OB/GYN Registry Review part 3 Flashcards
leg contains the ____ and ____
tibia
fibula
The forearm contains the ____ and ____
radius
ulna
at least three of the associated defects
VACTERL association
VACTERL
vertebral defects
anorectal atresia
cardiac defects
tracheoesophageal atresia
renal anomalies
limb defects
abnormal curvature laterally or S-shaped spine
scoliosis
abnormal posterior curvature of the spine
kyphosis
associated with amniotic band, limb body wall complex, and VACTERL
scoliosis and kyphosis
limb body wall complex is also known as:
body stalk anomaly
fatal condition caused by vascular occlusion, amnion rupture, or embryonic dysgenesis, elevated AFP
limb body wall complex
appears as if front of abdomen is stuck to placental wall due to very short of absent cord. Body wall defects, limb defects, craniofacial defects, marked scoliosis
limb body wall complex
dwarfism
achondroplasia
autosomal dominant. Most common non-lethal dysplasia
heterozygous achondroplasia
autosomal recessive and fatal dysplasia
homozygous achondroplasia
macrocrania, frontal bossing, trident hand, rhizomelia,
achondroplasia
prominent forehead
frontal bossing
space between third and fourth digits
trident hand
proximal limbs are much shorter than distal l
rhizomelia
rare, lethal condition; absent mineralization/ossification of bones, especially noted in pelvis, spine, and cranium. NO shadowing, micromelia, fractures. polyhydramnios
achondrogenesis
“imperfect bone formation”. Brittle bone disease. results in multiple fractures in utero and under-ossified bones.
osteogenesis imperfecta
refers to the ability of compressing cranium with probe pressure
soft skull
Type ___ osteogenesis imperfect is always fatal
II
Most common lethal dysplasia
thanatophoric (death bearing) dysplasia
abnormal shaped bone growth
thanatophoric dysplasia
“cloverleaf skull”, bell-shaped chest, telephone receiver bowed long bones
thanatophoric dysplasia
Caudal regression syndrome is also referred to as
sacral agenesis
absence of sacrum and coccyx
caudal regression syndrome
defects in lumbar spine and lower limbs; strong association with uncontrolled maternal (pre-gestational) diabetes/diabetes mellitus
caudal regression syndrome
Mermaid syndrome. Fusion of lower extremities. Bilateral renal agenesis often accompanies this disoder
Sirenomeliag
germ cell tumor seen as complex mass extending posteriorly and inferiorly from distal spine. More commonly seen in females. Malignant potential
Sacrococcygeal teratoma
clubfoot is associated with trisomy
13
talipes equinovares
clubfoot
medial inversion of foot. Bottom of foot and metatarsals appear in the same plane as the tibia and fibula
clubfoot
Rockerbottom foot is associated with trisomy:
18
rounded bottom of foot, normal foot/ankle angle
rockerbottom foot
Sandal gap is associated with trisomy
21
space between big two and second digit
sandal gap
absent radius, hypoplastic ulna, missing thumb
radial ray defect
polydactyly is associated with trisomy
13
Clinodactyly is associated with trisomy
18
Syndactyly is associated with
triploidy
sticky bands of amnion result from rupture of the amnion. fetal parts can be caught and causes amputations and odd facial clefts.
amniotic band syndrome
Fetal kidneys produce:
amniotic fluid
GI abnormalities most often result in
polyhydramnios
The stomach is _____ to the diaphragm
inferior
The stomach should empty of fill every ___ minutes
30
Cord insertion is just _____ to the level of the kidneys, should be smooth with no herniations or mass
inferior
absence of a section of the esophagus
esophageal atresia
Esophageal atresia is associated with trisomy
18
“double bubble” sign demonstrating fluid filled stomach and fluid filled proximal duodenum
duodenal atresia
Duodenal atresia is associated with trisomy
21
most common type of colonic atresia that leads to bowel obstruction
anorectal atresia
functional bowel obstruction caused by the absence of nerves within bowel wall
Hirschsprung disease
Echogenic bowel is associated with trisomy __ and cystic fibrosis
21
Most common malignant abdominal mass in neonates. Adrenal gland tumor. Mass superior to kidney.
Neuroblastoma
Most common abnormality of the liver
hepatomegaly
Hepatomegaly is associated with:
Beckwith-Wiedemann syndrome
herniation of bowel through an opening on the right side of cord insertion. Not covered by a membrane or skin. Highly elevated AFP. Usually isolated.
gastroschisis
Persistent herniation of bowel and possibly other organs into the base of the umbilical cord after 12 weeks. Always midline and covered by membrane. AFP may be normal
Omphalocele
Omphaloceles are associated with trisomies
13
18
Fetal kidneys form in the
pelvis
The fetal kidneys rise to the renal fossas by __ weeks
9
By __ weeks, the kidneys are fully functional
10
At __ weeks, the kidneys produce urine
12
The bladder can be seen by ___ weeks
13
The kidneys can be seen by ___ weeks
15
After ___ weeks, the majority of amniotic fluid is made of up fetal urine
16
_____ abnormalities are the most frequent cause of oligohydramnios
renal
Most common renal anomaly
duplicated collecting system
failure of kidney to form; unilateral or bilateral
renal agenesis
“lying down” adrenal sign, adrenal gland is flattened and parallel to spine
absence of renal arteries coming off of aorta
renal agenesis
______ renal agenesis: fluid and bladder will be normal
unilateral
______ renal agenesis: NO BLADDER and NO FLUID
bilateral (Potters syndrome)
2 kinds of polycystic kidney disease:
autosomal recessive PKD
autosomal dominant PKD
infantile polycystic kidney disease
autosomal recessive PKD
adult polycystic kidney disease
autosomal dominant PKD
ARPKDis ______ and will be _____
nonfunctional, fatal
ARPKD is associated with:
Meckel-Gruber syndrome
occipital encephalocele
ADPKD does not affect the function of the kidneys until:
late adulthood
bilateral, echogenic kidneys
non-functioning kidneys
absent bladder
oligohydramnios
fatal
ARPKD
may be normal
bilateral, enlarged echogenic kidneys
functioning kidneys
normal bladder/normal fluid
cysts develop as an adult
ADPKD
can be unilateral or bilateral; large cysts affecting the entire kidney
kidney appears to fill abdomen
affected kidney is non functional
multicystic dysplastic renal dysplasia
caused by early renal obstruction. unilateral or bilateral, kidney becomes small and echogenic with peripheral renal cysts, Non-functional disease
obstructive cystic dysplasia
most common fetal abnormality
hydronephosis
any obstruction to normal succession of urine flow will result in back up and cause dilation _____ to obstruction
proximal
Dilatation of the renal pelvis >4mm in second trimesteer
pyelectasis
dilatation of the renal pelvis > 7mm in the third trimester
pyelectasis
most common cause of hydronephrosis
ureteropelvic junction
UPJ causes dilatation of:
renal pelvis only
least common cause of hydro. Kidneys and ureter obstruction
ureterovesicular junction
everything bladder up dilated
bladder outlet obstruction
_______ causes bladder outlet obstruction in male fetus
posterior urethral valve
leads to massively dilated bladder. “keyhole” sign; dilated bladder; and dilatered posterior urethra. Dilation of ureters and kidneys will occur eventually.
bladder outlet obstruction
megcystis
dilated bladder
absent abdominal musculature, undescended testis, urinary tract abnormalities, also referred to as Eagle-Barret syndrome
Prune Belly Syndrome
bladder located outside of the pelvis. lower abdominal mass inferior to umbilicus.
bladder exstrophy
bladder, intestines, genitalia outside of the pelvis.
cloacal extrophy
most common cause of ambiguous genitalia is a
female with clitoromegaly
abnormal curvature of the penis
hypospadias
35 years or older at EDD
advanced maternal age
analysis of fetal chromosomes
karyotyping
single defect leading to development of other defects
sequency
group of clinically observable findings that often exist together
syndrome
nonrandom occurrence of at least 3 associated defects
association
any structure feature that is abnormal
anomaly
any abnormal number of chromosomes
aneuploidy
normal chromosomes
euploid
two complete sets of chromosomes. Humans have 23 pairs = 46 chromosomes
diploid
three complete sets = 69 chromosomes
triploid
only only of an individual chromosome (45 chromosomes)
monosomy
three copies of one individual chromosome one extra = 47 chromosomes
trisomy
mixed pattern aneuploid
mosaic
samples placental for aspiration of trophoblastic cells
Earliest procedure done TA or TV between 10-12 weeks
fetal loss rate 0.8%
chorionic villi sampling
samples amniotic fluid.
15 weeks onward
US guided TA
Fetal loss rate 0.5%
amniocentesis
percuteaneous umbilical cord sampling. samples fetal blood. After 17 weeks
US guidance
samples through umbilical cord near insertion into placenta. Fetal loss rate 0.1%
Cordocentesis
Most common aneuploid
trisomy 21
occurs in 1 in 800 births
trisomy 21
elevated HCG and inhibin A
Low AFP, estriol, and PAPP-A
trisomy 21
absent nasal bone is associated with
trisomy 21
flattened profile is associated with
trisomy 21
thickened NF is associated with
trisomy 21
macroglossia is associated with
trisomy 21
echogenic intracardiac focus is associated with
trisomy 21
Cardiac defects is associated with
trisomy 21
Duodenal atresia is associated with:;
trisomy 21
echogenic bowel is associated with
trisomy 21
short limbs are associated with
trisomy 21
sandal gap feet are associated with
trisomy 21
Trisomy 21 is also referred to as
Downs syndrome
Trisomy 18 is also referred to as
Edward Syndome
All lab values decreased in this trisomy
18
choroid plexus cysts are associated with
trisomy 18
strawberry skull is associated with
trisomy 18
micrognathia is associated with
trisomy 18
omphalocele is associated with
trisomy 18
esophageal atresia is associated with
trisomy 18
clenched hands (clinodactyly) is associated with
trisomy 18
Rockerbottom feet is associated with
trisomy 18
Cardiac defects are associated with trisomy
18
Trisomy 13 is also known as
Patau’s Syndrome
Holoprosencephaly is associated with
trisomy 13
facial abnormalities is associated with
trisomy 13
microcephaly is associated with
trisomy 13
polydactyly is associated with
trisomy 13
omphalocele is associated with
trisomy 13
cardiac defects is associated with
trisomy 13
clubfeet is associated with
trisomy 13
Turners syndrome is also known as
Monosomy X
Low AFP and estriol
with hydrops: low HCG and inhibin A
low PAPPA-A
Turners syndrome
females, cystic hygroma, increased NT, renal anomalies, cardiac defects, nonimmune hydrops
Turners Syndrome
3 sets with a total of 69 chromosomes, Usually fatal early
triploid
high HCG (with molar)
triploidy
partial molar
small, low set ears
syndactyly (fused digits)
IUGR
cardiac defects
theca-lutein cysts
Triploidy
PKD, encephalocele, microcephaly, polydactyly
Meckle-Gruber
bilateral renal agenesis, oligohydramnios, pulmonary hypoplasia, facial abnormalities
Potter syndrome
Macroglossia, large organs
Beckwith-Wiedemann
Omphalocele, ectopia cordis, sternal and diaphgragmatic defects
Pentalogy of Cantrell
Vertebra, anorectal, cardiac, trachea, esophageal, renal, limbn
VACTERL
limb amputations, facial clefts, gastroschisis, skeletal defects
amniotic band
abdominal wall defects, scoliosis, facial, and limb defects
limb body wall
IUGR, microcephaly, microophthalmos, cardiac defects, hypospadias
Fetal alcohol
cloverleaf skull due to craniosynostosis (premature fusion of sutures_
Kleebattschadel
heart and upper extremity malformations
Holt-Oram
Ears, mandible, and palate malformations
Treacher-Collins
median gestational age of delivery for twins
36 weeks
arise from 2 separate eggs that were fertilized
dizygotic
arise from 1 zygote that splits
monozygotic
most common type of twinning
dizygotic
chorion forms the:
gestational sac and placenta
the innner membrane and goes with yolk sac
amnion
Dizygotic will always be ______
dichorionic/diamniotic
results from single ovum that splits
monozygotic
Early division <4 days results in ______
dichorionic/diamniotic
Most common division, 4-8 days:
monochorionic/diamniotic
Late division >8 days results in:
monochorionic/monoamniotic
can be seen as two completely separate gestational sacs within the uterine cavity
dichorionic
Dichorionic/diamniotic is associated with the _____ sign
twin peak (lambda/delta)
Monochorionic/diamniotic is associated with the ____ sign
T
Monochorionic share one placenta so there is increased risk of ______ and ______
fetal shunting
growth issues
Fetal shunting through vessels in the placenta
Twin to Twin transfusion syndrome
the donor twin suffers from _____ and _____ in TTTS.
IUGR
anemia
Recipient twin suffers from _____ and _____ in TTTS
hydrops
CHF
1st initial sonographic indication of TTTS:
discordant fetal growth
donor twin TTTS
smaller/IUGR
oligohydramnios
anema
recipient twin TTTS
larger
polyhydramnios
hydrops/CHF
most severe type of TTTS
stuck twin
abnormal anastamosis of placental vessels that support the growth of parasitic or acardiac twin
TRAP sequence
one normal fetus and an abnormally developed fetus with no heart, fetus maintains the growth of the parasitic twin
acardiac twin
The pump twin in TRAP sequence has a mortality rate of 50% secondary to ______ and ______.
polyhydramnios
prematurity
The acardiac twin in TRAP sequence demonstrates ______, _____, and ______
absent upper body
absent heart
hydrops
conjoined twins are only ________
monochorionic/monoamniotic
most common conjoined twins
thoracopagus omphalopagus
fetal death in 1st trimester and is maintained, not reabsorbed
fetus papyraceus
Death of a twin in the early first trimester and is reabsorbed
vanishing twin
Fetal deminse in the 2nd trimester of monochorionic gets can lead to:
twin embolization sydrome
Normal placental thickness
2-4 cm
exchanges gas and waste products with nutrients and oxygen. means of nutrition and respiration; major function of an excretory organ
placenta
maternal side of placenta
decidua basalis
fetal side of placenta
chorion frondosum or chorionic plate
functional unit of placenta; lobes of chorionic villi
cotyledons
2 discs of equal size joined together by an isthmus of placental tissue
bilobed placenta
additional small lobe separate from the main placental mass but connected by vascular connections. No placental tissue connection
accessory/succenturiate lobe
curled up placental contour appearing as a shelf. curled edges, do not lay flat or smooth along wall. Increased risk of abnormal placental development and future abruption
circumvallate placenta
pools of maternal venous blood. sonolucent areas within placental mass. will not fill in with color but can be “swirling in B-mode
venous lakes/maternal lakes/ placental lakes/ lacunae
Advanced maturation of the placenta can be an indication of maternal complications leading to ______ and _____
placental insufficiency
asymmetrical IUGR
Grade 0 placenta
homogenous, smooth echotexture. No indentations in chorionic plate. Smooth borders
Grade 1 placenta
subtle indentations in chorionic plate, small random hyperechoic foci
Grade 2 placenta
larger comma-like indentations alter chorionic plate, larger calcifications in basal plate
Grade 3 placenta
post dates/advanced. Complete indentations chorionic to basal plate. Irregular calcifications with shadowing. Related to drug abuse and preeclampsia. May cause IUGR if early gestation
placenta is implants within the LUS and covers/near to internal os
placenta previa
Most likely cause of painless vaginal bleeding in 2nd and 3rd trimester
placenta previa
internal os is completely covered by placental tissue
complete previa
edge of placenta touches internal os
marginal previa
edge of placenta is within 2 cm of internal os
low-lying placenta
general term for abnormal adherence of placenta to myometrium
accreta
loss of basal plate or myometrial/serosal layer, multiple placental lacunae, and increased peripheral vascularity
accreta
placenta adhered to wall
accreta
placenta invades myometrium
placenta increta
penetrates through uterus and breach serosal layer
placenta percreta
Premature separation of placenta from uterine wall. high risk of fetal death
placental abruption
bleeding, pain, tenderness, trauma, decreased hematocrit
placental abruption
hypoechoic or anechoic between placenta and uterine wall at level of basal plate
placental abruption
most severe type of abruption; entire retroplacental hematoma
Complete abruption
few centimeters of separation between placenta and uterine wall
partial abruption
placental edge, lifting the chorionic membrane from wall
marginal placental abruption
most common placental tumor
chorioangioma
most common location for chorioangioma
adjacent to umbilical cord insertion at placenta
The umbilical cord contains:
2 arteries and 1 vein
The bmilical cord is surrounded by ______
Wharton’s jelly
The umbilical cord is developed from ______ and _____
yolk sac
vitelline duct
______ carry deoxygenated blood bback to placenta
arteries
The placental cord insertion normally inserts in the:
central part of the placenta
battledore placenta
marginal cord insertion
cord insertion within 2 cm of the placenta
marginal cord insertion
insertion in the membranes beyond the placental edge and insert into side of hterine wall
velamentous/membranous cord insertion
fetal vessels implanted across the internal os. May rupture as cervix dilates.
vasa previa
cyst of cord adjacent to vessels. Usually near placenta. May be seen as free floating cord with “bubble” inside of adjacent to cord vessels.
allantoic cyst
cyst of cord near fetal abdomen
omphalomesenteric cyst
most common tumor of cord, Solid hyperechoic masses, Near placenta
hemangioma
_____ is determined by the deamnds of the organ
resistance
When an organ requuires or wants more blood, the volume flow is increased by:
lowering the resistance
Uterine arteries gravid uterus
_____ volume flow
____ resistance
high
low
The umbilical artery doppler assesses for _____ and ______
placental resistance
fetal well-being
_____ is the means of respirations and nutrition
placenta
Increased placental resistance indicates ______
placental insufficiency
EFW below 10th percentile. Biometry measures 2 weeks below expected gestational age.
IUGR
_____ is used to evaluate for IUGR
AC
entire fetus is evenly small. Usually starts earlies and related to a fetal syndrome
symmetric IUGR
“brain-sparing” head biometery may be WNL. Results in abnormal HC/AC ratio. Gerneally presents later (2nd trimester and on) and related to maternal complications, placental insufficiency and abnormal dopplers.
asymmetric IUGR
The MCA Doppler is used to assess:
fetal hypoxia or anemia
Anemia reduces ______, making blood less vscious.
hemoglobin
Directs blood from placenta to fetus
umbilical vein/ductus venosus
______ should be steady, minimally phasic with constant flow towards the fetus.
umbilical vein
dividing the uterus in 4 quadrants and measuring the largest pocket of fluid in each quadrant
amniotic fluid index
AFI normal range:
5-24
Amniotic fluid progressively increases until ___ weeks, then slowly decreases
28
Maximum vertical pocket excluding fetal parts and cord
Deepest vertical pocket
BPP criteria
fetal breathing
gross fetal movements
fetal tone
amniotic fluid
The most accurate measure of lung maturity is performed by _____ to measure the lecithin/Sphingomyelin ratio AKA L/S ratio
amniocentesis
overlapping skull bones/collapsing brain
Spaulding sign
air air trapped in abdomen and lungs and increased echogenicity
Roberts sign
Features of 2nd 3rd trimester fetal demise
spaulding sign
roberts sign
exaggerated curvature of spine
fluid found in 2 fetal cavitiies
hydrops
fluid around the heart
pericardial effusion
fluid around the lungs
pleural effusion
fluid in the abdominal cavity
ascites
edema of the skin (thickness >5mm)
subcuteaneous edema/anasarca
Hydrops is associated with ______ and ______
polyhydramnios
placentomegaly
Cause of immune hydrops
Rh isoimmunization/ Rh incompatability
antibodies destroy the fetus’ red blood cells leading to fetal anemia and hydrops
erythroblastosis fetalis
caused by any other reason for hydrops
non-immune hydrops
TORCH
toxoplasmosis
other infections
rubella
cytomegalovirus
herpes simplex
group of infections that cross the placenta causing damage to the fetus
TORCH
IVC syndrome. When gravid uterus compresses IVC lowering blood pressure and causing patient to feel dizzy, sweaty, and nauseous
Supine hyvolemic syndrome
presence of pregnancy-induced hypertension and proteinuria
preeclampsia
long-standing, uncontrolled preeclampsia causing headaches and seizures
eclampsia
HELLP syndrome
hemolysis
elevated liver enzymes
low platelets
higher risk of maternal complications of miscarriage and toxemia. Also increased risk of congenital anomalies: heart, skeletal, syndromes, etc
pregestational diabetes mellitus type 1 or 2
most common type of diabetes with pregnancy and resolves after birth. Major risk is macrosomia.
gestational diabetes
EFW greater than the 90th percentile
macrosomia
neonate weights >4500g
macrosomia
painless premature dilation of the cervix
normal at least 3 cm in length
incompetent cervix
onset of labor before 37 weeks
pre-term labor
premature rupture of membranes prior to the onset of labor. oligohydramnios
PROM
Normal post partum uterus returns to non-gravid size __-__ weeks after delivery
6
8
Part of placenta may be left behind. C/o post partum vaginal bleeding. seen as echogenic intracavitary mass within the endometrium or thickened irregular endometrium
retained products of conception
results from c-section. complex mass adjacent to scar between LUS and posterior bladder wall
Bladder flap hematoma
fever, increased WBC, tenderness. associated with poor nutrition and hygiene, anemia, c-section, prolonged labor. No specific sonographic findings if no abscess.
infection/abscess
complex fluid collection
abscess
_______ imaging angle is best for smooth interfaces such as visualizing an interventricular septum or amniocentesis needle
perpendicular
reducing acoustic exposure by limiting use of controls that increase output and considering overall scan time
ALARA
velocity scale is also known as:
pulse repetition frequency
_____ the scale for slower flow or when not sensitive enough
Decrease
_____ the scale when it’s aliasing
Increase
Multiple gestations are at an increased risk of:
preeclampsia
preterm delivery
low birth weight
fetal anomalies
miscarriage
perinatal death
Medial gestational age of delivery for twins
36 weeks
arise from 2 separate eggs that were fertilized
dizygotic twinning
arise from 1 zygote that splits
monozygotic twinning
_____ twinning is more common
dizygotic
The chorion forms the ____ and ____
gestational sac
placenta
the inner membrane and goes with the yolk sac
amnion
