OB/GYN Test 3

What gonadotropin produced by the anterior pituitary gland initiates the development of follicle within the ovary?

As the dominant follicle develops, what hormone does it secrete?

What hormone influences final stages of follicles development, & peaks causing ovulation?

When does menstrual age begin?

When does fetal age begin?

Alternative names for fetal age?

Importance of Menstrual Age?

What is the triple-marker?

Where/When does fertilization occur?

What is the outer layer of the ovum?

What is a fertilized egg called?

What are gametes?

What is a morula

What comprises a blastocyst?

When do blastocysts occur?

When will a blastocyst implant in the UT?

What determines a positive pregnancy?

When would a trophoblast produce hCG?

During embryonic development, what are the 3 germ cell layers called of the trilaminar disk?

What do the endoderm, mesoderm, and ectoderm form?

What is the first organ to function during embryonic development?

How many days does it take the zygote to reach the uterus after fertilization?

When would you use the term embryo?

When would you use the term fetus?

When does the primary yolk sac cease to function?

Which yolk sac is seen during ultrasound?

What does the secondary yolk sac do?

When does the secondary yolk sac form?

What is the approximate measurement of the gestational sac when the secondary yolk sac forms?

What hormone do trophoblasts produce? Why?

What produces proteolytic enzymes?

What is the function of the proteolytic enzymes?

Def. the cellular and vascular changes occurring in the endometrium at the time of implantation

3 layers of the decidual reaction

Define decidual basalis

Define decidual casularis

Define decidual parietalis (vera)

What will the embryo appear as on week 5 sonographically?

What 2 things develop during week 5?

When is the embryonic period?

What is the most critical time of embryonic development when all the internal and external structures are present and congenital malformations can originate?

What has developed at the end of week 6?

What is the sonographic appearance of an embryo that is 8 weeks old?

What has developed at week 8?

What has developed at 10 weeks?

When will the amniotic cavity fuse with the chorion?

What has developed by week 11?

What happens at week 12?

small GS within an echogenic endometrium with focal thickening at implantation site characterizes what?

When can hCG be detected?

What is a Qualitative hCG?

What is a Quantitative hCG?

What does hCG stand for?

Def. refers to the level at which a gestational sac should be visible with regards to hCG

What is the discriminatory level for a TV exam?

What is the discriminatory level for a TA exam?

The symptoms below are associated with what?
incorrect dates
gestational trophoblastic disease (molar pregnancy)
multiple gestations

The symptoms below are associated with what?
incorrect dates
ectopic pregnancy
embryonic demise

Describe the normal sonographic gestational sac appearance

What is the first structure seen within the gestational sac?

Where does the yolk sac lie?

For TA exams, what MSD measurement of the gestational sac will the yolk sac be visible? (both early and always)

For TV exams, what MSD measurement of the gestational sac will the yolk sac be visible?

What is the normal diameter of the yolk sac at 5-10 weeks?

What are the functions of the yolk sac?

When does the double-bleb sign occur?

What is the double-bleb sign?

What the 2 fetal membranes?

What becomes the covering of the umbilical cord?

When does the amnion fuse with the chorion?

The Amnion is not vascular and develops from what?

This structure surrounds the gestational sac and merges with the edge of the placenta.

Which gender provides the structures below?
inner cell membrane
embryo
amnion
yolk sac

Which gender provides the structures below?
trophoblastic tissue
placenta
hCG
gestational sac (chorion)

5 functions of the amniotic cavity

What areas produce amniotic fluid?

What is primarily responsible for amniotic fluid production?

In the 2nd/3rd trimester amniotic fluid is regulated by what?

What is the sonographic appearance of amniotic fluid?

Def. not enough amniotic fluid

Def. too much amniotic fluid

What is associated with oligohydramnios?

What is associated with polyhydromnios?

What is the sonographic appearance of chorionic fluid?

Def. Embryonic tissue lining the exterior of the gestational sac

What is the purpose of the chorionic cavity?

Define Chorionic Villi

Define chorionic frondosum

Define chorionic laeve

A heart rate will be visible on a TV exam when the CRL measures what?

What is the normal heart rate at 6 weeks?

What is the normal heart rate at 9 weeks?

What is the normal heart rate between 10 and 24 weeks?

When does the umbilical cord form?

What is contained in the umbilical cord?

What umbilical structure is associated with bladder development?

What umbilical structure connects the primitive gut to the yolk sac?

Def. gelatinous substance within the umbilical cord

How is the gestational sac measured?

Where do you measure the gestational sac?

How accurate is the gestational sac measurement for determing embryonic age?

When would you stop measuring the gestational sac for embryonic age?

Which transducer is most accurate for measuring structures during early OB?

A gestational sac measuring MSD = 2mm corresponds to what age?

A gestational sac measuring MSD = 5mm corresponds to what age?

At what age will the yolk sac appear?

At what age will the embryo and yolk sac be visible?

What is the most accurate of all fetal measurements?

How many CRL should be taken?

When the fetal pole is visible how quickly does it grow?

How is gestational age calculated from CRL?

When are CRL no longer necessary?

Why are CRL measurements less accurate after the 12th week?

Prosencephalon AKA

Mesencephalon AKA

Rhombencephalon AKA

When do the lateral ventricles appear?

When does the choriod plexus appear?

Sonographic appearance of lateral ventricles?

Sonographic appearance of choroid plexus?

Def. failure of the fetal gut to return after it herniates

Def. Absence of cranial vault/cerebral hemispheres

Def. Lucency at the back of
head/neck

Def. termination of the pregnancy prior to 20 weeks

Spontaneous Abortion will occur approximately _____ weeks after embryonic demise.

What percentage of pregnancies end in spontaneous abortion?

75% of spontaneous abortions occur before _____ weeks.

What are some causes of Spontaneous Abortion?

Spontaneous Abortion begins with ________ into the decidual basalis, followed by _______ and ________ around the implantation site causing the embryo to die.

What will the uterus and cervix do after a spontaneous abortion?

What happens during a complete abortion?

What happens during an incomplete abortion?

What happens during a missed abortion?

Def. Condition in which the pregnancy appears normal but clinical signs such a bleeding or cramping suggest pregnancy is in jeopardy

What happens during an inevitable abortion?

Def. gestational sac seen in uterus but embryo failed to develop or died at a stage before it was visible

What was an anembryonic pregnancy formerly called?

What is the sonographic appearance of an anembryonic pregnancy?

What risks are associated with a large yolk sac?

What is the max diameter of the yolk sac at 10 weeks gestation age?

What risks are associated with abnormally shaped or calcified yolk sacs?

A CRL of 5-9 mm with a heart rate of < 100 BPM or a CRL of 10-15 mm with a HR of < 115 BPM indicates

What is the most common reason for bleeding during the first trimester?

Def. an accumulation of blood beneath the chorion

What is the sonographic appearance of an acute chorionic hemorrhage?

What is the most important criteria for subchorionic hemorrhage?

Describe an early pregnancy failure.

What is the name for a surgical abortion?

What pills cause a medical bortionl?

91% of expectant miscarriages occur after ____ days.

What is the leading cause of pregnancy related deaths during the first trimester?

Ectopic pregnancy is the cause of ____% of all pregnancy related deaths.

What has caused ectopic pregnancies to increase of the past 10 years?

What are the symptoms of ectopic pregnancy?

What are the risk factors for ectopic pregnancy?

What poplulation is at most risk for an ectopic pregnancy?

—Heterotopic
Ectopic pregnancies

What is the ring of fire sign?

What should you demonstrate if there is a live embryo in the adnexa

—Empty uterus and adnexal mass
hCG >1500 mIU/ml
Free fluid in pelvis
Look for decidual reaction and “ring of fire” around ectopic

—Sonographic pitfalls “pseudogestational sac”-fluid in the endometrial canal
Mimics normal GS
Look for decidual reaction

—Surgical
Resection of diseased tube
Early diagnosis w/ TV = more conservative
Laporascopy
–Definitive diagnosis
—Medical
Goal is to find early before rupture
Methotrexate
61-93% success

Methotrexate

—Spectrum of pathologies resulting from the excessive proliferation of trophoblastic tissue
—Paternal genomes control the proliferation of trophoblastic tissue, maternal genomes control growth of the embryo
—GTD is caused from excessive paternal genomes
Complete mole
Partial mole
Invasive mole
Choriocarcinoma
Mole with coexisting normal fetus

GTD clinical signs

—Most common form of GTD
—1:1500 USA; 1:82
Taiwan
—Risk factors include:
< 20 yrs and >40 yrs
Low economic status
Diets deficient in protein and folic acid
—Genetics:
1: Duplicated male chromosomes and normal ovum
2: Normal male chromosomes and empty ovum

Haploid
Single set of unpaired chromosomes

—Hydropic chorionic villi enveloped by hyperplastic atypical trophoblasts
—No embryo or fetal tissue is present
—Sonographic findings:
Multiple scattered cystic spaces filling a thickened endometrial cavity- “cluster of grapes”
Uterus larger than dates
Enlarged ovaries from theca lutein cysts

—2 normal sperm fertilize the same normal ovum
—2 types of chorionic villi
Normal
Hydropic swelling (trophoblastic hyperplasia)

—Pathology
Deformed GS
Growth-restricted fetus with anomalies
Large placental size with cystic spaces
Trophoblastic proliferation not as severe
—Symptoms
Less severe than complete
—Sonographic appearance is similar to a missed or incomplete abortion

Therapy for molar pregnancy

—2 conceptions occur as in twinning, but one develops into a mole and the other a normal fetus—
Cases have been reported of normal going to term, but itis very risky. Mom has to be monitored closely for hemorrhage, severe HTN, or toxicity—
Maternal risks are significant and termination is given as an option; Risk for future molar pregnancy or PTN increases

2 types of Persistent trophoblastic disease

Persistent trophoblastic disease

AKA Chorioadenoma destruens —Most common form of PTN (80-95%)—Trophoblastic tissue that penetrates the myometrium and/or adjacent structures. May penetrate the uterine wall and cause uterine rupture and hemoperitoneum —Considered a malignant, non-metastatic form of GTD—Diffuse echogenic material with cystic spaces filling the endometrial cavity and extending into myometrium (“more mole than uterus”)

—very rare—1:30,000 pregnancy; 1:40 molar pregnancies—Vascular invasion, hemorrhage, and necrosis of the myometrium are common—Tumor composed of syncytiotrophoblastic and cytotrophoblastic cells—Considered the malignant, metastatic form of GTD—Can metastasize to the lung, brain, liver, bone, GI tract, or skin

Name Disease:
—Elevated hCG
—No embryo or fetal tissue present
—Enlarged uterus
—Mass with complex, marked vascularity

Treatment for PTN

If abnormality is suspected in 1st trimester follow-up is recommended or genetic testing:– by testing what?

What is the major advantage of screening anomalies in the 1st trimester?

Def. performed from 15 wksAmniotic fluid is drawn ransabdominally under U/S guidance to avoid fetus, placenta, and umbilical cord

List the Genetic Testing options

What type of US scans are the most accurate for assessment of fetal anatomy

When do most congenital anomalies occur?

When are most congenital anomalies diagnosed?

List some congenital anomalies

Def. exaggerated, hyperextension of the neck, open spinal defects, occipital encephalocele

Def. protrusion of the brain through a bony defect in the skull

Def. absence of the brain and cranial vault, base of skull and face are present along with some brain tissue

Def. partial or complete absence of the cranium, bony structures absent

Def. lack of closure of the spinal column, bulging of spine or meninges into a sac; prognosis depends on severity

Def. cystic dilatation of the 4th ventricle and abnormal configuration of the cerebellum

Def. 3 levels of severity, absence of brain tissue in varying degrees; no cerebral hemispheres or ventricles

Def. hydrocephaly, dilatation of the ventricles without enlargement of the cranium; increased amount of CSF

Def. herniation of the abdominal contents into the umbilical cord; often associated with other congenital anomalies

Def. open defect in the anterior abdominal wall; organs are not covered by a membrane, they are seen “floating” in the amniotic fluid; not associated with other congenital anomalies

—Def. One of the most common abnormalities seen in the 1st trimester—Single or multiple cystic areas, of lymphatic origin, within the soft tissue surrounding the neck—Associated with chromosomal abnormalities such as Turner’s and Down syndromes