OB TEST #3

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Author:
marie78
ID:
261315
Filename:
OB TEST #3
Updated:
2014-02-11 22:47:59
Tags:
ENDO
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Description:
LECTURES 9-12
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  1. HCG/IUP Discriminatory Zone (Transabdominal)
    bhCG 1,800 mIU/ml should see GS
  2. HCG/IUP Discriminatory Zone (Endovag)
    bhCG 1,000 mIU/ml should see GS
  3. Gestational Sac Size (Endovag)
    • 8-13 mm Yolk Sac
    • 16-18 mm Embryo
  4. Gestational Sac Size (Transabd)
    • 20 mm Yolk Sac
    • 25 mm Embryo
  5. USA Decidual Reaction in early IUP
    • Can be seen w/ 3 distinct layers in Endom
    • 2 echogenic rings
    • Decidua Capsularis
    • Decidua Parietalis/Vera
    • Decidua Basalis- maternal portion of placenta
  6. USA Yolk Sac
    • Symmetrical & round
    • Hyperechoic ring
    • Anechoic inside
    • <6mm
    • Located outside Amnion
  7. USA Corpus Luteum Cyst of Pregnancy
    • Cyst
    • Thicker wall
    • measuring @ 30 mm/3 cm
  8. USA Gestational Sac
    • Round, oval or tear drop shape
    • Located toward UT fundus or mid-UT
    • Echogenic, in-tact borders
    • Anechoic inside
  9. (Common locations) ECTOPIC PREGNANCY
    • Ampulla of FT
    • OV
    • Cornua
    • C-section scar
    • CX
    • Abdomen
  10. (Ring of Fire) ECTOPIC PREGNANCY
    • Incr Vascularity around a GS w/ low resist flow
    • Make sure to differentiate fr CL cyst
  11. (Pseudogestational Sac) ECTOPIC PREGNANCY
    • Fake gestational sac
    • Empty
    • Found in UT
  12. USA ECTOPIC PREGNANCY
    • Empty UT
    • Adnexal mass
    • FF in cul-de-sac, adnexa, fornices, Morrison's pouch (FL may be complex)
  13. (Labs) ECTOPIC PREGNANCY
    • HCG normal and doesn't incr high enough
    • +Preg test
  14. (Clinical Signs) ECTOPIC PREGNANCY
    • Amenorrhea
    • +Preg test
    • Vag spotting/bleeding
    • Adnexal tenderness
    • Pelvic pain
    • Shoulder pain
  15. Complete Abortion
    • All product of Conception are expelled
    • May experience bleeding/cramping
  16. USA Complete Abortion
    • Empty UT
    • Normal Endom
    • Possible small amt of fl
    • UT may be enlarged 4 up to 2-weeks after
  17. Incomplete Abortion
    Part of products of conception are expelled while a portion remain in UT
  18. USA Incomplete Abortion
    • Thickened/irreg endo
    • May be fl in endo
    • Retained Prod of Conception (RPOC)
    • Incr Vasc around endo up to 5 days after
    • CX can be open/close
  19. Missed abortion
    Presence of an embryo w/o cardiac activity
  20. USA of Missed abortion
    • -FHT
    • watch for 3 mins to confirm absence of heart beat
    • NO Fetal movement
  21. Inevitable abortion
    aka: Abortion in Progress
  22. USA of Inevitable abortion
    • GS is low
    • Dilated CX
    • Anechoic Crescent
    • PROM-Premature Rupture of Membranes
  23. Anembryonic Pregnancy
    • aka: Blighted Ovum
    • Embryo does not develop or stops early in growth & Cannot be seen
  24. USA of Anembryonic Pregnancy
    • GS is large
    • No identifiable embryo in GS (>25mm) MSD
    • Fluid fluid level= blood (+embryonic death)
    • GS might have irreg borders
  25. 1st Trimester measurements
    (MSD Calc)
    • MSD=Length + Ht + Width
    •                     3
    •  +/- 2 weeks
  26. 1st Trimester measurements
    (CRL)
    Top of Head to Bottom of Rump (Most accurate) up to 12 weeks only

    +/- 4 days
  27. 1st Trimester measurements
    (FHR)
    • 100-180 bpm (normal range)
    • M-mode
  28. Nagele's Rule
    • Calculating EDD (Est Del. Date)
    • EDD= LMP-3mos+7days
  29. Length of Pregnancy
    40 weeks
  30. 1st Trimester routine scan
    (Normal protocol)
    • Complete Pelvic Exam
    • Location of GS 
    •    Shape of GS, MSD, YS
    • Presence of Embryo or Fetal Pole
    • CRL
    • Presence/absence of Fetal Heart tones
    •    Heart rate, M-mode, Fetal #
  31. 1st Trimester routine scan
    (Why perform one?)
    • To make sure:
    • It is really +
    • Health of UT
  32. 1st Trimester routine scan
    (When should you see a heartbeat?)
    • CRL of 5 mm
    • 5-6 weeks endovag
  33. IF bhCG is too HIGH?
    • Incorrect dates (further along than you think)
    • GTD (molar pregnancy) Extremely Elevated
    • Mult gestations
  34. IF bhCG is too LOW?
    • Incorrect dates (not further along)
    • Ectopic pregnancy
    • Embryonic demise
    • Abnormal IUP
  35. At what rate do bhCG levels rise throughout 1st trimester of preg?
    • Double every 2-3 days up to 8 wks of gestation
    • Plateaus around 8-9 wks then declines bec placenta takes over
  36. When do Amnion and Chorion fuse?
    By weeks 12-16
  37. Up to what week is the physiologic gut herniation normal?
    By wk 12
  38. Cephalic Index (CI)
    Head shape  

    Normal range: 0.70-0.86 (70-86%)
  39. DOLICOCEPHALY
    • Long, Narrow head
    • CI: <70%
  40. BRACHYCEPHALY
    • Short, Wide head
    • CI: >86%
  41. Intraocular measurement
    • Medial portion of the eyes (in-between)
    • Inner orbit
  42. HYPERTELORISM
    Eyes FAR apart
  43. HYPOTELORISM
    Eyes CLOSE together
  44. BINOCULAR MEASUREMENT
    Outer rim of eyes
  45. FERTILIZATION
    • Union of Sperm & ovum
    • 24-36 hours after ovulation
    • Occurs in Ampulla of Ft
    • Zona Pellucida: outer part of Ovum
  46. BLASTOCYST
    Hollow ball of cells that implants to endo 7 days after fertilization
  47. MORULA
    Solid mass of dividing cells located in isthmus of tube enter UT
  48. TROPHOBLAST
    • Outer lining of Blastocyst
    • Produce HCG to extend the life of CL
    • Becomes the chorion
  49. CHORION
    • Membrane that forms the fetal portion of placenta
    • Outer Lining of GS
  50. AMNION
    • Forms from inner cell mass
    • Membrane contains baby & amniotic fl
  51. VITELINE DUCT
    Stalk connecting YS to embryo
  52. Heterotopic Pregnancy
    • 1 IUP and 1 EUP 
    • Fr GIFT/ZIFT
  53. FETAL LIE
    • Relationship of Fetal long axis to the long axis of mom (SAG, TRV, OBLIQUE)
    • Baby's position in UT
  54. FETAL PRESENTATION
    Fetal part closest to CX
  55. GTD (Gestational Trophoblastic Disease)
    • Molar Pregnancy
    • Abnormal GROWTH of trophoblastic tissue
  56. GTD Labs
    Very Elevated HCG
  57. GTD (Completed Hydatidiform Mole)
    • Most common form of GTD
    • Enlarged, heterogeneous UT
    • Grape clusters
    • NO Fetal parts
  58. GTD (Partial Mole)
    • Irreg Fetal tissue
    • Grape Clusters
    • Partial Mole/Partial Fetal Parts
  59. GTD (Choriocarcinoma)
    • Malignant GTD
    • Could be from years later
    • Vascular invasion, hemorrhage & necrosis of myometrium
  60. 2nd Trimester Scanning (Protocol)
    • Eval Fetus (s)
    • Position
    • Heart tones & rate
    • Amniotic Fl Vol
    • Placenta position & appearance
    • Fetal Cord insert
    • Biometric Analysis
  61. 2nd Trimester Scanning  
    (what must be seen @ sacrum?)
    • Sacrum comes to a point
    • Looking for closed neural tube
  62. 2nd Trimester Scanning
    (How is the fetal heart positioned in chest?)
    Apex should point  to the LT
  63. 2nd Trimester Scanning 
    (How many times should measurement be taken?)
    • 2x
    • New pictures each time
    • Only BPD/HC can be used twice
  64. 2nd Trimester Scanning 
    (Types of Fetal Presentation)
    • Cephalic:
    • Vertex, Sinciput, Brow, Face

    • Breech:
    • Footling=hips extended, feet presenting
    • Frank=hips flexed, knees extended
    • Complete=hips flexed, knees flexed

    Shoulder
  65. MONOZYGOTIC (Twins)
    from 1 fertilized ovum (Identical twins)
  66. DIZYGOTIC (Twins)
    From 2 fertilized ova (Fraternal Twins)
  67. Types of Amnion/Chorion combinations (Twins)
    • Dichorionic/Diamniotic (2 placenta/2 sacs)
    • Monochorionic/Diamniotic (1 placenta/2 sacs)
    • Monochorionic/Monoamniotic: (1placenta/1sac)= 50% mortality rate/Monozygotic pregnancy
  68. The earlier the egg splits, the LESS environment the twins share=BETTER

    (T/F)
    TRUE
  69. How do Conjoined twins happen?
    • Embryonic disk divides after 13 days of gestation
    • (the lesser time, the better)
  70. TTTS
    • Twin-to-Twin Transfusion
    • 1 twin will have bl shunted away="donor" twin
    • 1 twin rcvs all the bl="recepient" twin
    • USA: 1 baby smaller, the other Bigger
  71. Acardiac Twin
    • aka: Acardiac "monster" or TRAP (Twin Reversed Art Perfusion Sequence)
    • Acardiac twin has no umbilical cord
    • NO heart motion, no brain
    • May move & grow

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