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OB Exam 1
Terms
Pregnancy
The implantation of a zygote into a
woman’s body. Pregnancy occurs when
a woman’s body responds to the
hormonal signals th...
Prenatal
Before birth
Postnatal
After birth
Perinatal
A 48-hour time period including the
day before and the day after birth
Neonatal
The time period including the first 4
weeks of life
Premature
A fetus born at less than 36 weeks
gestational age
Postmature
A fetus born at greater than 42 weeks
gestational age
Gravida
The number of pregnancies including
the current one
Para
The number of pregnancies carried
to term
Nullipara (Nullip)
Characterizes a woman during her
first pregnancy
Multipara (Multip)
Characterizes a woman after several
pregnancies
Grand Multip
Characterizes a woman who has 5 or
more successful previous
pregnancies
Trimester
The 40 weeks from LNMP of a normal
pregnancy is divided into 3 trimesters of 13
week duration.
Pregnancy is 266 days +/- 1...
LNMP
Last normal menstrual period; First
day of cycle or LMP
Pregnancy dating
In US, dated from the 1st day of the
LNMP

The earlier in pregnancy the sonogram
is performed the more accurate the
dating
FISH
(fluorescence in situ hybridization)
Useful for gene-mapping and
identifying chromosomal
abnormalities like Trisomy-21 or
...
Nabothian cyst
A mucus filled lump on the surface of
the cervix caused by plugged up
mucus glands
Ovarian hyperstimulation
A syndrome usually seen in women
who take certain fertility medicines
that stimulate egg production
Occurs after ovulation...
Demise
The loss of a fetus at any stage
Chorionic villus sampling
The removal of a small piece of
placenta tissue (chorionic villi) from
the uterus during early pregnancy to
screen the bab...
Percutaneous umbilical blood
sampling (PUBS)
A highly specialized prenatal test in
which a blood sample is removed
from the umbilical cord and tested
for genetic probl...
Methotrexate
One of the most effective and commonly
used medicines in the treatment of several
forms of arthritis and other rheumatic
c...
Propaganda
Ideas, facts, or allegations spread
deliberately to further one’s cause or
to damage an opposing cause; also; a
public act...
Thoracoamniotic shunting
The treatment of choice for
management of the fetus with
symptomatic fetal hydrothorax (FHT)
before 32 weeks of gestation
Intrauterine growth restriction
(IUGR)
Reduced growth rate (symmetrical
IUGR) or abnormal growth pattern
(asymmetrical IUGR) of the fetus;
resulting in a small f...
Human chorionic gonadotropin
(hCG)
Hormone secreted by
syncytiotrophoblasts of the developing
embryo
Laboratory test indicates pregnancy
when values are elev...
Macrosomia
Exceptionally large infant with
excessive fat deposition in the
subcutaneous tisse
Most frequently seen in the fetuses
of ...
Maternal serum alphafetoprotein (MSAFP)
Biomedical test used to assess fetal risk for
aneuploidy or fetal defect (neural tube
defects)
Component of the “triple sc...
Polycystic Ovarian Syndrome
Ovary doesn’t make all the hormones it
needs for the egg to fully mature, so the
follicle grows and builds up fluid
Most c...
Decidua
Endometrium of pregnancy
“falling away”
Decidua basilis
The decidua in contact with the chorion
frondosum, which eventually develops
into the placenta
Chorion frondosum
Villous chorion
Decidua capsularis
The decidua in contact with the chorion
laeve
When the decidua capsularis is pressed
against decidua vera on the opposite ...
Chorion laeve
Smooth chorion
Decidua parietalis
(decidua vera)
Endometrial lining which is not initially
involved in the implantation and is
therefore not associated with the
placenta
Chorion
Extraembryonic membrane that is formed
from trophoblastic cells and forms the
outer wall of the blastocyst at the time of
...
Chorionic frondosum
(villous chorion) Interweaving of chorion
villi and decidua basalis.
Establishes early utero-placenta
circulation
Amnion
The inner membrane which holds the embryo suspended in
the amniotic fluid
Amnion extends over the placenta except at the u...
Syncytiotrophoblast
Cells form isolated spaces called lacunae
which later develop into intervillous
spaces in the placenta where maternal
bloo...
Placenta
Organ that provides hormones to
support pregnancy and that is the site of
communication between the mother’s
blood and fet...
Threatened abortion
Bleeding in early pregnancy
Inevitable abortion
Term assigned after it is determined that
the pregnancy is non-viable
Elective abortion
Medical term for an induced abortion
performed at a woman’s request
Missed abortion
Occurs when the products of gestation
remain in the uterus and cause
continued bleeding
Therapeutic abortion
An induced abortion for the health of
the mother
Pre-eclampsia
Having high blood pressure during
pregnancy and too much protein in
urine at 20 weeks
Choriocarcinoma
Type of gestational malignant tumor
that arises from the trophoblasts of the
forming placenta within the uterus
Theca Lutein Cyst
Nonfunctional cyst found on the ovary
and are associated with excess amounts
of gonadotropins
Cervical cerclage
Surgical procedure to correct cervical
incompetence
Cervix is stitched closed so that
premature birth or miscarriage is
av...
Decidual cast
Occurs when the decidua of the uterus
discards

Appearance of the uterus when it comes
out
Well known with ectopic pregnan...
Adnexa
Parts next to each other or attached to
each other
Mullerian duct
Ducts in the embryo that develop into
female parts
Idiopathic
Spontaneous or unknown cause or
origin
Braxton hicks
False labor pains that often occur early
on in pregnancy
Not a true contraction
Hyperemesis gravidarum
Excessive vomiting during early
pregnancy that results in at least a 5%
reduction in body weight
Blighted ovum
A miscarriage in which the baby does
not develop or demises early but the
gestational sac remains
PAPP-A
Pregnancy Associated Plasma Protein A
Can be a part of 1st trimester screening
measure with a blood test
D&C
Dilation and curettage
A procedure in which the cervix is
dilated in order to remove the
endometrium
MSD
Mean sac diameter
Figured from several different
measurements
Fundal height
Abdominal measurement of the uterine
length
Measured from the symphysis pubis to
the tip of the fundus in cm
The cm length...
Large for gestation age
A baby whose weight is greater than
4000 grams at term
Small for gestational age
A full term baby whose weight is less
than 2500 grams at birth
Hi-risk pregnancy
A pregnancy with maternal or fetal
factors which predispose to increase
maternal or fetal morbidity and
mortality
• Bleedi...
Normal fetal heart rate
120 – 160 bpm with marked variability
Reactive fetal heart rate
Heart rate increases with movement
Aka: fetal heart acceleration
Estriol
Estrogen product produced by the
placenta from fetal precursors
estradiol
Estrogen product produced by the
placenta from maternal precursors
Triple screen
A measurement of estriol, HCg, and AFP
in the maternal serum
Fetal monitoring
Monitoring of fetal heart rate and
uterine contractions
Placental reserve
(placental suficiency)
Measurement of the ability to supply
sufficient oxygen to the fetus even during
contractions, which reduce maternal blood
...
Cervical effacement
Shortening of the cervix
Cervical dilation
Dilation (opening) of the cervix
Quickening
Initial perception of fetal movement by the
mother
Usually occurs between 17 and 21 weeks
*inexact method of determining E...
Oligohydramnios
Insufficient amounts of amniotic fluid
Polyhydramnios
Excessive amounts of amniotic fluid
Apgar score
Standard for comparing the condition of the
baby at birth and a way of detecting depressed
newborns
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Measurement...
Biophysical fetal profile
An intrauterine score designed to detect
depressed fetuses
Scores of 0 or 2 are given for:
• Fetal breathing movements
• G...
Dubowitz score
Standard test of the baby’s physical
characteristics and neurological (reflex)
responses that is completed in the
nursery ...
Primordia
The first recognizable, histologically
differentiated stage in the development
of an organ
Allantois
A vascular fetal membrane of reptiles,
birds, or mammals that is formed as a
pouch from the hindgut and that in
placental ...
BhCG
Produced by the cells of the implanting
egg and can be produced in the absence
of an embryo
Can be detected in maternal pl...
Trisomy-13
A syndrome associated with the
presence of an extra chomosome 13
Characterized by mental retardation,
cardiac problems, an...
Verix or vernix caseosa
A white substance covering the skin of a
baby directly after birth
Composed of sebum and cells that have
sloughed off fetu...
Pyelectasis or hydronephrosis
Dilation of the renal pelvis in a fetus due
to urine or fluid collection
• Hydronephrosis – when it exceeds
10mm at 20-24 ...
Transudation
A fluid or solute moving through a
membrane
It moves by osmotic or hydrostatic
pressure gradient
Wharton’s jelly
A supportive tissue derived from
extraembryonic mesoblast that
surrounds the umbilical cord protecting
the vessels within
...
Congenital anomaly
Something that is unusual or different at
birth
Minor anomaly
Defined as an unusual anatomic feature
that is of no serious medical or cosmetic
consequence to the patient
Major anomaly
By contrast to minor anomaly might be a
cleft lip and palate, a birth defect of
serious medical and cosmetic
consequence t...
Hydrocele
A fluid-filled sac surrounding a testicle
that results in swelling of the scrotum
Up to 10% of male infants have a
hydroce...
Cerebellar vermis
Portion of the cerebellum in the midline
is not as prominent as the lateral
hemispheres

Receives visual input from the su...
Cotyledon
Discrete elevations of chorioallantoic
tissue of the ruminant fetal membranes
that adhere intimately with the materal
caru...
Aneuploidy
Refers to the abnormal copy number of
genomic elements
One of the most common causes in
morbidity and mortality in human
p...
OB Exam 1
Normal First Trimester
How many chromosomes are in a
gamete
Haploid - 23
How many chromosomes after
fertilization?
Diploid - 46
What do the follicles on an ovary
produce?
estrogen
What does estrogen stimulate?
The endometrium to grow and
thicken
What releases gonadotropin?
Hypothalamus
What stimulates the pituitary to
release luteinizing hormone and
FSH?
Gonadotropin
What does the luteinizing
hormone stimulate?
For one follicle to mature
Where does the oocyte go after
it is released?
Fallopian tube
What happens to the follicle
after rupture?
Becomes corpus luteum & produces
progesterone
What causes menstruation?
If fertilization doesn’t occur, estrogen
& progesterone drop
Where does fertilization typically
occur?
Fallopian tube
What happens to the corpus
luteum after fertilization?
Continues to produce progesterone
and some estrogen
What stage are weeks 1 – 4?
Zygote
What stage are weeks 5 – 10?
Embryo
What stage are weeks 11 – 40 ?
Fetal stage
When and how is a morula
formed?
By day 3 – 4, from the fertilized ovum
(zygote) divides
What is the organized form of
the morula?
Blastocyst
What feeds the blastocyst?
The thickened endometrial layer
(decidua)
What are the outer cells of the
blastocyst?
Trophoblast
What part of the blastocyst
becomes the embryo?
The cell disc
What are the 2 layers of the
trophoblast?
1. Inner – cytotrophoblast
2. Outer layer - syncytiotrophoblast
What does the cytotrophoblast
form?
• Chorion
• Amnion
• Connecting stalk
What does the
syncytiotrophoblast do?
• Invade the decidua
• Form lacunae (which develop into
intervillous spaces)
What hormone does the
trophoblast secrete?
hCG
What is the purpose of hCG?
Extends the life of the corpus
luteum/progesterone
When does the blastocyst
implant?
7 days after fertilization
What happens to the primary
yolk sac?
It disappears
What connects the secondary
yolk sac to the fetal body?
Vitelline duct (yolk stalk)
Where is the secondary yolk sac?
In the extraembryonic coelum,
between the amnion and chorion
What is normal size for the
secondary yolk sac?
< 6mm
What is the function of the
secondary yolk sac?
Nutrients and hematopoiesis
What days in the zygote stage
does conception happen?
14 days
When does the morula become a
blastocyst?
18 – 21 days
When does implantation begin?
19 – 21 days
What happens in days 25 – 26 of
the zygote stage?
• Implantation complete
• Lacunar network formed
• Focal thickening of the decidua at
the site of implantation
What happens in response to
estrogen and progesterone?
Transformation of endometrial cells
into glycogen and lipoid cells
What are the 3 distinct layers of
the decidua?
• Decidua basalis
• Decidua capsularis
• Decidua parietalis (decidua vera)
Which decidua attaches at the
chorion frondosum
Decidua basalis
Which decidua is not involved in
implantation?
Decidua parietalis (decidua vera)
Which decidua develops into the
placenta?
Decidua basalis
Which decidua covers the
remaining endometrial cavity?
Decidua parietalis (decidua vera)
Which decidua closes over the
blastocyst?
Decidua capsularis
When can the Intradecidual Sac Sign
/ Double decidua sign be seen?
Week 4
What stage are weeks 5 – 10?
Formation stage
What structures are present in
weeks 4 – 5?
• Yolk sac
• Neural plate and folds
What are the sonographic
features of week 4 – 5?
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Yolk sac in the gestational sac
Located in the fundus
Round or oval with smooth walls
Decidual thickening of >3mm
Where would the yolk sac been
seen in week 4 – 5?
Between the amnion and chorion
By what day should the
gestational sac be seen?
Day 34 (4 weeks)
By what day should the yolk sac
be seen?
Day 42 (5 weeks)
In week 4 – 5, what should the
diameter of the gestational sac be?
8 mm
In weeks 4 -5 what should the
hCG count be?
1800 mlU/ml
In weeks 4 – 5, what should the
decidual wall thickening measure?
> 3 mm
What structures are present in
weeks 5 – 6?
• Limb buds
• Primordia of liver, pancreas, lungs,
thyroid gland, heart
• Neural groove closes and the
primary brain vesic...
What are the sonographic
features of week 5 – 6?
• Double blep sign (amnion with yolk sac
• Embryo may be seen adjacent to yolk
sac
• Embryo heart beat
• Double decidua si...
What week should the embryo be
seen?
Or size of the gestational sac?
By week 6, or gestational sac of 1.5 cm
What would the embryo measure to
be able to detect heart beat?
5 mm CRL
7mm CRL (2014 Notes)
What structures are seen in
week 6 – 7?
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Brain has single vesicle
Heart bulges from the body
Embryo is C-shaped
Arm buds elongate, leg buds appear
Nostr...
What are the sonographic
features of week 6 -7?
The amnion is close to the embryo
What is the CRL in week 6 -7?
9 – 10 mm
What happens in week 7 – 8 ?
• Body axis straightens
• Arms & legs extend straight forward
• Digits, ears, eyelids, elbow, and wrists are
formed
• Pulm...
What would the CRL be in week
7 – 8?
21 – 23 mm
What happens in week 8 – 9?
• More straightening of axis
• Touch pads swollen on fingers
• Midgut herniates into the umbilical
cord (between weeks 8 –...
What are the sonographic
features in week 8 – 9?
The choroid plexus is seen in the
lateral ventricles
What would the CRL be in week
8 – 9?
28 – 30 mm
What happens in week 9 – 10?
• Eyelids cover eyes
• Brain structures complete
• Rapid growth
What would the CRL be in week
9 – 10?
30 – 40 mm
What would the CRL be week 11
& up?
40 – 85 mm
By when should the kidneys be
seen in adult position?
15 weeks
By 14 weeks (2014)
By when should the stomach be
seen?
12 weeks
When does the midgut herniation
return to the abdominal cavity?
11- 12 weeks
When is the cerebellum formed?
11 Weeks
When does ossification of long bones begin?
12 weeks
When should cranial anatomy be
seen?
After 12 weeks
When should the bladder be
seen?
By 14 weeks
When should the 4 chamber
heart be seen?
At 12 weeks
What does the mean sac
diameter correlate with?
Menstrual age
(1 cm = 1 week)
((Accurate through Wk 8)
What diameter should the yolk
sac never exceed?
6 mm
What is the most accurate way to
date a pregnancy?
By the crown rump length
With what accuracy does the CRL
date the pregnancy?
+ / - 5 days
((To 13 Wks Gestation))
What is included in the mean sac
diameter?
Only anechoic fluid space, not walls
Where should the gestational sac
be located?
To one side of the endometrium near
fundus
When should the yolk sac be
seen?
When the mean sac diameter is
8 mm
When should the fetal heart rate
be visualized?
By 6 weeks
(via TV)
What is the normal fetal heart
rate?
90 – 175 bpm
When is the nuchal Translucency
seen?
In the first trimester
When do you measure NT?
• 10 to 14 weeks
What is the nuchal lucency?
Anechoic area in the posterior nuchal
region of the fetus
What does nuchal translucency
screening detect?
What is a normal NT?
< 3.4 mm
The risk for having a child with
trisomy 21, 13 and 18
What factors are include in
nuchal transluceny screening?
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PAPP-A values
BhCG lab values
Maternal age
Fetal nuchal translucency
measurement
What forms the umbilical cord?
The fusion of the yolk stalk and
allantoic duct
When does the umbilical cord
develop?
During the 7 – 8th week
What forms the umbilical
vessels?
The allantois vessels
What is the cavity between the
amnion and chorion?
Extraembryonic coelum
(chorionic cavity)
What is the inner membrane that
suspends the embryo in amniotic
fluid?
Amniotic membrane –
Covers the cord as it expands
What is the outer membrane that
implants to form the placenta?
Chorion membrane
When does the amnion and
chorion fuse?
By 16 weeks
When is quantitative hCG
assessed?
1st and 2nd trimester
Where is beta hCG produced?
By trophoblasts
When should the 2nd international
standard be positive?
(Pregnancy Test)
7 – 10 days after conception
What could be the cause for
increased serum levels?
• Incorrect dates
• Multiple gestations
• Trophoblast dissease (greater than
60,000 mIU/ml early
What could be the cause of
decreased serum levels?
• Incorrect dates
• Embryonic demise
• Ectopic pregnancy – will show
slow rise but overall value is
decreased
Where is PAPP-A glycoprotein
produced?
by trophoblasts
What does a decrease in PAPP-A
indicate?
Aneuploidy (Downs)
OB EXAM #1
1st Trimester Pathology
What is the incidence of bleeding
in pregnancy after the LNMP?
20 – 25 %
What is the continuation rate for
light bleeding?
84 %
What is the continuation rate for
moderate bleeding?
40 %
What is the continuation rate for
heavy bleeding?
20 %
What are the non-pregnancy
causes of bleeding?
• Cervical polyps
• Cervical infection
What is a complication of
hyperemesis gravidarum?
Dehydration
Hyperemesis gravidarum may be
related to__________.
Elevated B-hCG
B-hCG are highest when?
• Molar pregnancies
• Higher in twins than singletons
What are common causes of pain
in pregnancy?
• Movement of retroverted uterus to an
anteverted position
• Torsion of corpus luteum cyst or theca
lutein cyst (with mola...
What does the development of
hypertension in the first trimester
related to?
Poor function or the presence of a
molar pregnancy
What does development of
hypertension later in pregnancy
relate to?
One symptom in the triad signaling
development of pre-eclampsia
What are the etiologies of
pregnancy failure/disruption in 1st
trimester?
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Idiopathic
Endocrine factors
Corpus luteum failure
Mullerian duct anomalies
Embryonic failure
Chromosomal ano...
What is TAB?
Therapeutic abortion
What is SAB?
Spontaneous abortion
What percentage of pregnancies
end in SAB?
12 %
75 % end in SAB before what
week?
Week 16
What are the categories of SAB?
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Complete abortion
Incomplete abortion
Missed abortion
Inevitable abortion
Blighted ovum
Threatened abortion...
What is complete abortion?
Evacuation of all products of
conception
What are the signs/symptoms of
a complete abortion?
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Rapid decline in hCG
Heavy vaginal bleeding with tissue/clots
Cramping
Cessation of pain and bleeding after
event...
What are the sonographic
features of a complete abortion?
• An empty uterus with a clean
endometrial stripe
• No adnexal mass or free fluid
• Moderate to bright endometrial
echoes ...
Incomplete abortion is also
known as _______
Retained products of conception
What are the signs/symptoms of
an incomplete abortion?
• Slow fall or plateau of hCG
• Moderate cramping
• Persistent moderate to heavy
bleeding
What are the sonographic features
of an incomplete abortion?
• Complex echo pattern within
endometrial cavity
• Bright echoes, may shadow to air
bubble or bone fragments
• Thickened e...
What is a missed abortion?
An intact nonliving embryo
What are the signs/symptoms of
a missed abortion?
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hCG levels less than expected
Loss of pregnancy symptoms
Brownish vaginal discharge
Some cramping/pain
What are the sonographic
features of a missed abortion?
• Absent cardiac and limb activity
• Fetal size is less than expected
• Uterine size is less than expected
What is an inevitable abortion
also called?
Pending abortion
What are the signs/symptoms of
an inevitable abortion?
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Uterus is small for dates
Variable/low hCG levels
Vaginal spotting
Cervical dilation
What are the sonographic features
of an inevitable abortion?
• Gestational sac is not in the
fundus and closer to the cervix
• Rupture of membrane with no
chance of survival
What are the sign/symptoms of
an imminent SAB?
• Moderate cervical effacement
• Rupture of membranes/leaking
fluid
• Prolonged bleeding
• Persistent cramping
What are the sonographic
features of an imminent SAB?
• Heart rate is less than 90
• Persistent misshapen yolk sac
• Gestation sac in the cervix or
lower uterine segment
• Cerv...
What is thought to be the cause
of a blighted ovum?
Early demise
What is a blighted ovum?
Anembryonic pregnancy/empty sac.
The gestational sac in utero without
embryo or yolk sac, with irregular
borders
What are the sign/symptoms of a
blighted ovum?
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Uterus is small for dates
Variable hCG levels
Vaginal spotting
Closed cervix
What are the sonographic
features of a blighted ovum?
• No identifiable embryo in a
gestational sac that is bigger than
25 mm
• Absent double blep sign
What is a threatened abortion?
The future of pregnancy at risk but is
currently viable
Not able to diagnose sonographically
What are the signs/symptoms of
a threatened abortion?
• Closed cervix
• Slight bleeding or cramping
Some bleeding in pregnancy is
common from ___________
Implantation bleeding
What is the chance of loss in
pregnancy under 7 weeks after the
heartbeat has been seen?
24 %
What is the chance of loss in
pregnancy over 7 weeks after the
heartbeat has been seen?
3%
What are the sonographic features
of a threatened abortion?
• Sonolucent crescent around GS
What could the sonolucent
crescent around the GS be?
Subchorionic hemmhorage or
unknown bleeding
What is habitual abortion?
3 or more miscarriages
What are the causes of habitual
abortions?
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Often genetic incompatibility
Fibroids
Uterine anomalies
Adenomyosis
Incompetent cervix
What is the incidence of all
pregnancies for an ectopic
pregnancy?
2%
What percentage of ectopic
pregnancies are in the fallopian
tube?
95 %
Where do ectopic pregnancies
occur?
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Peritoneum
Ovarian
Cervical
Interstitial/cornual
Intermural
Heterotopic
What is the occurrence of maternal
deaths with an ectopic pregnancy?
10 %
What are the risk factors for
ectopic pregnancies?
• Damage to Fallopian tubes
• Previous PID or ectopic
• Tubal surgeries
• Endometriosis

• Use of IUD
• Infertility treatm...
What are the signs/symptoms of
an ectopic pregnancy?
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Pain
Vaginal bleeding (35 %)
Palpable adnexal mass
Asymptomatic
Shock if ruptured
hCG doesn’t rise as it shou...
What is the occurrence of a live
extrauterine pregnancy in the
adnexa?
25 %
Where is an ectopic most
commonly found?
The same side with the corpus
luteum
(has the appearance of a cyst)
What are features of a
pseudogestational sac?
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No embryo or yolk sac
Centrally located
Homogeneous echoes within
High resistant waveform
What is the trend in hCG with
ectopic pregnancies?
To increase at slower rates than
normal
If no IUP is seen and hCG is greater
than 1000 IU/ml, what does this
typically indicate?
Ectopic pregnancy or very recent
miscarriage
What is the pre-symptomatic
phase of ectopic pregnancy?
May be picked up by low hCG level,
lack of IUP on sonogram
What is the symptomatic phase
of ectopic pregnancy?
• Tubal rupture, intraperitoneal
bleeding
• Shock, hypotension, abdominal pain
What is the 2nd most common
type of ectopic pregnancy?
Interstitial/cornual ectopic
What are the features of an
interstitial/cornual ectopic
pregnancy?
• Eccentric sac location in uterus
• Less than 5 mm distance from sac
to uterine serosa
• May be live or may just be a mas...
What kind of ectopic pregnancy has
the highest maternal mortality rate?
Interstitial/corual ectopic
Why does cornual ectopic have the
highest maternal mortality rate?
Massive hemmorhage
What would a sac in the cervix
be?
Cervical ectopic
What is the potential with a
cervical ectopic?
Massive hemorrhage & Future
Infertility
Which ectopic is difficult to
diagnose?
Peritoneal ectopic
To diagnose a peritoneal ectopic,
what must be seen?
The uterus separate from pregnancy
What may mimic an ovarian
mass?
Ovarian ectopic
What type of ectopic is the
history important?
Ovarian ectopic
What is a coexisting IUP and
ectopic?
Heterotropic ectopic/pregnancy
Why are heterotopic
ectopic/pregnancy increasing?
Infertility procedure
What is the treatment for ectopic
pregnancies?
• Oral low does methotrexate,
which kills trophoblastic tissue
• Injection of methotrexate directly
into sac
• Laparoscopy...
What is the cause of the most
common bleeding in the 1st
trimester?
Subchorionic hemorrhage
What causes subchorionic
hemorrhage?
Implantation of blastocyst
What is subchorionic
hemorrhage?
Low pressure bleeding between the
gestational sac and placenta
What are the signs/symptoms of
subchorionic hemorrhage?
• Bleeding & spotting
• Uterine contractions
What are the sonographic features
of subchorionic hemorrhage?
•
•
•
•

Crescent shaped
Echogenic area (recent)
Anechoic (old)
No color Doppler
What is a Hydatidiform Mole?
Produce of conception in which trophoblast cells
fail to differentiate so produces abnormal
placental tissue
More common i...
What are hydatidiform moles
associated with?
Theca Lutein Cysts
Over$ due to high hCG
Largest functional cyst
Bilateral 6-12 cm
Multiple & septations common
Signs and Symptoms of
Hydatidform Mole
•
•
•
•
•
•

Increased hCG (Hyperemesis)
Bleeding
HTN/Preeclampsia
Decrease AFP
Uterus Enlarged
Theca Lutein Cysts (Bilate...
What is seen more in the 2nd
trimester, and is a higher pressure
bleed?
Placental hematoma
What is the cause of placental
hematoma?
Placental separation
What relates to the outcome of the
pregnancy with placental
hematomas?
How large it is
What is the appearance of a
placental hematoma?
Similar to subchorionic hemorrhage
What is the incidence of fetal
demise with placental hematoma?
50 %
When is an incompetent cervix
most common?
2nd trimester
What are the characteristics of
an incompetent cervix?
• Shortening, and opening so that
membranes may protrude
• Painless dilation and delivery
What length is considered
shortened in a cervix?
Less than 3.0 cm length
What are the sonographic features
of an incompetent cervix?
• Funneling of Y, V, U shape
What is the treatment(s) of an
incompetent cervix?
Cervical cerclage
What are the masses that coexist
with pregnancy that are seen?
•
•
•
•
•
•

Corpus luteum cyst
Leiomyomas
Myometrial contractions (mimics a mass)
Hematosalpinx/hematoma
IUCDs with coexi...
A corpus luteum cyst is most
common in _____________, and
usually regresses by _____________
1st trimester
2nd trimester
If a corpus luteum cyst continues
after then 1st trimester, what is then
considered?
Surgical removal
What type of uterine mass may
increase in size in 1st trimester and
early 2nd trimester?
Leiomyomas
What causes leiomyomas to
increase in size in the 1st and 2nd
trimesters?
Estrogen
What is a concern with
leiomyomas and pregnancy?
Can compress the sac if it grows too
fast
What are the features of a
leiomyoma?
• Attenuates sound
• Hyper to hypoechoic
• Differentiate from Braxton-Hicks
contractions by:
• Decreased vascular in fibro...
When are myometrial
contractions most common?
1st and 2nd trimesters
What are the features of a
myometrial contraction?
• Painless contraction
• Myometrium thickens for 20 – 30
mins
• Spontaneously disappears
What causes
hematosalpinx/hematoma?
Implantation bleeding or other GYN
infection
What is a hydatidiform Mole?
• Gestational trophoblastic disease
The product of conception in which the
trophoblast cells fail to differentiate so
they...
To whom are hydatidiform moles
most common?
Asian descent
What are hydatidiform moles
associated with?
Theca lutein cysts
•
•
•
•
•

Largest functional cyst
Seen 20 – 35 % of the time
Overstimulation due to high hCG levels
Bi...
What are the sign/symptoms of a
hydatidiform mole?
•
•
•
•
•
•
•

Bleeding
Increased hCG
Hyperemesis
Preeclampsia
Decreased AFP
Uterus is large for gestational age
Theca lut...
Is a complete mole benign or
malignant?
Benign form, with malignant
potential
What is the cause of a complete
mole?
An abnormal ovum, or 2 sperm
fertilizing an ovum
What is the incidence of a partial
(incomplete) mole of all moles?
5%
Is a partial mole considered
benign or malignant?
Benign, has very little malignant
potential
What is the appearance of the
placenta with a partial mole?
Enlarged and engorged with cystic
spaces
What is a partial mole?
Hyperplasia of trophoblast will be
localized within placenta rather than
general
What is the ploidy of a complete
mole?
Normal diploid
What is the ploidy of an
incomplete mole?
Triploid
Can a fetus coexist with a complete
mole or incomplete mole?
Incomplete mole
What is an invasive mole?
Hydropic villi invades myometrium
What percentage of molar
pregnancies move to an invasive
mole?
15 %
What are the sign/symptoms of
an invasive mole?
• Persistent bleeding
• Elevated hCG
What is choriocarcinoma?
Malignant metastatic trophoblastic
disease
What is the incidence of molar
pregnancies progressing to
choriocarcinoma?
2–5%
What are the
characteristics/appearance of
choriocarcinoma?
• Spreads quickly
• Complex in appearance
throughout myometrium
What is the sonographic appearance
of choriocarcinoma in the 1st
trimester?
•
•
•
•

May appear normal
Appear like a missed abortion
Incomplete abortion/blightled ovum
Echogenic mass in endometrium
...
What is the sonographic appearance
of choriocarcinoma in the 2nd
trimester?
• Snowstorm / grape clusters
• mid level tissue with cysts
(chorionic villi)
What is the treatment for
choriocarcinoma?
Curettage
What is the residual rate of
choriocarcinoma after evacuation?
20 %
What is the most common
abnormality of the first trimester in
the fetus?
Cystic hygroma
What is cystic hygroma likely
associated with?
Chromosomal abnormalities
• Trisomy 21, 18, 13 and Turner’s
syndrome (most common)
What is the sonographic features
of cystic hygroma?
• Vary in size
• Soft tissue thickening on posterior
neck and thorax
•

**must differentiate from NT
What are the abnormalities
found in the 1st trimester fetus?
•
•
•
•
•

Cystic hygroma
Umbilical cord cyst
Obstructive uropathy
Abdominal wall defects
Cranial anomalies
What is methotrexate used for?
To terminate early pregnancy
(most common for ectopic
pregnancy)
How effective is methotrexate
injected if 6 weeks or less and the
intact embryo is seen?
96 %
What are complications of
methotrexate being injected?
Excessive bleeding
What is dilation and curettage (D&C)
or dilation and evacuation (D&E)?
Method where the cervix is manually
dilated and the endometrium is
scraped away
When is in vitro fertilization
considered?
After 1 year with no conception
What is the sonographic usage
for in vitro fertilization?
•
•
•
•

Assess infertility cause
Ovary monitoring during stimulation
Egg retrieval assistance
Assess embryo after implant...
What are complications of in
vitro fertilization?
• Multiple gestations
• Fetal reduction
• Hyperstimulation syndrome
Why is fetal reduction used?
To improve the survival rate of
remaining fetus
Used with quadruplets or more to increase birth
rate
When is fetal reduction used?
In late 1st trimester
What techniques are used in
fetal reduction?
• Transcervical aspiration of GS
•
•

Infection possibility
Increases cervical incompetence

• Transvaginal puncture and e...
OB Exam 1
2nd Trimester Routine Sonogram
What percentage of fetuses are
in the cephalic position at term?
95 %
What percentage of fetuses are
in the breech position at term?
5%
What is the occurrence of fetuses in
the shoulder/transverse position at
term?
rare
What structures are included in
the facial profile?
Fetal forehead
Fetal nose
Upper and lower lips
Chin
What proportion is expected in
the facial profile?
1/3 forehead
1/3 eyes and nose
1/3 mouth and chin
What structures are present in
the coronal face?
Orbits
Ethmoid bones
Zygomatic bone
Nasal septum
Maxillae
Mandible
What structures are imaged in
tangential views?
Nostrils
Maxillae
Mandible
Ears
Why do we document nose and
lips?
To look for continuity of the upper lip
(assessing for cleft)
What is assessed in the orbits?
That there are 2 present, and their
spacing
How is the inner orbital distance
measured?
Medial to medial border
How is the outer orbital distance
measured?
Lateral to lateral border
What does the OOD (outer orbital
distance) measurement compare to?
Better or as good as BPD
When does the appearance of
the brain remain constant?
16 – 18 weeks
What is the appearance of the
fetal brain by sonogram?
Hypoechoi – anechoic
(small reflectors and water content high)
What kind of artifact is expected
while imaging the fetal brain?
• In the near field ½ of brain
• Reverberation or shadowing
When do the bones in the skull
ossify?
By 12 weeks
What is the shape of the skull
more superior (high)?
Round
What is the shape of the skull
inferior (low)?
Oval
What is the ventricle pathway?
•
•
•
•
•
•
•
•

Lateral ventricles
Foramen of Monro/interventricular foramen
3rd ventricle
Aqueduct of Sylvius/cerebral a...
What is the appearance of the
brain at the falx cerebri?
Thin midline hyperechoic line
What is the appearance of the brain
just inferior to the falx cerebri?
White matter tracts parallel to falx
At the level of the lateral ventricles
what other structure is seen?
Choroid plexus
What are the characteristics of
the choroid plexus?
• Echogenic tear shaped
• Near the posterior end of ventricles
• The atria measure < 10 mm
What is the largest width of the
cranium?
Mid diameter
What structures are present in
mid diameter?
•
•
•
•

Midline falx
Cavum septum pellucidum
Thalmus
3rd ventricle
What is the shape of the head at
mid diameter?
Oval and symmetric
What level is the BPD taken?
Mid diameter
How is the BPD measurement
taken?
• Leading edge to leading edge of bone
• No skin or tissue included
When is the BPD most accurate
for growth and dates?
In the 2nd trimester

After 13 weeks
What level is the head
circumference taken?
Mid diameter

Same as the BPD
How is the head circumference
taken?
Outer margin of the skill, not including
any tissue
What is another optional
measurement that can be taken at
the mid diameter?
Occipital frontal diameter
What is being assessed at the
corpus callosum?
It’s presence

Not documented unless pathology is
seen
Where is the cerebellum?
Within the posterior fossa
What are the hemispheres joined
by?
Cerebellar vermis
Where is the cerebellar width
measurement taken?
At the level of the cerebellum, vermis,
and 4th ventricle
When is the cerebellum width
measurement valid?
To 20 weeks GA
How does the cerebellar width
measurement coincide with the GA?
Width in mm = GA in weeks
What is the normal measurement of
the cisterna magna?
3 – 11 mm
Where is the cisterna magna
measurement taken?
From vermis to inner skull bone
What is the appearance of the
cisterna magna?
Anechoic with linear echoes of dura
What is the normal
measurement of the nuchal fold?
5 mm or less
When do you measure the
nuchal fold?
Between 15 – 21 weeks
What is the apperance of the
sphenoid bone by sonogram?
An X
How should the vertebral column
be imaged?
Coronally image the cervical, thoracic,
and lumbar/sacral spine – to the tip of
the sacrum
What is being looked for when
assessing the vertebral column?
•
•
•
•
•
•

2 -3 ossification points
Tapers at sacrum
Widens near skull base
3 spread equidistance
Spinal column is close...
How will an abnormal vertebral
column appear?
Splayed in a V or U configuration
What structures are assessed in
the thorax?
•
•
•
•

Ribs/bones
Lungs
Heart
Diaphragm
What is to be imaged for the
ribs/bones?
Only documented when confenital
anomalies suspected
How will the lungs appear?
Solid and homogeneous
Slightly hyperechoic to liver
How should the heart be
imaged?
Using zoom
What should be imaged in the
heart?
• 4 chamber view
•

With septum perpendicular to beam

• Outflow tract
•

RVOT, LVOT
What commonly happens if the
heart is compressed or imaged for
long periods?
Heart rate can slow
What is being assessed in the 4
chamber view?
• Equal sized atria and ventricles
respectively
• Foramen ovale flaps into LA
• Moderator band in RV
• TV more apical than...
What are the normal
measurements of the IVS?
< 4 mm
What is the position and axis in
the fetus?
•
•
•
•
•
•

Transverse
Apex points toward left
RV lies toward sternum
LA lies toward spine
IVS ~ 45 degree angle from mid...
What is levocardia?
Heart is mostly in the left chest
(normal)
What is dextrocardia?
Heart is mostly in the right chest
What is mesocardia?
Heart is mostly midline
What is levoversion?
Apex pointed to the left
(normal)
What is dextroversion?
Apex pointed to the right
What is mesoversion?
Apex pointed to the midline
How do you get the LVOT from 4
chamber?
Sweep anterior for 5 chamber
Turn 45 – 90 degrees for PLAX
What is being assessed in the
LVOT view?
• IVS for VSD
• Continuity of IVS and Ao wall
• Continuity of posterior Ao wall and
anterior MV leaflet
• Ao root caliber
What is the normal Ao root
caliber?
3 – 8 mm
In what view can the pulmonary
trunk be measured?
RVOT
In the PSAX view what is being
assessed?
• Spatial relationship between Ao & PA
(should be equal)
• See the ductus between the PA and Ao
• Branching of the 2 main ...
What is the best view for great
vessel transposition?
PSAX
What is the appearance of the
ductus arteriosis from a sagittal
view?
Like a hockey stick
(less curved than the AA)
What is the first thing to come
into the thoracic aorta?
Ductus arteriosis
What is the normal
measurement of the aortic arch?
3 – 8 mm (20 – 40 weeks)

Never > 1 cm
What are the other structures that
can be seen, but not routinely
documented?
• Pulmonary vein
• IVC
• SVC
What is used to assess
arrhythmias?
M-mode
What is used to assist in
documenting blood flow?
Color Doppler
What plane is the diaphragm
best seen in?
Longitudinal
What is to be visualized when
looking at the diaphragm?
That the stomach is inferior and the
heart is superior to the diaphragm
What is the site for abdominal
measurement?
At the portal vein within the liver
When is the gallbladder in the
right quadrant?
At 20 weeks
What is the appearance of the
liver?
Midlevel gray and vessels seen within it
How is the abdominal
circumference taken?
• Outer margin of skin
• At the level of the left portal vein as J
or L from umbilical vein
What structures are seen when
the AC is taken?
• Liver
• Stomach
• Possible adrenals
•

****NOT KIDNEYS
AC is most accurate in what
trimester for weight?
3rd
When should the abdominal
circumference be taken?
After 14 weeks
When can the stomach be seen?
After 12 weeks
What typically fills the stomach
of the fetus?
Amniotic fluid
When can the kidneys be seen?
By 15 weeks
When do the kidneys begin to
produce larger amounts of urine for
amniotic fluid?
15 – 18 weeks
How do the kidneys appear in
the 2nd trimester?
Ovoid with ill defined borders
How do the kidneys appear in
the 3rd trimester
Borders and pelvis are more defined
What is pyelectasis?
When the kidney pelvis contains small
amounts of fluid
With pyelectasis prior to 20 weeks,
how much is considered
insignificant?
< 5 mm
With pyelectasis between 20 – 30
weeks, how much is considered
insignificant?
< 8 mm
With pyelectasis after 30 weeks,
how much fluid is considered
insignificant?
< 10 mm
What is being assessed with the
bowel?
Echogenicity

Should be isoechoic to hyperechoic to
liver
When can the bladder be seen?
By 14 weeks
How should the bladder appear?
Anechoic, if filled
If bladder fills and empties, what
does this indicate?
Function of 1 kidney
How often does the bladder fill
and empty?
Every 30 – 60 minutes
When should genitalia be
documented?
When screening for congenitally linked
disorders and multiple gestations
When can genitalia be seen?
15 – 16 weeks
Prior to 15 – 16 weeks how will
labia appear?
Swollen
What is common to see in fetal
testicles?
Hydrocele
When do the testicles descend?
28 weeks
Which extremities should be
imaged?
All 4
What should be seen in the
extremities?
• That all hands/feet are present
• That hands extend
• Assess foot bottom
How should the femus length be
measured?
• Using the most anterior femur
• Only the diaphysis
Is the femur length more or less
affected by IUGR?
Less
Femur length is most accurate
INDIVIDUAL measurement for
dates/growth in what trimester?
3rd trimester
When should the femur length
be used?
After 14 weeks
When should the other long
bones be measured?
If there is 2 weeks difference between
femur length and other measurements
What accuracy are dating
measurements in the 1st trimester?
+ / - 5 days
What accuracy are dating
measurements in the 2nd trimester?
+ / - 10 days
What accuracy are dating
measurements in 3rd trimester?
+ / - 20 days
How often should interval
growth assessments be taken?
At least 2 weeks apart
How is fetal blood oxygenated?
The placenta
How does the fetus receive
oxygenated blood?
Umbilical vein
How does the umbilical vein
bypass the liver?
Through the ductus venosus
How does blood bypass the RV
(lungs)?
Through the foramen ovale
Where does the LV pump blood
to?
Aorta and brain
Where does blood entering the
RV come from?
SVC and coronary sinus
Where does deoxygenated blood
leave the fetus?
Via the umbilical arteries from fetal iliac
arteries
What close when the umbilical cord
is clamped at birth and the lungs fill
with oxygen?
• Ductus venosus
• Foramen ovale
• Ductus arteriosis
How wide is the umbilical cord?
1 cm wide
What is the length of the
umbilical cord?
40 – 60 cm
What is the layout of the
umbilical cord?
The arteries spiral the larger vein
What is the likeliness of having
only one umbilical artery?
• 1 % in singletons
• 7 % in twins
When is it common to have only
1 umbilical artery?
• Diabetes
• LBW
What surrounds the umbilical
cord?
Wharton’s jelly
(connective tissue)
What is the role of the placenta?
Permits exchange of oxygenated
maternal blood with deoxygenated fetal
blood
What are the lobules of the
placenta called?
Cotyledons
What is the functioning unit of
the placenta?
Chorionic villi
Where are the villi?
Within intervillous spaces
What bathes the villi with blood?
Spiral areries
What forms the maternal portion
of the placenta?
Decidua basalis – called the basal plate
What forms the fetal portion of
the placenta?
Chorion frondosum – called the
chorionic plate
When does the chorion fuse with
the amnion?
By 16 weeks
Where does the umbilical artery
branch?
Along chorionic plate of the placenta
What forms the umbilical vein?
The confluence of chorionic villi
What is the function of the
placenta?
•
•
•
•

Respiration
Nutrition
Excretion
Protection
•

Microorganisms/rejection

• Storage
•
•
•
•

Carbohydrates
Protein
...
What is the sonographic
appearance of the placenta?
•
•
•
•

mid gray
Homogenous
Hyperechoic to uterus
Chorionic plate is more echogenic than
basal plate
• Endometrial veins ...
What is the normal
width/thickness (AP) of the
placenta?
< 5 cm
What are some variants seen?
• Subplacental maternal venous
congestion
•

Tubular vascular areas under the placenta in
myometrium

• Placental lakes/la...
What should be assessed for the
placenta?
•
•
•
•
•

Location
Echogenicity
Entire length
Locate upper and lower margin
Placental grade
What describes placental grade
0?
Homogenous with smooth chorionic
plate
What describes placental grade
1?
Scattered calcifications; subtle idention
of chorionic plate, irregular brightness
What describes placental grade
2?
Basal echogenic calcification densities;
comma like surface
What describes placental grade
3?
Irregular calcification densities with
shadowing; subchorionic fibrin deposits,
indentions go to basal plate – cumulus
clo...
What are the normal contents of
amniotic fluid?
•
•
•
•
•
•

Bilirubin
Fetal cells
Vernix caseosa
Fetal enzymes – AFP
Nutrients
Urea
What is the function of amniotic
fluid?
• Fetal movement / prevents adherence
• Symmetrical growth of fetus
• Equalizes pressure
•

Aids in lung maturity

• Consi...
Where is amniotic fluid produced
in the 1st trimester?
The placenta
Where is amniotic fluid produced
after 18 weeks?
Kidneys
How should amniotic fluid be
assessed?
• With the transducer perpendicular to
the table
• Don’t include myometrium, cord
loops or extremities
In 4 quadrant/amniotic fluid
index what is considered low?
5 – 10 cm
In 4 quadrant/amniotic fluid index,
what is considered normal?
10 – 20 cm
In 4 quadrant/amniotic fluid
index, what is considered high?
20 – 25 cm
What is the normal range in a
single pocket of amniotic fluid?
2.5 – 7.5 cm
What is fundal height in cm
equal to?
Gestational age
When does quickening occur?
15 – 16 weeks
When does the fetus have daily
movements?
16 – 20 weeks
What are the sonographic
characteristics of placentomegaly?
• Placenta weighing >600 g
• Thickness > 5 cm
What is a Succenturiate Placenta?
• Placenta w/ 1 or more accessory lobes
• Vessels may infarct & necrose
• Associated w/
– Velamentous insertion
– Vasa Pre...
Sonographic Assessment of
Succenturiate Placenta?
• Extra lobes w/ same echogencity
• Ant. & Post. Placenta seen
• Assess if connecting vessels overly cervix
Annular Placenta
• Forms like band or ring attached all the way
around uterus
• Placenta Membranacea
– No differentiation of trophoblastics...
Placenta Extrachorialis
• Edge of placental membrane lifts away from
uterine wall and folded back on itself w/in
amniotic space
• Portion not cove...
Circummarginate vs Circumvallate
• Circummarginate more likely
– Fetal membrane insertion is flat

• Circumvallagte
• Thickened rolled chorioamniotic membr...
Signs of Placenta Previa
• Painless bright red bleeding
• Premature contraction
• Transverse fetal position
Sonographic Technique for Placenta
Previa
• TV or transperineal
• Contraction/Braxton Hicks
• Lateral placenta most common false positive
Placenta Accreta
• Villi anchored/adherent to myometrium
instead of decidua so absence of decidua
basalis
Placenta Increta
• Villi implant into myometrium
Placenta Precreta
• Infiltrate past myomerium and implant in/past
serosa of uterus
Appearance of Accreta, Increta, &
Precreta
•
•
•
•
•
•
•
•
•

Normal
Common location at Ant. lower uterine seg.
Large numerous placental lacunae
Turbulent flow at jx...
Placental Cysts
• Anechoic structure appearing anywhere on
surface of placenta
• Placental lakes-lacunae
– Under chorionic plate
– Irregul...
Fibrin Deposits
• Hypoechoic regions w/in placenta containing
strand like material
• Linear echogenic streaks w/in anechoic lesion
• No va...
Intervillous Thrombus
• Intraplacental hemorrhage or clot due to
breaks in villi capillaries
– Clot into cystic space w/ fibrin strangds

– RH s...
Appearance of Intervillus
Thrombus
• Hypoechoic to anechoic masses w/in placenta
increase in size w/ maturity
• Cystic spaces w/ fibrin strands
Placental Infarcts
• Ischemic areas of necrosis when obstruction
of the spiral arteries occurs
Teratomas
(Placental Tumors)
• Benign, some malignant
• Contain structures derives from the three
germ cell layers
• Complex mass in placenta w/ calcif...
Chorioangioma
(Placental Tumors)
• Benign tumor from proliferation of chorionic
vessels
• Capillary hemangiomas
• Can become an AV malformation shunting
bl...
Worst Placental Hemorrhage?
• Retroplacental

• Least severe?
– Paraplacental/Marginal
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Transcript of "Ob exam #1 study slides"

  1. 1. OB Exam 1 Terms
  2. 2. Pregnancy
  3. 3. The implantation of a zygote into a woman’s body. Pregnancy occurs when a woman’s body responds to the hormonal signals that indicate fertilization has occurred. The ovum is fertilized.
  4. 4. Prenatal
  5. 5. Before birth
  6. 6. Postnatal
  7. 7. After birth
  8. 8. Perinatal
  9. 9. A 48-hour time period including the day before and the day after birth
  10. 10. Neonatal
  11. 11. The time period including the first 4 weeks of life
  12. 12. Premature
  13. 13. A fetus born at less than 36 weeks gestational age
  14. 14. Postmature
  15. 15. A fetus born at greater than 42 weeks gestational age
  16. 16. Gravida
  17. 17. The number of pregnancies including the current one
  18. 18. Para
  19. 19. The number of pregnancies carried to term
  20. 20. Nullipara (Nullip)
  21. 21. Characterizes a woman during her first pregnancy
  22. 22. Multipara (Multip)
  23. 23. Characterizes a woman after several pregnancies
  24. 24. Grand Multip
  25. 25. Characterizes a woman who has 5 or more successful previous pregnancies
  26. 26. Trimester
  27. 27. The 40 weeks from LNMP of a normal pregnancy is divided into 3 trimesters of 13 week duration. Pregnancy is 266 days +/- 10 When patient conceives 14 days after the first day of the LNMP the pregnancy is 280 days or 40 weeks from the first day of the LNMP
  28. 28. LNMP
  29. 29. Last normal menstrual period; First day of cycle or LMP
  30. 30. Pregnancy dating
  31. 31. In US, dated from the 1st day of the LNMP The earlier in pregnancy the sonogram is performed the more accurate the dating
  32. 32. FISH
  33. 33. (fluorescence in situ hybridization) Useful for gene-mapping and identifying chromosomal abnormalities like Trisomy-21 or DiGeorge syndrome
  34. 34. Nabothian cyst
  35. 35. A mucus filled lump on the surface of the cervix caused by plugged up mucus glands
  36. 36. Ovarian hyperstimulation
  37. 37. A syndrome usually seen in women who take certain fertility medicines that stimulate egg production Occurs after ovulation and ovaries become very swollen
  38. 38. Demise
  39. 39. The loss of a fetus at any stage
  40. 40. Chorionic villus sampling
  41. 41. The removal of a small piece of placenta tissue (chorionic villi) from the uterus during early pregnancy to screen the baby for genetic defects
  42. 42. Percutaneous umbilical blood sampling (PUBS)
  43. 43. A highly specialized prenatal test in which a blood sample is removed from the umbilical cord and tested for genetic problems or infections PUBS can be done after the 18th week of pregnancy
  44. 44. Methotrexate
  45. 45. One of the most effective and commonly used medicines in the treatment of several forms of arthritis and other rheumatic conditions Known as a disease-modifying antirheumatic drug because it not only decreases the pain and swelling of arthritis, but it also can decrease damage to joints and long-term disability
  46. 46. Propaganda
  47. 47. Ideas, facts, or allegations spread deliberately to further one’s cause or to damage an opposing cause; also; a public action having such an effect
  48. 48. Thoracoamniotic shunting
  49. 49. The treatment of choice for management of the fetus with symptomatic fetal hydrothorax (FHT) before 32 weeks of gestation
  50. 50. Intrauterine growth restriction (IUGR)
  51. 51. Reduced growth rate (symmetrical IUGR) or abnormal growth pattern (asymmetrical IUGR) of the fetus; resulting in a small for gestational age (SAG) infant
  52. 52. Human chorionic gonadotropin (hCG)
  53. 53. Hormone secreted by syncytiotrophoblasts of the developing embryo Laboratory test indicates pregnancy when values are elevated hCG levels will likely decrease after the 1st trimester when the placenta takes over
  54. 54. Macrosomia
  55. 55. Exceptionally large infant with excessive fat deposition in the subcutaneous tisse Most frequently seen in the fetuses of diabetic mothers
  56. 56. Maternal serum alphafetoprotein (MSAFP)
  57. 57. Biomedical test used to assess fetal risk for aneuploidy or fetal defect (neural tube defects) Component of the “triple screen” Normal value varies with gestational age Maternal serum is tested between 15-22 weeks of gestation to detect abnormal levels
  58. 58. Polycystic Ovarian Syndrome
  59. 59. Ovary doesn’t make all the hormones it needs for the egg to fully mature, so the follicle grows and builds up fluid Most common cause of female infertility
  60. 60. Decidua
  61. 61. Endometrium of pregnancy “falling away”
  62. 62. Decidua basilis
  63. 63. The decidua in contact with the chorion frondosum, which eventually develops into the placenta
  64. 64. Chorion frondosum
  65. 65. Villous chorion
  66. 66. Decidua capsularis
  67. 67. The decidua in contact with the chorion laeve When the decidua capsularis is pressed against decidua vera on the opposite side of the endometrial cavity by the developing pregnancy, the villi attach to the chorion laeve regresses or may slough off
  68. 68. Chorion laeve
  69. 69. Smooth chorion
  70. 70. Decidua parietalis (decidua vera)
  71. 71. Endometrial lining which is not initially involved in the implantation and is therefore not associated with the placenta
  72. 72. Chorion
  73. 73. Extraembryonic membrane that is formed from trophoblastic cells and forms the outer wall of the blastocyst at the time of implantation Outer membrane adjacent to the uterine wall, then extending over the fetal side of the placenta
  74. 74. Chorionic frondosum
  75. 75. (villous chorion) Interweaving of chorion villi and decidua basalis. Establishes early utero-placenta circulation
  76. 76. Amnion
  77. 77. The inner membrane which holds the embryo suspended in the amniotic fluid Amnion extends over the placenta except at the umbilical cord where it is continuous with the outer membrane of the cord @6 weeks amnion is closely adjacent to the embryo @8 weeks is more circular in shape By 10 weeks occupies most of gestational sac By 15th week it is fused with the chorion
  78. 78. Syncytiotrophoblast
  79. 79. Cells form isolated spaces called lacunae which later develop into intervillous spaces in the placenta where maternal blood flows and makes contact with fine fetal capillaries in the villi, finger like projections of placental tissue
  80. 80. Placenta
  81. 81. Organ that provides hormones to support pregnancy and that is the site of communication between the mother’s blood and fetal capillaries contained within the villi
  82. 82. Threatened abortion
  83. 83. Bleeding in early pregnancy
  84. 84. Inevitable abortion
  85. 85. Term assigned after it is determined that the pregnancy is non-viable
  86. 86. Elective abortion
  87. 87. Medical term for an induced abortion performed at a woman’s request
  88. 88. Missed abortion
  89. 89. Occurs when the products of gestation remain in the uterus and cause continued bleeding
  90. 90. Therapeutic abortion
  91. 91. An induced abortion for the health of the mother
  92. 92. Pre-eclampsia
  93. 93. Having high blood pressure during pregnancy and too much protein in urine at 20 weeks
  94. 94. Choriocarcinoma
  95. 95. Type of gestational malignant tumor that arises from the trophoblasts of the forming placenta within the uterus
  96. 96. Theca Lutein Cyst
  97. 97. Nonfunctional cyst found on the ovary and are associated with excess amounts of gonadotropins
  98. 98. Cervical cerclage
  99. 99. Surgical procedure to correct cervical incompetence Cervix is stitched closed so that premature birth or miscarriage is avoided
  100. 100. Decidual cast
  101. 101. Occurs when the decidua of the uterus discards Appearance of the uterus when it comes out Well known with ectopic pregnancies
  102. 102. Adnexa
  103. 103. Parts next to each other or attached to each other
  104. 104. Mullerian duct
  105. 105. Ducts in the embryo that develop into female parts
  106. 106. Idiopathic
  107. 107. Spontaneous or unknown cause or origin
  108. 108. Braxton hicks
  109. 109. False labor pains that often occur early on in pregnancy Not a true contraction
  110. 110. Hyperemesis gravidarum
  111. 111. Excessive vomiting during early pregnancy that results in at least a 5% reduction in body weight
  112. 112. Blighted ovum
  113. 113. A miscarriage in which the baby does not develop or demises early but the gestational sac remains
  114. 114. PAPP-A
  115. 115. Pregnancy Associated Plasma Protein A Can be a part of 1st trimester screening measure with a blood test
  116. 116. D&C
  117. 117. Dilation and curettage A procedure in which the cervix is dilated in order to remove the endometrium
  118. 118. MSD
  119. 119. Mean sac diameter Figured from several different measurements
  120. 120. Fundal height
  121. 121. Abdominal measurement of the uterine length Measured from the symphysis pubis to the tip of the fundus in cm The cm length approximates the weeks of gestation
  122. 122. Large for gestation age
  123. 123. A baby whose weight is greater than 4000 grams at term
  124. 124. Small for gestational age
  125. 125. A full term baby whose weight is less than 2500 grams at birth
  126. 126. Hi-risk pregnancy
  127. 127. A pregnancy with maternal or fetal factors which predispose to increase maternal or fetal morbidity and mortality • Bleeding • Polyhydramnios • Development of hypertension
  128. 128. Normal fetal heart rate
  129. 129. 120 – 160 bpm with marked variability
  130. 130. Reactive fetal heart rate
  131. 131. Heart rate increases with movement Aka: fetal heart acceleration
  132. 132. Estriol
  133. 133. Estrogen product produced by the placenta from fetal precursors
  134. 134. estradiol
  135. 135. Estrogen product produced by the placenta from maternal precursors
  136. 136. Triple screen
  137. 137. A measurement of estriol, HCg, and AFP in the maternal serum
  138. 138. Fetal monitoring
  139. 139. Monitoring of fetal heart rate and uterine contractions
  140. 140. Placental reserve (placental suficiency)
  141. 141. Measurement of the ability to supply sufficient oxygen to the fetus even during contractions, which reduce maternal blood supply to the placenta *If placental reserve is not adequate, it is said that the patient has placental insufficiency
  142. 142. Cervical effacement
  143. 143. Shortening of the cervix
  144. 144. Cervical dilation
  145. 145. Dilation (opening) of the cervix
  146. 146. Quickening
  147. 147. Initial perception of fetal movement by the mother Usually occurs between 17 and 21 weeks *inexact method of determining EDC Timing related to: • Parity • Position of the placenta • Awareness of mother
  148. 148. Oligohydramnios
  149. 149. Insufficient amounts of amniotic fluid
  150. 150. Polyhydramnios
  151. 151. Excessive amounts of amniotic fluid
  152. 152. Apgar score
  153. 153. Standard for comparing the condition of the baby at birth and a way of detecting depressed newborns • • • • • Measurements of 0,1,2 are given for: Heart rate Respiratory effort Muscle tone Reflex irritability Color **Apgars are noted at 1 & 5 mins after birth **healthy baby will have an apgar of 8-10
  154. 154. Biophysical fetal profile
  155. 155. An intrauterine score designed to detect depressed fetuses Scores of 0 or 2 are given for: • Fetal breathing movements • Gross body movement • Fetal body tone • Reactive fetal heart rate • Amniotic fluid volume
  156. 156. Dubowitz score
  157. 157. Standard test of the baby’s physical characteristics and neurological (reflex) responses that is completed in the nursery during the first 24 hours of life
  158. 158. Primordia
  159. 159. The first recognizable, histologically differentiated stage in the development of an organ
  160. 160. <