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radiology > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

menstrual age:

A

embryologic age + 14 d

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2
Q

embryo

A

0-10 wks (menstrual age)

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3
Q

fetus

A

> 10wks (f after e)

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4
Q

threatened abortion

A

bleeding w/ closed cervix

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5
Q

inevitable abortion

A

cervical dilation and/or placental and/or fetal tissue hanging out

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6
Q

incomplete abortion

A

residual products in uterus

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7
Q

complete abortion

A

all products out

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8
Q

missed abortion

A

fetus dead, still in uterus

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9
Q

intradecidual sign-when

A

early gest sac, 4.5 wks

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10
Q

double decidua sac sign-layers

A 
decidua capsularis (closest) and basalis/vera (myometrial)
decidua peritalis-opposite wall
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11
Q

when do amnion and chorionic mems fuse?

A

14-16 wks

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12
Q

etiology of amniotic band syndrom

A

amnion disrupted bf 10 wks –> fetus cross into chorionic cav and get tangled in fibrous bands

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13
Q

YS abnormal morphology

A
  • 6 < x < 3 mm
  • calcified
  • solid
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14
Q

normal YS-size, consistency, appearance

A
  • 3-6 mm, cystic
  • 5.5 wks
  • in chorion connect to umb via vitelline duct
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15
Q

double bleb sign

A

-YS and Amn sac with emb in middle

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16
Q

Summary of sonogram antenatal findings

A

0-4.3 weeks: no ultrasound findings
4.3-5.0 weeks:
possible small gestational sac
possible double decidual sac sign (DDSS)
possible intradecidual sac sign (IDSS)
5.1-5.5 weeks:
​gestational sac should be visible by this time
5.5-6.0 weeks
yolk sac should be visible by this time
gestational sac should be ~6 mm in diameter
double bleb sign
>6.0 weeks
fetal pole may be identifiable on endovaginal ultrasound (1-2 mm)
fetal heart rate (FHR) should be ~100-115 bpm
gestational sac should be ~10 mm in diameter
6.5 weeks
crown rump length (CRL) should be ~5 mm
7-8 weeks
CRL is between 11-16 mm
cephalad and caudal poles can be identified
8-9 weeks
CRL is between 17-23 mm
limb buds appear
head can be seen as separate from the body
9-10 weeks
CRL is between 23-32 mm
fetal heart rate 170-180 bpm
fetal movement can be seen
a round hypoechoic structure in the fetal brain represents a developing embryonic/fetal rhombencephalon
nuchal translucency may begin to be seen

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17
Q

pseudogestational sace

A

ectopic

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18
Q

when should you see YS-wk, size, b-hcg

A

~5.5 wks, GS ~8mm, b-HCG 5000 mIU/L

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19
Q

implantation bleed

A

small subchor hem at chorion/endom attach

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20
Q

subchorionic hemorrhage-what matters

A
  • fetal demise-% placental detach; hematoma >2/3 chorion circumference
  • (+) maternal age worse outcome
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21
Q

criteria fetal demise-diagnostic

A
  • CRL 7mm, ø HR
  • GS >25mm, ø embryo
  • ø HR 14+ days s/p GS
  • ø HR 11+ d s/p GS + YS
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22
Q

criteria fetal demise-suspicion

A
  • ø embryo 6+ wks after last menstrual pd
  • GS 16-22mm w/o emb
  • ø HR 13 days s/p GS
  • ø HR 10 d s/p GS + YS
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23
Q

pregnancy of unknown location

A

+b-hcg, nothing in uterus

1) normal
2) occult ectopic
3) complete miscarriage

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24
Q

order of EP PPV

A
  • live adnexal preg-100%
  • mass-75-80%, +FF-97%
  • free fluid-70% (inc if fluid echo)
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25
Q

fetal growth measurement

A
  • BPD-thal, outer to inner. Aff by head shape
  • HC-same slice. Less off by head shape
  • AC-umb v and LPV
  • FL-long dimension of shaft
  • composite for GA during 2nd & 3rd TM
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26
Q

Symmetric vs Asymm IUGR

A
  • S=small head, skinny body, same thru out pregn, sylph, scotch, some extra chroms
  • Asymm-abd small, aching belly (malnutrition), abn high BP, Alastic skin (Ehler Danlos), Asymm time interval (3rd TM)
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27
Q

Gestational accuracy throughout pregn

A
  • 1st TM CRL-0.5 wks
  • 2nd TM Composite GA- 1.2 wks
  • 3rd TM CGA-3.1 wks
28
Q

umbilical artery systolic/diastolic ratio

A

2-3 @ 32wks

-should not be more than 3 at 34wks

29
Q

biophysical profile to assess acute and chronic hypoxia.

A
  • score 2 points if N, total 8-10=N
  • amn fluid-1 pocket >2cm in vertical plane. For chronic hypoxia
  • fetal tone-1 ep extension from flexion. For acute hypoxia.
  • fetal breathing-1 episode breathing motion ~30s. For acute hypoxia.
  • non stress test-2+ fetal heart acc 15+BPM, 30+s-For acute hypoxia.
30
Q

amniotic fluid index

A
  • vertical heigh of deepest fluid pocket in each quadrant of uterus, sum 4 measurements
  • N 5-20
  • oligo <5
  • poly->20cm OR single pocked >8
31
Q

variant placental morphology

A

bilobed
succenturiate
circumvallate

A bilobed placenta also referred to as bipartite placenta, is a variation in placental morphology and refers to a placenta separated into two near equal-sized lobes. If more than two lobes are present, it is termed a trilobed, four-lobed and so on. If the second lobe is smaller than the main lobe (with the umbilical cord insertion), then the smaller lobe is termed a succenturiate lobe.

A succenturiate lobe is a variation in placental morphology and refers to a smaller accessory placental lobe that is separate to the main disc of the placenta. There can be more than one succenturiate lobe.

Circumvallate placenta refers to a variation in placental morphology in which, as a result of a small chorionic plate, the amnion and chorion fetal membranes ‘double back’ around the edge of the placenta.

32
Q

placental thickness abN

A

too thin <1cm

too thick >4cm

33
Q

placental abruption-clinical pres

A

painful

34
Q

placental previa

A
  • painless
  • low lying (w/I 2 cm), marginal, complete, central

New revised classification with 3 categories only

1) Placenta previa (PP): Placenta covers internal os (IO)
2) Low-lying placenta (LLP): Placenta edge ≤ 2 cm from IO
3) Normal: Placenta edge > 2 cm from IO
* Avoid terms marginal or partial PP (deemed confusing)

35
Q

placental creta types

A

accreta-through myom
increta- less through myom
percreta-transmural, serosal breach

36
Q

placenta chorioangioma

A

hamartoma near cord insertion

  • flow w/I mass pulsating at FRH (perfused by fetal circulation)
  • compl: >4 cm or choraniomatosis (mult)-sequester platelets, cause hydros (high output failure)
37
Q

placenta chorioangioma vs hematoma

A

chorioangioma has pulsating doppler flow

38
Q

abn umbilical cord insertions

A
  • velamentous
  • marginal
  • vasa previa

In a velamentous cord insertion, the umbilical cord inserts into the fetal (chorio-amniotic) membranes outside the placental margin and then travels within the membranes to the placenta (between the amnion and the chorion).

39
Q

vasa previa

A

fetal vess cross (or almost cross) internal cervical os caused by velamenetous insertion or placental succenturiate lobe

  • type 1-conn to velamentous cord insertion w/I main placental body
  • type 2-conn to bilobed placenta or succenturiate lobe, type TWO att to TWO lobes
40
Q

nuchal cord

A

wraps around fetus neck

41
Q

umbilical cord cyst

A
  • omphalomesenteric duct=per
  • allantoic = central
  • if persist into 2/3rd TM–> trisomy 18/13
42
Q

nuchal translucency

A
  • Normal fluid filled SQ space at back of fetal neck
  • 9-12 wks (CTC), 11-15wk (FTC), CRL 45-85 mm
  • N=<3 mm
  • neutral neck, nasal bone seen, mid sag, well delineated skin edge

*combined w/ maternal serum to calculate overall risk of T21

43
Q

chiari II findings

A
  • banana (loss of normal bilobed cerebellum)

- lemon (flat/concave frontal bone)

44
Q

ventriculomegaly on sonogram

A

> 10mm

-dangled choroid off the wall >3m

45
Q

choroid plexus cyst

A
  • usually means nothing

- T18, 21, turners, klinefelter

46
Q

facial cleft

A

MC fetal facial anomoly

  • 30%=chromosomal anomaly
  • 80% also have cerebral palsy
47
Q

echoogenic intracardiac focus

A

normal Ca of papillary m (LV)

-T21, 13

48
Q

abN heart rates

A
  • <100

- >180

49
Q

echogenic bowel

A

should be same as liver

->bone=bad

50
Q

short femur

A

<5th percentile

-skel dysplasia

51
Q

incompetent cervix

A

endocervical canal <2.5 cm in length
-ass w/ high risk premature delivery

Cervical insufficiency (CI): Inability of cervix to retain pregnancy in absence of contractions or labor
Clinical diagnosis

Short cervix: Cervical length (CL) < 10th percentile for gestational age
Sonographic observation; < 25 mm at < 24 weeks

Img: Dilated internal os (IO): Measure anterior-posterior diameter

52
Q

things that grow in a pregnant person

A
  • babies
  • splenic a aneurysms
  • renal AMLs
  • fibroids
53
Q

maternal complications

A
  • hydronephrosis (R>L, mech compr.)
  • fibroids-grow early via estrogen (shrink later via progesterone). infarct via compression of vess
  • uterine rupture-3rd TM at site of prior c-section
  • HELLP
  • Peripartum cardiomyopathy-last mo-5mo’s pp
  • sheehan syndrome-pit hem
  • -ovarian v thrombophlebitis-pp fever
  • retained products
  • endometritis
54
Q

categorizing multiple gestations

A

Dichorionic Diamniotic-separate or fused placentas
Monochorionic, diamniotic
mono/mono

55
Q

differentiating mnochorionic from dichorionic gestation

A

membrane >4mm=di (made of 4 layers)

  • twin peak sign-btw di/di
  • T-sign-thin mem=mono
56
Q

twin gestation complications to know

A
  • twin twin transfusion syndrome (TTTS)-monochorionic. Disporoportionate bf
  • twin reversed arterial perfusion syndrome (TRAP)-monochorionic
  • Twin Anemia Polycythemia Sequence (TAPS)
  • One Dead Twin
  • Twin embolization syndrome-when 1 monochorionic twin dies; causes CNS, GI or Renal infarcts.
57
Q

fetus papyraceous

A

pressed flat seat fetus

Fetus papyraceous is defined as a compressed fetus, the mummified, parchment-like remains of a dead twin that is retained in-utero after intrauterine death in the second trimester.

58
Q

“combined test”

A
  • NT, b-hcg, PAPP A

- sens 85%, FP 5%

59
Q

“fully integrated test”

A

combined test < 14 wks + quad screen

  • 15-19 wks
  • 90-95% sens, FP 2.5-5%
60
Q

“quad screen”

A

AFP
Estriol
B hcg
inhibin A

*performed at 15-19 wks

61
Q

hydros fetalis

A

2+ fluid filled compartments in fetus

  • subq edema=5mm+ thickness
  • pleural effusions
  • pericardial effusion
  • ascites
  • non-immune=70-90% (CV MC, 40%, hematologic, infection (herpes, parvovirus)
  • Rh incompatibility no longer as common as it previously was
62
Q

at what b-hcg should a GS be seen? YS?

A

2000 transvag
6500 transabd

YS: 5000

63
Q

percentage breakdown of ectopic pregnancy locations

A
  • 95% tubal- ampulla 70%, isthmus 12%, fimbria 11%
  • 2-3% interstitial corneal
  • <1% ovary
  • c-section scar-rare
  • abd-rare
64
Q

recommendation for CPC in setting of amniocentesis

A
  • no other risk factors-offer amniocentesis

- other RFs-amniocentesis recommended or encouraged

65
Q

single umbilical cord

A
  • single umbilical artery ass w/ fetal anomalies (CV MC) in up to 50%
  • T13, T18
66
Q

bladder flap hematoma

A

extraperitoneal blood collection at site of c-section incision, collecting btw bladder and AND LOWER uterine segment

radiology (31 decks)

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