songraphy of the second and third trimesters

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Gravidity

Total number of pregnancies

Human chorionic gonadotropin

hormone within the maternal urine and serum

Menstrual age

duration of pregnancy determined from the last mentrual period

Parity

Number of live births

Trimester

pregnancy is divided into three, thirteen week segments

Apex

Where the ventricals of the heart come to a point directed toward the left hip.

Breech

indicates the fetal head is toward the fundus of the uterus

Ductus Arteriosus

Structure that carries oxygenated blood from the pulmonary artery to the descending aorta

Ductus venosus

Structure that carries oxygentated blood from the umbilical vein to the inferior vena cava

frontal bossing

potrusion to bulging of the forehead that results from hydrocephalus

Micrognathia

abnormally small chin

Midline echo

linear echoes located centrally in the fetal head that are produced by the borders of the opposing cerebral hemishperes

Nomogram

Written representation by graghs diagrams or charts of the relationship between numerical variables.

Normalcitus

Typical position of the abdominal organs with the liver and ivc on the right, stomach on the left, and the apex of the heart directed toward the left.

Transverse fetal lie

Indicates the fetus is lying transversely in the uterus, horizontal or perpendicular to the maternal sagittal axis.

Vertex

Indicates that the fetal head is towards the fundus of the uterus.

hCG

Pregnancy can be clinically verified aproximately 6-8 days after ovulation by the presence of ____ in maternal urine of serum.

Gravidity

The number of pregnancies including the present one is ____.

Parity

A numeric system that describes all possible pregnancies is used to report _____.

2, 1, 0, 3

AG4P2103 describes a patient undergoing her fourth pregnancy. She has had _____ full term deliveries, _______ premature births, _____ early pregnancy losses, _______ living children.

Mother

The sonographer should initially determine the position of the fetus in relationship to the position of the _____.

Cardiac

It is important to remember to view ____ activity at the beginning of each study to insure that the fetus is alive.

Left and Right

After fetal position is conceptualized the sonographer determines the ____ of the fetus.

34

The fetal position changes less frequently after ___ weeks.

Transverse

If the fetus is lying perpendicular to the long axis of the mother, it is described as a _____ fetal lie.

Vertex, Breech

If the fetus is lying longitudinal or parallel to maternal long axis, it is described as a ___ (head down) presentation or ____(head up) presentation.

Footling

A ____ breech is found when the hips are extended and one (single footling) or both feet (double footling) are the presenting parts closest to the cervix.

Down, Up

If the fetus is in a vertex presentation with the fetal spine toward the maternal right side, the right side of the fetus is ___ and the left side of the fetus is ____.

Hypoechoic

Fetal brain tissue, a solid structure, may appear ___ or systic because of the low density of the tissue.

Large

As the brain develops, structures change their sonographic appearances (the choroid plexuses seem ______ early in pregnancy), but as the brain grows, these structures appear small in relationship to the entire brain.

Ossify

By the twelfth week of gestation, the cranial bones _____.

Dura, Pia Arachnoid

Two types of brain tissues are highly echogenic, the _____ and the ______, which cover the inner and outer brain surfaces.

Round or Oval, Smooth

In a transverse plane, at the most cephalad level within the skull, the contour of the skull should be ____ (depending on exact level) and should have a ____ surface.

Falx Cerebri

At this level, the interhemispheric fissure, or ____, is observed as a membrane separating the brain into two equal hemispheres.

Central Nervous

The fetal ventricles are important to assess because ventriculomegali or hydrocephalus (dialated ventricular system) is a sign of _____ system abnormalities.

Glomus of the Choroid Plexus

If the _____ appears to float or dangle within the cavity, measurements of ventricular size are recommended to exclude abnormally enlarged or dialated ventricles (ventriculomegali).

10

Any ventricle measuring greater than ___ mm is considered outside of normal error ranges and is therefore abnormal, warrenting further consultation and prenatal testing.

Midline echo complex

The widest transverse diameter of the skull is the ____ and is therefore the proper level at which to measure the biparietal diameter and to assess the developement of the midline brain stuctures.

Third

Between the thalamic structures lies the cavity of the ____ ventricle.

Willis

The circle of ____ may be seen anterior to the midbrain and appears as a triangular region that is highly pulsatile as a result of the midline/ positioned anterior cerebral artery and lateral convergence of the middle cerebral arteries.

Cerebellum

The _____ is located in the back of the cerebral peduncles within the posterior fossa.

Cisterna Magna

The ___ (a posterior fossa sistern filled with CSF) lies directly behind the cerebellum.

3-11

The nomal cisterna magna measures _____ mm., with an average size of 5-6mm.

Cerebellum

In second trimester sonographic examinations, the thickness of the nuchal skin fold is measured in a plane containing the cavum septi pellucidi, the _____, and the cisterna magna.

positioning, amniotic fluid, acoustic

Facial morphology becomes more apparent in the second trimester, but visulaization is heavily dependant of fetal _____, adequate ammounts of _____, and exellent _____ window.

1/3

In a normally proportioned face, the segments containing the forehead, the eyes and nose, and the mouth and chin each form approximately ___ of the profile.

Swallowing

The oral cavity and tongue are frequently outlined during fetal ____.

Periphery

Fetal hair is often observed along the ___ of the skull and must not be included in the biparieatal diameter measurement.

cervical, thoracic, lumbar, sacral.

The standard antepartem obstectric examination guidelines requires the sonographer to image and record the _____, _____,_____ and ______ spine.

3

There are ____ ossification points in each vertebra.

Railway

The double line appearance of the spine is referred to as the "______ sign" and is generated by echoes from the posterior and anterior laminae and spinal chord.

Equidistant

In a transverse plane, all three ossification points are visible; the points are spaced ____, and the spinal column appears as a closed circle, indicating closure or the neural tube.

Center

Three echoes form a circle that represents the ____ of the vertebral body and the posterior elements (laminae or pedicles).

Transverse

Optimal viewing of the spine occurs when the fetus is lying on its side in a _____ direction with its back a slight distance from the uterine wall.

Homogeneous

The fluid-filled fetal lungs are observed as solid, _____ masses of tissue bordered medially by the heart, inferiorly by the diaphram, and laterally by the rib cage.

cardiac position, situs, and axis. apex should be pointing to the fetal left. Presence of right vetricle. equal size ventricles and atria, an intraventricular septum that appears uninterrupted. normal placement of the tricuspid and mitral valves. normal rhythm and rate (120-160BPM), show views of ventricular outflow tracks when feasible.

These criteria are used to assess the fetal heart.

longitudinal

The diaphragm is the muscle that seperated the thorax and abdomen and is commonly viewed in the ________plane.

swallowed

The esophagus and oropharynx help determine the location of the corotid arteries and are outlined when amniotic fluid is ____ by the fetus.

pulsations

The sonographer should recognize the characteristic arterial ___ from the aorta and its branches.

Right

The IVC is identified coursing to the ___ and parallel with the aorta.

oxigination

Fetal ____ occurs in the placenta where small fetal vessels on the surface of the villi are bathed by maternal blood within the intervillous spaces.

Higher

Concentrations of waste products, such as urea and creatinine are ____ in fetal blood, and these products diffuse into the maternal circulation.

bypasses

Fetal circulation ____ the lungs since the fetal lungs do not oxiginate blood.

away

the ductus arteriosus shunts blood _____ from the lungs.

directly

Fetal circulation shunts oxiginated blood arriving from the placenta away from the abdomen ____ to the heart and then to the brain.

ductus venosus

The hepatobiliary system serves the important function of shunting oxygen-rich blood arriving from the placenta directly to the heart throught the _____.

umbilical

Oxiginated blood from the placenta flows through the ____ vein, within the umbilical cord, to the fetal cord insertion, where it enters the abdomen.

falciform

From the umbilicus, the umbilical vein courses cephalad along the ____ ligament to the liver, where it connects with the left portal vein.

hepatic

This blood then filters into the liver sinusoids, returning to the IVC by drainage into the _____ veins.

foramen

IVC blood flows from the right atrium through the left atrium by way of the ____ ovale.

foamen ovale, ductus venosus, ductus arteriosus

After birth the ___, the _____, and the ____ close, and the fetal circulation converts to the pattern seen throughout the rest of life.

left

The ___ lobe of the liver is larger than the right lobe because of the large quantity of oxiginated blood flowing through the left lobe. You are a real dick this book.

gall bladder

The fetal ____ appears as a cone-shaped or tear-drop shaped cystic structure located in the right upper abdomen just below the left portal vein.

stomach

The splene may be observed by scanning transversely and posteriorly to the left of the the ____.

11th

The stomach becomes apparent as early as the ____ week of gestation as swallowed amniotic fluid fills the stomach cavity.

16th

The full stomach should be seen in all fetuses beyond the ___ week of gestation.

meconium

The large bowel typically contains ____ particles and may measure up to 20mm. in the preterm fetus and even larger near the time of birth or in the postdate fetus.

15th

The kidneys are located on either side of the spine in the posterior abdomen and are apparent as early as the ___ week of pregnany.

pelvocaliceal

The ____ center may be difficult to define in early pregnancy, where as with continued maturation of the kindeys, the borders become more defined and the renal pelvis becomes more distinct.

10

A renal pelvis that measures greater than _____ mm. beyond 20 weeks of gestation is considered abnormal.

echogenic

The center of the adrenal gland appears as a central ___ line surrounded by tissue that is less echogenic.

once

A fetus generally voids atleast ____ an hour, so failure to see the bladder should prompt the sonographer to recheck the bladder for filling.

normal

The bladder should be visualized in all ____ fetuses and is an important indicator of renal function.

abducted

Identification of the male and female genitalia is possible provided the fetal legs are ____ and a sufficient quantity of amniotic fluid is present.

12-16th, 20-22nd

The gender of the fetus may be appreciated as early as ___ weeks of gestation, although clear deliniation may not be possible untill the _____ weeks.

12th

The male genitalia may be differentiated as early as the ____ week of pregnancy.

soft tissue

The scrotal sac is seen as a mass of ____ between the hips with the scrotal septum.

bowing, fractures

The sonographer must attempt to not only measure fetal limb bones but also survey the anatomic configurations of the individual bones whenever possible for evidence of _____, _____, or demineralization, as seen in several common forms of skeletal dysplasias.

humerus

The ____ is found in a sagittal plane by moving the probe laterally away from the ribs and scapula.

39th

Epiphyseal ossification centers may by apparent around the ____ week of pregnancy.

ulna

The laterally positioned ____ projects deeper into the elbow, which is helpful in differentiating this bone from the medially located radius.

opened

Coronally the hands and fingers may be viewed when ____.

33-35

The distal femoral epiphysis is seen within the cartilage at the knee and this signifies a gestational age beyond ____weeks of gestation.

u

I love ____.

average age

average of multiple fetal perameters ages.

biparietal diameter

fetal transverse cranial diameter at the level of the the thalamus and cavum septi pellucidi.

Chiari's malformations

associated with spinal defects.

"Lemon" sign

occurs with spina bifida; frontal bones collapse inward.

crown-rump length

most accurate measurement for determining gestational age made in the first trimester

embrionic heart rate

the heart rate before the early ninth week of gestation

gestational sac

structure that is normally found within the uterus and contains the developing embryo

growth-adjusted sonar age

the method whereby the fetus is categorized into small, average, or large growth percentile.

hypertelorism

condition in which the orbits are close together

intrauterine growth restriction

condition in which the fetus is not growing as fast as normal, usually considered being malnourished or abnormal.

microphthalmos

small eyes

platycephaly

flattening of the skull

spina bifida

failure of the vertabrae to close

binocular distance

measurement that includes both fetal orbits at the same time to predict gestational age

brachycephaly

fetal head is relatively wide in the transverse diameter and shortened in the anteroposterior diameter.

"banana" sign

refers to the shape of the cerebellum when a spinal defect is present.

dolichocephaly

fetal head is relatively narrow in the transverse plane and elongated in the anteroposterior plane

femer length

measurement of the femoral diaphysis

gestational sac diameter

used in the first trimester to estimate appropriate gestational age with menstrual dates

humeral length

measurement from the humeral head to the distal end of the humerus

hypotelorism

condition in which the orbits are close together

last menstrual period.

the first day of the LMP is used as the start date for human pregnancies

oxycephaly, acrocephaly

the condition of having a malformed cranial vault with a high or peaked appearance and a vertical index above 77. It is caused by premature closure of the coronal, sagittal, and lambdoidal sutures.

small for gestational age

a normal but small fetus

decidua

Sonographically the earliest sign of intrauterine pregnancy is the ___ that appears as an echogenic thickening filling of the fundal region of the endometrial cavity occuring at approximately 3-4 weeks of gestation.

anteroposterior, transverse, longitudinal

At 5 weeks the average of the 3 perpendicular internal diameters of the gestational sac, calculated as the mean of the ____ diameter, the ____ diameter and the ____ diameter, can provide an adequate estimation of menstrual age.

10

The sac grows rapidly in the first ____ weeks, with an average increase of 1mm. per day.

8

When the gestational sac exceeds ____mm. in mean internal diameter a yolk sac should be seen.

6, 8

Normal yolk sac size should be less than ____ mm.; greater than ___ mm. has been associated with poor pregnancy outcome.

16

When the mean gestational sac diameter exceeds ____mm., an embryo with definate cardiac activity should be well visualized with endovaginal scanning.

1-2

The embryonic echoes can be identified as early as 38-39 days of menstrual age, and the crown-rump length is usually ____ mm. at this stage.

CRL

The most accurate sonographic technique for establishing gestational age in the first trimester is ___.

.8

In general the CRL should increase at a rate of ____mm. per day.

anembrionic

Absence of an embryo by 7-8 weeks of gestation is consitant with an embrionic demise or a ____ pregnancy.

CRL (in centimeters) + 6

If a nomogram is not readily available to identify gestational age a convenient formula is gestational age in weeks = _____.

biparietal, head, abdominal, femur

In the second trimester, the gestational age perameters extend to the ___ diameter, ____ circumference, ___ circumference, and ____ length.

1

The reproducibility of the BPD is plus or minus ____ mm.

3, 1.8

The growth of the fetal skull slows from ____mm. per week in the second trimester to ____ mm. per week in the third trimester.

axial

The fetal head should be imaged in a transverse ___ section, ideally with the fetus in a direct occiput transverse position.

thalamus, cavum septi pellucidi

The BPD should be measured perpendicular to the fetal skull at the level of the ___ and ____.

falx cerebri, cavum septi pellucidi, choroid plexus

Intracranial landmarks should include the ___ anteriorly and posteriorly, the ___ anteriorly in the midline, and the ___ in the atrium of each lateral ventricle.

ovoid

The head shape should be ___ not round (brachycephaly) because this can lead to overestimation of gestational age, just as a flattened or compressed head (dolichocephaly) can lead to underestimation of gestational age.

leading, leading

The calipers should be placed from the ___ edge of the parietal bone to the ____ edge of the opposited parietal bone, or outer edge to inner edge.

transverse

The ___ head circumference is less affected than the BPD by head compression; therefore the head circumference is a valuable tool in assessing gestational age.

perpendicular

The proper coronal view should be ___ to the standard transverse HC view passing through the thalamus.

underestimate, overestimate

One can _____ gestaional age from a dolichocephalic head or ___ with brachycephaly.

growth perameter

The AC is very useful in monitering normal fetal growth and detecting fetal growth disturbances, such as intrauterine growth restriction and macrosomia; however it is mored useful as a ___ than in predicting gestational age.

liver, umbilical

The fetal abdomen should be measured in a transverse plane at the level of the ____ where the ____ vein branches into the left portal sinus.

circular

The abdomen should be more ____ than oval because and oval shape indicates an oblique cut resulting in a false estimation of size.

femur

An especially useful perameter that can be used to date a pregnancy when a fetal head cannot be measured because of position or when there is a fetal head anomaly is the _____ length.

distal femur point

Often an echo from the near side of the cartileginous distal femoral condyles will be seen, called the ___ and should not be included in the measure of the diaphysis.

femur

The tibia and fibula can be measured by first identifying the ___, then following it down until the two parallel bones can be identified.

abdomen

Humerus length is sometimes more difficult to measure than femur length because the humerus is usually found very close to the fetal ___, but can exhibit a wide range of motion.

elbow

The ulna can be distinguished from the radius because it penetrates much deeper into the ____.

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