OB/GYN Boards Review Pt 2

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dorkfork
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287931
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OB/GYN Boards Review Pt 2
Updated:
2014-11-15 11:30:57
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1st Trimester Placenta Complications Procedures
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1st Trimester physiology and patholgy, maternal complications,genetics, related procedures, multiple gestations
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  1. Fundal height measurement
    Measured from symphysis pubis to superior aspect of uterine fundus.

    • -16-34 weeks- cm measurement= ga in weeks
    •     i.e. 18 weeks= 18 cm
    • -20 weeks closer to fundus
    • -Max height at 36 weeks
  2. Normal gestation is how long
    280 days or 40 weeks from LNMP (first day)
  3. Naegele's Rule
    Calculate due date by adding 9 months and 7 days  to the 1st day of the last period.
  4. When is hCG first secreted?
    1st secreted by the chorion of the blastocyst by 14 days post fertilization.
  5. At what beta hCG level should we see a gestational sac? (1st IRP)
    1000mIU/mL
  6. At what beta hCG level should we see the yolk sac? (1st IRP)
    7200 mIU/mL
  7. At what beta hCG level should we see a live embryo? (1st IRP)
    10800 mIU/mL
  8. Low hCG levels associated with?
    • Ectopic pregnancy
    • Spontaneous abortion
  9. High hCG levels are associated with?
    • Multiple gestations
    • Hydatidiform mole (low MSAFP)
    • T21
  10. Nuchal translucency
    ≥ 3.5mm

    Between 11 and 13 weeks ga

    87% sensitive for detection of T21
  11. Triple screen
    3 blood tests- MSAFP, estriol, Beta hCG 

    Performed between 14 and 19 weeks ga

    • Used to identify risk for
    • -chromosomal abnormalities (70% sensitive for T21)
    • -birth defects(open NTD)
  12. MSAFP
    • Produced in fetal liver
    • Normal levels in both maternal and fetal serum
  13. Increased MSAFP
    • Open NTD> *spina bifida, anencephaly*
    • Underestimation of GA
    • Multiple gestation
    • Threatened abortion
    • Congenital nephrosis
    • Duodenal atresia
    • Omphalocele
    • Sacrococcygeal teretoma
  14. Decreased MSAFP
    • Long standing fetal death
    • T21
    • T13, T18
    • Hydatidiform mole
    • Pseudopregnancy
  15. Decreased Estriol
    • Risk for:
    • -Growth restriction
    • -Fetal death
    • -Anomalies- T21
    • -Post maturity
    • -Pre-eclampsia
    • -Rh immunization
  16. Quad screen
    Triple screen (MSAFP, Beta hCG, and Estriol) with the addition of inhibin A

    Inhibin A is produced in fetus and placenta and has an abnormal increase with T21 (86% detection)
  17. Cell free fetal DNA
    • Indicates if at risk of having a fetus with T21, T18, T13
    • Blood sample taken at 10 weeks LNMP
    • Extremely sensitive for detection of downs and T18 (98%) 
    • Slightly less sensitive for T13(65%)
  18. CVS
    • Chorionic villi retrieved from chorion frondosum
    • Performed between 10 and 14 weeks
    • Most done transcervical
    • Risk of abortion... slightly higher than amnio
  19. Amniocentesis
    • Usually performed between 15 and 17 weeks
    • Provides kayotype
  20. Parturiton
    the birth process
  21. Effacement
    Thinning of cx
  22. Abortion
    delivery that occurs prior to 20 weeks ga
  23. Duel's sign
    Subcutaneous scalp edema
  24. Method to remove products of conception
    • D&C
    • D&E
    • Labor induction
  25. Acytlechoinesterase (ACHE)
    Can detect spina bifida
  26. Ithopedion
    Calcified fetus
  27. A disorder with one defective gene is considered what?
    Autosomal Dominant
  28. Polyhydramnios (3rd trimester value)
    >23cm AFI
  29. Oligohydramnios (2nd vs 3rd trimester)
    • 2nd= <5cm
    • 3rd= <3cm
  30. Thick placenta is associated with:
    • Maternal diabetes
    • Eyrithroblastosis fetalis
    • TORCH
    • Nonimmune hydrops
  31. Causes of postpartum hemmorhage
    • #1>> uterine atony (inability to contract)
    • multiple gestation
    • polyhydramnios
    • macrosomia
    • long labor
  32. Chorioadenoma detruens
    Molar pregnancy that is invasive but does not metastisize
  33. Drug used to combat RH immunization
    rhogam
  34. When should the uterus return to pregravid size?
    4 weeks postpartum
  35. Maternal HTN is associated with?
    • IUGR
    • Thin placenta
    • Fetal demise
    • Advanced placental age
    • Oligohydraminios
  36. Peuperium
    Term for after birth
  37. Cystic hygroma is associated with what chromosomal abnormality?
    Turners
  38. Caudal regression syndrome
    Associated with maternal diabetes
  39. Midline anechoic brain lesion with color
    Vein of galen anyeurism
  40. Causes of oligohydramnios
    • Fetal demise
    • IGUR
    • PROM
    • Bilateral renal agenisis
  41. Long bone least affected by IUGR
    clavicle
  42. Gestational sac measurements are accurate in estimating ga with in what margin?
    2 weeks
  43. What does the placenta form from?
    Chorion and the decidua
  44. Placental thickness
    • @ term rarely exceeds 4cm
    • thickness= ga +/- 10mm
  45. Smoking causes what type of change to placenta
    Causes it to age faster
  46. Stage 3 placenta should not be seen until when?
    • 35 to 37 weeks
    • Diabetics may be 0 ot 1 at term
  47. Cerebellar measurements loose accuracy when?
    30 weeks
  48. Cephalic index
    • Normally 70-85%
    • bpd/ofd X 100
    • Low CI = dolichocephally
    • High CI = brachycephally
  49. Vitelline duct
    • AKA omphalomesenteric duct
    • Connects yolk sac to embryo once they diverge from one another
  50. Gestational sac should take up half the uterine cavity when?
    ~8 weeks ga
  51. 1st sight at which fluid will collect if there is an obstruction of CSF?
    Lateral ventricular atria
  52. Best view of the diaphragm
    Coronal or parasagital
  53. Bladder in male fetus' are sometimes enlarged bc of what?
    PUV
  54. Coronal view of the fetal bladder will consistently demonstrate what other anatomy?
    Iliac bones
  55. Largest normal measurement of the yolksac
    ≤6mm
  56. Double bleb sign
    Amnion and yolk sac
  57. Amount of fluid needed for amnio
    20-30mL (no amnio prior to 15 weeks)
  58. PUBS
    • More comprehensive karyotyping than amniocentesis
    • Sensitive for mosacism
    • Needle inserted 2-3cm from insertion into placenta
    • Blood obtained from umb vein
    • Can cause hematoma
    • Puncturing artery can cause bradycardia
  59. Fetal lung maturity
    • L/S ratio
    • Phosphatidyglycerol
    • Flourescence Polarization ( currently most widely used) elevated surfactanct to albumin ratio indicates lung maturity
  60. List the three potential spaces of the female pelvis.
    • Space of Rezius (prevesical or retropubic space)
    • Anterior cul-de-sac (uterovesical pouch)
    • Posterior cul-de-sac (pouch of Douglas, rectouterine space)
  61. Describe the location of the Space of Retzius.
    Space anterior to the bladder (between the transversalis fasica and the umbilical prevesical fascia)
  62. Describe the location of the Anterior cul-de-sac.
    • Posterior to the urinary bladder
    • Anterior to the uterine body and fundus
  63. Describe the perimetrium.
    Outter layer of the uterine tissue
  64. Describe the location of the Posterior cul-de-sac aka the Pouch of Douglas.
    • Retrouterine space
    • Posterior to uterus and upper 1/3 of vagina
    • Anterior to rectum
  65. List the tissue layer of the uterus.
    • Perimetrium
    • Myometrium
    • Endometrium
  66. Describe the myometrium
    Middle, smooth muscle layer of the uterine tissue
  67. Describe the endometrium
    • Inner mucous later of the uterine tissue
    • Line uterine cavity and is shed during menstration
  68. List and describe the anatomic divisions of the uterus.
    • Fundus: superior portion above entrance of fallopian tubes
    • Body: Mid portion/ corpus
    • Isthmus: narrow lower uterine segment
    • Cervix: inferior portion
  69. Normal measurement and location of the fallopian tubes
    • 7-12cm in length
    • 3mm in diameter
    • Extends from uterine fundus to ovaries
  70. List and describe the divisions of the fallopian tubes.
    • Isthmic: longest thinnest section
    • Ampullary: usual site of fertilization; common site of ectopic pregnancy
    • Infundibulum: largest section
    • Fimbria: fingerlike ends
  71. Describe the vascular supply of the uterus.
    Aorta > common iliac arteries > internal iliacs > anterior trunk > R & L uterine arteries
  72. Describe the vascular supple of the ovaries
    • Aorta > L & R ovarian arteries
    • IVC > R ovarian vein
    • IVC > L renal vein > L ovarian vein
  73. List & decribe the tissue layers of the ovaries
    • Cortex: outer portion containing follicles
    • Medulla: inner portion containing blood vessels connective tissue and smooth muscle
  74. Describe the typical uterine position when the bladder is empty.
    Anteverted: tilts anteriorly
  75. List the most consistent landmarks for identification of the ovaries
    • Uterus
    • Internal iliac arteries which lay posterior to the uterus
  76. The ovaries are located in the fossa of __________.
    Waldeyers
  77. Describe the sonographic pattern and normal measurement range of the endometrial cavity during the early proliferative phase of the normal menstrual cycle.
    • end of menses
    • 2-3mm
    • Thin, hyperechoic line
  78. Describe the sonographic pattern and normal measurement range of the endometrial cavity during the proliferative phase of the normal menstrual cycle.
    • Estrogen
    • 8mm thick
    • Hypoechoic junctional zone deep to endometrium
  79. Describe the sonographic pattern and normal measurement range of the endometrial cavity during the periovulatory phase of the normal menstrual cycle.
    • Striated (triple layer sign)
    • Hyperechoic lines surrounding 2 hypoechoic layers
    • Midcycle
    • Signifies time when endometrium is receptive to implantation
  80. Describe the sonographic pattern and normal measurement range of the endometrial cavity during the secretory phase of the normal menstrual cycle.
    • >/=15mm
    • Thickest
    • Hyperechoic & thick
    • Right before period starts
  81. Describe the hormonal control of the menstrual cycle
    • FHS stimulates follicle to develop.
    • Estrogen increases & LH surges
    • Progesterone increases and builds up endometrium
    • Once the progesterone drops the endometrium is shed
    • 2 Phases: proliferative and secratory
  82. List the terms and stages of development of a corpus luteum for a cycle not ending in pregnancy.
    Develops @ site of ovulation and degenerates once body realizes there is no pregnancy (lack of Beta hCG
  83. Fetal landmarks identifiable on ultrasound at week 4.
    gestational sac ~2-3mm
  84. Fetal landmarks identifiable on ultrasound at week 5.
    yolk sac, fetal heart beat (end of 5th week), earliest sign of the morrow reflex, MSD = 5mm, double bleb sign (5 to 7 weeks)
  85. Fetal landmarks identifiable on ultrasound at week 7
    crown-rump length is obtainable ~8mm, rapid head growth, corpus leutem reaches max size
  86. Fetal landmarks identifiable on ultrasound at week 8.
    • limb buds, head, ventricles in brain, mid gut herniates into base of umbilical cord, earliest date to see fluid in stomach
    • CRL = 23mm (weight = 1 gram)
  87. Fetal landmarks identifiable on ultrasound at week 9.
    choroid plexus, brain
  88. Fetal landmarks identifiable on ultrasound at 10
    stomach week 10 ~2-3cm, midgut returns
  89. Fetal landmarks identifiable on ultrasound at week 12.
    hands/fingers, bladder, mid gut retracts from herniation
  90. Fetal landmarks identifiable on ultrasound at week 14.
    CRL ~8.5cm, sex recognition possible, kidneys visable
  91. Embryo should be seen when gestational sac measures what?
    >18mm
  92. Yolk sac should not be seen when gestational sac measures what?
    >12mm
  93. What is the double sac sign?
    • Hyperechoic: decidua perietalis
    • Hypoechoic: unoccupied lumen
    • Hyperechoic: decidua capsularus
  94. List the progression of embryological development
    Gamete > zygote > blastomere > morula > blastocyst > throphoblast & inner cell mass
  95. Gamete
    A male or female reproductive cell (sperm, egg) capable of entering into a union with another in process of fertilization. (23 chromosomes each)
  96. Zygote
    Organism produced by union of 2 gametes. (46 chromosomes)
  97. Blastomere
    The progressively smaller cells formed by cleavage of fertilized ovum
  98. Morula
    Berrylike solid mass of cells which reaches uterine cavity ~3-4 days after fertilization
  99. Blastocyst
    Central fluid cavity forms and by 7th day, cells differentiate into outer layer (trophoblast) and inner cluster of cells (inner cell mass)
  100. Trophoblast
    Becomes chorionic membrane and fetal contribution to placenta
  101. SAB
    • Spontaneous abortion
    • Expulsion (live or stillborn) of products of conception before 20th completed week of gestation with out deliberate interference
  102. TAB
    • Therapeutic abortion
    • Interruption of pregnancy for legally acceptable, medically approved indications
  103. STB
    • Stillborn (born dead)
    • Fetus, irrespective of its gestational age, that after complete expulsion from the mother shows no evidence of life
  104. Neonatal death
    death of liveborn infant within first month of life (28 days or less)
  105. ECT
    Ectopic pregnancy
  106. Describe the routine gestational dating parameters used during the first trimester pregnancy.
    • 6-12 weeks = crown-rump length
    • before 6 weeks = Mean Sac Diameter (MSD)
  107. Cardiac activity should be present when CRL is what?
    5-7mm
  108. When is the rhombencephalon visualized?
    7-9 weeks
  109. Normal midgut herniation should meaure
    • <7mm
    • If more than 7mm consider omphalocele
    • Should not see herniation when CRL 45mm or more
  110. Bradycardia in 1st trimester
    90 and below
  111. Anembryonic pregnancy
    • AKA blighted ovum
    • Demise occurs early in pregnancy
    • Embryo has been reabsorbed or development ceased before formation of embryonic disc
  112. Inevitable abortion
    • lack of cardiac activity
    • dilated cx >3cm
    • low position of embryo/fetus
    • irregular gs
    • bleeding
    • cramping
  113. Compound pregnancy
    • AKA heterotropic pregnancy
    • IUP with coexisting ectopic
  114. Ectopic beta hCG level
    Subnormal rise in beta hCG levels (below 66%) is seen in 85% of ectopics.
  115. Pseudosac sign
    Transabdominally- looks like normal early IUP without cresent sign
  116. Sonographic indicators of ectopic
    • 100%- extrauterine embryo with cardiac activity
    • 100%- adnexal mass containing yolk sac or nonliving embryo
    • 95%- "tubal" or "adnexal ring" surrounding a fluid collection
    • 92% complex or solid adnexal mass- no embryo, yolk sac or tubal ring
  117. Cervical ectopic
    • Incidence increases after injury to EC (post D&C, bx, or section) interfering with normal implantation
    • Can be fatal due to severe hemmorhage
    • ? true cervical ectopic vs abortion in progress
  118. Risk of rupture of an ectopic pregnancy significantly increases at what point?
    after 7 weeks LNMP
  119. Hemoperitoneum in the cul de sac is a red flag for what?
    Ruptured ectopic
  120. Gestational trophoblastic disease
    • HX of spontaneous abortion
    • Retained products of conception persist and continue to secrete hCG (@ higher levels than in a normal IUP)
    • Theca lutein cysts are associated from the ovarian hyperstimulation (multiple and bilateral)
  121. Symptoms of gestational trophoblastic disease
    • absence of fetal parts/heart tone
    • uterine bleeding in 1st trimester
    • hyperemisis
    • pre-eclampsia
    • LGA
    • High hCG levels
  122. Complete hydatidiform mole
    • fertilization of empty ovum
    • Sperm duplicates its own chromosomes (46xx)- all paternally derived
    • Echogenic mass with hydropic vili filing and expanding EC 
    • "swiss cheese pattern"
    • Bilat theca lutein cysts 20-50% of the time
  123. Partial mole
    • Fetal parts identified
    • Usually triploidy
    • No term cases
    • Rare
  124. Invasive mole
    • AKA choriocarcinoma destruens
    • 12-15% of pts with a molar pregnancy
    • invasion of myo/parametrium
    • Hypervascularity in myometrium
  125. Choriocarcinoma
    • Most malignant form of trophoblastic disease
    • 50% hx of molar pregnancy
    • Mets- lung, brain, liver, bone, GI tract
    • indistinguishable from benign mole
  126. Treatment for molar pregnancy
    D&C = methotrexate
  127.  Abnormal nuchal translucency measurement
    >3mm
  128.  Abnormal nuchal translucency increases risk for?
    • Aneuploidy (particularyl when sepatated)
    • T21
    • T18
    • Turners
  129. Most common feature of T13?
    Holoprocencephaly
  130. Cystic hygroma is associated with?
    Turners
  131. 2nd most common NTD?
    Anencephaly
  132. FGR is associated with what chromosomal abnormalities?
    T18 and 13
  133. Most single umbilical arteries are ____ sided.
    Left
  134. ______ anomalies are most common with SUA.
    Cardiac
  135. False umbilical knot
    Folding of vessels
  136. Lack of Wharton's jelly is seen with:
    • T21
    • Velementous insertion
    • Coarctation of the AO
    • Intrauterine death
    • Preterm delivery
  137. Majority of umbilical cord cysts are:
    Paraxial- eccentrically located, vessels not displaced
  138. Multiple cord cysts are associated with:
    • Anueploidy
    • Increased nuchal thickness
    • Poor outcome
  139. Allantoic cord cyst
    • True cyst secondary to patent urachus
    • Always near cord insertion
  140. Most common cord tumor
    Hemangioma
  141. Nuchal cord
    Cord around babies neck
  142. Normal cord length
    50cm
  143. Oblicate cord
    Near cervix
  144. Vasa previa
    Segment of cord located between fetal presenting part and lower pole of intact membranes
  145. Velamentous insertion
    Cord inserts into amniotic membrane instead of placental tissue
  146. Intrahepatic 4VC associated with:
    Excelent prognosis and usually isolated finding
  147. Extrahepatic 4VC associated with:
    • T18
    • Almost all cases have SUA
  148. Normal placental thickness = ____ +/- _____
    Gestational age in mm +/- 10 mm
  149. Thin placenta is associated with:
    • Pre-eclampsia
    • IUGR
    • Chromosomal abnormalities
    • Preconceptual diabetes
    • Sever intrauterine infection
    • HTN
  150. Thick placenta is associated with:
    • Gestational maternal diabetes
    • Hydrops
    • Fetal anomalies
    • Molar pregnancy
    • Anemia
    • Infection
  151. Circumvallate placenta
    • Edges of placenta not attatched
    • Creates a cupped appearance
  152. #1 cause of painless vaginal bleeding
    Placenta previa
  153. Most common site of abruption is:
    At placental margin- subchorionic
  154. Abruption risk factors
    • Pre-eclampsia
    • HTN
    • Trauma
    • Cocaine/cigarette
    • AMA
  155. Acute abruption w/48 hrs
    Hyperechoic
  156. 3-7 day old abruption
    Isoechoic
  157. 1-2 week abruption
    Hypoechoic
  158. 2+ week old abruption
    Anechoic
  159. Placenta accreta
    Villi grow into myometrium
  160. Placenta increta
    Villi grow through myometrium
  161. Placenta percreta
    Villi penetrate serosa and may extending into rectum or bladder
  162. Placenta accreta risk factors
    • Precious c-section
    • Placenta previa
    • Submucosal fibroid
    • Uterine cornua
  163. Most common benign neoplasm of the placenta
    Chorioangioma
  164. Low risk for preterm labor occurs at a cervical length of:
    Greater than or equal to 30mm
  165. Intermediate risk of preterm labor occurs at a cervical length of:
    20-30mm
  166. High risk for preterm labor occurs when the cervical length is:
    less than 20mm
  167. 1st sign of decreased cervical length
    Funneling

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