OB/GYN Flashcards
Levator ani muscle
Forms the pelvic floor along with the piriformis muscles, supports and positions the pelvic organs. Posterior to vagina and cx. Medial to obturator internus muscles.
Illiopsoas muscles
Lateral landmark of the true pelvis. Course anterior and lateral through the false pelvis
Piriformis muscles
Arise from the sacrum, form part of the pelvic floor. Posterior to the uterus, ovaries, vagina, and rectum. Course diagonally to the obturator internus muscle
Psoas muscles
Arises from the lumbar spine. Course laterally and anteriorly into the false pelvis. Round in shape in thetransverse plane.
Obturator internus muscles
Lateral margins of the true pelvis. Posterior and medial to the Illiopsoas muscles. Level of that vagina, lateral to the ovaries abutting the lateral walls of the urinary bladder.
Broad ligament
Creates the retrouterine in the vesicouterine pouches. Provides a small amount of support to the uterus
Cardinal ligament
Extends across the pelvic floor, firmly supports the cervix, attaches at the isthmus portion of the uterus
Round ligament
Arises in the uterine cornua, anterior to the fallopian tubes, helps to maintain anteflexion of the uterine body and fundus, Contracts during labor.
Suspensory ligament
Also known as infundibulopelvic ligament, extends from the lateral portion of the ovary to the pelvic sidewall.
Uterosacral ligament
Extends from the upper cervix to the lateral margins of the sacrum, firmly supports the cx
Arcuate vessels
Prominent vascular structures in the outer one third of the myometrium
Internal iliac arteries
Posterior to the uterus and ovaries, A.k.a. hypogastric arteries, supply the bladder uterus vagina and rectum give rise to the uterine arteries
Ovarian arteries
Slightly inferior to the renal arteries, Course medial within the suspensory ligaments, primary blood supply to the ovaries
Ovarian veins
Course within the suspensory ligaments, right ovarian vein empties directly into the IVC, left ovarian vein empties into the left renal vein
Uterine arteries
Medial in that elevator ani muscles, Ascend on a tortuous, course lateral to the ut within the broad ligament.Supply the cervix vagina uterus ovaries and fallopian tube
Perimetrium
Serosal or external surface of the ut
Endometrium
Mucous membrane lining the uterine cavity composed of two layers: functional and basal
Uterine isthmus
Located between the survey and body of the uterus, termed lower uterine segment during pregnancy
Uterine arteries?
Demonstrate a high resistance flow pattern, resistive index of the arcuate arteries range between .86+ or -.04 (reproductive) and .89+ or -.06 (post menopause)
Normal sonographic appearance of the endometrium is?
Outer basal layer appears hypoechoic, inner functional layer typically appears hyperechoic
What is the location of the uterus?
Stationed in the pelvis, anterior to the rectum, and for scarier to the urinary bladder
How do we measure the endometrium?
Anterior-posterior thickness is measured in the sagittal plane, measured from echogenic interface to echogenic interface(functional layer) thin hypoechoic area (basal layer) is not included in the measurement
Premenarche uterine size:
2-4 x .5-1 x 1-2cm
Uterine menarche size?
6-8.5 x 3-5 x 3-5 cm nulliparus
8-10.5 x 3-5 x 5-6 cm
Parous
Postmenapausal uterine size?
3.5-7.5 x 2-3 x 4-6 cm
Anteflexion
Uterine fundus bends on the cervix
Anteversion
Cx forms an angle less than or equal to 90° with vaginal canal, most common uterine position
Retroflexion
Uterine fundus or body curved backward on the cx, cx remains in the anteverted position
Retroversion
Cx forms in less than 90° with a vaginal canal, uterus and cervix display a posterior tilt
Arcuate ut?
Septum between the mullerian ducts is almost complete resorption of septum with only mild indention of the endo of the fundus. My separation of the superior endo.
Bicornuate ut?
Partial fusion of the mullerian ducts. Deep notch in the fundus, 2 distinct endos separated by a small amount of myometrium
Didelphys ut?
Complete failure of the myllerian ducts to fuse, wide separation between two distinct uterine fundi (trvs plane) 2 separate cx, possible septated vagina
Septae ut?
Complete fusion of the mullerian ducts with failure to completely reabsorb the septum, 2 uterine cavities and one uterine fundus. Wide separation within the endo cavity by fibrous tissue or myometrium
Subseptae ut?
Thinseparation within the endo cavity by fibrous tissue or myometrium
Unicornuate ut?
Unilateral development of the paired mullerian ducts, small uterine size, lateral uterine position
OVs
Dual blood supply through the ovarian and uterine arteries
Estrogen is produced by?
Secreted by the follicle
Progesterone is secreted by?
The corpus luteum
Loc of ovs?
Intraperitonea, medial to the external illiac vessels, anterior to the internal illiac vessels and ureter, posterior to the fallopian tubes and broad ligament
Nomal sono appearance of ovs?
Ovoid medium-level echogenic structure, isoechoic compared to the normal ut
PW of ov?
During menses and early prolifirative phases, the ovarian artery demonstrates a high resistance and low flow velocity. RI ranges from .4-.8
PI ranges from .6-2.5
Ovs size?
2.5-5 x .6-2.2 x 1.5 -3 cm
Divisions of the FTS:
Interstitial, isthmus, ampulla ( most common area of ect preg) infundibulum
Size of the FTs?
7-12 cm 8-10 mm in diameter
Bladder
Postvoid residual normally should mot exceed 20 ml. Bladder wall thickness should not exceed 5mm
Bladder diverticulum?
Anechoic pedunculation of the uri bladder
Bladder ureterocele:
Hyperechoic septation seen within the bladder @ the ureteric orifice ( UTI)
Bladder calculus
Hyperechoic focus within the bladder, shadowing (hematuria)
Cystitis
Infection, dysuria, frequency, leukocytosis. Increase in bladder wall thickness
Bladder malignancy
Transitional cell carcinoma, painless hematuria, frequency, dysuria, echogenic mass, irregular margins.
Bladder polyp:
Frequency, echogenic intraluminal mass, vascular flow
What does menstruation depend on?
The functional integrity of the hypothalamus, pituitary gland, and ovarian axis
Estradiol is?
Primarily reflects the activity of the ovs, during pregnancy, levels will stedealy rise.
Estrogen
Normal levels: 5-100ug/24 h, primary female sex hormone. Produces by developing follicles and placenta. FSH and LH stimulate production of estrogen in ovs.
FSH
Secreted by the anterior pituitary gland, initiates follicular growth and and stimulates the maturation of the graafian follicle
LH?
Essential in both males and females for reproduction, secreted by anterior pituitary gland, increasing estrogen levels stimulate LH production, triggers ovulation and initiates the conversion of rhe residual follicle into a corpus luteum. LH surge typically lasts on the 48 hours
Progesterone
Produced in the adrenal gland’s, corus luteum, Brain and placenta. Prepares the Endo or possible implantation or starting the next menstrual cycle
Endometrium
Endo thickness should not exceed 14 mm, Endo without HRT should not exceed 8 mm and it is consistently benign when measuring 5 mm or less
Menstrual phase of endo
Early phase: hi point point central line during menstruation measuring 4 to 8 mm. Late phase: then discrete hyperechoic line postmenstruation measuring 2 to 3 mm
Proliferation phase
Days 6 to 14 increasing estrogen levels regenerate a functional layer, coincides with the follicular phase of the ovary. Early phase: days 6 to 9 thin echogenic Endo measuring 46 mm. Late phase: days 10 to 14. A triple line Measuring 6 to 10 mm thick hypoechoic functional layer and hyperechoic basal layer
Secretory phase
Days 15 to 28 functional layer continues to thicken. Functional layer appears hyperechoic, basal layer appears hypoechoic, acoustic enhancement, greatest thickness measuring 7 to 14 mm
Ovaries
Visualization of a cumulus opphorus indicates follicular maturity, with ovulation typically occurring within 36 hours. LH usually reaches its peak10-11 hrs before ovulation
Secretory phase
Days 15 to 28 functional layer continues to thicken. Functional layer appears hyperechoic, basal layer appears hypoechoic, acoustic enhancement, greatest thickness measuring 7 to 14 mm
Ovaries
Visualization of a cumulus opphorus indicates follicular maturity, with ovulation typically occurring within 36 hours. LH usually reaches its peak10-11 hrs before ovulation
Follicular phase
Early phase: days 1-5 multiple small anechoic functional cysts
Late phase: days 6-13, graafian follicle reahes 2-4 cm in diameter before ovulation
Ovulatory phase
Occurs @ the rupture of the graafian follicle, day 14. Minimal amount of cul-de-sac fluid
Luteal phase
Days 15-28, constant 14 day lifespan. Corpus luteum grows for 7-8 days, secreting some estrogen and an increasing amount of progesterone. If no fertilization cl regresses after 9 days
Hemorrhagic cyst
Severe acute pain, nausea, vomitting, low grade fever
Cystic teratoma (dermoid)
Most common primary ovarian neoplasm, “ tip of the iceberg” commonly located superior to the uterine fundus
Mucinous cystadenoma
Pelvic pain, irregular menses, bloating, multilocular anechoic mass, generally unilateral
Serous cystadenoma
Pelvic pain, irregular menses, bloating
Theca lutein cysts
Assoc with high levels of hCG, multilocular cystic structure, bilateral condition
Hyperplesia
Proliferation of the endometrial lining
Intramural leiomyoma
Mass distorting the myometrium, most common loc
Submucosal leiomyoma
Mass distorting the endo, least common but most likely to cause symptoms
Fibroma
Rare, benign stromal tumor, pelvic pain or fullness, menopause
Thecoma
Pelvic pain or pressure, menopause
when does a corpus luteum resolve?
by 16 weeks
what is the max measurement of a normal dominant follicle?
3 cm
what is a theca lutein cyst?
the largest of functional cysts, multilocular and bilateral, associated with gestetional throphoblastic disease
Rt sided ovarian torsion can mimic what?
acute appendicitis
any pt with a suspicious ovarian mass, should be evaluated in what other areas?
peritoneum, lymp nodes, liver and pleural space
endometriosis:
is the presence of functional endometrial tissue outside of the endo and myometrium
endometrioma
localized endometrial tissue, “chocolate cyst”
when in an NT performed?
between 11.5-13.5 weeks, greater than 3 mm is abnormal
an abnormal NT in the presence of a normal karyotype is associated with what?
increased incidence of congenital heart disease
what do low levels of PAPP-A and beta-hCG levels indicate?
abnormal implantation, poor placentation, or risk of trisomy 21
when is CVS performed?
between 9 and 12 weeks gestation
what are the components of quad screening, and when is it performed?
during the second trimester, MS-AFP, hCG, inhibin A, and uE3.
trisomy 18, Edward’s syndrome labs:
decreased, MS-AFP, decreased hCG, and decreased uE3
trisomy 21, Down syndrome labs:
decreased MS-AFP, increased hCG, decreased eU3 and increased inhibin-A
when is amniocentesis usually performed?
at around 16 weeks gestation
when does the morula enter the ut?
4 days after fertilization
when does the blastocyst implant itself in the endo?
7 days post-fertilization
when do the amnion and chorion fuse?
12-16 weeks
when is the yolk sac present?
when MSD is greater than or equal to 8 mm TV
when should the yolk sac be seen transabdominally?
by 7 weeks with sac measuring 20 mm
when is the rhombencephalon observed in the embryo?
between 8-11 weeks
NT:
should be performed in a sag plane, between 11.5-13.5 weeks. measurement should not exceed 3 mm.
NF:
should be performed in a trv plane, between 15-21 weeks, measurement should not exceed 6 mm.
when do fetal testes descend into the scrotum?
between 26-34 weeks gestation
