Test 4 Flashcards
first thing to determine in 2nd and 3rd tri scanning
determine fetal position in relationship to mother/cervix
after determining fetal position, what should be done next?
determine left and right side (situs)
fetal lie is describe in relationship to ___________
maternal long axis
what does “cephalic position” mean
head closest to cervix. vertex
fetus lying perpendicular to long axis of mother
transverse fetal lie
what should be reported when fetus is in transverse fetal lie
position of fetal head (maternal right/left)
position of spine (inferior, superior, anterior, posterior)
in oblique fetal presentation, describe ______ and ______
quadrant of the head and direction of the spine
cranial bones ossify by _____
12 weeks
survey the head checking for ____
contour or outline of skull bones highest level in brain
head appears as circle at _____
highest level
head appears as an oval at _____
ventricular, peduncular and basal levels
distortion of skull shape is caused by (4)
extracranial masses
CNS anomalies
skeletal pathology
fetal death
normal fetal brain parenchyma appears _____ because of _____
hypoechoic
small size and high H2O content
sulcus and gyrus echogenicity
more echogenic
Branches of anterior cerebral artery run within _____ and pulsate
sulci
Standard OB exam requires records of (6)
cerebellum choroid plexus cisterna magna lateral ventricles midline falx cavum septum pellucidi
at what level is midline falx seen
superior level in TRV
white matter tracts location (2)
lateral and parallel to midline falx
above level of lateral ventricles
choroid plexus location
roofs of each ventricles except frontal ventricular horn
connection of inferior portion of lateral ventricles with temporal and posterior horns
atrium of lateral ventricles
shape of choroid plexus
tear-shaped
most inferior portion of choroid plexus
glomus
site of atrium
glomus (most inferior portion of choroid plexus)
normal atrium measurement
6.5mm
atrium measurement of more than ______ warrants serial imaging
10mm
what do you see inferior to ventricular atrium
thalami and ambient cicterns
location for BPD measurement
inferior to ventricular atrium
area of thalami
brain structures seen at BPD level
cavum septum pellucidum
midline echo
thalamus
location of 3rd ventricle
between thalami
location of cavum septum pellucidum (CSP)
anterior to thalamus
between leaves of septum pellucidum
location and echogenicity of corpus collosum
echopenic (low echogenicity)
between frontal ventricular horns
pulsations from _____ artery observed between lobes of peduncles at interpeduncular cistern
basilar
location of circle of willis
anterior to midbrain
shape of circle of willis
triangular region
what is seen in the center of circle of willis
suprasellar cistern
location of cerebellum
back of cerebral peduncles within posterior fossa
cerebellar hemispheres are joined by _____
cerebellar vermis
distortion of cerebellum suggests _______
spina bifida
location of cisterna magna
behind cerebellum
what excludes almost all open spinal defects
normal cisterna magna
thinned out or obliterated cisterna magna suggests ______
Arnold-Chiari malfornation
normal size of cisterna magna
3-11mm
average 5-6mm
how is cisterna magna measuremed
vermis to inner skull
echogenic structures within cisterna magna
dural folds attaching falx cerebelli
at what level is nuchal skin fold measured (3)
cavum septi pellucidi
cerebellum
cisterna magna
normal nuchal skin fold thickness
5mm or less up to 20 weeks
site of pituitary gland
junction of sphenoid wings and petrous bones
at sella turcica
location of sella turcica
junction of sphenoid wings and petrous bones
where are orbits visualized
below cerebellar plane
anophthalmia
absence of eyes
hypotelorism
fused or closely spaced eyes
hypertelorism
widened eyes
how are orbits measured (2)
coronal scan - posterior to glabella-alveolar line
TRV - below BPD
in what position are orbital distances determined
occipitoposterior
how is IOD measured
(inner orbital distance)
medial border of orbit to opposite medial border
how is OOD measured
(outer orbital distance)
lateral border of one orbit to lateral of the other
micrognathia
small chin
frontal bossing
forehead more prominent than usual as in skeletal dusplasia
frontal slanting
opposite of frontal bossing
forehead caves in
when is frontal slanting seen
microcephaly
when are oral cavity and tongue outlined
during swallowing
macroglossia
large tongue
macroglossia is associated with (2)
Beckwith-Wiedeman sundrom and aneuploidies
in what view is cleft lip diagnosed
coronal
Standard antepartum OB exam spine requirements (4)
cervical thoracic lumbar sacral spine (to exclude malformations)
what should be seen on each vertebra and in what view are they seen
3 ossification points.
TRV
railway sign
double line appearance of spine
appearance of vertebral column (pedicles) in spinal defects
V, C, or U shaped
landmark for heart and its position
lungs
what do fetal lungs look like
solid, fluid filled homogenous masses
borders of lungs
heart medially
rib cage laterally
diaphragm inferiorly
what can displacement of the heart suggest
lung masses or subdiaphragmatic hernia
bony landmarks of chest cavity (3)
ribs
scapulae
clavicles
when do you see total length of ribs
oblique sections
when are clavicles observed
coronal sections of thorax
in what views is scapula seen and what does it appear like
sagittal, TRV or full length in oblique
echogenic linear echo adjacent to rib shadows
in what view is the sternum seen
axial sections showing bony sequence of echoes
lie of fetal heart and why
more TRV because lungs are not inflated
4 chamber heart can be seen in what views
beam perpendicular to septum
beam perpendicular to valves
angling cephalad after obtaining TRV abdomen
what should you access in 4 chamber view of heart (5)
cardiac position situs axis apex pointing to the left presence of both ventricles
Which ventricle is larger and why
right
pumps blood through ductus arteriosus and descending aorta
which heart valve is lower
tricuspid
EIF
echogenic intracardiac focus
echogenic structure within chamber that persists despite different transducer approaches
in what plane is the diaphragm viewd
longitudinal
what’s suggested by diaphragm curving towards abdomen
increased thoracic pressure due to mass or effusion
on what side is diaphragm more obvious and why
right because of liver interface
what excludes left sided diaphragmatic hernia
visualization of stomach inferior to diaphragm
sign of left-sided diaphragmatic hernia
fetal heart displaced to the right
what helps determine location of CCA and how is it outlined
esophagus and oropharynx
outlined during swallowing
where does fetal oxygenation occur
placenta within intervillous spaces
what shunt blood away from the lungs
ductus arteriosus
what shunts blood directly to heart
ductus venosus
flow of blood to fetus
placenta umbilical vein course cephalad along falciform ligament through liver left portal vein right posterior and anterior portal veins liver sinusoids hepatic veins IVC heart Ao from l ventricle and pulmonary art from r ventricle ductus arteriosus (from r ventricle)
OR placenta umbilical vein ductus venosus IVC
right ventricle pumps blood to
pulmonary artery
ductus arteriosus
descending aorta
left ventricle pumps blood to
ascending aorta and brain
where do umbilical arteries arise from
fetal iliac arteries
what makes up fetal hepatobiliary system (6)
liver portal veins hepatic veins hepatic arteries GB bile ducts
fetal heart failure may be diagnosed by doppler evaluation of ______
ductus venosus
what lobe of liver is larger and why
left
large quantity of oxygenated blood
what discerns the liver and what echogenicity is it
pebble gray echogenicity
portal and hepatic veins
storage site for glucose sensitive to disturbances in growth
liver
GB is located below _____
left portal vein
GB should not be mistaken for _____
left portal vein
fetal pancreas location and how should the fetus be luing
posterior to stomach, anterior to splenic vein
fetus lying spine down
location of spleen
in TRV posterior and left of stomach
fetal GI tract is composed of ____ (4)
esophagus
stomach
small intestine
large intestine (colon)
when is stomach apparent and why
11th week
fills with swallowed amniotic fluid
when should full stomach be seen
> 16 weeks
when can small bowel be differentiated from large bowel
> 20 weeks
large bowel measurement
20mm in preterm and larger in postdate
echogenicity of bowel
greater than liver
what is hyperechoic bowel
bowel as echogenic as bone
what is hyperechoic bowel associated with
aneuploidy and neonatal pathology
components of urinary system (3)
kidneys, ureters, bladder
when are kidneys seen and what do they look like
13th week
ovoid retroperitoneal structures without distinctive borders
echo-free area in the center of kidney
renal pelvis
abnormal renal pelvis measurements
> 5mm before 20 weeks
8mm 20-30 weeks
10mm beyond 30 weeks
pyelectasis
persistent bilateral renal pelvis dilation
when and how are adrenals seen
TRV above kidneys
20 weeks
center of adrenal gland
echogenic line surrounded by less echogenic tissue
left adrenal gland is close to ____
TRV aorta
how often does the fetus void
once an hour
failure to visualize bladder in oligohydromnios suggests ____ (2)
renal abnormality or premature rupture of membranes
how do you locate fetal genitalia
follow long axis of fetus towards hips
bladder is posterior to genital organs
tangential scanning planes between thighs
when can gender be appreciated
12 weeks
in what plane is female genitalia seen
TRV
why can labia appear edematous and swollen
due to circulating maternal hormones
what does scrotal sac look like
mass of soft tissue between hips with scrotal septum and testicles
common benign finding in male genetalia
hydrocele
short femur and humerus are associated with
aneuploidy
how is humerus located
sagittal plane laterally from ribs and scapula
how is long axis humerus seen
lateral to scapular echo
when are epiphyseal ossification centers of humerus seen
39 weeks
what does TRV humerus appear as
solitary bone surrounded by muscle and skin
how are radius and ulna imaged
tracing humerus to elbow
example of positive demonstration of fetal tone
hand movement
what does visualization of distal femoral epiphysis within cartilage at knee signify
33-35 weeks gestation
what is proximal epiphyseal center found at tibial end
35 weeks
which bone is larger, tibia or fibula
tibia
what is persistent and abnormal flexion of ankle associated with
clubfeet
what should you evaluate after the fetus has been studies (3)
placenta
amniotic fluid
pelvis
what are absent cord twists associated with
poor pregnancy outcome
max umbilical vein diameter by 30 weeks
.9cm
velamentous cord insertion
atypical insertion location
echogenicity of placenta in early pregnancy
pebble-gray
functions of amniotic fluid (5)
free movement maintenance of intrauterine pressure maintenance of temperature protection from injury lung development
up to what time does volume of amniotic fluid increase and when does it diminish
increase until 34 weeks and diminish after
true or false:
amnion is contiguous with membrane lining umbilical cord
true
subamniotic collection
fluid under membrane floating on top of placenta
subchorionic collection
fluid under membrane ending at edge of placenta
when should transperineal and transvaginal imaging of cervix be done
when cervix is shortened or theres a risk of incompetent cervix or premature delivery
length of normal cervix
3cm or more
how should you measure a round sac
one inner to inner
how do you measure an ovoid sac
two measurements inner to inner
perpendicular to each other
how long is the fetal pole when cardiac activity should be seen
> 7mm
at what GA is CRL measured
6-12 weeks
when is EHR measured (2)
5-9 weeks
CRL
how accurate is EHR
+-6days
what does it mean when EHR is more than 6 days behind CRL
impending 1st trimester failure
how fast does EHR accelerate (3)
3.3bpm/day
10 beats every 4 days
>100 beats in 1st month
how is BPD measured
leading edge to leading edge
outer to inner
how do you measure HC
outer margins of skull
how is coronal head circumference (CHC) measured and what should you see
perpendicular to TRV HC
thalamus and brain stem
Where is AC measurement taken
umbilical portion of left portal vein
how is femur length measured
greater trochanter to femoral condyles
what should not be included in femur length
epiphyseal cartilages and dustal femoral point (DFP)
normal femur shape
straight lateral border and curved medial border
which bone is lateral and thinner (tibia or fibula)
fibula
what bone is longer
(ulna or radius)
and where is is longer
ulna
longer proximally
orbital diameter normal measurements
13mm at 12 weeks to 59mm at term
at what level is the cerebellum measured (3)
cerebellum
vermis
4th ventricle
how are cistern magnum and nuchal fold recorded
by angling inferior from cerebellum
definition of IUGR
decreased rate of fetal growth
weight at or below 10%
maternal risk factors for IUGR (6)
previous IUGR fetus HTN smoking uterine anomaly placental hemorrhage placental insufficiency
definition of SGA
weight below 10th percentile without reference to cause
two types of IUGR
symmetric and asymmetric
cause and time of symmetric IUGR
1st trimester insult like chromosomal anomaly or infection
cause and time of symmetric IUGR
late 2nd and 3rd trimester
caused by placental insufficiency
clinical signs of IUGR
decreased fundal height
decreased fetal motion
GRADE 3 PLACENTA B/F 36 WEEKS or decreased thickness
increased RI in umbilical artery }(S/D >3)
most sensitive indicator of IUGR
AC measured at portal-umbilical venous complex
biophysical profile tests (5)
cardiac nonstress test (NST) fetal breathing movement (FBM) fetal body movement (FM) fetal tone (FT) amniotic fluid volume (AFV)
what is true breathing movement
inward movement of chest wall and outward movement of abdominal wall
what is an alternative area to watch for fetal breathing
fetal kidney in long
fetal tone
extension and flexion of one of limbs or trunk
definition of macrosomia (2)
> 4000g
too large for pelvis
risk factors for macrosomia (8)
multiparity age >35 pre-pregnancy weight >70kg/154lb PI in upper 10% pregnancy weight gain >20kg/44lb postdate pregnancy history of LGA DM
malformation resulting in increased fetal size
beckwith-wiedemann
marshall-smith
soto’s
weaver’s
two types of macrosomia
mechanical and metabolic
mechanical macrosomia types (3)
fetus generally large
large fetus with large shoulders
normal trunk but large head
mechanical macrosomia with generally large fetus occurs due to _____ (3)
genetic factors
prolonged pregnancy
multiparity
mechanical macrosomia with large fetus and large shoulders occurs in _______
diabetic mothers
mechanical macrosomia with normal trunk but large head is caused by _____
genetic constitution pathologic process (hydrocephalus)
decidua basali
reaction between blastocyst and myometrium
decidua capsularis
reaction over blastocyst closest to endometrium
decidua vera (parietalis)
reaction except for areas beneath and above implanted
chorion fondosum
forms fetal part of placenta, contains villi
chorion leave
nonvillious part of chorion around gestational sac
chorionic plate
fetal surface of placenta
basal plate
maternal surface of placenta
functions of placenta (6)
respiration nutrition excretion protection storage hormonal production
oxygenated blood is thought to placenta through _____
end spiral arteries
what separates fetal blood from maternal blood and what is it composed of _______ (3)
thin layer of capillary wall, trophoblastic basement membrane and thin rim of cytoplasm of cyncytiotrophoblasts
how is fetal placenta anchored to maternal placenta
cystotrophoblastic shell and anchoring villi
maternal placental circulation may be reduced by ________
decreased uterine blood flow
HTN
renal disease
placental infarction
abnormal cordal attachments to placenta (2)
battledore and velamentous placenta
where does secondary yolk sac form
ventral surface of embryonic disk
fetal membranes (4)
chorion
amnion
allantois
yolk sac
when does amnion develop and where is it attached
28th menstrual day
margins of embryonic disk
when does amnion fuse with chorion
16th week
separation of amnion and chorion beyond 16th week suggests ____ (3)
polyhydramnios, aneuploidy or prior amniocenthesis
separation of amnion and chorion may also be simulated by _______
hemorrhage
normal cord diamater
1-2cm
normal cord length
40-60cm
functional endocrine unit of placenta
chronic villi
inner layer of placenta and what does it produce
cytotrophoblast
neuropeptides
outer layer of placenta and what does it produce
syncytiotrophoblast
hCG, human placental lactogen hPL, sex steroids (estrogen and progesterone)
what/who produces progesterone
maternal-placental interaction
no contribution from the fetus
what/who produces estrogen
maternal, placental and fetal contributions
fetal surface of placenta
echogenic chorionic plate along
basal plate
maternal portion of placenta next to myometrium
what can vessels behind basal plate be confused with
placental abruption
when can normal placenta be identified
8 weeks
appearance of placenta at 8-20 weeks (3)
homogenous
mid-level gray
smooth borders
thickness of placenta
2-3cm >23 weeks
appearance of placenta after 20 weeks
intraplacental sonolucenies and placental calcifications
what are placental lakes
placental sonolucencies
may have blood flow
“swirling flow”
what separates placenta from myometrium
subplacental venous complex
normal and abnormal AFI
8-22 normal
22 is increased
3 types of cord insertions
placental, marginal, velamentous
when is cervix falsely elongated
full bladder
when cervix is elongated, how does normal placenta look
may appear to be covering internal cervical os and give false impression of previa
how do you better demonstrate internal cervical os (2)
trendelenburg position
relieve pressure of uterus on lower uterine segment
best imaging tool for lower uterine segment and inferior edge of placenta
TV
succenturiate placenta
anterior and posterior placenta that does NOT communicate
(accessory) - joined to main placenta by blood vessels
placental migration
position of placenta changes because of physiologic changes in lower uterine segment
low blood supply in LUS - atrophy
High blood supply in fundus - hypertrophy
uterine artery resistence
high during 1st tri
low during 2nd tri
where is lowest resistance of uterine artery seen
placental side
abnormal trophoblastic invasion of apiral arteries is associated with (produces high RI) (4)
placental insufficiency
IUGR
preeclampsia
placental abruption
normal placenta characteristics at delivery (4)
15-20cm in diameter
discoid in shape
600g
complications of short umbilical cord (8)
traction during labor rearing of cord abruption inversion of uterus preterm delivery decreased heart rate meconium staining fetal anomalies
complications of long umbilical cord (3)
prolapsing
twisting
tying in true knots
where is fibrin most pronounced
floor of placenta
causes for placentomegaly (9)
DM anemima thalassemia Rh sensitivity fetomaternal hemorrhage chronic intrauterine infections TTTS congenital neoplasms fetal malformations
causes for small placenta (3)
IUGR
infection
aneuploidy
risk factors for placenta previa (7)
c section advanced maternal age smoking cocaine abuse prior placenta previa multiparity uterine surgery
complications of placenta previa (5)
preterm delivery maternal hemorrhage placental invasion postpartum hemorrhage IUGR
painless bright red vaginal bleeding in 3rd trimester signifies with possible myometrial contractions
placenta previa
vasa previa
fetal vessels run in membranes across cervical os
causes of vasa previa
velamentous insertion
succenturiate lobe
what does placenta increta result from
underdeveloped decidualization of endometrium
placenta increta is associated with ______
placenta previa
curcumvallate/circumarginate placenta
placenta attached to fetal surface rather than to villous placental margin
chorionic villing around borders of placenta not covered by chorionic plate
placental margin is folded, thickened or elevated
what is circumvallate/circummarginate placenta associated with (4)
PROM
preterm labor
IUGR
placental abruption
sites of placental hemorrhage (4)
reptoplacental
subchorionic
subamniotic
intraplacental
placental abruption
separation of normally implanted placenta prior to term delivery
premature placental detachment
where does bleeding from placental abruption occur
decidua basalis
what does retroplacental abruption result from
rupture of spiral arteries causing high pressure bleed
retroplacental abruption is associated with _____ (2)
HIT
vascular disease
presentation of retroplacental abruption (4)
asumptomatic or bleeding
thickened placenta
hypoechoic in older bleeds
separation of placenta from uterine wall
most common type of placental abruption and what is it known as
marginal
subchorionic bleeds
what causes marginal hemorrhage and what kind of bleed is it
tears of marginal veins
low-pressure bleed
subchorionic hemorrhage accumulates _____
at the site of separation
what causes intervillous thrombosis
intraplacental hemorrhage caused by breaks in villous capillaries
placental infarcts
focal discrete lesion caused by ischemic necrosis
what do large placenta infarcs reflect
underlying maternal vascular disease
placental infarcts are difficult to distinguish from ____
intraplacental hemorrhages
clinical symptoms of gestational trophoblastic disease (4)
N/V
elevated hCG
vaginal bleeding
larger than dates
chorioangioma
most common
benign vascular tumor of placental consisting of fetal vessels (capillary hemangiomas arising beneath chorionic plate)
large chorioangiomas may act as ———-
arteriovenous malformation shunting blood from fetus
fetal complications of chorioangioma (6)
polyhydramnios hydrops anemia cardiomegaly IUGR demise
lab values of chorioangioma
elevated AFP in AF and maternal blood
Di/Di monozygotic twins occur if separation occurs during ______ days of pregnancy
first 4
risk of monochorionic twins
placental vascular anastomosis
risk of monoamniotic twins
entanglement of umbilical cord
when does the umbilical cord form and from what
first 5 weeks
fusion of yolk stalk and allantoid ducts
what does outpouching from urinary bladder form
urachus
allantoic vessels become _______
umbilical vessels
cord acquires epithelial lining as a result of (2)
enlargement of amniotic cavity
envelopment of the cord by amniotic membrane
diameter and length of cord
1-2cm
40-60cm
umbilical arteries arise from _____ and course along _____
internal iliac arteries
fetal bladder
what is the umbilical vein formed by
confluence of chorionic veins of placenta
after birth, umbilical arteries become _____ and vein becomes ____
lateral ligaments of bladder/superior vesical arteries
ligament of liver
ductus venosus
thin intrahepatic channel with echogenic walls between left and caudate lobes
umbilical cord length in 1st tri
same as CRL
short umbilical cord
short umbilical cord is associated with (7)
oligohydramnios restricted space/multiple gest intrinsic fetal anomaly tethering of fetus by cord inadequate fetal descent cord compression fetal distress
coiling of umbilical cord is related to ____
fetal activity
how does umbilical cord coil
to the left near fetal insertion site
what happens is cord is atretic and fetus is attached to placenta at umbilicus
omphalocele is present
long umbilical cord
> 80cm
long umbilical cord is associated with (7)
polyhydramnios nuchal cord true knots cord compression cord presentation prolapsed cord stricture or torsion
diameter of long cord
2.6-6cm
abnormally thick cord is associated with(4)
DM
Edema/hydrops
Rh incompatibility
fetal demise
cystic mass in a cord is usually _______ origin (2) and ____ size
omphalomesenteric or allantoic
where are cystic cord masses usually located
fetal end of cord
masses associated with umbilical cord (10)
omphalocele gastroschisis umbilical herniation teratoma aneurysm varix hematoma true knot angioma thrombosis
omphalocele
failure of intestine to return to abdome
gastroschisis
right paraumbilical defect measuring 204cm
not covered by membrane
lab associated with gastroschisis
elevated AFP
omphalomesenteric cyst
cystic lesion and dilation of segment of omphalomesenteric duct
lined by epithelium
size of omphalomesenteric cyst
up to 6cm
omphalomesenteric cyst is associated with ______
meckel’s diverticulum
most common location of umbilical cord thrombosis
umbilical vein
incidence of umbilical vein thrombosis is higher in _______
infants of diabetic mothers
secondary umbilical thrombosis is due to _____ (5)
torsion knotting looping compression hematoma
phlebitis and arteritis may cause _____
umbilical thrombosis
true knots are associated with (4)
long cords
polyhydramnios
IUGR
monoamniotic twins
false knots are seen when ____
vessels are longer than cord
most common cord entanglement in fetus
nuchal cord
nuchal cord
multiple coils aound fetal neck
battledore placenta
marginal insertion of the cord
when is battledore placenta significant and why
when cord insertion is near the os
may prolapse or be compressed during contractions
velamentous insertion of cord
cord inserts into membranes before entering placenta
rinks of velamentous cord insertion (3)
thrombosis
cord rupture at delivery
vasa previa
velamentous insertion is associated with (5)
low birth weight SGA preterm low apgar scores abnormal HR pattern
single umbilical artery has been associated with (4)
congenital anomalies
IUGR
perinatal mortality
chromosomal abnormalities
single umbilical artery is most often associated with what system anomalies?
MSK
where does focal dilation of umbilical vein occur
intraabdominally, extrahepatic location
amniotic fluid is produced by _____ (5)
umbilical cord membranes lungs skin kidneys
amount of amniotic fluid is regulated by (5)
production removal fluid exchange within lungs membranes cord
skin is permeable to water until _______ at ________ weeks
keritinization
24-26
production of urine and ability to swallow begins ____
8-11 weeks
most significant amount of urine is produced at _____
18-20 weeks
by _____ weeks, AF volume incerases by ______
20 weeks
10ml/day
oligohydramnios measurement
AFI
polyhydramnios measurement
AFI>24cm
largest vertical pocket 8cm or more
normal single pocket AF
2-8cm
two diameter AF pocket measurement and what’s normal
horizontal x vertical to obrain volume
15-50cm is normal
what measurement is the best predictor of oligohydramnios
two-diameter pocket
what measurement is the best predictor of polyhydramnions
largest vertical pocket
dolichocephaly and BPD accuracy
head large in AP diameter
BPD underestimated
brachycephaly and BPD accuracy
head large in TRV
BPD overestimated
polyhydramnios definition
AF >2000ml
polyhydramnios uterus size
larger than dates
acute onset of hydramnios may be _______ (4)
painful
compress organs and vascular structures
cause hydronephrosis
produce SOB
polydydramnios is associated with ____ (5)
CNS disorders - depressed swallowing GI problems - esophageal atresia, stomach, duodenum or small bowel hydrops skeletal anomalies renal disorders
maternal conditions associated with polyhydramnios (5)
DM obesity Rh incompatibility anemia CHF
development of oligohydramnios is attributed to (5)
congenital anomalies IUGR postterm pregnancies ROM aitrogenesis
maternal conditions associated with oligohydramnios (5)
HTN preeclammpsia cardiac and renal disease connective tissue disorders patients on indomethacin
fetal hypoxia may produce _______ and _____
growth restriction and oligohydramnios
iatrogenic causes of oligohydramnios (4)
medications
fluid loss
maternal fluid depletion
procedures such as CVS
medications associated with oligohydromnios (4)
nonsteroidal antiinflammatory
angiotensin-converting enzyme inhibitors
calcium channel blockers
nitrous oxide
fetal conditions associated with oligohydramnios (5)
IPCKD renal agenesis posterior urethral valve syndrome dysplastic kidney chromosomal abnormalities
patient presents with sudden gush or leaking fluid
rupture of membranes
what is used to determine presence of AF in vaginal secretions
nitrazine paper and fern test
abnormal ROM associated with (6)
preterm delivery fetal/neonatal death RDS prolapsed umbilical cord chorioamnionitis placental abruption
amniotic band syndrome is associated with _______ and can cause ______
abnormality in fetal membranes
malformation of limbs, craniofacial region and trunk
synonyms for amniotic band syndrome (4)
ADAM
amniotic band sequence
aberrant tissue bands
congenital constricting bands
etiology of amniotic band syndrome
rupture of amnion leading to entanglement by firous mesodermic bands from chorionic side
entrapment of fetal parts by amniotic band syndrome can cause (3)
lymphedema
amputations
slash defects
common findings of amniotic band syndrome (4)
facial clefts
asymmetric encephalocele
constriction or amputation of extremities
clubfoot
amniotic sheets, shelves and folds
echogenic, nonfloating bands crossing amniotic cavity
difference between amniotic sheets, shelve, folds vs amniotic band syndrome (3)
shelves, sheets and folds are thicker
do not cause malformations
signify uterine synechiae
amniotic sheets are caused by (3)
uterine scars from instrumentation
c-section
endometritis
who’s at risk for developing endometrial scars (5)
D&C intrauterine infections edometritis removal of fibroids and polyps prior c-section
what are synechiae associated with
infertility and miscarriages
patients with synechiae and infertility may also have _____
asherman’s syndrome
echodense line separated from uterine wall by echolucent space
may surround fetus or be freely mobile
amniotic sheets
hydrops
disparity between amounts of fluid produced and absorbed leading to edema
types of edema in hydrops (5)
pleaural effusions ascites cardiac effusion skin edema anasarca
other findings in hydrops (4)
enlarged umbilical cord
polyhydramnios
placental edema
enlarged liver or spleen
what can abdominal musculature be mistaken for
hydrops/ascites
skin edema has what measurement
> 5-6mm
measurement of pericardial effusion
> 2mm
placental edema measurement
thickened placenta
>4-4.5cm in AP
immune hydrops is associated with
alloimmune hemolytic disease
Rh immunication
causes of nonimmune hydrops (2)
sporatid cardiac insufficiency (due to tumors or arrhythmia)
nuchal skin fold location and measurement
cavum septi pellucidi
cerebellum
cisterna magma
5mm or less at
