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OB/GYN review > Test 2 > Flashcards

Test 2 Flashcards

1
Q

what is the AIUM statement?

A

fetal ultrasound should be preformed only when there is a valid medical reason, and the lowest possible ultrasonic exposure settings should be used to hain the necessary diagnostic info

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2
Q

what is the principle of prudent scanning?

A

ALARA

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3
Q

what do bioeffecrs depend on?

A

intensity of the beam, the duration of exposure, as well as frequency

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4
Q

where is thermal bioeffects?

A

ultrasound travels through tissue, energy is absorbed by the tissue components and coverted to heat

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5
Q

increased heat is considered a potential ________

A

teratogen

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6
Q

what does thermal bio effects do?

A
  • affects the rate of chemical reactions

- alters the equilibrium between chemical reactions

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7
Q

what is a non thermal bio effect?

A

caviation

gas bubbles

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8
Q

what is caviation?

A

the expansion and contraction or collapse of gas bubbles during the oscillatory cycle

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9
Q

what does damage tissues containing gas do?

A
  • potentially pertains to the neonate

- lung, inestine

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10
Q

what is thermal index?

A

a thermal index of one (TI 1) indicates conditions under which the rise in temperature would likely by 1C

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11
Q

what is the threshold in thermal index before any evidence of development effect occurs?

A

1.5 to 2C

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12
Q

what is considered potentially hazardous in thermal index?

A

diagnostic exposure that elevates embryonic and fetal in situ temperature above 41C for 5 minutes should be considered potentially hazardous

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13
Q

Routine grey scale ultrasound in the 1st trimester is __________ to have adverse effects.

A

unlikely

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14
Q

what is the rise in temperature with modern ultrasound systems?

A

usually less than 1C

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15
Q

what may cause a rise in temperature of more than 1.5C in the first trimester?

A

Doppler US for fetal heart rate when used for more than 30 seconds

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16
Q

what does teratogenic mean?

A

able to disturb the growth and development of an embryp or fetus

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17
Q

what can produce teratogenic effects?

A

elevated maternal temperature whether from illness or exposure to heat

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18
Q

for all OB sonograms obtained before 8 weeks what should the TI setting be set to?

A

soft tissue (TI’s)

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19
Q

for all OB tests preformed after 8 weeks what should the TI setting be set to?

A

bone (TIb)

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20
Q

what should the power not be set to ever for an OB study?

A

never be near 100%

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21
Q

what is mechanical index?

A

describes the potential for mechanical bio-effects (caviation, gas bubbles) to occur

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22
Q

what can mechanical index be used to estimate?

A

for the degree of bio-effects a given set of ultrasound parameters will induce

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23
Q

a higher mechanicnal index means a higher ___________

A

bio effect

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24
Q

what MI should US scanners not exceed?

A

1.9

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25
Q

what are fetal sonographic examinations?

A
  • first trimester
  • standard second or third trimester
  • limited examination
  • specialized examination (level 2, targeted exam)
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26
Q

describe specialized examination?

A
  • detailed anatomic examination
  • preformed when an anomaly is suspected
  • indicated by fam history
  • biochemical abnormalities
  • indicated by the results of a standard examination
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27
Q

what does a standard OB sonogram in the 1st trimester include?

A
  • evaluation of the presence, size, location, and number of gest. sacs
  • the gestational sac is examined for the presence of a yolk sac and embryo
  • measure embryo/fetus and cardiac activity
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28
Q

what should be examined in first trimester imaging?

A
  • uterus
  • cervix
  • adnexa
  • cul-de-sac
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29
Q

what does a standard OB sonogram in the 2nd or 3rd trimester include an evaulation of?

A
  • fetal presentation
  • amniotic fluid volume
  • cardiac activity
  • placental position
  • fetal biometry
  • fetal number
  • anatomic survey
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30
Q

what should be examined in the 2nd/3rd trimester when technically feasible?

A

maternal cervix and adnexa

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31
Q

what does lower freq provide?

A

more penetraton

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32
Q

what does higher freq provide?

A

better resolution

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33
Q

what do transvaginal transducers allow for?

A

superior resolution while still allowing adequate penetration

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34
Q

how often should instrumentation used for diagnostic testing be maintained in good operating condition and undergo routine calibration?

A

at least once a year (annually)

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35
Q

what routine inspection and testing must be done in all existing equipment?

A

testing for electrical safety

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36
Q

who must request for the examination?

A

must be originated by a physician or other appropriately licensed health care provider or under the providers direction

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37
Q

what should thier be a permanent record of?

A

ultrasound examination and its interpretation

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38
Q

what images must be obtained?

A

all appropriate areas, both normal and abnormal

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39
Q

what should images be labeled with?

A
  • patient ID
  • facility ID
  • exam date
  • side (right or left)
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40
Q

what should be obtained in the patients medical record?

A

an official interpretation (final report) of the ultrasound findings

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41
Q

retention of the US examination should be consistent with both what?

A

clinical needs and with relevant legal and local health care facility requirements

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42
Q

what are some causes of uncertain LMP?

A
  • poor menstrual history
  • amenorrhea
  • prolonged or short cycle-not every 28 days
  • DUB
  • recent miscarriage
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43
Q

with advances in prenatal testing, pregnancy is now known to have a duration of how long?

A

280 days from the first day of the LMP, also referred to as 9 calendar or 10 lunar months

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44
Q

in clinical practice, the term gestational age is often used interchangeably with what?

A

menstrual age

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45
Q

what is needed to manage the pregnancy optimally?

A

the knowledge of an acurate gestational age

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46
Q

what is the biometry measurments of the 1st trimester?

A
  • gestational sac (mean sac diameter)

- crown rump length

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47
Q

what are the additional measurments in the 1st trimester?

A
  • yolk sac (2-6mm)

- nuchal translucency (<3mm between 11 and 14 weeks)

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48
Q

what is the 1st sonographic evidence of an intrauterine pregnancy?

A

gestational sac

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49
Q

what is a gestational sac?

A

anechoic fluid collection surrounded by an echgenic ring in the fundal region of the endometrial cavity

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50
Q

what is a vital structure of a normal pregnancy and what is it made of?

A

echogenic ring=chorionic and decidua capsularis

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51
Q

what does absence of the echogenic ring prompt?

A

suspicion of a pseudogestational sac associated with ectopic pregnancy

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52
Q

how is the mean sac diameter (MSD) calculated?

A

measurement of gestational sac in all 3 dimentions

-made at the interface between the echogenic border and the fluid

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53
Q

what is the gestational sac surrounded by?

A

decidualised endometrium

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54
Q

with transvaginal technique how will a pregnancy 4 weeks and 1 or 2 days from LMP be visualized?

A

2-3 mm fluid collection within the uterus

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55
Q

what should MSD correlate with?

A

suspected gestational age

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56
Q

how fast does gestational sac grow?

A

approx 1mm per day

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57
Q

evidence of developing intrauterine pregnancy should be seen transvaginally with a serum beta-hCG level greater than what?

A

1000-2000 mIU/mL

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58
Q

what standard is used in the beta-hCG?

A

international reference preparation

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59
Q

describe alpha fetaprotein (AFP)?

A
  • produced by the fetus
  • found in the amniotic fluid and maternal serum
  • normal values vary with gestational age
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60
Q

what may cause high values of AFP?

A
  • underestimated gest. age
  • fetus older than expected
  • multiple gestations
  • open neural tube defect
  • abdominal wall defect
  • cystic hygroma
  • renal anomalies
  • fetal demise
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61
Q

what may cause low levels of AFP?

A
  • overestimated gestational age
  • fetus younger than expected
  • chromosomal abnormalities
  • trophoblastic disease
  • long-standing fetal demise
  • chronic maternal hypertension
  • diabetis
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62
Q

with TVS, gestational sac measuring _____ should demonstrate a yolk sac

A

< 8mm

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63
Q

yolk sac measuring 8mm should be consistent with what?

A

5-5.5 week gestation

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64
Q

what does the yolk sac do?

A

supplies nutrition for the developing embryo through the vitelline duct

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65
Q

how can the yolk sac be seen?

A

yolk sac and embryo can be seen seperated by the echogenic amnion but connected by the vitelline duct

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66
Q

what should the size of the yolk sac be in the first trimester?

A

2-6 mm

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67
Q

what is an abmornally sized yolk sac indicative of?

A

pending loss or fetal abnormality

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68
Q

how should the yolk sac be measured?

A

with placement of calipers along the inner borders of the echogenic ring (AP)

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69
Q

what does the yolk sac assist in?

A

locating the developing embryo and possible cardac acitivity

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70
Q

what is associated with a poor prognosis with the yolk sac?

A
  • size
  • shape
  • echogenicity of the yolk sac
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71
Q

how long is the embryonic period?

A

week 6 through week 10 of pregnancy

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72
Q

what rate does the embryo grow?

A

1mm per day

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73
Q

how does the embryo appear?

A

flat, disc like structure

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74
Q

when may the heart beat be found in the embryo?

A

5.5 weeks or when the CRL measures 5mm

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75
Q

when should the embryo be visualized in a gestational sac with transabdominal?

A

gestational sac measures 25mm

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76
Q

what is the normal embryonic heart rate?

A

120-180 beats per minute

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77
Q

what should be done when the embryonic heart rate is 100 beats or less?

A

it should be compared with the maternal heart rate to ensure that maternal uterine vessels are not being samples and inaccurately represented as embryonic cardiac activity

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78
Q

when does the embryo begin to assume a C-shaped appearance?

A

by about 8 weeks

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79
Q

if there is more than one first trimester scan with a mean sac diameter or crown-rump length measurment what should be used to determine gestational age?

A

the earliest ultrasound with a crown rump length equivalent to atleast 7 weeks (or 10mm) should be used to determine gestatinal age

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80
Q

when is the distinction between the head and torso of the fetus easily recognized?

A

around 11-12 weeks

81
Q

how is an accurate CRL measurement taken?

A

placement of the calipers at the top of the fetal head (crown) to the bottom of the torso (rump)

82
Q

when do we avoid using CRL measurment?

A

when the embryo is flexed

83
Q

what measurement is used as a early screening tool for possible fetal aneuploidy?

A

nuchal translucency

84
Q

what is an increased NT thickness associated with?

A
  • genetic syndromes
  • structural anomalies
  • adverse outcome
85
Q

what must be assessed before the NT measurment is used?

A

gestatinal age with CRL

86
Q

what CRL can a NT be evaluated?

A

CRL no less than 45 mm and no more than 84mm

87
Q

what gestional ages are CRL 45mm and 84mm?

A

11 and 13+6 weeks

88
Q

when is the NT considered thickened?

A

3mm or more

89
Q

what plane is used when measureing NT?

A

sagital plane

90
Q

what is the sonographers role in early pregnancy?

A

viability

91
Q

when can diagnosis of embryonic dealth be made?

A

if CRL measures 5mm and cardiac activity is not seen

92
Q

what may lead to pregnancy loss in 1st trimester?

A

subchorionic hemorrhage

93
Q

what are subchorionic hemorrhages?

A

low pressure hemorrhages that occur most commonly in the 1st trimester of pregnancy

94
Q

how do subchorionic hemorrhages result?

A

result from implantation of the fertlized ovum into the uterus

95
Q

what distinguishes subchorionic hemorrhage from abruption placentae?

A

hemorrhage is seen between the uterine wall and the membranes and are not associated with the placenta

96
Q

what may subchorionic hemorrhage lead to?

A

may spontaneously regress or may leas to spontaneous abortion

97
Q

where does hemorrhage have a better prognosis?

A

better in the lower segment than at the uterine fundus

98
Q

what patients with subchorionic hemorrhage have a higher incidence of pregnancy loss?

A

patients who present with bleeding

99
Q

what can help differentiate a hematoma from a neoplasm?

A

hematoma will have a lack of vascularity

100
Q

what is a threatened abortion?

A

characterized by bleeding without cervical dilation

101
Q

what is a missed abortion?

A

characterized as embryonic death without expulsion of the products of conception

102
Q

what is a complete abortion?

A

when there is expulsion of the products of conception

103
Q

when does SAB (abortion) rate decrease dramatically?

A

when the pregnancy reaches 12 weeks

104
Q

what is considered embryoinic bradycardia less than 7 weeks?

A

<85 beats per minute

105
Q

what is considered embryonic bradycardia over 7 weeks gestation?

A

<100 beats per minute

106
Q

when should the embryo be seen with TAS?

A

MSD 25mm

107
Q

when should the embryo be seen with TVS?

A

MSD 16mm

108
Q

when should the yolk sac be seen with TVS?

A

MSD 8mm

109
Q

when should the yolk sac be seen with TAS?

A

MSD 20mm

110
Q

what is the leading cause of maternal death in the first trimester?

A

ectopic pregnancy

111
Q

what are risk factors for an ectopic pregnancy?

A
  • PID
  • tubal surgery
  • maternal congenital anomalies
  • late primiparity
  • defective zygote
  • fertility treatments
  • intrauterine device (IUD)
112
Q

where is the most common location of an ectopic pregnancy?

A

ampulla region of fallopian tube (75%-80%)

113
Q

what are locations for an ectopic pregnancy?

A
  • cervix
  • ovary
  • uterine cornua
  • broad ligament
  • abdomen
114
Q

what is a heterotopic pregnancy?

A

intrauterine pregnancy and ectopic pregnancy

115
Q

what are the signs and symptoms of an ectopic pregnancy?

A
  • intrauterine pseudodac or decidual reaction
  • postive pregnancy test
  • poor correlation with B-hCG
  • bleeding and severe pain
  • cul-de-sac fluid
  • adnexal ring sign
  • complex adnexal mass with or without live pregnancy
  • significant amount of hemoperitoneum
116
Q

what can a trophoblastic be?

A
  • benign
  • malignant
  • malignant/metastatic
117
Q

what are the types of trophoblastic diseases?

A
  • complete hydatiform mole
  • hydadiform mole with coexistent fetus
  • partial mole
  • invasive mole
  • choriocarcinoma
118
Q

what are the risk factors for trophoblastic disease?

A
  • maternal age

- previous history of a molar pregnancy

119
Q

what is a major sign of gestational trophoblastic disease?

A

hyperemesis

120
Q

what are symptoms of molar pregnancy?

A
  • vaginal bleeding
  • hyperrmesis
  • preeclampsia
  • thyrotoxicosis
  • respiratory distress
121
Q

what is elevated with molar pregnancy?

A

elevated B-hCG

122
Q

what is low in molar pregnancy?

A

AFP levels are low in a hydatiform mole

123
Q

what does organs look like with a molar pregnancy?

A

uterus is greater in size than the expected gestatinal age + bilateral ovarian enlargment owing to theca-lutein cysts

124
Q

what is considered a complete hydatioform mole?

A

paternal origin and devoid of maternal chromosomes which results in a 46 XX karyotype without fetal development

125
Q

what is considered a partial hydadiform mole?

A

triploidy with a 69 XXX of which 23 chromosomes are of the maternal contribution and 46 chromosomes are of the paternal contribution

126
Q

what gives a snowstorm appearance?

A

hydropic chorionic villi

127
Q

what is an invasive hydatiform mole?

A

when the hydropic villi of a partial or complete mole invade the uterine myometrium and sometimes uterine wall

128
Q

what is a choriocarcinoma?

A

a malignant tumour that arises from the trophoblastic epithelium

129
Q

where may a choriocarcinoma metastasize?

A 
lung
skin
intestines
liver
spleen
heart
brain
130
Q

what presents clinically with a choriocarcinoma?

A
  • vaginal bleeding
  • enlarged uterus and ovaries
  • elevated B-hCG
131
Q

when may a choriocarcinoma occur?

A

develop after a molar pregnancy but can also occur after a normal pregnancy, SAB, or ectopic pregnancy

132
Q

why is there an increase of incidence of multiple gestations?

A

throughout the years there has been a widespread of reproductive technology and an aging maternal population

133
Q

what is another name for chorionicity?

A

placentation

134
Q

what is dichorionic?

A

two chorions produce 2 placentation sites

135
Q

is dichorionic or monochorionc more common?

A

dichorionic

136
Q

what presents the least risk for twins?

A

dichorionic

137
Q

what is monochorionic?

A

the development of one chorion results in a shared placental site, which places the pregnancy at higher risk

138
Q

is monoamniotic or diamniotic at higher risk?

A

monochorionic because of risk of cord accidents

139
Q

what is zygosity?

A

refers to the number of zygotes produced at the time of fertilization

140
Q

when does dizygotic twins occur?

A

when 2 seperate ova are fertilized by 2 seperate sperm cells

141
Q

when does monozygotic twims occur?

A

when one ovum is fertilized by a single sperm

142
Q

the later the cleavage occurs the ___________

A

more that is shared

143
Q

when does conjoined twins occur?

A

13 days after conception

144
Q

what are clinical signs of multiple gestation?

A
  • large for dates
  • hyperemesis
  • hypertension
  • increased human chorionic gonadotropin
  • increased alpha feta protein
145
Q

what is the most common complication with multiple gestations?

A

premature labour

because of increasd uterine volume

146
Q

twin pregnancies are ____ more likely than singleton pregnancies to be complicated by premature labour

A

5X

147
Q

triplet gestations are ______ higher than singelton pregnancies to be complicated by premature labour

A

10X

148
Q

what is considered a significant finding associated with premature delivery?

A

cervical length of less than 2.5 cm or the presence of funneling

149
Q

a fetal weight less than what is suggestive of IUGR?

A

10th percentile

150
Q

what are other signs of IUGR?

A
  • oligohydramnios

- high resistance umbilical artery pulsed doppler waveform

151
Q

what may IUGR be the result of?

A

result of twin-twin transfusion

152
Q

The incidence of a major fetal anomaly in a multiple gestation is _____ compared with ______ in a singleton pregnancy

A

4%

2%

153
Q

what malformation is the most common in multiple gestations, especially monozygotic twins?

A

central nervous system

154
Q

twins and especially triplets are at an increased risk of what?

A

cerbral palsy

155
Q

what are common maternal complications?

A

pregnancy-induced hypertension and pree-clampsia are

156
Q

what are the features of eclampsia?

A
  • hypertension
  • edema
  • proteinuria
  • convulsions
157
Q

what is hypertension associated with?

A

IUGR and placental abruption

158
Q

what do we assess with placental sites?

A
  • the number and location of the placentas
  • membrane thickness
  • the appearance of the membrane attachment
159
Q

what should be done when the 2 cord insertion sites can be seen in the same plane?

A

one should look for the presence of an interfetal membrane

160
Q

if no membrane exists between the cord insertion sites what are the twins most likely?

A

monochorionic, monoamniotic

161
Q

what does the intertwin membrane seperating monochorionic twins consist of?

A

2 layers of amnion

162
Q

what does the monochorionic intertwin membrane measure?

A

1mm

163
Q

what does the membrane seperating the monochorionic, diamniotic form?

A

a T shape

164
Q

what does the membrane seperating the dichorionic, diamniotic twins look like?

A

twin peak or a lambda sign

165
Q

what is often the first sign of complcations of multigestational pregnancies?

A

a difference in growth (discordant growth)

166
Q

when is the growth of twins considered discordant?

A

if the difference in their birth weights is greater than 20% of the larger twins weight

167
Q

what is the main factor contributing to increased mortality rates of monoamniotic twins?

A

cord entanglement

168
Q

what do we look at in cord entaglement?

A

evaluate for increased arterial and venous velocities and for evidence of high resistance in the umbilical artery

169
Q

what is the most common method of evaluating AVF in a multiple gestation?

A

the single pocket method and subjective evaluation

170
Q

what is considered polyhydramnois?

A

MVP that exceeds 8cm or

AFI exceeding 18-20

171
Q

what may be a feature of a recipient twin in a gestation with twin-twin transfusion?

A

excess fluid

172
Q

what suggests oligohydramnois?

A

MVP less than 2cm or

AFI less than 5cm

173
Q

what can olighydramnois, a complication associated with donor twin in gestations with twin-twin transfusion, be caused by?

A

IUGR

174
Q

what does oligohydramnois cause wth the amniotic membrane?

A

stuck to the uterine wall

175
Q

50% of patients with 3 or more gestational sacs are at risk for spontaneoud reduction before when?

A

12 weeks of gestation

176
Q

the risk of co-twin death for monochorionic twins was _________ than for dichorionic twins

A

5 times higher

177
Q

what is vanishing twin?

A

twin gestations diagnosed in the 1st trimester, one twin dies, leaving behind an empty sac and it may be completely reabsorbed

178
Q

what is fetal papyraceus?

A

refers to a twin fetus that has died early in development and has been pressed flat against the uterine wall by the living fetus

179
Q

what does pagus mean?

A

joined (conjoined twins)

180
Q

what are conjoined twins?

A

monozygotic twins that are physically united at birth as a result of incomplete division of the embryonic disk

181
Q

what is craniopagus?

A

twins who are joined at the head

182
Q

what is thoracopagus?

A

twins are joined at the thorax

183
Q

what is omphalopagus?

A

twins are joined at the anterior mid trunk

184
Q

when is conjoined twins suspected?

A

when monoamniotic twins do not move away from each other and is confirmed when fusion of the fetal parts is identified

185
Q

what is twin-twin transfusion caused by?

A

unbalances shunting of blood from one twin to the other

186
Q

where are vascular connections found?

A

in virtually all monochorionic twins

187
Q

what is the bloodflow in twin-twin transfusion?

A

the donor twin pumps blood from its arterial system into the venous system of the recipient twin

188
Q

what is the blood flow in twin-twin transfusion for the donor twin?

A

donor twin recieves less bloos and is usually growth restricted, hypovolemic, and anemic

189
Q

what is the blood flow in twin-twin transfusion for the recipient twin?

A

recipient twin recieves too much blood, and although it may be normal in size, it is often macrosomic and hypervolemic

190
Q

what can the extra blood flow and work placed on the recipient twins heart result in?

A

fetal hydrops or heart failure

191
Q

what does TRAP syndrome stand for?

A

Twin Reversed Arterial Perfusion Sequence

192
Q

what is TRAP syndrome?

A

rare condition that complicates approximately 1% of monochorionic pregnancies

193
Q

how does TRAP occur?

A

occurs because of paired artery-artery or vein-vein anastomosis within the shared placenta

194
Q

which twin in TRAP has normal circulation?

A

the pump twin or normal twin

195
Q

what does the recipient twin in TRAP lack?

A

a functional heart, allowing perfusion of the normal twin to pump blood into the acardiac twin

196
Q

what is the blood flow to the acardiac twin like?

A

umbilical arteries and into the internal iliac arteries is retrograde

197
Q

what results in abnormal devlopment especially in the upper body in TRAP syndomre?

A

limited amounts of oxygen and nutrients are delivered to torso and lower extremities

198
Q

what is common in TRAP syndrome?

A

clubbing of the feet or absent toes

OB/GYN review (8 decks)

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