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118 Cards in this Set
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- Back
- 3rd side (hint)
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A basic ultrasound examination during the first trimester should include? |
1. Location of the pregnancy (intrauterine or ectopic) 2. Measurement of the crown-rump length or the gestational sac measurements if the CRL cannot be seen 3. Evaluation of the fetal number (if multifetal, numbers of amnions and chorions) 4. Location of the placenta 5. Evaluation of the adnexal structures |
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In about 85% of normal pregnancies, the b-hCG levels will double every? |
Will double every 48-72 hours |
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The abbreviation 'EGA' stands for? |
Estimated Gestational Age |
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A b-hCG level of less than 5mIU/mL is considered what for pregnancy? |
Negative |
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A b-hCG level of anything greater than 25mIU/mL is considered what for pregnancy? |
Positive |
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A transvaginal ultrasound should be able to show at least a gestational sac once the b-hCG levels reach between which numbers? |
1200mIU/mL - 1,400mIU/mL... however, it can be seen as low as 500 mIU/mL transvaginally. |
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The b-hCG levels __________ be used to date a pregnancy since these numbers can vary so widely. |
should not |
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The gestational sac may be identified between how many weeks? |
4 - 5 weeks |
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There should be a gestational sac within the uterus at 5 weeks. Its size then should be? |
5mm |
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The yolk sac should appear within the gestational sac at how many weeks? What should the size of the sac be at that time? |
5-5.5 weeks; 10mm |
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The embryo and cardiac activity should appear within the gestational sac at how many weeks? What should the size of the sac be at that time? |
6+ weeks; 18mm |
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Which measurement is the most accurate in dating a pregnancy during the first trimester? |
The crown-rump length |
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The abbreviation "EDC" stands for? |
Estimated date of confinement |
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The abbreviation "EDD" stands for? |
Estimated date of delivery |
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The crown-rump length measurement has an accuracy rate of +/- how many days? |
+/- 4 days |
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If there is no fetal pole present within the gestational sac after the sac measures _________, then there might be a problem with the pregnancy progressing properly. |
25mm (or 2.5 cm) |
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First trimester scanning is helpful in finding the predicted risk for having a child with which two disorders? |
Trisomy 18 (Edwards Syndrome) Trisomy 21 (Down Syndrome) |
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The risk of having a child with either down syndrome or Edwards syndrome can be calculated by using which three things? |
1. The sonographic measurement of the nuchal translucency 2. b-hCG level measurements 3. Maternal serum PAPP-A (pregnancy associated plasma protein-A) levels |
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The red calipers are showing the appropriate measurement of what? |
The nuchal translucency |
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This would be a considered an abnormal what? |
Nuchal translucency |
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This disorder is a neural tube defect that occurs when the "cephalic" or head end of the neural tube fails to close, resulting in the absence of a major portion of the brain, skull, and scalp. |
Anencepahly |
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Which is the most common neural tube defect? |
Anencephaly |
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This would be an image of which disorder? |
Anencephaly |
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This disorder is a neural tube defect where there is a partial or complete absence of the skull bones, causing the brain to become exposed. It commonly occurs alongside anencephaly.
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Acrania
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In anencephaly, the fetus only has a ________ but no brain or skull. |
brainstem |
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In acrania, the fetus has a developed ________, but no skull. |
brain |
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This is a disorder of the lymphatic system in which there is an absence or inefficient connections between the lymphatic and venous systems. |
Cystic hygroma |
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_________________ can range from increased nuchal translucency to thin-walled cystic masses that can become larger than the fetal head. |
Cystic hygromas |
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Cystic hygromas often occur because of a ____________ disorder. |
chromosomal |
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It is rare but possible for _______________ to recover because correct communications can form between the lymphatic and venous systems later on in the gestation, allowing for some fetuses to recover from the condition with just residual skin where the cystic areas occured. |
Cystic hygromas |
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Morbidity and mortality appear to be more common among fetuses with _______ in their cystic hygromas. |
septa |
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When cystic hygromas are associated with fetal ________, which is fluid collection within the fetal bodily organs, the mortality rate is almost 100%. |
hydrops |
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Cystic hygromas are strongly associated with which syndrome, causing an abnormal phenotype in affected girls. |
Turner Syndrome (45XO) |
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This baby has been affected with which disorder? |
Cystic hygroma |
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The red arrow is pointing to a cyst growing behind the head of this fetus, which is characteristic of which disorder? |
Cystic hygroma |
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The red arrow is pointing to an enlarged nuchal translucency with an enormous cyst growing behind this fetus's head. This is characteristic of which disorder? |
Cystic hygroma |
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This fetus has septations within the _________________ developing behind the back of his head. This is characteristic of which disorder? |
cystic hygroma |
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Cystic hygromas found in a purely ____________ location on the neck are usually not related to deadly cystic hygromas. |
anterior |
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It is normal to see bowel herniation until ___ weeks gestation, but it should be gone by ___ weeks. |
10 weeks; should be gone by 11 weeks |
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This disorder is a herniation of abdominal contents to the right of the umbilical cord. There is no membranous sac covering the herniation. |
Gatroschisis |
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A ______________ usually contains intestines and has no surrounding membrane protecting it, allowing for the contents to float around within the amniotic fluid. |
gastroschisis |
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This image is an example of which disorder? |
Gastroschisis |
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This image is an example of which disorder? |
Gastroschisis |
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This disorder is an abdominal wall defect at the base of the umbilical cord, causing an infant to be born with a sac protruding through the defect containing many of the abdominal organs. |
Omphalocele |
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This image shows a fetus with a sac protruding through the base of its umbilical cord. This disorder is known as what? |
An omphalocele |
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This is a condition where the heart of the fetus develops outside of the body. |
Ectopia Cordis |
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The heart on this fetus has developed outside of its body. This is an example of which disorder? |
Ectopia Cordis |
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Cysts that form around the umbilical cord that can become large enough to compete with the umbilical cord for oxygen and blood supply, possibly causing a miscarriage, are known as what? |
Umbilical cord cysts |
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Which two pelvic masses can form during the first trimester? |
Ovarian masses and uterine masses (fibroids) |
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Until the placenta forms, the _______________ will appear as an ovarian mass but rather is just the dominant follicle that released the egg. It will continue releasing estrogen and progesterone until the placenta appears in order to support the pregnancy. |
Corpus luteum cyst |
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Fibroids may cause __________________ contractions, or false contractions, because of the uterine muscle spasms they cause. |
Braxton Hicks |
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This disorder is characterized by implantation of the conceptus anywhere outside of the endometrial cavity. |
Ectopic pregnancy |
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The most common site of ectopic pregnancies are in the _____________, specifically the __________. |
fallopian tubes; ampulla |
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More than 50% of ectopic pregnancies occur on the __________ side, which is unfortunate since the appendix is also located on this side of the body. |
right |
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Small pockets of fluid within the endometrium, which may take on a cystic-like appearance, can sometimes be seen when a _________ is present. |
ectopic |
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In ______________ pregnancies, the b-hCG production is impaired and will not increase as drastically as in normal intrauterine pregnancy. |
ectopic |
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A _______________________ is a pregnancy where the woman has an intrauterine pregnancy and an extrauterine pregnancy at the same time. |
Heteroectopic pregnancy |
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Heteroectopic pregnancies are uncommon, with recent studies suggesting prevelance rates of what? |
1 in 6,000 to 8,000 pregnancies |
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This image demonstrates an empty uterine cavity with a conceptus implanted in one of the adnexal structures. This is an example of what type of pregnancy? |
Ectopic pregnancy |
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This image demonstrates a conceptus implanted within the endometrial cavity and another conceptus implanted outside of the uterus. This is an example of which type of pregnancy? |
Heteroectopic pregnancy |
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A _____________ ectopic pregnancy is when the conceptus implants on any site within the uterus other than in the endometrial cavity. |
uterine |
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Which type of ectopic pregnancy is the most life threatning? |
An interstitial or cornual ectopic pregnancy and a cervical ectopic pregnancy |
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Rarely, a conceptus may leave the pelvic cavity and implant into the peritoneum, known as an _______________ ectopic pregnancy. |
abdominal |
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When the endometrium is preparing for implantation of a fertilized egg, it will sometimes make what is known as a __________, or a "fake-looking" gestational sac. |
pseudosac |
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Pseudo gestational sacs are often confused for actual pregnancies, but absence of the ___________________ eliminates that possibility. |
double decidual sac sign |
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Sometimes, misidentification of the ______________ cyst can be confused with an ovarian ectopic pregnancy.
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corpus luteum
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A ________________ is often seen when color doppler is turned on and placed around a gestational sac. |
"ring of fire" |
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If the patient's b-hCG levels are greater than ______, a gestational sac should always be seen within the uterus if the pregnancy is developing normally. |
1500 |
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This is a type of pregnancy that occurs when a fertilized ovum fails to develop because the inner cell mass never develops. The only component is a gestational sac there is no yolk sac or embryo
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Blighted ovum
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This image demonstrates an empty gestational sac. This is an example of which disorder? |
A blighted ovum |
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This image demonstrates an empty gestational sac with irregular walls. This is characteristic of which disorder? |
A blighted ovum |
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This is a type of abortion where the entire conceptus is expelled from the uterus. |
Complete abortion |
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This is a type of abortion where only a partial amount of the conceptus is expelled from the uterus and some part or parts of it still remain within the uterus. |
Incomplete abortion |
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This is a type of abortion where the evacuation of the conceptus is unavoidable. Continuous vaginal bleeding occurs because the uterus contracts in an attempt to evacuate the conceptus. |
Inevitable abortion |
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This is a type of abortion where there is a gestational sac within the uterus with an embryo inside, but there is no fetal heart motion and the conceptus was either not evacuated or has not yet been evacuated by the body. |
Missed abortion |
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This image represents the classical "hourglass" sign, which is an example of what type of abortion? |
An inevitable abortion |
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This image represents a gestational sac with an embryo inching its way towards the cervix. This is an example of what type of abortion? |
An inevitable abortion |
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This image demonstrates a gestational sac with an embryo inside that has been confirmed to have no heartbeat. The body did not evacuate this fetus or it still has yet to evacuate it. This would be an example of what type of abortion? |
A missed abortion |
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In this image, a developing fetus is seen within a gestational sac. A clot is also present near the gestational sac. This is an example of what type of abortion? |
A threatened abortion |
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This is a type of molar pregnancy where the sperm fertilizes an empty egg. |
Complete molar pregnancy |
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This image demonstrates the classical "bunch of grapes" sign. There is no gestational sac present within the uterus. This is an example of which type of molar pregnancy? |
Complete molar pregnancy |
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This image demonstrates the classical "bunch of grapes" sign. There is no gestational sac present within the uterus. This is an example of which type of molar pregnancy? |
Complete molar pregnancy |
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This is a type of molar pregnancy that occurs when two sperm fertilize one egg, causing an abnormal 69-numbered chromosome baby. |
Partial molar pregnancy |
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This image demonstrates an abnormal fetus and abnormal placental tissue developing within this uterus. This is an example of which type of molar pregnancy? |
Partial molar pregnancy |
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This image demonstrates an abnormal fetus and abnormal placental tissue developing within this uterus. This is an example of which type of molar pregnancy? |
Partial molar pregnancy |
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During molar pregnancies, the placenta grows abnormally but still produces the hormone ______________, which make patients with this disorder feel the symptoms of _______________. |
b-hCG; pregnancy |
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A "cluster of grapes" is a classical sign of which disorder? |
Molar pregnancy |
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In molar pregnancies, it is not uncommon to see enlarged ovaries with cystic-like looking structures in them known as? |
Theca-Lutein cysts |
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These non-cancerous cysts are sometimes found in patients with molar pregnancies that stem from abnormally high b-hCG levels. They are known as? |
Theca-Lutein cysts |
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Treatment for molar pregnancies consists of evacuating all of the contents within the uterus. In order to do this, a ________________ is ordered. |
dilation and curettage (D&C) |
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After evacuating a molar pregnancy via a dilation and curettage, it is important that the patient see her doctor frequently, as molar pregnancies can __________ within the uterus and body. |
regrow |
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Patients who have just recently had a molar pregnancy should not try to get pregnant again for another __ to __ months after being fully cured. |
6 to 12 |
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Methotrexate is a medication that is used to kill off tissue from which types of pregnancies? |
Ectopic and molar pregnancies |
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If left untreated, placental tissue from molar pregnancies can act like a cancer and ___________ (spread) to other organs like the lungs, brain, bones and vagina. |
metastasize |
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The first ultrasound in the ______ trimester is the most accurate one for dating a pregnancy. |
first |
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Scenario:
Part 1: The patient is 10 weeks by her dates. The ultrasound findings are as follows: the crown-rump length measures 10mm and is compatible with 7 weeks. The fetal heart activity is seen. What is your impression?
Part 2: What if the same patient was bleeding? What would your impression then be? |
Part 1: This patient is off on her dates. Her last menstrual period is wrong. She is not as far along as she thought.
Part 2: She may be having a threatened abortion because the fetal heart is still seen. |
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Scenario: The b-hCG is 500 mIU/mL. The ultrasound shows a prominent endometrial echo. No intrauterine pregnancy is seen transabdominally or transvaginally. What is your impression? |
It is just too early to see a gestational sac within the uterus yet. Transvaginally, one can sometimes see a gestational sac at 500 mIU/mL, but that's not always the case. You should always be able to see a gestational sac transvaginally when the b-hCG has reached between 1,200 to 1,400 mIU/mL. |
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Scenario: The b-hCG is 2,500 mIU/mL. The patient states she is 8 weeks by her dates. There is a sac seen. The sac measures 3.0 cm. The yolk sac and embryo are not seen. What is your impression? |
This is a blighted ovum because no embryonic components can be seen (there is no yolk sac or embryo). |
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Scenario:
Part 1: The patient is 9 weeks by her dates. The crown-rump length is compatible with 9.5 weeks, with a fetal heart rate of 130 beats per minute. The yolk sac is seen. The ovary contains a cyst with low-level echoes that measures 2 cm. What is your impression?
Part 2: How many weeks is she?
Part 3: What would your impression be if no heart activity was seen? |
Part 1: From what is described, this is a normal pregnancy. The crown-rump length has an error of +/- 4 days, so she is right on her dates.
Part 2: She is 9 weeks. It is okay to be off by a few days. Her initial dates should never be changed just because she is a few days off.
Part 3: If no heart activity is seen, the impression would be that this patient is having a missed abortion. |
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Scenario: The patient's b-hCG is 60,000 mIU/mL. She is 6 weeks by her dates. She has hyperemesis (excessive vomiting), cramping and bleeding. What are the possible scenarios that you should think about before you start scanning? |
1. She might have a molar pregnancy (molar pregnancies cause the same signs and symptoms as regular pregnancy and cause b-HCG levels to be extremely elevated). 2. She might be having twins. 3. She's off on her dates and she's farther along than she thought. |
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Scenario:
Part 1: The b-hCG is 5,000 mIU/mL. There is a sonolucent area centrally located within the uterus. There is a cystic structure seen on the left ovary, and the right ovary appears within normal limits. There is a small amount of free fluid in the cul de sac posterior to the uterus. There is a hypoechoic circular area seen medial to the left ovary with increased color flow. What is your impression?
Part 2: What if the cavity was empty? |
Part 1: This patient is having an ectopic pregnancy in the area that is medial to the left ovary.
Part 2: Even if the cavity were empty, it's still an ectopic. Sometimes with an ectopic you can see a pseudosac form in the uterus or small little cystic-like areas form within the uterus as well. |
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Which is most likely to be associated with a chromosomal problem: a gastroschisis or an omphalocele? |
An omphalocele |
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What does 'AUA' stand for? |
Average ultrasound age |
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How is the mean sac diameter calculated? |
It's calculated by adding the sums between the:
Length and AP diameters in longitudinal and the transverse diameter (or the width)... and dividing the sum by three. |
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What is the most common ovarian mass? |
The corpus luteum cyst |
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What is the most common uterine mass? |
Fibroids |
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What is important to remember about fibroids? |
Their size and location |
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Where are the worst locations for fibroids to be? |
On the cervix itself or near the placenta |
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Describe the characteristics of the yolk sac. |
It is a sonolucent, thin-walled circular structure between the amnion and chorion. It can appear as early as 5 - 5.5 weeks and should be gone by weeks 12-14. |
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Women who have a molar pregnancy should get a chest x-ray before and after they get treated because? |
The lungs are a primary site of metastasis for molar pregnancies |
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The red line is pointing to which structure? |
The yolk sac |
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The red line is pointing to which structure? |
The amnion |
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The red line is pointing to which structure? |
The embryo |
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The red x's are calipers taking which measurements? |
The crown-rump length |
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The red line is pointing to which sturcture? |
The chorion |
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The risk of having another molar pregnancy is what? |
1 in 100 |
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A condition in which an abnormally low fetal heart rate below is 100 BPM is called? |
Embryonic Bradycardia |
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A condition in which the fetus is unable to achieve its genetically determined potential size. fetal weight is below the 10th % for gestational age determined through ultrasound. This called? |
Embryonic Oligo or growth restriction |
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