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45 Cards in this Set

  • Front
  • Back
Measurements for Dating
Sac volume 5 weeks
CRL 6.5 weeks
BPD 12 weeks
Femur Length 12 weeks
Cerebellar width 15-16 weeks
US Features of a Normal Intrauterine Pregnancy

5 weeks
Gestional sac visible at the fundus
The gestational sac is surrounded by an echodense ring
Assymetry of this ring is apparent
US Features of a Normal Intrauterine Pregnancy

6 weeks
embryonic structures apparent
US Features of a Normal Intrauterine Pregnancy

6.5 weeks
cardiac movement identifiable within the fetus CRL approx. 5mm
Indications for US Scanning inthe First Trimester
Threatened miscarriage
Pelvic pain
Suspected Ectopic
Uncertain LMP
Evaluation of retained products
Threatened Miscarriage

Definition: Blood per vagina with a closed cervical os
Incidence 25% of all pregnancies-50% go on to abort

Demonstration of a living fetus 90-97% favorable outcome.
Anembryonic Pregnancy (Blighted Ovum)

Definition: A fertized ovum in which development has been arrested. The majority have chromosomal abnormalities.
No fetal parts seen within a sac diameter > 30mm
No yolk sac seen within the gestational sac > 20mm
Irregular sac contour
Abnormal implantation site
Ectopic Pregnancy

Risk factors
previous ectopic
IUCD in situ
Hx of PID
Previous tubal surgery
Assisted conception IVF
Ectopic Pregnancy

US Findings
US evidence of intrauterine pregnancy excludes ectopic (1/30000 heterotopic pregnancy

Endometrial thichening (pseudogestational sac)
Adnexal mass
Demonstration of a living fetus outside of the Uterus
1/7000 IVF)
Absent Intrauterine Pregnancy with a Positive Pregnancy Test
Early intrauterine pregnancy , 5 weeks
recent complete/incomplete abortion
Routine Anomaly Screening
measure bpd, head cicumference and femur length
head shape and internal structures cavum septum pellucidum, cerebellum, ventricular size at the atrium < 10mm
Spine Longitudinal and transverse
Abdominal shape and contents at the level of the stomach
Abdominal shape and contents at the level of the kidneys and umbilicus
Renal pelvis , 5mm
Longitudinal Axis thoracic abdominal appearance (diaphragm/bladder)
Thorax at the level of the 4 chamber view
Arms 3 bones
Legs 3 bones
Cardiac outflows
face and lips
Liquor volume
Increases until approximately 34 weeks then decreases to term
(at 20 weeks it maesures 400ml)

AFI 4 lateral quadrants
Liquor volume

DD of Abnormal Liquor volume
Severe oligohydranious
i)renal agenesis/bilaterally non-functioning kidneys
ii)premature rupture of membranes
iii)severe growth restriction

Moderate Oligohydramnious
i) real anomalies
ii) premature rupture of membranes
iii) Growth restriction

Diabetes Maternal
Fetal anomalies (fetus hydropic, cardiovascular anomalies, obstructive malformation of the GIT (eg tracheoesophageal fistula, duodenal stenosis) space occupying lesion in the thorax resulting in disordered swallowing, rarer cusess bone dysplasias, neuromuscular disorders)
Fetal Hydrops

Definition: skine edema and at least one of the following, ascites, pleural or pericardial effusion
Rhesus incompatibility
Other blood groop incompatibility

Cardiovascular (arythmias, anatomical defects, cardiomyopathies)

Chromosomal (Turner's Treisomies, Triploidy)

Infections (CMV, Toxo, Rubella, Syphilis)

Twin Pregnancies (twin to twin transfusion)

Hematological (alpha thalasemia, large AV shunt)

Thoracic mass lesions (hiatis hernia, CCAM, Pulmonary lymphangectasia)

Gastronitestinal (atresia, volvulus, perforation)

Umbilicus/Pacenta (choriangioma, fetomaternal transfusion)

Urinary (congenital nephrosis)

Misc (skeletal dysplasia, fetal tumors)
Raised Serum Alpha-Fetoprotein

Protein produced by the fetus and crosses the placenta to enter the maternal blood. The level rises during normal pregnancy. For abnormality screening best tested 16-18 weeks.
Wrong dates
Missed Abortion
CNS abnormalities (anen cephaly, spina bifida, encephalocele)
Renal anomalies (renal agenesis, multicystic dysplasia, hydronephrosis)
Anterior Wall Defects (omphalocele, gastroschisis)
Ultarsound Signs suggesting a Chromasomal Abnormality at 11-13 weeks
nuchal translucency related to gestation and maternal age)

Cystic hygroma

Ultarsound Signs suggesting a Chromasomal Abnormality at the 20 week Anomaly scan
Cystic Hygroma
Gross Renal Anomalies
Major Structural Cardiac Defects (cushion defects)
Symmetrical growth restriction
Severe growth reytardation Duodenal stenosis/atresia
Single umbilical vein (associated with any structural anomaly)
Abnormal placenta (cystic and thickened)
Nuchal Membrane > 6mm in 2nd Trimester
Soft Markers of Chromosomal Disorders
Choroid plexus cyst
Mild ventriculomegaly
Echogenic Focus in the cardiac ventricles
Echogenic bowel
Cystic Structure Seen in the Fetal Abdomen
Renal (multicystic dysplasia, hydronephrosis, bladder in outflow obstruction)

Gut obstruction ( duodenal (double bubble) jejunal (multiple filled loops - both with polyhydramnious)

Ovarian cyst (simple, complex associated with torsion)
Mesewnteric Cyst
Reduplication Cyst
Hepatic cysts
Pancreatic cysts
Major Structural Abnormalities Diagnosable Antenatally

Multicystic dysplastic Kidney
Autosomal Reccesive polycystic disease
Autosomal Dominant dominant polcystic disease
Abnormalities Diagnosable Antenatally

Spina Bifida
Abnormalities Diagnosable Antenatally

Anterior Abdominal Wall Defects
Gastroschisis (a defect seperate to the cord insertion through which small and large bowel herniates. No covering membrane. Umbilical vessels not involved. Long term prognosis good. not associated with other defects)

Omphalocele (abodominal wall defect resulting from failure of small bowel to re-enter abdomen. Membrane (amnion) covers the eventrated viscera (small bowel +/- liver) Umbilical veis pass through the defect. High incidence .30% of chromosomal abnormalities. Poor Prognosis)
Abnormalities Diagnosable Antenatally

Congenital Diaphragmatic Hernia
Incidence 1/2000 - 1/5000
High association with other anomalies
Motality 80%

US displaced heart with bowel within the thorax polyhydramnious may occur late in pregnancy
Abnormalities Diagnosable Antenatally

Cardiac Anomalies
Normal exan requires the visualization of

4 chmbers with an intact ventricular septum
Normal AV valvles
Normal Srmilunar Valves
Normal Connections of the Great Vessels Complete heart block is associted withmaternal SLE and positive Rho and anti cardiolipin antibodies
Abnormalities Diagnosable Antenatally

Skeletal Anomalies
Thanatophoric Dwarfism

Somrtimes Lethal
Chondroectodermal dysplasia
Chondroplasia punctata

Not Usually lethal

Lethal with a narrow thorax
Thanatropic dysplasia
asphyxiating thoracic dysplasia
Fetal Growth

Fetal measuremeents of growth
abdominal circumferencew
head circumference
Types of Growth Restriction

Type 1
Time of onset 2nd trimester. Form is symmetrical with the whole of the body being affected.

genetic (low growth potential)
intauterine infections
severe placental insufficiency
drugd (alcohol, smoking)
Types of Growth Restriction

Type 2
Time of onset 3rd trimester.
Form is assymetric, the trunk is more affected that the head.

maternal renal or vascular disease
placental insufficiency
Abnormalities of the Placenta Praevia
Definition part of the placenta covers the cervical os.
20% at 20 weeks (low lying)
0.5% at term

Incidence increases with:

maternal age
previous uterine surgery
Abnormalities of the Placenta Praevia

symmetrical complete
assymetrical complete
marginal praevia
low lying placenta
preterm delivery
increased perinatal mortality

maternal hemorrhage
preterm delivery
increased perinatal mortality
intaruterine growth

(last three related to detachment of the placenta)retardation
Placental Hemorrhage
Intervillous thrombis (DD maternal venous lakes)
Placental Abruption

Definition: premature separation of normally sited placenta

Maternal Risk factors
vascular disease
Drug abuse cocaine
fibrois trauma
Gestational Trophoblastic Disease
Definition: Proliferative disease of the trophoblast

hydatidiform mole
invasive mole

Risk factors
Inceasing maternal age
previous mole

Incidence Geographic Variation
1/2000 USA
1/100 Indonesia

US Appearance. large echogenic mass occupying the uterine cavity qith multiple fluid levels

Raised B-HCG in 100% of cases

Association Theca Lutein Cysts (multiseptate in 20-50% of patients
Normal Uterus
Nulliparous postpubertal 7X4X5

Multiparity increases the uterine size 1 cm in all directions

Size of the Uterus progressively reduces folowing the menopause
Endometrial Thickness

prolipherative phase 3-5mm
Secretory phase 5-6mm
Postmenopausal <4mm
Endometrial Thickness

Early intrauterine pregnancy
ectopic pregnancy
estrogen excess
Endometrial hyperpalsia/carcinoma (> 4mm abnormal for post menopausal women)
Endometrial Polyp
Enlarged Uterus
Carcinoma endometrial
sarcoma (rare)
Congenital uterine anomaly (uterus didelphys)
The Normmal Ovary
lenght X width X depth X 0.5223
Child 1 ml
Normal post pubertal state 5.3-7.6 my (excludes a dominant follicle

Normal post menopausal state 4.3 ml (range 1.5-10.3)
Ultarsound Signs of Ovulation
Collapse of Follicle
Free fluid in the pouch of Douglas
Echo free zone aroud the endometrium-myometrial edema
Definition of simple cystic structures in the Ovary
Developing Follicle 0.4-1.4 cm
Mature Follicle 1.5-2.9 cm
Follicular Cyst > 3cm
Ovarian Mass

Simple cystic structures
follicular cyst (may be functioning ie hormone secreting
polycystic ovaries
Ovarian Mass

Complex (mainly cystic)
ectopic pregnancy
Ovarian Mass

Complex (mainly solid)
granulosa cell tumor
ectopic pregnancy
Ovarian Mass
Solid teratoma
arrhenoblastoma (arrhenoblastoma is a rare ovarian stromal neoplasm that secretes testosterone)