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608 Cards in this Set
- Front
- Back
Where does the word pelvis come from?
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Latin and Greek, meaning "dish" or "bowl"
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Central section of the skeleton/ positioned etween the lower end of the spine, which it supports, and the lower extremeties, upon which it rests.
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pelvic girdle
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Four bones of the bony pelvis
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sacrum (posterior), coccyx (posterior), two innominate bones (fusion of the ilium, ischium, and the pubis/ anterior and lateral)
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What is the pelvis divided into?
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False pelvis and true pelvis, divided by an imaginary plane running from the sacral prominence to the upper margin of the symphysis pubis
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sits above the imaginary plane and is bounded by the iliac wings/ is a broad shallow cavity that supports the abdominal viscera (bowel)
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False pelvis
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sits below the imaginary plane and is further divided into pelvic inlet and pelvic outlet
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True pelvis
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part of the true pelvis bounded by the pubic bones anteriorly and the sacral promontory posteriorly
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pelvic inlet
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part of the true pelvis bounded by the ischial tuberosities laterally and the coccyx posteriorly
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pelvic outlet
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In the absence of masses in the nongravid pt, the uterus, ovaries, and adnexa are situated in the _____.
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true pelvis
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ligaments that bind the pelvic bones together
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osseous
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ligaments that support the uterus and ovaries
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suspensory
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arise superiorly and laterally from the uterus and inferiorly from the vagina to provide primary support for the uterus
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cardinal ligament
(suspensory) |
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**(lateral) extend from the lateral aspects of the uterus, and attach to the lateral pelvic side walls
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broad ligament
(suspensory) |
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extend posterolaterally from the supravaginal cervix, encircle the rectum, and insert onto the fascia over the sacrum
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sacro-uterine ligament
(suspensory) |
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**situated anterior and inferior to the broad ligaments and fallopian tubes, they attach the uterine cornu to the anterior pelvic wall
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round ligament
(suspensory) |
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attach the inferior ovary to the uterine corny, posterior to the fallopian tube on each side
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ovarian ligament
(suspensory) |
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attach the ovary to the posterior layer of the broad ligament on each side
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mesovarium ligament
(suspensory) |
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the superior margin of the broad ligament on each side, lteral to the fimbria of the fallopian tubes, through which course the ovarian vessels and nerves
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infundibulopelvic ligament
(suspensory) |
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bind the sacrum and iliac bones
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sacroiliac ligament
(osseous) |
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bind the sacrum, iliac, and coccyx
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sacrosciatic ligament
(osseous) |
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bind the sacrum and coccyx
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sacrococcygeal ligament
(osseous) |
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bind the two pubic rami
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pubic ligament
(osseous) |
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False pelvic muscles
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rectus abdominus, psoas major, iliacus
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forms the anterior margin of the abdominal and pelvic spaces/ it extends from the symphysis pubis to the costal margin
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rectus abdominis muscles
(false pelvis) |
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originates at the lower thoracic vertebrae and extends lateral and anterior as it courses through the lower abdomen, along the pelvic side wall to eventually insert on the lesser trochanter/ just inferior to the iliac crest, it merges with the iliacus muscle creating the iliopsoas muscle/ it forms part of the lateral margins of the pelvic basin
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psoas major muscles
(false pelvis) |
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**arises at the iliac crest and extends inferiorly until it merges with the psoas major/ it forms the ilac fossa on both of the pelvic side walls.
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iliacus muscle
(false pelvis) |
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**constitute the pelvic diaphragm muscles
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levator ani and coccygeus muscles
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**attach to the side of the true pelvis, extend madially to fuse with the opposite side, and thus form the floor of the pelvic cavity.
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levator ani muscles
(true pelvis) |
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aruse from the ischial spine and the sacro-sciatic ligament on either side, insert onto the coccyx and close the posterior part of the pelvic diaphragm and outlet
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coccygeus muscle
(true pelvis) |
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**triangular muscle arising from the anterolateral wall of the pelvis/ extends from the brim of the true pelvis and exits through the lesser sciatic foramen to insert on the greater trochanter of the femur.
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obturator internus
(true pelvis) |
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arise from the sacrum, pass laterally through the greater sciatic notch, and insert on the greater trochanter of the femur/ they are identified posteriorly in the pelvis
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piriformis muscle
(true pelvis) |
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musculomembranous, highly distensible sac located between the symphysis pubis and the vagina
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urinary bladder
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Where do the ureters insert in the bladder?
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the inferior third of the posterior wall on either side
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superior concavity of the bladder
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dome
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Three layers of tissue in the bladder
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outer epithelial, middle muscularis, and inner mucosal
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allows for the exretion of urine, arises along the inferior middle portion of the urinary bladder/ at it's point of exit, it is surrounded by a thickened region of bladder wall referred to as the internal urethral sphincter.
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urethra
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When is the bladder adequately full for transabd scanning?
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when the dome of the bladder extends above the fudnus of the uterus
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muscular tube, approximately 7-10 cm in length, extending from the cervix to the external vaginal introitus/ composed of smooth muscle, elastic connective tissue, and stratified squamous epithilium which line the inner surface/ the upper portion attaches circumferentially to the cervix approx half way up
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vagina
|
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ring-like blind pouch that surrounds the cx
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vaginal fornix
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surrounds the posterior aspect of the external cx/ is a frequent site of vaginal fluid collections due to gravity dependence
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posterior fornix
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surround the lateral aspect of the external cervix on either side.
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lateral fornices
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surrounds the anterior aspect of the external cervix/ is much smaller than the posterior fornix
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anterior fornix
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muscular structure suspended by ligaments and normally located in a mid-sag plane in the true pelvis/ bordered ant by the bladder and post by the rectosigmoid colon
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uterus
|
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the largest part of the uterus/ contains the uterine cavity/ the corpus is predominantly muscular and widens superiorly as the fundus, above the insertion of the fallopian tubes/ the cone-shaped cornua are lateral, where the tubes enter the uterus/ the lower uterine segment, sometimes called the isthmus, transitions into the cx at the location of the internal os
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body of uterus
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located posterior to the angle of the urinary bladder/ comprised predominantly of collagenous and elastic tissue/ narrower than the uterine body and measure 3-4 cm in length in the nulliparous female/ the mucosal-lined endocervical canal is contiguous with the uterin cavity at the internal os and opens into the upper vagina at the external os/ the lower portion projects into the vagina
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cervix
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Largest organ in the normal female pelvis when the bladder is empty
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uterus
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A mobile, hollow, muscular, pear-shaped structure partially covered in peritoneum
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uterus
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Normal menarchal uterus measurements
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7.5cm long, 5cm wide, 2.5 cm AP
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Three layers of the uterus
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External or serous layer
Middle or muscular layer Internal mucous layer |
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External uterus layer
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peritoneum surrounds the uterus except where the baldder lays against it at the cervical-vaginal connection
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Myometrium
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middle uterus layer that composes majority of the uterus/ primarily smooth muscle that is longitudinal and circular
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Endometrium
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-inner uterus layer
-lined by a thin mucous membrane -varies in appearance and thickness |
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Endo thickness of menstruating female
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4mm - 12mm
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Endo thickness of postmenopausal female
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4mm - 10mm
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Two layers of endometrium
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Functional layer (zona functionalis) and deep basil layer (zona basalis)
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Retroflexion
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uterus tipped backward at cervix
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Retroversion
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uterus tilted posterior
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Retroversion with retroflexion
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uterus tilted posterior and tipped backward
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The uterus is supported in its midline position by...
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paired broad ligaments, round ligaments, and uterosacral ligaments
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**double fold of peritoneum/ provide bilateral support for the uterus
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broad ligaments
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What do the broad ligaments surround?
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the fallopian tubes, round ligaments, ovary, paraovarian, connective tissue, unstriped muscular fiber, blood vessels, and nerves
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**Occupy space between the layers of broad ligament and occur in front of and below the fallopian tube/ these two cords commence on each side of the superior aspect of the uterus and course upward and lateral to the inguinal canal and labia majora
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round ligaments
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**attach ovaries to uterus
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ovarian ligaments
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**attach ovaries to pelvic wall
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suspensory ligaments
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located in the adnexa, are contained in a special fold of the broad ligament called the mesosalpinx
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fallopian tubes
|
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Normal measurements of fallopian tubes
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12 cm long, 1 to 4 mm in diameter
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funnel-shaped lateral tube that projects beyond the broad ligament to overlie the ovaries/ free edge of the funnel has fimbrae
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infudibulum
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fimbrae
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fingerlike projectors draped over the ovary on the free edge of the infudibulum of the fallopian tubes
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widest part of the fallopian tube
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ampulla
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**where does fertilization occur?
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ampulla
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hardest part of the fallopian tube, lies just lateral to the uterus
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isthmus
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part of the fallopian tube that pierces the uterine wall
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interstitial
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muscular tube composed of primarily smooth muscle with some skeletal muscle fibers/ is the passageway for the products of the menstrual cycle and is easily distendible/ has a mucous membrane lining in its muscular wall to recieve secretions
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vagina
|
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How long is the vagina?
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10 cm
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**Where does the vagina lie?
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ant to the rectum and anal canal and post to the pubic symphysis, urinary bladder, and urethra
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Where is the urethra located?
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in the lower part of the anterior vaginal wall
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opening of the urethra
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external urethral meatus/ ant to the opening of the vagina
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found in the upper end of the vagina, near the external cx/ has ant side and post side/ post side is covered with peritoneum and may perforate by instruments being misdirected causing peritonitis
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fornix
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almond shaped, attached to the back of the broad ligament by mesovarium, sometimes called suspensory ligament/ lie in ovarian fossa
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ovary
|
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ovary measurement
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3cm
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what is the ovarian fossa bounded by?
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external iliac vessels, ureter, and obturator nerve
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ovarian blood supply
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receives blood from ovarian artery/ blood drained by ovarian vein into IVC on right and on LEFT into left renal vein
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outer region of the ovary that surrounds the medulla consisting primarily of follicles in varying stages of development/ it is covered by dense connective tissue, the tunica albuginea, and a thin single layer of cells, the germinal epithelium
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cortex
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part of ovary composed of connective tissue containing blood, nerves, lymphatic vessels, and some smooth muscle
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medulla
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provides blood to the pelvis cavity through the external and internal iliacs
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common iliac artery
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course along the pelvic brim
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external iliac artery and vein
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runs down into the pelvis on the post wall to provide multiple branches to the pelvic structures
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internal iliac artery
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enters the pelvis as it courses ant to the internal iliac artery to empty into the post base of the bladder
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ureter
|
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**supplies blood to the uterus, arises from the internal iliac artery/ courses medially over the ureter in the base of the broad ligament to the uterus at the cervical level/ tortuous
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uterine artery
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**two sources of blood supply to the vagina
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ant surface supplied with blood from a branch off the uterine artery/ post surface is supplied from a branch of the internal iliac vessel
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where does the ovary receive its blood supply?
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from the aorta
|
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the ovarian arteries are...
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tortuous
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The pelvis is divided by...
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an oblique line that separates the greater (false) and the lesser (true) pelvis.
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passes through the sacrum to the superior margin of the pubis symphysis
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pelvic brim
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cephalic to the pelvic brim and is bordered by the abdomen cephalically and the lesser pelvis caudally
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greater pelvis
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part of the abdominal cavity found below the pelvic brim
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pelvic cavity
|
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formed by the sacrum and coccyx covered by the piriformis and coccygeus muscles
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posterior wall of pelvic cavity
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lateral margins of the pelvic cavity
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hip bones covered by the obturator internus muscle
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formed by the levator ani and coccygeus muscles
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lower margin of the pelvic floor
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region above the diaphragm
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pelvic cavity
|
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smaller area below the pelvic floor
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perineum
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lowest part of the peritoneal cavty
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rectouterine pouch/ Pouch of Douglas/ posterior cul-de-sac
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originates at the lower thoracic vertebrae and extends lateral and ant as it coursed through the lower abdomen/ separates from the vertebral column at the level of L5 and coursed through the pelvis to insert on the lesser trochanter
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psoas major muscle
|
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forms the lateral margins of the pelvic basin/ formed just inferior to the iliac crest when the psoas major merges with the iliacus muscle
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iliopsoas muscle
|
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arises at the iliac crest and extends inferiorly until it merges with the posas major to form the pelvic side wall
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iliacus
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pass out from the pelvis through the sciatic foramina to attach to the greater tuberosity of the femur
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piriformis and obturator internus
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muscular part of the sacrospinous ligament and forms the posterior part of the pelvic diaphragm
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coccygeus muscle
|
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**forms the anterior part of the pelvic diaphragm
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levator ani muscles
|
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form the floor of the pelvis
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levator ani muscles
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play an important role in rectal and urinary continence and maintain the position of the uterus and ovaries
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levator ani muscles
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reproductive cell produced by the ovaries
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ovum
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**ovaries produce two known hormones/ they are responsible for maintaining secondary gender characteristics, preparing the uterus for implantation, and for development of the mammary glands
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estrogen and progesterone
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What is estrogen secreted by?
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follicles
|
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**What is progesterone secreted by?
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corpus luteum
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Reproductive years
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begin around age 11 to 13 at the onset of menstruation and end around 50 years of age
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once a month when an ovum is released from one of the two ovaries/ speculated that this alternates between the two ovaries
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ovulation
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begin development in embryonic life and remain in the ovaries until menses begins/ some mature and discharge from the ovaries on a monthly basis while others die
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ova
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prepuberty stage, time before the onset of menses
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premenarche
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stage after reaching puberty, onset of menses
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menarche
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menses has stopped permanently
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menopause
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The cyclic changes of the uterus during the menstrual cycle are directly related to...
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the interaction of the hormones produced by the ovaries and the hormones from the pituitary gland
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**Approx days 1-4/ the ovaries contain many primary follicles/ uterus is shedding the superficial layer of the endo
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menstrual phase
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**days 5-14/ ovaries begin a period of rapid growth under the influence of fsh/ the ova grows, fills with fluid, and begins to secrete estrogen/ one follicle reaches maturity/ ovulation occurs
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proliferative phase
|
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**One follicle grows to reach maturity/ estrogen levels increase to trigger production of more fsh/ pituitary gland begins to secret luteinizing hormone/ shift in hormones causes the release of egg from ruptured follicle/ at the same time estrogen levels increase and the endo beings to regenerate
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ovulation in the proliferative phase
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**approx days 15-29 (to the onset of menses)/ collapsed follicle begins to grow and form corpus luteum, or yellow body which secretes progesterone and estrogen/ progesterone levels increase and the endo prepares to accept fertilized egg/ if fertilization does not occur, the corpus luteum will degenerate due to decreased progesterone and estrogen levels, menses occurs, and the cycle starts over/ if fertilization does occur the corpus luteum conts to secrete these hormones for about 3 months until placenta forms
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secretory phase
|
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Hormonal contraceptives
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-oral: contains estrogen and progesterone/ inhibit ovulation and changes endo linig and cervical mucus
-depot-medroxyprogesterone acetate: injected every 3 months/ inhibits ovulation and thickens mucus -Levonorgestrel implants: thin capsules inserted under the skin of the upper arm/ inhibits ovulation and thickens mucus -Post-coidal hormonal contraceptive (pcc): morning after pill/ should be administered within 72 hours after unprotected sex |
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Barrier contraceptive methods
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-diaphragm
-cervical cap -condoms |
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Surgical Fertility control
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hysterectomy/ elective abortion
|
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Intrauterine Contraceptive Device (IUD)
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foreign body placed in the endometrial cavity providing a hostile environment thus discouraging implantation/ ovulation and corpus luteum formation is not impaired/
Types: -Progestasert has core of progesterone that is released over a period of time/ T-shaped/ currently on the market -Paraguard Copper T is wrapped in fine copper stranding/ currently on market -Lippes loop -Copper 7 -Saf-T-Coil -Dalkon Shield |
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IUD Placement
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Inserted in the uterus cavity during menses and provide reliable birth control/ pt should check for proper placement weekly by palpating string in cx/ If string is not felt the iud could have been expelled or the string could have retracted into the uterus/ sensitive preg test is performed, if neg the dr will explore the uterine cavity with sterile hooked probe. if the iud is not found or if preg test is pos then an u/s is performed
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Risk associated with iud's
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usage with preg increases risk of spontaneous abortion/ iud can become imbedded in myometrium/ abscess formation/ perforation/ lost iud/ PID
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Sonographic appearance of IUD
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highly reflective/ entrance-exit reflections/ post shadowing/ focal uterine calcifications or intrauterine gas bubbles may simulate an IUD
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two conjoined uteri that share the same medial wall, both have a fallopian tube, endo, and mymetrial structures, share the same cervix
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bicornuate uterus
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rare, two complete, independent uteri form, the fallopian tube attaches to the lateral angle of each uterus, each uterus functions separately, each one can sustain a pregnancy
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Uterus didelphys
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entire uterine cavity is separated by a thin septum
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complete septum
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half of uterus with only one fallopian tube attachment
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unicornuate uterus
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not uterine body, fallopian tubes come to a blind end, only a small ribbon of fibromuscular tissue is present or minute particles of the mullerian duct are present
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uterine aplasia
|
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most common tumor of uterus/ benign
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fibroid/myomas/leiomyomas
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benign tumor of uterus/ most often found in premenopausal women over 30 and younger in African-American women/ made of smooth muscle of uterin wall (myometrial tissue)/ encapsulated with a pseudocapsule so they are easy to remove/ may degenerate with atrophy and vascular compromise/ liquefaction, necrosis, hemorrhage, and ultimate calcification may take place
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fibroid
|
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**this benign tumor of the uterus usually does not become malignant, however it is sensitive to estrogen and may increase in size during pregnancy/ after menopause, with the regression of estrogen stimulation, the tumor becomes smaller but does not entirely disappear/ clinically they cause uterine irregularity and enlargement with the sensation of pelvic pressure and sometimes pain/ patterns of irregular bleeding, menometrorrhagia or menorrhagia are symptoms/ can contribute to infertility by distorting the fallopian tube or endometrial cavity, if located in the lower segment may interfere with vaginal delivery
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fibroid
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location of leiomyoma/ deforming the endometrial cavity and causing irregular or heavy bleeding
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submucosal
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location of leiomyoma/ deforming the myometrium, the MOST COMMON type
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intramural
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**location of leiomyoma/ sometimes becoming pedunculated and appearing as extraunterin masses
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subserosal
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characterized by nests of endometrial tissue within the myometrium/ causes heavy painful bleeding/ diffuse uterine enlargement/ not reliably diagnosed by ultrasound
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adenomyosis
|
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less than 5% of uterine malignancies/ derived from smooth muscle in the wall of the uterus/ thought to arise from preexisting leiomyomas/ resembles fibroids or endometrial CA/ enlargement of a fibroid in a perimenopausal or postmenopausal women raises the suspicion
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Uterine leiomyosarcoma
|
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**caused by unopposed estrogent (usually Premarin) and appears as thickening of the endometrium/ premenopausal women > 14mm, postmenopausal women > 8mm/ women on sequential estrogen and progesterone replacement can have endometrial measurements up to 15mm during the estrogen phase, so it is best to evaluate endo at BEGINNING or END of hormone cycle
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Endometrial hyperplasia
|
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usually asymptomatic but can cause uterine bleeding/ typically cause diffuse or focal endometrial thickening/ appear as either cysts or dense masses in endo cavity on u/s, better visualized when there is fluid in the endo
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Endometrial Polyps
|
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**Often occurs with PID but can also occur postpartum/ on u/s the endo appears prominent, irregular, or both with a small amount of endo fluid/ rarely gas bubbles form/ in the postpartum period the presence of retained tissue is difficult to distinguish from inflammatory debris or blood clots
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Endometritis
|
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Scar tissue found in women with a prior hx of uterine curettage or spontaneous abortion/ sonography may demonstrate bright echoes within the endometrial cavity
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Synechiae
|
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**MOST COMMON is adenocarcinoma occuring in perimenopausal and postmenopausal women with irregular bleeding/ associated with estrogen stimulation/ earliest change is thickened endo/ studies show that endo thickness of less than 5mm reliably excludes significant endo abnormalities/ tv us is helpful in screening by accurately measuring the thickness of endo and can also demonstrate myometrial invasion by showing an irregular interface between the endo and myometrium
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Endometrial Carcinoma
|
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most common type of endometrial carcinoma
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adenocarcinoma
|
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Occur with ectopic pregnancy, endometritis, degenerating fibroids, and recent abortion/ when visualized it should be measured AP without endometrium included
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Small Endometrial Fluid Collections
|
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should be regarded as suspicious/ can be caused by radiation in women who have had gyn malignancies/ or caused by uterine, cervical, tubal, or ovarian carcinoma/ can be caused by benin conditions such as congenital anomaly or cervical stenosis due to instrumentation or childbirth/ pt typically compains of abd pain and has abd mass/ usually has little or no bleeding/ can develop pyrometra (puss in uterus)/ sonographically appears as large endo fluid collection in a moderately enlarged uterus
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Large Endometrial Fluid Collections
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cervical cysts from dilated or obstructed transcervical gland/ round fluid filled structures usually less than 2 cm
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Nabothian Cysts
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Hyperplastic protrusion of epithelium of cervix/ usually from chronic inflammation may be pedunculated
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Cervical Polyps
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**acquired from prior irritation of cervix/ post-menopausal is usually asymptomatic while menopausal women have fluid filled uterus with oligomenorrhea or amenorrhea with cramping
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cervical stenosis
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Affects women of menstrual age/ areas of increased echogenicity or hypoechoic areas with an irregular outline signify changes compatible with CA/ discharge or bleeding, possible obstruction of ureters/ should be found with pap/ seen with EVUS or transrectal us/ look for bladder involvement/ us may be used for staging and biopsy
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Cervical Cancer
|
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**Seen in hysterectomy pts after surgery/ upper limits 2.1cm/ evaluated for fibrosis or mass especialy if hysterectomy was due to malignancy
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Vaginal Cuff
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cysts in vagina, fairly common with cystic appearance/ vag carcinoma show solid
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Gartner's duct cyst
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Occurs when dominant follicle fails to ovulate and remains mature/ the follicle should involute and regress in size/ thin-walled, small cyst/ may be multiple in number/ ovary is neither distorted or enlarged/ may lead to menstrual irregularity/ surgical intervention may be necessary
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Follicular cyst
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**Forms after a normal 12mm to 17mm corpus luteum ruptures/ will usually regress and spontaneously resolve/ hemorrhage may result/ when hemorrhagic, it may be assoc with varying degrees of intra-abdominal bleeding, pelvic pain, vomiting, tender enlarged ovary, elevated temp/ hemorrhagic cyst will be complex with areas of cystic hemorrhage/ must be differentiated from ectopic
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Corpus Luteum
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Formed to support the pregnancy until the tenth week of pregnancy/ thin-walled, unilateral cyst, can enlarge up to 5cm/ pt is usually asymptomatic
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Corpus luteum of pregnancy
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**Often bilateral/ the growths usually disappear by themselves, but may rupture/ not common/ can be associated with two rare gyn disorders: hydatiform moles and choriocarcinoma
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Theca lutein cyst
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aggressive uterine cancer that develops after pregnancy or hydatiform mole
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choriocarcinoma
|
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**rare benign tumor or mass that develops in the uterus/ it is essentially an over development of tissue that would normally become placental tissue/ often no fetus actually develops/ the cause of the abnormality is not known
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hydatiform mole (molar pregnancy)
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arise from gartner's duct remnant/ make up 10% of all adnexal masses/ usually found within the broad ligament/ often asymptomatic/ thin-walled, vary in size
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paraovarian cyst
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**most common in early childhood, ages 10 and under/ occurs when ovary partially or completely rotates/ may present with severe pelvic pain, nausea, vomiting, palpable adnexal mass/ ovary may be enlarged and hyperechoic/ doppler should demonstrate absence of flow
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ovarian torsion
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**one of the most common epithelial tumors/ 30% of all ovarian tumors/ benign serous cystadenoma generally found in women ages 20-50/ rapid growing/ may enlarge up to 20cm/ approx 70% of the masses are unilateral/ mass is cystic/ can be pedunculated, contain septa and debris
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serous cystadenoma
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**less common/ benign, multi-septated tumor that may extend into abdomen
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Mucinous cystadenoma
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**Commonly referred to as "dermoid cyst"/ 25% of ovarian neoplasms/ usually in young women/ may be filled with sebaceous material and hair/ 75% are unilateral/ irregularly shaped and thick-walled/ mild to acute abd pain/ adnexal fullness/ pressure symptoms/ complex cyst may shadow and may distort the peripheral bladder wall/ may range from cystic to complex depending on the amount of hair, teeth, and bone present
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Cystic teratoma
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Arise from ovarian stroma/ 5% of all ovarian neoplasms/ 90% unilateral/ range in size/ mostly found in women near 50-60/ solid, well-encapsulated tumors/ most common tumor is Meig's Tumor
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Fibroma
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**Characteristics of Meig's Syndrome (fibroma)
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pelvic mass, hydrothorax, ascites, pleural effusion, characteristic resolve after tumor removal
|
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Benign, solid, unilateral/ range in size/ menopausal and postmenopausal women/ pelvic pain and pressure/ malignancy is rare/ shadowing, calcifications, necrosis, and cystic degeneration may occur
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Theca cell tumor
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uncommon solid mass in women after 40 yrs of age
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Brenner tumor
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rare malignant tumor mainly in chidren and young adults
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solid teratoma
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rare malignant in females 10-30 yrs/ solid, irregular
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Dysgerminoma
|
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Secondary ovarian carcinoma with primary neoplasms of the GI tract
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Krukenberg's tumor
|
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**Ectopic endometrial tissue/ found on structures within pelvic and abdominal cavities/ implants can form cysts called endometrioma or chocolate cyst/ reproductive age/ multiple sex partners/ difficult to see on u/s/ dyspareunia, metromenorrhagia, dismenorrhea
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Endometriosis
|
|
**Multiple, small thin-walled cysts/ also known as Stein-Leventhal Syndrome/ women ages 20-30/ polycystic ovaries, hirsutism, amenorrhea, enlarged ovaries, obesity, impaired infertility/ high LH/FSH ratio/ hyperandrogenization/ can have POD WITHOUT Stein-Leventhal/ ovaries enlarged bilaterally/ numerous small cysts/ may be unilateral
|
Polycystic Ovarian Disease
|
|
**Inflammatory condition of the uterus, cervix, ovaries, fallopian tuves, peritoneal surfaces./ may cause endometritis, salpingitis, hydrosalpinx, pysalpinx, and TOA, infection is usually bilateral, most often affects sexually active women during their childbearing years, most cases are thought to stem from std's (two most common are gonorrhea and chlamydia), may also be caused from bacteria entering the body after gyn events or procedures such as IUD insertion, childbirth, spontaneous or elective abortion, endometrial biopsy
|
PID- Pelvic Inflammatory Disease
|
|
PID may cause severe symptoms, minor symptoms, or no symptoms at all. Symptoms include:
|
vaginal discharge with a bad odor, painful urination, pain in the lower abd (often a mild ache), abnormal uterine bleeding, fever, chills, nausea, vomiting
|
|
___ is used to monitor follicle development during spontaneous or induced ovulation.
|
Ovarian scanning
|
|
Reasons to monitor follicles with u/s
|
Timing insemination, timing medication, dx of ovulatory malfunction
|
|
What is the cause of 20-40% of female infertility cases?
|
Tubal obstruction
|
|
Causes of tubal obstruction
|
adhesions from surgery, infection, ruptured appendix
|
|
**Hyperstimulation of the ovaries with medication (clomiphene, human menopausal gonadotropin-releasing hormong) is done ____ and continued for _____ days with frequent u/s monitoring of follicular growth.
|
after menses, 7 to 10 days
|
|
During induced hyperstimulation, follicles enlarge from ___ at the end of menses to over ___ 10 days later.
|
3-5mm/ over 20 mm
|
|
group of closely associated granulose cells, which surrounds the oocyte
|
cumulous oophorus
|
|
(Infertility) Before ovulation, ___ is seen on the wall of the clear follicle. HCG is administered when serverl follicles reach to size of ___ and the final maturation occurs.
|
cumulous oophorus/ 16mm
|
|
(infertility)
The oocytes are incubated and inseminated and then the fertilized ova are inserted through the cervix into the uterus. After ___ an u/s is done to look for gest sac. |
3 weeks
|
|
Complications of ovarian stimulation
|
multiple gestations, hyperstimulation syndrome, must severe case occurs when the ovaries continue to enlarge rapidly after ovulation
|
|
also known as gestational age and is calculated by adding 2 weeks to the embryologic age (date from which conception occurs)
|
menstrual age
|
|
embryologic age
|
date from which conception occurs
|
|
the length of time calculated from the first day of the last normal period (LMP) to the point at which the pregnancy is being assessed
|
menstrual age
|
|
**A mature ovum is released at day ___ of the menstrual cycle.
|
14
|
|
The ovum is swept into the distal fallopian tube vis the ___
|
fimbrae
|
|
**Fertilization occurs here ___ days after ovulation
|
ampulla/ 1 to 2 days
|
|
The fertilized ovum is referred to as ...
|
zygote
|
|
The zygote undergoes rapid cellular division to form ___
|
16 cell morula
|
|
Further cell profileratin brings the morula to the ___ stage.
|
blastocyst
|
|
contains trophoblastic cells and the "inner cell mass" which forms the embryo
|
blastocyst
|
|
The blastocyst enters the uterus ____ days after fertilization
|
4-5 days
|
|
Implantation occurs ___ days after ovulation.
|
7-9 days
|
|
When implantation is completed the trophoblast goes on to form ___, which forms into the early gest sac.
|
primary villi
|
|
Within the conceptus, the inner cell mass matures into...
|
the embryonic disc, the future embryo, and the primary yolk sac.
|
|
**At approx __ days, the primary yolk sac is pinched off by the extra embryonic coelom, forming the ____.
|
23 days/ secondary yolk sac
|
|
The ____ is the yolk sac seen on u/s throughout the first trimester.
|
secondary yolk sac
|
|
At the beginning of the ___ week, the bilaminar embryonic disc undergoes gastrulatin and is converted into the trilaminar (three germ layer) embryonic disc.
|
5th week
|
|
______ begins at the beginning of the 5th week.
|
Organogensis
|
|
On u/s, the embryo is first seen when there is heart motion at approx ___
|
5.5 weeks
|
|
When you can first see the embryo, the approx crl is ___
|
2mm
|
|
When you first see the embryo, it is seen between the ____ and the ____.
|
secondary yolk sac and the immediate gestational wall
|
|
With tv u/s, the amniotic cavity and chorionic cavities can be seen after ___ weeks.
|
5.5 weeks
|
|
The chorion and amnion fuse at approx ____ weeks.
|
16 and 17 weeks
|
|
Embryonic period
|
6 to 12 weeks
|
|
Fetal period
|
begins after 10 weeks
|
|
At the beginning of the ___ week the embryo begins to take on a c-shape.
|
6th
|
|
Narrowing between the embryo and yolk sac creates the ____
|
yolk stalk
|
|
As embryonic folding occurs, the ___ aspect of the yolk sac is incorporated into the embryo developing the foregut, midgut, and the hindgut, and the entire gastrointestinal tract, liver, biliary tract, and pancreas.
|
dorsal aspect
|
|
At the same time as embryonic folding, the ____, ____, and ____ are brought together to form the umbilical cord.
|
yolk stalk, connecting stalk, and allantois
|
|
The limb buds are recognizable during the ___ week, and as is the embryonic tail.
|
6th week
|
|
The spine develops in weeks ___.
|
5-7
|
|
Sonographically parallel echogenic lines representing the spine can be seen ____.
|
7 to 8 weeks
|
|
During the ___ week, upper limbs form first, followed by the lower extremeties.
|
6th week
|
|
Hands and feet develop later and are complete by the end of the ___ week.
|
10th week
|
|
Sonographically, the limb buds can be detected from the ____ week on.
|
7th
|
|
Fingers and toes are visible at ___ weeks using tv u/s.
|
11 weeks
|
|
The anterior abdominal wall is developed by ____, and simultaneously the primitive gut is formed.
|
6 weeks
|
|
The midgut, derived from the ___, develops and forms the majority of the small bowel, cecum, ascending colon, and proximal transverse colon.
|
primitive gut
|
|
The ___ enlongates faster than the embryo is growing, causing the ___ to herniate into the base of the umbilical cord
|
midgut
|
|
**Until approx ___ weeks, the midgut loop continues to grow and rotate before it descends into the fetal abdomen at about ___ weeks.
|
10 weeks/ 11 weeks
|
|
**Bowel appears as an ___ in the base of the umbilical cord before 11 weeks.
|
echogenic mass
|
|
After ___ weeks, the echogenic mass is no longer visualized and echogenic bowel is seen within the fetal abd.
|
12 weeks
|
|
Around the ___ week, three primary brain vesicles develop: ____, _____, and _____.
|
6th week/ procencephalon, mesencephalon, and rhombencephalon
|
|
____ divides into two segments: the cephalic portion (_____) and the caudal portion (____)
|
rhombencephalon/ metencephalon, myelencephalon
|
|
Once the rhombencephalon divides with its corresponding flexure, the ___ forms/ this can be seen on u/s from _____ weeks
|
cystic rhomboid/ 8-11 weeks
|
|
The cerebral hemispheres may be seen at around ____.
|
9 weeks
|
|
The echogenic ___ fill the cerebral ventricles in the first trimester, and the sonolucent ____ can be seen around the choroids/ the cerebral falx may also be seen.
|
choroids/ cerebral spinal fluid (CSF)
|
|
The ____ is the first organ to function.
|
heart
|
|
The heart starts beating at approx ____ weeks.
|
5.3 to 5.5 weeks
|
|
By the end of the ___ week the heart has obtained its adult configuration.
|
8th
|
|
Cardiac activity should always be seen by ___.
|
46 menstrual days
|
|
FHR at 6 weeks
|
90 bpm
|
|
fhr at 9 weeks
|
170 bpm
|
|
fhr throughout the remainder of the first and second trimester after 9 weeks
|
approx 140 bpm
|
|
The most accurate dating during pregnancy
|
ultrasound within the first trimester
|
|
Two parameters for u/s during the first trimester
|
CRL and gest sac size
|
|
**___ is the most accurate measurement with deviations of + or - ____.
|
CRL, 5-7 days
|
|
CRL can be obtained as early as ___ weeks using tv u/s, using the heart motion to identify the embryo
|
5.5 weeks
|
|
CRL should be used until ___ weeks, when the fetus begins to curl making measurement of length difficult.
|
12 weeks
|
|
Gest sac size correlates closely with ___ early n pregnancy/ as a rule it remains accurate until ___ weeks of gestation.
|
menstrual age/ 8 weeks
|
|
Sonographically the gest sac or mean sac diamter is deterined by the sum of the ___, ___, and ____.
|
length, width, and height of the sac
|
|
When measuring the gest sac, only include ___.
|
fluid space, not the echogenic decidua.
|
|
Yolk sac should be seen within a sac measuring ____.
|
10-15 mm
|
|
Yolk sac should always be seen by ___.
|
20 mm
|
|
The normal diamter of the yolk sac should never exceed ____.
|
5.6 mm
|
|
___ yolk sacs have threatening outcomes.
|
Enlarged
|
|
Approx 10% of maternal deaths are related to ____
|
ectopic pregnancy
|
|
Ectopic preg assoc with:
|
pid, iud's, fallopian tube surgeries, infertility treatments, hx of ectopic
|
|
**Ectopic preg clinical findings
|
pelvic pain, vag bleeding, palpable adnexal mass
|
|
Most common location of ectopic preg/ other sites include ovary, broad ligament, peritoneum, and cx
|
95% within fallopian tube
|
|
As many as 20% of pts with ectopics also have ____
|
pseudogestaional sac (sac-like structure)
|
|
Guidelines to differentiate between early gest sac and pseudogestational sac
|
-Pseudogestational sacs do not contain embryo or yolk sac
-Pseudo are centrally located in the endo -homogenous low level echoes can be seen in pseudo -evaluate adnexal areas closely -look for extrauterin gest sac with echogenic ring/ may contain yolk sac and sometimes embryo -color doppler: increased blood flow in and around an ectopic most of the time -free fluid found in approx 80% of pts with ectopic |
|
Adnexal masses seen with ectopic
|
hematoma or hematosalpinx/ corpus luteum cyst can mimic ectopic/ endometrioma
|
|
symptoms of gestational trophoblastic disease in first trimester
|
vag bleeding, elevated beta-hcg, hyperemesis, preeclampsia
|
|
**anembryonic pregnancy
|
aka blighted ovum/ gest sac in which the embryo fails to develop/ u/s: large empty gest sac, no yolk sac, embryo, or amnion will be seen
|
|
**Incomplete abortion
|
u/s: intact gest sac with a nonliving embryo, collapsed sac, thickened endo, embryonic parts the may or may not cause acoustic shadowing
|
|
**Complete abortion
|
empty uterus, no adnexal masses, no free fluid, + hCG levels
|
|
Cardiac rates during the first trimester range from ____
|
90-170 bpm
|
|
FHR less than ___ have been shown to have poor prognosis.
|
less than 90 bpm
|
|
If gest sac is ___ less than the CRL, oligohydramnios is suspected.
|
4mm
|
|
**one of the most common abnormalities seen in the first trimester/ highly assoc with chromosomal anomalies
|
cystic hygroma
|
|
**For fetuses detected with cystic hygromas in the first and second trimesters, ___ is the most common karyotype.
|
Turner's syndrome
|
|
If cystic hygromas resolve by ___ weeks, most fetuses are chromosomally normal.
|
18
|
|
If cystic hygromas persist, all are ___.
|
abnormal.
|
|
If cystic hygroma or nucal thickening is seen in first trimester, ___ and ___ are required.
|
genetic counseling and further sonographic monitering
|
|
**Cystic hygromas seen in the first trimester may vary in size, but all appear on the ___ aspect of the ____ or ____.
|
posterior aspect/ fetal neck or upper thorax
|
|
**Caution should be taken not to mistaken cystic hygroma for ____.
|
normal amniotic membrane in which the embryo is lying
|
|
Abdominal wall defects must be distinguished from ____, which appears as an echogenic mass between ____ weeks.
|
normal physiologic midgut herniation/ 8 to 10 weeks
|
|
**___ is never herniated into the base of the umbilical cord so any evidence of this outside the ant abd wall should be considered abnormal.
|
Liver
|
|
**The diagnosis of ___ can be more difficult to diagnose in the first trimester, but reports have shown bowel to be separate from the umbilical cord.
|
Gastroschisis (right side)
|
|
**___ have been reported to be highly assoc with chromosomal abnormalities/ cannot be differentiated from normal physiologic bowel migration and should be diagnosed after ___ weeks.
|
Omphaloceles/ 12 to 14 weeks
|
|
dominant structure seen within the embryonic cranium during the first trimester/ fills the cranial vault
|
choroid plexus
|
|
Traditional cranial anatomy can be seen after ___ weeks, repeat u/s at this time to confirm any suspected anomalies.
|
12-14 weeks
|
|
Fetal abdominal organs, liver, biliary system, spleen, stomach, kidneys, and colon are well formed by the ___ trimester.
|
second
|
|
The stomach should be identified in the ____.
|
upper left quadrant.
|
|
Most fetuses have fluid in their stomach by ____ weeks or older.
|
14 to 16 weeks
|
|
The presence of an echogenic mass within the fetal stomach in a fetus with placental abruption should raise the possibility of ___.
|
hematoma
|
|
The umbilical vein courses ____ in the free margin of the ____.
|
cephalically/ falciform ligament
|
|
**The umbilical vein joins the umbilical portion of the left portal vein at the ___ margin of the ____.
|
caudal/ left intersegmental fissure of the liver
|
|
After birth, the umbilical vein collapses and becomes the ____.
|
ligamentum teres
|
|
The fetal liver accounts for ___ of the total fetal weight at 11 weeks and ___ of the total weight at term.
|
10%/ 5%
|
|
The hepatic veins and fissures are formed by the ___.
|
end of the first trimester
|
|
The normal gallbladder may be seen on u/s after ____.
|
20 weeks
|
|
The gallbladder is distinguished by its locatin to the ___ of the portal-umbilical vein.
|
right
|
|
The fetal spleen is homogenous in texture, similar in echogenicity to the kidneys and slightly ___ than the liver.
|
less echogenic
|
|
The fetal kidneys are located on either side of the spine and are apparent as early as ___.
|
15 weeks
|
|
A renal pelvis measuring __ mm beyond __ weeks is abnormal.
|
10mm beyond 20 weeks
|
|
Fetal adrenal glands can be seen as early as ___.
|
20 weeks
|
|
**The center of the fetal adrenal glands is ____ with a _____ outer border.
|
echogenic/ hypoechoic
|
|
The fetus normally voids approx every ___. If not seen, check again in 30 min.
|
60 minutes/ hour
|
|
**As long as fluid witin the fetal ballder and the amniotic sac is seen, you can assume...
|
at least one kidney is functioning properly.
|
|
Gender may be determined as early as ____, but it is better to wait until around 20 weeks.
|
14
|
|
**The apex of the heart should point to the ___.
|
fetal left side.
|
|
Rt and lt ventricles and rt and lft atria should be ___.
|
equal in size
|
|
The foramen of ovale opens toward the __ as blood is shunted from the right atrium, bypassing the lungs.
|
left atrium
|
|
**The ___ inserts lower, or closer, to the apex, than the mitral valve. Both valves ___ during diastole and ___ during systole.
|
tricuspid valve/ open/ close
|
|
The fluid filled fetal lungs are solid homogenous masses of tissue bordered medially by the __, inferiorly by the ___, and laterally by the ___.
|
heart, diaphragm, ribs
|
|
In the sag view, the lungs can be seen ___ to the diaphragm.
|
superiorly
|
|
Spinal defects are suspected when the trv spine appears as...
|
a V, C, or U shape
|
|
make up the chorion/ form the fetal portion of the placenta called the chorion frondosum
|
trophoblastic cells
|
|
fetal portion of the placenta
|
chorion frondosum
|
|
forms the maternal portion of the placenta/ is one of the endometrial layers
|
decidua basalis
|
|
the reaction between the blastocyst and the myometrium
|
decidua basalis
|
|
portion of the decidua that "envelops" the blastocyst
|
decidua capsularis
|
|
reaction of the endo on the opposite side of implantation
|
decidua vera (parietalis)
|
|
The ___ on the implanted side rapidly increase in size and number to form the chorion frondosum or villous chorion.
|
chorionic villi
|
|
Two types of trophoblastic cells
|
syncytiotrophoblast and cytotrophoblast
|
|
the outer layer with multinuclear cells
|
syncytiotrophoblast
|
|
the inner layer with mononuclear cells
|
cytotrophoblast
|
|
trophoblastic cells that together with the decidua form the placenta
|
chorion frondosum
|
|
chorion opposite the implantation side
|
chorion laeve
|
|
fetal surface of the placenta
|
chorionic plate
|
|
maternal surface of the placenta
|
basal plate
|
|
The amnion and chorion fuse by the ___. If separation is seen after this, it may be assoc with poly or previous amnio.
|
16 weeks
|
|
**The yolk sac lies...
|
between the amnion and chorion
|
|
When the cord is attached to the margin of the placenta/ usually has no signficance unless it is affected during delivery
|
battledore placenta
|
|
attachment of the umbilical cord to the chorion beyond the margin of the placenta/ tends to be assoc with unsupported cord vessels (lack Wharton's jelly) and may tear loose during delivery and cause hemorrhage
|
velamentous placenta
|
|
when the cord is over the internal os
|
vasa previa
|
|
cord insertion into the margin of the placenta
|
battledore placenta
|
|
spontaneous painless uterine contractions described originally as a sign of pregnancy
|
braxton-hicks contractions
|
|
**chorionic plate of the placenta is smaller than the basal plate, with a flat interface between the fetal membrances and the placenta
|
circummarginate placenta
|
|
**chorionic plate of the placenta is smaller then the basal plate/ the margin is raised with a rolled edge
|
circumvallate placenta
|
|
**also known as gestational trophoblastic disease/ abnormal proliferation of the trophoblastic cells in the first trimester
|
molar pregnancy
|
|
growth of the chorionic villi superficially into the myometrium
|
placenta accreta
|
|
growth of the chorionic villi deep into the myometrium
|
placenta increta
|
|
**placenta completely penetrates the uterine serosa (outer covering)
|
placenta percreta
|
|
**placenta completely covers the lower uterine segment (internal os)
|
placenta previa
|
|
one or more accessory lobes connected to the body of the placenta by blood vessels
|
succenturiate placenta
|
|
occurs when the intermembranous vessels course across the cervical os
|
vasa previa
|
|
premature detachment of the placenta from the maternal wall/ occurs in 1 in 120 pregnancies/ bleeding occurs at the basalis/ clinically, preterm labor, vag bleeding, abd pain, fetal distress or demise, uterine irritability/ u/s: abnormal size and texture and hypoechoic to isoechoic area either retroplacental or subchorionic (echogencity depends on age of bleed)
|
Abruptio placenta
|
|
Retroplacental abruption
|
from spiral arteries and is a high pressure bleed/ found in assoc with hypertension and vascular disease/ may show no bleeding vaginally if blood remains retroplacental
|
|
Marginal abruption
|
from tears in the marginal veins and is a low-pressure bleed/ assoc with smoking
|
|
2nd most common tumor occuring in 1% of pregnancies/ usually small and benign proliferation of fetal vessels/ complications include poly, fetal hydrops, fetal cardiomegaly, iugr, fetal demise, and premature labor/ elevated afp/ u/s shows well circumscribed solid or complex mass protruding from fetal side of placenta/ may be near cord insertion
|
Chorioangioma
|
|
Maternal factors that may affect placenta grade
|
diabetes, hypertension, Rh isoimmunization, smoking
|
|
Grade 0 placenta
|
most early placentas/ smooth homogenous texture with a well defined chorionic and basal plate/ no echogenic densities
|
|
Grade 1 placenta
|
has indentations and small undulations of the chorionic plate with small echogenic densities (calcium)/ basal plate remains smooth
|
|
Grade 2 placenta
|
echogenic areas within placental tissue/ indentions (comma like) in the chorionic plate/ echogenic foci along basal plate/ most pregnancies have grade 2 placentas when delivered at term
|
|
Grade 3 placenta
|
deep indentations forming echogenic rings around placental tissue, creating cauliflower appearance or cotyledon appearance/ may be anechoic areas within the sections which represent placental lakes/ calcifications along the basal plate which may shadow/
|
|
Normal placenta at delivery
|
15-20 cm in diameter, 4 cm thick, and around 500-600 grams (1 to 1 1/2 lbs)
|
|
Type of abortion with no pain or bleeding
|
missed abortion
|
|
double bleb sign
|
amniotic and yolk sac attached to gest sac with embryonic disc in between
|
|
Type of cerclage that is sometimes permanent and makes a c-section neccessary
|
Shirodkar
|
|
most common type of cerclage
|
McDonald's procedure
|
|
central portion of vertebrae
|
centrum
|
|
**Valve between right atrium and right ventrile, 3 flapped valve
|
Tricuspid
|
|
**2 flapped valve between left atrium and left ventricle
|
Bicuspid
|
|
**Angle heart is positioned at
|
45 degrees to the left
|
|
Cephalic index equation
|
BPD/OFD * 100
|
|
**Cephalic index < 70%
|
Dolichocephaly
|
|
**Cephalic index >85%
|
Brachycephaly
|
|
Cephalic index between 70-85%
|
normal
|
|
puerperium
|
after delivery
|
|
cancer in the myometrium, formed after conception, aka hydatiform mole
|
chorioadenoma druens
|
|
Most common cause of post partum hemhorrhage
|
uterin atony
|
|
**unit of measurement for MSAFP
|
MoM, >2 is elevated
|
|
PG (phosphatidylglycerol)
|
lung maturity
|
|
**PUBS
|
percutaneous umbilical cord blood sampling/ cordocentesis/ >18 weeks
|
|
lithopedian
|
"stone baby"
|
|
Deuel's sign
|
fetal death/ halo
|
|
**prosencephalon fails to develop into two hemispheres/ cyclopia/ proboscis, alobar most serious
|
holoprosencephaly
|
|
**Where are encephaloceles usually found?
|
occipital and frontal region of cranium
|
|
**What is holoprosencephaly most often assoc with?
|
cyclopia/proboscis
|
|
At what age do you measure nuchal thickness?
|
10-14 weeks
|
|
abnormally large bladder
|
megacystis
|
|
****What is hcg produced by?
|
trophoblast cells of the placenta
|
|
what hormone stimulates cervical mucus production?
|
estrogen
|
|
dystocia
|
abnormal or difficult labor
|
|
Fundal placenta
|
implanted on the uterine fundus
|
|
Posterior placenta
|
implanted on the post wall
|
|
Ant placenta
|
implanted on the ant wall
|
|
fundal ant placenta
|
when the placenta is implanted in the fundus and projects onto the ant wall
|
|
fundal post plac
|
implanted in the fundus and projects on to the post wall
|
|
Accuracy of bpd between 17- 26 weeks
|
+/- 11 days
|
|
Accuracy of bpd after 26 weeks
|
+/- 3 weeks
|
|
The skull grows ___ per week in the 2nd trimester and ___ per week in the third.
|
3mm/ 1.8mm
|
|
GASA
|
growth adjusted sonor age/ obtain a measurement at 20-26 weeks, then compare it to a one taken between 31 and 33 weeks/ growth intervals are compared with averages to determine fetal size.
|
|
**The fetal abdomen should be measured in trv plane at the elvel of the umbilical vein and stomach. This is where the umbilical vein branches into the ___ forming a J shape.
|
portal vein
|
|
The ___ is almost as accurate as the BPD for dating.
|
femur length
|
|
Measure the femur from __ to __.
|
major trochanter to the external condyle
|
|
When the femur is more the __ weeks off from the other measurements, all long bones should be measured and the exam should be considered a target exam.
|
2 weeks
|
|
Accuracy of femur length
|
+/- 2 weeks
|
|
Normal range of afi
|
8-20 cm
|
|
polyhydramnios
|
fluid greater than 22 cm
|
|
oligohydramnios
|
fluid less than 5 cm
|
|
**If the fetus cannot urinate, fluid will be __. If the fetus cannot swallow, fluid will be ___.
|
low/ high
|
|
**5 parameters of BPP
|
cardiac non-stress test/ fetal breathing movements/ gross fetal body movement/ fetal tone/ amniotic fluid volume
|
|
NST
|
done using doppler to record fhr and its reactivity to uterine contractions/ usually 40 min/ normal or reactive if fhr increases by 15 bpm or more twice in the study, accelerations last at least 15 sec, and gross fetal movements are noted over 20 min without late decelerations
|
|
BPP- fetal breathing movements
|
at least one episode lasting 30 sec during a 30 min study
|
|
BPP- fetal body and trunk gross movements
|
at least 3 definite extremity or trunk movements are seen in 30 min
|
|
BPP- fetal tone
|
at least one episode of extension/flexion of an extremity or the spine
|
|
BPP- AFV
|
two pockets with at least 2 cm of fluid in each or afi within normal limits
|
|
vertex/cephalic
|
fetal head is located at the level of the symphysis pubis
|
|
breech
|
when the lower extremities or lower body are found in the lus and the head is visualized in the uterine fundus
|
|
Frank Breech
|
flexion of the hips and extension of both knees toward the fetuses head/ may be safely turned for vag delivery
|
|
Complete breech
|
both hips and lower extremeties are found in the lower pelvis/ c-section
|
|
Incomplete breech
|
single or double footling/ hips are extended and one or both feet are the presenting parts closest to the cx/ c-section
|
|
**Twin-to-twin transfusion
|
monochorionic pregnancy/ arteriovenous shunt within shared placenta through which the arterial blood of one twin is pumped into the venous blood of the other/ donor twin's arterial blood is shunted through the recipient twin's venous system/ donor twin has less blood, becomes anemic, oligo/ recipient twin gets too much blood, too large, poly, may have heart failure or hydropic/ "stuck twin"/ both may die
|
|
Conjoined twins
|
identical twins that develop with a single placenta from a single fertilized ovum/ same sex and race/ more often female/ more often in India and Africa/ separate 13 days after fertilization
|
|
**Immune hydrops signs seen on u/s
|
scalp edema, abdominal or other tissue edema, ascites or effusions in fetus, poly, large thick placenta, large liver and/or spleen
|
|
**What is nonimmune hydrops most often assoc with?
|
cardiovascular problems
|
|
If poly and macrosomia are seen, this may indicate ____.
|
poor maternal glucose control
|
|
**___ are assoc with maternal hypertension, causing fetal growth restriction.
|
small placentas
|
|
Pregnancy induced hypertension (PIH)
|
includes preeclampsia and eclampsia
|
|
Preeclampsia signs
|
high blood pressure, proteinuria, edema/ untreated may cause seizures or death to mother and fetus
|
|
Eclampsia
|
serious and must be delivered immediately before seizures and coma sets in/ more common in first pregnancies
|
|
**u/s findings with hypertension
|
oligo, fetal growth restriction, placental abruptions
|
|
At ___ weeks, the fetal heart should be heard with doppler
|
12
|
|
At __ weeks, the uterine fundus should be ___.
|
20 weeks, at the level of the umbilicus.
|
|
If see spaulding's sign, exaggerated curve of spine, or gas in fetus, you can assume...
|
the fetus has been dead over 48 hours
|
|
****Advantages of chorionic villi sampling (cvs)
|
-done earlier than amnio (10-12 weeks)
-results faster (in a week) -earlier results allow more options |
|
**Neural tube defects and other structural malformations cannot be detected with...
|
cvs
|
|
Amniocentesis
|
15-16 weeks/ approx 20mL collected with second trimester amnio/ approx 1 mL with earlier amnio
|
|
Cordocentesis
|
analyze chromosomes/ fetal blood obtained through needle aspiration of teh umblical cord/ can be useful when used to wamnio and also in anomalies found later in preg.
|
|
most common chromosomal anomaly
|
Trisomy 21 (Down's)
|
|
**Trisomy 21
|
Down's/ more frequent with ama but can occur with any maternal age/ have one extra chromosome at the 21 pair location/ have heart defects and alimentary disorders that cause early death/ mental retardation is always present (degree is different)/ respiratory problems, eye problems, and premature aging/ amnio to confirm
|
|
**Sign u/s may see with Down's/Trisomy 21 (do not assure diagnosis)
|
nuchal fold > or equal to 6mm/ hypoplasia of the middle phalanx or clindodactly of the 5th finger (overlapping, larger than normal space between first and second toes/ short femur/ duodenal atresia/ shortened ear lenght/ heart defects/ iugr/ mild pyelectasis >4mm AP/ echogenic bowel/ mild ventriculomegaly/ simean crease/ nonimmune hydrops/ brachycephaly/ flattened nose bridge
|
|
2nd most common trisomy
|
Trisomy 18/ Edward's syndrome
|
|
**Trisomy 18
|
3 chromosomes at the 18 location/ abnormal triple screen is good indicator/ 90% die withinn first year and large portion spontaneously abort/ survivors have short life span and are severely mr and physically limited.
|
|
**U/s signs for trisomy 18
|
vsd (90%), dolichocephaly, microcephaly, hydrocephalus, agenesis of corpus callosum, cerebellar hypoplasia, agensis of corpus callosum, cerebellar hypoplasia, strawberry shaped head, choroid plexus cyst, low set ears, micrognathia, cleft lip and palate, hypertelorism, persistently clenched hangs, talipes (clubfoot), rocker-bottom feet, overlapping fingers, limb reduction, dandy walker malformation, abnormal cisterna magna, 2 vessel cord, omphalocele, diaphragmatic hernia, neural tube defect, cystic hygroma, renal anomalies
|
|
**In 3rd trimester, seeing the combo of poly, iugr, and abnormal hand posturing is highly predictive of ...
|
Trisomy 18
|
|
Trisomy 13/ Pateu's syndrome
|
3 chromosomes at the 13 location/ severe with brain anomalies/ most die within first year
|
|
**u/s signs of trisomy 13
|
holoprosencephaly, agenesis of corpus callosum, microcephaly, hypotelorism, proboscis, cyclopia, single nostril, micrognathia, vsd, asd, hypoplastic left heart (90% have heart anomalies), omphalocele, renal anomalies, meningomyelocele, polydactyly, talipes, rocker bottom feet, overlapping fingers, cystic hygroma, echogenic chordae tendineae, may be confused with Meckel-Gruber syndrome
|
|
Triploidy
|
when 2 sperm fertilize one egg/ creates extra set of chromosomes (69 instead of 46)/ occurs in 1% of pregnancies/ most spontaneously abort in first trimester
|
|
**U/s signs of triploidy
|
heart defects, renal anomalies, omphalocele, meningomyelocele, agenesis of corpus callosum, hydrocephalus, dwm, low set ears, hypertelorism, cleft lip and palate, micrognathia, cryptorchidism, ambiguous genitalia, syndactyly (fused digits), talipes, iugr, oligo, placental degeneration/ live births die shortly after birth/ mosaic form is possible and may be compatible with life, but sever mental retardation is present
|
|
**Turner's syndrome
|
missing one of the sex chromosomes/ only one X present at the point of sex chromosomes/ may show elevated msafp if cystic hygroma is present/ will be girl
|
|
**U/s signs assoc with Turner's syndrome
|
cystic hygroma (most common sign), cardiac anomalies, lymphedema, hydrops, renal anomalies, short femur, most spontaneously abort/ poor prognosis with large cystic hygroma and edema or hydrops
|
|
**If a fetus with Turner's syndrome survives, it will be girl and have problems such as...
|
immature sexual development, amenorrhea, short stature, webbed neck, cubitus valgus (abnormal elbow angle), shield chest or barrel chest with widely spaced nipples, hearing problems, require hormonal replacements, normal intelligence
|
|
rupture of the amnion that leads to entrapment or entanglement of the fetal parts by the sticky chorion
|
Amniotic band syndrome
|
|
**group of disorders having in common the existence of an omphalocele, macroglossia, and visceromegaly
|
Beckwith-Wiedmann syndrome
|
|
defect in the lower abdominal wall and ant wall of the urinary bladder
|
cloacal extrophy
|
|
**opening in the layers of the abdominal wall with evisceration of the bowel and occasionally the stomach and genitourinary organs
|
gastroschisis
|
|
**anomaly with large cranial defects, facial cleft, large body wall defects and limb anomalies
|
Limb-body wall complex
|
|
**develops when there is a midline defect of the abdominal muscles, facia, and skin that results in the herniation of teh intraabdominal structures into the ase of the umbilical cord
|
omphalocele
|
|
Most common congenital heart defect
|
VSD
|
|
2nd most common heart defect
|
ASD
|
|
3rd most common heart defect
|
pulmonary stenosis
|
|
Hypoplastic right heart
|
pulmonary atresia causes right ventricle under development/ tricuspid atresia/ be sure it is not on the left
|
|
Epstein's anomaly
|
congenital heart anomaly in which the tricuspid valve has dysplastic leaflets with altered structure and/or position/ us: fetal echocardiography has proved to be reliable in differentiating the variants of tricuspid valvular disease, diagnosing associated cardiac lesions and predicting subsequent outcome
|
|
Tetralogy of Fallot
|
most common form of cyanotic heart disease (interruption in blood flow casing cyanosis or blue color to skin)
|
|
Hypoplastic Left Heart
|
group of congenital anomalies characterized by underdevelopment of the aortic valve, left ventricle, mitral valve, and left atrium/ is the congenital heart anomaly that imposes the most severe form of impedance to aortic blood flow in humans/ used to be known as aortic atresia/ aortic atresia is not always synonymous with an underdeveloped left ventricle and about 6% of all pts with aortic atresia will have a normal sized lf ventricle/ bad prognosis
|
|
Transposition of the great arteries
|
aorta connected to right vent/ pulmonary artery connected to left vent/ no problems in utero/ good prognosis post natally with surgical intervention
|
|
Single ventricle
|
single ventricle of indeterminate, left, or rt ventricular type 1 with two separate atrioventricular valves or a common valve/ a rudimentary chamber is present with ventricles of the lt ventricular type, and may be present when the dominant ventricle has a right ventricular morphology
|
|
**Absence of skull and of the cerebral hemispheres/ coronal section through the fetal face will show bulging eyes with absence of the frontal bones, given the appearance of a frog
|
anencephaly
|
|
___ is not considered a neural tube defect since if occurs when the mesenchyme does not migrate over brain.
|
Acrania
|
|
developmental abnormality characterized by a partial or complete absence of calvarium, with complete but abnormal development of brain tissue/ characterized by partial or complete absence of the neurocranium, with complete but abnormal development of brain tissue/ this rare lethal congenital anomaly has important implications for ob management and counseling/ us allows early diagnosis
|
Acrania
|
|
refers to the absence of the cranium with the exception of the occipital bone
|
Meroacrania
|
|
form of anencephaly with rudimentary brain and cranium
|
Meroanencephaly
|
|
**Midline frontonasal herniation of brain and/or meninges through a skull defect/outcome depends on contents of the sac/ if it is just the meninges (lining of the brain) prognosis is better than if actual brain tissue is present
|
Cephalocele
|
|
**aka myelomeningocele, meningocele, and raschisis/ can be defined as a midline vertebral defect, resulting in exposure of neural contents to the amniotic fluid/ in the immense majority of cases, the defect is located on the post vertebral arches/ in rare cases the defect is caused by division of the vertebral column
|
spina bifida
|
|
**cleft of opening in spine covered with skin
|
spina bifida occulta
|
|
**contains meninges only
|
meningocele
|
|
**contains meninges and spine material
|
meningomyelocele
|
|
**very large and severe form of spina bifida
|
raschisis
|
|
**Almost all cases of spina bifida are assoc with ___, characterized by herniation of the cerebellar vermis through the foramen Magnum. In these cases, the fourth ventricle is dislocated towards the neural canal, the post fossa is shallow, and the tentorium is also displaced downwards. This finding is amost invariabley assoc with ___.
|
Arnold-Chiari type II malformation/ obstructive hydrocephalus
|
|
**varies in degree/ agenesis or hypoplasia of cerebellum with dilated 4th ventricle/ us: post fossa cyst that can vary considerably in size, splaying of the cerebellar hemispheres as a result of complete or partial agenesis of the cerebellar vermis, enlarged cisterna magna cauesd by cerebellar vermis anomaly and post fossa, ventriculomegaly
|
Dandy Walker Malformation
|
|
**covers a range of anomalies with varying degrees of abnormal brain cleavage/ three forms: alobar (most severe), semilobar, lobar (mildest)
|
Holoprosencephaly
|
|
fibrous tract that connects the cerebral hemispheres and aids in learning and memory
|
corpus callosum
|
|
Agenesis of the corpus callosum
|
etiology is unclear, but is thought to involve a vascular disruption or inflammatory lesion before 12 weeks/ may be assoc with other cns malformations, autosomal dominant, autosomal recessive, or x-linked syndromes, also trisomy 13 and 18/ isolated may be asymptomatic or assoc with mr and/or seizures/ absence of corpus callosum, elevation and dilation of the third ventricle, widely separated lat ventricular frontal horns with medial indentation of the medial walls, dilated occipital horns (colpocephaly) giving the lat vents a teardrop shape/ other findings assoc with this include holoprosencephaly, dwm, cranial lipoma, arnold-chiari malformation, hydrocephaly, encephalocele, porencephaly, microcephaly, lissencephaly
|
|
Vein of Galen aneurysm
|
rare arteriovenous malformation/ vein will be enlarged and communicate with normal appearing arteries/ sporadic with male predominance/ usually isolated, but can be assoc with congenital heart defects, cystic hygroma, and hydrops/ prognosis is generally poor, especially when assoc with hydrops/ when symptoms appear later in childhood prognosis is good/ us: cystic space that may be irregular in shape and is located midline and postersuperior to the third vent, turbulent flow with doppler, always use color doppler to rule out cysts
|
|
**Choriod plexus cysts
|
cysts that are round or ovoid and found within the choroid plexus/ made up of csf/ usually isolated but can be assoc with trisomy 18 and 21/ will often resolve by 22-26 weeks/ us: cysts ranging from .3 to 2 cm, unilateral or bilateral, solitary or multiple, unilocular or multilocular, enlargement of the vent with large cyst
|
|
Hydranencephaly
|
destruction of the cerebral hemispheres by occluesion of the internal carotid arteries/ brain parenchyma is destroyed and replaced by csf/ the midbrain and cerebellum are present/ basal ganglia, choroid plexus and thalamus may be spared/ may be assoc with poly/ no existing structural or chromosomal anomalies are assoc/ prognosis is poor, with death occuring at birth or shortly after
|
|
What is hydranencephaly caused by?
|
congenital infection or ischemia
|
|
Hydranencephaly u/s
|
absence of normal brain tissue with almost complete replacement with csf/ absent of partially absent falx/ presence of midbrain, basal ganglia, and cerebellum/ choroid plexus may be seen/ macrocephaly may occur
|
|
What might hydranencephaly be confused with?
|
severe hydrocephalus, but the presence of an intact falx and surrounding brrim of brain tussue may help differentiate/ or holoprosencephaly with sever ventriculomegaly
|
|
Ventriculomegaly aka Hydrocephalus
|
dilation of the vents of the brain/ hydracephalus occurs when ventriculomegaly is coupled with enlargement of the fetal head/ cause by obstruction of cerebral spinal fluid flow/ mild may be assoc with trisomy 21, 13, and 18/ dilated when >10mm/ dangling choroid/ possible dilation of 3rd and 4th vents
|
|
eyes too close together
|
hypotelorism
|
|
hypertrophied tongue
|
microglossia
|
|
small chin
|
micrognathia
|
|
small eyes
|
microphthalmia
|
|
Cleft lip occurs due to...
|
primary and seconday palate not fusing
|
|
Cleft palate is when ...
|
lateral palatine processes fail to fuse
|
|
Esophageal atresia
|
usually assoc with a tracheoesophageal fistula/ when this occurs amniotic fluid cannot pass to the intestines for absorption and poly results
|
|
Esophageal stenosis
|
narrowing of the esophagus, usually the distal third portion/ occurs from incomplete recantilization of the esophagus during the 8th week of development
|
|
Duodenal stenosis
|
narrowing of the pyloric sphincter
|
|
Duodenal atresia
|
complete blockage at the pyloric sphincter/ assoc with trisomy 21/ require immediate surgery after birth to connect stomach to jejunum bypassing obstruction
|
|
Umbilical hernia
|
when the intestines return normally to the abdominal cavity and then herniate either prenatally or postnatally through an inadequately closed umbilicus/ differs from omphalocele in that the protruding mass is covered by subcutaneous tissue and skin
|
|
Hirschsprung's disease (megacolon)
|
congenital disorder in which there is abnormal innervation (the arrangement or distribution of nerves to an organ or body part) of the large intestines/ difficult to diagnose prenatally, but may be suspected when dilated bowel loops are seen
|
|
LETHAL autosomal recessive short limb dwarfism marked by long bone and trunk shortening, decreased echogenicity of the bones and spine, and flipper like appendages
|
Achondrogenesis
|
|
a defect in the development of cartilage at the epiphyseal centers of the long bones producing short, square bones
|
Achondroplasia
|
|
short-limb dysplasia that manifests in the second trimester/ conversion abnormality of cartilage to bone affecting the epiphyseal growth centers/ extremeties are markedly shortened at birth with a normal trunk and frequent enlargement of the head
|
Heterozygous achondroplasia
|
|
short limb dwarfism affecting fetuses of achondroplasia parents
|
Homozygous achondroplasia
|
|
congenital condition characterized by decreased mineralization of the bones resulting in ribbon like and bowed limbs, under ossified cranium, and compression of the chest/ early death often occurs
|
Hypophosphatasia
|
|
metabolic disorder affecting the fetal collagen system that leads to carying forms of bone disease/ intrauterine bone fractures, shortened long bones, poorly mineralized calvaria, and compression of teh chest found in type II
|
Osteogenesis Imperfecta
|
|
anomalies of the hands and feet in which there is an addition of a digit/ may be found in assoc with certain skeletal dysplasias
|
Polydactyly
|
|
LETHAL short limb dwarfism characterized by a marked reduction in the length of the long bones, pear shaped chest, soft tissue redundancy, and frequently clover leaf skull and ventriculomegaly
|
Thanatophoric dysplasia
|
|
rounded calyces with renal pelvis dilation measuring greater than 10mm AP
|
Calyectasis
|
|
occurs when the kidney is located on the opposite side of the uretal orifice
|
crossed renal ectopia
|
|
failure of the testes to descend into the scrotum
|
cryptorchidism
|
|
protrusion of the post wall of the urinary bladder, which contains the trigone of the bladder and the uretic orifices
|
extrophy of the bladder
|
|
**dilated renal pelvis
|
fetal hydronephrosis
|
|
condition in which both ovarian and testicular tissues are present
|
hermaphroditism
|
|
forms when the inferior poles of the kidney fuse while they are in the pelvis
|
horseshoe kidney
|
|
**collection of fluid in the vagina and uterus
|
hydrometrocolpos
|
|
dilated ureters
|
hydroureters
|
|
abnormal congenital opening of the male urethra on the underside of the penis
|
hypospadia
|
|
autosomal recessive disese that affects the fetal kidneys and liver/ the kidneys are enlarged and echogenic on u/s
|
infantile polycystic kidney disease
|
|
multiple cysts replace normal renal tissue throughout the kidney/ usually causes renal obstruction
|
Multicystic dysplastic kidney disease
|
|
occurs when the kidney does not migrate upward into the retroperitoneal space
|
pelvic kidney
|
|
**occurs only in males/ is manifested by the presence of a valve in the post urethra/ causes back up of urine in the bladder, ureter, and severe cases in the kidneys/ severe oligo with complete obstruction/ prognosis invariably fatal but placement of a bladder shunt improves survival
|
posterior urethral valve
|
|
**characterized by renal agenesis, oligo, pulmonary hypoplasia, abnormal face and malformed hands/feet
|
Potter's syndrome
|
|
dilatation of the fetal abd secondary to severe bilateral hydro and fetal ascites/ fetus also has oligo and pulmonary hypoplasia
|
Prune-belly syndrome
|
|
dilated renal pelvis measuring 5 to 9 mm AP
|
Pyelectasis
|
|
renal system fails to develop
|
Renal agenesis
|
|
Most common fetal anomaly
|
Hydronephrosis
|
|
**occurs as a response to a blockage of urine at some junction in the urinary system/ may be uni or bilateral/ unilateral commonly results from an obstruction at the juction of the renal pelvis and ureter (ureteropelvic junction obstruction)
|
Hydronephrosis
|
|
most common reason for hydro in neonates/ obstruction at the junction of the renal pelvis and ureter/ causes are abnormal bends or kinks in the ureter, adhesions, abnormal valves in ureter, abnormal outlet shape at UPJ or absence of the long muscle that is imperative to normal excretion of urine/ us: collection of urine located medially within the renal pelvis that communicates with the calyces. the ureter, bladder, and amniotic fluid are usually normal since this is most commonly unilateral
|
Ureteropelvic Junction Obstruction
|
|
commonly presents with dilation of the ureter (megaureter)/ results from a primary ureteral defect (stenotic ureteral valves or fibrosis) and occur secondray to obstruction at another level
|
Ureterovesicle Junction Obstruction
|
|
adrenal tumor that may be observed prenatally
|
Neuroblastoma
|
|
occurs in male fetuses and is an accumulation of seroud fluid surrounding the testicle/ may occur bilateral or unilateral/ usually benign
|
Hydrocele
|
|
46 XX, masculinization of the external genitalia- enlarged clitoris, abnormalities of urogenital sinus, and partial fusion of labia
|
Female Pseudohermaphrodites
|
|
46 XY/ variable external and internal genitalia depending on the development of the penis and genital ducts
|
Male Pseudohermaphrodites
|
|
When a long bone measures 4 SD or more below the mean for gest age. An FL-AC ratio <0.16 helps define the degree of shortness as severe.
|
Severe micromelia
|
|
Severely hypoplastic thorax
|
small chest, lungs cannot develop, thus survival is impossible/ a thoracic circumferance less than the 5th percentile for gest age is considered indicative of a lethal skeletal defect
|
|
This uniformaly lethal skeletal dysplasia is characterized by extreme rhizomelia, bowed long bones, a narrow thorax with normal trunk length, and relatively large head/ name derived from Greek "thanatophoros" meaning death-bearing/ us: cloverleaf skull, severely shortened limbs, hypoplastic thorax, platyspondyly, mild hypomineralization, poly
|
Thanatophoric dysplasia
|
|
autosomal recessive/ most severe form of achondrogenesis, with severe micromelia, short trunk, protruding abd, poor skull, and vertebral ossification, small pelvic bone
|
Type I
|
|
autosomal dominant/ less severe form of achondrogenesis, large head compared to body, relatively normal skull ossification but lack of vertebral ossification, small chest, thicker ribs without fractures/ us: lack of vertbral ossification, large head possibly with decreased ossification of the cranium, severely shortened limbs, small chest, poly, assoc with cleft lip/palate, micrognathia
|
Type II
|
|
A disorder of production, secretion, or function of collagen, the earliest diagnosis of type II has been reported at 15 weeks ga/ normal us after 17 weeks should exclude type II/ abnormally fragile bones, which are hypomineralized, fracture in utero, resulting in severe micromelia and irregularity of the bones/ us: presence of fractures or excessive callus formation of long bones, severe micromelia, severe hypomineralization of skull, small bell-shaped thorax, multiple rib fractures
|
Osteogenesis Imperfecta Type II
|
|
rare bony demineralization disorder resulting from low levels of serum and tissue alkaline phosphatase/ us: severe micromelia, with possible bowing of long bones, severely underossified bones, marked demineralization of cranium resulting in an apparent increased echogenicity of the falx cerebri, fractures may be present
|
Congenital hypophosphatasia
|
|
lethal skeletal dysplasia characterized by bent or bowed limbs/ most commonly the tibia and femurs are affected/ assoc with congenital heart disease, hydronephrosis, hydrocephalus/ us: bent long bones, especially lower ext bones, narrowed thorax and hypoplastic or absent scapulae, assoc CNS and renal anomalies
|
Camp(t)omelic dysplasia
|
|
rare lethal dysplasia characterized by polydactyly and an extremely small thorax/ death results from respiratory insufficiency/ us: severe micromelia, polydactyly, severely narrowed thorax with short ribs, gamut of other anomalies (cardiac, renal, cleft lip/palate)
|
Short-rib polydactyly syndrome
|
|
Osteogenesis Imperfecta Types I, III, and IV
|
NON-lethal, type I (most common) and iv generally have good prognosis/ occasional fractures, mild limb bowing, easy bruising, and blue sclera/ type I also manifests deafness
|
|
Osteogenesis Imperfecta types i and iv u/s
|
limb shortening or bowed bones, usually nt until after 24 weeks ga/ normal mineralization, but occasionally demineralization with type i/ isolated fractures
|
|
osteogenesis imperfecta type iii u/s
|
moderate to severe shortening of long bones/ thickened hypoechoic irregular lower extremity bones
|
|
permanent curvature or deflection of one or more fingers/ severe cases have overlapping digits and a clenched hand
|
clinodactyly
|
|
the fusion of digits, either soft tissue or bony fusion
|
syndactyly
|
|
lower extremity fusion and abnormal or absent foot structures/ oligo, single femur or two femora constantly seen side by side, abnormal or absent foot structures, assoc with bilateral renal agenesis (BRA) and skeletal abnormalities
|
Sirenomelia (mermaid syndrome)
|
|
most cases are sporadic, some are assoc with diabests/ includes spectrum of skeletal anomalies of the lower spine and lower limbs, such as sacral agenesis, lumbar spine or lower thoracic spine agenesis/ there are assoc anomalies of the gi and gu tracts, the cns, and heart/ us
|
caudal regression syndrome
|
|
abnormal curvature of the spine may involve any segment, but most frequently the thoracolumbar spine is affected/ assoc with other structural defects is common, most notably cns and vater, but severe curvatures are assoc with lethal anomalies such as anencephaly, limb-body wall complex, and amniotic band syndrome
|
scoliosis and kyphosis
|
|
Diaphragmatic hernias usually occur on the ___ side.
|
left
|
|
***Gastroschisis is not assoc with...
|
increased risk of chromosomal abnormalities.
|
|
Which lobe of the liver is larger in the fetus?
|
left
|
|
most common cause of prune belly syndrome
|
puv (posterior urethral valve)
|
|
**what is assoc with unilateral renal agenesis for females and males?
|
females: uterine anomalies
males: testicular hypoplasia, agenesis, or hypospadias |
|
abnormal migration of neurons from the germinal matrix to the surface of the brain/ the surface of the brain lacks normal sulci and gyri and appears smooth/ diagnosis is not make until 3rd trimester/ assoc with mild ventriculomegaly and possibly an abnormal corpus callosum
|
Lissencephaly
|
|
abnormal clefts in the cereral hemispheres in the region of the primary fissures/ clefts are usually bilateral symmetrical, but not always/ brain appears split into ant and post parts
|
schizencephaly
|
|
**Dandy-Walker malformation
|
assoc of large cisterna magna, ventriculomegaly, cerebellar vermian agenesis/ thought to be due to failure of the vellum medullare to regress, combined with cerebellar cleft malformation and failure of the cerebellar commissure to develop into the vermis/ causes obstruction of 4th ventricle outflow and subsequent cystic enlargement of the post fossa
|
|
presence of cystic areas within the cerebral parenchyma/ cystic cavities may communicate with the ventricular system or subarachnoid space and are varied in size and location/ believed to be result of lysis of in utero intracranial hemorrhange or cstic encephalomalacia/ some consider hydranencephaly severest form of this
|
porencephaly
|
|
most severe/ large single cavity with minimal amount of cerebral tissue surrounding it, fused thalami, and a facial syndrome with hypotelorism and other craniofacial anomalies
|
alobar holoprosencephaly
|
|
more cerebral tissue present, occipital lobe present, assoc cleft palate and cleft lip
|
semilobar holoprosencephaly
|
|
interhemispheric fissure is developed, but there is variable degree of fusion and the csp is absent (some survive)
|
lobar holoprosencephaly
|
|
Hypothesis for the cause of hydranencephaly
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intrauterine infarction secondary to bilateral ica occlusion or malformation/ primary agenesis of the neural wall
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Are any other defects assoc with hydranencephaly?
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no
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Filly's Rule
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If the atrium of the lateral vent and the cisterna magna both measure less than or equal to lomm, there is a 95% negative predictive value for ANY cns anomaly.
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**most common cause of hydrocephaly
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aqueductal stenosis (narrowing of the aqueduct of sylvius- 3rd vent outflow)/ may result from inflammatory process of developmental anomaly/ noncommunicating
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dramatic neural tuve defect, characterized by an exaggerated sinal lordosis, cervical rachischisis, and an occipital encephalocele/ us: exaggerated, hyperextionson of the fetal head, demonstration of cervical spina bifida
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iniencephaly
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**Chiari type 2 malformation
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variable displacement of the cerebellum, 4th vent, and medulla oblongata through the foramen magnum
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lemon sign
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frontal bossing of cranium
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**banana sign
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dislocated cerebellum and obliteration of the cisterna magna
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completely open spine with herniation and/or destruction of the spinal cord
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rachischisis
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**failure of closure of the vertebral column without any associated external abnormalitites
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spina bifida occulta
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begins with the formation of the neural plate, then the neural folds, and the ultimate fusion and closure as the neural tube
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neurulation
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thickening of embryonic ectoderm and adjacent mesoderm
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neural plate
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an invagination of the neural plate along its central axis
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neural groove
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thickening of the neural plate lateral to the neural groove/ these folds cont to thicken and grow toward the midline until they meet and fuse leaving both ends open (neuropores)
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neural folds
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any substance causing abnormal structures in an embryo
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teratogen
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***Elevated msafp
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> or equal to 2 MOM/ assoc with wrong dates, mult gests, open neural tube defects, ventral wall defects
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**Decreased msafp
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wrong dates, trisomies 13, 18, 21, fetal demise,
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**hCG and uE3 levels in Downs
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hCG tends to be elevated 2 times the median level and uE3 tends to be lower than normal
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**hCG, AFP, and uE3 levels in Trisomy 18
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all are decreased
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Pt presents with cramping and heavy vag bleeding for 3 days. What is the most liekly explanataion?
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incomplete spontaneous abortion
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The highest oxygenated blood is found in what fetal heart chamber?
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right atrium
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**The cisterna magna appears on u/s as
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anechoic space inferior to the cerebellum
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The foramen of ovale helps direct blood from the rt atrium to the
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lt atrium
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**Some of the fetal blood that passes into the liver via the umbilical vein goes directly into the ductus venosum. The rest passes into the ...
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portal venous system
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****The third vent is a midline intracranial structure surrounded by a hypoechoic region call the
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thalamus
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The chorionic membrane is derived from what component of the conceptus?
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trophoblast
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The ductus arteriosus allows passage of blood from the pulmonary art to the
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aortic arch
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***The most common us finding assoc with Patau's syndrome is...
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holoprosencephaly
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The fetal position that has a higher incidence of cord prolapse
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footling breech
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No identificaiton of an embryonic pole by what criteria of sac size is considered abnormal?
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MSD > 25mm
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**Lat displacement of the ant horns of the lat vents, upward displacement of the third vent, absence of the csp, and assoc neurologic abnormalities describe...
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agenisis of the corpus callosum
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A yolk sac is considered abnormal when diameter exceeds...
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6mm
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In a ruptured ectopic pregnancy, which section of the fallopian tube is potentially the most life-threatening?
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Interstitial
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A small rounded echogenic structure within the left vent of a fetal heart most likely is...
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chordae tendineae/ papillary muscle
(efi) |
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**Hypertension decreases blood flow and results in...
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small placenta
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Epiphyseal centers will not be identified before ...
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30 weeks
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With normal growth during first trimester, the gest sac should grow....
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1mm per day
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Which long bone is least likely to be affected by intrauterine growth restriction?
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clavicle
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Twin growth is similar to that of singletons up to..
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30 weeks
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A molar pregnancy that is considered invasive but does not metastasize is called...
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chorioadenoma destruens
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The postpartum period lasts...
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6-8 weeks
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The ureter and iliac vessels are ___ to the ovary.
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posterior
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gonadotropin releasing hormone is secreted by...
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hypothalamus
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uterine arteries flow in nongravid uterus
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inceasing resistance with age
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**two forms of endometriosis
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diffuse and localized
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localized overgrowths of endo tissue
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endometrial polyps
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flow in metabolically active tissue, like ovarian malignancy
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low velocity and high resistance
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in menstruating women, doppler evaluatin should be done in...
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early follicular phase
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mean sac diameter within 5mm of crl indicates...
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increased risk for preg failure
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CRL in cm + 6
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ga in weeks
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CRL in mm + 42
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ga in days
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Umb artery doppler
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low resistance, progressively so with increasing gest age
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overlapping skull bones in fetal demise are seen...
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one week after the death
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what does pubs sample?
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umbilical vein
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first day of period until day 14 (ovulation)
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follicular phase
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ovary phase after ovulation, correlates with secretory phase
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luteal phase
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increased LH, decreased FSH
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PCOS
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