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116 Cards in this Set
- Front
- Back
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How many chromosomes are in a gamete
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Haploid - 23
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How many chromosomes after fertilization?
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Diploid - 46
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What do the follicles on an ovary produce?
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estrogen
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What does estrogen stimulate?
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The endometrium to grow and thicken
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What releases gonadotropin?
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Hypothalamus
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What stimulates the pituitary to release luteinizing hormone and FSH?
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Gonadotropin
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What does the luteinizing hormone stimulate?
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For one follicle to mature
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Where does the oocyte go after it is released?
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Fallopian tube
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What happens to the follicle after rupture?
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Becomes corpus luteum & produces progesterone
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What causes menstruation?
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If fertilization doesn’t occur, estrogen & progesterone drop
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Where does fertilization typically occur?
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Fallopian tube
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What happens to the corpus luteum after fertilization?
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Continues to produce progesterone and some estrogen
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What stage are weeks 1 – 4?
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Zygote
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What stage are weeks 5 – 10?
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Embryo
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What stage are weeks 11 – 40 ?
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Fetal stage
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When and how is a morula formed?
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By day 3 – 4, from the fertilized ovum (zygote) divides
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What is the organized form of the morula?
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Blastocyst
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What feeds the blastocyst?
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The thickened endometrial layer (decidua)
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What are the outer cells of the blastocyst?
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Trophoblast
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What part of the blastocyst becomes the embryo?
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The cell disc
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What are the 2 layers of the trophoblast?
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Inner – cytotrophoblast
Outer layer - syncytiotrophoblast |
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What does the cytotrophoblast form?
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Chorion, Amnion, Connecting stalk
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What does the syncytiotrophoblast do?
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Invade the decidua, Form lacunae (which develop into intervillous spaces)
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What hormone does the trophoblast secrete?
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hCG
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What is the purpose of hCG?
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Extends the life of the corpus luteum/progesterone
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When does the blastocyst implant?
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7 days after fertilization
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What happens to the primary yolk sac?
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It disappears
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What connects the secondary yolk sac to the fetal body?
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Vitelline duct (yolk stalk)
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Where is the secondary yolk sac?
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In the extraembryonic coelum, between the amnion and chorion
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What is normal size for the secondary yolk sac?
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< 6mm
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What is the function of the secondary yolk sac?
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Nutrients and hematopoiesis
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What days in the zygote stage does conception happen?
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14 days
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When does the morula become a blastocyst?
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18 – 21 days
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When does implantation begin?
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19 – 21 days
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What happens in days 25 – 26 of the zygote stage?
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Implantation complete
Lacunar network formed Focal thickening of the decidua at the site of implantation |
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What happens in response to estrogen and progesterone?
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Transformation of endometrial cells into glycogen and lipoid cells
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What are the 3 distinct layers of the decidua?
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Decidua basalis, Decidua capsularis, Decidua parietalis (decidua vera)
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Which decidua attaches at the chorion frondosum?
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Decidua basalis
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Which decidua is not involved in implantation?
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Decidua parietalis (decidua vera)
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Which decidua develops into the placenta?
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Decidua basalis
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Which decidua covers the remaining endometrial cavity?
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Decidua parietalis (decidua vera)
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Which decidua closes over the blastocyst?
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Decidua capsularis
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When can the Intradecidual Sac Sign / Double decidua sign be seen?
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Week 4
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What stage are weeks 5 – 10?
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Formation stage
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What structures are present in weeks 4 – 5?
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Yolk sac, Neural plate and folds
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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 |
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Where would the yolk sac been seen in week 4 – 5?
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Between the amnion and chorion
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By what day should the gestational sac be seen?
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Day 34 (4 weeks)
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By what day should the yolk sac be seen?
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Day 42 (5 weeks)
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In week 4 – 5, what should the diameter of the gestational sac be?
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8 mm
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In weeks 4 -5 what should the hCG count be?
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1800 mlU/ml
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In weeks 4 – 5, what should the decidual wall thickening measure?
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> 3 mm
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What structures are present in weeks 5 – 6?
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Limb buds
Primordia of liver, pancreas, lungs, thyroid gland, heart Neural groove closes and the primary brain vesicles form Opitcal vesicles 2 heart tubes fuse and contraction begins with unidirectional blood flow |
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What are the sonographic features of week 5 – 6?
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Double blep sign (amnion with yolk sac)
Embryo may be seen adjacent to yolk sac Embryo heart beat Double decidua sign |
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What week might the embryo be seen adjacent to the YS? Or size of the gestational sac?
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By week 6, or gestational sac of 1.5 cm
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What would the embryo measure to be able to detect heart beat?
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5 mm CRL
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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 Nostrils and eyes develop |
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What are the sonographic features of week 6 -7?
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The amnion is close to the embryo
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What is the CRL in week 6 -7?
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9 – 10 mm
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What happens in week 7 – 8 ?
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Body axis straightens, Arms & legs extend straight forward, Digits, ears, eyelids, elbow, and wrists are formed, Pulmonary trunk separates from heart, renal pelvis, calyces, and ureters form, Brain has 3 vesicles
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What would the CRL be in week 7 – 8?
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21 – 23 mm
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What happens in week 8 – 9?
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More straightening of axis, Touch pads swollen on fingers, Midgut herniates into the umbilical cord (between weeks 8 – 12), Brain hemispheres and falx formed
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What are the sonographic features in week 8 – 9?
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The choroid plexus is seen in the lateral ventricles
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What would the CRL be in week 8 – 9?
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28 – 30 mm
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What happens in week 9 – 10?
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Eyelids cover eyes, Brain structures complete, Rapid growth
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What would the CRL be in week 9 – 10?
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30 – 40 mm
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What would the CRL be week 11 & up?
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40 – 85 mm
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By when should the kidneys be seen in adult position?
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15 weeks
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By when should the stomach be seen?
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12 weeks
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When does the midgut herniation return to the abdominal cavity?
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11- 12 weeks
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When should cranial anatomy be seen?
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After 12 weeks
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When should the bladder be seen?
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By 14 weeks
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When should the 4 chamber heart be seen?
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At 12 weeks
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What does the mean sac diameter correlate with?
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Menstrual age (1 cm = 1 week)
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What diameter should the yolk sac never exceed?
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6 mm
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What is the most accurate way to date a pregnancy?
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By the crown rump length
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With what accuracy does the CRL date the pregnancy?
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+ / - 5 days
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What is included in the mean sac diameter?
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Only anechoic fluid space, not walls
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Where should the gestational sac be located?
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To one side of the endometrium near fundus
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When should the yolk sac be seen?
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When the mean sac diameter is 8 mm
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When should the fetal heart rate be visualized?
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By 6 weeks (via TV)
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What is the normal fetal heart rate?
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90 – 170 bpm
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When is the nuchal lucency seen?
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In the first trimester
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What is the nuchal lucency?
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Anechoic area in the posterior nuchal region of the fetus
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What does nuchal translucency screening detect?
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The risk for having a child with trisomy 21, 13 and 18
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What factors are include in nuchal transluceny screening?
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PAPP-A values, BhCG lab values, Maternal age,Fetal nuchal translucency measurement
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What forms the umbilical cord?
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The fusion of the yolk stalk and allantoic duct
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When does the umbilical cord develop?
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During the 7 – 8th week
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What forms the umbilical vessels?
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The allantois vessels
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What is the cavity between the amnion and chorion?
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Extraembryonic coelum (chorionic cavity)
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What is the inner membrane that suspends the embryo in amniotic fluic?
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Amniotic membrane – Covers the cord as it expands
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What is the outer membrane that implants to form the placenta?
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Chorion membrane
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When does the amnion and chorion fuse?
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By 16 weeks
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When is quantitative hCG assessed?
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1st and 2nd trimester
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Where is beta hCG produced?
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By trophoblasts
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When should the 2nd international standard be positive?
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7 – 10 days after conception
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What could be the cause for increased serum levels?
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Incorrect dates, Multiple gestations, Trophoblast dissease (greater than 60,000 mIU/ml early
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What could be the cause of decreased serum levels?
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Incorrect dates, Embryonic demise, Ectopic pregnancy – will show slow rise but overall value is decreased
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Where is PAPP-A glycoprotein produced?
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by trophoblasts
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What does a decrease in PAPP-A indicate?
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Aneuploidy (Downs)
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complete abortion
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rapid decline in hCG
heavy vaginal bleeding w/ tissue/clots cramping cessation of pain and bleeding after event disappearance of signs of pregnancy empty uterus w/ clean endometrial stripe no adnexal mass or free fluid mod-bright endometrial echoes |
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incomplete abortion
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retained products of conception
slow fall or plateau of hCG mod cramping persistant mod-heavy bleeding complex echo pattern w/on endometrial cavity bright echoes, may shadow thicken endometrium |
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missed abortion
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intact nonliving embryo
hCG levels less than expected loss of pregnancy symptoms brownish vaginal discharge some cramping/pain absent cardiac/limb activity uterus and fetal size < expected |
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inevitable abortion
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pending abortion
uterus small for dates variable/low hCG levels vaginal spotting cervical dilation GS not in fundus and closer to cervix rupture of membrane w/ no change of survival |
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imminent abortion
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moderate cervical effacement
rupture of membranes/leaking fluid prolonged bleeding persistent cramping hrt rate<90 persistent misshapen YS GS in cervix or lower uterine segment cervical dilation small GS |
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empty sac/blighted ovum
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GS in utero w/o embryo or YS w/ irregular borders
uterus small for dates variable hCG levels vaginal spotting closed cervix no identifiable embryo in GS > 25 mm absent double blep sign |
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threatened abortion
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future of pregnancy at risk but currently viable
not able to diagnose sonographically closed cervix slight bleeding or cramping sonolucent crescent around GS |
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habitual abortion
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3 or more miscarriages
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molar pregnancy
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product of conception in which the trophoblast cells fail to differentiate so produce abnormal placental tissue
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signs/symptoms of molar pregnancy
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bleeding
increased hCG (into the millions) hyperemesis preeclampsia decreased AFP uterus LGA theca lutein cysts (bilateral) |
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theca lutein cysts
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on the ovaries
largest functional cyst seen 20-35% of the time overstimulation d/t high hCG levels bilateral multiple and septations common |
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complete mole
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embryo fails to develop
due to abnl ovum or 2 sperm fertilizing one ovum normal diploid 46XX malignant potential but considered a benign form |
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partial/incomplete mole
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hyperplasia of trophoblast will be localized w/in placenta rather than general
triploid karyotype is most common identifiable placenta--enlarged and engorged w/ cystic spaces very little malignant potential--considered benign coexistent fetus |
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invasive mole
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hydropic villi invades myometrium
15% of pregnancies will move to this form persistent bleeding and elevated hCG malignant nonmetastatic trophoblastic disease |
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choriocarcinoma
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malignant metastatic trophoblastic disease
2-5% of moles progress to this 50% from moles 50% from normal pregnancy or SAB spreads quickly complex in appearance throughout myometrium |
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cystic hygroma
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most common abnormality of 1st trimester
likely associated w/ chromosomal abnormalities genetic counseling and amniocentesis offered vary in size soft tissue thickening on posterior neck and thorax must differentiate from NT |
