12. OB Flashcards
(92 cards)
1
Q
Menstrual Age:
A
Embryologic Age + 14 days
2
Q
Embryo:
A
0-10 weeks (menstrual age)
3
Q
Fetus:
A
> 10 weeks (Menstrual age)
4
Q
Bleeding with closed cervix
A
Threatened abortion
5
Q
Cervical dilation and/or placental and/or fetal tissue hanging out
A
Inevitable abortion
6
Q
Residual products in the uterus
A
Incomplete abortion
7
Q
All products out
A
Complete abortion
8
Q
Fetus is dead, but still in the uterus.
A
Missed abortion
9
Q
This is the early gestational sac.
A
Intradecidual sign
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
11
Q
You can see the early gestational sac around =
A
4.5 weeks
12
Q
A
Double Decidual Sac sign
This is another positive sign of early pregnancy.
13
Q
This is the first structure visible within the GS.
A
Yolk Sac
14
Q
You should always see the Yolk sac when the GS measures =
A
8 mm
15
Q
A
Yolk Sac
Should be oval or round, fluid filled, and smaller than 6 mm.
16
Q
Where is the yolk sac located?
A
Chorionic Cavity and hooked up to the umbilicus by the vitelline duct
17
Q
Normal Appearance of the Yolk Sac
A
Should NOT be:
Too big (> 6mm)
Too small (< 3 mm)
Solid
Calcified
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.
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
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
21
Q
This is typically used to estimate gestational age, and is more accurate than menstrual history.
A
Crown Rump Length
22
Q
Embryo is normally visible at =
A
6 weeks
23
Q
A gestational sac without an embryo. When you see this, the choices are:
A
a. Very Early Pregnancy
b. Non-viable Pregnancy
24
Q
You should see yolk sac on TVS at ___mm.
A
8 mm
25
Large sac (>8-10mm) + Distorted contour + NO yolk sac =
Non-VIable pregnancy
26
Pseudogestational Sac
"blood in the uterine cavity with surrounding bright decidual endometrium (charged up from the pregnancy hormones)"
27
small subchorionic hemorrhage that occurs at the attachment o f the chorion to the endometrium.
Implatation Bleeding
28
Fetal demise in subchorionic hemorhage is strongly associated with?
% of placental detachment
29
Crown-rump length of >7 mm and no heartbeat
Pregnancy Failure
30
Mean sac diameter o f >25 mm and no embryo
Pregnancy Failure
31
No embryo with heartbeat > 2 wks after a scan that showed a Gestational saca withouth yolk sac
Pregnancy Failure
32
No embryo with heartbeat >11 days after a scan that showed a gestational sac with a yolk sac
Pregnancy Failure
32
No embryo >6 wk after last menstrual period
Suspicious for Pregnancy Failure
33
Mean sac diameter of 16-24 mm and no embryo
Suspicious for Pregnancy Failure
34
No embryo with heartbeat 13 days after a scan that showed a gestational sac without a yolk sac
Suspicious for Pregnancy Failure
35
No embryo with heartbeat 10 days after a scan that showed a gestational sac with a yolk sac
Suspicious for Pregnancy Failure
36
This is the vocabulary used when neither a normal lUP or ectopic pregnancy is identified in the setting of a positive b-hCG.
Pregnancy of Unknown Location
37
Typically this just means it is a very very early pregnancy, but you can’t say that with certainty.
Pregnancy of Unknown Location
38
3 possibilities in the case of Pregnancy of Unknown Location
1. Normal early pregnancy
2. Occult Ectopic
3. Complete Miscarriage
39
Pregnancy of Unknown Location management:
Follow up (Serial b-hCG) and repeat US
40
The following increase the risk of ectopic pregnancy:
Being a free spirit (Hx of FID)
Tubal Surgery
Endometriosis
Ovulation Induction
Previous Ectopic
Use of an lUD.
41
The majority of ectopic pregnancies (nearly 95%) occur in
Fallopian Tube (AMPULLA)
2% are interstitial = portion of the tube which passes through the uterine wall
42
Interstitial ectopic implantation risk
Rupture = hemorrhage
43
Always start down the ectopic pathway with =
(+) BhCG - 1500-2000 mIU/L - you should see a gestational sac
44
BhCG at around 5000 mIU/L, you should see =
A yolk sac
45
General rule about BhCG in ectopic pregnancy
Normal doubling time = ectopic less likely
46
Tubal Ring Sign - 95% specific
"An echogenic ring, which surrounds an un-ruptured ectopic
pregnancy"
This is an excellent sign of ectopic pregnancy
47
Live Pregnancy / Yolk Sac outside the uterus =
Slamt dunk! ==== ECTOPIC!
48
Nothing in the uterus + anything on the adnexa (other than corpus luteum) =
75%-85% for ectopic
if + moderate volume of free fluid = 87% positive
49
Nothing in the uterus + moderate free fluid =
70% PPV
More risk if the fluid is echogenic
50
Where is BPD measured?
Recorded at the level of the thalamus from the outeiinost edge of the near skull to the inner table of the far skull
51
Abdominal Circumference is recorded at =
the junction o f the umbilical vein and left portal vein
52
Femur Length
Longest dimension of the femoral shaft
NOT included = epiphysis
53
Age in the first trimester is made from
CRL
54
Second and third trimester estimates for age are typically done using
BPD
HC
AC
FL
55
Gestation Age accuracy
1st =
2nd =
3rd =
1st = CRL 0.5 weeks
2nd = 1.2 weeks (between 12-18)
3rd = 3.1 weeks (between 36 and 42)
56
Readings Suggestive of iUGR:
Estimated Fetal Weights Below 10th percentile
Femur Length / Abdominal Circumference Ratio (F /AC) > 23.5
Umbilical Artery Systolic / Diastolic Ratio > 4.0
57
Most common cause for developing oligohydramnios during the 3rd trimester
= Fetal Growth Restriction associated with Placental Insufficiency.
58
IUGR + 3rd trimester = Normal head + small body + Mom with pre-eclampsia =
Asymmetric IUGR
59
IUGR + throughout pregnancy = small overall (head not spared + poor prognosis =
Symmetric IUGR
60
Causesof Symmetric IUGR
TORCH
Fetal alcohol syndrome
Drug abus
Chromososmal abnormalities
Anemia
61
Where is MCA doppler done?
Proximal 1/3 of the vessel
62
Normal fetal MCA
should be a high resistance waveform with continuous forward flow of diastole (the space between the waveform peaks).
63
Abdnormal fetal MCA
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
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.
Cerebroplacental Ratio
Cerebroplacental Ratio: >1:1 is normal
65
This thing was developed to look for acute and chronic hypoxia.
Biophysical profile
66
Components of Biophysical Profile
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
What component of Biophysical Profile is used to assess chronic hypoxia
Amniotic fluid
68
Macrosomia causes
Maternal DM
69
Complications of Macrosomia during delivery
Brachial plexus injury
Neonatal hypoglycemia
Meconium aspiration
70
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).
Erb's Palcy
71
Erb's Palsy
Aplastic or hypoplastic humeral head/glenoid in a kid
72
Early on, the fluid in the amnion and chorionic spaces is the result of
Filtrate from the membranes
73
The amniotic is made by the fetus at week?
after 16 weeks
74
The balance o f too much (polyhydramnios) and too little (oligohydramnios) is maintained by
swallowing of the urine and renal function
75
if you have too little amniotic fluid you should think
kidneys aren't working
76
If you have too much amniotic fluid you should think
swallow or other GI problems
77
the most common cause of polyhydramios
Maternal DM
78
Made by measuring the vertical height of the deepest fluid pocket in each quadrant of the uterus, then summing the 4 measurements.
Amniotic Fluid Index.
79
Normal AFI
5-20 cm
80
Polyhydramnios is defined as
AFI > 20 cm, or single fluid pocket > 8 cm
81
Oligohydramnios is a frequent finding in
IUGR related to placental insufficiency
82
There should be less than __ mm of separation of the choroid plexus from the medial wall of the lateral ventricle.
If more = think of
< 3 mm
If more = ventriculomegaly
83
Normal Cisterna magna measurement
Too small =
Too large =
2 - 11 mm
Too small = Chiari II
Too large = Dandy Walker
84
the lung of the fetus should be similar in appearnce to the
LIVER - homogeneously echogenic
85
Calcified papillary muscle is associated with increased risk of?
Downs
"Echogenic foci in the ventricle"
86
Bowel should be less than ___ mm in diameter
Bowel should be less than 6mm in diameter.
87
Bowel can be moderately echogenic in the 2nd and 3rd trimester but should never be more than
Bone
88
Adrenals are how many times largert than their relative adult size?
20x
89
There are two main ways to show a two vessel cord
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
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
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.
