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83 Cards in this Set

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The 3 layers of the dicidua
1. Decidua Capsularis (surrounds blastocyst)

2. Decidua Vera/Parietalis (lines remainder of endo cavity)

3. Decidua Basalis - attachment by blastocyst to support the trophobastic implanatation.
When can you first see the Gestational Sac and at what size?
GS is first seen at 4.5 weeks

GS size is 3-5 mm
How fast does the gestational sac grow mm/day?
1 mm/day
How big is the GS at 5 weeks?
10 mm or 1 cm
When can you first see the Yolk Sac?
6 weeks
When can you first see the fetal heart and at what size?
5 weeks at 4 mm
How big is the embryo at 6 weeks
5 mm
How big is the GS at 7 weeks and embryo?
GS = 2.4 embryo = 1 cm
When does embryogenesis end?
10 weeks and choroid plexus is dominant within the fetal brain.
What amount pelvic dilation is normal in 2nd/3 tri?
4.33 mm or less.
Two components of the placenta?
1. chorion frondosum - from blastocyst (fetal portion)

2. Decidua basalis - maternal portion
You can see the difference in amnion chorion until about how many weeks?
15-16 weeks.
velamentous cord insertion means?
The c0ord inserts at one edge and into the membranes.
What are allantoic cysts?
Cysts where the cord enters the fetal abdomen.
Classic features of placenta previa?
painless vaginal bleeding in second and tird trimester?
What is vasa previa with velamentous cord insertion
Occurs when thef etal vessels from placenta cross between the internal cervical os and the presenting fetal part.
Ratio of S/D in
1. umbelical artery
2. middle cerebral artery
- Umbelical artery= high velocity with considerable diastolic flow.

- MCA = high resistance flow withy little diastolic flow
When is CRL used to date pregnancy?
5-12 weeks
When can you use transcerebellar measurements for dating?
- until approximately 20 weeks the transcerebellar measurement is approximately equivalent to gestational age.

- when bpd is distorted
How big should these be?
- Lat Vent
- Cisterna magna
- NT
-NF
- Lat vent = <11 mm
- CM = <10 > 2
-NT = <3
-NF = <6
Maternal causes of IUGR
- Poor nutrition
-smoking
-heart conditions (including HTN)
-diabetes
-chronic renal disease
Placental causes of IUGR
-placental ischemia and infarcts

- abruption
Fetal causes of IUGR
- Infections (TORCH)
-chromosomal anomalies
-mutiples
- TWINS and cause -polyhydramnios too
Appearance of twins with Twin-to-Twin transfusion syndrom
- recipient twin = large, hydrops
- donor = small, IUGR
Appearance of twins with Acardiac parabolic twins
Pump twin = - edemous and hydropic
Donor twin = grossly thickened skin with cystic hygromas
Sono appearance of macrosomic babies - >90%
polyhydramnios , thick skin, enlarged placenta
What is VACTERAL ( more common in diabetics)
V- vertebral
A - norectal
C-ardiac
T-racheal
E-sophageal
R-enal
L-imb deformities
Finding of Rh isoimmunization fetus
- hydrops
-pleural effusion
-pericardial effusion
-ascities
-skin thickening
-enlarged placenta
-polyhydramnios
Causes of polyhydramnios
- skeletal dysplasia
-CNS anomalies
GI anomalies
-maternal diabetes
-chest/abdominal masses
-Rh incompatability
Diagnostic limit for Polyhydramnios
- > 20 cm - 4 quads

- >8 cm - single pocket
Causes of Oligohydramnios (DRIPPC)
D- emise
R-enal anomalies
I-UGR
P-ROM
-Postdates
-C-hromosomal anomalies
Amount of fluid with oligohydramnios
4 pockets = 5-10 cm

1 pocket - >2 cm
MSAFP
- Decreased with
- Increased with
-Decreased with Downs
-Increased with
* spina bifida
-anencephaly
-encephalocele
-incephaly
-abdominal wall defects
-gastroschisis
-omphalocele
-triplody
-placental mass and thickening
-multiple gestations
-fetal death
What is measured with tripple screen and most often used to screen for what?
1. MSAFP
2. decreased estriol
3. increased hCG

Down's Syndrom / T21
5 most common seen chromosomal anomalies seen with US
1. Down's syndrom (T21)
2. Edwards' syndrom (T18)
3. Patau's syndrom (T13)
4. Turner's syndrom (monosomy X
5. Triploidy
Symtoms of Dandy-Walker syndrome
- 4th ventricle obstruction & dilated
-Dilation of 3rd and lateral ventricle
-hypoplastic cerebellar vermis
US symptoms of Arnold-chiarii II malformation
- spinabifida
-banana-shaped cerebellum, displaced posteriorly, and a lemon-shaped cranium
US symptoms of Hydrancephaly (brain infarct with desctuction of parenchyma in frontal and paraetotemproal regions)
- complete absence of brain above the level of the brainstem
U/S symptoms of Holoprosencephaly

What is it strongly associated with (other defects)
- lateral ventricles are fused
-thalamus is fused
-absent 3rd ventricle
-fused common ventricle expands into dorsal cyst

- Other midline defects
-T 13
- midline facial malformations
probosscis
US symptom of cephalocele and encepholacele
- meninges and or/ brain protrude through a bony defect
What are central defects strongly associated with
T 13 and holoprosencephaly
2 syndroms micrognathia is associated with
T 13
T 18
What syndroms are cystic hygromas associated with
* Turmers
- T 21, T18

Lesser association with T13
What is seen with Open spina bifida (spina bifida cystica)
- meningocele ( minenges protrude through the defect and make a sac with CSF)

- myelominingocele - neural elements and CSF protrude into a sac enclosed by meninges

ELEVATED AFP
What is seen with closed spina bifida (oculta)
- Small bony defect covered by skin
Associations with omphaloceles
- Chromosomal anomalies

- Increased MSAFP
What are Gastroschesis associated with?
Right of umb cord, no membrane!

No association with other anomolies or karyotype.

Increased MSAFP
Appearance of Pentalogy of Cantrell
- omphalocele and heart are located outside of the chest
Levels of CAMs
- (fluid in lungs) cystic or solid-looking mass in thorax, displacing heart

Type I: large cysts, anechoic areas

Type II: numerous small to medium-sized cysts

Type III: multiple tiny cysts forming a solid, echogenic mass
Diaphragmatic hernias
-occur most often on what side
-associated with
- Left side
- chromosomal anomalies and heart problems
Autosomal recessive (infantile) polycystic kidney DZ
Causes what?
- oligohydramnios or anhydramnios
-enlarged, echogenic kidneys
- small or no bladder
Multicystic dysplastic kidney diz is
- TMC cystic renal abnormality
- unilateral, bilat (fatal).

- affected kidney is large with multiple noncommunicating cysts
Causes of hydronephrosis
- renal abnormalities
-obstruction of fetal urinary tract
-
Ureteropelvic junction obstruction causes?
- dilated renal pelvis and calyces, often bilat
Posterior uretheral valve obstruction causes?
- males, dilated, thick-walled bladder with dilated posterior urethera (keyhole sign),
0bilat hydro neurphosis and hydroureter
- oligohydramnios
-ascites
Duodenal atresia is associated with what syndrom
- appearance by U/S
Down's Syndrom (T21)
- distended stomach and proximal duodenum (double bubble)
-polyhydramnios
What is the apperance of meconium cysts and meconium periotonitis
-dilated loops of bowel
psedocysts with echogenic and calcified walls
-intrabdominal fluid
What is Rizomelia
Shortening of proximal limbs
What is Mesomelia
Shortening of middle segment of limb
What is micromelia
Shortening of entire limb
What is Acromelia
Shortened distal segments (hands/feet)
Achondrogeneisis (lethal, short-limb dysplasia)
-results in
- polyhydramnios
-short ribs
-very short limbs
-bell shaped abdomen
Thananatophioric dysplasi (TMC lethal form of dwarfism)
- polyhydramnios
very short bones
-bowed femurs
-protruding, bell-shaped abadomen with small thorax
-macrocephaly with cloverleaf skull
-trident hand
Achondroplasia (autosomal diminant( lethal in homozygous form(
Fetus appears normal until 24 weeks, then
-short limbs, bell shaped trunk, large head, flat nose, prominant forehead
Osteogenesis imperfecta (3 forms) type
-bowed, irregular, fragile bones with fractures, hypominiealization of skeleton
What is associated with Clubfoot (abnormal angle beetween the lower leg and foot
- oligohydramnios, neurologic disorders, spina bifida, chromosomal disorders
What Trisomy is polydactyly associated with
T 13 (pateaus)
Characteristics of Beckwith-Wiedemann Syndrom
- autosomal dominant with enlargement of all organs
-omphalocle
-cardiac anomalies
-macroglossia
Characteristics of Down syndrom (T21)
Dodenal atresia
-endocardial cusion defects
-posterior urethral valves
- screen with tripple screen
-thickend NT
Short femur and humerous
Echogenic bowl
sandal gap between toes
Characteristics of T 18 (Edwards's Sytndrom)
-diaphragmatic hernia
congenital heart defects
-clenched hand
clubfeet/hands
choroid plexus cyst
omphalocle
IUGR
2 vessel cord
Characteristics of T13 (Patau's syndrom(
- holoprosencephaly
facial abnormalities (midline defects)
- congenital heart lesions
-clubfeet
-omphalocle
-IUGR
-Two -vessel cord
What viruses are included with TORCH
T-oxoplasmosis
C-ytomegalic inclusion disease
P-arvo virus
H-iv/ Herpes
What are the 3 forms of gestational trophoblastic disese? (high hCG)
1. Hytadidiform mole
2. Invasive moles
3. Choriocarcinoma
Normal size of UT
Pre cvx 2:1

9x3x4
Potential spaces for fluid accumulation
1. anterior cul-de-sac
2. posterior cul-de-sac (pouch of douglas)
3. Space of Retzius between pubic symphisis and anterior bladder wall
What is Ashermans syndrom, US signs?
Adhensions in uterous
Endometrium measurement for postmenopause
3-5
no greater than 8
Appearance of endometrial CA
- thickend endo with variable echogenicity
-polypoid mass
-low impedance floor
endometrial halo
What are dermoids/cystic teratomas
B-9
Tip of the iceberg, hair, teeth, skin, fat
What are cystadenomas (serous and muscinous(
B-9 thin, serous septa or papillary projections, often bilateral
What are stromal tumors (2)
B-9
Fibromas and thecomas
solid tumors
What tumor is Meig's syndrom associated with
Fibromas, abdominal ascitees, pleaural effusions
Doppler patterns B-9 and malignant masses and corpus lutea
B-9 = high resistance doppler

Malignant = low resistance doppler

Theca Lutea- low resistance doppler