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OB Flashcards

1
Q

At what beta should gestational sac be seen?

A

1500 (approx. 5 weeks)

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2
Q

When is normal yolk sac seen?

A

5.5 weeks

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3
Q

When should fetal heart activity be seen?

A

CRL 7 mm

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4
Q

Findings definitive for pregnancy failure

A

CRL > 7mm, no heartbeat
MSD >25 mm, no embryo
Absence of embryo >2 weeks after sac with no yolk sac
Absence of embryo >11 days after sac with yolk sac

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5
Q

Findings suspicious for pregnancy failure

A 
CRL < 7mm, no heartbeat
MSD 16-24, no embryo
Empty amnion
Enlarged yolk sac (>7mm)
Small sac in relation to embryo
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6
Q

Locations of ectopic pregnancy in order of prevalence

A

*Tubal most common! (95%)
Ampulla&raquo_space;> isthmus > fimbria > interstitial > ovary
Other sites rare: abdominal, c-section scar, cervical

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7
Q

Which type of ectopic has greatest risk of bleeding

A

Interstitial

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8
Q

Differences b/w complete and partial molar preg

A

Complete: Most common, no fetal parts, loss of egg DNA prior to fertilization, diploid karyotype 46XX (90%) or 46XY, higher bHCG, may progress to invasive mole or choriocarcinoma

Partial: Some fetal parts, two sperm fertilizing 1 egg, triploid karyotype 69XXX, XXY, XYY, lower bHCG than complete

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9
Q

Imaging findings in GTD

A

Partial mole: enlarged placenta, cystic spaces, empty sac containing abnormal fetal parts +/- hydropic degeneration

Complete mole: enlarged uterus, multiple cystic spaces (snow storm or bunch of grapes), theca lutein cysts**

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10
Q

Choriocarcinoma usually arises from the following:

A 
Molar pregnancy (50%)
Miscarriage (30%)
Normal pregnancy (20%)
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11
Q

Risks of mono-di and mono-mono pregnancies

A

Twin twin transfusion, acardiac twins (twin reversed arterial perfusion sequences - TRAPS), twin embolization

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12
Q

Differentiating features between di-di, mono-di and mono-mono pregnancies on US

A

Di-di - 2 placentas, 2 amnions, twin peak/lambda sign
Mono-di - thin intertwin membrane
Mono-mono - no intervening membrane, intertwined cords

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13
Q

Normal AFI

A

5-25 cm (or deepest pocket 2-8 cm)

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14
Q

Normal NF

A

<6 mm

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15
Q

Normal cervical length

A

> 2.5 cm (funnelling progresses from T-Y-V-U)

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16
Q

RFs for placental abruption

A

maternal HTN, drugs, trauma, advanced maternal age

Usually late in 2nd trimester

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17
Q

Imaging findings placenta accreta/increta/percreta

A

Loss of the retroplacental hypoechoic space
Prominent venous lakes or vessels (best seen on MRI where there are abnormal vessels in myometrium)
Disruption of border between uterus and bladder (percreta)

*scarring most common cause (prior csx, d&c, pregnancies, also previa)

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18
Q

Findings in fetal hydrops

A 
Ascites
Pleural effusion
Pericardial effusion
Generalized body edema (anasarca, skin thickening)
Polyhydramnios
Placental enlargement
Hepatomegaly

**Must have at least 2 of these findings

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19
Q

List the causes of fetal hydrops

A

Immune: Rh incompatibility

Non-immune:

  • Syndromes (turners, triosmies)
  • Cardiac (arrhythmia, congential heart anomalies)
  • High output shunts (vein of Galen malformation, hemangiodendothelioma)
  • Infection (parvovirus most common, TORCH)
  • Twin twin tranfusion, TARPS
  • Other: nephrotic snydrome, hepatitis, venous/lymphatic obstruction
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20
Q

What is Potter’s sequence?

A

Constellation of findings secondary to severe oligohydramnios

  • Pulmonary hypoplasia
  • Abnormal facies - low set ears, flattened nose, wrinkled skin, micrognathia
  • Club feet, muscular contractures
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21
Q

Causes of polyhydramnios

A

50% idiopathic
others:
- primary GI obstruction/atresia
- secondary GI obstruction (hernia, omphalocele)
- CNS anomalies causing swallowing difficulties
- twin twin transfusion
- placental issues (i.e. chorioangioma)

22
Q

Causes of oligohydramnios

A

Renal abnormalities (agenesis, ARPKD), ureter (UPJ obstruction, PUV), PROM, twin-twin transfusion

23
Q

Normal ventricular size

A

<10 mm at atria

24
Q

Which neural tube defect gives highest elevation of MSAFP

A

Anencephaly

25
Q

Differentiating features between anencephaly and hydranencephaly

A

Anencephaly - no cranial vault or brain tissue above orbits, results from neural tube defect

Hydranencephaly - skull present, brain tissue replaced with fluid, often due to vascular insult

26
Q

Findings in Dandy-Walker malformation

A

Hypoplasia of vermis
Cystic dilation of the 4th ventricle, extending posteriorly
Enlarged posterior fossa

Ddx: mega cisterna magna, Joubert (molar-tooth sign), other cystic structures in posterior fossa

27
Q

Imaging findings Chiari II malformation

A

Intra-cranial- banana/ lemon sign, agenesis CC, absent CSP, hydro, enlarged foramen
NTD - myelomeningocele/tethered cord

Other findings: scoliosis, spinal segmentation anomalies, syrinx, club feet

28
Q

Secondary signs of absent CC

A
  • absent CSP
  • teardrop lateral ventricles
  • parallel ventricles
  • concave margin of medial border of lateral ventricle
  • midline inter-hemispheric cyst (superior herniation of 3rd ventricle)
29
Q

Ddx absent CSP (high yield)

A

agenesis of cc
holoprosencephaly
septo-optic dysplasia
schizencephaly

30
Q

Most common type of congential diaphragmatic hernia

A

Bochdalek; most on the left, posterolateral

Can be associated with other anomalies (cardiac) and syndromes

31
Q

Differences between CPAM and sequestration

A

CPAM - cystic or solid appearing (type III), blood supply from pulmonary circulation, not associated with other anomalies

Sequestration - echogenic lung mass (not cystic), usually in the lower lobes (left side), systemic blood supply from aorta; can be infra-diaphragmatic

Can have combined/mixed picture (esp with CPAM and extra-lobar sequestration)

32
Q

Bell shaped thorax causes

A

pulmonary hypoplasia (causes: mass effect from lesion such as CPAM, oligohydramnios - Potters sequences, skeletal dysplasias with short ribs)

33
Q

Imaging findings in CHAOS

A

Bilateral, enlarged echogenic lungs; requires EXIT procedure for delivery

34
Q

DDx for double bubble sign

A

Duodenal atresia, web, stenosis, annular pancreas (last 3 will have some distal gas as not complete obstruction)

35
Q

DDx echogenic bowel

A

Down syndrome
TORCH infection
CF
Swallowed intra-amniotic blood

36
Q

Differences between omphalocele and gastoschisis

A

O: more common, umbilical cord inserts at apex, covered in peritoneum, associated with anomalies in up to 75% of cases (cardiac, trisomies 18 & 13, Beckwith-Wiedemann)

G: paraumbilical (usually on right), no covering sac, isolated anomaly but can have associated atresias

37
Q

Imaging findings ARPKD

A

Enlarged, echogenic kidneys (can’t see the cysts because of small size); poor prognosis

38
Q

Findings in multi-cystic dysplastic kidney

A

Non-communicating cysts and dysplastic renal parenchyma; end result of obstructive uropathy

39
Q

Findings in thanatophoric dysplasia

A

Most common lethal skeletal dysplasia

  • narrow thoracic cavity, short ribs
  • short, thick, bowed tubular bones (telephone receiver)
  • soft tissue thickening in extremities
  • macrocephaly, platyspondyly**
  • clover leaf skull
  • squared iliac bones, trident acetabula
40
Q

Key imaging findings in Trisomy 21

A
  • incr nuchal fold
  • absent nasal bone
  • cystic hygroma (more common in Turner syndrome)
  • cardiac (VSD, ASD - primum/AVSD)
  • echogenic intra-cardiac focus
  • echogenic bowel
  • duodenal atresia
  • short femurs and humerus
  • sandal gap toes
41
Q

Key imaging findings in Trisomy 18

A
  • **strawberry sign skull
  • choroid plexus cysts
  • **facial anomalies: cleft palate, micrognathia
  • cardiac anomalies
  • omphalocele
  • renal: horseshoe kidneys, hydro
  • **clenced hand that does not open, overlapping fingers
  • **rocker bottom feet
42
Q

Key imaging findings in Trisomy 13

A
  • **holoprosencephaly
  • midline facial anomalies (brain predicts face)
  • cardiac anomalies
  • omphalocele
  • renal: horseshoe, polycystic
  • **polydactyly
43
Q

Key imaging findings in Beckwith-Wiedmann syndrome

A
  • Macroglossia
  • Hemihypertrophy
  • Organomegaly
  • Omphalocele**
  • Perinatal hypoglycemia

**increased risk of childhood cancer (mainly Wilms and hepatoblastoma)

44
Q

Imaging findings Meckel-Gruber

A
  • Encephalocele
  • Renal dysplasia (echogenic kidneys)
  • Polydactyly
45
Q

Which syndrome is most commonly associated with a cystic hygroma

A

Turner syndrome; also associated with trisomies

46
Q

Grading of germinal matrix

A

1 - confined to matrix
2 - extends into ventricles, NO ENLARGED VENTRICLES
3 - extends into ventricles, ENLARGED VENTRICLES
4 - extends outside of ventricles into parenchyma

47
Q

Normal placental thickness

48
Q

Causes of increased placental thickness

A

TORCH, GDM, hydrops

- with cysts: molar pregnancy, triploidy, placental mesenchymal dysplasia (Beckwith Wiedmann)

49
Q

Causes of decreased placental thickness

A

Pre-eclampsia

IUGR

50
Q

US findings morbidly adherent placenta/placenta accreta spectrum disorders

A
  • *Gray-scale and color Doppler US - high sensitivity and specificity**
  • irregular or absent retroplacental clear space
  • multiple irregular placental lacunae (Swiss-cheese appearance)
  • turbulent high-velocity flow deep in the placenta separate from the fetal surface of the placenta

An abnormal uterine serosa–bladder interface is reported as the US sign with the highest positive predictive value for MAP

Body Imaging (11 decks)

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