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GYN exam 3 > TEST 3 STUDY GUIDE EMBRYOLOGY, INFERTILITY, US IN OB > Flashcards

TEST 3 STUDY GUIDE EMBRYOLOGY, INFERTILITY, US IN OB Flashcards

1
Q

____ are derived from primordial germ cells , multiply quickly and w/ degeneration at birth there are 1-2 million.

A

oogonium

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2
Q

oogonia differentiate into primary oocytes w/ a single layer of granulosa cells from the cortical cord forming the _____ _____; this process remains arrested untill puberty.

A

primordial Follicles (ovaries)

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3
Q

true or false?the ductus venosus shunts oxygenated blood past the liver into the IVC

A

true

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4
Q

what is the first system to become functional in the embryo?

A

cardiovascular

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5
Q

the celiac artery, SMA, and IMA develop from the ______ _____ _____

A

vitelline artey complex

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6
Q

gestational (postovulatory) age is considered from:

A

2 weeks from the first day of the LMP

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7
Q

What caries oxygenated blood from the embryonic portion of the placenta to the embryonic tubular heart?

A

umbilical veins

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8
Q

the pancreas is formed from the ___

A

foregut

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9
Q

during embryonic life, what is the spleen responsible for?

A

producing RBC and WBC

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10
Q

the external genitals of male and femaly embryos are undifferentiated until the 8th week of gestation; before that all embryos have a region known as the _____ _____.

A

genital tubercle

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11
Q

when does neural tube formation take place?

A

3 to 4 weeks gestation

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12
Q

the liver and pancreas originate in the embryonic ____

A

duodenum

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13
Q

the _____ & ____ systems develop simultaneously arising from mesoderm on common ridge.

A

urinary and reproductive

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14
Q

congenital anomalies of the ___ system is highly associated with the ____ system.

A

urinary; reproductive

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15
Q

the _____ ____ (Woofian duct) develops into the urinary system.

A

Mesonephric duct (Woofian duct)

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16
Q

true or false? gonadal ridges are formed before the ovaries or testies

A

true

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17
Q

the ______ _____ (Mullerian duct) developos into the female reproductive system

A

paramesonephric ducts (Mullerian duct)

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18
Q

The mesonephric ducts (Wolffian ducts) and paramesonephric ducts (Mullerian duct) arise from mesoderm on ____ _____.

A

common ridges

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19
Q

the female reproductive system development is linked to ___ ___

A

renal system

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20
Q

what is the formula to calculate pediatric ovarian size?

A

prolate ellipse formula

L x H x W x 0.523= ___cm3

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21
Q

what is the prolate elipse formula?

A

measure pediatric ovarian size

prolate elips formula: L x H x W x 0.523= ___ cm3

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22
Q

when do the external genitalia develop by?

A

12 weeks

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23
Q

no morphologic indication of sex until __ weeks. until this point male and female embryos appear identical

A

9

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24
Q

what type o sonography outlines vagina to see pelvic mass or complex congenital abnormality?

A

hydrosonovaginography

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25
Q

what is the measurement of the bladders smooth thin wall when full or partial full?

A

< 3 mm if full or <5 mm if partial full

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26
Q

what should we look for when imaging the bladder and how do we angle the transducer?

A

look for bilateral ureteral jets

angle transducer cauded to view bladder neck and urethra

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27
Q

what do we look for post void of urinary bladder?

A

check for urinary residual, or to seperate cyst from bladder

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28
Q

what is the newborn uterus measurements and what does it look like?

A
  • prominent 3.5 cm thickened, bright echogenic endometrial lining
  • teardrop shape (inverse pear) shape until 2-3 months old
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29
Q

what is the measurement of the prepubertal uterus and what shape is it?

A

prepubertal uterus:

  • 2.5-3 cm length
  • fundus to cx ratio decreases to 1:1
  • inverse pear shape
  • endometrial stripe not visualized (because endometrium doesnt thicken until period starts)
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30
Q

what supples the uterus with blood?

A

uterine arteries branch off internal iliac arteries

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31
Q

true or false? it is possible to see flow in myometrial tissue w/ no flow in endometrium

A

true

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32
Q

how is the vagina best visualized?

A

on midline longitudinal image TA

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33
Q

what does the vagina look like sonographically?

A
  • tubular structure behind bladder continuous with cervix
  • mucosal wall cause bright echo within tubular structure
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34
Q

what is the best way to measure ovarian size?

A

ovarian volume using the prolate-ellipse formula:

L x H x W x 0.523 = ___ cm3

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35
Q

what supplies the ovaries w/ blood

A

blood supply from the ovarian artery originating from aorta and uterine artery

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36
Q

approximately 0.5% of femal patients have ____ uternine anomalies. ___ ____ abnormalites are about 50% of the total number.

A

congenital

urinary tract

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37
Q

what are some congenital anomalies associated with?

A

spontaneous abortion, and obstetric complications

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38
Q

what is the most comon genital anomaly detected in utero?

A

hydrometrocolpos (fluid filled vagina and uterus)

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39
Q

true or false? hydrometrocolpos can sometimes compress urinary tract to cause hydronephrosis or hydroureter

A

true

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40
Q

hydrometrocolpos

A

fluid filled uterus (metro) and vagina (colpos)

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41
Q

what are the 6 types of Mullerian anomalies?

A
  1. incomplete vaginal canalization (segmental mullerian agenesis)
  2. unicornuate uterus
  3. uterus didelphys
  4. bicornuate uterus (best trans)
  5. septate uterus
  6. DES exposure in utero
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42
Q

the ___ portion of the paramesonephric (Mullerian) duct fuses and develops into the uterus and part of the vagina

A

caudal

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43
Q

the ____ parts of the paramesonephric (Mullerian )ducts form the uterine tubees

A

cranial

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43
Q

what forms most of the female genital tract?

A

paramesonephric (Mullerian duct)

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44
Q

what causes the newborn female uterus to appear prominent with thickened hyperechooic endometrial lining?

A

hormonal stimulation received in utero

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45
Q

prepubertal size of the uterus demonstrates a fundus:cx ratio of what?

A

1:1

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46
Q

congenital anomalies of the uterus have a high association with ___ anomalies

A

renal

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47
Q

hydrocolpos

A

fluid filled vagina

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48
Q

bicornuate uterus

A

duplication of the uterus w/ a common cervix

  • low incidence of infertility
  • best seen in trans
  • rudimentary horn may cause complications
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49
Q

unicornuate uterus demonstrates:

A

uterus is small and laterally positioned

  • infertility and pregnmancy loss
  • renal agenesis contralateral side
  • uterus long and slender
  • difficult to differentiate from normal
  • deviated long, slender (ex cigar) uterine shape
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50
Q

didelphys uterus demonstrates:

A

complete duplication of the uterus, cervix, and vagina

  • complete duplication
  • does not usually require tmt
  • 2 endometrial complexes
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51
Q

what causes vaginal atresia and how is it diagnosed?

A
  • cause: segmental agenesis or incomplete canalization of the vagina.
  • Diagnosed by: development of fluid or blood in the uterus and cervix (hydrocolpos, hydrometrocolpos, or hematometrocolpos)
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52
Q

septate uterus demonstrates:

A

2 closely spaced uterine cavities w/ 1 fundus and 2 cervical canals or vaginal septum

  • high incidence of fertility problems
  • septum can be removed by hysteroscope
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53
Q

____ _____ has the highest incidence of fertility problems; the septum may be removed hysteroscopically

A

septate uterus

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54
Q

segmental mullerian agenesis ( incomplete vaginal canalization) appearance:

A
  • produces transverse vaginal septum or vaginal atresia
  • Dx by dev of hydrocolpos, hydrometrocolpos or hematometrocolpos
  • Cx may by absent w/ or w/o blood in uterus or cx
    • in neonatal -large cystic pelvic/abd mass bec. maternal sim or it is sen at puberty
    • may also be caused by imperforate hymen
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55
Q

unicornuate uterus appears:

A
  • renal agenisis on contralateral side
  • uteus long & slender (ex cigar), small and positioned laterally
  • hard to tell from normal

infertility and pregnancy loss

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56
Q

uterus didelphys appears:

A

complete duplication w/ 2 endometrial compleses

(doesnt urually require treatment

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57
Q

bicornuate uterus appears:

A

duplication w/ common cervix

best seen in trans

low incidence of infertility

rudimentary horn may cause problems

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58
Q

septate uterus appears:

(we dont usually see this because it is very thin)

A

2 uterine cavities closely spaced w/ 1 fundus and 2 cervical canals or vaginal septum

**highest incidence of infertility**

septum can be removed w/ hysteroscope

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59
Q

DES exposure in utero appearance:

A

normal uterus w/ t-shaped endometrial cavity

causes vag malignancies-

their mothers took DES in 70s due to risk of abortion

difficult to diagnose w/ US

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60
Q

the most common cause of female pseudohermaphroditism is:

A

a congenital virilizing adrenal hyperplasia.

an increase in androgens leads to masculinization

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61
Q

true or false? Mullerian abnormalities include improper fusion, incomplete development of one side, and incomplete vaginal canalization.

A

true

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62
Q

what is percocious puberty?

A

onset of normal physiologic and endocrine processes of puberty in girls before age 8.

  • must have all 3 signs (breast dev., pubic and axillary hair, menstruation)
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63
Q

causes of precocious puberty

A
  • idiopathic 80% secondary to eary activation of hypothalmic-pituitary-gonadal axis
  • may be related to CNS lesion tht effects hypothalmus
  • 20% 2o to causes other than pit axis= pseudoprecocious
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64
Q

precocious puberty sonographic appearance:

A
  • adult configured uterus
  • symetric ovarian enlargement *VERIFIES true precocious puberty
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65
Q

precocious puberty treatment

A

hormone replacement therapy w/ US follow ups to monitor size and volume changes

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66
Q

pseudoprecocious puberty definition and causes

A
  • incomplete precocious puberty
    • do not have all 3 signs
      • **breast development, axillary and pubic hair, menstruation**
  • hormone secretion from pathology other than hypothalmic-pituitary-axis
  • CAUSES: enchphalitis; hypothyroidism, mccune albright syndrome, ovarian neoplasm , brain tumor
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67
Q

pseudoprecocious puberty sonographic findings:

A
  • infantile uterus and ovaries
  • if infantile uterus and asymetrical enlarged ovaries, suggest ovarian pathology
    • usually CT or MRI of adrenal and hypothalmic region
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68
Q

Neonatal Cysts appearance

A

typical ovary heterogeneous & cystic

Most cysts < 9mm resolve spontaneously

Cysts >2 cm; pathology

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69
Q

true or false? neonatal cysts have a higher incidence w/ babies whos mothers had toxemia, diabetes, and Rh isoimmunization, hypothyroidism

A

true

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70
Q

appearance & complications of neonatal cysts

A
  • complications: hemorrhage, salpingotorsion
  • appearance
    • various size
    • simple
    • or hemorrhagic w/ internal exhoes
      • may be caued by torsion
      • may see hemorrhagic ascites and/or peritonitis (free fluid)
    • may compress other organs
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71
Q

ovarian torsion facts

A
  • usually occur w/in first 2 decades of life
  • rt side 3x more likely to torse than left (less space on left due to gut)
  • s/s: severe onset abd pain
  • Sonographic: enlarged ovary, fluid in cul de sac, or tumor
    • Color doppler: variable
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72
Q

Ovarian teratomas are uncomon in neonate and adolescents

  • ___ ____ tumors 60% of ovarian neoplams in pt < age 20
A

germ cell

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73
Q

what is the most common benign pediatric germ cell tumor?

A

benign mature teratoma or dermoid cyst

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74
Q

benign mature teratoma or dermoid cyst appearance & complication:

A
  • size: 5-15 cm
  • multiple appearance
  • most common complication: torsion (16-40%)
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75
Q

true hermaphroditism have both ___ and ____ tissue

A

ovarian and testicular

76
Q

errors in sexual development result in ____ ____(hermaphroditism)

A

ambiguous genitalia (hermaphroditism)

77
Q

**dermoid cyst

A

dermoid cyst

showing tip of the iceburg

shadowing makes it hard to see boundaries

78
Q

scrotum appearance

A

scrotum appearance

2 testes

low level echogenicity

7-10mm diameter

mediastinum teste and epididymus not seen until after puberty

79
Q

cryptorchidism

A

undescended teste, location important, associated w/ increased risk of malignancy, infertility, torsion

80
Q

anorchidism

monorchidism

A

ano- absence of both testes

mono- absence of 1 teste (usually left)

81
Q

acute scrotal pain common causes:

A

testicular torsion and epidymitis is most common

torsion of apendages, trauma, acute hydrocele and incarcerated hernia

82
Q

dermoid tumor appearance:

A
  • complex mass- heterogenous
  • mural nodules and echogenic foci w/ acoustic shadowing
  • neonatal period –> less shadowing seen than in adolescent

Image: classic dermoid mesh (screen door)

83
Q

ovarian cystic teratoma: most common germ cell tumor

tip of iceburg –> makes it hard to see boundaries

A

ovarian cystic teratoma: most common germ cell tumor

tip of iceburg –> makes it hard to see boundaries

84
Q

dermoid cyst

A

dermoid cyst

85
Q

epididymititis

A

infection of epidydymis, common in men all ages

increased flow to epididymis w/ extension into teste ( when infection spreads)

86
Q

infertility affects 1 in __ couples in the US. 40% male, 40% femalw, 20% combined or unknown

A

7

87
Q

when evaluating infertile pt, what are the sonograpohers 2 main objective?

A
  1. access the structural anatomy
  2. assess the endometrium
88
Q

a ____ uterus is associated with a high incidence of inferility because of an inadequate blood supply from the septum

A

septate

89
Q

__ of fallopian tubes is evaluated by sonographic and saline exam

A

patency

90
Q

the clinical triad of a polycystic ovarian syndrome includes:

A

oligomenorrhea, hirtsutism, and obesity

91
Q

female factors of infertility:

A
  • cervical
  • endometrial/uterine
  • tubal
  • ovulatory
  • peritoneal
92
Q

male factors of infertility:

A
  • not enough sperm
  • decreased sperm motility
  • obstruction of spermatic ducts or vas deferens
  • scrotal varicolceles
93
Q

role of the cervix

A

provide nonhostile environment for sperm

glands secrete mucus

crypts hold sperm

94
Q

most common cause of hostile cervical mucus?

A

in accurate timing in relation to ovulation- too late or too early

95
Q

_____ test evaluates cervical mucus w/in 24 hours of intercourse to look for # and motility of sperm

A

postcoital

96
Q

nongravid uterus cervical length and opening is hard to assess, hysterosalpingogram can be used to ev. internal os diameter. diameter < __ mm may indicate cervical stenosis

A

< 1 mm

97
Q

true or false? congenital uterine anomalies make up 1% and includes defects in mullerian duct dev, fusion , or reabsorbtion, and are associated w/ renal anomalies

A

true

98
Q

____ and ___ uterus are most easily seen in trans; look for 2 cervix and vagina

A

bicornate and didelphys

99
Q

___ uterus has high incidenence of infertility; 2 uterine cavities and a single fundus; septum causes problem for implantation (important diagnosis)

A

septate

100
Q

infertility

A

the inablilty to conceive within 12 months w/ regualr coitus

100
Q

___ daughters presents w/ T-shaped uterus and has an increased risk of cervial incompetence

A

DES

101
Q

complications associated w/ assisted reproduction include:

A

hyperstimulation, multiple gestations, and ectopic pregnancy

101
Q
A
102
Q

to become pregnant, endometrial thickness of __ mm is needed

A

6 mm

103
Q

Luteal phase deficiency:

A

lack of progesterone production

104
Q

after ovulation, ___ is secreted by the corpus luteum; secretion of ___ begins in secretory phase of the endometrial cycle

A

progesterone

progesterone

105
Q

average size and rate of growth of dominate follicle

A

1-3mm/day

average 22 mm

105
Q
A
106
Q

when is the 3 line sign seen and what does it consist of?

A

seen during the endometrial phase ; consists of hypoechoic mucosa and the echogenic interface where they meet

107
Q

true or false? MRI and HSG beter to image uterine anomalies

A

true

108
Q

true or false? 3D US is the best (2nd best=trans. TV) to see bicornate uterus

A

true

109
Q

__ and __ uteruses are not assosicated w/ infertility

A

bicornate didelphys

110
Q

tshaped uterus is a congenital anomaly caused by exposure to ___; if the level of progeterone produced in the luteal phase is inadequate, then the endometrial lining may be thinner than normal.

A

DES

111
Q

Endometrial ____ usually have a narrow base attachment w/ vascular pedicle feeding it.

A

polyps

112
Q

how does uterine synechiae (scars) appear on US?

A

hyperechoic linear strands (adhesions) extending from one wall of uterine cavity to the other.

cause: multiple biopsies, D&E, (wont allow uterus to expand)

113
Q

what causes polycystic ovarian syndrome?

A

pituitary gland producing more LH than FSH

114
Q

What is given to trigger ovulation as a substitute for LH ?

A

hCG

115
Q

severe ovarian hyperstimulation syndrome appears:

A

enlarged ovaries w/ multiple cysts, ascites, and pleural effusion

116
Q

image bicornate uterus

A

image bicornate uterus

117
Q

what 4 conditions of the endometrium can all lead to unsuccessful pregnancy?

A
  1. Luteal Phase deficiency-(lack of progesterone production)
  2. submucosal fibroids (broad base circumf flow)
  3. polyps (narrow base stalk - vascular pedicle)
  4. synechiae {scars} linear strands adhesions (dont let the uterus expand)
118
Q

___ and ____ must have 2 endometriums going to each horn to be bicornate or didelphys

A

bicornate; didelphys

119
Q

____ are estrogen dependant, and usually have rounded borders

A

fibroids

120
Q

submucosal fibroids

A

submucosal fibroids

121
Q

saline infused sonography of submucosal fibroid with SIS and color Doppler showing circumferential flow

A

saline infused sonography of submucosal fibroid with SIS and color Doppler showing circumferential flow

122
Q

SIS & Polyp

A

SIS & Polyp

123
Q

uterine synechia w/ SIS

A

uterine synechia w/ SIS

image (catheter going into cervix w/ balloon on the end ot hold it in place)

124
Q

what two things do we evaluate the fallopian tubes for?

A

hydrosalpinx and patency

125
Q

How do we evaluate the fallopian tubes for patency?

A
  • injecting saline and looking for spillage in cul-de-sac-
    • (can also be done w/ air)
  • HCG hysterosalpingogram (fluoroscopy w/ x ray imaging)
  • Rubins test- (CO2 in fallopian tube)
  • sugically laparoscopy (chromopertubation)
126
Q

Robins Test facts:

A
  • (No longer used)
  • simplest and oldest test for tubal patency using CO2 under pressure
  • very unreliable
127
Q

___phase- several follicles <5mm

A

follicular

128
Q

Best predictor of ovulation that rises after ovulation?

A

basal body temp

129
Q

___ rises just before ovulation and found in urine?

A

LH

130
Q

_____ can inhibit release of FSH and LH

A

polycystic ovarian syndrome (PCOS)

**common w/ infertility**

131
Q

an ovarian cyst > ___ could interfere w/ the response of ovarian stimulation and may represent a persistent follicle.

A

15 mm

132
Q

follicles

A

follicles

133
Q

____ ___ ___ often occurs w/ clinical triad (oligomenorrhea, hirsutism, obesity)

A

polycystic ovarian syndrome

134
Q

PCOS polycystic ovarian syndrome definition:

(string of pearls)

A
  • 12 or more follicles measuring 2-9mm
  • ovarian volume > 10 cm3

(string of pearls)

135
Q

PCOS causes:

A

obesity, diabetes, thyroid, adrenal, or pituitary gland dysfunction

136
Q

Polycystic Ovarian Syndrome (PCOS) presents with:

A

irregular bleeding, thick endometrium, endometrialCA from chronic elevation of estrogen, hirsutism from chronic androgen level elevation

137
Q

PCOS sonographic appearance:

A

normal or round ovary w/multiple small immature follicles on periphery (**string of pearls**)

138
Q

polycystic ovarian syndrome: mechanism

A

immature follicles continue to produce estrogen and androgen which inhibit pit gland. pituitary gland produces more LH than FSH causing follicle to remain in arrested state of development –>no marure ova is released with ovulation

139
Q

____ ____ causes 25% of infertility cases

A

peritoneal factors

endometriosis and adhesions

140
Q

when do peritoneal inclusion cysts form?

A

when fluid collects between adhesions that obstruct the fimbriated end of the fallopian tube

alot of these will reoccur

141
Q

_____ is ectopic endometrial tissue commonly occuring in bilateral ovaries

A

endometriosis

( chocolate cyst)

142
Q

______ is the most common benign gynecologic disease in women. approx 10-25% of women w/ gynecologic disease

40% occur in women w/ infertility

A

endometriosis

143
Q

what is a normal endometrial response associated with overstimulation?

A

increasing thickness from 2-3mm to 12-14 mm

144
Q

thin endometrium, <8mm is associated with what?

A

decreased fertility in secretory phase

145
Q

monitoring the endometrium we assess thickness and echogenicity pattern

A
  • endometrial response - increaed thickness
    • from 2-3mm to 12-14mm
    • measure long plane
    • outer to outer (double layer thickness)
    • normal trilaminar pattern
    • < 8mm - decreased fertility
146
Q

uterine artery spectral doppler evaluation:

A
  • PI: 2.00-2.99 (ovulation
  • ascending branch lateral to cervix on TV
  • use color to help ID vessels
147
Q

Ovarian Induction therapy

what does US monitor? and what does ovarian induction therapy require?

A
  • US monitors number and size of follicles in days 8-14 (follicular phase)
  • document all follicles > 10 mm (1cm) in both long and trans planes
148
Q

_____ and ___ levels determine the approx time of ovulation

A

follcile size; estradiol

149
Q

what do the drugs clomiphene citrat (Clomid) or gonadotropin (Pergonal) day 3-5 in normal cycle do?

A
  • Enlarges multiple follicles instead of single dominant follicle.

then US to monitor # & size of follicles day 8-14 (follicular phase) Count all follicles >1cm long & trans

150
Q

true or false?with ovarian induction therapy, optimum mean follicle size is 15-20 mm. hCG may be given IM to trigger ovulation; w/ retrieval 30-34 hrs later.

A

true

151
Q

Ovarian stimulation

A

cumulus oophorus will become free floating, right before ovulation

152
Q

what are the 3 types of assisted reproductive therapy

A
  • IVF
  • GIFT & ZIFT
  • IUI
153
Q

what is IVF?

A

in vitro fertilization - method of fertiliing ova outside the body

treatment plan: ovarian monitoring, needle aspiration of oocytes, incubation of oocytes, fertilization, trnsferring embryos to uterus

154
Q

IVF, optimal placement of the embryos is within 2 cm or 15 mm from fundus

A
155
Q

embryo transfer facts:

A
  • embryo transfer can be done laparoscopically or by US guidance
  • uterus length measured TA w/ full bladder
  • speculum inserted cervix is cleaned
  • catheter inserted through cervix and embryos inserted
156
Q

true or false? it is estimated that 25-30% of IVF pregnancies result in multiple gestations

A

true

157
Q

what pts are GIFT and ZIFT reserved for?

A

patients with 1 functional fallopian tube, unexplained infertility, or cervical factors

158
Q

What is GIFT and ZIFT? what is the difference btween the two?

A

ovarian stimulation, oocyte retrieval, mixed w/ sperm in dish and transferred through catheter into fallopian tube

  • GIFT- gamete intrafallopian tube transfer
    • fertilization takes place inside body {in vivo}
  • ZIFT - zygot intrafallopian tube transfer
    • same as GIFT but fertilization takes place outside body {in vitro}
    • laparascopically, gamete or zygote in fimbriated end of fallopian tube
    • US guided -gamete or zygote in isthmic portion of fallopian tube
159
Q

what are GIFT and ZIFT success rates?

A

22-28% w/ US guidance

160
Q

Intrauterine insemination (IUI)

A
  • technique used to treat male infertility or unexplained infertility
  • catherter containing sperm is placed into uterine fundus
  • sperme prep may be from a donor-AID artificial insemination using donor sperm
  • US guidance can be used
161
Q

the risk of heterotropic pregnancy increases to 1;100 with ___ ___ ____

A

assisted reproductive technologies.

162
Q

when does fertilization occur outside the body?

A

in vitro fertilization, and ZIFT

163
Q

US is correlated to ___ levels to determine the approx time of ovulation

A

estradiol

164
Q

dermoid cyst

tip of the ice burg

A

dermoid cyst

“classic dermoid mesh”

looks like a screen

165
Q

what are the 3 complications of assisted reproductive technology?

A
  • Ovarian hyperstimulation syndrome (OHSS)
  • Multiple Pregnancies -25%
  • Ectopic Pregnancy
166
Q

what is Ovarian hyperstimulation syndrome (OHSS)

A

Enlarged ovaries, multiple cysts, abd ascites, pleural effusions

167
Q

OHSS is more common with ______ and there will be mild ovarian enlargemnt of _-_ cm.

A

PCOS; 5-10cm

168
Q

Multiple Pregnancies is:

A

3 or more increased risk fetal/neonatal morbidity & mortality

pt is counseled about fetal reduction by injectin potassium chloride into chest or fetal heart

169
Q

2 Peritoneal Factors:

A
  • Adhesions (Bands of scar tissue)
    • Can obstruct fimbriated end of fallopian tube
    • Peritoneal Inclusions Cysts form when fluid collects between these adhesions
  • Endometriosis - ectopic endometrial tissue
    • Ovaries are most common site
    • Often bilateral
170
Q

______ is used for evaluating the peritoneal factors, adhesions and endometriosis.

A

Laparoscopy

171
Q

true or false? with assisted reproductive technology there is an increase risk for ectopic pregnancy, and heterotopic pregnancy

A

true

172
Q

heterotopic pregnancy

A

ectopic pregnancy coexisting w/ intrauterine pregnancy (adnexa needs to be carefully imaged to r/o heterotopic pregnancy.

173
Q

true or false? OHSS is exacerbated during pregnancy?

A

true

174
Q

treatment of OHSS include

A
  • Serial scans during ovarian stim cycles
  • Careful tailoring of dose of gonadotropins helps to limit risk of OHSS
  • Abort tmt cycle or coast final days of tmt
  • Continue follicular dev but withhold admin of addl gonadotropin
  • Preform oocyte aspiration after 1-3 day of unstimulated development
  • All embryos may be cryopreserved and single embryo replaced in subsequent cycle
175
Q

true or false? assisted reproductive technology - due to the risk of multiple pregnancies and fetal/neonatal mobidity and mortality, pt with multiple pregnancies is counseled about fetal reduction by injecting potassium chloride into chest or fetal heart

A

true

176
Q

treatment of extreme cases of OHSS

A

Extreme cases

  • Abdominal paracentesis
  • Drain several liters of ascitic fluid
  • Transvaginal us guided aspiration of ascites
177
Q
A

normal uterus

178
Q
A

uterus didelphys

complete duplication of the vagina, cervix and uterus,

179
Q
A

uterus bicornis bicollis

bicornuate uterus has two uterine horns that are fused at 2 cervixes

180
Q
A

uterus bicornis unicollis

bicornuate uterus has two uteine horns that are fuesed at one cervix

181
Q
A

uterus subseptus

is a milder anomaly marked by a midline myometrial septum within the endometrial canal

182
Q
A

uterus unicornis

1 Mullerian duct develops forming a single uterine horn and a uterine tube continuous with 1 cervix and 1 vagina

183
Q

**what causes uterine uterine malformations with anatomic variations of the uterus, cervix, and vagina?

A

the incomplete fusion or agenesis of the Mullerian ducts

184
Q

**dermoid tumor**

dermoid mesh

A

multiple linear hyperechoic interfaces floating within cyst (hair)

185
Q

**dermoid cyst**

tip of the iceburg

A

tip of the iceburg - shadowing makes it hard to see boundaries

mixture of matted hair and sebum producing ill defined acoustic shadowing that obscures posterior wall of lesion

GYN exam 3 (7 decks)

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