OB II Final Review from PP slides 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 mestruation
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
supports the cervix
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 and 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 cyss
what are the most common tumors of the uterus
fibroids (leiomyomas)
where can fibroids form
submucosal
intramural - most common site
subserosal
pedunculated
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, retrovegainal septum, peritoneal surface of posterior wall of uterus
what is the most common benign tumor of the ovary
dermoid
what is a mucinous cystadenoma
Epithelial tumor lined with mucinous elements of endodermis and bowel
Typically larger than serous cystadenoma
Simple, septated cyst with differing echogenicity
what is a serous cystadenomas
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
what is hydrops
excessive fluid within fetal body cavities
ascites, pericardial effusion, pleural effusion, polyhydramnios
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
what are sonographic markers for downs
thick NT/nuchal fold choroid plexus cysts echogengic bowel pylectasis short long bones EIF absent nasal bone omphalocele talipes micrognathia diaphragmatic hernia
how often does trisomy 21 occur
1/600 births
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
how often does trisomy 13 occur
1/5,000 births
what are sonographic markers for Pataus
holoprosenchephaly polydactyly talipes cleft lip & palate renal anomalies menignomylocele
what are sonographic makers for Turners Syndrome
cystic hygroma heart defects coarctaion of the aorta hydrops renal anomalies
what commonly causes triploidy
1 ova fertilized by 2 sperm
what are sonographic markers for Triploidy
heart defects omphalocele renal anomalies cranial defects facial defects
what is VACTERL
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
what are some sonographic markers in diabetic pregnancies
polyhydramnios macrosomia caudal regression syndrome NT defects heart defects renal anomalies GI defects single umbilical artery
what is preeclampsia
high blood pressure
proteinuria
edema
what is eclampsia
preeclamptic signs with seizures
maternal obesity can cause what type of defects
neural tube defects
at what week is it still considered preterm labor
37 weeks
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 is a vanishing twin
early fetal demise that is absorbed
what is fetus papyraceous
fetal demise still in utero
what is poly-oli sequence
“stuck twin” occurs around 16-26weeks
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
thoracopagues omphalopagus craniopagues pygopagus ischiopagus
What is Fitz-Hugh-Curtis syndrome
Perihepatic inflammation that can result from PID or endometritis
What are the 2 types of 3D acquisitions
Manual “free hand”
Automatic
What are the 2 types of 3D imaging modes
Multiplanar reconstruction mode
Volume rendering mode
What is multiplanar reconstruction
Demonstrates anatomy in 3 different planes and angles (long, trans, coronal)
What is volume rendering
An extension of multiplanar, where the techniques are applied to a ROI 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
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
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
Mono mono 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 is exophtalmia
Abnormal protrusion of the eyeballs
What is the most common neck mass
Cystic hygroma
What is anencephaly
Absence of skull and brain
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
What malformation is associated with a banana shaped cerebellum and lemon shaped head
Arnold Chiari
What are the sonographic findings of spina bifida
Splaying of posterior ossification center Meningocele Meningomylocele Cleft in skin Intracranial malformations
What kind of intracranial malformations could be present with spina bifida
Lemon head
Banana cerebellum
Absent cisterna magna
Ventriculomegaly
When is a ventricle considered dilated
Greater than 10mm
What can cause ventriculomegaly
Spina bifida
Encephalocele
Fetuses younger than ____ are considered non viable, due to pulmonary development
24 weeks
how do you evaluate the fetal chest
size
shape
symmetry
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
one or more large cysts that replace normal lung tissue
2-10cm
favorable outcome
what is type 2 CCAM
lesions that have multiple small cysts
poor outcome
what is type 3 CCAM
large bulky noncystic mass
what are bronchogenic cysts
most common lung mass that is a small circumscribed masses without a mediastinal shift
what is pulmonary hypoplasia
poor or reduced lung growth causing 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%
what is pleural effusion
accumulation of fluid within the pleural cavity
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
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 ompalocele
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
early entrapment in amniotic bands can lead to what
severe craniofacial defects
internal malformations
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 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
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 weeker 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
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 and posterior urethra “keyhole” appearance
what is the most common fetal anomaly
hydronephrosis
the renal pelvis should not measure more than ____
4mm
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 large head or cloverleaf head flat vertebral bodies 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
what are sonographic findings of jeunes syndrome
small thorax
rhizomelia
renal dysplasia
polydactyly
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
what community has a high incidence of Ellis-Van Creveld
Amish
what is another name for Ellis-Van Creveld
chondoectodermal dysplasia
what are sonographic features of Ellis-Van Creveld
short limbs
polydactyly
heart defects 50%
narrow thorax
