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OB/Gynecology > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What are the functions of the placenta?

A

respiration, nutrition, storage, excretion, immunity, hormone production

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2
Q

Maternal circulation from aorta.

A

ovarian artery, arcuate, radial, spiral

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3
Q

How early can the placenta be seen?

A

8 weeks

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4
Q

Grade 0 placenta

A

no visible calcifications, smooth chorionic plate

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5
Q

Grade 1 placenta

A

Scattered tiny calcifications, subtle indentations

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6
Q

Grade 2 placenta

A

Larger basal echogenicities, larger indentations of chorionic plate

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7
Q

3 part of the early umbilical cord

A

Allantois, body stalk, vitelline duct

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8
Q

What does the allantois become?

A

develops into the bladder and will leave a remnant called the urachus.

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9
Q

Carries oxygenated blood from placenta to fetus.

A

Umbilical vein

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10
Q

Carries deoxygenated blood from the fetus to the placenta.

A

Umbilical artery

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11
Q

Where does gas exchange occur?

A

Placenta

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12
Q

Umbilical vein shunt to IVC

A

Ductus venosus

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13
Q

RA shunt to LA

A

Foramen ovale

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14
Q

PA shunt to AO

A

Ductus arteriosus

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15
Q

What does diastolic flow represent in a doppler of the umbilical artery?

A

Vascular resistance in placenta

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16
Q

When are the fetal kidneys functioning and produce the majority of fluid?

A

14 weeks

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17
Q

When does the fusion of the amniotic and chorionic membranes occur?

A

End of 16th week

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18
Q

What type of solids can be found within amniotic fluid (other than water)?

A

vernix, fetal cells, proteins, urea

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19
Q

Role of amniotic fluid

A

nutrition, free fetal movement, growth of GI tract, lung growth, protection, maintains fetal body temperature, bacteriostatic for potential infections

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20
Q

Define oligohydramnios.

A

< 2cm x 1 cm pocket or < 5 cm AFI

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21
Q

Define polyhydramnios.

A

> 8 cm x 1 cm pocket or > 25 cm AFI

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22
Q

Define placenta previa.

A

Placenta implanted in lower segment of uterus

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23
Q

Symptoms of placenta previa

A

Painless vaginal bleeding

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24
Q

Risk factors for placenta previa.

A

Previous c-sections, maternal age, multiparas, smoking, twins, infertility treatments

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25
Q

Define low lying placenta.

A

1-19 mm from internal os

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26
Q

Define complete previa.

A

Placental edge overlaps internal os by 1 mm or more

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27
Q

Define marginal previa.

A

Placental edge exactly reaches internal os by 0 mm

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28
Q

What is Braxton Hicks?

A

Uterine contractions

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29
Q

Abnormal adherence of the placenta to the uterus with subsequent failure to separate after delivery.

A

Placenta accreta

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30
Q

Define placenta accreta.

A

Implantation directly onto myometrium rather than decidua basalis

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31
Q

Define placenta increta.

A

Implantation directly into myometrium.

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32
Q

Define placenta percreta.

A

Placental growth extending through the myometrium or through the uterine serosa.

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33
Q

Define placental abuption.

A

Defective maternal vessels rupture and cause separation of the placenta - leads to bleeding and decidual hematoma.

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34
Q

Risk factors for placental abruption.

A

Maternal chronic HTN, smoking, cocaine, preeclampsia, PROM, trauma

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35
Q

Risk factors of Succenturiate & Bilobed placentas.

A

Vasa previa, retained placenta, velementous or marginal CI

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36
Q

Vessels presenting in front of fetus.

A

Vasa previa

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37
Q

Elevated placental edge.

A

Circumvellate

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38
Q

Flat margin placental edge.

A

Circummarginate

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39
Q

Marginal CI

A

Umbilical cord inserts < 2 cm from the placental edge

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40
Q

Velamentous CI

A

Umbilical cord inserts into membranes instead of directly into the placenta - lack of Wharton’s jelly surrounding the vessels

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41
Q

Most common benign and vascular tumor found in placenta

A

Chorioangioma

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42
Q

Solid highly vascular mass within or projecting from placenta

A

Chorioangioma

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43
Q

Scar tissue within the uterus

A

Uterine synechia(e)

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44
Q

Scar tissue within the uterus

A

Uterine synechia(e)

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45
Q

What are the differentials for bleeding after 20 weeks gestation?

A

Placenta previa, placental abruption, vasa previa, gestational trophoblastic disease (GTD)

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46
Q

3 Fetal head views?

A

Ventricular, Thalamic, Cerebellar

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47
Q

What is seen in the Ventricular view of fetal head?

A

falx, lateral ventricles (anterior, posterior), atrium (< 10mm), choroid plexus, calvarium (bone)

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48
Q

What is seen in the Thalamic view of the fetal head?

A

falx, thalami, 3rd ventricle, CSP, calvarium

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49
Q

What is seen in the Cerebellar view of the fetal head?

A

Cerebellum, nuchal fold (< 6 mm), cisterna magna (< 10 mm), vermis, falx, calvarium, CSP, thalamus

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50
Q

How is NF measured?

A

Outside of bone to outside of skin

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51
Q

Normal axis of fetal heart

A

45 degrees from midline and levocardia

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52
Q

Which heart view rules out 96% of abnormalities?

A

4CH view

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53
Q

Echogenicity of fetal lungs

A

Hyperechoic

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54
Q

When is the GB visualized?

A

After 20 weeks

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55
Q

When should the stomach always be visualized by?

A

14 weeks

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56
Q

When should the kidneys be visualized?

A

14-16 weeks

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57
Q

Echogenicity of kidneys

A

Hyperechoic then isoechoic

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58
Q

Normal amount of fluid in renal pelvis?

A

< 5 mm

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59
Q

What part of femur is measured?

A

Diaphysis

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60
Q

What is Frank Breech?

A

Babys hip joints are fixed and knee joints are extended

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61
Q

What is a Complete Breech?

A

Babys hip and knee joints are fixed

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62
Q

What is included in Biometry?

A

BPD, HC, FL, HL, AC=EFW (estimated fetal weight)

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63
Q

What is the most accurate predictor of GA?

A

Head Circumference

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64
Q

Normal CI range? Brachycephaly? Doliocephaly?

A

Normal 70-85%
Brachy > 85%
Dolio < 70%

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65
Q

What is SGA? LGA?

A

SGA is < 10%ile

LGA is > 90%ile

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66
Q

SGA - types?

A
  1. small but healthy
  2. small because of chromosomal or environmental etiology
  3. high risk for poor perinatal outcome including death and may have IUGR
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67
Q

Criteria for IUGR?

A

Fetal weight falls below 10%tile, a drop of more than 2 quartiles (50%)

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68
Q

Asymmetrical IUGR causes?

A

Maternal: HTN, smoking, medications, chronic disease, infection
Environmental: abruption, placenta previa, twin to twin transfusion (TTTS)

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69
Q

3T signs of IUGR?

A

Delayed/absent growth with serial scans, abnormal umbilical artery dopplers, oligohydramnios, grade 3 placenta, low BPP score

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70
Q

Causes of fetal death?

A

Asphyxia, maternal complications, congenital/chromosomal abnormalities, infection, unknown

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71
Q

Causes of fetal hypoxia?

A

uteroplacental insufficiency, reduced O2 in blood due to low hemoglobin, reduced blood flow to fetal tissues (ischemia)

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72
Q

What does UA circulation indicate?

A

Status of placental circulation

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73
Q

PI equation

A

PI=S-D/M

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74
Q

What should PI be around?

A

1

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75
Q

Does MCA have low or high resistance?

A

High

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76
Q

Does UA have low or high resistance?

A

Low

77
Q

What is the Ductus Venosus?

A

Connection between IVC and umbilical vein

Normally biphasic and antegrade

78
Q

BPP scoring guide?

A

Breathing, movement, tone, SDP/AFI, UA Dopplers scored over 30 min window

*Score below 6: increased risk of asphyxia, low cord pH, cerebral palsy, still birth

79
Q

What is a Non-Stress Test?

A

2+ heart accelerations above 15 bpm or more lasting 15 secs over 20 min period, done twice

80
Q

Acute Hypoxia indicator? Chronic?

A

Acute: BPP & NST
Chronic: amniotic fluid

81
Q

What does the Prosencephalon become?

A

Telencephalon, Diencephalon

Forebrain

82
Q

What does the Mesencephalon?

A

Mesencephalon

Midbrain

83
Q

What does the Rhombencephalon become?

A

Metencephalon, Myelencephalon

Hindbrain

84
Q

Foramen of Munro

A

Connection between paired lateral ventricles and 3rd ventricle of brain

85
Q

Foramen of Magendie

A

Links 4th ventricle to CM (spinal cord)

86
Q

Foramen of Luschka

A

Links between 4th ventricle and subarachnoid space (paired)

87
Q

Role of Choroid Plexus

A

Produce CSF

88
Q

Corpus Callosum

A

Myelinated nerve fibres that connect brain hemispheres

89
Q

Enlarged ventricles with increased intracranial pressure

A

Hydrocephalus

-may lead to irreversible damage

90
Q

Most common cranial abnormality

A

Ventriculomegaly

-when atria are > 10 mm

91
Q

Which chromosomal abnormality is Ventriculomegaly a soft marker for?

A

Trisomy 21

92
Q

Which lab is increased with NTD?

A

AFP

93
Q

Absent calvarium/skull

A

Acrania/Exencephaly

94
Q

Absent brain and skull. “Frog-like” eyes. Polyhydramnios.

A

Anencephaly

95
Q

Anencephaly + extending to spine

A

Craniorachischisis

96
Q

Herniation of meninges and brain through bony skull defect. Solid extra-cranial mass.

A

Encephalocele

97
Q

Herniation of meninges/CSF through bony skull defect. Most are occipital. Extra-cranial cystic mass protruding from skull. Microcephaly and increased incidence of ventriculomegaly.

A

Cranial meningocele

98
Q

Extreme flexion of head, open spinal defect, occiput defect. Lethal. “Star Gazing”

A

Iniencephaly

99
Q

Abnormal cleavage of prosencephalon leads to failure of brain to divide into halves. Associated w/ Trisomy 13 (most common) and Trisomy 18. Facial abnormalities.

A

Holoprosencephaly

  1. Lobar
  2. Semi-lobar
  3. Alobar (monoventricle)
100
Q

Absent corpus callosum (ACC) and CSP

A

Alobar and Semi Lobar Holoprosencephaly

101
Q

Arrested development or hypoplasia of cerebellar vermis - obstruction of Foramen Magendie and Luschka

A

Dandy Walker

102
Q

Cystic dilatation of 4th ventricle, absent vermis, ventriculomegaly, displacement of cerebellar hemispheres due to fluid

A

Dandy Walker

103
Q

Amniotic fluid and bile

A

Meconium

104
Q

Esophagus doesn’t connect to stomach. Transesophageal fistula seen in 90%. Polyhydramnios seen.

A

Esophageal Atresia

105
Q

VACTERL?

A 
V-vertebral
A-anorectal atresia
C-cardiac
TE-esophageal atresia 
R-renal
L-limb
106
Q

Esophageal atresia is associated with which aneuploidy?

A

T18 (most common), T21

107
Q

Duodenal Atresia is associated with…

A

Down syndrome, cardiac anomalies, all of VACTERL

U/S: Double bubble (dilated duodenum & stomach), polyhydramnios

108
Q

Echogenic bowel is assoc. w/ which aneuploidy?

A

T21

109
Q

Causes of large bowel obstuction?

A

Imperforate anus, anal atresia, Hirschsprung’s disease

110
Q

Anorectal atresia is assoc. w/…

A

Caudal regression, VACTERL

111
Q

Hirschsprung’s disease…?

A

Congenital mega colon - no control of peristalsis

112
Q

Hydrops

A

large amounts of fluid builds up in baby

112
Q

Focal dilatation of umbilical vein

A

Umbilical vein varix

113
Q

Failure of abdominal wall to close, protrusion of intestines. Assoc. w/ ascites, polyhydramnios, IUGR. Increased AFP. NOT assoc. w/ chromosomal anomalies.

A

Gastroschisis

114
Q

Midline defect - mass at base of umbilical cord containing organs. Umbilical vessels seen entering mass. Usually assoc. w/ chromosomal anomalies.

A

Omphalocele

115
Q

Limb body wall complex

A

Severe form of amniotic band syndrome - lethal! short cord and exposed organs seen

116
Q

Most severe anorectal malformation that can develop hydrocolops - in females only!

A

Persistent cloaca

117
Q

When can kidneys be reliably seen?

A

12 weeks

118
Q

Findings of bilateral renal agenesis.

A

Potter facies - limb deformities, pulomonary hypoplasia, low set ears, oligohydramnios

119
Q

How to get LVOT from 4CH view?

A

Angle superiorly

120
Q

How to get RVOT from 4CH view?

A

Angle more superiorly than LVOT and rotate transducer to demonstrate RV and PA

121
Q

3VV?

A

PA, ascending AO, SVC

122
Q

Bulbis cordis becomes?

A

Outflow tracts

123
Q

Truncus arteriosis becomes?

A

Great vessels (PA and AO)

124
Q

Sinus Venosus becomes?

A

Atrium, SA node, oblique vein, coronary sinus, IVC, SVC

125
Q

Ostinum Secundum aka…

A

Foramen Ovale

126
Q

Septum primum…

A

Divides atrium into left and right

127
Q

Most common congenital heart defect

A

VSD - most commonly perimembranous

128
Q

VSD is assoc. w/?

A

T21, T18, T13

129
Q

Most common cardiac anomaly in fetus w/ down syndrome..

A

ASD - absent septum secundum

130
Q

AVCD aka atrioventricular canal defect…

A

Septum primum ASD + VSD + common AV valve

Look at 4CH view
Assoc. w/ T21

131
Q

Tetralogy of Fallot…

A

Large VSD, AO override, PA stenosis

Look at LVOT view

132
Q

Ebstein anomaly is assoc. w/…

A

ASD, TOF, coarctation of aorta, transposition (common), mat use of lithium

133
Q

Truncus arteriosus…

A

Single great artery - common trunk w/ a large VSD

134
Q

Transposition of great arteries (TGA)….

A

VA discordance - RV connects to AO, LV connects to PA

Vessels will be parallel, hard to line up for 3VV

135
Q

Most common cardiac tumor…

A

Rhabdomyosarcoma - round, hyperechoic masses assoc. w/ Tuberous Sclerosis

136
Q

Causes of pulomnary hypoplasia…

A

oligohydramnios, no thoracic space, skeletal/neural malformations, chromosomal syndromes

U/S: Bell-shaped chest/abdomen

137
Q

CPAM…

A

congenital pulmonary malformation

138
Q

What is CPAM?

A 
Multiple cystic masses of segmental lung tissue. May lead to hydrops - pressure on heart.
3 types: 
1. Macrocystic (2-10 cm)
2. Macrocystic (0.5-2 cm)
3. Microcystic (< 0.5 cm)
139
Q

Pulmonary sequestration…

A

congenital anomaly, non-functioning portion of lung tissue - most commonly extralobar and on left side

140
Q

Most common diaphragmatic hernia…

A

Foramen of Bockdalek - left posterior lateral defect involving stomach & bowel

141
Q

Right anterior medial diaphragmatic hernia…

A

Foramen of Morgagni - usually bowel & liver involved

142
Q

Most common non-lethal skeletal dysplasia. Short long bones.

A

Achondroplasia

“trident” hand, macrocranium

143
Q

Most common lethal skeletal dysplasia.

A

Thanatophoric dysplasia - severe micromelia, cloverleaf skull aka Kleeblattschadel, bell-shaped abdomen, polyhydramnios, head anomalies

144
Q

Achrondrogenesis

A
  1. micromelia
  2. hypomineralization
  3. macrocranium
145
Q

Osteogenesis Imperfecta

A

Inherited collagen disease - extremely fragile bones

146
Q

Diastrophic dysplasia

A

club foot, hitchhiker thumb, cleft palate/micrognathia, micromelia

147
Q

Rocker bottom feet assoc. w/…

A

T18 and T13

148
Q

Soft markers for T21

A

NF, echogenic bowel, ventriculomegaly, echogenic intracardiac focus, short long bones, absent/hypo NB

149
Q

Soft marker for T18

A

Choroid plexus cyst, enlarged CM

150
Q

Increased hCG levels in 2T are a soft marker for…

A

T21

151
Q

T18 Findings…(Edward’s Syndrome)

A

Strawberry shaped head, CP cysts, ACC, dandy walker, micrognathia, hypotelorism, clenched hand, crytorchidism, VSD, coarct. ao, diaphragmatic hernia, omphalocele, rocker bottom feet, polyhydramnios

152
Q

T21 Findings…

A

Brachycephaly, ventriculomegaly, flattened face, duodenal atresia, echogenic bowel, hydronephrosis, NF thick, AVSD, VSD, TOF, echogenic focus, short limbs, absent/hypo NB, clinodactyly

153
Q

Findings with T13…(Patau Sydrome)

A

holoprosencephaly, facial abnormalities (cleft lip, etc.), ventriculomegaly, ACC, NF thick, NTD, cardiac and renal anomalies, echogenic bowel, omphalocele, polydactyly, 1 UA, microcephaly

154
Q

Triploidy Findings….

A

Meningomyelocele, cystic hygroma, omphalocele, NF thick, club foot, holoprosencephaly, ACC, dandy walker, etc.

155
Q

Turner syndrome Findings…

A

always female, short stature, streak gonads, 45X, lethal, cystic hygroma, ascites, pleural effusion, horseshoe kidney, etc.

156
Q

Fluid-filled sac-like structure that protrudes from back of head or neck

A

Cystic hygroma

157
Q

Distinct feature of Apert Syndrome

A

Frontal bossing, beaked nose

158
Q

Undescended testes

A

Crytorchidism

159
Q

Fetal parts entrapped in fibrous septa

A

Amniotic band syndrome

160
Q

Herniated viscera within a complex membrane

A

Limb-body-wall complex

161
Q

Fetal Alcohol Syndrome Findings…

A

microcephaly, micrognathia, cleft lip and palate, depressed nasal bridge, low forehead, malformed ears, small eyes, ASD, VSD, IUGR

162
Q

Risk factors for a multi pregnancy…

A

ART (assisted reproductive technology), maternal age, race, genetics, environment

163
Q

Unprotected fetal umbilical cord vessels run across internal os

A

Vasa Previa

164
Q

Maternal complications of twins…

A

morbidity, mortality, PROM, preeclampsia, HTN, placenta previa, post partum hemorrhage, anemia, pyelonephritis

165
Q

Type of twins - zygote divides at day 3…

A

DC/DA

166
Q

Type of twins - zygote divides at day 4-7….

A

MC/DA

167
Q

Type of twins - zygote divides at day 8-13…

A

MC/MA

168
Q

Type of twins - zygote divides at day 13+ …

A

Conjoined

169
Q

of gestational sacs

A

chorionicity

170
Q

of yolk sacs

A

amnionicity

171
Q

“T-sign” thin membrane (< 2mm)

A

MC/DA

172
Q

Fused lambda/chorionic peak sign (> 2mm)

A

DC/DA

173
Q

Twin A is labelled…

A

Closest to internal os

174
Q

What is considered discordant growth in twins?

A

discrepancy of 20% based on EFW

175
Q

“vanishing twin”

A

demise of co-twin

176
Q

Highest mortality of all twins…

A

MonoAmniotic

177
Q

Embedding of fetus due to vitelline duct anastomosis

A

Fetus in fetu or heterotopic parasitic twin

178
Q

Arterial-arterial anastomoses across fetuses

A

TRAP aka twin reversed arterial perfusion (acardiac twinning)

179
Q

What happens in TRAP syndrome?

A

Deoxygenated blood flows from donor twin to acardiac twin (no head or heart).
Pump twin has risk of CHF. Treated with laser ablation.

180
Q

TTTS?

A

Twin to twin transfusion - imbalance of twin placental vessels. Donor (oly) and Recipient (poly). MC/DA and same gender. Major imbalance of amniotic fluid and weight discordance.

181
Q

Genetic screening method where had previously abnormal triple screen and hx of spontaneous abortions or fetal anomalies. 2-4 weeks for results. Performed between 15-20 weeks gestation.

A

Amniocentesis

182
Q

AFP and fetal risk of isoimmunization (bili levels) analysis and detection of NTDs method..

A

Amniocentesis

183
Q

Byproduct of RBC breakdown in Rh sensitization?

A

Bilirubin

184
Q

Fetal distress is evaluated by?

A

Meconium

185
Q

What is Chorionic Villus Sampling?

A

High risk 1T procedure where trophoblastic tissue is sampled. Results within 3-10 days.

186
Q

What is PUBS?

A

Percutaneous umbilical blood sampling. Performed 17 weeks to term. Sedative is used. Used to evaluate and treat fetal conditions.

187
Q

Erythroblastosis Fetalis

A

Destruction of fetal RBCs by maternal IgG antibodies which results in fetal anemia. MCA needs to be doppler.

OB/Gynecology (2 decks)

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