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OBGYN 1 > 7.2 18 Wk Detailed scan > Flashcards

7.2 18 Wk Detailed scan Flashcards

(64 cards)

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1
Q

what should we be assessing and documenting in our initial overall sagittal sweep?

A

In the over all sweep, sweep from fundus to cervix to assess for fetal lie

  • image the fundus and the cervix (measure the cervix)
  • check for fetal HR
  • check # of fetuses
  • check for amniotic fluid
  • placental location
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2
Q

when we do our overall TRX sweep along the lateral aspect of the uterus and adnexa what are we assessing/looking for?
how would we document these finds?

A

-looking for fibroids on the uterus
… document in 2 planes, measure and doppler

-looking for an adnexal mass on the ovary, usually the corpus luteum or a dermoid cyst
… document in 2 planes, measure and doppler

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3
Q

what is a dermoid cyst

A

cyst that contains all germ cell tissue (endoderm, mesoderm, ectoderm)

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4
Q

what are we assessing/documenting when looking at the placenta?

A
  • postion (low or normal)
  • texture
  • measuring the distance from the lower placenta edge to the internal os
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5
Q

what is the minimum distance that the lower placental edge should be from the internal os of the cervix?

A

minimum 2cm from the internal os

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6
Q

what risks does a short cervix pose?

A

risk for preterm delivery

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7
Q

what should the cervix measure?

A

~30mm

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8
Q

when very superior, how will the fetal head shape appear?

A

round

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9
Q

list the cranial images we take

A 
BPD, OFD, HC
ventricular image
bilateral choroid image
cerebellar/posterior fossa image
orbital image
nose, lips image
profile
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10
Q

what does the BPD level assess?

A 
cavum septi pellucidi
third ventricle
ambient cistern
falx
head shape
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11
Q

what does the bilateral chord image assess

A

echotexture of both choroids (should be smooth)… check for cysts

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12
Q

what does the cerebellar image or level assess?

A
  • prescence of the vermis
  • cerebellar size
  • cisterna magna
  • nuchal fold
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13
Q

what is micropthalmia?

A

small eyes

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14
Q

what is anopthalima? how do we rule this out?

A

no eyes

R/O by seeing lenses

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15
Q

what is the nose/lip image used to assess?

A

assessing for cleft lip and abnormal nostrils

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16
Q

what is the profile image used to assess?

A

assess chin for micro or retrognathia… and nasal bone to see if its present, absent or hypoplastic

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17
Q

what is micrognathia?

what is retrognathia?

A

micro: small chin
retro: receding chin (normal size)

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18
Q

what should a normal nasal bone measure?

A

> 2.5mm

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19
Q

when you see the three ossification centres of the spine, what does the 1 anterior and 2 posterior ossification centres represent?
are any other areas of the fetal spine visible on US?

A

anterior: vertebral body
post: laminar junctions/lamina

NO

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20
Q

as gestration progresses, how do the laminar junctions ossify?

A

into a linear structure

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21
Q

when is ossification complete?

A

at 18 wks

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22
Q

in what two plane should the spine be imaged?

A

SAG and TRX…. coronal is acceptable is SAG isnt possible

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23
Q

how many images of the spine do we take in SAG?

A

two

1: at the distal end to include the sacrum (lumbar)
2: at the cephalic end to include the cervical spine and skull

include as many vertebral ossifications as possible

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24
Q

is it the most important to sweep the spine in TRX or SAG?

A

TRX

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25
how many images of the spine do we take in TRX? | what must they/it include?
one: at the lumbosacral junction/sacrum must include both iliac crests and 3 ossification centres... must also show bladder
26
in what area would we see a neural tube defect when scanning the fetal spine?
lumbosacral area in SAG
27
what is the AC image used to assess?
-presence of stomach and position of organs (cytosinverses- stomach on right) ... dont confuse GB with stomach
28
whats a term used in OB that refers to the confluence of the umbilical vein and the L portal vein?
portal sinus
29
which vein becomes the lig theres after birth?
fetal umbilical vein
30
in general, what are we assessing when scanning the fetal heart?
- size of chambers and valve placement | - m mode for fetal HR (though the atria and ventricles to check for heart block)
31
what what level would you do a chest circumference if necessary?
4CH view of the heart
32
the heart occupied how much of the fetal chest?
1/3
33
what are we assessing when imaging the outflow tracts (RVOT & LVOT) of the heart?
looking to R/O great vessel abnormalities (RVOT and LVOT long axis look the same as PLAX RVOT and PLAX) also looking at lungs
34
what % of heart abnormalities are detected in the 3 vessel view?
90-95%
35
how does the fetal heart lie in the chest?
in a horizontal plane
36
whats the purpose of doing a SAG assessment of the abdomen and chest? what structures are included in this image?
- look for location of stomach compared to diaphragm - look at echo texture of lungs compared to liver heart, diaphragm, stomach,
37
how should the echo texture of lungs compared to liver?
liver should be isoechoic to lungs in 2nd trimester then increase in echogenicity when compared to liver in 3rd trimester
38
how does the diaphragm appear on US?
hypoechoic b/c theres not air in the lungs
39
how will the sm and lg bowel appear? | diameter of lg bowel at term
sm: clusters of rings surrounded by the lg bowel lg: in the 3rd trimester lg bowel will look hypoechoic and prominent 17mm
40
are the kidneys distinctively seen in 2nd trimester? | 3rd trimester?
no | yes, pyramids and calyces are well seen
41
upper limit of norm for renal pelvis | what can it indicate if they're enlarged?
5mm is upper limit, normal is 3 mm T21
42
how do we take the kidney image?
in TRX with the spine in the middle, must see renal pelvis
43
when would you do a SAG image of the kidneys
if abnormalities like hydronephrosis and renal cysts are detected
44
is kidney length approximately equal to gestation age?
yes
45
how often should the bladder empty and fill?
very 20 mins
46
at what level do we find and document the 2 umbilical arteries?
the level of the bladder... document and use colour doppler or power doppler
47
do the umbilical arteries carry oxygenated or deoxygenated blood?
deoxy.
48
how will the waveform of the umbilical arteries appear?
will have an arterial waveform due to babys cardiac activity
49
how many vessels does the umbilical cord have? | in what plane do we image the vessels?
3: 2 arteries, 1 vein TRX to document all 3
50
why do we image the cord inserting into the fetal abdo and the placenta?
- checking for abdo wall defects (omphalocele- liver outside the abdo) - checking for where the old inserts... should be more than 2 cm in from the edge of the placenta
51
when can the genitalia be seen
if fetus is laying face up with legs apart
52
when do testicles descend?
28 wks
53
when is the humerus measured?
at 2nd trimester detailed scan
54
describe the appear of the radius and ulna on US
ulna: medial, thinner and longer radius: lateral, thicker and shorter
55
what does it indicate if you can image the tib, fib and all toes at the same time?
club foot
56
should the tib or the fib be larger?
tib is larger
57
when would you measure all long bones?
with certain syndromes or chromosomal abnormalities which would make them look abnormal
58
is the AFI performed at the detailed 18 wks scan?
no
59
what type of assessment is done at 18 wks? | amniotic fluid volume increases until how many weeks?
subjective assessment of fluid (increased or decreased) 34 wks, then it decreases
60
which structures contribute to the amount of amniotic fluid (AF) in the uterus?
fetal urinary sys umbilical cord lungs skin
61
what is the vernix?
waxy substance that covers babys skin, may be seen floating in AF
62
why does supine hypotension occur?
baby is compressing moms IVC
63
where does the fetal umbilical vein course?
through the falciform ligament
64
Which long bone in the arm can be missing in a lot of syndromes?
Radial bone

OBGYN 1 (24 decks)

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