Obstetrics Flashcards
(188 cards)
1
Q
What are the functions of the placenta?
A
respiration, nutrition, storage, excretion, immunity, hormone production
2
Q
Maternal circulation from aorta.
A
ovarian artery, arcuate, radial, spiral
3
Q
How early can the placenta be seen?
A
8 weeks
4
Q
Grade 0 placenta
A
no visible calcifications, smooth chorionic plate
5
Q
Grade 1 placenta
A
Scattered tiny calcifications, subtle indentations
6
Q
Grade 2 placenta
A
Larger basal echogenicities, larger indentations of chorionic plate
7
Q
3 part of the early umbilical cord
A
Allantois, body stalk, vitelline duct
8
Q
What does the allantois become?
A
develops into the bladder and will leave a remnant called the urachus.
9
Q
Carries oxygenated blood from placenta to fetus.
A
Umbilical vein
10
Q
Carries deoxygenated blood from the fetus to the placenta.
A
Umbilical artery
11
Q
Where does gas exchange occur?
A
Placenta
12
Q
Umbilical vein shunt to IVC
A
Ductus venosus
13
Q
RA shunt to LA
A
Foramen ovale
14
Q
PA shunt to AO
A
Ductus arteriosus
15
Q
What does diastolic flow represent in a doppler of the umbilical artery?
A
Vascular resistance in placenta
16
Q
When are the fetal kidneys functioning and produce the majority of fluid?
A
14 weeks
17
Q
When does the fusion of the amniotic and chorionic membranes occur?
A
End of 16th week
18
Q
What type of solids can be found within amniotic fluid (other than water)?
A
vernix, fetal cells, proteins, urea
19
Q
Role of amniotic fluid
A
nutrition, free fetal movement, growth of GI tract, lung growth, protection, maintains fetal body temperature, bacteriostatic for potential infections
20
Q
Define oligohydramnios.
A
< 2cm x 1 cm pocket or < 5 cm AFI
21
Q
Define polyhydramnios.
A
> 8 cm x 1 cm pocket or > 25 cm AFI
22
Q
Define placenta previa.
A
Placenta implanted in lower segment of uterus
23
Q
Symptoms of placenta previa
A
Painless vaginal bleeding
24
Q
Risk factors for placenta previa.
A
Previous c-sections, maternal age, multiparas, smoking, twins, infertility treatments
25
Define low lying placenta.
1-19 mm from internal os
26
Define complete previa.
Placental edge overlaps internal os by 1 mm or more
27
Define marginal previa.
Placental edge exactly reaches internal os by 0 mm
28
What is Braxton Hicks?
Uterine contractions
29
Abnormal adherence of the placenta to the uterus with subsequent failure to separate after delivery.
Placenta accreta
30
Define placenta accreta.
Implantation directly onto myometrium rather than decidua basalis
31
Define placenta increta.
Implantation directly into myometrium.
32
Define placenta percreta.
Placental growth extending through the myometrium or through the uterine serosa.
33
Define placental abuption.
Defective maternal vessels rupture and cause separation of the placenta - leads to bleeding and decidual hematoma.
34
Risk factors for placental abruption.
Maternal chronic HTN, smoking, cocaine, preeclampsia, PROM, trauma
35
Risk factors of Succenturiate & Bilobed placentas.
Vasa previa, retained placenta, velementous or marginal CI
36
Vessels presenting in front of fetus.
Vasa previa
37
Elevated placental edge.
Circumvellate
38
Flat margin placental edge.
Circummarginate
39
Marginal CI
Umbilical cord inserts < 2 cm from the placental edge
40
Velamentous CI
Umbilical cord inserts into membranes instead of directly into the placenta - lack of Wharton's jelly surrounding the vessels
41
Most common benign and vascular tumor found in placenta
Chorioangioma
42
Solid highly vascular mass within or projecting from placenta
Chorioangioma
43
Scar tissue within the uterus
Uterine synechia(e)
44
Scar tissue within the uterus
Uterine synechia(e)
45
What are the differentials for bleeding after 20 weeks gestation?
Placenta previa, placental abruption, vasa previa, gestational trophoblastic disease (GTD)
46
3 Fetal head views?
Ventricular, Thalamic, Cerebellar
47
What is seen in the Ventricular view of fetal head?
falx, lateral ventricles (anterior, posterior), atrium (< 10mm), choroid plexus, calvarium (bone)
48
What is seen in the Thalamic view of the fetal head?
falx, thalami, 3rd ventricle, CSP, calvarium
49
What is seen in the Cerebellar view of the fetal head?
Cerebellum, nuchal fold (< 6 mm), cisterna magna (< 10 mm), vermis, falx, calvarium, CSP, thalamus
50
How is NF measured?
Outside of bone to outside of skin
51
Normal axis of fetal heart
45 degrees from midline and levocardia
52
Which heart view rules out 96% of abnormalities?
4CH view
53
Echogenicity of fetal lungs
Hyperechoic
54
When is the GB visualized?
After 20 weeks
55
When should the stomach always be visualized by?
14 weeks
56
When should the kidneys be visualized?
14-16 weeks
57
Echogenicity of kidneys
Hyperechoic then isoechoic
58
Normal amount of fluid in renal pelvis?
< 5 mm
59
What part of femur is measured?
Diaphysis
60
What is Frank Breech?
Babys hip joints are fixed and knee joints are extended
61
What is a Complete Breech?
Babys hip and knee joints are fixed
62
What is included in Biometry?
BPD, HC, FL, HL, AC=EFW (estimated fetal weight)
63
What is the most accurate predictor of GA?
Head Circumference
64
Normal CI range? Brachycephaly? Doliocephaly?
Normal 70-85%
Brachy > 85%
Dolio < 70%
65
What is SGA? LGA?
SGA is < 10%ile
| LGA is > 90%ile
66
SGA - types?
1. small but healthy
2. small because of chromosomal or environmental etiology
3. high risk for poor perinatal outcome including death and may have IUGR
67
Criteria for IUGR?
Fetal weight falls below 10%tile, a drop of more than 2 quartiles (50%)
68
Asymmetrical IUGR causes?
Maternal: HTN, smoking, medications, chronic disease, infection
Environmental: abruption, placenta previa, twin to twin transfusion (TTTS)
69
3T signs of IUGR?
Delayed/absent growth with serial scans, abnormal umbilical artery dopplers, oligohydramnios, grade 3 placenta, low BPP score
70
Causes of fetal death?
Asphyxia, maternal complications, congenital/chromosomal abnormalities, infection, unknown
71
Causes of fetal hypoxia?
uteroplacental insufficiency, reduced O2 in blood due to low hemoglobin, reduced blood flow to fetal tissues (ischemia)
72
What does UA circulation indicate?
Status of placental circulation
73
PI equation
PI=S-D/M
74
What should PI be around?
1
75
Does MCA have low or high resistance?
High
76
Does UA have low or high resistance?
Low
77
What is the Ductus Venosus?
Connection between IVC and umbilical vein
Normally biphasic and antegrade
78
BPP scoring guide?
Breathing, movement, tone, SDP/AFI, UA Dopplers scored over 30 min window
*Score below 6: increased risk of asphyxia, low cord pH, cerebral palsy, still birth
79
What is a Non-Stress Test?
2+ heart accelerations above 15 bpm or more lasting 15 secs over 20 min period, done twice
80
Acute Hypoxia indicator? Chronic?
Acute: BPP & NST
Chronic: amniotic fluid
81
What does the Prosencephalon become?
Telencephalon, Diencephalon
| Forebrain
82
What does the Mesencephalon?
Mesencephalon
| Midbrain
83
What does the Rhombencephalon become?
Metencephalon, Myelencephalon
| Hindbrain
84
Foramen of Munro
Connection between paired lateral ventricles and 3rd ventricle of brain
85
Foramen of Magendie
Links 4th ventricle to CM (spinal cord)
86
Foramen of Luschka
Links between 4th ventricle and subarachnoid space (paired)
87
Role of Choroid Plexus
Produce CSF
88
Corpus Callosum
Myelinated nerve fibres that connect brain hemispheres
89
Enlarged ventricles with increased intracranial pressure
Hydrocephalus
| -may lead to irreversible damage
90
Most common cranial abnormality
Ventriculomegaly
| -when atria are > 10 mm
91
Which chromosomal abnormality is Ventriculomegaly a soft marker for?
Trisomy 21
92
Which lab is increased with NTD?
AFP
93
Absent calvarium/skull
Acrania/Exencephaly
94
Absent brain and skull. "Frog-like" eyes. Polyhydramnios.
Anencephaly
95
Anencephaly + extending to spine
Craniorachischisis
96
Herniation of meninges and brain through bony skull defect. Solid extra-cranial mass.
Encephalocele
97
Herniation of meninges/CSF through bony skull defect. Most are occipital. Extra-cranial cystic mass protruding from skull. Microcephaly and increased incidence of ventriculomegaly.
Cranial meningocele
98
Extreme flexion of head, open spinal defect, occiput defect. Lethal. "Star Gazing"
Iniencephaly
99
Abnormal cleavage of prosencephalon leads to failure of brain to divide into halves. Associated w/ Trisomy 13 (most common) and Trisomy 18. Facial abnormalities.
Holoprosencephaly
1. Lobar
2. Semi-lobar
3. Alobar (monoventricle)
100
Absent corpus callosum (ACC) and CSP
Alobar and Semi Lobar Holoprosencephaly
101
Arrested development or hypoplasia of cerebellar vermis - obstruction of Foramen Magendie and Luschka
Dandy Walker
102
Cystic dilatation of 4th ventricle, absent vermis, ventriculomegaly, displacement of cerebellar hemispheres due to fluid
Dandy Walker
103
Amniotic fluid and bile
Meconium
104
Esophagus doesn't connect to stomach. Transesophageal fistula seen in 90%. Polyhydramnios seen.
Esophageal Atresia
105
VACTERL?
```
V-vertebral
A-anorectal atresia
C-cardiac
TE-esophageal atresia
R-renal
L-limb
```
106
Esophageal atresia is associated with which aneuploidy?
T18 (most common), T21
107
Duodenal Atresia is associated with...
Down syndrome, cardiac anomalies, all of VACTERL
U/S: Double bubble (dilated duodenum & stomach), polyhydramnios
108
Echogenic bowel is assoc. w/ which aneuploidy?
T21
109
Causes of large bowel obstuction?
Imperforate anus, anal atresia, Hirschsprung's disease
110
Anorectal atresia is assoc. w/...
Caudal regression, VACTERL
111
Hirschsprung's disease...?
Congenital mega colon - no control of peristalsis
112
Hydrops
large amounts of fluid builds up in baby
112
Focal dilatation of umbilical vein
Umbilical vein varix
113
Failure of abdominal wall to close, protrusion of intestines. Assoc. w/ ascites, polyhydramnios, IUGR. Increased AFP. NOT assoc. w/ chromosomal anomalies.
Gastroschisis
114
Midline defect - mass at base of umbilical cord containing organs. Umbilical vessels seen entering mass. Usually assoc. w/ chromosomal anomalies.
Omphalocele
115
Limb body wall complex
Severe form of amniotic band syndrome - lethal! short cord and exposed organs seen
116
Most severe anorectal malformation that can develop hydrocolops - in females only!
Persistent cloaca
117
When can kidneys be reliably seen?
12 weeks
118
Findings of bilateral renal agenesis.
Potter facies - limb deformities, pulomonary hypoplasia, low set ears, oligohydramnios
119
How to get LVOT from 4CH view?
Angle superiorly
120
How to get RVOT from 4CH view?
Angle more superiorly than LVOT and rotate transducer to demonstrate RV and PA
121
3VV?
PA, ascending AO, SVC
122
Bulbis cordis becomes?
Outflow tracts
123
Truncus arteriosis becomes?
Great vessels (PA and AO)
124
Sinus Venosus becomes?
Atrium, SA node, oblique vein, coronary sinus, IVC, SVC
125
Ostinum Secundum aka...
Foramen Ovale
126
Septum primum...
Divides atrium into left and right
127
Most common congenital heart defect
VSD - most commonly perimembranous
128
VSD is assoc. w/?
T21, T18, T13
129
Most common cardiac anomaly in fetus w/ down syndrome..
ASD - absent septum secundum
130
AVCD aka atrioventricular canal defect...
Septum primum ASD + VSD + common AV valve
Look at 4CH view
Assoc. w/ T21
131
Tetralogy of Fallot...
Large VSD, AO override, PA stenosis
Look at LVOT view
132
Ebstein anomaly is assoc. w/...
ASD, TOF, coarctation of aorta, transposition (common), mat use of lithium
133
Truncus arteriosus...
Single great artery - common trunk w/ a large VSD
134
Transposition of great arteries (TGA)....
VA discordance - RV connects to AO, LV connects to PA
Vessels will be parallel, hard to line up for 3VV
135
Most common cardiac tumor...
Rhabdomyosarcoma - round, hyperechoic masses assoc. w/ Tuberous Sclerosis
136
Causes of pulomnary hypoplasia...
oligohydramnios, no thoracic space, skeletal/neural malformations, chromosomal syndromes
U/S: Bell-shaped chest/abdomen
137
CPAM...
congenital pulmonary malformation
138
What is CPAM?
```
Multiple cystic masses of segmental lung tissue. May lead to hydrops - pressure on heart.
3 types:
1. Macrocystic (2-10 cm)
2. Macrocystic (0.5-2 cm)
3. Microcystic (< 0.5 cm)
```
139
Pulmonary sequestration...
congenital anomaly, non-functioning portion of lung tissue - most commonly extralobar and on left side
140
Most common diaphragmatic hernia...
Foramen of Bockdalek - left posterior lateral defect involving stomach & bowel
141
Right anterior medial diaphragmatic hernia...
Foramen of Morgagni - usually bowel & liver involved
142
Most common non-lethal skeletal dysplasia. Short long bones.
Achondroplasia
"trident" hand, macrocranium
143
Most common lethal skeletal dysplasia.
Thanatophoric dysplasia - severe micromelia, cloverleaf skull aka Kleeblattschadel, bell-shaped abdomen, polyhydramnios, head anomalies
144
Achrondrogenesis
1. micromelia
2. hypomineralization
3. macrocranium
145
Osteogenesis Imperfecta
Inherited collagen disease - extremely fragile bones
146
Diastrophic dysplasia
club foot, hitchhiker thumb, cleft palate/micrognathia, micromelia
147
Rocker bottom feet assoc. w/...
T18 and T13
148
Soft markers for T21
NF, echogenic bowel, ventriculomegaly, echogenic intracardiac focus, short long bones, absent/hypo NB
149
Soft marker for T18
Choroid plexus cyst, enlarged CM
150
Increased hCG levels in 2T are a soft marker for...
T21
151
T18 Findings...(Edward's Syndrome)
Strawberry shaped head, CP cysts, ACC, dandy walker, micrognathia, hypotelorism, clenched hand, crytorchidism, VSD, coarct. ao, diaphragmatic hernia, omphalocele, rocker bottom feet, polyhydramnios
152
T21 Findings...
Brachycephaly, ventriculomegaly, flattened face, duodenal atresia, echogenic bowel, hydronephrosis, NF thick, AVSD, VSD, TOF, echogenic focus, short limbs, absent/hypo NB, clinodactyly
153
Findings with T13...(Patau Sydrome)
holoprosencephaly, facial abnormalities (cleft lip, etc.), ventriculomegaly, ACC, NF thick, NTD, cardiac and renal anomalies, echogenic bowel, omphalocele, polydactyly, 1 UA, microcephaly
154
Triploidy Findings....
Meningomyelocele, cystic hygroma, omphalocele, NF thick, club foot, holoprosencephaly, ACC, dandy walker, etc.
155
Turner syndrome Findings...
always female, short stature, streak gonads, 45X, lethal, cystic hygroma, ascites, pleural effusion, horseshoe kidney, etc.
156
Fluid-filled sac-like structure that protrudes from back of head or neck
Cystic hygroma
157
Distinct feature of Apert Syndrome
Frontal bossing, beaked nose
158
Undescended testes
Crytorchidism
159
Fetal parts entrapped in fibrous septa
Amniotic band syndrome
160
Herniated viscera within a complex membrane
Limb-body-wall complex
161
Fetal Alcohol Syndrome Findings...
microcephaly, micrognathia, cleft lip and palate, depressed nasal bridge, low forehead, malformed ears, small eyes, ASD, VSD, IUGR
162
Risk factors for a multi pregnancy...
ART (assisted reproductive technology), maternal age, race, genetics, environment
163
Unprotected fetal umbilical cord vessels run across internal os
Vasa Previa
164
Maternal complications of twins...
morbidity, mortality, PROM, preeclampsia, HTN, placenta previa, post partum hemorrhage, anemia, pyelonephritis
165
Type of twins - zygote divides at day 3...
DC/DA
166
Type of twins - zygote divides at day 4-7....
MC/DA
167
Type of twins - zygote divides at day 8-13...
MC/MA
168
Type of twins - zygote divides at day 13+ ...
Conjoined
169
of gestational sacs
chorionicity
170
of yolk sacs
amnionicity
171
"T-sign" thin membrane (< 2mm)
MC/DA
172
Fused lambda/chorionic peak sign (> 2mm)
DC/DA
173
Twin A is labelled...
Closest to internal os
174
What is considered discordant growth in twins?
discrepancy of 20% based on EFW
175
"vanishing twin"
demise of co-twin
176
Highest mortality of all twins...
MonoAmniotic
177
Embedding of fetus due to vitelline duct anastomosis
Fetus in fetu or heterotopic parasitic twin
178
Arterial-arterial anastomoses across fetuses
TRAP aka twin reversed arterial perfusion (acardiac twinning)
179
What happens in TRAP syndrome?
Deoxygenated blood flows from donor twin to acardiac twin (no head or heart).
Pump twin has risk of CHF. Treated with laser ablation.
180
TTTS?
Twin to twin transfusion - imbalance of twin placental vessels. Donor (oly) and Recipient (poly). MC/DA and same gender. Major imbalance of amniotic fluid and weight discordance.
181
Genetic screening method where had previously abnormal triple screen and hx of spontaneous abortions or fetal anomalies. 2-4 weeks for results. Performed between 15-20 weeks gestation.
Amniocentesis
182
AFP and fetal risk of isoimmunization (bili levels) analysis and detection of NTDs method..
Amniocentesis
183
Byproduct of RBC breakdown in Rh sensitization?
Bilirubin
184
Fetal distress is evaluated by?
Meconium
185
What is Chorionic Villus Sampling?
High risk 1T procedure where trophoblastic tissue is sampled. Results within 3-10 days.
186
What is PUBS?
Percutaneous umbilical blood sampling. Performed 17 weeks to term. Sedative is used. Used to evaluate and treat fetal conditions.
187
Erythroblastosis Fetalis
Destruction of fetal RBCs by maternal IgG antibodies which results in fetal anemia. MCA needs to be doppler.
