OB/GYN Review
A 30-year-old woman 2 months postpartum with AUB undergoes transvaginal sonography. The examination reveals a normal-size uterus, a 12 cm thick endometrium, and an echogenic mass within the uterine cavity. Serum β human chorionic gonadotropin testing is negative. What is the most likely cause of AUB?
Retained products of conception
patient is seen with heavy bleeding 7 days after delivery of a 36-week infant. Ultrasound reveals an enlarged postpartum uterus containing an echogenic mass. This suggests which of the following?
Retained products of conception
A 32-year-old woman is seen for an elevation of the alpha fetoprotein level at 2.8 MoM. The sonographic evaluation reveals a fetal age consistent with last menstrual period without any anomalies. The placenta has a subchorionic hypoechoic area. What is the most likely explanation for the elevated alpha fetoprotein level?
Retroplacental clot
The cystic space within the embryonic head visualized at approximately 8 weeks' gestational age is the developing:
Rhombencephalon
What is a complication of vasa previa?
Rupture of the umbilical vessels from compression or tearing the vesel during labor
A 22-year-old pregnant woman is seen in the sonography department with heavy bleeding and cramping. She had a sonogram 1 week prior because of an episode of spotting, which revealed a 6-week embryo. The current sonogram reveals a uterus without evidence of an embryo or gestational sac. This is most consistent with which of the following?
SAB (Complete)
What is the most common congenital neoplasm?
Sacrococcygeal teratoma
The nuchal translucency thickness used for genetic screening in the first trimester of pregnancy must be obtained in the:
Sagittal plane
What does a granulosa cell tumour do? What does this cause?
Secretes estrogen which thickens the endometrium
What is the most common congenital uterine abnormality?
Septate uterus
What can chronic salpingitis result in?
Significant tubal scarring and presence of hydrosalpinx
The fetal thoracic circumference should be closely evaluated and compared with the abdominal circumference in the event of a suspected:
Skeletal dysplasia
What is a Gartner duct cyst?
Small cyst within the vagina
What is the treatment of tubo-ovarian abscess?
Small: antibiotic Large: surgical exision
What does the caudal end of the neural tube become?
Spinal cord
If the cisterna magna is absent or obliterated, what is this associated with?
Spinal dysraphism
What is the most common finding in CDH?
Stomach above diaphragm
What is the sonographic appearance of PCOS?
String of pearls
What differentiates subchorionic hemorrhage from plancental abruption?
Subchorionic hemorrhage does not communicate with the placenta
A 30-year-old woman with menorrhagia undergoes a pelvic sonogram that reveals a hypoechoic mass distorting the endometrium. This mass attenuates the sound beam, it has a broad base, and the endometrium courses over it. What is the most likely diagnosis?
Submucosal fibroid
A patient who is scheduled for a pelvic sonogram states that she currently has a Mirena IUD in place. What is the shape of this IUD?
T
What are the mildest forms of osteogenesis imperfecta?
TYpe 1 and 4
A 42-year-old woman with a history of breast cancer undergoes a pelvic sonogram, which demonstrates cystic changes within the endometrium. Which of the following is the most likely cause of the endometrial appearance?
Tamoxifen changes
What does the round ligament support?
The Uterine fundus
What does estradiol reflect?
The activity of the ovaries
What is bicornis bicollis?
The duplication of both cervix and uterus
What regulates ovulation?
The hypothalamus
What does the suspensory ligament support?
The lateral portion of the ovary
If the embryonic heart rate is 100 bpm or less, what should be investigated?
The maternal uterine vessel to ensure that embryonic cardiac activity was actually being measured
What secretes FSH?
The pituitary gland
What is the purpose ovarian cortex?
The site of follicular development
What are benign cystic teratomas composed of?
The three germ cell layers
What is the purpose of the ovarian medulla?
The vascular core of the ovary
What separates the cerebellar hemispheres?
The vermis
What happens to edtradiol levels during pregnancy?
They will steadily rise
What does the endometrium look like in a woman who is taking OC or Depot?
Thin echogenic line
What is meconium peritonitis?
This is rare and is a complication in fetuses with perforation of a bowel obstruction
What is a pass for fetal movement?
Three separate fetal movements within 30 min
What is another name for a Brenner tumour?
Transitional cell tumours
If a patient has active bleeding or PROM, how do we investigate sonographically?
Translabial
What is a dinstinguishing ft. of the late proliferative phase?
Triple line appearance
A patient presents with a history of severe pelvic pain, fever, and purulent discharge. A pelvic sonogram demonstrates a properly placed IUD and a complex adnexal mass. The ovary cannot be identified within or adjacent to the adnexal mass. What is the most likely diagnosis?
Tuboovarian abscess
What is the most common for of achondrogenesis?
Type 2
Which is the most severe form of achondrogenesis?
Type I
What is the most severe and lethal form?
Type II
What is velamentous cord insertion?
Umbilical cord inserts into membranes before entering placenta
What is the 'tip of the iceberg' sign?
Unique sonographic sign of a dermoid
A pelvic sonogram is performed on a 33-year-old woman with pelvic pain. She describes the pain as a constant dull ache that seems to increase when standing. Transabdominal sonography shows an enlarged, fibroid uterus, normal ovaries, and bilateral cystic areas that appear to be tubular. What should the sonographer do next?
Use color doppler to see if the tubular structures are prominent veins
What happens to infants with thanatophoric dysplasia
Usually die shortly after birth d/t pulmonary hypoplasia
What is septate uterus?
Uterine cavity is separated by a thin septum
What does the broad ligament support?
Uterus
What structure connects the yolk sac to the embryo?
Vitelline duct
What makes the association with aneupoidy greater with an omphalocele?
When bowel is included in the herniation
How do follicular cysts occur?
When dominant follicles fail to ovulate or to regress
What is adenomyosis?
When glands and stroma from the basal layer of the endometrium penetrate into the myometrium
When does invasive hydatidiform mole occur?
When hydropic villi of a partial or complete mole invades the uterine myometrium and uterine wall
When does shoulder dystocia occur
When the arm of the fetus prevents or complicates deliver and may result in serious traumatic injury
What is macrosomia?
When the estimated fetal weight is greater than or equal to 4500g
What is uterus subseptus
When the septum is only partially resorbed
When is SAB classified as complete?
When there is expulsion of the products of conception
When does expulsion of an IUD typically occur?
Within the first year, most commonly within the first few months after insertion
Which age group is commonly affected by epithelial tumors?
Women in their 40-50
What is Meigs' syndrome?
a benign solid ovarian mass which causes ascites and pleural effusion
What is vasa previa?
a condition that describes vessels of fetal origin that completely or partially cover the internal cervical os
WHat is esophageal atresia?
a congenital blockage of the esophagus and may be associated with a fistula connecting the esophagus and trachea
What is limb-body wall complex?
a fatal condition that results from abnormal body folding during early embryologic development
What is Limb-body wall complex identified by?
a large, anterior abdo wall defect with an absent or short umbilical cord
WHat is type IV CCAM?
a peripheral cyst
What is abruptio placenta (placental abruption)?
a placenta that partially or completely prematurely separates
What is pulmonary sequestration?
a rare abnormality characterized by a mass of lung tissue that does not connect with the tracheobronchial tree
What is pulmonary effusion?
a rare entity characterized by an abnormal accumulation of fluid in the fetal thorax occuring
What is type II CCAM?
a single large cyst and smaller cysts less than 1 cm
What is a levonorgestrel implant?
a thing capsule placed under the skin for 5 years
What is PUV?
abnormal valves in the posterior urethra
When does a corpus lutein cyst rupture?
about the time of menstruation
What is anencephaly?
absence of the cranium and brain above orbits
What is Dandy Walker malformation?
absence or dysplasia of the cerebellar vermis and maldevelopment of the fourth ventricle with replacement by a posterior fossa cyst
What is radial ray defect?
absence or hypoplasia of the radius
What is the most suggestive sonographic finding of esophageal atresia?
absent stomach
What is Type 0 CCAM?
acinar dysplasia
What are the three types of placenta creta?
acreta increta percreta (gets worse as we add a letter to the beginning)
What is the most severe form of holoprosencephaly?
alobar
What is placenta creta?
an abnormal placental attachment to the uterus as the result of an abnormal or absent decidua basalis
What is polycystic ovarian syndrome?
an endocrine disorder that produces anovulation and results in infertility
What is salpingitis?
an infection of the fallopian tubes that may be acute, subacute, or chronic
What does a gestational sac look like?
anechoic fluid collection surrounded by echogenic ring in fundal region of endo
If the cranial end of the neural tube fails to close, what does this result in?
anencephaly
What is another name for the vesicouterine pouch?
anterior cul de sac
What are the symptoms of nabothian cysts?
asymptomatic
Where is the width of the uterus measured?
at the widest portion of the uterine body in the short axis
What is placenta acreta
attachment of the chorionic villi to the myometrium
7. Which of the following is not associated with Arnold-Chiari malformation? a. Ventriculomegaly b. Spina bifida occulta c. Lemon sign d. Banana sign
b
What is embryonic bradycardia? (before and after 7 wk)
before: 85 bpm after: 100 bpm
When does the neural tube close?
betweel 3-4wk
What is normal AFV?
between 2-8cm
What is needed to differentiate endo hyperplasia from endometrial adenocarcinoma?
biopsy
What is SGA?
birth weight or fetal weight less than 10th percentile
What is threatened abortion?
bleeding without cervical dilation
what can fetal ascites be associated with.
bowel or bladder performation or fetal hydrops. Congenital infection or abdo neoplasm
What does a cephalic index of more than 84 indicate?
brachycephalic shape
8. Which organ produces alpha fetoprotein? a. Brain b. Lung c. Liver d. Kidneys
c
A 28-year-old pregnant woman presents to the emergency department at 30 weeks' gestation with knifelike abdominal pain following a motor vehicle accident. Her abdomen is tense and hard on palpation. Ultrasound reveals a large hypoechoic collection of fluid in the retroplacental region. This is consistent with which of the following? a. Marginal abruption b. Placenta previa c. Placental abruption d. Subchorionic hemorrhage
c
Sonographic evaluation at 19 weeks' gestation reveals an appropriately growing infant with unilateral talipes. Which of the following conditions may be associated with this finding? a. Ectopia cordis b. Omphalocele c. ABS d. Gastroschisis
c
What can meconium peritonitis reveal on sonography?
calcification in the fetal abdo on the peritoneal surfaces and scrotum in male fetus
What predicts preterm labor?
cervical shortening
What does the cardinal ligament support?
cervix
what is preterm labor?
cervix is dilated in the presence of contractions of the uterus b/t 20-37 wk gestation
What is the risk of PROM before 37 weeks?
chorioamnionitis
What is the echogenic ring on a gestational sac? (2)
chorion and decidua capsularis
What can cause a nabothian cyst?
chronic cervicitis
What is the most common congenital defect of the face?
cleft lip/palate
What is alobar holoprosencephaly?
complete failure of separation of the forebrain
what is a nuchal cord?
cord completely surrounds fetal neck with more than one loop.
What is a battledore (marginal) placenta?
cord inserts into the end margin of the placenta
What is prolapsed cord?
cord precedes fetus in the birthing process
3. A patient is seen for evaluation at 16 weeks' gestation for an alpha fetoprotein of 4.2 MoM. Which of the following sonographic findings would suggest a recalculation of the alpha fetoprotein? a. Fetal death b. Sonographic dating of 12 weeks c. Twin gestation d. Sonographic dating of 19 weeks
d
When does the ovulatory phase occur?
day 14
When does early follicular phase occur?
days 1-5
When is the menstrual phase?
days 1-5
When does late follicular phase occur?
days 6-13
What is cleft lip/palate?
defect in the upper lip or palate in the roof of the mouth
What is acrania?
destructio of brain matter exposed to amniotic fluid
What are the two types of adenomyosis?
diffuse and focal
How does bowel obstruction appear on ultrasound?
dilated loops of bowel at the level of the obstruction. Prox obstruction more likely to be fluid filled.
What is mild hydronephrosis?
dilation of the renal pelvis
What is moderate hydronephrosis?
dilation of the renal pelvis and calyces
What is spina bifida aperta?
disruption of the skin and subcutaneous tissues is visible over the area of the spine where te incomplete closure occurs. Meninges protrude and are exposed to amniotic fluid
How can we differentiate a subserosal fibroid from other fibroids?
distorts uterine contour
What does a cephalic index of 76 indicate?
dolichocephalic shape
What is missed abortion?
embryonic death without expulsion of the products of conception
What two conditions do people with PCOS need to be monitored for?
endo carcinoma and breast cancer
What causes ovarian hyperstimulation?
excessive human chorionic gonadotropin levels
What is nonstress test?
exhibits two fetal heart accelerations within 20 min or placental grade >_2
What is spina bifida occulta?
failure of the dorsal portions of the vertebrae to fuse with one another, covered by skin and not noticeable unless there is a small tuft of hair or dimple
who is anencephaly more common in?
females and monozygous twins
What is an oblique fetal lie?
fetal head and body are lying at a 45 degree angle to maternal sag plane
What is a cephalix or vertex position?
fetal head lies most inferior, closest to cervical os
What is IUGR?
fetus that has not reached growth potential b/c of genetic enviro factors. Most likely SGA (can be normal)
What ovarian phase does early proliferation coincide with?
follicular phase
What does the cranial portion of the neural tube become?
forebrain, midbrain, hindbrain
What is gastroschisis?
full thickness abdowall defect that usually lies to the right of the umbilicus
What is the greatest risk factor for macrosomia?
gestational diabetes
What is severe hydronephrosis?
gross dilation of the collecting system with a decrease in renal cortical tissue
What is symmetric IUGR?
head and abdo are proportionately decreased
Which cysts have a fishnet or reticular appearance?
hemorrhagic cyst
What is congenital diaphragmatic hernia?
herniation of the abdo contents into the thorax through a defect in the diaphragm
What is the most common form of achondroplasia?
heterozygous
What is the most lethal form of achondroplasia?
homozygous
What is meningomyelocele associated with?
hydrocephalus
How does the inner functional layer of the endometrium appear on ultrasound?
hyperechoic
What is pre-eclampsia characterized by?
hypertension and proteinuria after 20 weeks GA
How does the outer basal layer of the endometrium appear on ultrasound?
hypoechoic
How does cervical carcinoma appear on ultrasound?
hypoechoic or heterogenous retrovesical mass
What occurs during the late luteal phase?
if fertilization does not occu, the corpus luteal cyst regresses
Where does the cord normally insert on the placenta?
in the mid portion.
Which presentation is the greatest risk for prolapsed cord?
incomplete breech
What surges stimulation of LH production?
increasing estrogen lvels
What can be two complcations of tubal scarring?
infertility and ectopic pregnancy
What do the umbilical arteries arise from?
internal iliac arteries
What is placenta percreta?
invasion through the myometrium into/through the uterine serosa
What happens to smooth muscle with adenomyosis?
it becomes hyperplastic
Which side is CDH typically on?
left
Which side are unilateral clefts often on?
left side
What endometrial thickness makes retained products of conception unlikely?
less than 10mm
What measurement dictates if the cervix is shortened?
less than 3cm
What is achondrogenesis?
lethal skeletal dysplasia caused by a defect in cartilage formation that leads to abnormal bone formation and hypomineralization of the bones
What is the mildest form of holoprosencephaly?
lobar
What is the AFP like in a complete molar pregnancy?
low
What is type I CCAM?
macrocystic masses that consist of multiple large cysts
Which gender experiences renal agenesis more often?
male
What is meningocele?
meninges herniated
What is type III CCAM?
microcystic variety that appears as large echogenic mass
What is type I thanatophoric dysplasia?
micromelia, curved femurs, narrow thorax
What is type II thanatophoric dysplasia?
micromelia, straight femur, narrow thorax, clover leaf skull
What is type III achondrogenesis?
micromelia, variable ossification of the spine and calivaria, no fractures
What could be the cause of an inferiorly located IUD?
migration or improper insertion
What is arcuate uterus?
minor lack of fusion of the fundal region that results in a slight depression
What is a pass for fetal breathing movement?
movement of diaphragm >_ 30 s
what is the most common type of leiomyoma?
myometrial
What is ARPKD characterized by?
nonobstructive dilations of the collecting ducts in the kidneys and hepatic fibrosis
What is a nabothian cyst?
obstructed inclusion cysts in the cervix
How does hydronephrosis lead to oligohydramnios?
obstruction is severe, bilaeral or associated with serious contralateral anomaly
When AFV is less than 2cm, what does this indicate?
oligohydramnios
What is a pass for fetal tone?
one complete episode of flexion to extension and back to flexion
What is a paraovarian cyst?
originates from wolffian structures located in the broad ligament
What is ovarian hyperstimulation?
ovaries massively enlarged with multiple luteinized follicles, called theca lutein cysts
What is the most common symptom of placenta previa?
painless bleeding in the third trimester
What is partial previa?
partially covers the internal cervical os
Which women does serous cystadenocarcinoma frequently present in?
peri & postmeno
What is cerclage?
placement of stitches in a weak, incompetent cervix to hold it closed to avoid preterm labor and delivery
If AFV is greater than 8cm, what does this indicate?
polyhydramnios
What is the treatment of PUV if found early in pregnancy?
prenatal vesicoamniotic shunting
What is aneuploidy?
presence of abnormal number of chromosomes
Risk factors for placenta creta are? (good luck...)
prior cesarean section placenta previa multiparity advanced maternal age D&C prior manual removal of the placenta recurrent SAB endometritis adenomyosis hypertension smoking prior uterine surgery.
If a mucinous cystadenoma/cystadenoma ruptures, what condition can occur?
pseudomyxoma peritonei
What does an abnormally small AC assist in the assessment of?
pumlonary hypoplasia
What is osteogenesis imperfection
rare disorder of connective tissue that leads to brittle bones and affects teeth, ligaments, skin, and blue sclera
What is the function of the umbilical artery?
return venous blood back to the placenta
Which trimester can anencephaly and acrania be diagnosed accurately?
second
What is achondrogenesis type I?
severe micromelia, lack of ossification of the spine and calivaria, fractured ribs
What is grade 3 placenta?
significant basal calcifications with chorionic plate indentations to basal layer (> 39 wk)
What is short rib-polydactly syndrom?
skeleta dysplasia characterized by presence of short limbs/ribs and polydactyly... duh
What are two additional defects that come with limb-body wall complex?
skeletal and craniofacial defects
What is micrognathia?
small or recessed chin
The normal fetus has a thoracic circumference slightly ___________ in size than the abdomen circumference
smaller
If the posterior neuropore fails to close, what happen?
spina bifida
What can be the signs of subchorionic hemorrage?
spotting or bleeding with or without uterine contractions
What is duodenal atresia characterized by?
stenosis, atresia, or development of webs that obstruct the distal duodenum
What is the most common letha skeletal dysplasia?
thanatophoric dysplasia
What produces progesterone? (4)
the adrenal glands, corpus luteum, brain and placenta
What secretes luteinizing hormone?
the anterior pituitary gland
How is bicornuate uterus and uterus didelphys differentiated?
the identification of the duplication of the vaginal vanal, which is evident in uterus didelphys
Where is the most common place for endometriosis to occur?
the ovaries
What is the sonographic appearance of pyosalpinx?
thick-walled tubular or serpiginous structures surrounding ovaries
What aneuploidy is holoprosencephaly mostly assocated with?
tri 13
What aneuploidy is choroid plexus cyst most commonly associated with?
tri 18
What is rockerbottom foot most commonly associated with?
tri 18
What chromosomal abnormalities are associated with omphalocele?
tri 18, 13, 21
What is duodenal atresia associated with?
tri 21
What chromosomal anomalies is esophageal atresia associated with?
tri 21 and 18
What can polydactyly be associated with?
tri18
What is Krukenberg tumour?
tumors containing mucin-secreting signet ring cells, which usually arise from the GI tract
What is the most common type of thanatophoric dysplasia?
type I
What is Dandy-Walker malformation frequently associated with?
ventriculomegaly
what is placenta increta?
villi invade myometrium
When is the embryonic period?
week 6 though week 10
what is the classic sonographic appearance of a endometrioma?
well-defined, thin-walled mass containing low-level, internal echoes with through transmission. May be unilocular or multilocular
What is large for gestational age?
when the estimated fetal weight is greater than the 90th percentile for GA
What is low lying placenta?
within 2 cm of internal os
What age group is typically affected by germ cell tumours?
young women
What is the sonographic appearance of uterus didelphys?
-2 separate endo echo complexes -Deep fundal notch is present, separated widely with a full completement of myometrium -2 cervix; 2 vagina
What nuchal fold thickness is associated with tri 21? Which weeks is the association present?
-5-6 mm ore more associated with tri 21 -weeks 18-24
What is hydrosalpinx?
-A distally blocked fallopian tube filled with serious or clear fluid. Often bilateral -Closed at fimbrae
What is a circumvallate placenta?
-Abnormal placental shape in which the membranes insert away from the placental edge towards the center
Where is the space of Retzius?
-Anterior to the urinary bladder -Posterior to the symphysis pubis
What are the most common cardiac anomaly seen with pentalogy of cantrell? (3)
-Atrial Septal defect -Ventricular septal defects -tetralogy of fallot
How is the FL measured?
-Closest femur -Only the diaphysis
What hormones are secreted by the ovaries, and by what?
-Estrogen (follicles) -Progesterone (corpus luteum)
What happens during the menstrual phase?
-Functional layer necroses -Decreased estrogen and progesterone
What occurs during the secretory phase?
-Functional layer thickens -Progesterone increases
What occurs during late follicular phase?
-Graafian follicle: 2-2.4 cm -Estrogen levels increase
What 4 things is a molar pregnancy associated with?
-Hyperemesis -Preeclampsia -thyrotoxosis -resp distress
What can increase fundal height?
-Multiple gestations -Hydatidiform moles -Polyhydramnios
What are the symptoms of chronic salpingitis? (2)
-Pain during intercourse -Pain during bowel movements
What is a partial hydatidiform mole?
-Paternal & maternal -69xxx or 69xxy karyotype
What occurs during the ovulatory phase?
-Rupture of Graafian follicle -Pelvic pain (called Mittelschmerz)
What can cause bilateral PID? (2)
-STI -IUD infection
Which structures can be seen in the AC image?
-Stomach -Umbilical vein -Spine **DO NOT WANT TO SEE KIDNEYS**
How does endomyometritis appear on ultrasoound?
-Thick and irregular, and the uterus may appear enlarged and inhomogenous
What happens during the early proliferative stage?
-Thin echogenic endo -Increasing estrogen
What synthesizes AFP? (3)
-Yolk sac -Liver -GI tract
What is succenturiate placenta?
-a result of the lack of the adjacent chorionic villi to atrophy
What is a pass for amniotic fluid volume? (2 answers)
-amniotic pocket > 2cm -amniotic fluid index >5cm
What can amniotic band cause? (3)
-amputation -contstriction with edema -clubfoot
Where is the vesicouterine pouch?
-anterior to the uterus -posterior to the uterine bladder
What occurs during the early luteal phase?
-corpus luteum secretes estrogen and progesterone -Free fluid in cul-de-sac
What are abnormalities of the umbilical cord?
-cyst -long cord -knots -nuchal cord -prolapsed cord -short cord -thrombosis of the umbilical vessels -varix of u vein
What is a transverse fetal lie?
-fetal head and body lay across maternal abdo
What is the pentalogy of cantrell?
-heart anomalies -Omphalocele -Pericardial defects -Ectopia Cordis -Diaphragmatic hernia (HOPED)
What are 5 clinical symptoms of PCOS?
-infertility -early pregnancy loss -hirsutism -acne -amenorrhea **can be asymptomatic**
What can meconium peritonitis result in?
-inflammation -meconium pseudocyst -Polyhydramnios
What are maternal causes of IUGR?
-maternal disease that compromises oxygen -Hypertension -Renal disease -insulin-dependent diabetes mellitus -systemic lupus erythematosus -sickle cell anemia -severe lung disease -cyanotic heart disease
How do nabothian cysts appear on ultrasound?
-multiple or solitary anechoic structures < 2cm -May contain internal echoes
What is the the sonographic appearance of acute salpingitis?
-nodular thickening of walls -Hyperemia -Anechoic or echogenic fluid in posterior-cul-desac -Uterine enlargement
What is achondroplasia?
-occurs from abnormal endochondral bone formation that results in rhizomelia -large head, prominent forehead, depressed nasal bridge, lordosis
What is a complete hydatidiform mole?
-paternal origin with no maternal DNA -46 xx karyotype
What can cause unilateral PID?
-pelvic abscess -complications of abortion or childbirth
What is chorioangioma?
-placental hemangioma -Arises from chorionic tissue of the amniotic surface of the placenta
What is an IUD made up of?
-plastic, wrapped in copper and may or may not contain hormones -Has plastic strings that suspend through the cervix
What are the risk of velamentous cord insertion? (5)
-preterm labor -abnormal fetal heart pattern -low apgar score -low birth weight -IUGR
What causes a tubo-ovarian abscess?
-pus leaking from an infected fallopian tube and may occur from communication with an ovary -Seen in later stages of PID
What is lobar holoprosencephaly?
-separation of the cerebrum -Fusion of lat vents -Absence of corpus callosum
How does tubal scarring appear sonographically?
-several cystic structures extending from the uterus to the adnexa -Often called "chain of lakes" or "string of pearls"
What is anencephaly associated with?
-spina bifida -cranioschisis -cleft lip/palate -talipes -omphalocele -aneuploidy
What two kidney anomalies are associated with uterine anomalies?
-unilateral renal agenesis -renal ectopia
What are the causes of hydrancephaly?
-vascular malformation -Congenital infections -cocaine abuse
What are the size of the follicles in PCOS?
0.5-0.9cm
What is the normal thoracic cicumference to abdo circumference ratio?
0.94
What are 6 complications with IUD?
1. Abnormal or ectopic location 2. Myometrial penetration 3. Perforation into peritoneal cavity 4. PID 5. Ectopic pregnancy 6. Coexisting intrauterine pregnancy
What does circumvallate placenta increase risk of? (4)
1. Abruption 2. IUGR 3. Premature labor 4. Perinatal death (PADI: Premature labor, Abruption, Death, IUGR)
What are the risk factors for placenta previa? (3)
1. Advanced maternal age 2. Muliparity 3. Previous c-section (AMC = Age, Multiparity, c-section)
What can be the clinical symptoms of Asherman Syndrome? (4)
1. Amenorrhea 2. Dysmenorrhea 3. Hypomenorrhea 4. Infertility
What are 4 complications of ovarian hypertimulation?
1. Ascites & pleural effusion 2. hypovolemia 3. Hypotension 4. impaired renal function
What are the 4 primary biometric measurements?
1. BPD 2. HC 3. AC 4. FL
What are the two most common types of ovarian neoplasms?
1. Benign cystic teratoma 2. Surface epithelial-serous cystadenoma
What three endometrial abnormalities can tamoxifen cause?
1. Carcinoma 2. Hyperplasia 3. Polyps
What are the portions of the fallopian tube from medial to lateral? (4)
1. Cornual 2. Isthmus 3. Ampulla 4. Infundibulum
What are the symptoms of adenomyosis?
1. Dysmenorrhea 2. Abnormal uterine bleeding 3. Enlarged uterus
What are causes of oligohydramnios and anhydramnios? (3)
1. Dysplastic kidneys 2. Urinary outlet obstruction 3. PROM
What can an IUD infection result in? (3)
1. Endomyometritis 2. Pyosalpinx 3. Tuboovarian abscess
What 3 things accompany PUV?
1. Enlarged bladder 2. bilateral hydronephrosis 3. Hydroureters
What are the 6 locations of an ectopic?
1. Fallopian tube 2. Cervix 3. Ovary 4. Broad ligament 5. Abdomen 6. Cornua *F*ilipe *C*ame *O*ver *B*ecause *A*rnold *C*alled
What are the five parameters measured in biophysical profile?
1. Fetal tone 2. Fetal movement 3. Fetal movement 4. Amniotic fluid volume 5. Nonstress test or placental grade **** ****only done if first test fails
What are the 5 functions of estrogen?
1. Formation of female secondary sex characteristics 2. Accelerates growth in height and metabolism 3. Reduces muscle mass 4. Stims endo growth and proliferation 5. Increases uterine growth
What are the 2 most common abdo wall defects?
1. Gatroschisis 2. Omphalocele
What are the three types of ovarian neoplasms?
1. Germ Cell 2. Epithelial 3. Sex cord-stromal
What are the four measurements of the first trimester?
1. Gestational sac (MSD) 2. Crown Rump Length 3. Yolk Sac 4. Nuchal Translucency
What are the four most common sex cord-stromal tumours?
1. Granulosa 2. Sertoli-leydig 3. Fibroma 4. Thecoma *G*ood *S*ex *F*ixes *T*orrettes
What are the two complications of RPOC?
1. Hemorrhage 2. Infection
What are the three causes of hematometra?
1. Imperforated hymen 2. cervical stenosis 3. vaginal neoplasm
What are 7 ways hydrops fetalis can manifest?
1. Increased placental thickness 2. Increased thickness of scalp 3. Body wall greater than 5mm 4. Hepatosplenomegaly 5. Pleural and pericardial effusions 6. Ascites 7. Structural fetal anomalies
What are four cause of hydrosalpinx?
1. Infection or STI 2. Previous surgery 3. Adhesions 4. Endometriosis
What 4 things make expulsion of an IUD more common?
1. Inserted soon after childbirth 2. History of previous expulsion 3. Nulliparity 4. Severe menorrhagia
What are two signs of cervical carcinoma?
1. Intermenstrual bleeding 2. Postcoital bleeding
What are the four types of fibroids?
1. Intramural 2. Subserosal 3. Pedunculated 4. Submucosal
What are 6 signs and symptoms of an ectopic pregnancy?
1. Intrauterine pseudosac or decidual rxn 2. Poor coorelation with b-hCG 3. Bleeding & severe pain 4. Cul-de-sac fluid 5. Complex adnexal mass with/without live pregnancy 6. Significant amount of hemiperitoneum
What other organs/body parts can produce small amounts of estrogen? (3)
1. Liver 2. Breasts 3. Adrenal glands
Where can choriocarcinoma metastasize to?
1. Lung 2. Skin 3. Intestines 4. Liver 5. Spleen 6. Heart 7. Brain
What 5 conditions are associated with cephaloceles?
1. Meckel-Gruber syndrome 2. Amniotic Band Syndrome 3. Cerebellar dysgenesis 4. Short limb dysplasia 5. Warfarin syndrome
What can bowel obstruction be associated with? (3)
1. Meconium peritonitis 2. Acites 3. Cystic fibrosis
What are two other names for leiomyomas?
1. Myomas 2. Fibroids
What are markers for acute fetal hypoxia? (4)
1. Nonstress finding 2. fetal tone 3. Breathing 4. Body movements
What two vessels supply blood to the ovary?
1. Ovarian artery 2. Uterine artery
What are 7 causes of low AFP?
1. Overstimated GA 2. Fetus younger than expected 3. Chromosomal abnormalities 4. Trophoblastic disease 5. Long-standing fetal demise 6. Chronic maternal hypertension 7. Diabetes
What are the risk factors for ectopic pregnancy?
1. Past ectopic 2. PID 3. Tubal surgery 4. Maternal congenital anomalies 5. Late primiparity 6. Defective zygote 7. Fertility treatments 8. IUD
What are 4 indications for a sonographic evaluation of the ovaries?
1. Pelvic pain 2. Pelvic fullness 3. Palpable mass 4. Family history of ovarian or breast cancer
What are the 4 symptoms of hematometra?
1. Pelvic pain 2. amenorrhea 3. hypomenorrhea 4. Pelvic mass
What are two other names for the secretory phase?
1. Post ovulatory 2. Premenstrual
What are two other names for the rectouterine pouch?
1. Posterior cul de sac 2. Pouch of Douglas
What are 3 complications of placental abruption?
1. Preterm delivery 2. intrauterine growth restriction 3. fetal death
What are two alternative names for the space of Retzius?
1. Retropubic space 2. Prevesicle space
What are the two most common types of epithelial ovarian neoplasms?
1. Serous cytadenoma/cystadenocarcinoma *most common* 2. Mucinous cystadenoma/cystadenocarcinoma
What are the potential complications of macrosomia? (9)
1. Shoulder dystocia 2. Soft tissue trauma 3. humeral and clavicular fractures 4. brachial plexus injury 5. Facial palsies 6. Meconium aspiration 7. Prolonged labor 8. Asphyxial injuries 9. Hydrops fetalis*
What can the result of subchorionic hemorrhage be? (2)
1. Spontaneously regress 2. Spontaneous abortion (SAB)
What 3 things is IUGR associated with?
1. Stillbirth 2. neonatal death 3. Perinatal morbidity
What two types of leiomyomas cause abnormal intrauterine bleeding?
1. Submucosal 2. Intramural
What are the three classifications of abortion?
1. Threatened 2. Missed 3. Complete
What are the 3 most common obstructive genitourinary anomalies?
1. UPJ obstruction 2. UVJ obstruction 3. PUV
What are eight causes of high AFP?
1. Underestimated GA 2. Fetus older than expected 3. Multiple gestations 4. Open Neural tube defect 5. Abdomina wall defect 6. Cystic hygroma 7. Renal anomaies 8. Fetal demise
What are the 7 risk factors of endometrial adenocarcinoma?
1. Unopposed estrogen stim 2. Obesity 3. Tamoxifen 4. Chronic anovulation 5. nulliparity 6. diabetes 7. hypertension
What are the 3 symptoms of choriocarcinoma?
1. Vaginal bleeding 2. enlarged uterus & ovaries 3. elevated h-cg levels
What does succenturiate placenta increase the risk of?
1. Velamentous cor 2. Vasa previa
If the cisterna magna is an abnormal size, what 3 pathologic conditions is this associated with?
1. Ventriculomegaly 2. Cerebellar hypoplasia 3. Dandy-Walker malformation *V*elma *C*all *D*ad
What 4 things can bowel obstruction occur with?
1. Volvulus 2. Atresia 3. Malrotation 4. Peritoneal bands (VAMP)
What are 4 symptoms of endo polyps?
1. coital spotting 2. Intermenstrual bleeding 3. Menorrhagia 4. Menometrorrhagia
What are 5 symptoms of IUD expulsion
1. cramping 2. Vaginal discharge 3. Intermestrual bleeding/spotting 4. Postcoital bleeding/spotting 5. Dyspareunia
What does RPOC look like sonographically?
1. echogenic mass in endo 2. Increased vascularity
What are the 7 complications of pregnancy with an IUD?
1. ectopic prengnancy 2. Spontaneous abortion 3. Chorioamnionitis 4. PROM 5. Preterm labour 6. Septic abortion 7. Maternal death
What are the three differential diagnoses for a thickened endometrium in a post menopausal women?
1. endo carcinoma 2. Endo hyperplasia 3. Polyps
What are the two types of placental abruptions?
1. marginal (low pressure) 2. Retroplacental (high pressure)
What are 5 causes of placental abruption?
1. maternal hypertension 2. vascular disease 3. placenta previa 4. smoking 5. cocaine abuse
What can be 4 symptoms of endometriosis?
1. pelvic pain 2. Dyspareunia 3. Abnormal uterine bleeding 4. Dysmenorrhea **Can be asymptomatic**
When does LH typically reach its peak?
10-12 hr before ovulation
Evidence of a developing intrauterine pregnancy should be recognized endovaginally with a serum beta-hCG (IRP) of:
1000-2000 mIU/mL
What amount of beta-hCG is indicative of a pregnancy?
1000-2000 mIU/ml
When is the differentiation of fetal head and torso recognizable?
11-12 weeks
When is nuchal translucency done?
11-14 weeks
Which decreases the risk of SAB dramatically?
12 weeks
What is the normal embryonic heart rate?
120-180 bpm
What anomalies are most commonly associated with micrognathia?
13 and 18
What measurement should the endometrium not exceed?
14mm
What is the normal range for AFI?
15-20cm (or 10-13cm +/- 5cm)
What days does the secretory phase occur?
15-28
When is placenta grade 1?
18-29wk
During the embryonic period, what is the growth rate of the embryo?
1mm per day
In the early first trimester of pregnancy, the gestational sac is expected to grow at a rate of:
1mm/day
What is the normal first-trimester gestational sac growth rate?
1mm/day
What is a normal yolk sac measurement?
2-6 mm
What is the normal measurement of a yolk sac?
2-6mm
What are the LxWxH measurements of a menarche ovary?
2.5-5cm x 1.5-3cm x 0.6-2.2 cm height
When does the fetus enter growth stage?
20 wk GA
At which CRL measurement should the embryo be visualized (via TVP)?
25mm
What are the LxHxW measurements of the uterus in a postmenopausal lady?
3.5-7.5cm x 2-3cm x 4-6cm
What is an abnormal placenta at 20 weeks gestation?
3cm or greater
Using transvaginal sonography, how early could a pregnancy be detected?
4 wk and 1 or 2 days since LMP
For nuchal translucency, what should the CRL be?
45mm-84mm
How long is an LH surge?
48 hr
What is an abnormal placenta at 40 weeks?
5 cm or greater
What are the normal levels of estrogen in urine?
5-100 μg/24 h
What occurs during early follicular phase?
5-11 small follicles
What is the normal volume of a postmenopausal ovary?
5.8cm^3
If a woman is experiences PMB, what should the thickness of the endometrium not exceed?
5mm
What is the normal lateral ventricle measurement?
6-10mm
What are the LxHxW measurements of the uterus in a nulliparous menarche lady?
6-8.5cm x 3-5 cm x 3-5 cm
A secondary yolk sac measuring greater than what measurement is considered to be abnormal and suspicious for abnormal pregnancy development?
6mm
What is a normal cephalic index?
76-84
At which week can the rhomencephalon and limb buds be seen?
8 weeks
What are the LxHxW measurements of the uterus in a parous menarche lady?
8-10.5cm x 3-5cm x 5-6cm
In the development of a normal intrauterine pregnancy, the yolk sac should be demonstrated transvaginally in a gestational sac with what minimum measurement?
8mm
At which MSD should a yolk sac be present? Corresponds with which GA?
8mm 5-5.5 wk GA
What is the normal volume of a menarche ovary?
9.8cm^3
When should a placenta be grade 0?
<18 wk
What is a normal nuchal translucency measurement?
<3mm
What is the normal measurement of the cisterna magna?
<_ 1cm
What should the endo thickness in a post menopausal women be?
<_8mm
When is a placenta grade 2?
>30wk
What is tamoxifen?
A drug administered to women with breast cancer to block estrogenic effects on breast tissue
What is an IUD?
A flexible contraceptive device inserted through the vaginal canal into the endo
If an invasive malignant ovarian tumor is discovered during pegnancy, what is it likely to be?
A malignant dysgerminoma
What is choriocarcinoma?
A malignant tumor that arises from the trophoblastic epithelium. Malignant metastatic form of gestational trophoblastic disease
What is congenital cystic adenomatoid malformation (CCAM)?
A rare lung abnormality characterized by an overgrowth of terminal bronchopulmonary tissue
The endometrial cavity in patients using hormone contraceptive therapy appears on ultrasound as a:
A thin echogenic linear structure
What is ectopia cordis?
A very rare defect in which the heart is partially or completely protruding through the thorax
What measurement is best for estimating fetal weight?
AC
What is the marker for chronic fetal hypoxia?
AFV
What is dolichocephaly?
Abnormally shortened BPD
What is brachycephaly?
Abnormally widened BPD
What is thrombocytopenia?
Absent radius syndrome
What is the most common non lethal skeletal dysplasia?
Achondroplasia
A 50-year-old woman experiencing AUB undergoes pelvic sonography. The uterine body is globular and slightly heterogeneous in appearance, several myometrial cysts are identified, and the endometrial-myometrial junction is not clearly delineated. What is the most likely diagnosis?
Adenomyosis
What is Asherman's syndrome?
Adhesions from a previous deep curretage or endometrial infection
Which race are leiomyomas more prevalent?
African american women
When does the fetal position change less frequently?
After 34 wk GA
When can choriocarcinoma develop?
After any type of pregnancy (molar, normal, SAB, ectopic)
What are retained products of conception?
After delivery or abortion some gestational contents may remain within the uterine cavity and cause bleeding or infection
When does invasive hydatidiform mole typically become apparent?
After the evacuation of a molar pregnancy
What is endometial hyperplasia?
An abnormal proliferation (growth) of the endometrium in response to excess or unopposed estrogen
What is another name for Sertoli-Leydig tumors?
Andoblastoma
What is the most common NTD?
Anencephaly
LH is secreted by what?
Anterior pituitary gland
Where is the rectouterine pouch located?
Anterior to the rectum and posterior to the uterus
What is the most widely used serum tumor marker for epithelial ovarian cancer
Antigen125
When are the primary biometric measurements taken?
Appx. 20 weeks
A 27-year-old woman with recurrent miscarriages presents for a pelvic sonogram. Sonography reveals a subtle fundal indentation on the uterus with a slightly concave uterine cavity. These findings are associated with which uterine anomaly?
Arcuate uterus
What is the mildest congenital uterine anomaly?
Arcuate uterus
How can ascites be differentiated from abdo muscle?
Ascites surrounds organ and abdo muscle surrounds entire abdo
Where is the MSD measurement taken?
At the fluid interface with the echogenic borders (inner to inner)
What is considered to be one of the best predictors for GA in the 2nd trimester?
BPD
Which two measurements create the cephalic index?
BPD and OFD
How can an IUD cause an infection?
Bacteria may neter the endo cavity as the IUD is inserted though the vaginal canal
An asymptomatic postmenopausal patient displays a 3.0cm simple ovarian cyst, this finding is considered?
Benign (< 5cm)
What are endometrial polyps?
Benign focal overgrowths of endometrial glands and stroma. Can extend into cervix or vagina
What are leiomyomas?
Benign smooth muscle tumours
What location of subchorionic hemorrhage has a better prognosis? What about worse?
Better: lower segment Worse: fundus
Where is subchorionic hemorrage seen?
Between the uterine wall and the membranes
Which uterine anomaly is at higher risk for a breech pregnancy?
Bicornuate uterus
What is the symptom of a molar pregnancy?
Bleeding
What is hematometrocolpos?
Blood accumulation in the uterus and vagina
What is hematocolpos?
Blood accumulation in the vagina
What is hematometra?
Blood trapped into the endo cavity
What is complete breech?
Both feet first (hips and knees flexed)
What is frank breech?
Butt first (knees extended; hips flexed)
4-When serial sonographic examinations demonstrate the progression of significant IUGR, the clinician needs to try to determine the cause of the problem. A fetal cause that can lead to IUGR is: a. Hypertension b. Placental insufficiency c. Chromosome abnormality d. Placental chorioangioma
C
What is the cephalic index equation?
CI = (BPD/OFD) x 100
Which measurement gives the most accurate GA estimate?
CRL
What CRL is cardiac activity seen at? What week does this correspond with?
CRL: 5mm GA: 5 wk
What is the function of the umbilical vein?
Carries oxygenated blood
What is the *third* most common gynecological maliginancy?
Cervical carcinoma
What does the uterosacral ligament support?
Cervix
What is menopause?
Cessation of menstruation for 12 mo.
What is uterus didelphys?
Complete failure of the mullerian ducts to fuse together
3-A 35-year-old multiparous woman is seen for an obstetric sonogram with bleeding at 32 weeks' gestation. Endovaginal ultrasound reveals a placenta on the anterior uterine wall, crossing the internal cervical os and extending 2 cm on the posterior uterine wall. What does this suggest?
Complete placenta previa
What are abdominal wall defects?
Congenital defects that result in protrusion of intraabdominal contents through an incomplete closure of the ventral wall
What type of tissues make up ovaries?
Cortical and medullary tissues
A 75-year-old woman undergoes a pelvic sonogram because of increasing abdominal girth and complaints of feeling exhausted. Sonographic evaluation demonstrates a 20 cm, complex, predominantly cystic mass occupying her pelvis and abdomen. Multiple papillary projections and septations are evident within the mass, which demonstrate vascularity on color Doppler imaging. What is the most likely diagnosis?
Cystadenocarcinoma
A 19-year-old woman was referred for a pelvic sonogram because of a palpable right adnexal mass and no other symptoms. The sonographer was unable to identify a normal right ovary but noticed a discrete area with hyperechoic dots and lines, including a rounded echogenic area that produced a shadow. At first, the area was thought to be bowel, but on observation, there was no peristalsis. These findings are most consistent with which type of ovarian mass?
Cystic teratoma
What is the most common presentation of vasa preview?
Dark vaginal bleeding with rupture of membranes
When does late proliferation occur?
Days 10-14 (preovulatory)
When does the early luteal phase occur?
Days 15-18 (post ovulation)
When is early proliferation?
Days 6-9
What is a cephalocele?
Defect in the cranium through which intracranial tissue protrudes, including meninges with or without brain tissue
What is an omphalocele?
Defects in the abdomen that result in the herniation of the intraabdominal contents into the umbilical stalk
What is hydrancephaly?
Destruction of the brain parenchyma with replacement by cerebrospinal fluid
The occipitofrontal diameter may be measured in the second or third trimester of pregnancy. This measurement in conjunction with BPD is best used to:
Determine fetal head shape
What is the primary producer of estrogen?
Developing follicles and placenta
What is amniotic band syndrome
Developmental disorder in which fibrous remnants of amnion constrict the fetus
What is thoracic circumference used for?
Diagnosis of potentially lethal fetal abnormalities (pulmonary hypoplasia)
Which uterine anomaly is always characterized by two cervices and two vaginas?
Didelphys
What is euploidy?
Difference of one or more complete sets of chromosomes
What is hydronephrosis?
Dilation of the renal collecting system
What is ventriculomegaly?
Dilation of ventricles without enlargement of the head
What is hydrocephaly?
Dilation ventricle with enlargement of the head
What is mile pyelectasis associated with?
Down Syndrome
What is the double bubble sign a sign of?
Duodenal atresia
What is bicornuate uterus?
Duplication of the uterus entering one cervix or two cervices, with only one vagina
What is bicornis unicollis?
Duplication of the uterus without duplication of the cervix
A 24-year-old woman with a positive pregnancy test result and pelvic pain is seen for an ultrasound. She has a history of pelvic inflammatory disease. The ultrasound reveals a uterus containing an anechoic sac that lacks a double decidual sac sign with a moderate amount of cul-de-sac fluid. This is most suspicious for which of the following?
Ectopic pregnancy
What si the leading cause of maternal death in the first trimester?
Ectopic pregnancy
What happens with the b-hCG in a molar pregnancy?
Elevates ( > 100,000 IU/mL)
A 75-year-old woman with postmenopausal bleeding undergoes pelvic sonography, which reveals a 1.5 cm endometrium. What is the most likely diagnosis?
Endo carcinoma
1-A 50-year-old woman with AUB undergoes a pelvic sonogram. Transvaginal sonography reveals a thickened endometrium with a single vascular feeding vessel apparent on color Doppler imaging. What is the most likely diagnosis?
Endo polyp
A 25-year-old woman with menorrhagia undergoes a pelvic sonogram, which demonstrates multiple intramural and subserosal fibroids, with the largest measuring 8 cm. The physician presents several treatment options. The patient wishes to maintain fertility. Which of the following is not a treatment option likely to be offered?
Endometrial ablation
What is the most common gynecologic cancer?
Endometrial adenocarcinoma
A 48-year-old woman undergoes a pelvic sonogram because of AUB. The uterus has a homogeneous echotexture, and the endometrial thickness is 1.7 cm. Sonohysterography reveals diffuse endometrial thickening with no intraluminal masses. What is the most likely diagnosis?
Endometrial hyperplasia
A 45-year-old woman with intermenstrual spotting undergoes transvaginal sonography. Endometrial thickness is 20 mm, and saline introduced during hysterosonography outlines a focal mass isoechoic to the endometrium. What is the most likely diagnosis?
Endometrial polyp
What is the second most common malignant epithelial tumor?
Endometrioid tumour
A 30-year-old woman with pelvic pain and dyspareunia presents for a pelvic sonogram. Sonography demonstrates a thin-walled cystic mass with low-level internal echoes and through transmission in the left adnexa. The right ovary and uterus appear normal. What is the most likely diagnosis?
Endometrioma
The sonographic images of a unilateral ovarian mass in a 25-year-old woman with menstrual irregularities demonstrate a well-defined, 5.0 cm homogeneous unilocular mass containing low-level internal echoes and posterior acoustic enhancement. These findings are most consistent with which ovarian pathology?
Endometrioma
What is the localized form of endometriosis called? (2 names)
Endometrioma or chocolate cyst
A 19-year-old woman is seen in her obstetrician's office 1 week after cesarean section. The cesarean section was urgent in nature and was performed at 27 weeks, 3 days gestational age for ruptured membranes, breech presentation, and extended period of fetal heart rate decelerations. The patient states that she has had increasing uterine tenderness over the last few days, which now is severe. She also says that she has had very minimal bleeding but a foul-smelling discharge and fever. The patient has no history of pelvic infections in the past. What is the most likely diagnosis?
Endometritis
What is macrosomia associated with?
Enlarged placenta
What is the most common ovarian tumor among 50+ women? (also accounts for most malignant ovarian neoplasms)
Epithelial ovarian neoplasms
What is the primary female sex hormone?
Etrogen
What is complete previa?
Extends completely across the internal os
What is myometrial penetration by an IUD?
Extension or penetration of the IUD through the basal layer of the endo into the uterine myometrium
What is assymetric IUGR associated with?
Extrinsic factors like placental insufficiency
What causes septate uterus?
Failure in reabsorption of the median septum.
What is the most common location of an ectopic pregnancy?
Fallopian tube (ampullary potion)
A woman with a 35-week pregnancy is found to have a normal-appearing fetus and AFI of 3 cm. She states she has not felt any more fluid leaking since last week. She has also noticed the baby is not moving like it usually does, and she has had a fever for 2 days. The fetus is at increased risk for what complication?
Fetal demise
What is breech?
Fetal head is located in the superior portion of the uterus
An AFI measurement was obtained on a 38-week gestational age pregnancy. The AFI was considered within normal limits. A fetal bladder was never demonstrated on imaging. What could be the likely explanation?
Fetus emptied bladder
A 25-year-old woman is referred for sonographic dating, with unknown LMP, no prior studies, and a fundal height measuring approximately 35 weeks. The average of four fetal parameters measured calculate to 32 weeks. AFI measures 17 cm. What is the most likely diagnosis?
Fetus is most likely normal with mild polyhydramnios
A 45-year-old woman with mild pelvic discomfort undergoes a sonographic examination, and a 3.0 cm hypoechoic solid ovarian mass is discovered. The images also demonstrate ascites and marked attenuation posterior to the mass. Which of the following is the most likely diagnosis?
Fibroma with Meigs'
A 28-year-old woman presents to the emergency department with increasing abdominal and pelvic pain. The patient states that she has been treated twice within the last year for PID, but she has not felt like this during the previous episodes. She thinks she may have a pelvic infection again, but she is also having pain in her right upper quadrant that is more severe when she coughs or moves. Sonography of the gallbladder appears normal. What is the likely diagnosis?
Fitz-Hugh-Curtis syndrome
What is the most common cause of ovarian enlargement in young women?
Follicular cysts
What is the hallmark of gastroschisis?
Free-floating bowel originating from the right of the umbilicus
Where is the length of the uterus measured?
From the fundus t the external cervical os
Which cyst reponds to cyclic changes?
Functional cyst
What is a theca lutein cyst?
Functional cyst related to human chorionic gonadotropin exposure
What is a hemorrhagic cyst?
Functional cysts bleeding inside
What is measured when measuring the endometrium?
Functional layer only. Do no include any fluid!
What is endometriosis?
Functioning endo tissue being located outside of the uterus
Where do most mets tumors to the ovaries come from? (2)
GI and Breast
6. A 25-year-old woman is seen for an alpha fetoprotein level of 5.7 MoM at 16 weeks' gestation. Sonographic evaluation reveals free-floating bowel anterior to the abdomen. What is the most likely diagnosis?
Gastroschisis
What is the first sonographic evidence of an intrauterine pregnancy?
Gestational sac
What are measurements in the late 2nd or 3rd trimester more accurate for estimating?
Gestational size
What is asymmetric IUGR?
Greater decrease in abdo size is seen (head and femur be normal)
The sonographic measurement of what fetal biometric parameter is least influenced by shape?
HC
What measurement is least influenced by head shape?
HC
How does arcuate uterus appear on ultrasound?
Hard to distinguish but there will be a subtle fundal indentation and the uterine cavity is slightly concave
What is the ratio of the normal heart circumference to the thoracic circumference?
Heart should be 1/3 of thoracic circumference
What complications may occur with uterus didelphys?
Hematocolpos and hematometracolpos
What can placenta previa lead to?
Hemorrhage which increases the risk of maternal morbidity and fetal mortality
A 29-year-old woman with left lower quadrant pain is referred for a pelvic sonogram to rule out ovarian torsion. The images demonstrate a 4.0 cm left ovarian mass containing a reticular pattern of echoes with posterior enhancement and peripheral ovarian flow by color Doppler imaging. A follow-up sonogram performed 2 months later demonstrates a normal left ovary and a 2.5 cm dominant follicle on the right ovary. By the time of the follow-up sonogram, the patient was asymptomatic. Which of the following is the most likely diagnosis for the first examination?
Hemorrhagic ovarian cyst
A patient presents with pain and spotting at 7 weeks' gestation. Ultrasound confirms a viable IUP consistent with the patient's last menstrual period. An adnexal "ring" sign is imaged in the left adnexal region adjacent to the left ovary. The sonographic finding describes which of the following diagnoses most accurately?
Heterotopic gestation
A 22-year-old woman is seen for an obstetric sonogram at 16 weeks' gestation by LMP for increased uterine size and absent heart tones. The sonogram shows a large heterogeneous mass within the uterus. No identifiable fetus or amniotic fluid can be detected. What is the most likely diagnosis?
Hydatidiform mole
If an IUD is embedded in the myometrium, what might be required for removal?
Hysteroscopy
What causes a leiomyoma to cause pain?
If it degenerates
What makes an IUD abnormally located?
If it is located within the endo cavity or if any part extends past the confines of the cavity into the uterus or cervix
When is a binocular measurement taken?
If the head is too low in the pelvis to take BPD
What is subchorionic hemorrhage often the result of?
Implantation of the fertilized ovum into the uterus
When is the risk of pregnancy with an IUD at its highest?
In the first year after insertion
A 29-year-old woman has an alpha fetoprotein value of 4.2 MoM at 18.5 weeks' gestation. Sonographic evaluation reveals a 24.5-week viable gestation with normal anatomy. What is the most likely explanation?
Inaccurate dating
What is the sonographic criteria for diagnosis of PCOS?
Include presence of 12 or more follicles measuring 2-9 mm or increased ovarian volume greater than 10mL
What do oral contraceptives and depot do?
Inhibit ovulation
What does FSH do?
Initiates follicular growth and stimulates the maturation of the Graafian follicle(s)
What is a heterotopic pregnancy?
Intrauterine + ectopic pregnancy
What is symmetric IUGR associated with?
Intrinsic insult (aneuploidy or fetal infection)
What is the problem of velamentous cord insertion?
It is not protected by Wharton Jelly
What two hormones stimulate the production of estrogen in ovaries?
LH and FSH
What is Nageles rule?
LMP... + 1 year - 3mo. + 7 days
What is holoprosencephaly?
Lack of cleavage of the forebrain
Which of the following endometrial phases demonstrates the thinnest dimension?
Late menstrual
What does the umbilical vein enter?
Left portal vein
What is the most common pelvic tumour?
Leiomyomas (also leading cause of hysterectomy)
What are the LxHxW measurements of the uterus in a premenarche girl?
Length: 2-4 cm Height: 0.5-10 cm Width: 1-2 cm
Which ovarian cysts are most likely to be benign?
Less than 5cm in diameter
What are two differentiations for omphaloceles?
Liver containing and non liver containing
What are the two types of endometriosis?
Localized and diffuse
What is a Granulosa cell tumour?
Low-grade malignant
What is a subchorionic hemorrhage?
Low-pressure hemorrhages that occur most commonly in the first trimester of pregnancy
A 29-year-old woman presents for obstetric sonography at 35 weeks' gestation. She has a history of gestational diabetes in two prior pregnancies. 218219 Sonograms at 11 weeks and 23 weeks have confirmed gestational age and have been otherwise unremarkable. The current examination reveals an average sonographic age of 38 weeks, 4 days. The placenta appears generous in size, measuring 6.2 cm. What is the most likely diagnosis?
Macrosomia
4-A 37-year-old woman is undergoing IVF. After receiving gonadotropins, her physician orders a transvaginal sonogram. The purpose for this sonogram is to?
Measure follicle size
What is the binocular measurement?
Measurement of the distance of both orbital rims
What does the ovarian ligament support?
Medial aspect of the ovary
What is meningomyelocele?
Meninges and nervous tissue exposed
A 55-year-old woman with stomach cancer is referred for a pelvic sonogram because of pelvic discomfort. The sonogram reveals bilateral solid ovarian masses. This finding is most consistent with which of the following?
Metastatic tumours
An 18-year-old woman is seen by her gynecologist with a 1-week history of spotting. She reports that she had a positive urine pregnancy test result after a missed period 7 weeks ago. Sonographic evaluation reveals an intrauterine sac with an embryo, without a heartbeat, measuring 6 weeks' gestation. This is consistent with which of the following?
Missed abortion
A 19-year-old woman, gravida 2, para 1, presents to the emergency department at 11 weeks' gestation with vaginal bleeding. Laboratory test results reveal a β-hCG level of 219,000 IU/mL. A sonogram is ordered to confirm which of the following?
Molar pregnancy
A 45-year-old woman undergoes a pelvic sonogram because of a family history of ovarian cancer. Her CA 125 levels are not elevated, and she is not experiencing any unusual symptoms other than weight gain. Sonography reveals a 15 cm, predominantly cystic mass with multiple septations, several papillary projections, and low-level echoes within the mass. Color Doppler imaging reveals vascularity within the solid components. Given the patient's history and sonographic findings, which of the following is the most likely diagnosis?
Mucinous cystadenocarcinoma
What is the preferred fibroid treatment if a patient wishes to be able to become pregnant one day?
Myomectomy b/c uterus is left in place
What does adenomyosis look like on ultrasound?
Myometrial alterations are seen
Where does the umbilical artery have low resistance flow?
Near the fetal insertion
Where does the umbilical artery have high resistant flow?
Near the placental insertion
A 24-year-old woman with a history of reduced fetal movement presents for an obstetric sonogram. There is no indication of bleeding, pain, or other complications. Based on previous unremarkable sonography in the first trimester, the pregnancy should currently measure 37 weeks' gestation. The patient is 5 feet, 11 inches in height, and the father is 6 feet, 7 inches in height. The average age by sonography is 40 weeks' gestational age. The remainder of the examination is unremarkable. What is the most likely diagnosis?
Normal growth from tall parents
What is the point of a biophysical profile?
Objective means for assessing fetal well being
What is grade 2 placenta?
Occasional basal calcifications with indentations of the chorionic plate
What is grade 1 placenta?
Occasional parenchymal calcifications
A 36-year-old woman is seen for a sonogram for an elevated alpha fetoprotein value at 17 weeks' gestation. A large protrusion of abdominal contents is identified, contained within a membrane. What is the most likely diagnosis?
Omphalocele
Incomplete breech?
One foot first
What vessels are in the umbilical cord?
One vein two arteries
A 25-year-old woman has a sonogram at an outpatient imaging center that revealed lateral ventricles measuring 14.2 mm and is referred to a maternal-fetal center. The patient declined alpha fetoprotein testing. Sonographic evaluation may reveal what?
Open NTD
What is a functional cyst?
Ovarian in origin and responds to cyclic hormonal changes
What does a surge in LH levels trigger?
Ovulation and initiates the conversion of the residual follicle into the corpus luteum
What does visualization of a corpus luteal cyst indicate?
Ovulation has occured (its a ruptured graafian follicle)
A 22-year-old woman with irregular menses presents for a transvaginal sonogram. The right ovary contains 15 follicles in the periphery measuring 3 to 6 mm in diameter. The left ovary and the uterus appear normal. The sonographic findings are compatible with:
PCOS
A 31-year-old woman with irregular menses and infertility presents for pelvic sonography. The ovaries have eight follicles measuring 3 to 6 mm in diameter. The most likely reason for this sonographic finding is:
PCOS
An 18-year-old female college student presents to the emergency department with pelvic pain. Initial laboratory work shows an elevated WBC count, elevated ESR, negative human chorionic gonadotropin, and normal urinalysis. During a pelvic examination, the patient experiences severe pain with any manipulation of the cervix. Sonography of the pelvis was ordered for suspected PID. On transabdominal sonogram, the uterus and ovaries appear normal with no free fluid seen. The patient refused endovaginal sonography because of the pain. What is the likely diagnosis?
PID is still likely, even with normal transabdominal sonogram
What is the most common clinical presentation of endometrial adenocarcinoma?
PMB
A detailed sonogram shows a large "keyhole" bladder in the fetus and oligohydramnios. The fetal kidneys are not well visualized, but large tubular structures are seen arising from the bladder. What is the most likely diagnosis?
PUV
What is the most common cause of bladder outlet obstruction?
PUV
What are the two types of IUD?
Paraguard (copper T) and Mirena
A 25-year-old woman is referred for a pelvic sonogram because of left lower quadrant pain. A pregnancy test is negative. The sonogram reveals a 2.0 cm unilocular, simple cyst adjacent to the left ovary. Which of the following statements is true regarding this finding?
Paraovarian cyst
Which cyst is located in the broad ligament?
Paraovarian cyst
What is semilobar holoprosencephaly?
Partial cleavage of the forebrain and absence of the corpus callosum
What causes bicornuate uterus?
Partial fusion of the mullerian ducts during embryologic development
A 41-year-old woman is seen by her obstetrician with vaginal bleeding and hyperemesis. Clinical examination reveals a uterus consistent with a 12-week gestation, which is inconsistent with her predicted 10-week gestation by last menstrual period. An ultrasound is performed and reveals a fetus without heart motion and a crown-rump length consistent with an 8-week gestation. An enlarged placenta is identified containing numerous small cystic lesions. This is most suggestive of which of the following?
Partial hydatidiform mole
How can septate uterus be treated?
Patient can have septum removed by hysteroscopy if infertility occurs
Severe IUGR is noted on a 30-week fetus. The patient denies having diabetes or lupus, and the fetus appears otherwise normal. What other factor could play a role in the growth of this fetus?
Patient has hypertension
An adnexal mass is palpated in a 34-year-old woman with pelvic pressure. Pelvic sonography reveals a 4 cm solid adnexal mass with a normal-appearing ovary adjacent to the mass. What is the most likely diagnosis?
Pedunculated fibroid
Who are endo polyps more prevalent in?
Peri or postmenopausal women
A 45-year-old woman with menorrhagia undergoes a pelvic sonogram that reveals a multiloculated cystic mass adjacent to the right ovary. The patient's medical history includes prior pelvic surgery for endometriosis 15 years ago. The patient denies any right lower quadrant pain. Which of the following is the most likely diagnosis?
Peritoneal inclusion cyst
Which cyst is caused by adhesions?
Peritoneal inclusion cyst
Where is the height (thickness) of the uterus measured?
Perpendicular to the length
A sonographic evaluation at 10 weeks' gestation reveals a small anterior abdominal wall defect. What is the most likely diagnosis at this gestational age?
Physiological gut herniation
What can a transverse lie be indicative of?
Placenta previa
4-A 39-year-old woman, gravida 4, para 3, is seen for an obstetric sonogram at 33 weeks' gestation for late prenatal care. The sonographer identifies placenta previa and observes a cesarean section scar, which is confirmed by the patient. The sonographer should also look for signs suggesting which additional abnormality?
Placental accreta
A 21-year-old woman is seen for an obstetric examination with an indication of large for gestational age at 28 weeks by first-trimester sonography. The sonogram shows a fetus measuring 28 weeks. The AFI is 25 cm. What is the most likely diagnosis?
Polyhydramnios
If the fetus looks like a small fish in a big fish bowl, what are they experiencing?
Polyhydramnios
Which women are most affected by endometrial carcinoma?
Postmeno
Which women are most likely to present with malignancy in their ovarian pathology?
Postmenopausal
What is the function of progesterone?
Preparing the endo for possible implantation
A patient with an IUD in place has a positive pregnancy test. A sonogram reveals a 7-week, viable gestation within the uterus. The IUD is identified in the lower uterine segment; however, the strings are not visible to the obstetrician. Leaving the IUD in situ during the pregnancy increases the risk for which complication?
Preterm labour
What is the function of the ovaries?
Produce ova
What is pyosalpinx?
Progression of PID in which the fallopian tubes become swollen with purulent exudates
If there is no echogenic ring what should we be suspicious of? What is this associated with?
Pseudogestational sac associated with ectopic
The absence of the thick echogenic rim surrounding the early gestational sac within the endometrial cavity is suspicious for:
Pseudogestational sac of ectopic pregnancy
A patient is seen with heavy bleeding 7 days after delivery of a 36-week infant. Ultrasound reveals an enlarged postpartum uterus containing an echogenic mass. What does this suggest?
RPOC
What is the most common complication of the uterus after delivery?
RPOC
What is a Sertoli-Leydig tumour?
Rare ovarian neoplasm occurring predominantly in menstruating women
Where is the most common site for fluid to accumulate in the female pelvis?
Rectouterine pouch