powerpoint 1 Flashcards
first trimester week range
1-13 weeks
what is gestational age?
age from LMP so conception + 14 days
what is fetal age?
age from date of conception
Naegele’s Rule equation
LNMP + 7 days – 3 months + 1 year
Estimated Delivery Date (EDD)
when does nausea start(weeks)
6-12 weeks
when does fetal heart tones start(week)
11 weeks
when does quickening start (week)
15-18 weeks
Which trimester ultrasound in more accurate for dating
1st trimester
when would you see a gestational sac
5 weeks
when would you visualize yolk sac
5-6 weeks
when would you see early embryonic pole with cardiac activity
6 weeks
Suggested Protocol
- Survey uterus and determine fetal number.
- Observe fetal cardiac activity
- Determine fetal position(s) and placental location(s).
- Check cervix and lower uterine segment.
- Survey for uterine or adnexal masses.
- Assess amniotic fluid.
- Perform anatomy survey of each fetus.
- Perform biometric measurements of each fetus.
3 different fetal lie
longitudinal, oblique, transverse
4 different fetal presentation
- Cephalic
- Breech
* Complete
* Incomplete
* Frank - Oblique
* Where is the fetal head? - Transverse
* Head to the right or left?
Fetal Presentation
different types of breech positions
complete
incomplete
frank
what is prolapsed cord?
cord comes into vaginal canal before baby
1st OB lab at gvltec
- Determine fetal position/lie and placental location.
- Observe (visual check) fetal cardiac activity
- Check cervix and lower uterine segment (LUS).
The LUS with a measurement of the cervix should be the first
image you take. - Perform biometric measurements of each fetus.
Obtain in the following order: BPD, HC, AC, and FL.
You should be able to complete these twice! - Perform anatomy survey of the fetus with remaining time.
GTC OB Lab
Protocol for DMS 165
What is Cervical Incompetence
Spontaneous, painless
dilatation of the cervix
normal cervical length
greater than 3cm
acronym for incompetent cervixes
Trust
Your
Vaginal
Ultrasound
what is funneling
amniotic sac going into birth canal
What is Biparietal Diameter (BPD)
Diameter of the fetus’ head from one parietal bone to the other.
where is the Head
Circumference (HC) took from
Taken at the same level as the BPD
intracranial landmarks for head measurements
- Falx cerebri anteriorlyand posteriorly and
perpendicular to sound. (horizontal on the screen) - Cavum septi pellucidi anteriorly in the midline
- Choroid plexus of the lateral ventricle-(not always seen).
- Thalami imaged equidistant from the
lateral walls of the calvarium
anterior vs posterior based on thalami
thalami is heart shaped and the humps are anterior, the point posterior
how to measure BPD
outer parietal bone on closest side to inside of parietal bone on far side
Cerebellum like 2 snowballs and peduncles rectangular
just image to see
Abdominal circumference
made from a transverse
axial image of the fetal
abdomen at the level of
the liver
just know that it is done at liver
Major landmarks for abdominal circumference…..
- Umbilical portion of the
left portal vein - Fetal stomach
- Fetal spine (9 o’clock or 3
o’clock)
how to measure Outer Binocular Distance
Calipers are placed on the
(outer) canthi of each eye.
symmetric vs asymmetric Intrauterine Growth Restriction (IUGR)
Symmetric IUGR Causes-
* Usually a result of a first trimester insult.
* Low genetic growth potential, intrauterine
infection, severe maternal malnutrition, fetal alcohol syndrome, chromosomal anomaly, or severe congenital anomaly
Asymmetric IUGR-
* Usually caused by placental insufficiency.
* Result of maternal diseases such as: diabetes, chronic HTN, cardiac or renal disease, placental abruption, multiple pregnancy, smoking, poor weight gain, drug usage, or uterine anomaly.
Maternal Factors for IUGR
Macrosomia
- Large for gestational age
- Birth weight of 4000g or more
- Commonly associated with maternal diabetes
- Morbidity related to birth trauma, asphyxia, and prolonged pregnancy
Macrosomia
Where is the lateral ventricle measured
transverse axial plane of the fetal head ( just superior to the BPD measurement)
what is the transventricular plane
where the lateral ventricle image is took
Normal lateral ventricular
measurement is …………
<10mm
lateral ventricular is measured from outside or inside walls
inside
dangling choroid sign is when ventricle is enlarged and choroid looks like it dangles
just the way the lateral ventricular looks at different gestational ages
how to find lateral ventricle
about a finger length behind thalami in the center of posterior hemisphere
Where is choroids located
in the roof of each ventricle. best seen when falx is vertical on screen
look for cyst in them
A fluid-filled cavity in the
anterior portion of the fetal
head.
* Usually visible around 16
weeks gestation.
-Not visible in late gestation or
neonatal life from fusion of
the two membranes making
up the walls of the CSP.
* Must be imaged during 2nd
trimester scan.
* Anterior horns of the lateral
ventricle are separated by it
Cavum Septum Pellucidum
How to measure the cerebellum
at the widest point including echogenic line
Measurement should be taken
at the most narrow part of the
cerebellum, from the vermis to
the inner skull table of the
occipital bone
Cisterna Magna measurement
Normal cisterna magna
measure ………..
<10mm
abnormal cerebellum/ CM- banana shaped cerebellum SEEN WITH SPINA BIFIDA
what is micronathia
recessed chin
what is frontal bossing
thick skin on forehead
Imaging Protocol of Fetal Spine
* Sagittal, transverse, and coronal images
* Cervical (C1-C7)
* Thoracic (T1-T12)
* Lumbar (L1-L5)
* Sacrum (S1-S5)
when baby is in prone position!
spine body is considered anterior process and lamina posterior process when ultrasound
- Heart (4 Chambers)
- 2 Ventricles
- 2 Atria
- Septa
- Best when baby is in a supine
position!
Anatomy Refresher
Position of the heart
Heart on the left, apex to the
left, left atrium closest to the
spine, right ventricle closest
to sternum
The four-chamber view checklist
includes the following.
* Right ventricle (lies directly behind
the sternum).
* Interventricular septum
* Left ventricle
* Two atrioventricular valves (tricuspid
and mitral valve).
* Right atrium.
* Inter-atrial septum and foramen
ovale (septum primum(top flap)/septum
secundum(bottom flap of Atrial))
* Left atrium and pulmonary veins (PV)
(the most posterior cardiac
chamber). Must see at least one PV
* Descending aorta (posteriorly,
between the left atrium and the fetal
spine).
Term used for the normal position of the heart and abdominal organs
Situs solitus
Term used when the chest and abdominal organs are placed in a mirror image of the normal position.
Situs inversus
Term used when the apex of the heart and the stomach are not on the same side.
* Usually the stomach is positioned correctly and the apex of the heart is placed on the right, instead of the left.
* This anomaly is more likely to have CHD than the other two anomalies mentioned above (about 95% or greater).
Situs ambiguous
Axis
* Levorotated (turned towards the left) 45 degrees +/- 20 degrees
Position
* Heart should be positioned in the anterior aspect of the chest.
The heart should fill _________ of the fetal thorax
1/3
The ____________ ventricle should make up
the apex of the heart and should be
“bullet shaped”
left
Right ventricle should
have ___________- band.
moderator
___________– valve should be
closer to the apex of the
heart than the mitral valve
Tricuspid
A _______________ is defined as a hole in the ventricular septum
of the heart that divides the right and left ventricular chambers
ventricular septal defect (VSD)
pulmonary artery comes off which ventricle and branches into how many branches
right ventricle and 2 branches
3 Vessel View (3VV) looks for which 3 things
Used to evaluate the
pulmonary artery (Pa),
Ascending aorta (Ao),
and superior vena cava
(SVC).
image
3 Vessel/Tracheal View (3VT)
Structures visualized in
this image are the
ductal arch (Da), aortic
arch (AA), SVC and
trachea (Tr)
looking for a V
image
which takes oxygenated blood to baby umbilical vein or artery
umbilical vein
Pulmonary veins should be
seen coming into the _____________
atrium
* You should see at least one
of these.
left
name of septum that divides left and right ventricle
interventricular
septum (IVS)
LVOT Imaging Checklist
The five-chamber view checklist
includes the following:
* Presence of a large vessel with
aortic characteristics (no
bifurcation) originating from the
morphologic left ventricle.
* Regular continuity of the anterior
wall of the aorta with the inter-
ventricular septum (membranous
part).
* The leaflets of the aortic valve
must be shown only in
the diastolic phase (aortic valve
closed).
* Normal size of ascending aorta
(similar to pulmonary artery).
RVOT Imaging Checklist
The right axis view (RVOT) checklist
includes the following.
* Presence of a large vessel with
pulmonary characteristics
(bifurcation: the main pulmonary
artery splits into left and right
pulmonary artery) originating from
the morphologic right ventricle.
* The pulmonary valve leaflets must be
shown only in the diastolic phase
(pulmonary valve closed).
* Normal size of the main pulmonary
artery (usually slightly larger than the
aortic artery).
* Regular great vessel (aorta-
pulmonary) crossing.
* Normal course of ductus arteriosus
(right short axis view) that connects
the pulmonary artery to the
descending aorta.
to evaluate the Genitourinary System the spine should be at __________-
6 or 12 oclock
Placenta grading 0
No visible calcification within the placenta
(most common in first trimester
Placenta grading 1
Small intraplacental calcifications
(May appear as early as 14 weeks and is most common until 34 weeks)
Placenta grading 2
Calcification of the basilar plate with comma
like echogenicities extending into the
placenta from indentations of the chorionic
plate
(Usually does not appear until after 30 weeks)
Placenta grading 3
Extensive basal echogenicities and the
curvilinear echogenicities extending
from the chorionic plate reach the basal
plate
(Not usually seen until after 35 weeks and then only in 30% of term placentas)
placenta dimensions
2.0 to 2.5 cm is average thickness
* > 3.3 cm for anterior placentas is too thick
* > 4.0 cm for posterior placentas is too thick
2 ways of measuring amniotic fluid
single deepest
vertical pocket (SDV) or 4 quadrants (AFI).
amniotic fluid volumes for SDV
Using SDV pocket
* Normal= > 2cm
* Oligohydramnios= < 2cm
* Polyhydramnios= > 8cm
amniotic fluid volumes for AFi
Using 4-quadrant AFI
* Normal= 8-22cm
* Oligohydramnios= <5cm
* Polyhydramnios= >22cm
which trisomy
ALPHA-FETOPROTEIN (AFP) (🡫)
hCG (🡩)
Unconjugated estriol (🡫)
trisomy 21
which Trisomy
ALPHA-FETOPROTEIN (AFP)(🡫)
hCG (🡫)
Unconjugated estriol (🡫)
trisomy 18
what does an high ALPHA-FETOPROTEIN (AFP) test mean
something isn’t contained like it should such as intestines
If you see ribs what part of spine are you in?
thoracic
If you see iliac wing which part of spine are you in?
lumbar
