ob

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Author:
rbeacr
ID:
120502
Filename:
ob
Updated:
2011-12-03 18:51:11
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Description:
The role of sonography in ob
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  1. who makes standards
    • ACR- american college of radiology
    • AIUM- american institute of ult. med
    • ACOG- american college of ob and gyn
  2. Indications for 1st trimester sonography
    • confirm iup
    • evaluate ectopic preg
    • define cause of vag bleeding
    • eval. pelvic pain
    • est. gestational age
    • diagnose mutiple preg
    • confirm cardiac activity
    • chorionic villous sampling, embryo trans, remove iucd
    • asess fetal anomolies- high risk
    • eval pelvic/adnexal mass abdnormality
    • screen for fetal aneuploidy (abd chrom #)
    • evaluate hydatidform mole
  3. IUGR
    intrauterine growth restriction

    macrosomia- gigantism
  4. Indications for 2nd & 3rd trimester sonography
    • gest. age, fetal growth, vag bleeding
    • cervical insufficency
    • abd/pelvic pain
    • fetal presentation
    • multiple gestations
    • amniocenteses or procedure
    • discrepancy btw uterine size and dates
    • pelvic mass, hydatidform mole
    • cervical cerclage placement
    • fetal death suspected
    • uterine abnormality
    • fetal well being
    • amniotic fluid abnormalities
    • placetal abruption
    • adjunct to external cephalic version
    • premature rupture membranes/labor
    • abn biochemical markers
    • followup fetal anomaly
    • followup placenta location- placenta previa
    • fetal condition for late fetal care
  5. abrupto placentae
    premature detachment of placenta from uterine wall
  6. oligohydramnios
    deficency of amniotic fluid resulting in embryonic defect through adherence of embryo and amnion

    bad for baby
  7. polyhydraminos
    excessive accumulation of amniotic fluid

    baby can still be ok
  8. cerclage
    sew cervix together
  9. MSAFO
    • maternal serum alphafetoprotien
    • increased amt risk of neural tube defects
  10. placenta previa
    low lying placenta by cervix
  11. aneuploidy
    not having exact multiple of usually choromsomes
  12. First trimester exam
    • before 13 weeks and 6 days
    • uterus, cervix, adnexa, gestational sac, embryo
    • dated from size
    • document heart motion
  13. First trimester risk assessment examination
    • measure nuchak translucency
    • screen for aneuploidity
    • fetal crown rump legnth
  14. Gravidity and parity
    • Gravidity- number of pregnancies including present
    • Parity- all possible pregnancy outcomes
    • POOOO
    • 1-full term
    • 2-premature/still born
    • 3-early preg loss/termination
    • 4-living children

    eg. G4P2103 (4th preg)
  15. Clincial Dates
    • LMP or LNMP is standard way to date
    • pregnacy lasts 266 days
    • the earlier the sonogram the more accurate date
  16. Trimesters
    • 1st- until 13wks 6 days
    • 2nd-from 14 wks- 26 wks. 6 days
    • 3rd- from 27weeks to term
  17. Nagele's rule
    • EDD = LNMP - 3 months + 7days
    • LMP = EDD + 3 months - 7 days

    commerical date wheels
  18. maternal risk factors
    • laytex allergy?
    • hypotension when supine?
    • warmth, dizziness, syncope during exam?
    • medications take?
    • bleeding? decreased fetal movement? pain? incomp cervix?
    • previous probelms? fibroids?
    • risk factors for anomolies?
  19. Safety of US
    • thermal (rise in temp)
    • mechanical forces
    • cavitation ( collapse of gas filled air bubbles)

    • doppler is higher energy
    • more research needed
  20. fetal ductus venosus
    vein passing through the liver and connecting the left umbilical vein with the ivc of fetus, losing circulation after birth and becoming ligamentum venosum of liver
  21. doppler for ob
    • used to detect flow in maternal and fetal vessles
    • ductus venosus, fetal heart, placenta

    • look for fetal heart defects
    • doppler during 1st trimester is controversial
  22. earlist structure seen in gestational sac
    yolk sac
  23. first trimester protocol
    • -Gest sac?
    • gest. sac location
    • presence or absence of yolk sac and embryo
    • crown rumo legnth- most accurate age
    • 4 weeks= echogenic curve adj to yolk sac
    • blood tests + 7-10 days embry. age
    • placenta= thickened density along gest sac
    • bowek herniates 8-11wks and returns into abd cavity
    • - Heart beat?
    • seen when 5mm for greater
    • -Fetal number?
    • -evaluate ut, ov, adnx?
    • corpus luteum, texture of ovaries, leiomyomateous growth
  24. 2nd and third trimester
    • fetal cardiac motion, fetal #, presentation, activity
    • volume of amniotic fluid
    • placenta location, umbilical chord, number of vessles
    • gest (mens) age
    • maternal anatomy (ovaries not imaged)
    • fetal anatomy after 18 wks

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