Role Of The Sonogrpaher In OB Flashcards

0
Q

Sonographer responsibilities…

A

Recommended requirements for OB exam
Know patients needs and/or physicians to altering exam
Be able to adjust exam based on maternal clinical history
Appropriate scanning techniques so nothing is missed
No personal biases

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1
Q

Sonography in OB…

A
Primary tool to evaluate fetus
Assess deleopment, growth, well being of fetus
Indenify problems
Prenatal diagnosis of abnormalities
Treatment of prenatal abnormalities
Parental education and counseling
Performed for ONLY valid reasons
Accurate, competent, safe, appropriate examination
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2
Q

Indications for 1st trimester OB scan…

A
Confirm IUP
R/o ectopic
Define bleeding or pain
Confirm gestational age
Confirm # of fetuses
Confirm cardiac activity
Evaluate maternal pelvic pathology
Screen for fetal anomalies
Evaluate for suspected hydatidform mole
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3
Q

Indications for 2nd/3rd trimester OB scan…

A
Gestational age, growth, presentation, number
Vaginal bleeding/cervical insufficiency
Cause of pain
Size/date discrepancy
Fetal viability
PROM/premature labor
Placental location
Fetal anomalies/abnormal maternal testing
Previous complications
Poor or no prenatal care
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4
Q

What is CPT?

A

Current procedural terminology (code-billing)
Identifies type of exam - OB limited, standard, specialized
Nuchal translucency
OB 1st trimester
TV or 3D/4D

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5
Q

Patient history…

A
Open & closed ended questions
LNMP or LMP
Gravida, parity
Any concerns or problems from the patient or physician 
Any previous pregnancy problems
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6
Q

Pregnancy dating…

A

Clinical vs date from previous exam
First day of LNMP
Pregnancy 266 days +/- 10 days
If conception was 14 of 28, from LNMP 280 or 40 weeks
GA assessment not precise
Does not predict EXACT date of labor/birth
If patient unsure of LNMP, ask for EDD from physician
EDD by 1st sonogram (under 20 wks)
Dates established by 1st trimester US-assess growth
Dates MOST ACCURATE in 1st trimester

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7
Q

What does CRL mean?

A

Crown rump length

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8
Q

Pregnancy is divided into how many trimesters? What are they?

A

3

1st - up to 13 wks 6 days GA (most accurate time for dating)
2nd - 14 to 26 wks 6 days GA
3rd - 27 wks to term (40 wks)

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9
Q

What is Nagele’s Rule?

A

EDD = LNMP - 3 months + 7 days

LMP = EDD + 3 months - 7 days

**use pregnancy wheel

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10
Q

Maternal risk factors…

A

Latex allergy?
Supine hypotension - IVC compression - dizziness
Taking meds
Problems - bleeding, cramps, decreased fetal motion, pain
Previous pregnancy problems
Maternal risk factors for anomalies
Aneuploidy - abnormal # of chromosomes - Downs syndrome

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11
Q

What is nuchal translucency?

A

Performed on fetuses 11-13 weeks GA

Normal is less than 3 mm

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12
Q

Safety of US…

A

Aprox 65% of all women have had an OB US
Used since 1950’s w/o side effects
Potential side effects - increased temp, cavitation
Use ALARA - as low as reasonably achieved; control bioeffects

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13
Q

Doppler for an OB patient…

A

Doppler - higher energy
Maternal & fetal vascular flow, fetal HR, placenta & umbilical cord
Doppler during 1st trimester controversial - use m mode

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14
Q

1st trimester imaging…

A

TA/TV exam for fetal size, HR, gestational size/contour/appearance
Location of gestational sac
Presence or absence of yolk sac and embryo/irregular masses
Yolk sac confirms IUP - approx 4 mm
Measure CRL for GA
Embryo visualized at 4 weeks
HCG positive at 7-10 days
Placenta thickened along margins
Bowel herniated at 8-10 wks, returns to ABD by 12 wks
Has a cardiac cavity (5 wks & alive)
Faster than maternal HR
Fetal number (embryo + sac)
Assess membrane structure, uterus, adnexa, cul de sac, texture of ovaries/uterus, presence of corpus luteum
MOST RELIABLE IN 1st TRIMESTER

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15
Q

2nd/3rd trimester imaging…

A

Fetal life, #, HR, presentation, & activity

Amniotic fluid volume - fluid produced by placenta, kidneys begin to produce urine, fluid increases till 34 wks, polyhydraminos (too much), oligohydramnios (too little)

Placenta location, appearance, relationship to cervix

Umbilical cord with vessels & appearance

Biometric measurements (BPD, HC, AC, FL, HR)

CRL most accurate in 1st trimester

Maternal anatomy - ovaries may be hard to see later in pregnancy

Fetal anatomy - better >18 wks; gender only important in abnormalities

16
Q

Routine anatomy…

A

Head & neck - cerebellum, choroid plexus, cist mag, lat vents, mid falx, cavum septi pellucidi, upper lip

Chest - 4 chamber heart, rt/lt outflow tracts

ABD - stomach, kidneys, bladder, umbilical cord insert & vessels

Spine - cervical, thoracic, lumbar, sacral - long & trans

Extremities - legs, feet, arms, hands

Gender