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Internevtional > OB/GYN ultraosund guided procedures > Flashcards

OB/GYN ultraosund guided procedures Flashcards

1
Q

What is percutaneous umbilical blood sampling (PUBS?

A
  • aka cordocentesis
  • smapling of blood via the vein in the umbilical cord
  • a diagnostic test that examines blood from the fetus to detect fetal abnormalities
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2
Q

PUBS procedure?

A
  • advanced imaging U/S determines location of umbilical cord insertion into the placenta
  • ultrasound guides a thin needle through the abdomen and uterine walls to the umbilical cord
  • needle is inserted into umbilical cord to retreieve a small sample of fetal blood
  • sample sent to lab for analysis and results are usually available within 72 hrs
  • simular to amniocentesis except the objectibe is to receive blood from fetus versus amniotic fluid
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3
Q

when is a PUBS test performed?

A

when diagnostic information can not be obtained through amniocentesis, CVS, ultrasound or the results of these tests were inconclusive

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4
Q

when is cordocentesis performed?

A

after 17 weeks into pregnancy

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5
Q

PUBS risk? (6)

A
  • miscarriage is the primary risk (occurs 1-2 times out of every 100 procedures)
  • Blood loss from the puncture site
  • Cord hematoma
  • Infection
  • Drop in fetal heart rate
  • Premature rupture of membranes
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6
Q

what does PUBS detect?

A
  • chromosome abnormalities and blood disorders
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7
Q

PUBS may be performed to help diagnose what? (5)

A 
Malformations of the fetus
Fetal infection (i.e. toxoplasmosis or rubella)
Fetal platelet count in the mother
Fetal anemia
Isoimmunisation – Rh compatibility
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8
Q

how is PUBS different from amniocentesis?

A

it does not allow testing for neural tube defects

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9
Q

renatal testing- reasons to test?

A
  • pursue potential medical interventions that may exist
  • begin planning for a child with special needs
  • start addressing anticipated lifestyle changes
  • identify support groups and resources
  • make a decision about carrying the child to term
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10
Q

why might parents decline prenatal testing?

A
  • personal or religious reasons where terminating the pregnancy is not an option
  • outcome has no impact on their comfort level
  • avoid risk of miscarriage or injury to fetus
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11
Q

what is coelocentesis?

A
  • sampling of fluid from the exocoelomic cavity
  • endovagninal approach
  • prenatal diagnosis at 7 weeks
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12
Q

disadvantages of coelocentesis?

A
  • coelomic calls difficult to culture
  • nuchal lucency + lab as accurate
  • procedure safety
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13
Q

what is culdocentesis?

A
  • fluid is aspirated from the posterior cul-de-sac
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14
Q

culdocentesis findings? (3)

A

blood: intraperitoneal bleeding
pus: infectious process
serous: ascitic fluid

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15
Q

culdocentesis indications?

A
  • large collection of fluid in the posterior col-de-sac
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16
Q

culdocentesis contraindications? (4)

A
  • masses
  • cysts
  • fixed retroverted uterus
  • bleeding diathesis
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17
Q

culdocentesis procedure?

A
  • sterile procedure
  • informed consent obtained
  • patients must sit or stand for 10-15 mins prior to procedure
  • topical anethetic applied to posterior vagina and cervix
  • lithotomy position, head elevated 60 degrees
  • speculum inserted
  • vagina and cervix cleansed with iodine
  • tenaculum used to grasp cervix
  • 18G needle attached to 20mL syringe instered through the posterior vaginal wall into posterior cul-de-sac
  • peritoneal fluid aspirtated
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18
Q

culdocentesis complications?

A
  • puncture pelvic nerves

- puncture vessels

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19
Q

what is Hysterosonography &Hysterosonosalpingography?

A
  • procedure used to improve or further evaluate the visualization of the uterus, endometrial canal, and tubal patency
  • typically performed 4-10 days into patients menstrual cycle
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20
Q

Hysterosonography &Hysterosonosalpingography indications? (6)

A
  • infertility
  • recurrent miscarriage
  • endometrial polyps, hyperplasia, carcinoma
  • AUB/ pre and postmenopausal
  • submucosal fibroids
  • uterine anomalies
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21
Q

Hysterosonography &Hysterosonosalpingography contraindications?

A
  • pregnancy
  • pelvic infections
  • excessive vaginal bleeding
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22
Q

Hysterosonography &Hysterosonosalpingography prior to procedure?

A
  • NSAID 1 hr prior
  • patient consent obtained
  • empty bladder
  • per procedural engovaginal images taken
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23
Q

what pre procedural endovaginal images are taken prior to Hysterosonography &Hysterosonosalpingography?

A
  • uterus and cervical position
  • size of uterus
  • endometrial thickness
  • rt and lt adnexa
  • r/o hydrosalpinx/ PID
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24
Q

Hysterosonography &Hysterosonosalpingography during procedure?

A
  • speculum is placed into vagina
  • swab with iodine is used to clean cervix
  • catheter is placed into the cervical os to access uterine cavity
  • speculum is removed
  • saline is injected slowly into uterus
  • sag and trv images and cine clips are taken during procedure
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25
Q

Hysterosonography &Hysterosonosalpingography diagnosis (4)?

A
  • endometrial polyps
  • submucosal fibroids
  • asherman syndrome (uterine synechiae)
  • tubal patency
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26
Q

Hysterosonography &Hysterosonosalpingography complications? (7)

A 
Pain
Cramping
Spotting / light bleeding
Watery discharge 
Nausea
Vasovagal
Infection
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27
Q

Hysterosonography &Hysterosonosalpingography failed attempts (4)?

A
  • severe cervical stenosis
  • pelvic pain
  • vagal symptoms
  • fear of procedure
28
Q

what is amniocentesis?

A
  • prenatal test where amniotic fluid is removed from amniotic cas by FNA
29
Q

how much fluid is drawn in amniosentesis?

A
  • less than 1 ounce of amniotic fluid

- body make more fluid therefore no harm done

30
Q

what is amniocentesis used for?

A
  • the infusion of dye (indigo carmine) to evaluate for rupture of membranes
  • Amniocentesis with the infusion of fluids (amnioinfusion) has been used in cases of oligohydramnios for therapeutic reasons or to improve visualization
31
Q

Amniotic fluid can help determine what? (7)

A
  • Used to obtain amniocytes for fetal karyotype
  • Prenatal genetic diagnosis of specific disorder
  • Evaluation for neural tube defects
  • Evaluation for infection
  • Determination of fetal lung indices
  • Determination of degree of fetal anemia
  • Therapeutic amniocentesis for polyhydramnios
32
Q

optimal time during pregnancy for amniocentesis?

A
  • 15-20w GA
33
Q

genetic testing should be done when? (4)

A
  • positive result from prenatal scanning
  • chromosomal or neural tube defect in previous pregnancy
  • > 35 years old
  • family hystory of specific genetic condition
34
Q

why should maturity testing be done? and when?

A
  • to determine if the lungs have matured enough for birth
  • only done is early delivary or c-section is taking place
  • between 32-39 weeks
35
Q

resons for amniocentesis? (5)

A
  • genetic testing
  • maturity testing
  • infection or illness
  • decrease amnitotic fluid amount
  • evalutate serverity of anemia in babies with Rh sensitization
36
Q

your doctor may advise against amniocentesis is? (3)

A
  • placenta problems
  • history of preterm labour
  • incompetent cervix
37
Q

risk/complications of amniocentesis?

A
  • miscarriage
  • leaking amniotic fluid
  • bleeding
  • membrane rupture
  • preterm labour
  • Rh sensitization
  • needle injury
  • infection and infection transmission
38
Q

amniocentesis pre-procedure?

A
  • informed consent
  • done in an out-patient facility or healthcare provider’s clinic
  • bring along someone for moral support and to drive you home
  • <20 w GA- full bladder
  • > 20w GA- empty blasser
  • lay on back with abdo exposed, u/s done to demonstrate position of fetus
  • takes approximately 20-30 mins
38
Q

amniocentesis pre-procedure?

A
  • informed consent
  • done in an out-patient facility or healthcare provider’s clinic
  • bring along someone for moral support and to drive you home
  • <20 w GA- full bladder
  • > 20w GA- empty blasser
  • lay on back with abdo exposed, u/s done to demonstrate position of fetus
  • takes approximately 20-30 mins
39
Q

anesthetic used in amniocentesis?

A
  • povidone-iodine (betadine) or chlorhexidine

- topical anestheic where needle is inserted

40
Q

needle for amniocentesis?

A
  • 22G
  • 3.5 inch spinal needle

20G used sometimes for therapeutic reasons later in GA
5-7 inch needles may be required in obese people

41
Q

how is amniocentesis preformed?

A
  • needle inderted
  • once in amniotic cavity, the stylet is removed and a syringe is attached to the needle
  • amniotic fluid if extracted into syringe
  • needle slowly removed
  • fetal cardiac activity is documented before the patient leaves the room
  • Rh0(D) immune globulin (RhoGAM) should be given for Rh-negative mothers after amniocentesis is complete
  • Appropriate cleaning and sterilization techniques used to clean the room and the equipment
42
Q

what should be given for Rh- negative mothers after amniocentesis is complete?

A

Rh0(D) immune globulin (RhoGAM)

43
Q

amniocentesis post-procedure?

A
  • A stinging sensation may be felt where the needle was inserted and withdrawn from
  • A cramping feeling may be felt from the needle puncturing the uterus
  • A post-procedure ultrasound will be done to monitor the fetal heart rate
  • Vaginal bleeding may follow the completion of the procedure
  • No strenuous physical activity is to be done 2-3 days afterward
44
Q

If any of these symptoms persist after an amniocentesis, contact your doctor (6)?

A
  • Persistent fluid leaking from vagina
  • Heavy vaginal bleeding
  • Abdominal pain uterine cramping that lasts more than a few hours
  • Fever
  • Redness and inflammation where the needle was inserted
  • Unusual fetal activity or a lack of fetal movement
45
Q

results of amniocentesis?

A
  • The cells extracted from the amniotic fluid can be tested directly or grown in cultures
  • Generally, the results will be available within 10-14 days following the procedure
  • For specific analysis – such as Trisomy 21, 18, or 13 – information can be gathered sooner using fluorescence in situ hybridization (FISH)
46
Q

what is chorionic villus sample (CVS)?

A

a prenatal test that involves taking a sample of fetal cellsfrom the tissue of the placenta under the guidance of an ultrasound scan.

  • These cells are taken from tiny finger-like projections on the placenta called the chorionic villi
  • The amniotic sac where your baby is growing will not be disturbed
  • Samples are then sent to a lab for genetic analysis
47
Q

purpose of CVS? (3)

A
  • Assess the fetal karyotype
  • Biochemical test of fetal cells for evaluation of disease status
  • Detectsmore than 200 genetic disorders including
48
Q

CVS detects more than 200 genetic disorders including? (2)

A
  • Trisomy 13, 18, 21

- tay-sachs disease

49
Q

what is CVS persormed?

A

between 10-13 weeks of pregnancy

50
Q

in CVS successful genetic diagnosis is obtained in what % of cases?

A

99.7%

51
Q

indications for CVS?

A
  • early u/s showed fetus has structural defects associated with chromosomal abnormality
  • mom or dad are both carriers of a recessive genetic disorder (cystic fibrosis/sickle cell disease)
  • previous pregnancy with genetic abnormality
  • family history
  • increased maternal age >35
52
Q

what are the 2 tequniques used to acquire CVS?

A
  1. transcervical CVS
  2. transabdominal CVS
  • placental location dictates approach
53
Q

when is transcervical approach used?

A

posterior and low placentas

54
Q

when is transabdominal approach used?

A

fundal and anterior placentas

55
Q

For either technique, an ultrasound is performed prior to the procedure to? (3)

A
  • measure size of baby
  • document location of placenta
  • obtain HR
56
Q

transcervical CVS procedural steps?

A
  • speculum inserted into vagina
  • cervix cleansed with antiseptic (betadine or chlorhexidine)
  • 5.7 Fr flexible CVS cannula with a rigid metal introducer is guide into placenta under u/s guidance
  • introducer withdrawn and a 20-cc syringe with 2mL of cell-transport is connected to cannula
  • suction applied to cannula as it is slowly withdrawn from placenta
  • once withdrawn suction is applied as the cannula is withdrawn from uterus and cervix
  • remainder of cell-transport medium is drawn through cannula to clear any residual villi
  • specimen is examined under a dissecting microscope for adequacy (at least 15 mg sample)
  • repeat pass with new needle may be performed if specimen is inadequate
  • fetal cardiac activity is documented
57
Q

transabdominal procedural steps CVS?

A
  • abdo prepared with antiseptic solution
  • shot of local anestheic (1% lidocaine)
  • u/s transducer sterilely draped
  • 18-20G needle inserted into placenta and stylet removed
  • 20 cc syringe with 2mL cell-transport medium is connected to needle
  • needle is guided back and forth through placenta while suction is intermittently applied to syringe
  • needle withdraw and remainder of cell-transport medium is drawn through medium to clear any villi lodged in needle
  • specimen is examines for adequacy
  • repeat pass with new needle may be needed in specimen is inadequate
  • fetal cardiac activity documented
58
Q

If your blood is Rh-Negative what will be administed after CVS?

A

RhoGam shot

  • because your babys blood may have mixed with yours during procedure and may not be compatible
59
Q

recovery from CVS?

A
  • about 24hr recovery

- some may experience light bleeding or cramps

60
Q

when to contact your doctor after CVS?

A
  • high temp (100.4F) or over
  • excess bleeding
  • excess vaginal discharge
61
Q

sonographers role during CSV?

A
  • perform prescan and confirm placental location
  • prepare trays and equipment
  • ensure and maintain sterile field
  • directly visualize needle of the catheter for precise diagnosis
  • watch patient for signs of discomfort or vasovagal reaction
62
Q

complications of CVS?

A
  • miscarriage (1%)- slighly higher % when done through cervix
  • bleeding
  • infection
  • Rh incompatibility in mother
  • rupture of membranes
63
Q

what has a high risk of miscarrige between amniocentesis and CVS?

A

CVS

64
Q

Results of CVS?

A
  • 2 weeks
  • the technicians at the laboratory isolate the fetal tissue cells and allow them to reproduce
  • analyze the cells for chromosomal abnormalities.
  • testing can tell baby’s gender
65
Q

what is a negative CVS?

A
  • negative for signs of any genetic defects

- possibility of the test missing some genetic defects

66
Q

postitive CVS?

A
  • baby has disorder being tested for

Talk to doctor about:

  • How the condition or defect may be treated either during or after the pregnancy
  • Special needs your child may have after birth
  • What other options you have regarding maintaining your pregnancy

Internevtional (12 decks)

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