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DUTEC 120 > Test 4 > Flashcards

Test 4 Flashcards

1
Q

first thing to determine in 2nd and 3rd tri scanning

A

determine fetal position in relationship to mother/cervix

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2
Q

after determining fetal position, what should be done next?

A

determine left and right side (situs)

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3
Q

fetal lie is describe in relationship to ___________

A

maternal long axis

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4
Q

what does “cephalic position” mean

A

head closest to cervix. vertex

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5
Q

fetus lying perpendicular to long axis of mother

A

transverse fetal lie

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6
Q

what should be reported when fetus is in transverse fetal lie

A

position of fetal head (maternal right/left)

position of spine (inferior, superior, anterior, posterior)

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7
Q

in oblique fetal presentation, describe ______ and ______

A

quadrant of the head and direction of the spine

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8
Q

cranial bones ossify by _____

A

12 weeks

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9
Q

survey the head checking for ____

A

contour or outline of skull bones highest level in brain

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10
Q

head appears as circle at _____

A

highest level

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11
Q

head appears as an oval at _____

A

ventricular, peduncular and basal levels

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12
Q

distortion of skull shape is caused by (4)

A

extracranial masses
CNS anomalies
skeletal pathology
fetal death

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13
Q

normal fetal brain parenchyma appears _____ because of _____

A

hypoechoic

small size and high H2O content

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14
Q

sulcus and gyrus echogenicity

A

more echogenic

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15
Q

Branches of anterior cerebral artery run within _____ and pulsate

A

sulci

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16
Q

Standard OB exam requires records of (6)

A 
cerebellum
choroid plexus
cisterna magna
lateral ventricles
midline falx
cavum septum pellucidi
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17
Q

at what level is midline falx seen

A

superior level in TRV

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18
Q

white matter tracts location (2)

A

lateral and parallel to midline falx

above level of lateral ventricles

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19
Q

choroid plexus location

A

roofs of each ventricles except frontal ventricular horn

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20
Q

connection of inferior portion of lateral ventricles with temporal and posterior horns

A

atrium of lateral ventricles

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21
Q

shape of choroid plexus

A

tear-shaped

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22
Q

most inferior portion of choroid plexus

A

glomus

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23
Q

site of atrium

A

glomus (most inferior portion of choroid plexus)

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24
Q

normal atrium measurement

A

6.5mm

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25
Q

atrium measurement of more than ______ warrants serial imaging

A

10mm

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26
Q

what do you see inferior to ventricular atrium

A

thalami and ambient cicterns

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27
Q

location for BPD measurement

A

inferior to ventricular atrium

area of thalami

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28
Q

brain structures seen at BPD level

A

cavum septum pellucidum
midline echo
thalamus

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29
Q

location of 3rd ventricle

A

between thalami

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30
Q

location of cavum septum pellucidum (CSP)

A

anterior to thalamus

between leaves of septum pellucidum

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31
Q

location and echogenicity of corpus collosum

A

echopenic (low echogenicity)

between frontal ventricular horns

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32
Q

pulsations from _____ artery observed between lobes of peduncles at interpeduncular cistern

A

basilar

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33
Q

location of circle of willis

A

anterior to midbrain

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34
Q

shape of circle of willis

A

triangular region

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35
Q

what is seen in the center of circle of willis

A

suprasellar cistern

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36
Q

location of cerebellum

A

back of cerebral peduncles within posterior fossa

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37
Q

cerebellar hemispheres are joined by _____

A

cerebellar vermis

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38
Q

distortion of cerebellum suggests _______

A

spina bifida

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39
Q

location of cisterna magna

A

behind cerebellum

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40
Q

what excludes almost all open spinal defects

A

normal cisterna magna

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41
Q

thinned out or obliterated cisterna magna suggests ______

A

Arnold-Chiari malfornation

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42
Q

normal size of cisterna magna

A

3-11mm

average 5-6mm

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43
Q

how is cisterna magna measuremed

A

vermis to inner skull

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44
Q

echogenic structures within cisterna magna

A

dural folds attaching falx cerebelli

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45
Q

at what level is nuchal skin fold measured (3)

A

cavum septi pellucidi
cerebellum
cisterna magna

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46
Q

normal nuchal skin fold thickness

A

5mm or less up to 20 weeks

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47
Q

site of pituitary gland

A

junction of sphenoid wings and petrous bones

at sella turcica

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48
Q

location of sella turcica

A

junction of sphenoid wings and petrous bones

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49
Q

where are orbits visualized

A

below cerebellar plane

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50
Q

anophthalmia

A

absence of eyes

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51
Q

hypotelorism

A

fused or closely spaced eyes

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52
Q

hypertelorism

A

widened eyes

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53
Q

how are orbits measured (2)

A

coronal scan - posterior to glabella-alveolar line

TRV - below BPD

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54
Q

in what position are orbital distances determined

A

occipitoposterior

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55
Q

how is IOD measured

A

(inner orbital distance)

medial border of orbit to opposite medial border

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56
Q

how is OOD measured

A

(outer orbital distance)

lateral border of one orbit to lateral of the other

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57
Q

micrognathia

A

small chin

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58
Q

frontal bossing

A

forehead more prominent than usual as in skeletal dusplasia

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59
Q

frontal slanting

A

opposite of frontal bossing

forehead caves in

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60
Q

when is frontal slanting seen

A

microcephaly

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61
Q

when are oral cavity and tongue outlined

A

during swallowing

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62
Q

macroglossia

A

large tongue

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63
Q

macroglossia is associated with (2)

A

Beckwith-Wiedeman sundrom and aneuploidies

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64
Q

in what view is cleft lip diagnosed

A

coronal

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65
Q

Standard antepartum OB exam spine requirements (4)

A 
cervical
thoracic
lumbar 
sacral spine 
 (to exclude malformations)
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66
Q

what should be seen on each vertebra and in what view are they seen

A

3 ossification points.

TRV

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67
Q

railway sign

A

double line appearance of spine

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68
Q

appearance of vertebral column (pedicles) in spinal defects

A

V, C, or U shaped

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69
Q

landmark for heart and its position

A

lungs

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70
Q

what do fetal lungs look like

A

solid, fluid filled homogenous masses

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71
Q

borders of lungs

A

heart medially
rib cage laterally
diaphragm inferiorly

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72
Q

what can displacement of the heart suggest

A

lung masses or subdiaphragmatic hernia

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73
Q

bony landmarks of chest cavity (3)

A

ribs
scapulae
clavicles

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74
Q

when do you see total length of ribs

A

oblique sections

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75
Q

when are clavicles observed

A

coronal sections of thorax

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76
Q

in what views is scapula seen and what does it appear like

A

sagittal, TRV or full length in oblique

echogenic linear echo adjacent to rib shadows

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77
Q

in what view is the sternum seen

A

axial sections showing bony sequence of echoes

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78
Q

lie of fetal heart and why

A

more TRV because lungs are not inflated

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79
Q

4 chamber heart can be seen in what views

A

beam perpendicular to septum
beam perpendicular to valves
angling cephalad after obtaining TRV abdomen

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80
Q

what should you access in 4 chamber view of heart (5)

A 
cardiac position
situs
axis
apex pointing to the left
presence of both ventricles
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81
Q

Which ventricle is larger and why

A

right

pumps blood through ductus arteriosus and descending aorta

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82
Q

which heart valve is lower

A

tricuspid

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83
Q

EIF

A

echogenic intracardiac focus

echogenic structure within chamber that persists despite different transducer approaches

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84
Q

in what plane is the diaphragm viewd

A

longitudinal

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85
Q

what’s suggested by diaphragm curving towards abdomen

A

increased thoracic pressure due to mass or effusion

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86
Q

on what side is diaphragm more obvious and why

A

right because of liver interface

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87
Q

what excludes left sided diaphragmatic hernia

A

visualization of stomach inferior to diaphragm

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88
Q

sign of left-sided diaphragmatic hernia

A

fetal heart displaced to the right

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89
Q

what helps determine location of CCA and how is it outlined

A

esophagus and oropharynx

outlined during swallowing

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90
Q

where does fetal oxygenation occur

A

placenta within intervillous spaces

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91
Q

what shunt blood away from the lungs

A

ductus arteriosus

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92
Q

what shunts blood directly to heart

A

ductus venosus

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93
Q

flow of blood to fetus

A 
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
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94
Q

right ventricle pumps blood to

A

pulmonary artery
ductus arteriosus
descending aorta

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95
Q

left ventricle pumps blood to

A

ascending aorta and brain

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96
Q

where do umbilical arteries arise from

A

fetal iliac arteries

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97
Q

what makes up fetal hepatobiliary system (6)

A 
liver
portal veins
hepatic veins
hepatic arteries
GB
bile ducts
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98
Q

fetal heart failure may be diagnosed by doppler evaluation of ______

A

ductus venosus

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99
Q

what lobe of liver is larger and why

A

left

large quantity of oxygenated blood

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100
Q

what discerns the liver and what echogenicity is it

A

pebble gray echogenicity

portal and hepatic veins

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101
Q

storage site for glucose sensitive to disturbances in growth

A

liver

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102
Q

GB is located below _____

A

left portal vein

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103
Q

GB should not be mistaken for _____

A

left portal vein

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104
Q

fetal pancreas location and how should the fetus be luing

A

posterior to stomach, anterior to splenic vein

fetus lying spine down

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105
Q

location of spleen

A

in TRV posterior and left of stomach

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106
Q

fetal GI tract is composed of ____ (4)

A

esophagus
stomach
small intestine
large intestine (colon)

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107
Q

when is stomach apparent and why

A

11th week

fills with swallowed amniotic fluid

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108
Q

when should full stomach be seen

A

> 16 weeks

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109
Q

when can small bowel be differentiated from large bowel

A

> 20 weeks

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110
Q

large bowel measurement

A

20mm in preterm and larger in postdate

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111
Q

echogenicity of bowel

A

greater than liver

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112
Q

what is hyperechoic bowel

A

bowel as echogenic as bone

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113
Q

what is hyperechoic bowel associated with

A

aneuploidy and neonatal pathology

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114
Q

components of urinary system (3)

A

kidneys, ureters, bladder

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115
Q

when are kidneys seen and what do they look like

A

13th week

ovoid retroperitoneal structures without distinctive borders

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116
Q

echo-free area in the center of kidney

A

renal pelvis

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117
Q

abnormal renal pelvis measurements

A

> 5mm before 20 weeks
8mm 20-30 weeks
10mm beyond 30 weeks

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118
Q

pyelectasis

A

persistent bilateral renal pelvis dilation

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119
Q

when and how are adrenals seen

A

TRV above kidneys

20 weeks

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120
Q

center of adrenal gland

A

echogenic line surrounded by less echogenic tissue

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121
Q

left adrenal gland is close to ____

A

TRV aorta

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122
Q

how often does the fetus void

A

once an hour

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123
Q

failure to visualize bladder in oligohydromnios suggests ____ (2)

A

renal abnormality or premature rupture of membranes

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124
Q

how do you locate fetal genitalia

A

follow long axis of fetus towards hips
bladder is posterior to genital organs
tangential scanning planes between thighs

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125
Q

when can gender be appreciated

A

12 weeks

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126
Q

in what plane is female genitalia seen

A

TRV

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127
Q

why can labia appear edematous and swollen

A

due to circulating maternal hormones

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128
Q

what does scrotal sac look like

A

mass of soft tissue between hips with scrotal septum and testicles

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129
Q

common benign finding in male genetalia

A

hydrocele

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130
Q

short femur and humerus are associated with

A

aneuploidy

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131
Q

how is humerus located

A

sagittal plane laterally from ribs and scapula

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132
Q

how is long axis humerus seen

A

lateral to scapular echo

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133
Q

when are epiphyseal ossification centers of humerus seen

A

39 weeks

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134
Q

what does TRV humerus appear as

A

solitary bone surrounded by muscle and skin

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135
Q

how are radius and ulna imaged

A

tracing humerus to elbow

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136
Q

example of positive demonstration of fetal tone

A

hand movement

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137
Q

what does visualization of distal femoral epiphysis within cartilage at knee signify

A

33-35 weeks gestation

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138
Q

what is proximal epiphyseal center found at tibial end

A

35 weeks

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139
Q

which bone is larger, tibia or fibula

A

tibia

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140
Q

what is persistent and abnormal flexion of ankle associated with

A

clubfeet

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141
Q

what should you evaluate after the fetus has been studies (3)

A

placenta
amniotic fluid
pelvis

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142
Q

what are absent cord twists associated with

A

poor pregnancy outcome

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143
Q

max umbilical vein diameter by 30 weeks

A

.9cm

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144
Q

velamentous cord insertion

A

atypical insertion location

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145
Q

echogenicity of placenta in early pregnancy

A

pebble-gray

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146
Q

functions of amniotic fluid (5)

A 
free movement
maintenance of intrauterine pressure
maintenance of temperature
protection from injury 
lung development
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147
Q

up to what time does volume of amniotic fluid increase and when does it diminish

A

increase until 34 weeks and diminish after

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148
Q

true or false:

amnion is contiguous with membrane lining umbilical cord

A

true

149
Q

subamniotic collection

A

fluid under membrane floating on top of placenta

150
Q

subchorionic collection

A

fluid under membrane ending at edge of placenta

151
Q

when should transperineal and transvaginal imaging of cervix be done

A

when cervix is shortened or theres a risk of incompetent cervix or premature delivery

152
Q

length of normal cervix

A

3cm or more

153
Q

how should you measure a round sac

A

one inner to inner

154
Q

how do you measure an ovoid sac

A

two measurements inner to inner

perpendicular to each other

155
Q

how long is the fetal pole when cardiac activity should be seen

A

> 7mm

156
Q

at what GA is CRL measured

A

6-12 weeks

157
Q

when is EHR measured (2)

A

5-9 weeks

CRL

158
Q

how accurate is EHR

A

+-6days

159
Q

what does it mean when EHR is more than 6 days behind CRL

A

impending 1st trimester failure

160
Q

how fast does EHR accelerate (3)

A

3.3bpm/day
10 beats every 4 days
>100 beats in 1st month

161
Q

how is BPD measured

A

leading edge to leading edge

outer to inner

162
Q

how do you measure HC

A

outer margins of skull

163
Q

how is coronal head circumference (CHC) measured and what should you see

A

perpendicular to TRV HC

thalamus and brain stem

164
Q

Where is AC measurement taken

A

umbilical portion of left portal vein

165
Q

how is femur length measured

A

greater trochanter to femoral condyles

166
Q

what should not be included in femur length

A

epiphyseal cartilages and dustal femoral point (DFP)

167
Q

normal femur shape

A

straight lateral border and curved medial border

168
Q

which bone is lateral and thinner (tibia or fibula)

A

fibula

169
Q

what bone is longer
(ulna or radius)
and where is is longer

A

ulna

longer proximally

170
Q

orbital diameter normal measurements

A

13mm at 12 weeks to 59mm at term

171
Q

at what level is the cerebellum measured (3)

A

cerebellum
vermis
4th ventricle

172
Q

how are cistern magnum and nuchal fold recorded

A

by angling inferior from cerebellum

173
Q

definition of IUGR

A

decreased rate of fetal growth

weight at or below 10%

174
Q

maternal risk factors for IUGR (6)

A 
previous IUGR fetus
HTN
smoking
uterine anomaly
placental hemorrhage
placental insufficiency
175
Q

definition of SGA

A

weight below 10th percentile without reference to cause

176
Q

two types of IUGR

A

symmetric and asymmetric

177
Q

cause and time of symmetric IUGR

A

1st trimester insult like chromosomal anomaly or infection

178
Q

cause and time of symmetric IUGR

A

late 2nd and 3rd trimester

caused by placental insufficiency

179
Q

clinical signs of IUGR

A

decreased fundal height
decreased fetal motion
GRADE 3 PLACENTA B/F 36 WEEKS or decreased thickness
increased RI in umbilical artery }(S/D >3)

180
Q

most sensitive indicator of IUGR

A

AC measured at portal-umbilical venous complex

181
Q

biophysical profile tests (5)

A 
cardiac nonstress test (NST)
fetal breathing movement (FBM)
fetal body movement (FM)
fetal tone (FT)
amniotic fluid volume (AFV)
182
Q

what is true breathing movement

A

inward movement of chest wall and outward movement of abdominal wall

183
Q

what is an alternative area to watch for fetal breathing

A

fetal kidney in long

184
Q

fetal tone

A

extension and flexion of one of limbs or trunk

185
Q

definition of macrosomia (2)

A

> 4000g

too large for pelvis

186
Q

risk factors for macrosomia (8)

A 
multiparity
age >35
pre-pregnancy weight >70kg/154lb
PI in upper 10%
pregnancy weight gain >20kg/44lb
postdate pregnancy
history of LGA
DM
187
Q

malformation resulting in increased fetal size

A

beckwith-wiedemann
marshall-smith
soto’s
weaver’s

188
Q

two types of macrosomia

A

mechanical and metabolic

189
Q

mechanical macrosomia types (3)

A

fetus generally large
large fetus with large shoulders
normal trunk but large head

190
Q

mechanical macrosomia with generally large fetus occurs due to _____ (3)

A

genetic factors
prolonged pregnancy
multiparity

191
Q

mechanical macrosomia with large fetus and large shoulders occurs in _______

A

diabetic mothers

192
Q

mechanical macrosomia with normal trunk but large head is caused by _____

A 
genetic constitution
pathologic process (hydrocephalus)
193
Q

decidua basali

A

reaction between blastocyst and myometrium

194
Q

decidua capsularis

A

reaction over blastocyst closest to endometrium

195
Q

decidua vera (parietalis)

A

reaction except for areas beneath and above implanted

196
Q

chorion fondosum

A

forms fetal part of placenta, contains villi

197
Q

chorion leave

A

nonvillious part of chorion around gestational sac

198
Q

chorionic plate

A

fetal surface of placenta

199
Q

basal plate

A

maternal surface of placenta

200
Q

functions of placenta (6)

A 
respiration
nutrition 
excretion 
protection
storage
hormonal production
201
Q

oxygenated blood is thought to placenta through _____

A

end spiral arteries

202
Q

what separates fetal blood from maternal blood and what is it composed of _______ (3)

A

thin layer of capillary wall, trophoblastic basement membrane and thin rim of cytoplasm of cyncytiotrophoblasts

203
Q

how is fetal placenta anchored to maternal placenta

A

cystotrophoblastic shell and anchoring villi

204
Q

maternal placental circulation may be reduced by ________

A

decreased uterine blood flow
HTN
renal disease
placental infarction

205
Q

abnormal cordal attachments to placenta (2)

A

battledore and velamentous placenta

206
Q

where does secondary yolk sac form

A

ventral surface of embryonic disk

207
Q

fetal membranes (4)

A

chorion
amnion
allantois
yolk sac

208
Q

when does amnion develop and where is it attached

A

28th menstrual day

margins of embryonic disk

209
Q

when does amnion fuse with chorion

A

16th week

210
Q

separation of amnion and chorion beyond 16th week suggests ____ (3)

A

polyhydramnios, aneuploidy or prior amniocenthesis

211
Q

separation of amnion and chorion may also be simulated by _______

A

hemorrhage

212
Q

normal cord diamater

A

1-2cm

213
Q

normal cord length

A

40-60cm

214
Q

functional endocrine unit of placenta

A

chronic villi

215
Q

inner layer of placenta and what does it produce

A

cytotrophoblast

neuropeptides

216
Q

outer layer of placenta and what does it produce

A

syncytiotrophoblast

hCG, human placental lactogen hPL, sex steroids (estrogen and progesterone)

217
Q

what/who produces progesterone

A

maternal-placental interaction

no contribution from the fetus

218
Q

what/who produces estrogen

A

maternal, placental and fetal contributions

219
Q

fetal surface of placenta

A

echogenic chorionic plate along

220
Q

basal plate

A

maternal portion of placenta next to myometrium

221
Q

what can vessels behind basal plate be confused with

A

placental abruption

222
Q

when can normal placenta be identified

A

8 weeks

223
Q

appearance of placenta at 8-20 weeks (3)

A

homogenous
mid-level gray
smooth borders

224
Q

thickness of placenta

A

2-3cm >23 weeks

225
Q

appearance of placenta after 20 weeks

A

intraplacental sonolucenies and placental calcifications

226
Q

what are placental lakes

A

placental sonolucencies
may have blood flow
“swirling flow”

227
Q

what separates placenta from myometrium

A

subplacental venous complex

228
Q

normal and abnormal AFI

A

8-22 normal

22 is increased

229
Q

3 types of cord insertions

A

placental, marginal, velamentous

230
Q

when is cervix falsely elongated

A

full bladder

231
Q

when cervix is elongated, how does normal placenta look

A

may appear to be covering internal cervical os and give false impression of previa

232
Q

how do you better demonstrate internal cervical os (2)

A

trendelenburg position

relieve pressure of uterus on lower uterine segment

233
Q

best imaging tool for lower uterine segment and inferior edge of placenta

A

TV

234
Q

succenturiate placenta

A

anterior and posterior placenta that does NOT communicate

(accessory) - joined to main placenta by blood vessels

235
Q

placental migration

A

position of placenta changes because of physiologic changes in lower uterine segment
low blood supply in LUS - atrophy
High blood supply in fundus - hypertrophy

236
Q

uterine artery resistence

A

high during 1st tri

low during 2nd tri

237
Q

where is lowest resistance of uterine artery seen

A

placental side

238
Q

abnormal trophoblastic invasion of apiral arteries is associated with (produces high RI) (4)

A

placental insufficiency
IUGR
preeclampsia
placental abruption

239
Q

normal placenta characteristics at delivery (4)

A

15-20cm in diameter
discoid in shape
600g

240
Q

complications of short umbilical cord (8)

A 
traction during labor 
rearing of cord
abruption
inversion of uterus 
preterm delivery
decreased heart rate
meconium staining
fetal anomalies
241
Q

complications of long umbilical cord (3)

A

prolapsing
twisting
tying in true knots

242
Q

where is fibrin most pronounced

A

floor of placenta

243
Q

causes for placentomegaly (9)

A 
DM
anemima
thalassemia
Rh sensitivity
fetomaternal hemorrhage
chronic intrauterine infections
TTTS
congenital neoplasms 
fetal malformations
244
Q

causes for small placenta (3)

A

IUGR
infection
aneuploidy

245
Q

risk factors for placenta previa (7)

A 
c section 
advanced maternal age
smoking
cocaine abuse
prior placenta previa
multiparity
uterine surgery
246
Q

complications of placenta previa (5)

A 
preterm delivery
maternal hemorrhage
placental invasion
postpartum hemorrhage
IUGR
247
Q

painless bright red vaginal bleeding in 3rd trimester signifies with possible myometrial contractions

A

placenta previa

248
Q

vasa previa

A

fetal vessels run in membranes across cervical os

249
Q

causes of vasa previa

A

velamentous insertion

succenturiate lobe

250
Q

what does placenta increta result from

A

underdeveloped decidualization of endometrium

251
Q

placenta increta is associated with ______

A

placenta previa

252
Q

curcumvallate/circumarginate placenta

A

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

253
Q

what is circumvallate/circummarginate placenta associated with (4)

A

PROM
preterm labor
IUGR
placental abruption

254
Q

sites of placental hemorrhage (4)

A

reptoplacental
subchorionic
subamniotic
intraplacental

255
Q

placental abruption

A

separation of normally implanted placenta prior to term delivery
premature placental detachment

256
Q

where does bleeding from placental abruption occur

A

decidua basalis

257
Q

what does retroplacental abruption result from

A

rupture of spiral arteries causing high pressure bleed

258
Q

retroplacental abruption is associated with _____ (2)

A

HIT

vascular disease

259
Q

presentation of retroplacental abruption (4)

A

asumptomatic or bleeding
thickened placenta
hypoechoic in older bleeds
separation of placenta from uterine wall

260
Q

most common type of placental abruption and what is it known as

A

marginal

subchorionic bleeds

261
Q

what causes marginal hemorrhage and what kind of bleed is it

A

tears of marginal veins

low-pressure bleed

262
Q

subchorionic hemorrhage accumulates _____

A

at the site of separation

263
Q

what causes intervillous thrombosis

A

intraplacental hemorrhage caused by breaks in villous capillaries

264
Q

placental infarcts

A

focal discrete lesion caused by ischemic necrosis

265
Q

what do large placenta infarcs reflect

A

underlying maternal vascular disease

266
Q

placental infarcts are difficult to distinguish from ____

A

intraplacental hemorrhages

267
Q

clinical symptoms of gestational trophoblastic disease (4)

A

N/V
elevated hCG
vaginal bleeding
larger than dates

268
Q

chorioangioma

A

most common

benign vascular tumor of placental consisting of fetal vessels (capillary hemangiomas arising beneath chorionic plate)

269
Q

large chorioangiomas may act as ———-

A

arteriovenous malformation shunting blood from fetus

270
Q

fetal complications of chorioangioma (6)

A 
polyhydramnios
hydrops
anemia
cardiomegaly
IUGR
demise
271
Q

lab values of chorioangioma

A

elevated AFP in AF and maternal blood

272
Q

Di/Di monozygotic twins occur if separation occurs during ______ days of pregnancy

A

first 4

273
Q

risk of monochorionic twins

A

placental vascular anastomosis

274
Q

risk of monoamniotic twins

A

entanglement of umbilical cord

275
Q

when does the umbilical cord form and from what

A

first 5 weeks

fusion of yolk stalk and allantoid ducts

276
Q

what does outpouching from urinary bladder form

A

urachus

277
Q

allantoic vessels become _______

A

umbilical vessels

278
Q

cord acquires epithelial lining as a result of (2)

A

enlargement of amniotic cavity

envelopment of the cord by amniotic membrane

279
Q

diameter and length of cord

A

1-2cm

40-60cm

280
Q

umbilical arteries arise from _____ and course along _____

A

internal iliac arteries

fetal bladder

281
Q

what is the umbilical vein formed by

A

confluence of chorionic veins of placenta

282
Q

after birth, umbilical arteries become _____ and vein becomes ____

A

lateral ligaments of bladder/superior vesical arteries

ligament of liver

283
Q

ductus venosus

A

thin intrahepatic channel with echogenic walls between left and caudate lobes

284
Q

umbilical cord length in 1st tri

A

same as CRL

285
Q

short umbilical cord

A
286
Q

short umbilical cord is associated with (7)

A 
oligohydramnios
restricted space/multiple gest
intrinsic fetal anomaly
tethering of fetus by cord
inadequate fetal descent
cord compression
fetal distress
287
Q

coiling of umbilical cord is related to ____

A

fetal activity

288
Q

how does umbilical cord coil

A

to the left near fetal insertion site

289
Q

what happens is cord is atretic and fetus is attached to placenta at umbilicus

A

omphalocele is present

290
Q

long umbilical cord

A

> 80cm

291
Q

long umbilical cord is associated with (7)

A 
polyhydramnios
nuchal cord
true knots
cord compression
cord presentation
prolapsed cord
stricture or torsion
292
Q

diameter of long cord

A

2.6-6cm

293
Q

abnormally thick cord is associated with(4)

A

DM
Edema/hydrops
Rh incompatibility
fetal demise

294
Q

cystic mass in a cord is usually _______ origin (2) and ____ size

A

omphalomesenteric or allantoic

295
Q

where are cystic cord masses usually located

A

fetal end of cord

296
Q

masses associated with umbilical cord (10)

A 
omphalocele
gastroschisis
umbilical herniation
teratoma
aneurysm
varix 
hematoma
true knot
angioma
thrombosis
297
Q

omphalocele

A

failure of intestine to return to abdome

298
Q

gastroschisis

A

right paraumbilical defect measuring 204cm

not covered by membrane

299
Q

lab associated with gastroschisis

A

elevated AFP

300
Q

omphalomesenteric cyst

A

cystic lesion and dilation of segment of omphalomesenteric duct
lined by epithelium

301
Q

size of omphalomesenteric cyst

A

up to 6cm

302
Q

omphalomesenteric cyst is associated with ______

A

meckel’s diverticulum

303
Q

most common location of umbilical cord thrombosis

A

umbilical vein

304
Q

incidence of umbilical vein thrombosis is higher in _______

A

infants of diabetic mothers

305
Q

secondary umbilical thrombosis is due to _____ (5)

A 
torsion
knotting
looping
compression
hematoma
306
Q

phlebitis and arteritis may cause _____

A

umbilical thrombosis

307
Q

true knots are associated with (4)

A

long cords
polyhydramnios
IUGR
monoamniotic twins

308
Q

false knots are seen when ____

A

vessels are longer than cord

309
Q

most common cord entanglement in fetus

A

nuchal cord

310
Q

nuchal cord

A

multiple coils aound fetal neck

311
Q

battledore placenta

A

marginal insertion of the cord

312
Q

when is battledore placenta significant and why

A

when cord insertion is near the os

may prolapse or be compressed during contractions

313
Q

velamentous insertion of cord

A

cord inserts into membranes before entering placenta

314
Q

rinks of velamentous cord insertion (3)

A

thrombosis
cord rupture at delivery
vasa previa

315
Q

velamentous insertion is associated with (5)

A 
low birth weight
SGA
preterm
low apgar scores
abnormal HR pattern
316
Q

single umbilical artery has been associated with (4)

A

congenital anomalies
IUGR
perinatal mortality
chromosomal abnormalities

317
Q

single umbilical artery is most often associated with what system anomalies?

A

MSK

318
Q

where does focal dilation of umbilical vein occur

A

intraabdominally, extrahepatic location

319
Q

amniotic fluid is produced by _____ (5)

A 
umbilical cord
membranes
lungs
skin
kidneys
320
Q

amount of amniotic fluid is regulated by (5)

A 
production
removal 
fluid exchange within lungs
membranes 
cord
321
Q

skin is permeable to water until _______ at ________ weeks

A

keritinization

24-26

322
Q

production of urine and ability to swallow begins ____

A

8-11 weeks

323
Q

most significant amount of urine is produced at _____

A

18-20 weeks

324
Q

by _____ weeks, AF volume incerases by ______

A

20 weeks

10ml/day

325
Q

oligohydramnios measurement

A

AFI

326
Q

polyhydramnios measurement

A

AFI>24cm

largest vertical pocket 8cm or more

327
Q

normal single pocket AF

A

2-8cm

328
Q

two diameter AF pocket measurement and what’s normal

A

horizontal x vertical to obrain volume

15-50cm is normal

329
Q

what measurement is the best predictor of oligohydramnios

A

two-diameter pocket

330
Q

what measurement is the best predictor of polyhydramnions

A

largest vertical pocket

331
Q

dolichocephaly and BPD accuracy

A

head large in AP diameter

BPD underestimated

332
Q

brachycephaly and BPD accuracy

A

head large in TRV

BPD overestimated

333
Q

polyhydramnios definition

A

AF >2000ml

334
Q

polyhydramnios uterus size

A

larger than dates

335
Q

acute onset of hydramnios may be _______ (4)

A

painful
compress organs and vascular structures
cause hydronephrosis
produce SOB

336
Q

polydydramnios is associated with ____ (5)

A 
CNS disorders - depressed swallowing 
GI problems - esophageal atresia, stomach, duodenum or small bowel 
hydrops
skeletal anomalies
renal disorders
337
Q

maternal conditions associated with polyhydramnios (5)

A 
DM
obesity
Rh incompatibility
anemia
CHF
338
Q

development of oligohydramnios is attributed to (5)

A 
congenital anomalies
IUGR
postterm pregnancies
ROM
aitrogenesis
339
Q

maternal conditions associated with oligohydramnios (5)

A 
HTN
preeclammpsia
cardiac and renal disease
connective tissue disorders
patients on indomethacin
340
Q

fetal hypoxia may produce _______ and _____

A

growth restriction and oligohydramnios

341
Q

iatrogenic causes of oligohydramnios (4)

A

medications
fluid loss
maternal fluid depletion
procedures such as CVS

342
Q

medications associated with oligohydromnios (4)

A

nonsteroidal antiinflammatory
angiotensin-converting enzyme inhibitors
calcium channel blockers
nitrous oxide

343
Q

fetal conditions associated with oligohydramnios (5)

A 
IPCKD
renal agenesis
posterior urethral valve syndrome
dysplastic kidney
chromosomal abnormalities
344
Q

patient presents with sudden gush or leaking fluid

A

rupture of membranes

345
Q

what is used to determine presence of AF in vaginal secretions

A

nitrazine paper and fern test

346
Q

abnormal ROM associated with (6)

A 
preterm delivery
fetal/neonatal death
RDS
prolapsed umbilical cord
chorioamnionitis
placental abruption
347
Q

amniotic band syndrome is associated with _______ and can cause ______

A

abnormality in fetal membranes

malformation of limbs, craniofacial region and trunk

348
Q

synonyms for amniotic band syndrome (4)

A

ADAM
amniotic band sequence
aberrant tissue bands
congenital constricting bands

349
Q

etiology of amniotic band syndrome

A

rupture of amnion leading to entanglement by firous mesodermic bands from chorionic side

350
Q

entrapment of fetal parts by amniotic band syndrome can cause (3)

A

lymphedema
amputations
slash defects

351
Q

common findings of amniotic band syndrome (4)

A

facial clefts
asymmetric encephalocele
constriction or amputation of extremities
clubfoot

352
Q

amniotic sheets, shelves and folds

A

echogenic, nonfloating bands crossing amniotic cavity

353
Q

difference between amniotic sheets, shelve, folds vs amniotic band syndrome (3)

A

shelves, sheets and folds are thicker
do not cause malformations
signify uterine synechiae

354
Q

amniotic sheets are caused by (3)

A

uterine scars from instrumentation
c-section
endometritis

355
Q

who’s at risk for developing endometrial scars (5)

A 
D&C
intrauterine infections
edometritis
removal of fibroids and polyps
prior c-section
356
Q

what are synechiae associated with

A

infertility and miscarriages

357
Q

patients with synechiae and infertility may also have _____

A

asherman’s syndrome

358
Q

echodense line separated from uterine wall by echolucent space
may surround fetus or be freely mobile

A

amniotic sheets

359
Q

hydrops

A

disparity between amounts of fluid produced and absorbed leading to edema

360
Q

types of edema in hydrops (5)

A 
pleaural effusions
ascites
cardiac effusion
skin edema
anasarca
361
Q

other findings in hydrops (4)

A

enlarged umbilical cord
polyhydramnios
placental edema
enlarged liver or spleen

362
Q

what can abdominal musculature be mistaken for

A

hydrops/ascites

363
Q

skin edema has what measurement

A

> 5-6mm

364
Q

measurement of pericardial effusion

A

> 2mm

365
Q

placental edema measurement

A

thickened placenta

>4-4.5cm in AP

366
Q

immune hydrops is associated with

A

alloimmune hemolytic disease

Rh immunication

367
Q

causes of nonimmune hydrops (2)

A 
sporatid
cardiac insufficiency (due to tumors or arrhythmia)
368
Q

nuchal skin fold location and measurement

A

cavum septi pellucidi
cerebellum
cisterna magma

5mm or less at

DUTEC 120 (3 decks)

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