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OBGYN > side dishes > Flashcards

side dishes Flashcards

1
Q

what does the placenta do

A

transports nutrients and oxygen to fetus

removes waste from fetus

produces hormones to sustain pregnancy

forms barrier between mat and fetal blood

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2
Q

placental is fully formed by __ GA

A

16-18w

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3
Q

fetal trophoblast becomes __

A

chorionic villi (frondosum)

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4
Q

maternal decidua becomes __

A

decidua basalis

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5
Q

placenta made up of __ cotyldons divided by septa

A

15-20

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6
Q

chorionic plate vs. basal plate

A

chorionic = fetal side

basal = maternal

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7
Q

grade 3 placenta prior to 36w GA is associated with __

A

advanced IUGR

sig mat HTN

heavy smoking

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8
Q

normal mean placental thickness roughly equal to __

A

weeks GA

> 4cm abnormal

  • measure from chorionic to basal plate
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9
Q

thick HETEROGENEOUS placenta associated with __

A

tirploidy

molar pregnancy

placental hemorrhage

fetal viral infections (oft with calcs)

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10
Q

thick, HOMOGENEOUS placenta associated with __

A

gestational DM

fetal hydrops

fetal viral infections (with calcs)

mat anemia

aneuploidy

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11
Q

thin placenta associated with __

A

mat HTN

chromosomal abnormalities

polyhydramnios

severe IUGR

advanced DM preconception

severe intrauterine infection

placenta membranacea

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12
Q

most hypoechoic lesions within placenta are __

A

venous lakes

** maternal blood
rouleau

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13
Q

placental lake aka

A

sonolucencies

hole

lucencies

** not lacunae??

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14
Q

most common placental tumour

A

choriocarcinoma

  • benign
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15
Q

sono features of choriocarcinoma

A

solid mass with variable echo pattern bulging at fetal surface (chorionic) of placenta

variable doppler (sometimes avascular)

+/- polyhydramnios

fetus normal or signs of hydrops

*** large >5cm associated with fetal CHF, IUGR and nonimmune hydrops

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16
Q

which placental tumour may elevate MSAFP

A

choriocarcinoma

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17
Q

a placenta which partially or completely covers the internal os of the cervix; degrees

A

placenta previa

complete

partial

marginal

low lying <2cm

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18
Q

placental migration aka

A

dynamic placentation
TROPHOTROPISM

normal migration from internal OS with progression of pregnancy

“grows toward nourishment” at fundus of uterus (better blood supply)

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19
Q

a normally implanted placenta that prematurely separates from the uterine wall

A

abruptio placenta

  • mild to severe
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20
Q

clinical signs of placental abruption

A

mild tenderness to rigidity

+/- bleeding

elevated MSAFP

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21
Q

risks for abruptio placenta

A

mat HTN

PROM

short umb cord

advanced mat age

previous abruption

abdominal trauma

smoking/cocaine

retroplacental myoma

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22
Q

fetal complications associated with abruptio placenta

A

fetal hypoxia

IUGR

premature delivery

demise

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23
Q

maternal complications of abruptio placenta

A

hypovolemic shock/cardiac arrest
* state of decreased blood volume

acute renal failure

disseminated intravascular coagulopathy
* excessive clotting throughout body

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24
Q

type of abruptio placenta

A

retroplacental

marginal

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25
Q

‘sono features of abruptio placenta

A

hematoma appearance either retroplacental or subchorionic

may appear normal if blod is freely escaping the uterus
* could be bleeding in a way that is not detectable

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26
Q

placenta accreta spectrum aka

A

placenta creta

placental invasion

morbidly adherent placenta (MAP)

accreta, increta, percreta

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27
Q

deficiency of decidua basalis

A

underdeveloped dicidua basalis allows varying degrees of invasion of chorionic villi into myometrium

replaced with connective tissue

accreta, increta, percreta

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28
Q

chorionic villi attach to the myometrium; most common form of placental invasion

A

placenta accreta

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29
Q

chorionic villi extend INTO the myometrium

A

placenta increta

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30
Q

chorionic villi penetrate THROUGH the uterine wall (ie into bladder)

A

placenta percreta

“past”

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31
Q

risk factors for placental invasion

A

previous csec

anterior placental previa/ low lying

hx of ut sx

increased parity

elevated MSAFP

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32
Q

sono findings for placental invasion in 1st trimester

A

may see GS location in csec scar

multiple irregular vascular spaces within placenta

colour usually intense blood flow within anechoic placental space (due to direct association with ut arteries)

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33
Q

sono features of placental invasion in 2nd/3rd trimester

A

multiple vascular lacunae

loss of normal hypoechoic retroplacental zone
* check angle of probe; can be angle dependent

** retroplacental myometrium should be >1mm
**pitfall, retroplacental zone may not be seen with normal anterior placenta (false positive)

extensive villi into myometrium, serosa, or baldder

abnormal uterine serosa-bladder interface

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34
Q

secondary placental lobe(s) attached to main body by velamentous connection

A

succenturiate lobe

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35
Q

significant associated risks for succenturiate lobe(s)

A

antepartum bleeding

vasa or placenta previa

fetal distress due to trauma to interconnecting vessels

postpartum bleed (retention)

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36
Q

succenturiate variant where two similarly sized placental lobes are present with vascular connection

A

bilobed placenta

ddx FMC, SCH

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37
Q

smooth chorion insertion into chorionic plate closer to the centre of the placenta than at the margin resulting in chorionic plate being smaller than basal plate

A

extrachorial placenta

partial (asymptomatic) or

complete (entire edge of placenta)
* associated with antepartum bleeding, preterm labour, placental abruption and IUGR

  • circumvallate
  • circummarginate
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38
Q

smooth chorion inserts closer to the centre of placenta and rolls UP

A

circumvallate placenta

ddx synechiae, ut septum, amniotic band syndrome

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39
Q

smooth chorion inserts closer to the centre of placenta and often not seen with ultrasound

A

circummarginate placenta

flat interface

‘spread like margerine’

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40
Q

LAX, circumvallate placental edges appear __ and SAX the edges appear __

A

LAX -> long
SAX -> short

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41
Q

a thin, membranous placenta occupying the entire periphery of the chorion (covering most or entire uterine wall)

A

placenta membranacea

decidua capsularis did not flattern the chorionic villi

placenta usually thinner than normal

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42
Q

placenta membranacea associated with __

A

invasion and placenta/vasa previa

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43
Q

CI at edge of placenta

A

battledore insertion

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44
Q

Ci away from placenta into membranes

A

velamentous CI

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45
Q

cylindrical shaped placenta (ring)

A

annularis placenta

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46
Q

thinning/ hole in middle of placental tissue

A

fenestrata placenta

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47
Q

embryonic diverticulum from YS to body stalk that becomes blind-ended tube from bladder to umb cord in fetus

A

allantois

-> urachus
-> median umbilical ligament

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48
Q

embryonic connection from midgut to YS that narrows and disappears by 9w GA

A

vitelline duct

-> Meckel diverticulum if not obliterated in utero (slight bulge in small intestine)

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49
Q

umb vein brings blood __ fetus and the umbilical arteries __ the fetus

A

vein TO the fetus

arteries RETURN to placenta

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50
Q

arteries are protected and insulated by __

A

Wharton’s jelly

covered by amnion

51
Q

normal cord length full term

A

55cm, 1-3cm thick

52
Q

short umb cord associated with

A

fetal movement disorders

placental abruption

cord rupture (subsequent demise)

53
Q

long umb cord associated with

A

fetal entanglement

true knots

thrombi

54
Q

normal umb coiling index (UCI)

A

~0.44 coils/ cm

55
Q

hypercoiled umb cord associated with

A

increased incidence of premature delivery

occlusion in cases with entanglement

low arterial pH

asphyxia

**usually associated with cocaine withdrawal issues

56
Q

undercoiled umb cord associated with

A

kinking, compression

low APGAR score

57
Q

associated risks if 2VC not an isolated finding

A

fetal anomalies (cardiac, renal)

IUGR

aneuploidy

velamentous CI

preterm delivery

58
Q

eccentric CI __ cm from edge

A

> 2cm but still off centre

59
Q

marginal insertion __ cm from edge

A

<2cm

can progress to velamentous Co and vasa previa

60
Q

associated risks with velamentous CI

A

no wharton’s jelly (vessel compression)

vasa previa

hemorrhage

61
Q

associated findings with velamentous CI

A

esophageal atresia

VSD

2VC

succenturiate placenta

low brith weight, cleft palate, hip dislocation/dysplasia, asymmetrical head shape, spina bifida

62
Q

pulse of velamentous CI will match __ heart rate

A

fetal

confirms not maternal vessels

63
Q

common umb cord masses

A

cysts

neoplasm

knots
- false (kink)
- true (polyydramnios, increased risks fetal loss)

hematoma

focal edema

64
Q

t/f single loop of cord around fetal neck is not cause for concern

A

true

if many, can cause cord shortening and the associated risks of that

asphyxia

management is close surveillance (count fetal movement, etc)

65
Q

PROM with cord prolapse; look for __

A

extent

= ruptured membranes and can restrict or occlude blood flow to fetus (compression)

***** obs emergency

66
Q

causes for cord prolapse

A

abnormal presentation of fetus

LONG cord

polyhydramnios

prematurity

twins

***** obs emergency

67
Q

cord wrapped around neck aka

A

nuchal cord

68
Q

causes for cord compression

A

oligohydramnios

nuchal cord loops

true knots

compression by fetus (ie. prolapsed cord, undercoiled cord)

SHORT cord

69
Q

what are the pregnancy membranes

A

amnion and chorion

amniochorionic membrane

wall preventing fluid from leaving too early “impermeable to amniotic fluid”

70
Q

__ membrane develops from trophoblast and is surrounding blasocyst

A

chorion

71
Q

outer blastocyst divides into 2 layers of trophoblast; they are __

A

syncytiotrophoblast (outer)
** future placenta
- dissolves endo to fuse to what is now decidua basalic

cytotrophoblast (inner)
** future smooth chorion
- decidua capsularis

72
Q

__ membrane forms adj to embryonic disc within blastocyst

A

amnion

73
Q

as gest sac explands, __ contacts decidua parietalis and fuses during 2nd trimester

A

amnion

74
Q

when amnion fuses to decidua parietalis, the uterine cavity is __

A

obliterated

75
Q

shelf vs sheet vs strand

A

shelf = indenting synechiae, circumvallate placenta, ut septum

sheet = compartments
** line no matter how you rotate

strand = linear membrane cause for amniotic band syndrome; sticky when rupture early
** dot when you rotate

76
Q

fetal development outside of amniotic cavity secondary to late rupture of amnion

A

extra-amniotic pregnancy

associated with SHEET septation

77
Q

septation sheets can be normal if separation occurs __ GA

A

< 16w GA

78
Q

amniochorionic membrane lifting from ut wall by subchorionic hematoma

A

abnormal septation sheet

can cause compartments and issues

79
Q

which membranous septation drapes over an anatomic ridge (ie. synechiae)

A

amniochorionic shelf

80
Q

vascularity of septations

A

avascular

some SHELVES have vascularity depending on type of anatomical adhesion (ie. uterine septation)

81
Q

amnion abuts the chorion around __ GA and amnion fuses with chorion around __ GA

A

abuts at 12-16w GA

fuses 20w GA

82
Q

chorionic cavity between amnion and chorion

A

subamniotic space

  • not continuous with uterine cavity
83
Q

uterine cavity between chorionic membrane and uterine wall

A

subchorionic

*fluid can leak to cervical cavity

84
Q

potential spaces for blood collection

A

subchorionic (uterine cavity)

retroplacental

subamniotic (chorionic cavity)

amniotic cavity

85
Q

subchorionic hemorrhage aka

A

subchorionic hematoma

86
Q

subchorionic bleeds aka

A

marginal placental abruption

*premature detachment at edge of placenta

87
Q

separation of amnion and chorion membranes

A

amniochorionic separation

*primary and secondary

88
Q

who regulates the amniotic fluid

A

fetus is the regulatory apparatus

89
Q

__ produces amniotic fluid

A

chorion plate of placenta

skin

urinary tract

respiratory tract

90
Q

__ removes amniotic fluid

A

GI tract

respiratory tract

uterine wall

91
Q

__ are the primary source of amniotic fluid after 16w GA

A

kidneys

92
Q

amniotic fluid peaks at __ GA and drastically reduces after __ GA

A

peaks at 30-36w

decreases after 42w

93
Q

SDP

A

2-8 cm

94
Q

AFI

A

10-20 cm

  • MB 8-18 cm
95
Q

fetal causes for oligohydramnios

A

triploidy

kidney problems

bladder outlet obstruction

96
Q

maternal causes for oligohydramnios

A

PROM

IUGR (shit placenta, HTN, drugs)

97
Q

placental causes for oligohydramnios

A

insufficiency

twin to twin transfusion syndrome (DA)
** donor twin has IUGR
recipient hydrops

98
Q

fetal complications with oligohydramnios

A

pulmonary hypoplasia
* bell shaped chest

distress (cord compression; asphyxia)

clubfoot

dolichocephaly

99
Q

management of oligohydramnios

A

amnioinfusion
* injection of saline

100
Q

most common cause for polyhydramnios

A

idiopathic

101
Q

fetal causes for polyhydramnios

A

CNS lesion

open NTD

upper GI atresias or bowel obstruction

dandy walker malformation

shit lungs, esophageal compression

CHF

skeletal dysplasia

unilat renal agenesis

102
Q

expected AFI with unilat renal agenesis

A

polyhydramnios

  • paradoxical increase of amniotic fluid
103
Q

expected AFI with upper GI atresia

A

polyhydramnios

104
Q

maternal causes for polyhydramnios

A

DM

hydrops (immune and non immune)

105
Q

expected AFI with mat DM

A

polyhydramnios

106
Q

expected AFI with mat HTN

A

oligohydramnios

** fetal IUGR

107
Q

expected AFI with dandy walker malformation

A

polyhydramnios

108
Q

placental causes for polyhydramnios

A

twin to twin transfusion
** recipient twin hydropic with polyhydramnios

can be MCDA (stuck twin gets oligo, other twin poly)

large placental chorioangioma
- fluid overload and fetal CHF

109
Q

features of placenta with polyhydramnios

A

thin placenta in severe cases

+/- cervical incompetence

110
Q

severe polyhydramnios SDP and AFI

A

> 16 cm

AFI >/= 35 cm

111
Q

management severe polyhydramnios

A

therapeutic amniocentesis

indomethacin therapy

112
Q

maternal clinical presentation with severe polyhydramnios

A

overdistended ut resultant preterm labour

SOB

insomnia

leg edema

supine hypotensive syndrome

113
Q

physiological sources of amniotic fluid echoes

A

desquamated fetal cells (epithelial)

venix caseosa (covering on fetal skin)

meconium (poop?)

114
Q

sludge in amniotic fluid risk for __

A

PROM and chorioamnionitis

115
Q

cervix length

A

> 3cm TAS
2.5cm EVS

116
Q

cause for congenital incompetence of cervix

A

DES exposure

isolated idiopathic

connective tissue disorder
** ie rheumatoid arthritis, lupus, sclerosis

117
Q

progressive severity of cervical incompetence

A

T

Y

V

U

118
Q

what GA is it okay to perform cervical stress test

A

15-24w GA

119
Q

most common suture technique for cervical cerclage

A

McDonald ‘purse stringe’

120
Q

preterm is __ GA

A

<37w

121
Q

post dates is __ GA

A

> 42w

122
Q

fetal vessels crossing IO, situating between presenting part of fetus and cervix

A

vasa previa

123
Q

partial separation (opening) of myometrium at the location of uterine scar (ie csec)

A

uterine dehiscence

*risk of rupture

124
Q

what length of uterine dehiscence is considered at risk of rupture

A

<3mm AP

OBGYN (8 decks)

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