OB Test 1 Flashcards
What are the 4 segments of the Fallopian Tube?
ampulla, isthmus, infidibular and fimbrae
Which part of the fallopian tube is the most distal?
fimbrae
Which part of the fallopian tube is the most proximal/medial and which one is the longest?
Isthmus: Proximal/medial
Ampulla: Longest
The Role of hCG
The hormone, human chorionic gonadotropin (a.k.a. hCG), is produced by _____ tissue and forms the basis of current pregnancy tests.
It is made by cells that form the _____, which nourishes the egg after it has been fertilized and becomes attached to the uterine wall.
It is believed to support the corpus luteum (remaining follicle “cyst” which produced the egg that was fertilized) thereby assuring a continuous supply of _____;
In the 1st trimester, hCG can first be detected by a normal blood test about _____ days after conception and about ___-___ days by a urine test.
hCG levels are first detected _____ weeks after the LMP (_____ days after ovulation), Doubles every ___-___ days and PLATEAUS at ___-___ weeks, then declines gradually
trophoblastic placenta progesterone 11 12 14 3 14 2 3 8 9
2 Common types of hCG tests
_____ hCG tests:
”+ or “-“ (Ex. home pregnancy test)
- urine test
- Just looks to see if hCG is present in the blood
_____ hCG test:
Actually dates pregnancy from “hCG” levels
- Blood (serum) test
- measures the amount of hCG actually present in the blood.
- Serum quantitative hCG may be correlated with gestational age.
qualitative
quantitative
hCG levels are important to determine the following:
Abnormal hCG levels
Greater than expected for dates
Associated with:
- Incorrect _____
- Gestational _____ disease
- Multiple _____
Less than expected for dates
Associated with:
- _____ pregnancy
- _____ demise
dates trophoblastic gestations ectopic embryonic
hCG - Q & A
What can a low hCG level mean? (Should be retested in 48-72 hrs)
- _____ of pregnancy dating
- Possible _____ or blighted ovum
- _____ pregnancy
What can a high hCG level mean? (should be retested in 48-72 hrs)
- _____ of pregnancy dating
- _____ pregnancy
- _____ pregnancy
What to expect of hCG levels after a pregnancy loss?
-levels return to a non-pregnant range about ___-___ weeks after a pregnancy loss has occurred.
Can anything interfere with hCG levels?
-Nothing should interfere with a hCG level except medications that contain _____. These medications are often used in fertility treatments and you health care provider should advise you on how they may affect a test. All other medications such as antibiotics, pain relievers, contraception or other hormone medications should not have any affect on a test that measures hCG.
miscalculation miscarriage ectopic miscalculation molar multiple 4 6 hCG
Importance of hCG levels
- An important use of serum hCG levels in the 1st trimester concerns the discrimination between a normal intrauterine pregnancy and an abnormal pregnancy that be _____.
- If the serum hCG concentration exceeds the discriminatory level of 800-1,000 units/liter (2 IS) and 1,000-2,000 units/liter (first IRB), then an intrauterine gestational sac should be visible with _____ sonography.
- If the hCG values exceed these levels and an intrauterine gestational sac is not visible, then _____ pregnancy or recent spontaneous _____ is possible.
ectopic
transvaginal
ectopic
abortionn
Can see the GS transabdominally ___-___ weeks LMP - 18-7,340 mlU/ml, 1,080-56,500 mlU/ml
See fetal pole ____-____ weeks LMP - 7,650-229,000 mlU/ml
5
6
7
8
NL hCG:
- Doubles every ___-___ hrs
- Subdoubles (Decrease) w/ _____ pregnancy
- Increases w/ _____ gestations
- Increases w/ _____ pregnancy(gestational trophoblastic disaese)
24 48 ectopic multiple molar
Development of the Embryo
- The next stage (after GS, YS) =_____
- characterized by the formation of the most _____ organs and _____ body structures
- Organ formation begins about ____ weeks after fertilization, the brain and spinal cord (neural tube) begins to develop. The heart and major blood vessels begin to develop by about day ___ or ___.
- The heart begins to pump fluid through blood vessels by day _____, and the first red blood cells appear the next day. Blood vessels continue to develop in the embryo and placenta.
- Almost all organs are completely formed by about ___ weeks after fertilization (which equals ___ weeks of pregnancy). The exceptions are the brain and spinal cord, which continue to mature throughout pregnancy.
- Most malformations occur during the period when organs are forming. During this period, the embryo is most vulnerable to the effects of _____, _____, and _____ Therefore, a pregnant woman should not be given any live-virus vaccinations or take any drugs during this period unless they are considered essential to protect her health
- Should be identified sonographically at approx ___ weeks
embryo 3 16 17 20 8 10 drugs radiation viruses 7
Development of the Fetus
- At the end of the 8th week after fertilization (10 weeks of pregnancy), the embryo is considered a _____ and the structures that have already formed grow and develop.
- By 12 weeks of pregnancy, the fetus fills the entire _____.
- By about 14 weeks, the _____ can be identified
- About 16 to 20 weeks, fetal _____ felt
- By about 23 to 24 weeks, the fetus has a chance of survival outside the _____.
- The _____ continue to mature until near the time of delivery. The _____ accumulates new cells throughout pregnancy and the first year of life after birth.
fetus uterus sex movement uterus lungs brain
Placenta/Chorion Frondosum & Embryo at approx 8 weeks
At approx. 8 weeks of pregnancy:
-The chorion frondosum surface (from the decidual _____ layer of endometrium is the embryonic portion of the placenta, which will later be known as the _____
- CF consist of finger-like projections, or _____, of the chorion surface which extends to meet the maternal portion of the placenta near the endometrial wall of the uterus.
- The chorion frondosum extends to meet the maternal portion of the placenta, which is composed of the _____ pool of maternal blood from material arteries and veins; this allows for diffusion of oxygen and of waste gases (such as carbon dioxide) between the membranous layers through a supply of arterial and venous blood from the maternal vessels
- A _____ membrane separates the embryo’s blood in the villi from the mother’s blood that flows through the space surrounding the villi (This arrangement allows materials to be exchanged between blood of mother and that of the embryo.
- The embryo “floats” in fluid (_____fluid), which is contained in a sac (_____ sac). The amniotic fluid provides a space in which the embryo can grow freely. The fluid also helps protect the embryo from injury. The amniotic sac is strong and resilient.
basalis placenta villi intervillous thin amniotic amniotic
Ultrasound “Markers” useful in determining early pregnancy and viability of the pregnancy include the following:
- _____ _____ _____ _____ (DDSS or DSS)
- _____ sac
- Fetal _____ and Measurement
- Fetal _____ and Activity
- Number of Gestational _____ and _____ sacs
Double Decidual Sac Sign yolk pole heart sacs yolk
Double Decidual Sac Sign (DDSS/DSS) & Gestational Sac (GS)
- DDSS is sonographically known as the “_____ decidual reaction”
- The 1st INTRAUTERINE STRUCTURE SEEN WITH US, IN nl PREGNANCY, is the _____ _____ (GS) with an ECHOGENIC THICKENED RIM CALLED THE DDSS; almost always seen with _____ US between 4.0-4.5 menstrual weeks (2-2.5 weeks after fertilization).
- A nl _____ is round or oval and located within the fundus or mid portion of the uterus. SONO characteristic: Anechoic sac with Echogenic (bright) rim and eccentric position within the endometrial cavity all help differentiate a “true” gestational sac from a pseudo gestational sac (seen with ectopic pregnancy). A pseudo sac will not havw the DDSS sono characteristic.
trophoblastic
gestational sac
transvaginal
GS
