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Obstetrics & Gynecolgy 1 > Mod 5 > Flashcards

Mod 5 Flashcards

(128 cards)

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1
Q

Pregnancy is dated by

A

Weeks from first day of the last menstrual period or LMP

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2
Q

Pregnancy

A

40 completed weeks gestation
280 days
3 trimesters

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3
Q

1st trimester

A 
From 0-13 weeks +6 days LMP
Confirms:
pregnancy
Pregnancy location
Size of embryo agrees with LMP dating 
Number of embryos 
Viability- fetal heart beat with M-mode
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4
Q

Embryo

A

Conceptus is called this from conception up to 10 weeks LMP

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5
Q

Fetus

A

After 10 weeks LMP embryo is renamed to this

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6
Q

Sonography uses this date

A

LMP

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7
Q

Embryologist use this date

A

Conception date

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8
Q

What do Sonographers measure when determining due date

A

Crown Rump Length - CRL

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9
Q

Ovulation

A

Occurs at day 14 in the ideal cycle
LH must surge for it to occur
Ovum is ejected from follicle, propelled towards Fallopian tube
Lives for 12-24 hours

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10
Q

Sperm

A 
200-500 million sperm deposited near cervix 
300-500 reach ovum 
100 million/ml is the normal count 
20 million or less is considered sterile
Survives usually for 24hrs 
- can survive up to 72hrs
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11
Q

Fertilization

A

Sperm passes through zona pellucida
Sperm head enlarges to become male pronucleus
Ovum completes its second meiotic division to become female pronucleus
Both pronucleo fuse and chromosomes intermingle

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12
Q

Zygote

A

Union of the sperm and ovum

Also called conceptus

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13
Q

Morula

A

Cluster of cells
Remains the same size but cells become smaller and smaller with each division
12-16 blastomeres

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14
Q

Blastocyst

A

Secretions cross the zona pellucida entering the morula forming a fluid cavity
Enters the uterus 6-7 days after fertilization

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15
Q

How long does the ovum travel and where does it eventually get fertilized

A

Travels about 24-36 hrs to a Pilar portion of Fallopian tube

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16
Q

Implantation occurs

A

Complete by 11-12 days post ovulation or 9-12 days post fertilization
Suppose to implant on the posterior portion of the uterus on the endometrium fundus

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17
Q

Celvage

A

Rapid cell decision without a change in the size of original zygote

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18
Q

Blastomeres

A

Two daughter cells

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19
Q

What are the two parts that the zygote separates into after fluid goes into zygote

A

Trophoblasts

Embryoblasts

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20
Q

Trophoblast

A

Outer cell to become placenta and chorion

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21
Q

Chorion

A

Responsible for fetal tissue

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22
Q

Embryoblast

A

Inner cell mass forms:
Embryo
Yolk sac
Amnion

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23
Q

What happens when the zona pellucida disappears

A

Blastocyst implants in the uterus

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24
Q

After implantation

A

Blastocyst is imbedded in endometrial epithelium

Trophoblasts differentiates into syncytiotrophoblast and cytotrophoblast

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25
Syncytiotrophoblast
Produces hCG | Erodes the endometrial stromatolites and blastocyst sinks into endometrium
26
Lacunae
Eroded space of endometrium | Become the intervillous spaces of the placenta
27
Cytotrophoblast
Produces fingerlike projections that extend into the forming lacunae network
28
Primary chorionic villi
Fingerlike projections of the cytotrophoblast Two types are: Chorion frondosum Smooth chorion/ chorion laeve
29
Chorion frondosum
Villi directly at the implantation site | Early placenta
30
Smooth Chorion/ chorion laeve
All the remaining villi around the gestational sac
31
Decidua cells in endometrium increase in size and content for implantation due to which hormone
Progesterone
32
What is the cause and the result of the endometrium undergoing a decidua reaction
Ectopic pregnancy | Result is the formation of a pseudo sac
33
What kind of reaction can occur in a bicoruate uterus
Decidua reaction Gives the appearance that this is twins as the non pregnant horn response to the increase in hCG
34
Decidua basalis
Part of the decidua underlying the conceptus Eventually becomes the maternal side of the placenta Thickens layer where implantation occurs
35
Decidua capsularis
Part that covers the gestational sac
36
Decidua parietalis
All remaining decidua
37
Double decidual sign
Sonographic descriptor Opposed layers of the decidua parietalis and capsularis can be identified on early u/s This should be always be tried to rule out pseudo sacs
38
Prior to fusion of decidua Vera and capsularis what exists and what happens to it during implantation
Potential space between the two layers | Blood can collect in this space if their is bleeding during implantation
39
Amniotic cavity
Formed by the small spaces that occur between the inner cell mass and the trophoblast Occurs by day 9
40
Blastocyst cavity is renamed to what when the amniotic cavity is visualized and can you see it on ultrasound
No viable on ultrasound | Now called the primitive yolk sac
41
Double bleb sign
Represent the early amnion and yolk sac | Only seen on EV at around 5 1/2 weeks
42
Embyro consists of what two layers
Epibalst | Hypoblast
43
Epiblast
Gives rise to nearly all the cells in the embryo | Also forms the amniotic membrane which houses the amniotic fluid
44
Hypoblast
Contributes to the formation of the primitive ectoderm
45
Bilaminar disc
Embryonic disc Occurs around 4 weeks LMP What the inner cell mass becomes
46
What is happening to the inner cell mass when implantation is occurring
It is changing
47
Trilaminar disc
At 5 weeks LMP | When gastrulation occurs
48
Gastrulation
Formation of the three layers Endoderm Ectoderm Mesoderm
49
Endoderm
1st layer to differentiate Inner layer Linings of GI and respiratory tract
50
Ectoderm
2nd layer to differentiate Outer layer Forms CNS Surface ectoderm ex: hair, skin, teeth and nails
51
Mesoderm
3rd layer to differentiate Middle layer Generally forms muscle and bone
52
Neurulation
Begins at 3 weeks after conception, 5 weeks LMP | Formation of neural plate, neural folds and neural tube
53
Neural tube
Closes around day 40 LMP | Starts closing in the middle than progresses to the caudal and cephalic ends
54
Visualizing the embryo on ultrasound
Decidua basalis amd chorion frondosum appear as thickened area along gestational sac
55
Embryonic pole
Develops in close proximity to chorion frondosum
56
Secondary yolk sac
Seen on ultrasound from 5 weeks to 10-12 weeks LMP | Occurs when the head and tail of the embryo fold in and incorporate part of the primitive yolk sac
57
Yolk sac
``` Provides nutrients prior to circulation Hematopoiesis starts here Forms vessels from allantois Formation of digestive tract occurs here Development of sex glands occur here ```
58
Allantois
Diverticulum of the yolk sac Forms umbilical vessels Involved in the formation of urinary bladder
59
Gestational sac grows how much a day
1.1mm
60
How much does the embryo grow everyday for the first 8 weeks
1-2mm
61
What is the upper limit of normal for the yolk sac before 10 weeks
6mm
62
Gestational sac sizes
Mean age- mean sac diameter 6weeks- 1.5cm 7weeks- 2cm 8weeks- 3cm
63
Qualitative pregnancy test
``` By urine Takes 2 mins @ home Can detect at 4weeks LMP Must meet threshold to get a positive Negative does not exclude pregnancy -either too early or diluted urine sample ```
64
Quantitative pregnancy test
``` By blood Tests the beta sub unit of HCG Takes 8hrs and is very sensitive Negative by this method excludes pregnancy Will show positive 23 days LMP Plateau at 8 weeks ```
65
EV scanning gestation sac sizes
4 weeks- 2-3mm 5 weeks- 5-6mm, yolk sac*2-3mm 6 weeks- CRL 3-4mm, FH seen 7 weeks- CRL 12-14mm
66
What are the three different units for beta hCG
FIRP SIS TIS
67
FIRP
First international reference preparation
68
SIS
Second international standard Values are 1/2 FIRP Oldest method
69
TIS
Third international standard | Values are the same as the FIRP
70
What should be considered if the the hCG is at or greater than the discriminatory zone
Ectopic pregnancy if no IUP is visualized
71
What is the discrimatory zone for hCG
500-1000 mIU/ml IS EV | 1000-2000 mIU/ml IRP EV
72
If the CRL of the embryo is 5mm or greater by EV what should be detected
Fetal heart motion
73
What happens to beta hCG levels in a normal IUP until 8 weeks gestation
They should double every 48 hrs
74
High beta hCG indicates
``` Multiple fetuses Hydatigiform moles Choriocarinoma Tetatomas Gonadotropin producing tumors ```
75
Low beta hCG indicates
Ectopic Missed abortion, fetal demise Inaccurate dates
76
Pseudocyesis
A condition where a women feels pregnant Symptoms of : nausea, bloating, full feeling in pelvis Pregnancy test is negative, ultrasound is normal non gravid uterus, no IUP detetected in endometrium These symptoms can be created psychologically
77
Early OB protocol
Sag midline uterus Trx vag, Cx, fundus Mean sac diameter if no embryo is identified If embyro is seen measure CRL 3 times Document yolk sac if seen M-mode heart rate if motion seen Document maternal ovaries Document hematoma near gestational sac if identified Document free fluid in two planes if seen If at 12-14 week do CRL and BPD EV scanning all pregnancies under 7 weeks gestation
78
Haploid
A single set of unpaired chromosomes (23) | A cell with 46 chromosomes divides into 2 new cells, each with 23 each with 23 chromosomes by meiosis
79
Diploid
Paired chromosomes | Organism with 46 chromosomes (23 pairs)
80
Triploid
3 complete chromosomes sets | 69 chromosomes
81
Trisomy
Condition where there is one extra chromosome present in each cell additional to the normal diploid
82
Trisomy 21
An extra chromosome on chromosome 21 | Results in Down syndrome
83
What is the karyotype now for Down syndrome
47 xx or xy
84
Karyotype
How chromosomes are expressed in a diagram Chromosome set of an individual Described in terms of both the number and the structure of the chromosomes
85
Mitosis
Process of nuclear division where cellular material is equally divided between both daughter cells All cells except gamete cells
86
Gamete cells
Sex cells
87
Meiosis
Process that reduces the number of chromosomes in gametes to half
88
Chromosomes
Threadlike nucleoprotein structure within the nucleus of a cell that contains DNA
89
DNA
Double stranded nucleus acid that is a constituent of chromosomes Contains hereditary information coded in specific sequences
90
Gene
Hereditary unit that carries hereditary traits For self reproducing Arrangement of DNA in a chromosome
91
Karyotype
chromosome set of an individual discribed in terms of both the number and the stucture represntation of chromosomes set in a diagram
92
endovaginal scan when necessary when no what is seen
embryo | embryonic heart beat
93
why is ultrasound used for obsetrical cases
determines viabilty, dating and number of embryos
94
why is dating important
certain testing in pregancy is performed at specific times in a pregnancy so that certain milestones of the pregancy are accuratley documented for that gestational age
95
inccurate dates can be caused by what factors
longer or shorter menstrual cycles
96
what can inaccuate dates lead to
false positive or negative values
97
1st trimester screen involves what
nuchal translucency | maternal bood work
98
what is the only definitve test for a 1st trimemster abnormal screen
amniocentesis
99
in the 1st trimester screen anything over what value is concidered in the risk assesment range
3mL
100
what does a nuchal translucency sca asses for
``` chromosomal abnormalities heart abnormalities lung abnormalities skeletal abnormalities congential infections blood disorders metabolic disorders ```
101
why is the 18 week scan the most important
assess all the structures of the fetus
102
can the 18 week scan be pushed back and if so till when and why
yes till 20 weeks enables the heart to be better visualized
103
18 week detailed scan involves the measurement of what structures
``` head spine fetal abdomen fetal chest femur length humerus length ankle veiw open hands placenta umbilical cord maternal structures ```
104
what are the measurements and structures of the head that are veiwed in a 18 week detailed screen
``` BPD HC cavum septum pellucidum cerebeller diameter ventricular diameter nuchal fold cisterna magna orbits nasal bone nose/lips profile ```
105
what are the measurements and structures of the fetal abdomen that are veiwed in a 18 week detailed screen
``` AC stomach kidneys bowel diaphragm bladder ```
106
what are the measurements and structures of the fetal chest that are veiwed in a 18 week detailed screen
lungs | heart
107
what are the measurements and structures of the fetal heart that are veiwed in a 18 week detailed screen
``` 4 chamber LT outflow RT outflow 3 vessel view m-mode for heart rate ```
108
what are the measurements and structures of the placenta that are veiwed in a 18 week detailed screen
location | thickness
109
what are the measurements and structures of the maternal structures that are veiwed in a 18 week detailed screen
cervix | uterus
110
in a 3rd trimester screen are the anatomy images reassesed if they are normal
no
111
after 12-16 weeks what is the amniotic fluid comprised of
fetal urine
112
a 3rd trimester screen is monitoring what
fetal well being- how well the placenta is working and if the fetus is safe in utero
113
what is assesed in a 3rd trimester screen
biometry for growth of fetus: BDP, HC, AC, FL fetal heart rate- m-mode biophysical profile: fetal well being and placental function placenta: growth and grade
114
fetal well being encompasses what
fetal movement fetal tone amniotic fluid fetal breathing movements
115
doppler is needed in 3rd trimester screen if
fetal growth is lagging amniotic fluid is low maternal reasons
116
what are the maternal reasons for doppler to be used in the 3rd trimester screen
high blood pressure | gestational diabetes
117
what are vessels samples that are taken in a 3rd trimester screen
umbilical artery middle cerebral artery of fetus ductus venosus
118
what is the maternal blood work taken at the 1st trimeseter screen (+ Nuchal)
PAPPA | hCG
119
what does the hCG level blood test assist with during a 1st trimester screen
nuchal translucency results to validate a problem
120
what is the maternal blood work taken at 16 weeks gestation
triple screen | quad screen
121
what is then maternal blood work taken at 24-28 weeks gestation
glucose tolerance screen
122
what is the glucose tolerance screen testing for
gestational diabetes
123
does gestational go away and if so when
yes but only when the placenta goes away
124
what is the time frame that gestational diabetes can impair a mother for
3-5 years
125
what can gestational dibetes develop into
type 2 diabetes
126
what does a routine obsetrical doctor visit entail
mom's: weight, blood pressure and urine uterine fundal height measurement postion of the baby by palpation fetal heart beat rate recorded with doppler
127
how often does a pregant patient have a routine doctors visit
monthly at the beginning of the pregnancy every 2 weeks if normal until around 36 weeks weekly if normal till term
128
post dates require what
ultrasounds to cheack fetal well being and growth

Obstetrics & Gynecolgy 1 (8 decks)

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