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2405 ch 42 &43
Phuong
180
Other
Not Applicable
04/17/2011

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Cards

Term
EDC also known as EDD what EDC and EDD stand for?
Definition
Estimated date of confinement and Expected date of delivery
Term
What is the Nagele's rule?
Definition
EDC=LMP-3mo +7 days
Term
first trimester is
Definition
0-12wk
Term
2nd trimester is
Definition
13-26wk
Term
3rd trimester is
Definition
27-40wk
Term
When is consider posterm or postdate?
Definition
42wk
Term
Why is it important to recognize normal fetal anatomy?
Definition
To know normal from an abnormal
Term
The pregnancy divided into three 13 week segments called?
Definition
Trimester
Term
Why should you develop an organized & systematic approach?
Definition
to assess the fetus, placenta, & amniotic fluid
Term
to find the fetal position if scan from sag midline of cx to fundus is to determine of what relationship?
Definition
Fetal position in relation to mother
Term
How do you determine fetal position in relation to mother?
Definition
scan sag midline from cx to fundus
Term
What do we should to determine to find fetal anatomy?
Definition
Direction/orientation
Term
What is called with fetal part closest to CX?
Definition
Fetal presentation
Term
What is the vertex of fetal presentation?
Definition
Cephalic/ fetal head near maternal CX; scan toward fundus; the body may lie oblique or long
Term
What is the breech of fetal presentation?
Definition

The lower extremities or lower body found in the LUS (lower uterine segment) with head in the fundus;

 

Term
Types of breech presentation include___
Definition
Complete-incomplete (footling)-frank
Term
What is the transverse of fetal presentation?
Definition
Transverse cross-section of fetal head or body when scanning sagittal
Term
Situs of fetal to determine the ___
Definition
Right and left of fetus to check for normal position of fetal organs
Term
Situs of fetal is also for verify of what?
Definition
 Anatomic landmarks are on the proper side
Term
What is BPD stand for
Definition
Bi - parietal diameter
Term
At what level of transvere axial scan plan, the BPD more likely to obtain?
Definition
Thalamus, CSP, and falx
Term
How to do the measurement of BPD?
Definition
From outer edge of cranium nearest to transducer to the inner edge of cranium farthest from transducer
Term
From outer edge of cranium nearest to transducer to the inner edge of cranium farthest from transducer is ____
Definition
Leading edge to leading adge
Term
Do not include soft tissue on the outer edge of this organ is the measurement of __
Definition
BPD
Term
What is the OFD stand for?
Definition
Occipital frontal diameter
Term
How to obtain the OFD?
Definition

Use the same transaxial image of BPD to measure along long axis of fetal head from Occipital to frontal bone

Caliper at outeredge of calvaria to outer edge of calvaria

Term
How to calculate the corrected BPD?
Definition
square root of [(BPD x  OFD)/1.265]
Term
What is the important thing to know when measure the head?
Definition
Do not include skin
Term
Composed of 2 lateral hemispheres with "dumbbell shaped" this is:
Definition
Cerebellum
Term
Cranial anatomy include:
Definition
Cerebellum,vermis, CSF (cerebrospinal fluid), Ventricles (4th, 3rd, 2 lateral), Choroid plexus, Cisterna Magna,
Term
To check for cranial contour there is include:
Definition
Lateral vent, Choroid plexus, Falx cerebri, Cerebellum, Thalamus, CSP, Cisterna magna,
Term
Fills central spinal cord, ventricles of brain and subarachnoid space; and protective cushion regulating pressure within spaces this is___
Definition
CSF (cerebrospinal fluid)
Term
This help manufacture or distribute CSF (cerebrospinal fluid) this is___
Definition
Ventricles
Term
How many ventricles total what are they?
Definition
4-2 lateral vents, one in each cerebral hemisphere, 1 third ventricle and 1 fourth ventricle
Term
One on each side of cerebral hemisphere what is this ventricle name?
Definition
Lateral
Term
This have dumbbell shaped structure in posterior with homogeneous and symmetric what is this?
Definition
Sonography of Cerebellum
Term
This ventricle in ML central in thalamus what is this?
Definition
3rd
Term
This ventricle is ML and more in posterior this is
Definition
4th
Term
This found in lateral, 3rd and 4th ventricles what is this?
Definition
Choroid plexus
Term
This is the largest space where CSF pools and located at base of cerebellum in posterior location in skull what is this?
Definition
Cisternal magna
Term
With ultrasound this is echogenic line dividing homogeneous cerebellum into right and left halves what is this?
Definition
Falx cerebri
Term
With ultrasound this cavity appears as echo free space and filled with choroid plexus what is this?
Definition
Lateral ventricles
Term
This is seen as echogenic structures within the lateral ventricles what is this?
Definition
Sonography of choroid plexus
Term
This show with diamond shaped in center of axial section taken thru temporal lobe and homogeneous what is this?
Definition
Sonography of thalamus
Term
This is ML structure containing of 2 small echogenic lines separated by CSF and parallel to falx what is this?
Definition
Sonography of CSP (cavum septum pellucidum)
Term
This appears anechoic posteroinferior to cerebellum what is this?
Definition
Sonography of cisterna magna
Term
What should document for fetal Heart in anatomy scan?
Definition
4 chambers; check for position and symmetry; and fetal heart rate
Term
How to identify the fetal kidneys?
Definition
On either side of spine- renal pelvis may contain small amount of fluid
Term
How is the bladder look like?
Definition
ML, round, fluid filled structure
Term
A hypoechoic line spearating lungs from abdomen what is this?
Definition
Diaphragm
Term
This structure locate in bladder and move cephalad, this is evaluated for anterior abdominal wall defects what is this?
Definition
Umbilical cord insert
Term
This confirm of 1 vein, 2 arteries, transverse look like a "mikey mouse" what is this?
Definition
3 vessel cord
Term
Extremities is
Definition
Verify 2 arms/hands and 2 legs/feet
Term
What are the structures of fetal anatomy scan nclude?
Definition
Cranium, Heart; kidneys; bladder; stomach;diaphargm; spine; umbilical cord insert; 3vc; extremities; and face
Term
This is anechoic structure on the left side of abdomen what is this?
Definition
Stomach
Term
Check for orbits; nasal bones this is in the view of___
Definition
Coronal frontal facial view
Term
Check for nostrils (nares) and nasal septum, lips this scan the image of:
Definition
Nose/lips
Term
What are images need to see in fetal face?
Definition
Facial profile; coronal frontal facial view; and nose/lips
Term
How to measure the head circumference?
Definition
The length outer perimeter of cranium use the same transaxial image as for BPD and measure with electronic ellipse or outer to outer BPD and OFD
Term
What is the formular to calculate HC?
Definition

HC=(D1 of BPD + D2 of OFD) x 1.57

 

Term
How many way to measure the head?
Definition
4- BPD, OFD and BPD--> corrected BPD, HC and CI (cephalic index)
Term
How many way to calculate HC?
Definition
2-electronic ellipse and outer to outer of BPD and OFD
Term
How to calculate CI?
Definition
CI=BPD/OFD x 100
Term
What is leading edge to leading edge mean?
Definition
Outer to inner
Term
What is CI determination of?
Definition
Normal head shaped or not
Term
If we have BPD measurement, to find the corrected BPD what do we need to do?
Definition
Find OFD then use square root the value of BPDxOFD/1.265
Term
Place caliper at outer edge of calvaria to outer edge of calvaria from occipital to frontal bone to find what?
Definition
OFD
Term

What scan plane use to find BPD, OFD, and HC?

 

Definition
Transaxial section at level of thalamus, CSP and Falx
Term
It is more difficult to measure BPD in 3rd tri with/because head____
Definition
Drops into pelvis
Term
 Normal CI is
Definition
80% with +/- 1 SD
Term
What is SD stand for?
Definition
Standard diviation
Term
What is this level if CI = 75-85% range
Definition
Normal range
Term
If CI >85% what is this level of head called?
Definition
Brachycephaly
Term
If CI <75% what is this level of head called?
Definition
Dolichocephaly
Term
What is the head shape have shortened transverse (BPD) and elongated AP plane (OFD) called?
Definition
Dolichocephaly
Term
What is the head shape have elongated transverse (BPD) and shortened AP plane (OFD) called?
Definition
Brachycephaly
Term
The length of outer perimeter of abdomen measured on transverse scan at level of____
Definition
Stomach; intrahepatic portion of umbilical vein (including skin); spine
Term
Which is consider the least accurate of measurements?
Definition
AC ( abdominal circuference)
Term
AC is
Definition
Consider more useful as growth parameter than to predict GA, but this is useful to detect fetal growth disturbances
Term
Which way is used to measure AC?
Definition
Ellipse or 2 sets of caliper (trans -TAD and AP- APD)
Term
How to calculate the AC?
Definition
= 1.57 x (A D1 + A D2)
Term
Which measurement is about as accurate as BPD in determination of GA?
Definition
FL (femur length)
Term
When to do a scan of FL what do you need to be sure these are stimultaneously in plane?
Definition
Femoral head or greater trochanter and femoral condyle
Term
How to do a measurement of FL?
Definition
Place calipers at junction of bone with cartilage to measure diaphysis (the calcified portion) and don't include the relection of epiphysis
Term
With humerus length measurement what do we need to measure?
Definition
The humerus shaft -diaphysis
Term
What are the other bones measurement of upper and lower extremities ?
Definition
Radius length, Ulna length, Tibia length, Fibula length
Term
This bone is medial and thicker than the lateral bone of lower extremity what is this bone?
Definition
Tibia
Term
This bone is lateral and more thinner than the medial bone what is this bone?
Definition
Fibula
Term
This bone in upper extremities penetrates deeper into elbow and larger and anatomically in medial position what is this?
Definition
Ulna
Term
Radial bone is more in
Definition
Lateral
Term
If epiphysis is seen in 33 wk and high amplitude echo adjacent to femur this is portion of ___
Definition
Distal femoral epiphysis - DFE
Term
If the epiphysis is seen at 35 wk with high amplitude echo adjacent to tibia what is this part?
Definition
Proximal tibial epiphysis - PTE
Term
If the epiphysis is seen at 38 wk what is this part?
Definition
The proximal humeral epiphysis- PHE
Term
Which identification can help to date but don't measure either present or not what is this structure?
Definition
Epiphysis
Term
Which way use to measure orbits?
Definition
IOD and OOD
Term
What is IOD?
Definition
Inner orbital distance- medial border of orbit to opposite medial border
Term
What is OOD?
Definition
Outer orbital distance- Lateral border of 1 orbit to opposite lateral wall
Term
What are the cranial measurement include?
Definition
Cerebellum, Cisterna Magna, Nuchal fold, Lateral ventricles
Term
How to scan and measure the cerebellum?
Definition
From level of BPD angle back into posterior fossa then measure end to end
Term
How to scan and measure the cisterna magna?
Definition
Angle slightly more inferior from cerebellum level, measure from vermis to inner occipital bone
Term
What measure of Cisterna Magna is consider abnormal?
Definition
>10mm or >1cm
Term
At the same level of Cisterna Magna what other measurement should be done here?
Definition
Nuchal fold
Term
How to measure nuchal fold?
Definition
From occipital bone to the edge of skin
Term
Nuchal fold consider abnormal at 15-21 wk if measurement is__
Definition
>6mm
Term
Where and how to measure the lateral ventricle?
Definition
At atrium, if wall of ventricle parallel using ventricle more distal to transducer
Term
What measuremen of lateral ventricles is considered abnormal?
Definition
>10mm or >1cm
Term
To determination of GA what parameters are used?
Definition
Estimated may improve if there are 2 or more parameter are used
Term
Is any single parameter is perfect to predict GA?
Definition
No
Term
What parameters are used to calculate fetal weight?
Definition
numerous formulas are used, most reliable formulas incorporate all parameters of BPD, HC, AC, and FL
Term
Why do we performed BPP?
Definition

to detecct fetal compromise

for normal is conservative care and for abnormal is use as timely delivery of neonate in best condition

Term
What is Hypertellerism mean?
Definition
To wildely space between orbits (eyes)
Term
What is Hypotellerism
Definition
Eyes are too close each other
Term
What is the type of US to check and see fetal well-being?
Definition
BPP
Term
What is the goal of pregnancy?
Definition
to reach to full term
Term
If the fetus measures smaller than dates is ____ and the weight is _____for GA
Definition

SGA (small for gestational age),

<10%

Term
If the fetus measures larger than dates this is _____and weight is ___for GA
Definition
large for GA (diabetic fetus) and >90%
Term
What is Macrosomia?
Definition
A birth weight of 4000 g or greater
Term
What is important for delivery purposes?
Definition
Knowledge of macrosomia
Term
What is the common result of macrosomia?
Definition
Poorly controlled maternal diabetes mellitus, hyperinsulinemia promotes accelerated somatic/body growth
Term
How many minutes BPP can be ranged?
Definition
5-30mins
Term
Somatic is mean
Definition
Body
Term
What is the risk factor of macrosomia?
Definition
Multiparous, AMA (advance of maternal age), obesity, diabetes, excessive pregnancy weight gain, hx of LGA fetus and postdate pregnancy
Term
With macrosomia the fetus have increase incidence of what?
Definition
Shoulder injuries, dystocia, fractures, and facial & brachial plexus palsies
Term
Which assessment is the useful measurement of fetal weight?
Definition
AC (abdomen circumference)
Term
Why AC is useful for assessment of fetal weight?
Definition
Elevated glucose levels leads to overgrowth of fetal chest/abdomen
Term
Macrosomia associated finding with:___
Definition
Elevated amniotic fluid (polyhydramnios)
Term
IUGR is term applies for fetal growth disorder that result on basis of a weight_____
Definition
below the 10th percentile for GA
Term
There are 2 classifications of IUGR ___
Definition
Symmetry and Asymmetry
Term
What are the clinical signs of IUGR?
Definition
Small for dates, maternal conditions associated with IUGR, history of SGA infant
Term
What is the symmetric IUGR?
Definition
All growth parameters are small, usually result of severe insult in the 1st trimester, appx 1/4 of IUGR=25%, and includes infection or congenital malformation
Term
US finding of symmetric IUGR are:___
Definition

Mature placenta earlier than expected

Oligohydramnios

Low BPP score

Abnormal Doppler assessments

All the measurement are greater than 2 wks below expected GA, but cerebellum may still measure appropriately

Term
US finding of Asymmetric IUGR are:___
Definition

HC/AC raio >=2 standard diviation (SD)

AC measuring > 2 weeks behind HC

Oligohydramnios

Advanced maturity of the placenta

Abnormal Doppler assessments

Term
What is Asymmetric IUGR?
Definition

Body is disproportionately smaller than head/limbs; usually in 2nd or 3rd trimester;

Usually results from placental insulfficiency (materna diabetes, chronic hypertension, cardiac disease, abruption placenta, smoking, multiple pregnancies, poor weight gain

Term
This is appx about 75% or 3/4  of all what is this?
Definition
Asymmetrical IUGR
Term
Asymmetrical IUGR is -_-
Definition
Due to protect the brain and ensure of brain sparing the asymmetry is between the head size and the abdominal size
Term
Fluid is produced by
Definition
Umbilical cord, membranes, lungs, skin, and kidneys
Term
Oligohydramnios is
Definition
Decrease amount of amniotic fluid
Term
Decreased amount of amniotic fluid (oligohydramnios) is associated with___
Definition
IUGR
Term
Divide the uterine cavity into 4 quadrants and measure largest vertical pocket in each quadrant with no umbilical cord or limbs is measurement/evaluation of __
Definition
AFI
Term
The formula of AFI is
Definition
RUQ+RLQ+LUQ+LLQ=AFI
Term
If the total of all 4 quadrants with a measurement of 5-22cm is consider as
Definition
Normal AFI
Term
With single pocket evaluation method normal is__
Definition
2-8 cm
Term
With single pocket evaluation method if <2cm is __
Definition
Oligohydramnios
Term
With single pocket evaluation method if >8cm is__
Definition
Polyhydramnios
Term
The subjective way to measure for experienced sonographer is __
Definition
Eyeball technique
Term
Placetal grade from___ is used to determine___
Definition
0-3 ; placental maturation
Term
What is grade 3 of placenta in the 2nd and 3rd trimester indication of??
Definition
Placental insufficiency
Term
Biophysical Profile is from__
Definition
1980's - Manning
Term
There are 5 parameters used for BPP is__ with 10 max score -
Definition
Fetal heart rate and 4 US variables
Term
List the BPP parameters used:-
Definition

cadiac non stress test (NST)

Observation of fetal breathing movements

Gross fetal body movements

Fetal tone

Amniotic fluid volume (AFV)

Term
What parameter some other lab omit and max score is 8
Definition
NST Cardiac non stress test
Term

How long is the fetus has a max time limit to perform these tasks?

 

Definition
30 mins
Term
How the score affect performance?
Definition
Score of "2" for performance or  a "0" for no performance
Term
For fetal breathing what need to observe?
Definition

simultaneous inward movement of chest wall with outward movement of anterior abdominal wall during the inspiration

Watch for the diaphragm

One episode of 30 sec during 30min =2 point

Absent no point are given=0

Sleep-wake cycle vary with the fetal central nervous system

Term
How many extremity or trunk movements must be observed within 30 minutes to score as 2 points?
Definition
At least 3 definitely
Term
Fetal tone presence of at least 1 episode of ___
Definition
extension and immediate return to flexion of an extremity or the spine
Term
What is the abnormal of fetal tone is noted?
Definition
Partial extension or flexion of an extremity without quick return and would be score 0 points
Term
Example of fetal tone are__
Definition
One active extension and flexion of an open and closed hand
Term
How to score the amniotic fluid volume in BPP exam?
Definition

At least 1 amniotic fluid pocket measuring with at least 2 cm or more in vertical axis

AFI may be used and score of 2 point if >5cm

Term
Non-stress test (NST) score of 2 if___
Definition

Two-2 fetal heart rate acceleration of 15 beats per min or more

Acceleration lasting at least 15 seconds

This associated with fetal movements over 30 mins

Term
Non-stress test (NST) score of 0 if___
Definition
2 fetal heart rate accelerate with gross fetal movement not seen in 30 min
Term
An abnormal after 30 wk of umbilical artery Doppler with systolic and diastolic ratio of ___
Definition
>3.0
Term
In the case associated with poor outcomes the Doppler of umbilical artery shows
Definition
Elevated resistance and causing absent or reverse end diastolic flow velocity waveform
Term
Normal BPP variables with __
Definition
[image] Score of 2
Term
Abnormal BPP variables with __
Definition
Score of 0
Term
The ratio Doppler of UA is higher if measure in ___
Definition
place close to the fetal cord insertion
Term
What % of infants weight >90% for GA in general population?
Definition
10%
Term
What % are considered macrosomia in general population?
Definition
8-10%
Term
What % of infants is LGA occur in diabetics?
Definition
25-42%
Term
What % of infants is macrosomia occur in diabetics?
Definition
10-50%
Term
SGA is
Definition
small fetuses with no maternal pathology and with normal of UA and MCA
Term
IUGR is
Definition
Small for GA, but underlying maternal pathology
Term
Proportionately reduced in size is
Definition
Symmetrical IUGR
Term
Proportionately small in relation to head and limbs is
Definition
Asymmetrical IUGR
Term
With Doppler there is reverse or absent diastolic flow indicate of___
Definition
Growth restricted fetus
Term
2 vessels are helpful tools to identify small fetuses at risk for an adverse outcome is___
Definition
UA and MCA
Term
Which segment is the last develop reversed flow?
Definition
Closer to placental insertion
Term
UA is best examined in__
Definition
free-floating umbilical cord
Term
The most common cause of fetal death is
Definition
Fetal hypoxemia or acidemia
Term
Which examination is highly accurate for predicting the presence of significant fetal hypoxemia or acidemia?
Definition
BPP Ultrasound
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