OB II Test 2 Review Flashcards
What is the most common cord entanglement?
Nuchal Cord PG: 1245
What defects are the most common if you see a single umbilical artery?
Genitourinary (Kidneys)??
PG: 1248
What kind of cord goes over the neck and shoulders?
True Knots of Cord
PG: 1245
What cord inserts into the membrane before it enters the placenta?
Membranous or Velamentous Insertion of Cord
PG: 1246
What might cause inadequate fetal decent?
Short Umbilical Cord
PG: 1241
What abnormality is most commonly associated with cord prolapse?
abnormal fetal position…my guess but there is a list on pg. 1247
What does the ductus venosus turn into after birth?
Ligamentum Venosum
Forms two weeks after birth.
PG: 1239
Which of the following is correct about a true knot?
Have been associated with: long cords,
polyhydramnios,
IUGR,
monoamniotic twins.
Knots may be single or multiple;
increased incidence of congenital anomalies.
May be formed when loop of cord slipped over infant’s head or shoulders during delivery.
Usually umbilical vessels protected by Wharton’s jelly and not constricted enough to cause fetal anoxia.
p. 1245
What is a vaso previa?
Presence of umbilical cord vessels crossing the internal os of the cervix.
PG: 1246
Which 2 structures fuse together to make the umbilical cord?
Omphalomesenteric (yolk stalk) and Allantoic Ducts.
PG: 1238
In the 1st trimester the umbilical cord length is usually the same size as ____.
Crown-Rump Length (CRL)
PG: 1241 or PP #18
What is the normal length of the umbilical cord?
40-60 cm.
PG: 1239
What are some associations with velamentous placenta cord insertion?
Higher risk of lower birth weight Small for gestational age Preterm delivery Low Apgar scores Abnormal intrapartum fetal heart rate pattern
PG: 1246
Knowledge about a single umbilical artery (know everything)
Occurs in 0.08%-1.9% of singleton births and 3.5% twin pregnancies.
More frequent in miscarriages and autopsy series.
Has been associated with:
-Congenital anomalies in 20-50% of cases
-Increased incidence of IUGR
-Increased perinatal mortality
-Increased incidence of chromosomal abnormalities (trisomies 18,13,21; Turner’s syndrome and triploidy)
Associated anomalies affect other organ systems such as:
-Musculoskeletal (23%)
-Genitourinary (20%)
-Cardiovascular (19%)
-GI (10%)
-CNS (8%)
p. 1247-1248
What is varix of the umbilical cord?
Focal dilatations of the umbilical vessels affecting the umbilical artery and vein. Nearly always intra-abdominal, but extra-hepatic in location.
PG: 1248
What are some predisposing conditions to cord prolapse?
Abnormal fetal presentation,
Nonengagement of fetus due to prematurity,
Long umbilical cord,
Abnormal bony pelvic inlet,
Leiomyomas,
Polyhydramnios,
Vasa previa,
Velamentous insertion of the cord,
Marginal insertion of cord in low lying placenta,
Incompetent cervix with premature rupture of membranes.
PG: 1247
What is the membranous covering of the umbilical cord?
Amniotic Membrane
PG: 1238 or PP Slide #6
What is the length of the short cord?
Less than 35 cm in length
p. 1241
What is gastroschisis?
Right paraumbilical defect involving all layers of abdominal wall. Measure 2-4 cm.
Not covered by a membrane.
PG: 1243
If a cord does not have coiling there is an increased risk for ___.
Mortality and morbidity
p. 1241
What is the length of a long cord?
> 80 cm.
PG: 1241
What are false knots?
When the blood vessels are longer than the cord. Often folded on themselves and produce nodulations on surface of the cord.
PG: 1245
In hypoplastic umbilical artery there is usually a difference in size from artery to artery, and it is usually greater than ___%.
50%
p. 1248
What is a significantly narrow chest?
Asphyxiating Thoracic Dystrophy
PG: 1312
What is the most important determinant for fetal viability?
Pulmonary Development
PG: 1311
What 3 things do we look at in the fetal chest?
Position of the fetal heart Orientation of the cardiac axis Measurement of the thoracic circumference p. 1313 ?????
Size
Shape
Symmetry
[In Green Box p. 1312]
If a chest circumference was done, what level would we do it at?
4 Chamber Heart
PG: 1312
Knowledge about fetal breathing (know everything)
most prominent in 2nd and 3rd trimester 1/3 of the time fetus spends breathing Seesaw chest movements are documented at least 20 sec Color Doppler is used on nostrils BPP is used for fetal well being Pg 1313
What is the normal degree of a cardiac axis?
22-75 degrees (45 Degrees average)
PG: 1313
What are common abnormalities with pulmonary hypoplasia?
Chromosomal anomalies Renal anomalies IUGR Premature rupture of membranes Masses in thoracic cavity [Green Box p. 1315]
What is CCAM(Congenital Cystic Adenomatoid Malformation)
Multi cystic mass within the lung consisting of primitive lung tissue and abnormal bronchial and bronchiolar-like structures Type 1: macro cystic Type 2: macrocystic w/ microcystic Type 3: microcystic Pg. 1317-1318
What are the 2 diaphragmatic hernias?
Foramen of Bochdalek
Foramen of Morgagni
PG: 1320-1321
Where are each of the diaphragmatic hernias located?
Foramen of Bochdalek= posteriorly and laterally, left
Foramen of Morgagni= anteriorly and medially
PG: 1320-1321
Which diaphragmatic hernia is most common?
Foramen of Bochdalek
PG: 1320
What are bronchogenic cysts?
Abnormal budding of the foregut and lack any communication with the trachea or bronchial tree.
Most common lung cysts
PG: 1315
The severity of pulmonary hypoplasia depends on ____.
When pulmonary hypoplasia occurred during pregnancy, its severity, and its duration.
PG: 1315
What is pulmonary sequestration?
Supernumerary lobe of the lung, separated from the normal tracheobronchial tree
Intralobar: extra pulmonary tissue is present within the pleural lung sac
Extralobar: connected to inferior border of the lung within its own pleural sac
Pg. 1317
What is the normal appearance of the fetal chest?
Bell-shaped
Ribs form lateral margins
Clavicles form upper margins
Diaphragm forms lower margins
Pg. 1311
What is the normal appearance of the fetal lungs with ultrasound?
Homogenous with moderate echogenicity.
Early: lungs > echogenicity than liver
Later: lungs = liver echogenicity
What is true about the fetal thorax?
- symmetrically bell shaped
- ribs form lateral margins
- diaphragm forms lower margin
- contains lungs and heart
- slightly smaller than abdomen
If you see pleural fluid, you should be looking at what structure very carefully?
Lung, Heart, and Diaphragmatic lesions.
PG: 1316
Congenital bronchial atresia is found more commonly in which lobe?
Left upper lobe
p. 1318
What is the outcome with each diaphragmatic hernias?
Both have poor prognosis
Pg. 1322
What is the mortality rate for diaphragmatic hernias? (low, medium, high)
Mortality rate is high (75%)
p. 1322
A big pleural effusion could cause ____.
Impairment of the lungs, which may result in pulmonary hypoplasia
p. 1317
What is amniotic band syndrome?
The rupture of the amnion, which leads to entrapment/entanglement of the fetal parts by the “sticky” chorion. Early entrapment may lead to severe craniofacial defects and internal malformations. Late entrapment leads to amputations or limb restrictions.
p. 1334
What is a lower abdomen defect of the urinary bladder?
Bladder exstrophy- Everted bladder becomes exposed on the lower abdominal wall; may be mild or severe.
p. 1334
Large cranial defects, facial clefts, large body wall defects, and limb abnormalities is associated with what?
Limb- Body Wall Complex
p. 1335
What abnormality is associated with evisceration of bowel to the right?
Gastroschisis
p. 1330
What is limb-body wall complex?
Anomaly associated with large cranial defects, facial clefts, body wall complex defects involving thorax, abdomen, or both, and limb defects. Occurs with the fusion of the amnion and chorion; amnion doesn’t cover the umbilical cord normally but extends as a sheet from the margin of the cord and is continuous with both the body wall and the placenta.
p. 1335
What can a low omphalocele be associated with?
Bladder or Cloacal exstrophy
Pg. 1328
What is Beckwith-Wiedemann syndrome?
Rare group of disorders having in common the coexistence of an omphalocele, macroglossia, and viseromegaly. Most cases are sporadic. Characterized by macrosomia, macroglossia, viseromegaly, embryonic tumors, omphalocele, neonatal hypoglycemia, and ear creases.
p. 1334
Gastroschisis is a consequence of atrophy of what structure?
Right umbilical vein or a disruption of the omphalomesenteric artery
p. 1330
Bladder exstrophy can be accompanied with which abdominal wall defect?
Omphalocele
p. 1334
What defects of the abdomen are most common?
Omphalocele, umbilical hernia, and gastroschisis
p. 1324
What is a critical process of closing the abdominal wall?
In the 6th week, a process called folding helps the embryo transform itself into a cylindrical shape
p. 1323
Normal embryologic herniation of the bowel allows what to occur?
it allows the abdominal cavity to catch up to the midgut. The midgut grows fast than the abdominal cavity.
p. 1324
What is omphalocele?
Congenital anterior abdominal wall defect in which abdominal organs (Liver, bowel, stomach) are atypically located within the umbilical cord and protrude outside the wall; develops when there is a midline defect of the abdominal muscles, fascia, and skin; covered in a membrane consisting on amnion and peritoneum
p. G-9 and 1326
What is gastroschisis?
Congenital defective opening in the wall of the abdomen just to the right of the umbilical cord; bowel and other organs (stomach and genitourinary organs, infrequently) may protrude outside the abdomen from this opening
p. G-5 and 1330
What 5 things are associated with Pentalogy of Cantrell?
1) Cleft distal sternum
2) Diaphragmatic defect
3) Midline anterior ventral wall defect
4) Defect of the apical pericardium with communication into the peritoneum
5) Internal cardiac defect
p. 1335
What is the most dramatic finding of ectopia cordis?
Presence of a heart outside the thoracic cavity; a portion or all of the heart may protrude through the defect in the sternum
p. 1335
Limb-body wall defects are more common on which side?
Left-side defects are three times more common than right
p. 1335
What tissue types does the membrane covering omphalocele consist of?
Amnion and peritoneum
p. 1326
What does the umbilical vein drain?
The placenta, body stalk, and evolving abdominal wall
p. 1324
The hepatic bud enlarges and the right umbilical vein atrophies at how many weeks?
7th week of gestation
p. 1324
8 images to identify on test (located in files on canvas)
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