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OB GYNE 4 > 8 Doppler > Flashcards

8 Doppler Flashcards

(86 cards)

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1
Q

What is Doppler assessing?

A

fetal and maternal circulation

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2
Q

Doppler uses ___ and ___ assessment for flow patterns and measurements and referenced to gestational age

A

Qualitative - Not measured loss D flow, reversal, notching

and Quantitative

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3
Q

Methods

A
  1. CW (non stress test)
  2. PW (velocities that produce F shifts < 1/2 PRF)
  3. Color - to locate, direction, MCA on C of W
  4. Power - when direction not needed, pick up very small vessels
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4
Q

Most fetal blood investigated is less than

A

1m/sec

so we are successful with PW

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5
Q

Doppler can cause____. Color doppler adds little extra energy where PW adds alot (Dr. Zwiebel)

A

Bioeffects

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6
Q

Diastolic velocities ____ as term approaches due to ____placental resistance (larger placenta vessels)

A

Increases; decreased

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7
Q

Semiquantitative Analysis is used because it is

A

angle independent*

bc it is difficult to control angle of incidence

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8
Q

What is PI (pulsatility index)

A

PI= S-D/mean velocity

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9
Q

What is RI (resistive index)

A

RI= S-D/S

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10
Q

What is the fav Ratio outcome we use now and why?

A

PI because it will continue to show change (have value) even when diastolic flow is zero

Unlike RI when D flow 0 RI =1

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11
Q

As impedance increases the pulsatility of flow velocity ______?

A

increases

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12
Q

How many waveforms should be measured and averaged to avoid error?

A
  1. (need this)
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13
Q

3 Factors that will affect outcome blood flow in diastole for measurement

A

Tachycardia and Bradycardia
Fetal breathing.
AVOID DOPPLER DURING FETAL BREATHING. (too many different PSV)

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14
Q

During embryonic period normal to have ___ resistance flow with ____ end diastolic flow

A

HIGH; ABSENT

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15
Q

Towards end of 1st Trimester end diastolic flow____

A

appears

small vessel

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16
Q

As pregnancy progresses the end diastolic velocity ____.

A

Increases

due to vessel enlargement

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17
Q

THE easiest vessel to. asses is the?

A

Umbilical artery (2 arteries in the cord, 1 is the vein=maternal)

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18
Q

Umbilical arteries are____

A

pulsatile

bc fetal heart pumping blood back into the placenta

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19
Q

Next most common vessel is the ?

A

MCA prox to transducer

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20
Q

Third most common

A

Ductus Venousus

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21
Q

Other vessels assessed

A

Umbilical vein
Fetal aorta - rare
Fetal IVC - rare

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22
Q

What does the PI, RU and S/D ratio do with increasing gestational age?

A

decreases because the diastolic flow is increasing

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23
Q

Ratios are higher if measured at the ___ ___ of the cord

A

fetal end

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24
Q

It is recommended to measure ____ cord

A

mid

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25
With twins measure the fetal artery just outside the ____ ___ so you don't mix them up
fetal abdomen
26
Abnormal findings is decreased or absent diastolic flow causing increased RI & PI In the _______ artery
umbilical
27
_____ of ______flow in the umbilical artery is severe can cause death (too much pressure on fetal heart)
Reversed; diastolic
28
RI >___ is abnormal from ___weeks onward
0. 72 ; 26 weeks | * must use gestational age when reference a value
29
Indications for doing doppler
``` Small for gestational age IUGR need umbilical artery doppler Mom have HTN IDDM (mom type 1, prior too) TTTS (monochoionic, 1 donor, 1 receipt) poor growth in both twins due to placental insuff. ```
30
Umbilical ARTERY Doppler Normally = Forward flow through ___ phases of the cardiac cycle
ALL
31
Umbilical ARTERY Absent ______flow is ABNORMAL and means the blood is stoping when the babies heart is relaxing. As well as _____ flow, opposite direction, severe destress.
Diastolic; reversed
32
With the fetal aorta you are sampling the ?
descending aorta, just about diaphragm
33
Appearance of the aorta is similar to the ____ artery but changes are noticed in aorta 1st. Decreased, absent or reversed diastolic flow same indications.
umbilical
34
What artery is used to assess brain sparing with IUGR fetuses?
MCA
35
What is poor perfusion called when baby shunt blood to head but body isn't growing at rate it should be, kidneys, less fluid, oligo?
Brain-sparing effect
36
CU ratio = ?
MCA PI/Umbilical Artery PI
37
With Anemia there will be ____ systolic velocity due to ____viscosity of blood (bc of decreased hematocrit)
Increased; decreased * (blood is runnier) *The PSV will increase with gestation
38
With Anemia what artery is looked at?
MCA for IMMUNE HYDROPS (Rh- incompatibility babies, mom sensitized from 1st pregnancy, can't have any transfer of blood, bc has antibodies)
39
And amnocentesis is required and possible blood transfusion if MCA measures?
>1 m/sec
40
Explain how to Measure MCA? (5)
``` Angle slightly caudal from BPD Measure MCA closest to transducer Must have MCA flow parallel with sound beam **0 Degree angulation Sample at prox segment MCA ```
41
What are we looking for with MCA sample in immune hydrops?
PSV *if not 0 = peaks are not seen well.
42
When fetal head is low or trouble with MCA what should you do?
give fetus a rest | pressure on head can cause distress abnormal waveform
43
The umbilical VEIN during embryonic period is?
pulsatile
44
The umbilical VEIN from 2nd trimester on should be?
NON pulsatile | *if pulsatile CHF? (tricuspid regurg)
45
The umbilical vein can be sampled in fetal __ or ___
abdomen or cord
46
Where is the Ductus Venosus is located
connector bw LPV and IVC
47
Ductus Venosus flow is?
biphasic
48
ABNORMAL Ductus Venosus is
flow go below the baseline
49
Ductus Venosus measurment is used with?
TTTS - recipient twin too much blood see blood below the baseline with TR.
50
Ductus Venosus is the regulator of?
oxygen to fetus | half blood returning from placenta is directed thru DV
51
Ductus Venosus scanning protocol
Level of AC Color of the umbilical vein sweep posterior towards fetal spine locate TURBULENT flow vessel (due to narrow lumen)
52
S wave = systolic peak D-rapid filling of ventricles A=?
Atrial contraction
53
What is abnormal Ductus Venosus waveform?
A wave reversal
54
IVC is what type of waveform?
Triphasic close to heart | Biphasic further away
55
Where should we measure IVC?
below diaphragm (away from heart)
56
PI ____ with fetal hypoxia/asphyxia (low oxygen)
Increases
57
IUGR- hypoxia/asphyxia waveform will show?
REVERSED flow in umbilical artery INCREASED DIASTOLIC flow in MCA IUGR indicates that the placental resistance is rising
58
Abnormal value of ____ is abnormal in 1st trimester and may predict placental insufficiency or Pre-eclampsia
PAPP-A
59
_____ in the uterine artery is abnormal
notching
60
Doppler in Gynecology is?
EV
61
When to use Doppler in Gynecology
Persistant trophoblastic disease Neoplasia or tumors AV fistulas
62
Uterine Artery doppler abnormalities can cause low resistance flow and cause
``` uterine fibroid (leiomyoma) or endo cancer ```
63
Arcuate vessels after baby can?
calcify
64
Endo carcinoma always use
Doppler with EV
65
With Endo polyps use color doppler to?
look for feeding vessel (stalk)
66
Ovarian Doppler with EV to look for? and you must use?
Torsion; spectral as well!
67
With an ovarian neoplasm you will see increased?
diastolic flow
68
What can look like neoplasm flow and be mistaken for mass?
CLC
69
Ovarian Doppler varies with _____cycle so need to know what cycle they're in.
menstrual
70
Ovary with dominant follicle ?
PI and RI decreased and increased flow in ovary
71
ovary without dominant follicle?
low or absent diastolic flow | changes with pregnancy
72
Ovarian Doppler Malignant lesions tend to have more of a ?
Central flow
73
Ovarian Doppler Benign lesions tend to have more of a ?
Peripheral flow
74
Perfect world pelvic US performed on day __ to __ to avoid confounding ovarian and endometrial findings, when we see large CLC
5-9
75
Paraovarian cysts may have a
papillae | more suggestive of ovarian cancer
76
Cogwheel sign is with ?
PID
77
Granulosa cell tumor produces hormones causes?
thickened endometrium
78
High distolic flow, low resistive flow = ___tumor
malignant (lots of flow)
79
Use power doppler small ___ and low ___
ROI (box); PRF
80
Inflammation of vein caused by clot, rare and associated with Postpartum, malignancies, PID is called?
Postpartum Ovarian Vein Thrombophlebitis *INCREASE RISK WITH C-SECTION PTs
81
What is Virchow's Triad?
1. Hypercoagulability in pregnancy 2. Venous stasis 3. Vessel damage due to UT expanding and contracting
82
In Postpartum Ovarian Vein Thrombophlebitis | What ovarian vein occurs more frequently ?
Right 80-90% | can use CT, MRI and US
83
Postpartum Ovarian Vein Thrombophlebitis | Sonography appears as?
tubular hypoechoic structure LACKING color | assess IVC for clot invasion
84
DDX for Postpartum Ovarian Vein Thrombophlebitis
Appendicitis fibroids neprolithiasis Tubo-ovarian abscess
85
Pelvic congestion symptoms and associations?
unknown cause Chronic dull ache, pain. associated with multiple babies and LE varices
86
Pelvic congestion appearance
multiple tubular structures, dilated pelvic veins, color seen.

OB GYNE 4 (11 decks)

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