OB Diagnostic Imaging, procedures & Documentation Flashcards

Question

Fetal Size - low/small - healthy - fetal macrosomia and IUGR

Answer 1

Estimations of the Baby can be made by OB small: 5.5 lbs normal : 8 lbs. macro: 11 lbs. IUGR: baby size < 5%tile of normal macrosomia: baby size > 95%tile of normal IUGR due to... placental or cord abnormalities - decrease perfusion, oxygen delivery, transport - incorrect cord insertion, single artery Materal Factors - age, small statre, stress, pre-eclapsia, substance use, undernutrtion - prior IGUR, HTN - TORCH infections Fetal Factors - cong. HD - diaprgmatic hernia - Trisomy 21, 18 or 13 - turners Fetal macrosomia - maternal DM - obesity in pregnancy - genetics - overdue baby - male - older maternal age

Answer 2

Level 2: done if abnormalities found in the typicla anatomy scan or for those at an increased risk of abnormalities Humerus length Nasal Bone length nuchal folds cerebellar diameter cisterna magna cervical length

Answer 3

**these can be benign if one is found, but when mutliple are, the risk of aneuplodiy increases** - echogenic focus in the heart - chorid plexus cyst - pyelectasis - ecogeneic bowel - short femus - hypomineralization of the fifth digit on hand

Answer 4

CVS: chorionic villus sampling - an alternative to amniocentesis: can be done earlier than amnio. - optional test: for those who want to know early, those with fmaily history,etc. : 99.9% accuracy! when: **can be done 10-12 weeks** - testing for aneuplodidy/genetic abnormalites **only** (or DNA analysis:CF,etc.) - does **NOT TEST for neural tube defects** How its done - trascervical or transabdominal approach: depenidng on location of the placenta - US guided: needle passed into the placenta to aspirtate for chorionic villi : analysis sent pregnancy loss - up to 1% each time

Answer 5

Amniocentesis **15-20 weeks** : 2nd - cytgenic analysis : **genetic abnormalities** - APF for **neural tube defects** **3rd trimester** - can be done to diagnose intraamniotic infection - documentation of fetal lung maturiaty - therapeudic procedure for those with hydraminos: too much fluid How its done - needle inserted through abd. wall, into unterine cavity and fluid with the cells of fetus are removed - US guided - risk of loss is 1:200

Answer 6

Anencephaly - lack of brain development : parts of brain and skull - saw often with Zika infection Hydrocephalus - increased/abnormal CSF buildup within the brain ventricles: increased pressure on the brain tissue Occipital Encephalocele - swelling of fluid over the occiptial bone midline

Answer 7

Gastroschisis - abdominal organs through a hole int he abdominal wall: without a covering or sace to protect! they're exposed - baby will be fine; just need to know because we need to be prepared at delivery - hole near the cord Omphalocele - like a gastrochisis but there is a fluid-filled thin naturally occuring sac thay is rarely opened or broken

Answer 8

Cervical Measurements normal cervix: 4 cm (size of fist) - should be closed from internal and external os - measured from internal to external Cervical Incompetence - when the cervix begins to open or shorten in the absence of contractions, prematurly - *contrasted with premature labor: which is shortening on the cervix with contractions* - can be fully open from internal to external, or can be funnel shaped How is this treated: **Cerclage**: a suture tie that keeps the cervix closed during pregnantc cannoy cerclage: if there is contractions or infection - removed ususally at 32 weeks incase contractions and labor begin

Answer 9

Placenta - materno-fetal interface: critical for proper fetal development - **typically attaches to fetal wall at during first trimester** = bleeding possibility - cord connects here to supply nourishment and oxygen to the baby What is it - fetal in origin: two layers (the chorion and the amnion) - contains trophoblasts: which release bHCG: allow crpus lutem to persist

Answer 10

Implantation - within the first trimester - location can be foudn via US as the fetus grows, the belly will expand upwards: the upward: thus the placenta will "grow" upwards Placenta previa: abnormal placental local- located close to or over the cerivcal os - this is a bleed risk! Placenta Previa Types complete: the placenta covers the cervical os *c section needed if within 2 cm* partial: partly covering the cervical os marginal: sitting next to the edge of the os low-lying: within 3 cm of the cerivcal os

Answer 11

Risk Factors - multipary: 7+ - advanced maternal age - prior C section or surgery - smoking - prior abortion Symptoms **painless vaginal bleeding** need to have limited instrumentaion, no intercourse, exercise, etc. = c section will be needed

Answer 12

Placeenta Accreta - when the placenta grows into the muscular layer of the uterus (into the myometrium or beyond) - may not be known until placenta cannoy be delivered Signs on US - see areas called **lacunae** which are diagnositic of an adherant placenta - indicate a sticky unterus wall and possible failure of the placenta to not dis-adheare during palcental devliery Risk Factors - prior D&C or instrumentation/surgery Effects & what to do - decreased the bleeding asap - may need to do a TAH to stop the bleeding

Answer 13

placenta previa placental abruption (complete pull off the uterine wall) cervical incompetence preterm labor

Answer 14

Previa - painless - variable amount of bleeding: but there will be some - visable on US Aburption - painfuL!!!!! - maynot have bleeding if it is concealed within the placenta - often have risk factors which make them known to be high risk - may not be able to be identified on US

Answer 15

Fetal Monitoring - to look for signs of fetal distress or hypoxia - usually for babies in distress, those at risk or those - ensureing proper nutrients and oxygen getting to the fetus - for high risk pt. (later done during delivery) How its done - external trasnducer attached to mom's abdomen - one will detect moms contractions = trochometer - one will detect babys HR

Answer 16

Non-Stress Test - a test done to monitor fetal HR in the absence of contractions - if contractions = stress test When - done **starting at 28-32 weeks** - not done before 28 weeks because its difficult to see accelerations before this time

Answer 17

Tocometer: reads moms uterus: determines if there are contarctions - contractions will appear like mountains on the bottomes strip - every red line distance = 1 minute Fetal HR: the top strip baseline: determine the baseline BPM (should be **110-160**) without the acels Want to see variability on the stripe - **absent variability = little to no squiggles = bad** - mild variability: not great, want to do something (1-5 beats) prokvoking to see the acels to ensure baby is ok - moderated varibaility= what we want to see (6-25 beats above/below) - marked variability: above 25 up or down from baseline: bad

Answer 18

accels - accelerations: we want to see these! - indicate baby is ok - we want to see 15 beats above for at least 15 seconds (at least 2 in 20 minutes) Decels Early Decels: typically due to head compression : see the HR of fetus dropping with the contraction: **they are in line with each other** - seeing early decels with accels i sok Variable Decels - random sshort dips in teh heart rate **without relation to the contractions** - this is due to **Cord Compression!!** - see these in short period with an accel is ok Late Decels = **BAD SIGN** - these are decels which begin with the contraction but end **AFTER** the contraction, they end later hence, late decels - they are due to **fetal/palcenta insuffiency** - may be a sign needing to deliver

Answer 19

Bradycardia - continous baseline below **115** - this is a **LATE finding of hypoxia** - THIS INDICATES A NEED TO C SECTION IMMEDIATELY Tachycardia - contuous baseline **above 160** - this is an **early finding** of hypoxia - can be due to tinteruterine use of terbutaline Sinusoidal pattern - **BAD SIGN** - immediate delivery

Answer 20

BPP: a test that can be done if needed after doing a fetal non-stress test - this can be done as the next step if needed: not all babies will get this What does it include: a 30 minute test - fetal HR assessment: the non-stress test - fetal breathing movements - gross body movements (flextion, extension, etc.) - fetal tone (hypotonia or normal tonia) - qualitative amniotic fluid volume Normal = **score of > 8/10** score of 6 = wait and repeat score of < 4= bad sign

Answer 21

Aminotic Fluid - protection & lung develpoment - important indicator of fetal well being - fetus swallows this, pees it back out Amniotic Fluid Index - amount that is "normal" depends on gestational age - divide abdomen into 4 quadrants - measure teh fluid while the woman is laying flat on her back: find larger pocket in each quadrant - between 5th-95th percentile isnormal amount can test amniotinc fluid, drain and see if theres too much etc.

Answer 22

Fetal Blood Sampling - percutaneous umbilical blood sampling (PUBS) aka cordocentesis - done under US guidance - an option for chromosomal or metabolis anyalysis of the fetus good to detect - Rh sensitization (monitor the Rh factor in baby) - neontal alloimmune throbocytopenia higher risk for - featl death 2% risk every time you do it & this needs to preformed often

Answer 23

Leopolds maeuver - determination of fetal postioning inthe uterus - vertex: head down: want this for devliery - leopolds: feeing the cephalic prominence (hard top of the head) for it at the pubic symphisis what occupies fundus: whats at the top location of small parts: feet and hands Presenting part: whats at the pubic symphsis wheres the head: if its not here...

Answer 24

Breech = position in which babies head is not down Frank Breech: cannonball with legs strigh up complete breech: cannonball with legs crossed incomplete breech: one leg up and dwon cannonball footling: one foot first Dx. Breech - US to find heda - pevlic exam - leopold manuever

Answer 25

Gestaional Age : **alwasy document GA in note** - include GA in week and how it was determined: FDLMP, 1st trimester growth scan, 2nd trimester? Nagele's rule - FDLMP - 3months + 7 days (plus 1 year) Gs & Ps - G = gravidity (currently pregnent) - Ps: FPAL - full term - preterm - abortions - living

Answer 26

Bishop Scoring - a labor note uses this: to assess readiness for/initiation of labor - determines the likelihood of a vaginal birth to be successful - **score of > 8 = successful vaginal birth** Bischop looks at - dilation - effacement - station - consistency - positon APGAR - newborn infant at 1 and 5minutes - score 0-10 with 7+ meaning good and < 4- resusitate

OB Diagnostic Imaging, procedures & Documentation Flashcards

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