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6. REPRODUCTIVE > 12. OB > Flashcards

12. OB Flashcards

1
Q

Menstrual Age:

A

Embryologic Age + 14 days

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2
Q

Embryo:

A

0-10 weeks (menstrual age)

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3
Q

Fetus:

A

> 10 weeks (Menstrual age)

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4
Q

Bleeding with closed cervix

A

Threatened abortion

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5
Q

Cervical dilation and/or placental and/or fetal tissue hanging out

A

Inevitable abortion

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6
Q

Residual products in the uterus

A

Incomplete abortion

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7
Q

All products out

A

Complete abortion

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8
Q

Fetus is dead, but still in the uterus.

A

Missed abortion

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9
Q

This is the early gestational sac.

A

Intradecidual sign

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10
Q
A

Intradecidual sign

You want to see the thin echogenic line o f the uterine cavity pass by (not stop at) the sac to avoid calling a little bit o f fluid in the canal a sac

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11
Q

You can see the early gestational sac around =

A

4.5 weeks

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12
Q
A

Double Decidual Sac sign

This is another positive sign of early pregnancy.

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13
Q

This is the first structure visible within the GS.

A

Yolk Sac

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14
Q

You should always see the Yolk sac when the GS measures =

A

8 mm

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15
Q
A

Yolk Sac

Should be oval or round, fluid filled, and smaller than 6 mm.

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16
Q

Where is the yolk sac located?

A

Chorionic Cavity and hooked up to the umbilicus by the vitelline duct

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17
Q

Normal Appearance of the Yolk Sac

A

Should NOT be:

Too big (> 6mm)
Too small (< 3 mm)
Solid
Calcified

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18
Q

The membranes of the amniotic sac and chorionic space
typically remain separated by a thin layer of fluid around

A

14-16 weeks at which point fusion is normal.

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19
Q

Amniotic Band Syndrome

A

If the amnion gets disrupted before 10 weeks = fetus might cross into the chorionic cavity = get tangled up in the fibrous bands

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20
Q
A

Double Bleb Sign

“Two fluid filled sacs (Yolk and Amniotic) with the flat embryo in the middle

This is the earliest visualization of the embryo

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21
Q

This is typically used to estimate gestational age, and is more accurate than menstrual history.

A

Crown Rump Length

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22
Q

Embryo is normally visible at =

A

6 weeks

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23
Q

A gestational sac without an embryo. When you see this, the choices are:

A

a. Very Early Pregnancy
b. Non-viable Pregnancy

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24
Q

You should see yolk sac on TVS at ___mm.

A

8 mm

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25
Q

Large sac (>8-10mm) + Distorted contour + NO yolk sac =

A

Non-VIable pregnancy

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26
Q
A

Pseudogestational Sac

“blood in the uterine cavity with surrounding bright decidual endometrium (charged up from the pregnancy hormones)”

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27
Q

small subchorionic hemorrhage that occurs at the attachment o f the chorion to the endometrium.

A

Implatation Bleeding

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28
Q

Fetal demise in subchorionic hemorhage is strongly associated with?

A

% of placental detachment

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29
Q

Crown-rump length of >7 mm and no heartbeat

A

Pregnancy Failure

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30
Q

Mean sac diameter o f >25 mm and no embryo

A

Pregnancy Failure

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31
Q

No embryo with heartbeat > 2 wks after a scan that showed a Gestational saca withouth yolk sac

A

Pregnancy Failure

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32
Q

No embryo with heartbeat >11 days after a scan that showed a gestational sac with a yolk sac

A

Pregnancy Failure

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32
Q

No embryo >6 wk after last menstrual period

A

Suspicious for Pregnancy Failure

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33
Q

Mean sac diameter of 16-24 mm and no embryo

A

Suspicious for Pregnancy Failure

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34
Q

No embryo with heartbeat 13 days after a scan that showed a gestational sac without a yolk sac

A

Suspicious for Pregnancy Failure

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35
Q

No embryo with heartbeat 10 days after a scan that showed a gestational sac with a yolk sac

A

Suspicious for Pregnancy Failure

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36
Q

This is the vocabulary used when neither a normal lUP or ectopic pregnancy is identified in the setting of a positive b-hCG.

A

Pregnancy of Unknown Location

37
Q

Typically this just means it is a very very early pregnancy, but you can’t say that with certainty.

A

Pregnancy of Unknown Location

38
Q

3 possibilities in the case of Pregnancy of Unknown Location

A
  1. Normal early pregnancy
  2. Occult Ectopic
  3. Complete Miscarriage
39
Q

Pregnancy of Unknown Location management:

A

Follow up (Serial b-hCG) and repeat US

40
Q

The following increase the risk of ectopic pregnancy:

A

Being a free spirit (Hx of FID)
Tubal Surgery
Endometriosis
Ovulation Induction
Previous Ectopic
Use of an lUD.

41
Q

The majority of ectopic pregnancies (nearly 95%) occur in

A

Fallopian Tube (AMPULLA)

2% are interstitial = portion of the tube which passes through the uterine wall

42
Q

Interstitial ectopic implantation risk

A

Rupture = hemorrhage

43
Q

Always start down the ectopic pathway with =

A

(+) BhCG - 1500-2000 mIU/L - you should see a gestational sac

44
Q

BhCG at around 5000 mIU/L, you should see =

A

A yolk sac

45
Q

General rule about BhCG in ectopic pregnancy

A

Normal doubling time = ectopic less likely

46
Q
A

Tubal Ring Sign - 95% specific

“An echogenic ring, which surrounds an un-ruptured ectopic
pregnancy”

This is an excellent sign of ectopic pregnancy

47
Q

Live Pregnancy / Yolk Sac outside the uterus =

A

Slamt dunk! ==== ECTOPIC!

48
Q

Nothing in the uterus + anything on the adnexa (other than corpus luteum) =

A

75%-85% for ectopic

if + moderate volume of free fluid = 87% positive

49
Q

Nothing in the uterus + moderate free fluid =

A

70% PPV

More risk if the fluid is echogenic

50
Q

Where is BPD measured?

A

Recorded at the level of the thalamus from the outeiinost edge of the near skull to the inner table of the far skull

51
Q

Abdominal Circumference is recorded at =

A

the junction o f the umbilical vein and left portal vein

52
Q

Femur Length

A

Longest dimension of the femoral shaft

NOT included = epiphysis

53
Q

Age in the first trimester is made from

A

CRL

54
Q

Second and third trimester estimates for age are typically done using

A

BPD
HC
AC
FL

55
Q

Gestation Age accuracy

1st =

2nd =

3rd =

A

1st = CRL 0.5 weeks

2nd = 1.2 weeks (between 12-18)

3rd = 3.1 weeks (between 36 and 42)

56
Q

Readings Suggestive of iUGR:

A

Estimated Fetal Weights Below 10th percentile

Femur Length / Abdominal Circumference Ratio (F /AC) > 23.5

Umbilical Artery Systolic / Diastolic Ratio > 4.0

57
Q

Most common cause for developing oligohydramnios during the 3rd trimester

A

= Fetal Growth Restriction associated with Placental Insufficiency.

58
Q

IUGR + 3rd trimester = Normal head + small body + Mom with pre-eclampsia =

A

Asymmetric IUGR

59
Q

IUGR + throughout pregnancy = small overall (head not spared + poor prognosis =

A

Symmetric IUGR

60
Q

Causesof Symmetric IUGR

A

TORCH
Fetal alcohol syndrome
Drug abus
Chromososmal abnormalities
Anemia

61
Q

Where is MCA doppler done?

A

Proximal 1/3 of the vessel

62
Q

Normal fetal MCA

A

should be a high resistance waveform with continuous forward flow of diastole (the space between the waveform peaks).

63
Q

Abdnormal fetal MCA

A

When the fetal brain experiences hypoxia there is a reflex response to protect the brain. This “brain-sparing reflex” will manifest early on as an increase in diastolic flow (less resistance).

64
Q

This is a ratio of the pulsatility in the MCA and Umbilical Artery that is used to evaluate the brain sparing reflex and predict outcomes.

A

Cerebroplacental Ratio

Cerebroplacental Ratio: >1:1 is normal

65
Q

This thing was developed to look for acute and chronic hypoxia.

A

Biophysical profile

66
Q

Components of Biophysical Profile

A
  1. Amniotic fluid
  2. Fetal movement = 3 movements
  3. Fetal tone = 1 ext from flex
  4. Fetal breathing = 1 episode lasting 30 sec
  5. Non-stress test = 2 or more FHR accelerations at least 15 bpm for 30 sec or longer
67
Q

What component of Biophysical Profile is used to assess chronic hypoxia

A

Amniotic fluid

68
Q

Macrosomia causes

A

Maternal DM

69
Q

Complications of Macrosomia during delivery

A

Brachial plexus injury
Neonatal hypoglycemia
Meconium aspiration

70
Q

Injury to the upper trunk o f the brachial plexus (C5-C6), most commonly seen in shoulder dystocia (which kids with macrosomia are at higher risk for).

A

Erb’s Palcy

71
Q
A

Erb’s Palsy

Aplastic or hypoplastic humeral head/glenoid in a kid

72
Q

Early on, the fluid in the amnion and chorionic spaces is the result of

A

Filtrate from the membranes

73
Q

The amniotic is made by the fetus at week?

A

after 16 weeks

74
Q

The balance o f too much (polyhydramnios) and too little (oligohydramnios) is maintained by

A

swallowing of the urine and renal function

75
Q

if you have too little amniotic fluid you should think

A

kidneys aren’t working

76
Q

If you have too much amniotic fluid you should think

A

swallow or other GI problems

77
Q

the most common cause of polyhydramios

A

Maternal DM

78
Q

Made by measuring the vertical height of the deepest fluid pocket in each quadrant of the uterus, then summing the 4 measurements.

A

Amniotic Fluid Index.

79
Q

Normal AFI

A

5-20 cm

80
Q

Polyhydramnios is defined as

A

AFI > 20 cm, or single fluid pocket > 8 cm

81
Q

Oligohydramnios is a frequent finding in

A

IUGR related to placental insufficiency

82
Q

There should be less than __ mm of separation of the choroid plexus from the medial wall of the lateral ventricle.

If more = think of

A

< 3 mm

If more = ventriculomegaly

83
Q

Normal Cisterna magna measurement

Too small =
Too large =

A

2 - 11 mm

Too small = Chiari II
Too large = Dandy Walker

84
Q

the lung of the fetus should be similar in appearnce to the

A

LIVER - homogeneously echogenic

85
Q

Calcified papillary muscle is associated with increased risk of?

A

Downs

“Echogenic foci in the ventricle”

86
Q

Bowel should be less than ___ mm in diameter

A

Bowel should be less than 6mm in diameter.

87
Q

Bowel can be moderately echogenic in the 2nd and 3rd trimester but should never be more than

A

Bone

88
Q

Adrenals are how many times largert than their relative adult size?

A

20x

89
Q

There are two main ways to show a two vessel cord

A

The first one is a single vessel running lateral to the bladder down by the cord insertion

The second is to show the cord in cross section with two vessels.

90
Q
A

Normal Cystic Rhombencephalon (6-8 weeks)

cystic structure in the posterior fossa around 6-8 weeks

D on’t call it a Dandy-Walker malformation, for sure that will be a distractor.
Welcome to your nightmare, bitch! j

91
Q
A

Physiologic Midgut Herniation

The midgut normally herniates into the umbilical cord around 9-11 weeks

Don’t call it an omphalocele, for sure that will be a distractor.

6. REPRODUCTIVE (17 decks)

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