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DMST 285 OBGYN 2 > The Cervix In Pregnancy > Flashcards

The Cervix In Pregnancy Flashcards

1
Q

What are methods to assess the cervix? 3

A
  1. Trans abdominal sonographic approach
  2. Translabial sonographic approach
  3. Transvaginal sonographic approach
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2
Q

What is a limitation of trans abdominal ultrasounds?

A

Need a partially full bladder

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3
Q

What happens if we pass the limitation for the trans abdominal ultrasound?

A

If the bladder is too full the over distended bladder will result in a falsely elongated cervix

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4
Q

What does this image demonstrate?

A

A transabdominal cervix

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5
Q

What does this image demonstrate?

A

An over distended bladder when and the effect it has on the cervix for a trans abdominal exam

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6
Q

What does this image demonstrate?

A

A uterine contraction

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7
Q

How do we measure a uterine wall and contraction?

A
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8
Q

When do we utilize translabial ultrasound?

A

Utilized when ruptured membranes have occurred

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9
Q

Can translabial ultrasounds can be performed with placenta previa?

A

Yes

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10
Q

What are some benefits and disadvantage of doing a translabial ultrasound?

A

Benefit: Empty bladder
Disadvantage: Gas in the rectum

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11
Q

What does this image demonstrate?

A

Translabial ultrasounds

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12
Q

What is the most accurate method of measuring the cervix?

A

Transvaginal

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13
Q

How far do we insert the probe for a Transvaginal ultrasound?

A

3 to 4cm

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14
Q

What is the Transvaginal ultrasound contraindicated with?

A

Ruptured membranes

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15
Q

Transvaginal ultrasounds may cause what?

A

Bleeding or contractions

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16
Q

What does the cervix look like sonographically?

A

Echogenic canal: may appear hypoechoic on occasion

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17
Q

What does this image demonstrate?

A

Translabial ultrasound

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18
Q

What is the length of the normal cervix?

A

Lower limit of normal is 30mm or 3cm

any shorter than 3cm = shortening or effacement

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19
Q

What are the cervix ranges for effacement?

A
  1. 15mm corresponds with 50% effacement
  2. 10 mm corresponds with 75% effacement
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20
Q

What does this image demonstrate?

A

The cervical gland area in EV

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21
Q

What is happening in the below images? Label what is happening from left to right

A
  1. Cervix is not effaced
  2. Cervix is 50% effaced
  3. Cervix is fully effaced
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22
Q

What is funneling of the cervix?

A

Defined as herniation of the fetal membranes into the internal OS, but the external os remains closed

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23
Q

Funneling of the cervix is a early sign of what/

A

Incompetent cervix

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24
Q

Funneling of the cervix has a increased risk of what?

A

Preterm delivery

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25
Q

Is it possible to carry pregnancies to term with funneling of the cervix?

A

Some pregnancies will carry to term without intervention

26
Q

When we do a Transvaginal what do we need to do?

A

Have the patient insert the probe live

27
Q

What does this image demonstrate?

A

Funneling cervix

28
Q

What does this image demonstrate?

A

Echogenic amniotic fluid sludge

29
Q

What is abnormal for a AP diameter of a dilated cervical canal?

A

> 5mm before 30 weeks

30
Q

Contractions in lower uterine segment can be confused with what?

A

Cervical incompetence

31
Q

How often does cervical incompetence happen?

A

~1 in 100 pregnancies

32
Q

What happens with cervical incompetence?

A

Cervix shorten, shortens or opens to early

33
Q

What kind of process is cervical incompetence?

A

It is a dynamic process because the cervix changes spontaneously dramatically in a short period of time

34
Q

Any one can develop cervical incompetence but there is higher risk if what? 6

A
  1. Irregular shaped cervix or uterus
  2. History of premature birth or miscarriage in the 2nd trimester
  3. Injury to cervix or uterus during a previous pregnancy
  4. History of surgery to cervix
  5. A genetic disorder like Ehlers- Danlos syndrome (which may cause cervical weakness)
  6. Expecting multiples
35
Q

Cervical incompetence can happen when?

A

Any time but typically between 14-27 weeks

36
Q

How does cervical incompetence present?

A

Presents as painless cervical dilation on US

37
Q

What is cervical incompetence similar to?

A

Preterm labour

38
Q

Cervical incompetence patients experience similar preterm labour symptoms such as what? 2

A
  1. Contractions strong enough to change the length of the cervix
  2. Cervix will shorten and dilate with these contractions
39
Q

What does normal preterm labour contractions Present like? 2

A
  1. Contractions that are changing the length of the cervix
  2. Stronger than Braxton Hicks contractions but mom has difficulty differentiating between the two
40
Q

What is cervical cerclage?

A

A purse string suture that is applied to the cervix

41
Q

When is the cervical cerclage usually inserted?

A

Between 13 and 16 weeks in patients with known incompetent cervix

42
Q

What does cervical cerclage result in?

A

Increased risk of amnionitis and rupture of membranes form the procedure

43
Q

What does this image demonstrate?

A

Cerclage

44
Q

When is cerclage placed?

A

After bulging membranes occurs

45
Q

Even if we place the cerclage after bulging membranes, what happens?

A

Still carries a 30% pregnancy loss rate

46
Q

What is important in terms of cerclage timing?

A

Early diagnosis

47
Q

How does the cerclage appear on ultrasound?

A

Appears as hyperechoic linear structure usually with acoustic shadow seen in the anterior and posterior cervix

48
Q

Ultrasound is used to assess _________ as well as _______ ______ and _____ the cerclage.

A
  1. Placement
  2. Funnelling
  3. Above
  4. Below
49
Q

What is a preterm birth?

A

Labour and/ or delivery before 37 weeks

50
Q

How often does preterm L and D happen?

A

5-10% of all pregnancies

51
Q

Even with all the careful screening has the preterm birth rate changed in the last 30 years?

A

No

52
Q

What are some clinical risks for preterm labour? 3 (what increases the risk)

A
  1. Twins, multiples
  2. Congenital malformation of the uterus
  3. Previous preterm labour
53
Q

For those with risks for preterm labour, they require what?

A

EV assessments of the cervix at each fetal assessment visit until 32 weeks gestation

54
Q

What is a low laying placenta and what does that mean for us?

A
  1. Placenta must be >2cm away from the internal OS and it is under 2cm from internal OS it will be dubbed Low lying
  2. We need to do a Cervical EV scan
55
Q

What is marginal placenta previa?

A

Placenta just touching the internal OS but not covering it

56
Q

When do we stop doing the EV scans of low laying placenta?

A

EV scanning is required at each fetal assessment visit until a minimum of 2cm is reached

57
Q

What is one thing we must always examine within the uterus?

A

Always examine the area within the uterus just superior to the internal OS of the cervix wit Colour doppler on every EV performed

58
Q

Wha is Vasa previa?

A

Vessels across the internal OS of the cervix

59
Q

What is Vasa previa associated with?

A

A succentuiate placenta

60
Q

What is a succenturiate placenta?

A

Placenta with an accessory lobe connected by vasa previa

61
Q

What is the difference between preterm labour and incompetent cervix?

A

Incompetent cervix are painless and if they had previous second trimester losses

DMST 285 OBGYN 2 (15 decks)

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