145 terms

OB/GYN Board Exam - Ultrasound 4

Chapters 22,23, 24, 25
When does Intrauterine Growth Restriction (IUGR) occur?
When developing fetus doesn't receive enough nutrition to provide for normal metabolic needs.
The major physiologic factor with IUGR is:
A decrease in uterine plasma volume.
IUGR causes are most related to what?
Uterus, placenta, AFV, and placental transfer rate
How much does the infant have to weigh to be considered IUGR?
Below the 10th percentile for gestational age.
IUGR infants are likely to be what? Why?
(b/c of diminished stores of fat & glycogen)
What are the clinical signs of IUGR?
UT small for dates
History of maternal condition associated with IUGR
Symmetric IUGR (25%)
Growth restriction affecting the entire fetus.
What is the cause of Symmetric IUGR?
Genetic or due to maternal infection.
Symmetric IUGR measurement:
All measurements are >2 wks BELOW expected GA (based on LMP)
Symmetric IUGR - What diameter is consistent with dates when others are less than expected?
Transcerebellar diameter
Symmetric IUGR - sono
Mature PL earlier than expected
Low BPP score
When does Asymmetric IUGR occur?
Last 8-10 weeks of pregnancy
What causes Asymmetric IUGR?
Hemodynamic patterns attempt to protect the brain, which receives the most nutrient rich blood first.
Asymmetric IUGR
Asymmetry between the head and abd
Asymmetric IUGR - what is the HC/AC ratio?
>2 SD
Asymmetric IUGR - The AC measures how many weeks behind the HC?
2 weeks
Asymmetric IUGR - sono
Mature PL earlier than expected
Erythroblastosis Fetalis
Destruction of fetal RBC's by antibodies with subsequent fetal or neonatal complications.
What are the causes of Erythroblastosis Fetalis?
Rh incompatibility
ABO incompatibility
Isoimmune Disease
Other minor blood group incompatibility
What are the clinical findings of Erythroblastosis Fetalis?
Fetal Death
Hydrops Fetalis
Hydrops Fetalis
An excessive accumulation of fluid in fetal tissues and body cavities.
What are the two types of Hydrops Fetalis?
1. Immune
2. Non-Immune
What is usually present with Hydrops Fetalis?
Interstitial Edema
Pleural effusion
Pericardial effusion
Immune Hydrops
Maternal antibodies recognize Rh antigens on fetus's RBC's as foreign & attack and destroy them.
What is the cause of Immune Hydrops?
Due to Rh (Rhesus) incompatibility
(AKA Rh isoimmunization)
Immune Hydrops occurs with what kinds of parents?
Rh-mother, Rh+father (Rh +fetus)
What results from the destruction of RBC's?
Erythroblast fetalis and fetal anemia
(which results in hydrops)
What determines fetal anemia?
Mid Cerebral Artery (MCA)
When does Immune Hydrops occur? Why?
Delivery, abortion, PL abruption, hemorrhage, or amniocentesis.

(b/c RBC's dont cross the PL)
What is given after each pregnancy or amniocentesis to prevent antibodies from forming?
Non-Immune Hydrops
Hydrops due to any cause other than Rh sensitization.
Non-Immune Hydrops causes: CIC CAT
C - cardiac anomalies (arrhythmias)
I - infection (TORCH) (Fifth Disease)
C - Chromosome abnormalities

C - Congenital hematologic disorders
A - Abdominal or pulmonary masses leading to venous
What is the earliest sign of Hydrops Fetalis?
Pericardial Effusion
Hydrops Fetalis - sono - HAPPP F
H - hepatosplenomegaly
A - ascites
P - PL thickening
P - pleural effusion
P - polyhydramnios

F - fetal skin thickening (anasarca) (>5cm)
Fetal demise sono findings:
Absent cardiac activity
Exaggerated fetal position
Fetal Demise - Robert's Sign
Echogenic foci (gas) in pulmonary vessels or abdomen.
Fetal Demise - When do you usually see Robert's Sign?
About 1 week after demise
Fetal Demise - Spaulding's Sign
Overlapping skull bones.
Fetal maceration (softening of tissue after death)
Fetal Demise - When do you usually see Spaulding's Sign?
About 1 week after demise
Fetal Demise - Duel's Sign/Halo Sign
Halo effect seen secondary to subcutaneous scalp edema in fetal demise.
Diabetes Mellitus (DM)
Produces disorders of carbohydrate metabolism related to insulin deficiency.
Diabetes Mellitus is characterized by what?
What can Diabetes Mellitus be related to?
Spontaneou (90%)
Pancreatic Disease
Hormonal Imbalence
Drug reactions
Diabetes Mellitus Type 1
Juvenile onset
Insulin Dependent
Diabetes Mellitus Type 2
Adult onset
Non-insulin dependent (occasionally insulin dep)
What is a serum marker for control of DM in insulin dependent patients?
Hemoglobin A1C
Gestational Diabetes
Glucose intolerance of pregnancy which results from hormonal and metabolic changes associated with pregnancy.
Gestational Diabetes frequently occurs in what trimester?
3rd trimester
What is Gestational Diabetes associated with?
DM - congenital anomalies : NGGCCSS
N - neural tube defects
G - GI anomalies
G - GU anomalies
C - Cardiovascular anomalies
C - caudal regression syndrome
S - Single umbilical artery
S - skeletal anomalies
DM - fetal complications: RHHIM
R - respiratory distress syndrome
H - hypoglycemia
H - hypocalcemia
M - macrosomia
Macrosomia fetal weight:
>4,000 grams
Birth weight >90th percentile for GA
Macrosomia is associated with what?
Birth trauma
DM - sono - Fetal anatomy
Single umbilical artery
Oligo or Poly
DM - sono - PL changes
Thickened PL (gestational diabetes)
DM - sono - Growth related changes
IUGR (Diabetes predating pregnancy)
Macrosomia (gest diabetes)
Essential HTN
Pre-existing HTN that is not related to the pregnancy
(AKA: Chronic HTN)
Pregnancy induced HTN
Gestational HTN
HTN during pregnancy without signs of pre-eclampsia
GEPHS stands for what?
Gestational Edema Proteinuria Hypertensive Syndrome
GEPHS is also known as:
Toxemia of pregnancy
GEPHS occurs in what type of patients?
Primigravidas (1st time preg)
Multiple gestation
Patients with family history
What are the 2 classifications of GEPHS?
Pre-eclampsia is characterized by what 4 things?
1. HTN
2. Generalized Edema
3. Proteinuria
4. Rapid weight gain (secondary to edema)
Eclampsia is characterized by what 3 things?
1. Convulsions
2. Coma
3. Death
(In addition to edema, proteinuria, HTN)
What are the maternal signs of Eclampsia? HAS HAG
A - ankle swelling
S - sudden excessive weight gain

H - headaches
A - abdominal pain and vomiting
G - generalized edema
Eclampsia - sono - FO PIIS
F - fetal demise
O - oligo

P - premature PL
I - increased risk of abruption
S - sono used to track fetal growth
HELLP Syndrome (complications of pre-eclamspia)
H - hemolysis (breakdown of RBC's)
E - elevated
L - liver enzymes
L - low
P - platelets
TORCH Infections
T - toxoplasmosis
O - other (syphilis)
R - rubella
C - cytomegalovirus
H - herpes
Toxoplasmosis is caused by what?
Protozoan, T gondii
Commonly found in cat feces and uncooked meat
Toxoplasmosis may result in what? JIMMI CHTT
J - jaundice
M - micropthalami
M - microcephaly
I - intracranial calcifications

C - CNS calcifications
H - hydrocephalus
T - thickened PL
T - thrombocytopenia
Rubella is also called:
German Measles
Rubella is especially teratogenic for the fetus during how many weeks?
1st 5 weeks of pregnancy
What are defects associated with Rubella?
Congenital Heart Disease
Mental Retardation
Cytomegalovirus (CMV) causes what if it occurs in the 1st trimester?
Fetal Demise
What is the most common infection in pregnancy?
Cytomegalovirus may cause:
Spontaneous Abruption
Fetal ascites
Fetal Death
Cranial anomalies
Chest anomalies
Herpes - when is it transmitted to the fetus?
During vaginal delivery
(C-section usually performed)
Common respiratory viral infection
PUBS stands for:
Percutaneous Umbilical Blood Sampling
Maternal infections - sono - HII CCV
H - hydrops
I - increased or decrease PL thickness

C - cranial/cerebral anomalies
C - cardiac anomalies
V - visceral calcifications (brain, liver)
Incompetent CX / Insufficient Cx
Premature dilation and enfacement of the UT CX.

Inability of the CX to prevent premature expulsion of the UT contents.
Is Incompetent CX congenital or aquired?
Incompetent CX is most commonly related to what?
CX trauma
Stitch the CX closed
Placed via McDonald or Shirodkar Procedure
Incompetent CX - What would be seen prior to 34 weeks?
Shortened CX (<2.5 to 3 cm)
Incompetent CX - What is the most reliable thing when diagnosing?
Dilation of CX (>2 cm in the 3rd trimester)
What are the clinical signs of maternal anemia?
Hgb < 10g/100mm
Hct < 30%
What are the types of maternal anemias? IF DAT
I - iron deficiency (95%)
F - folic acid deficiency

D - drug induced hemolytic anemia
A - aplastic anemia
T - thalassemia
Uterine rupture is a major cause of what?
Maternal Death
What are the clinical signs associated with uterine rupture?
UT pain
Small amount of Vaginal Bleeding
Sudden increase in fetal station (position)
What are the sonographic signs associated with Uterine rupture?
Large amount of maternal free intraperitoneal fluid
Preterm Labor
The onset of labor prior to 37 weeks
What are the etiologies of Preterm Labor? HUMMPP SAM
H - heavy smoking
U - UT anomalies
M - multiple gestation
M - maternal stress
P - poly
P - previous UT surgery

S - systemic infections (appendicitis with sepsis)
A - antepartum bleeding (previa, abruption)
M - maybe idiopathic
Premature Rupture of the Membranes (PROM)
Spontaneous rupture prior to labor
PROM clinical signs:
Large passage of watery fluid from VG
What are the PROM sono signs?
Oligohydramnios with NORMAL fetal bladder
What happens to UT fibroids during pregnancy?
Enlarge due to estrogen stimulation
Ovarian cysts are ------- seen during pregnancy.
What 2 types of Ovarian Cysts are associated with pregnancy?
Corpus Luteum Cysts
Theca Lutein Cysts
Corpus Luteum Cysts are normal in which trimester?
1st trimester
Corpus Luteum Cysts usually regress by how many weeks?
12-15 weeks
Corpus Luteum Cysts secrete ------.
What do Theca Lutein Cysts occur with?
Gestational Trophoblastic Disease
Amniotic Band Syndrome is caused by what?
Disruption of the amnion early in pregnancy
Amniotic Band Syndrome
Bands of tissue that trap and constrict portions of the fetal body
What is the most severe associations with Amniotic Band Syndrome?
Limb-Body Wall Complex (LBWC)
Amniotic Band Syndrome - what are the craniofacial defects?
Asymmetric Encephalocele
Asymmetric Facial Clefts
Severe facial dysmorphia
Amniotic Band Syndrome - what are the limb defects?
Extremity amputation
Amniotic Band Syndrome - What are the visceral defects?
Abdominal wall defects
Ectopia Cordis
Trisomy 13 is also called:
Patau's Syndrome
Trisomy 13 is associated with what?
Psychomotor Retardation
Multiple anatomic abnormalities
Trisomy 13 - What is the prognosis?
(85% die within the 1st year)
Trisomy 13 - What is associated with it? HIPS C
H - holoprosencephaly
P - polydactyly
S - single umbilical artery

C - cleft lip/palate (esp median cleft)
What else is associated with Trisomy 13? TACO V
T - truncus arteriosus
A - agenesis of corpus callosum
C - cystic renal dysplasia
O - omphalocele

What is common with Trisomy 18 (Edwards Syndrome)?
What is the average lifespan with Trisomy 18 ?
5 days
What is Trisomy 18 associated with?
Psychomotor Retardation
Growth Deficiency
What pathologic abnormalities are associated with Trisomy 18 ? VAMPIR SOCS
M - micrognathia
P - polyhydramnios
R - rocker bottom foot

S - "strawberry" shaped cranium
O - overlapping fingers
C - CP cysts
S - single umbilical artery
What else is associated with Trisomy 18? HODE
H - hydronephrosis
O - omphalocele
D - diaphragmatic hernia
E - enlarged CM
Trisomy 21 (Down's Syndrome) is associated with what?
Mental retardation
Characteristic physical appearance
Trisomy 21 - sono - DAVE TRENCH SPC
D - duodenal atresia
E - endocardial cushion defect

T - thickened nuchal fold
R - renal pyeliectasis
E - echogenic intracardiac focus
N - non-immune hydrops
C - cystic hygroma
H - hyperechoic bowel

S - small/absent nasal bone
P - pleural effusion
C - cinodactyly
Incidence rate for Trisomy 13,18,21:
Trisomy 13 - 1:6,000
Trisomy 18 - 1:3,000
Trisomy 21 - 1:710
Turner's Syndrome is also referred to as:
Monosomy X (45 XO)
Turner's Syndrome
Complete or partial absence of an X chromosome
Turner's Syndrome - sono
Cystic Hygroma
Non-immune hydrops
Cardiovascular abnormalities
Horseshoe Kidneys
Renal Agenesis
Turner's Syndrome - postnatally sono
Hypoplastic/Aplastic UT
OV dysgenesis
Streak like ovary
Beckwith-Weidmann Syndrome
The presence of EMG anomalies:
E - exomphalos (omphalocele)
M - Macroglossia
G - Gigantism
Beckwith-Weidmann Syndrome is associated with what?
Cardiac malformations
PL enlargement
PL chorioangiomas
Postnatal renal tumor (Wilm's Tumor)
Pentalogy of Cantrell is associated with which 2 major defects?
Ectopia Cordis
What are the other defects associated with Pentalogy of Cantrell?
Vertebral anomalies
Teralogy of Fallot
Trisomy 13 & 18
Turner's syndrome
Craniofacial abnormalities
Single umbilical artery
Fetal ascites
Meckel-Gruber Syndrome is autosomal:
Autosomal Recessive
Meckel-Gruber Syndrome
Polycystic kidneys
Cleft Lip
V - vertebral anomalies
A - anal atresia
C - cardiac anomalies
T - tracheo-
E - esophageal fistula
R - renal & radial ray anomalies
L - limb deformities
Fetal Alcohol Syndrome
Results from excessive maternal alcohol consumption
(binge drinkers)
What is associated with Fetal Alcohol Syndrome?
Mental Deficiency
Cardiac Septal Defects
Hypospadias and other genital abnormalities
Holt-Oram Syndrome
Hereditary syndrome of malformations of the heart and upper extremities.
What is Holt-Oram Syndrome associated with?
Varied hand anomalies
Cardiac septal defects
Noonan Syndrome
Facial anomalies (hypertelorism, low set ears)
Cystic hygroma
Cardiac abnormalities
Treacher-Collins Syndrome is also called:
Mandibulofacial Dysostosis
Treacher-Collins Syndrome is autosomal:
Autosomal Dominant
Treacher-Collins Syndrome affects which 3 structures?
Ears, Mandible, Palate
What is associated with Treacher-Collins Syndrome?
Congenital heart defects
Small mandible
Autosomal Trisomy
Ellis-Van Creveld Syndrome has a high prevalence rate in which culture?
The amish
What is associated with Ellis-Van Creveld Syndrome?
Thoracic Dysplasia
Mild to moderate limb shortening
50% have CHD (most commonly ASD's)