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Fetal Spine Pathology Flashcards

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1
Q

Each vertebra will develop from

A

Three ossification centres

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2
Q

What forms the central portion of the vertebral body

A

Centrum

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3
Q

What will the 2 neural processes form

A 
Pedicles
Transverse processes 
Laminae
Spinous process 
Posterolateral part to the vertebral body
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4
Q

When is the ossification of the laminae complete

A

18weeks

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5
Q

What could be missed potentially if a fetus is scanned before 18weeks

A

Spina bifida

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6
Q

What increases the risk of NTD

A 
Valproate acid
Folic acid deficiency 
History of spinal defect 
-previous pregnancy 
-Fx of NTD
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7
Q

What is a spina bifida

A

Defect in the structure of the spinal canal that may result in the herniation of its contents

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8
Q

What are the contents contained in a spina bifida

A

Meninges
CSF
Neural tissue

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9
Q

A spina bifida is a

A

NTD

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10
Q

What are other NTD

A

Encephalocele

Anencephaly

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11
Q

What are the different variations of Spina Bifida

A

Spina bifida occulta

Spina bifida aperta

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12
Q

What does a spina bifida occulta involve

A

Only the deeper layers

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13
Q

What may only be seen in a spina bifida occulta

A

A skin dimple or patch of hair on the skin

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14
Q

Is a spina bifida occulta a open or closed defect

A

Closed

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15
Q

What layers does a spina bifida aperta involve

A

All layers- from dura to skin

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16
Q

Is spina bifida aperta a open or closed defect

A

Open

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17
Q

What are the 2 types of spina bifida aperta

A

Meningocele

Myelomeningocele

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18
Q

What is a meningocele

A

Only meninges protrude with CSF

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19
Q

What is a myelomeningocele

A

Protrusion that contains meninges, CSF and neural tissue

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20
Q

AFP is produced by the

A

Fetal liver

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21
Q

When is the quad screen done

A

At week 16

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22
Q

What does AFP cross

A

Placenta

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23
Q

What must be considered for the levels of AFP

A

Gestational age, since the levels vary with age

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24
Q

MS AFP is elevated with what

A

NTD that are not covered by skin

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25
What causes the MS AFP to be elevated
``` Abdominal wall defects Multifetal pregnancies Fetal death Urinary obstruction Cystic hygroma Incorrect dates ```
26
What is the most common reason AFP will be elevated
Incorrect dates
27
NTE usually occur where
In the lumbrosacral spine
28
What is a NTD associated with
Meckel grub are syndrome Trisomy 18 Triploidy
29
What is Spinal dysraphism
Abnormal closure of the spine | Also called rachischisis
30
What does rachischisis mean
Spinal dysraphism, or failure of fusion of the vertebral arches
31
The level of the NTD corresponds to which landmarks
T-12 most distal rib L-5 superior margin of iliac wing S-4 most caudal ossification center in 2nd trimester
32
The higher the defect the neural tube what will happens to the fetus
The more defects it will have
33
What is also effected when there is a NTD
Legs
34
What will happen to the legs with a NTD
Clubfoot and hip dislocation ebcause of an imbalance of muscular activity due to nerve involvement or impairment of neural tube defect
35
What is the US appearance of a NTD
Splayed laminae | Protruding mass or cyst
36
When there is a NTD what should also be looked
Arnold chiari II malformation | Ventriculomegaly
37
Assessment of the spine is best done in what plane
Transverse
38
What is the prognosis of a NTD
Dependant on location and extent
39
What is iniencephaly
Special case of dysraphism involving the back of the cranium and c-spine
40
What does inien refer to
Nape of the neck
41
What causes iniencephaly
Segmentation error of the upper spine that shortens the neck and the head becomes dorsiflexed
42
What is iniencephaly known as
Star gazing position
43
What can iniencephaly be associated with
Anencephaly
44
What is scoliosis
Lateral curvature of the spine
45
What is kyphosis
Exaggerated curvature of the spine in the Sagittal plane
46
What would you expect to see in the brain with iniencephaly
Hydrocephalus
47
What are scoliosis and kyphosis associated with
Amniotic band syndrome Skeletal dysplasia VACTERL Caudal regression syndrome
48
Who had a increased risk for having a fetus with caudal regression
Mother with maternal diabetes
49
What is caudal regression
Range of anomalies of the spine from absence of part of the sacrum to absence of lumbar spine
50
What is sirenomelia
``` Absence of sacrum Fusion of the legs Rectal atresia Renal dysgenesis or agenesis Oligohydraminos ```
51
What is the prognosis for sirenomelia
Fatal, all die in infancy
52
What is the most severe form of caudal regression
Sirenomelia
53
What does a sacrococcygeal teratoma contain
Elements of many tissues
54
Where can teratomas arise from
Sacrum or coccyx Brain Gonads
55
What are the four types of sacrococcygeal teratomas
External mass predominant Eternal mass with internal components Internal mass predominant with smaller external component Presacral mass
56
What is the appearance of sacrococcygeal teratoma on US
Mass in rump or buttocks area adjacent to spine | Displaces the pelvic structures and may compress the ureters causing hydronephrosis
57
If there is AV shunting from sacrococcygeal teratoma what might be seen
Heart failure
58
What is the echotexture of a sacrococcygeal teratoma
85% are solid/mixed 15% cystic Possible to see calcifications
59
If a sacrococcygeal teratoma has a solid or mixed echotexture, is it benign or malignant
Malignant
60
What is the prognosis of of a sacrococcygeal teratoma
It is dependant on size of mass and severity of structure displacement
61
If the mass is >4.5cm that what would be warranted at delivery
C-section
62
What is a DDX for a sacrococcygeal teratoma
Rectal duplication Anterior myelomeningocele Sarcoma

Ob / Gyn 2 (8 decks)

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