POCUS - OB/GYN Flashcards
The anterior and posterior cul-de-sacs are within what body cavity?
The peritoneum
Most women have a _______-verted uterus.
ante
The non-gravid uterus is usually how long?
7-8 cm
It’s usually 4 cm wide and 4 cm deep.
A ___________ uterus has one cervix and two uterine bodies.
bicornuate
Didelphus has two cervixes.
The __________ ligament connects the ovaries to the uterine body.
broad
A normal ovary has what dimensions?
2 cm x 2 cm
True or false: the uterus is usually midline.
True, but many women will have tilting to one side or another
What clips do you need in assessing a fetus?
- Video scanning through the whole child to demonstrate intrauterine pregnancy
- Still video demonstrating movement
- M-mode of heartbeat
- Video of heart beating
Which transducer should you use for the transabdominal fetal US?
Curvilinear
The sagittal transabdominal exam should be done with the probe indicator in the __________ direction. `
cephalad
The endometrial stripe is more _______-echoic than the myometrium.
hyper
In the transverse transabdominal exam, the probe indicator points to the patient’s ________.
right
Up until ______ weeks, no intrauterine pregnancy can be detected on TVUS.
4.5
The __________ is the first TVUS sign of a pregnancy and shows up at ________ weeks.
gestational sac; 4.5-5
The __________ sac is within the _________ sac.
yolk; gestational
The embryo is typically visible by ______ weeks via TVUS.
6
If a first-trimester pregnant woman is thin, you can use the __________ probe.
linear
True or false: the endovaginal US is best done with a full bladder.
False
Empty bladder is best.
The endovaginal US should be inserted with the dot in the ____________ position when doing the sagittal exam.
12 o’clock
Before you push the endocavitary probe farther in, try ______________.
fanning from side to side to see if the uterus pops into view
This is important not just for the comfort of the woman, but also because you can easily bypass the uterus and scan into bowel.
The transverse endovaginal exam should be done with the indicator dot in the ___________ direction.
patient’s right
The endometrium is ________-genic compared to the myometrium.
hyper
It’s not an IUP until you can see ______________.
the yolk sac or embryo – more than just the gestational sac which could be a pseudo-gestational sac
The ____________ sac is usually visible by about 5.5 weeks and a quantitative hCG of 5,000.
yolk
A yolk sac w/ an echogenic center is consistent with _____________.
pregnancy failure
True or false: the embryo is within the yolk sac.
False
The embryo is within the amniotic sac.
The embryo is usually visible by _______ weeks and a quant of _________.
6 weeks; 15,000
Cardiac activity should be seen when the crown-rump length is _______.
> 5 mm
Crown-rump length should not be used when the embryo can __________.
flex
When the crown-rump length is > 5 mm, the HR should be > what?
110
Less than 5 mm should be 80-90 BPM.
Measure the HR with ________ mode.
M
Before diagnosing an IUP, you need to verify in two planes that the gestational sac is surrounded by at least __________ of myometrium.
5 mm
This is because an interstitial ectopic can be surrounded by myometrium on one side but not another.
The embryo closest to the _________ is referred to as embryo A.
cervix
Pregnancy failure is diagnosed by gestational sac > ___ mm w/ no yolk sac or embryo.
16 mm
Yolk sac greater than _____ mm is suspicious for pregnancy failure.
7
What scans are needed for an ectopic evaluation?
- Transabdominal sagittal and transverse looking at the uterus and adnexa
- Transvaginal sagittal and transverse looking at the uterus and adnexa
- Morrison’s pouch
Definitive ectopic findings are seen in only ___% of ectopic pregnancies.
20
What features suggest pseudogestational sac?
Located centrally (as opposed to eccentrically) within the endometrial cavity and with only one layer of wall instead of the double decidual sign
The trilaminar sign is sensitive for what?
Ectopic pregnancy
This is three echogenic lines in the uterus with no fluid between.
What is the differential for an anechoic structure in the cervical canal?
- Cervical ectopic pregnancy
- Miscarriage in process
- Nabothian cyst
The incidence of heterotopic pregnancy in women who’ve undergone IVF treatment is as high as ________.
1:50
Fetal cardiac activity is typically only detectable after _____ weeks gestation.
6
The ovaries are ___________ to the internal iliac vessels.
anteromedial
In the transverse transvaginal exam, the indicator is pointed toward the patient’s ____________.
right
What common pathology shows up as an anechoic circle in the lower uterine segment?
Nabothian cyst
These are endocervical glands that become filled with fluid.
How do you discriminate between a Nabothian cyst and a cervical ectopic pregnancy?
Nabothian cysts have no surrounding desidual reaction and are located within the myometrium
The outermost layer of the uterus that fibroids can be in is called what?
Subserousal
What are the findings of ovarian torsion?
Enlarged ovary
Heterogenous appearance (due to ischemia)
Twisted pedicle
Absent flow (usually a late finding)
Whirlpool sign
How can you tell a high-resistance waveform?
There will be an abrupt cutoff of the spectral waveform in diastole
How do theca lutein cysts appear?
Bilateral enlarged ovaries with multiple thin walled cysts
These are often seen in molar pregnancies.
How many cysts per ovary are needed for PCOS diagnosis?
25
The cysts of PCOS are typically what size?
2-9 mm
Where are the cysts in PCOS typically located?
Peripherally
Other than an ectopic pregnancy, what adnexal masses also have the ring of fire sign?
Corpus luteum cysts
If you can determine that it is intraovarian then you can be sure it is a corpus luteum cyst, otherwise you may not be able to distinguish them
In what two scenarios is it normal to see dilated fallopian tubes (i.e., hydrosalpinx)?
After a hysterectomy or tubal ligation
Dilated fallopian tube has what classic US appearance?
Serpiginous tube
What is one sign that pelvic fluid is pathogenic?
Echogenic fluid
Physiologic fluid will never have internal echos.
What are the rough markers of small, moderate, and large volume free pelvic fluid?
Small: isolated to the lower uterine segment
Moderate: rises above the lower uterine segment (to the mid uterus) but there is no connection to fluid beyond the uterus
Large: extends beyond the uterus to the peritoneum
Lie refers to what aspect of the fetus?
“Lie” refers to if the baby is in plane with the mother, transverse, or oblique
Sonographically, what does twin A and twin B refer to?
Twin B is the one farther from the cervix
What are the two ways of measuring amniotic fluid?
Maximum vertical pocket and amniotic fluid index
MVP is preferred – recently shown to have just as good diagnostic sensitivity for oligo- and polyhydramnios with decreased rates of obstetric intervention and similar rates of maternal adverse outcomes.
How do you measure MVP?
Sagittal orientation, sweep through, find the deepest pocket free of fetal parts and cord
What is normal MVP?
2 - 8 cm
What is normal AFI?
5 - 20 cm (in 2nd and 3rd trimesters)
How do you measure AFI?
Same as MVP: sagittal orientation, divide into quarters, sum the deepest pocket in each
What is the most common cause of 3rd trimester vaginal bleeding?
Placenta previa
With placental localization, it’s most important to find the ________ edge.
inferior
Seeing the inferior edge is needed to rule or placenta previa.
What are the three grades of placenta previa?
Low-lying: placenta is within 2 cm of the os
Marginal: placenta is on the edge of the cervical os
Complete: placenta covers the os
Where is BPD measured?
At the level of the septum pellucidum
Where on the skull (like, the leading edges) is BPD measured?
Outer skull to inner skull
How is head circumference measured?
At the level of the septum pellucidum, fit an ellipse on the outside of the parietal bones
What are the landmarks of abdominal circumference?
Above the kidneys (they should not be seen), below the heart (also should not be seen), visualizing the aorta, umbilical vein, and stomach
Measure abdominal circumference on the ______ of the skin.
outer (like HC)
When measuring femur length, do not include the _____________.
epiphyses
