placenta, umbilical cord, and maternal midline
What is the major protein in the fetal serum that is produced by the yolk sac in early gestation and later by the fetal liver?
Alpha-fetoprotein
Where can AFP be found?
Fetal spine
Gastrointestinal tract
Liver
Kidney
AFP can be measured in what two things?
Maternal serum (MSAFP) or amniotic fluid (AFAFP)
Reasons for high levels of AFP
Neural tube defects Encepaloceles Kidney lesions Placental lesions Heart failure Liver diseases in mother Cystic adenomatoid malformations
MSAFP levels increase with..
advancing gestational age and peak from 15-18 weeks, then decrease with fetal age
Which two abdominal wall defect produce elevations of AFP? Which one is higher?
Omphalocele
Gastroschisis; higher level
what is hydrops
excessive fluid within fetal body cavities
What is nonimmume hydrops
hydrops that is not related to Rh factor
what is the sonographic appearance of hydrops
scalp edema pleural effusion pericardial effusion ascites polyhydramnios thick placenta
Hydrops can be caused by
Fetal anemia
what are sonographic markers for downs
thick NT/nuchal fold choroid plexus cysts echogengic bowel pylectasis short long bones echogenic intracardiac focus absent nasal bone omphalocele talipes micrognathia diaphragmatic hernia
Another name for trisomy 21
Down syndrome; most common chromosomal disorder, associated with maternal age
how often does trisomy 21 occur
1/600 births
Another name for trisomy 18
Edwards syndrome; second most common chromosomal disorder
how often does trisomy 18 occur
3/10,000 births
what are sonographic markers for Edwards
heart defects clench hands omphalocele micrognathia talipes choroid plexus cysts strawberry head cleft lip & palate diaphragmatic hernia renal anomalies cerebellar hypoplasia meningomyelocele SUA IUGR and hydramnios
Another name for trisomy 13
Patau’s syndrome
how often does trisomy 13 occur
1/5,000 births
what are sonographic markers for Pataus
holoprosenchephaly-40% polydactyly talipes cleft lip & palate renal anomalies menignomylocele heart defects omphalocele micrognathia
what are sonographic makers for Turners Syndrome
cystic hygroma heart defects coarctaion of the aorta hydrops renal anomalies
Turner’s syndrome
XO syndrome-occurs in females only
High risk for utero demise
Survivors have ovarian dysgenesis and short stature
what commonly causes triploidy
1 ova fertilized by 2 sperm
Complete extra set of chromosomes
triploidy
*majority spontaneously abort prior to 20 weeks
what are sonographic markers for Triploidy
heart defects omphalocele renal anomalies cranial defects facial defects
what is VACTERL
Group of complex anomalies vertebral defects anal atresia cardiac anomalies transesophageal fistula renal anomalies limb dysplasia
what diseases can happen to pregnant women
diabetes hypertension (chronic or pregnancy induced)
hypertensive mothers can have what size placenta
small
Insulin-dependent diabetes mothers are at an increased risk for
early and late trimester pregnancy loss
congenital anomalies
what are some sonographic markers in diabetic pregnancies
polyhydramnios macrosomia caudal regression syndrome-most common NT defects heart defects renal anomalies GI defects single umbilical artery
what is preeclampsia
high blood pressure that develops with proteinuria or edema
what is eclampsia
mother can develop seizures and coma
maternal obesity can cause what type of defects
neural tube defects
Uterien fibroids may cause
Pain or premature labor, delivery complications depending upon location
Uterine contractions can resolve in how many minutes?
20 to 30 mins
Uterine contractions can appear as what on ultrasound?
Focal mass and mimic a fibroid
at what week is it still considered preterm labor
37 weeks
Zygocity
number of ovum fertilized-monozygotic and dizygotic
Chorionicity
number of placentas-monochorioinc and dizygotic
Amnionicity
number of amniotic sacs
what are dizygotic twins
2 separate ova fertilized by 2 separate sperm
what are monozygotic twins
1 fertilized egg that divides into 2 fetuses
when does Di-Di twinning occur
division of zygote at 1-3 days
when does Di-Mono twinning occur
division of zygote at 4-8 days
when does Mono-Mono twinning occurs
division of zygote at 8 days
when does conjoined twinning occurs
division of zygote after 13 days
what percentage of pregnancies began with twins and end with a singleton
70%
what is a vanishing twin
early fetal demise that is absorbed
what is fetus papyraceous
fetal death that occurs after the fetus has reached a certain growth that is too large to resorb into the uterus
what is poly-oli sequence
“stuck twin” occurs around 16-26 weeks
one twin has polyhydramnios the other has oligohydramnios
what is twin to twin transfusion
an arteriovenous shunt within the placenta the arterial blood of 1 is pumped into the venous system of 2
what happens to the fetuses in twin to twin
the donor twin becomes anemic and growth restricted (oligo, pulmonary hypoplasia, renal hypoplasia) poor outcome
the recipient grows too quickly, too much blood, has polyhydramnios, can have heart failure, and hydropic
what type of twinning is twin to twin transfustion
monochorionic diamniotic
what is acradiac twin
twin abnormality where 1 twin develops without an upper half, occurs in monochorionic twins
what are the 5 different locations for conjoined twins
thoracopagus- joined at chest omphalopagus- joined at abdomen craniopagus- joined at head pygopagus- joined at butt ischiopagus- joined at hip
What is Fitz-Hugh-Curtis syndrome
Perihepatic inflammation that can result from PID or endometritis
Another name for 4D
active matrix arrays
What was the first company to actively use the 3D technology in 1989?
Kretztechnik AG
Basic features of 3D ultrasound
Represent the structure, texture, and form a specific area of interest
Steps to obtain a 3D image
- Echo-data must process along an ultrasound beam
- The ultrasound beam must move over the area of interest
- Translation and rotation of the axis from the ultrasound beam and the time of the reflected sound waves creates the 3D data set, which is converted into distance information by the assumption of the speed of sound within the area of interest
- Storage of the data and gap-filling procedure
- Visualization of the data obtained
What are the 2 types of 3D acquisitions
Manual “free hand”
Automatic- more accurate
What are the 2 types of 3D imaging modes
Multiplanar reconstruction mode
Volume rendering mode
What is multiplanar reconstruction
First method of 3D imaging
Movement of the intersection planes throughout the 3D volume and rotating the image planes; the sonographer or physician has the liberty to generate anatomic views from an infinite number of perspectives
What is volume rendering
This method is an extension of the planar reconstruction method, because the additional image processing techniques are applied to a region of interest (ROI) within the 3D volume data set
What are the 2 types of 3D rendering modes
Surface rendering
Transparent rendering
What is surface rendering
Displays surface detail of anatomy Ex. Fetal face
What is transparent rendering
Looks beyond the surface anatomy to reveal structures located within
Sometimes called x-ray mode
not useful in OB imaging
What are other modes to transparent rendering
Maximum
Minimum
X-ray
When does the umbilical cord form
Develops in the first 5 weeks
Where does the umbilical cord rise from
Omphalomesenteric (yolk stalk) and allantios ducts
How long are the intestines herniated outside the fetal abdomen
From 7-10 weeks
What covers the umbilical cord
Whartons jelly-myxomatous connective tissue
What is the diameter of the umbilical cord
1-2cm
What is the normal length of the umbilical cord
40-60 cm
What is the ductus venosus
Conduit between the portal system and systemic veins
What is a short cord
Less than 35cm
What is a long cord
Greater than 80cm
What are true knots
Knot is formed when a loop of cord is slipped over the fetal head or shoulders
What are true knots associated with
Long cords
Polyhydramnios
IUGR
Monoamniotic twins
What is a velamentous cord insertion
Cord inserts into the membranes before the placenta
What is the occurrence of cleft lip and palate with different races
Blacks 1/3,000
Whites 1/600
Asians 1/350
Native Americans 1/150-250
What percentage of cleft lips are complete? unilateral?
complete cleft lip- 85%
unilateral- 70%
What is exophtalmia
Abnormal protrusion of the eyeballs
What is the most common neck mass
Cystic hygroma
Rare neck lesions
Cervical meningomyelocele Hemaniomas Teratomas Goiter Sarcoma Metastatic adenopathy
What is anencephaly
Most common neural tube defect
Absence of the brain
Caused by the failure of closure of the neural tube at the cranial end
Lethal
What is the occurrence of anencephaly
1/1,200
What are cephaloceles
A neural tube defect in which the meninges or meninges and brain herniate thru a defect in the calvarium
What abnormalities associate with cephaloceles
Trisomy 13
Meckel Gruber syndrome
What can cause a celphalocele
Amniotic band syndrome
What is a encephalocele
A herniation of the meninges and brain thru a defect
What abnormalities associate with encephaloceles
Meckel Gruber
Meckel Gruber syndrome is commonly identified by what sonographic findings
cephaloceles/ or encephaloceles
polydactytly
polycystic kidneys
Arnold-Chiari malformation demonstrates
Banana shaped cerebellum
scalloping frontal bones
lemon shaped head
What are the sonographic findings of spina bifida
Splaying of posterior ossification center
Meningocele-protrusion of a saclike structure that may be anechoic
Meningomylocele- contains neural elements
Cleft in skin
Intracranial malformations
What kind of intracranial malformations could be present with spina bifida
Lemon head-flattening of the frontal bones
Banana cerebellum
Absent cisterna magna
Ventriculomegaly
Abnormalities linked with ventricular dilation include
aqueductal stenosis,
arachnoid cysts,
and vein of Galen aneurysms.
Common causes of ventriculomegaly include
spina bifida, and encephaloceles
When is a ventricle considered dilated
Greater than 10mm
What is the most important determinant for fetal viability?
Pulmonary development
Fetuses younger than ____ are considered non viable, due to pulmonary development
24 weeks
how do you evaluate the fetal chest
size
shape
symmetry
Average cardiac axis is
45 degrees
Lung echogenicity
homogenous and moderately echogenci
What two problems can complicate the exact determination of echogenicity
Overlying ribs
Acoustic enhancement produced by blood in the heart
ultrasound cannot asses what in the fetal chest
lung maturity
what is congetntial cystic adenomatoid malformation (CCAM)
abnormal cystic growths within the bronchial trees that can cause a mediastinal shift, hydrops and polyhydramnios
how many types of CCAM are there
3
what is type 1 CCAM
several large cysts that replace normal lung tissue
2-10cm
favorable outcome
what is type 2 CCAM
lesions that have multiple small cysts < 1cm
poor outcome
associated with fetal and or chromosomal abnormalities in 25% of cases-renal agenesis, pulmonary anomalies, diaphragmatic hernia
what is type 3 CCAM
large bulky noncystic mass
echo-dense masses of the entire lung lobe
Common findings with CCAM
Mediastinal shift
Hydramnios
Hydrops
Steps to take when CCAM is present
- Determine the number and size of cysts •Check for mediastinal shift
- Identify and asses the size of lungs
- Look for hydrops
- Exclude cardiac masses and other fetal anomalies
what are bronchogenic cysts
Occurs within the mediastinum or lung
Most common lung mass detected prenatally that is a small circumscribed masses without a mediastinal shift
what is pulmonary hypoplasia
poor or reduced lung growth causing small, inadequate lungs
what is are common causes for pulmonary hypoplasia
prolonged oligohydramnios or a small thoracic cavity
what % of neonates die from pulmonary hypoplasia
80%
Severity of pulmonary hypoplasia depends on what three things
When it occurred in the pregnancy
Its severity
Duration
what is pleural effusion
accumulation of fluid within the pleural cavity appearing isolated or secondary to multiple fetal anomalies
if pleural effusion is seen, what structures should be carefully search
lungs, heart and diaphragm to rule out associated abnormalities
what is the occurrence of a congenital diaphragmatic hernia
1/2,000 to 1/5,000
What is congenital diaphragmatic hernia
an opening in the pleuroperitoneal membrane
at how many weeks is the diaphragm intact
by the end of the 8th week
what is the most common type of diaphragmatic hernia
hernias 90% of the time are thru the foramen of Bochdalek
where is the foramen of Bochdalek located
posterior and laterally
what are the 2 most common anterior abdominal wall defects
gastroschisis
omphalocele
what process helps the embryo transform itself into a cylindrical shape
“folding”
when do the intestines return to the abdominal cavity
12 weeks
what is an omphalocele
central abdominal wall defect with eviscerated bowel and or liver into the base of the umbilical cord
what forms the membrane that surrounds the omphalocele
peritoneum and amnion
what can occur with omphaloceles
ascites polyhydramnios complex cardia diseases GI defects NT defects genitourinary tract anomalies diaphragmatic hernia
what is gastroschisis
an opening in the abdominal wall with a herniation of bowel, no membranous covering the herniation of the stomach and genitrourinary organs happen infrequently
what causes gastroschisis
atrophy of the right umbilical vein or disruption of the omphalomesenteric artery
how big are gastroschisis defects
2-4cm located to the right of a normal cord insertion
gastroschisis causes an elevation in what lab
MSAFP
markedly dilated bowel in gastroschisis may suggest what
infarction or bowel atresia
What is amniotic band syndrome
is the rupture of the amnion, which leads to entrapment of entanglement of fetal parts by the “sticky” chorion
early entrapment in amniotic bands can lead to what
severe craniofacial defects
internal malformations
associated anomalies associated with amniotic band syndrome
anomalies of the limbs, cranium, face, thorax, spine, and abdominal wall
limb body wall complex involves what other defects
cranial defects
facial clefts
body-wall defect of thorax / abdomen (or both)
limb defects
scoliosis is associated with what type of defect
limb body wall defect
what side is more common to be affected by limb body wall
left side 3x more likely than right
what is the sonographic appearance of haustral folds
thin linear echoes with the lumen of the colon
what is the normal diameter of the colon at full term
14-18mm
*later on the colon diameter increases and the fold become longer and thicker
what is the appearance of meconium as it grows near term
increasing echogenicty
what is situs inversus
total or partial reversal of thoracic and abdominal organs
what organs are involved with partial situs inversus
only the heart or abdominal organs are reversed, the stomach may or may not be involved
what is pseudoascites
a sonolucent band near the fetal anterior abdominal wall
when can pseudoascites be seen
18 weeks or greater
what happens in duodenal atresia
the duodenal lumen is blocked by a membrane that prohibits the passage of amniotic fluid, causing a double bubble
where are most cases of duodenal atresia founds
below the ampulla
what abnormality can often coexist with double bubble
an annular pancreas
what % of double bubble cases have trisomy 21
30%
what % of duodenal atresia have other anomiles
50%
what is the occurrence of esophageal atresia
1/2,500 live births
what % of esophageal atresia cases have coexisting anomalies
50%-70%
what is the most common anomaly found with esophageal atresia
anorectal atresia (others could be VACTERL)
what is the occurrence of extrophy of the bladder
1/50,000 male births
what causes bladder extrophy
a defective closure of the inferior part of the abdominal wall at 4 weeks
what 2 renal findings are incompatible with life
renal agenesis
infantile polycystic kidney disease
when do the fetal kidney start contributing to amniotic fluid
14-16 weeks
in renal agenesis what structures can be mistaken for as kidneys
adrenal glands
what is the sonographic appearance of renal agenesis
severe oligohydramnios after 13 to 15 weeks
persistent absence of the bladder
failure to see kidneys
small thorax
what is Potters syndrome associated with
renal agenesis oligohydramnios pulmonary hypoplasia abnormal facies malformed hands and feet
how many types of Potters syndrome are there
4
what is type 1 Potters syndrome
(AR) infantile polycystic kidney disease
what is type 2 Potters syndrome
renal agenesis, multicystic kidneys, renal dysplasia
what is type 3 Potters syndrome
(AD) polycystic kidney disease
what is type 4 Potters sydndrome
renal dysplasia obstructive kidney disease
what is the most common form of renal cystic disease in infants and neonates
multicystic dysplastic kidney disease
what happens in multicystic dysplastic kidney disease
renal tissue is replace by multiple noncommunicating cysts, causing the kidney to be nonfunctional
what is the sonographic appearance of infantile polycystic kidney dieases
kidneys appear enlarged
what is the most common reason for hydronephorsis in utero
UPJ
where does the UPJ obstruction occur
at the junction between the renal pelvis and ureter
True/False UPJ’s are usually a unilateral defect
True
what can cause UPJ
abnormal bend/kinks in ureter abnormal valves in ureter abnormal outlet shape
what findings occur with posterior urethral valves
hydronephrosis
hydroureters
enlarged bladder
posterior urethra “keyhole” appearance
what is the most common fetal anomaly
hydronephrosis
the renal pelvis should not measure more than ____
4mm
what is utereocele
cystic dilation of the intravesical segment of the distal ureter
what is skeletal dysplasia
abnormal growth and density of cartilage and bone
how many types of skeletal dysplasia are there
over 100, but not all are detected by ultrasound
dwarfism occurs ______ to a skeletal dysplaisa
secondary
what is rhizomelia
short long bones (Hum/Fem)
what is mesomelia
short distal bone (ulna/radius, tib/fib)
what is micromelia
shortening of all the extremity bones
what are sonographic findings of thanatophoric dysplaisa
rhizomelia bowed long bones narrow thorax normal trunk length large head or cloverleaf head flat vertebral bodies(platyspondyly) frontal bossing hypertelorism
what is type 1 thanatophoric dysplaisa
short, curved femurs and flat vertebral bodies
what is type 2 thanatophoric dysplaisa
straight, short femurs, flat vertebral bodies and cloverleaf skull
what is the most common nonlethal skeletal dysplaisa
achondroplasia
what is the occurence of achondroplasia
5-15/10,000 births 1/66,000 births in USA
what type of bones does achondroplasia produce
short, squat bones
what % of achondroplasia cases are from spontaneous mutation
80% but some can be transmitted in an autosomal form
what is osteogenesis imperfecta
disorder of production, secretion or function of collagen causing brittle bones and hypomineralization
what is the occurrence of osteogenesis imperfecta
1/20,000 - 30,000 births
what are findings of osteogenesis imperfecta type 2
numerous fractures short femurs decreased mineralization of bones and calvarium
what is the occurrence of osteogenesis imperfecta type 2
1/60,000 births
jeunes syndrome has what
a very narrow thorax, causing pulmonary hypoplasia
how is jeunes syndrome acquired
inherited by an auto-recessive manner
1 in 70,000 births
what are sonographic findings of jeunes syndrome
small thorax
rhizomelia
renal dysplasia
polydactyly (14%)
how often does club foot occur
1/400 births unilateral; higher in males
what chromosomal anomaly has rocker-bottom feet
trisomy 18
how often does Ellis-Van Creveld syndrome occur
1/200,000 births
Ellis-Van creveld syndrome is also known as
chondoectodermal dysplasia
what community has a high incidence of Ellis-Van Creveld
Amish
what are sonographic features of Ellis-Van Creveld
short limbs polydactyly heart defects- 50% narrow thorax death up to 50% survivors are short, normal intellect
