FINAL STUDY GUIDE OB/GYN DMS

DUCTUS ARTERIOSUS

+ + NOW WE WILL EXAMINE ANOTHER SHUNT FOUND IN FETAL CIRCULATION. + THE SECOND SHUNT IN THE FETAL CIRCULATORY SYSTEM IS THE DUCTUS ARTERIOSUS. + THIS SHUNT CONNECTS THE PULMONARY ARTERY TO THE AORTIC ARCH. + THROUGH THIS VESSEL, BLOOD THAT HAS A MEDIUM OXYGEN SATURATION LEVEL IS DIVERTED FROM THE LUNGS, BECAUSE THE LUNGS ARE NOT YET FUNCTIONING AND ONLY NEED ENOUGH PERFUSION TO CONTINUE TO GROW AND DEVELOP. + THE DUCTUS ARTERIOSUS PROTECTS THE LUNGS FROM CIRCULATORY OVERLOAD. + IT ALSO ALLOWS THE RIGHT VENTRICLE OF THE FETAL HEART TO STRENGTHEN. +

WHAT ARE THE CAUSES OF FETAL DEMISE

+ AN IMMINENT ABORTION IS DEFINED AS PROFUSE BLEEDING WITH THE CERVIX BEGINNING TO DILATE. THE SAC MAY BE LOW IN THE UTERINE CAVITY. + FETAL DEMISE IS DEFINED AS A CLEARLY IDENTIFIABLE FETAL POLE WITH NO FETAL HEART MOTION (FHM). THE FINDINGS MUST BE PERSONALLY VIEWED AND CONFIRMED BY THE RADIOLOGIST OR OBSTETRICIAN. + A MISSED ABORTION IS THE RETENTION OF A DEAD EMBRYO OR FETUS IN THE FIRST TRIMESTER. +

ANENCEPHALY AND ITS ASSOCIATED COMPLICATIONS

+ ANENCEPHALY IS THE ABSENCE OF THE CEREBRAL HEMISPHERES OF THE BRAIN, AS WELL AS THE OVERLYING SKULL AND SCALP. + ONLY THE STRUCTURES AT THE BASE OF THE BRAIN ARE PRESENT. + THIS ANOMALY CAN BE VISUALIZED ON TRANSVAGINAL ULTRASOUND BY NINE TO TEN WEEKS OF GESTATION. + ANENCEPHALY IS THE MOST COMMON AND SEVERE FORM OF NEURAL TUBE DEFECT. IT IS LETHAL. IT IS 37 TIMES MORE COMMON IN FEMALES THAN MALES. THE RECURRENCE RATE IN FAMILIES CAN BE AS HIGH AS 35%. + IT IS MOST COMMON IN AREAS OF THE WORLD WHERE SPINA BIFIDA IS COMMON, IN IRELAND, SCOTLAND, WALES, EGYPT, AND NEW ZEALAND. THE LOWEST INCIDENCE IS IN JAPAN. THE INCIDENCE APPEARS TO BE HIGHEST IN POPULATIONS OF CELTIC ORIGIN. +

WHAT ARE THE CAUSES OF ECTOPIC PREGNANCY

+ ANYTIME THAT A FERTILIZED OVUM IMPLANTS IN A LOCATION OUTSIDE THE ENDOMETRIAL CAVITY (FUNDUS, CORPUS), WE CALL IT AN ECTOPIC PREGNANCY. A SUSPECTED ECTOPIC PREGNANCY IS A LIFE THREATENING SITUATION. NEVER SEND A PATIENT HOME WHEN ECTOPIC PREGNANCY CANNOT BE RULED OUT. AN ORDER TO RULE OUT ECTOPIC PREGNANCY IS ALWAYS A STAT EXAMINATION. DIAGNOSIS OF ECTOPIC PREGNANCY IS MADE THROUGH A COMBINATION OF CLINICAL INFORMATION, LEVELS OF BETA HCG, AND THROUGH THE INFORMATION GAINED IN AN ULTRASOUND EXAMINATION. ULTRASOUND ALONE IS NOT ALWAYS DEFINITIVE IN RULING OUT AN ECTOPIC. +

WHAT ARE THE UTERINE POSITIONS AFTER DELIVERY

+ BY ONE WEEK AFTER BIRTH, THE FUNDUS OF THE UTERUS SHOULD BE JUST SUPERIOR TO THE UMBILICUS. + THE UTERUS IS SLIGHTLY RETROVERTED AND DEXTROVERTED (TO THE RIGHT) AFTER BIRTH. THIS IS KNOWN AS PHYSIOLOGIC RIGHT TORSION OF THE UTERUS. + REGRESSION OF THE UTERUS TO ITS NORMAL SIZE AND SHAPE IS PROGRESSIVE, AND IS USUALLY EVALUATED BY MANUAL EXAMINATION. + THE SIZE AND SHAPE OF THE UTERUS IS SOMEWHAT VARIABLE ON ULTRASOUND, AND DEPENDS UPON THE TIME AT WHICH THE UTERUS IS EXAMINED AFTER BIRTH. +

ENDOCARDIAL CUSHION DEFECT

+ ENDOCARDIAL CUSHION DEFECTS (AV DEFECTS) OCCUR WHEN THE ATRIO-VENTRICULAR ORIFICE FAILS TO SEPARATE INTO THE TRICUSPID AND MITRAL VALVES. TWO MAJOR FORMS OF ENDOCARDIAL CUSHION DEFECTS ARE COMPLETE AV CANAL AND PARTIAL AV CANAL. + THE ULTRASOUND APPEARANCE MAY VARY IN THESE CONDITIONS IN RELATION TO THE SEVERITY. + THIS DEFECT IS ASSOCIATED WITH DOWN'S SYNDROME. +

WHAT IS ENDOMETRIOSIS

+ ENDOMETRIOSIS IS DEFINED AS THE PRESENCE OF ENDOMETRIAL TISSUE OUTSIDE OF THE ENDOMETRIAL CAVITY OF THE UTERUS, + OR + IT CAN ALSO BE DEFINED AS THE GROWTH AND PROLIFERATION OF ENDOMETRIAL TISSUE IN LOCATIONS OTHER THAN THE ENDOMETRIAL CAVITY. THE GLANDS AND STROMA OF THE UTERINE LINING (ENDOMETRIUM) CONTINUE TO RESPOND TO HORMONAL INFLUENCES AND PROLIFERATE IN ECTOPIC LOCATIONS. THIS MEANS THAT EACH MONTH BLEEDING AND, THEREFORE, GROWTH OF THE TISSUE OCCURS. IT IS CONSIDERED TO BE A BENIGN PROCESS. COMPLICATIONS INCLUDE ADHESIONS, SCAR FORMATION, AND BLOCKAGE OF THE FALLOPIAN TUBES. +

FETAL PSEUDOASCITES

+ FETAL ASCITES IS FREE FLUID WITHIN THE FETAL PERITONEAL CAVITY. THIS CONDITION MAY BE SEEN WITH FETAL HYDROPS, BOWEL PERFORATION, URINARY ASCITES RELATED TO BLADDER OUTLET OBSTRUCTION, HEART FAILURE, AND TWIN TWIN TRANSFUSION SYNDROME. IF HYPOECHOIC STERILE MECONIUM ASSOCIATED WITH BOWEL PERFORATION OCCURS, AND LEAKS INTO THE PERITONEUM, BRIGHT ECHOGENIC FOCI IN THE FLUID MAY BE VISUALIZED ON ULTRASOUND. + SOMETIMES A HYPOECHOIC RING AROUND THE ABDOMINAL WALL MAY SIMULATE ASCITES. THIS IS CALLED PSEUDOASCITES. THE HYPOECHOIC RING AROUND THE ABDOMINAL WALL REPRESENTS THE HYPOECHOIC ABDOMINAL MUSCULATURE. +

FETAL DEMISE

+ FETAL DEMISE IS ALSO KNOWN AS FETAL DEATH. + WHEN DEMISE OCCURS AT LESS THAN 20 WEEKS OF GESTATION IT IS CLASSIFIED AS AN ABORTUS. + WHEN FETAL DEMISE OCCURS AT 20 WEEKS OR BEYOND, OR THE FETUS WEIGHS MORE THAN 500 GRAMS, IT IS CLASSIFIED AS A STILLBIRTH. A DEATH CERTIFICATE MUST BE COMPLETED. +

FIBROIDS CLASSIFICATION

+ FIBROIDS OR MYOMAS ARE CLASSIFIED IN RELATION TO THEIR POSITION WITHIN THE UTERINE WALL. + THE MOST COMMON TYPE IS THE INTRAMURAL. THIS TYPE DEVELOPS INTERSTITIALLY WITHIN THE MYOMETRIUM. + THE SUBSEROSAL TYPE DEVELOPS CLOSE TO THE PERITONEAL SURFACE OF THE UTERUS AND MAY SIGNIFICANTLY DISTORT THE CONTOUR OF THE UTERUS. + THE SUBMUCOSAL TYPE FORMS AND GROWS NEAR THE ENDOMETRIUM AND MAY DISTORT THE ENDOMETRIAL STRIPE. SUBMUCOSAL FIBROIDS ARE LESS COMMON, BUT CAUSE THE MOST SYMPTOMS. + PEDUNCULATED FIBROIDS ARISE FROM SUBSEROSAL FIBROIDS. THEY CAN GROW AWAY FROM THE MYOMETRIUM ON A PEDICLE. TORSION CAN OCCUR CAUSING PAIN, INFARCTION, DEGENERATION AND NECROSIS. +

WHAT IS FITZHUGH-CURTIS SYNDROME AND WHAT IS IT ASSOCIATED WITH

+ FITZHUGH-CURTIS SYNDROME OCCURS WHEN PID PROGRESSES TO PERITONITIS OR ABSCESS. THE FREE FLUID IN THE PELVIS OF THE PATIENT WITH PID TRAVELS UP THE PARACOLIC GUTTERS AND INTO THE SUBHEPATIC SPACE (MORRISON'S POUCH). + THIS FLUID CAUSES PERI-HEPATIC AND DIAPHRAGMATIC INFLAMMATION. +

GESTATIONAL TROPHOBLASTIC DISEASE

+ GESTATIONAL TROPHOBLASTIC DISEASE INVOLVES A GESTATIONAL EVENT IN WHICH THERE IS AN + ABNORMAL PROLIFERATION OF THE TROPHOBLAST. TROPHO MEANS "NUTRITION" AND BLAST MEANS "BUD" OR "EARLY DEVELOPMENT CELL". + AN ABNORMAL CHROMOSOMAL KARYOTYPE IS PRESENT. THERE ARE SEVERAL TYPES OF GESTATIONAL TROPHOBLASTIC DISEASE. + SOME TYPES ARE BENIGN, AND SOME ARE MALIGNANT. + VERY RARELY, WE SEE A TYPE OF TROPHOBLASTIC DISEASE THAT IS NOT LINKED TO A GESTATIONAL EVENT. NON-GESTATIONAL TROPHOBLASTIC DISEASE INCLUDES CHORIOCARCINOMA OF THE OVARIES OR TESTES. +

VAGINAL ANOMALIES (VAGINAL AGENESIS)

+ HEMATOCOLPOS, + HEMATOMETRA, AND + HEMATOMETROCOLPOS ARE ALL CONDITIONS THAT ARE SEQUELA OF FAILURE OF THE TISSUE TO RUPTURE, TRANSVERSE SEPTA WITHIN THE UPPER PORTION OF THE VAGINA, OR FAILURE OF THE SINOVAGINAL BULBS TO DEVELOP, OR DEVELOP PROPERLY. HEMATOCOLPOS IS THE RETENTION OF BLOOD IN THE VAGINA. HEMATOMETRA IS THE RETENTION OF MENSTRUAL BLOOD IN THE UTERUS. HEMATOMETROCOLPOS IS THE RETENTION OF MENSTRUAL BLOOD IN THE UTERUS AND VAGINA. + VAGINAL AGENESIS IS THE ABSENCE OF THE VAGINA. + VAGINAL ATRESIA REFERS TO THE LACK OF NORMAL VAGINAL DEVELOPMENT. +

POLYHYDRAMNIOS IS ASSOCIATED WITH WHICH CONDITIONS

+ IN 60 % OF THE CASES THE CAUSE OF POLYHYDRAMNIOS IS UNKNOWN. + IT CAN BE RELATED TO A FETAL FACTOR SUCH AS A GI TRACT ANOMALY THAT CREATES A BLOCKAGE AND PREVENTS THE FETUS FROM SWALLOWING. THIS COULD BE CAUSED BY A MASS IN THE NECK OR THORAX. + IT COULD ALSO BE RELATED TO A MATERNAL FACTOR, SUCH AS MATERNAL DIABETES. + -CONJOINED TWINS

WHAT IS THE MOST COMMON CONGENITAL FETAL DEFECT AFFECTING THE HEART

+ IN OUR LECTURE TODAY WILL DISCUSS THE FETAL CIRCULATORY SYSTEM, AND CONTRAST AND COMPARE THE FETAL CIRCULATION TO THAT OF THE ADULT CIRCULATION. + ALSO INCLUDED IN OUR DISCUSSION WILL BE THE MORE COMMON OF THE FETAL CONGENITAL HEART ANOMALIES. THESE INCLUDE + SEPTAL DEFECTS, + VENTRICULAR HYPERTROPHY, + HYPOPLASTIC HEART SYNDROMES, + COARCTATION OF THE AORTA, + ENDOCARDIAL CUSHION DEFECTS, + TETRALOGY OF FALLOT, + EBSTEIN'S ANOMALY, + TRANSPOSITION OF THE GREAT ARTERIES, AND + TRUNCUS ARTERIOSUS. +

WHAT CAN BE HELPFUL IN DIAGNOSIS OF RENAL AGENESIS

+ IT IS MORE COMMON IN MALE FETUSES THAN IN FEMALES. + SEVERE OLIGOHYDRAMNIOS WILL BE SEEN BETWEEN 16 AND 28 WEEKS. THIS IS BECAUSE THE AMOUNT OF URINE VOLUME PRODUCED BY THE FETUS IS NOT SIGNIFICANT UNTIL ABOUT 18-20 WEEKS. AFTER 20 WEEKS, THE FETUS MODIFIES THE URINE VOLUME BY SWALLOWING AND URINATION. + SEVERE OLIGOHYDRAMNIOS DOES NOT ALLOW THE FETAL LUNGS TO MATURE AND NEONATAL DEATH IS DUE TO PULMONARY HYPOPLASIA. + ALTHOUGH THE PRIMARY US FINDING IN BILATERAL RENAL AGENESIS IS INABILITY TO VISUALIZE THE RENALS, SECONDARY SIGNS INCLUDE AN ABSENT BLADDER, OLIGOHYDRAMNIOS, FACIAL ANOMALIES, AND CLUBFOOT (TALIPES EQUINOVARUS), WHICH RESULTS DUE TO LACK OF CUSHIONING BY THE AMNIOTIC FLUID. IF ONE KIDNEY IS PRESENT AND FUNCTIONING, THESE SECONDARY SIGNS WILL BE ABSENT. PLEASE REMEMBER THAT THE ADRENAL GLANDS ARE LARGER IN THE FETUS. THEY MAY SOMETIMES SIMULATE THE APPEARANCE OF KIDNEYS. +

UTERINE ATONY AND ITS ULTRASOUND APPEARANCE

+ LET US FIRST DISCUSS ACUTE POSTPARTUM HEMORRHAGE. + AFTER BIRTH, THE UTERUS MUST CONTRACT IN ORDER TO COMPRESS THE BLOOD VESSELS AT THE SITE OF DETACHMENT OF THE PLACENTA. IF THE UTERUS FAILS TO DO THIS, BLEEDING WILL OCCUR AT THE SITE. THIS IS KNOWN AS UTERINE ATONY AND IS THE MOST COMMON CAUSE OF ACUTE POSTPARTUM HEMORRHAGE. DAMAGE AND LACERATION OF THE SOFT TISSUES OF THE CERVIX, VAGINA, OR PERINEUM MAY ALSO BE THE CAUSE OF ACUTE POSTPARTUM HEMORRHAGE. + THE TREATMENT FOR UTERINE ATONY IS MANUAL MASSAGE OF THE UTERUS WITH THE PATIENT IN A SUPINE POSITION. IF THIS IS NOT EFFECTIVE, AN IV DRIP OF OXYTOCIN MAY BE ADMINISTERED. IF NEITHER OF THESE TREATMENTS IS EFFECTIVE, BLOOD TRANSFUSIONS WITH EXPLORATORY SURGERY ARE WARRANTED. ON ULTRASOUND, + THERE IS NO CHANGE IN THE UTERINE APPEARANCE FROM THAT OF A NORMAL POSTPARTUM UTERUS. IN OTHER WORDS, UTERINE ATONY CANNOT BE DETECTED THROUGH AN ULTRASOUND EXAMINATION. +

TERATOGENIC AGENT AND THEIR ADVERSE EFFECT ON FETUS, WHEN DO THEY AFFECT THE FETUS THE MOST

+ SOME DRUGS AND SUBSTANCES CAN ADVERSELY AFFECT THE FETUS. + NOT ALL DRUGS ARE ASSOCIATED WITH FETAL MALFORMATION, ONLY WITH POOR MATERNAL NUTRITION, AND POOR MATERNAL NUTRITION CAN AFFECT THE FETUS AS IUGR. + SOME DRUGS ARE PROVEN TO BE TERATOGENS. + A TERATOGEN IS ANY CHEMICAL, DRUG, OR INFECTION THAT HAS THE ABILITY TO ALTER MORPHOLOGY OR FUNCTION OF THE FETUS. MICROCEPHALY IS ASSOCIATED WITH EXPOSURE TO ENVIRONMENTAL TERATOGENS

BRENNERS TUMOR

+ THE BRENNER TUMOR IS A + VERY RARE SOLID EPITHELIAL OVARIAN NEOPLASM. IT MAKES UP ONLY 1-2% OF ALL OVARIAN NEOPLASMS. + ON ULTRASOUND, THE TUMOR WILL APPEAR AS A SOLID, + ECHOGENIC, OR HYPOECHOIC MASS WITH CYSTIC SPACES WITHIN. + THESE NEOPLASMS ARE SMALL, TO 8 CM IN SIZE. + THESE TUMORS OCCUR MORE OFTEN IN THE POSTMENOPAUSAL PATIENT WHO IS IN HER 50 S OR 60 S. + ULTRASOUND IS UNABLE TO DIFFERENTIATE BETWEEN A BRENNER TUMOR AND OTHER SOLID OVARIAN TUMORS, SUCH AS FIBROMAS, THECOMAS, OR PEDUNCULATED MYOMAS OF THE UTERUS. +

WHAT ARE THE SONOGRAPHIC CRITERIA FOUND IN CASE OF ECTOPIC PREGNANCY

+ LETS TALK ABOUT THE DIFFERENT ULTRASOUND APPEARANCES OF AN IUP, VERSUS AN ECTOPIC PREGNANCY. AN ECHOGENIC ENDOMETRIUM MAY BE INDICATIVE OF A VERY EARLY IUP, OR AN ECTOPIC PREGNANCY. AN IUP WILL DEMONSTRATE A GESTATIONAL SAC WITH THE DOUBLE SAC SIGN REPRESENTING THE DECIDUA PARIETALIS AND THE DECIDUAL CAPSULARIS. A PSEUDO GESTATIONAL SAC IS A SINGLE DECIDUAL LAYER SURROUNDING AN ENDOMETRIAL FLUID COLLECTION. THIS IS NOT A TRUE INTRAUTERINE PREGNANCY, JUST A DECIDUAL REACTION TO THE ECTOPIC. IT IS FORMED BY A DECIDUAL CAST. IN THE CASE OF AN INTERSTITIAL PREGNANCY, THE SAC IS LOCATED ADJACENT TO THE UTERINE CORNUA. IT MAY BE DETECTED LATER BECAUSE THERE IS SLIGHTLY MORE ROOM FOR GROWTH IN THIS LOCATION. IT IS CONSIDERED MORE DANGEROUS THAN AN ECTOPIC LOCATED IN THE FALLOPIAN TUBE. RARELY, THE GESTATIONAL SAC IS LOCATED BELOW THE LEVEL OF THE INTERNAL OS. THIS IS CONSIDERED AN ECTOPIC PREGNANCY TOO. ANOTHER POSSIBILITY, WHEN THE SAC IS VISUALIZED BELOW THE INTERNAL OS, IS AN ABORTION IN PROGRESS. IF A PREGNANCY IS LOCATED IN THE TUBE, AND HAS NOT RUPTURED, THE ONLY WAY TO DIFFERENTIATE BETWEEN A SIMILAR APPEARING ADNEXAL MASS IS THROUGH THE VISUALIZATION OF A GESTATIONAL SAC WITH A FETAL POLE AND CARDIAC ACTIVITY. MANY TIMES DOPPLER WILL DEMONSTRATE THE "RING OF FIRE" SURROUNDING THE ECTOPIC IN THE ADNEXAL SPACE. IF THE PREGNANCY IS LOCATED IN THE TUBE AND HAS RUPTURED, OR IS LEAKING, THE FORMATION OF A COMPLEX MASS WILL OCCUR THAT CHANGES WITH TIME. LOOK FOR FLUID IN THE CUL DE SAC AND GUTTERS IF WARRANTED. AN ABDOMINAL PREGNANCY IS USUALLY DIAGNOSED LATER THAN A TUBAL PREGNANCY. RUPTURE IN A TUBAL PREGNANCY IS USUALLY BETWEEN 6-12 WEEKS. VISUALIZATION OF AN EXTRA UTERINE PREGNANCY OF MORE THAN 12 WEEKS IS SUGGESTIVE OF AN ABDOMINAL PREGNANCY. AN ABDOMINAL PREGNANCY IS SOMETIMES DIFFICULT TO DIAGNOSE, AND CONSIDERED VERY DANGEROUS FOR THE MOTHER. A CONCURRENT ECTOPIC PREGNANCY AND IUP IS POSSIBLE, ALTHOUGH RARE. IT IS BECOMING MORE COMMON WITH THE USE OF OVULATION INDUCTION THERAPY FOR INFERTILITY. +

WHAT CONDITIONS ARE ASSOCIATED WITH OLIGOHYDRAMNIOS

+ OLIGOHYDRAMNIOS IS RARELY UNEXPLAINED. SOME OF THE MOST COMMON CAUSES OF OLIGOHYDRAMNIOS ARE + PROM (PREMATURE RUPTURE OF MEMBRANES), + IUGR (INTRAUTERINE GROWTH RESTRICTION), AND + ABNORMALITIES OF THE FETAL GENITOURINARY TRACT. SINCE MOST OF THE AMNIOTIC FLUID IS PRODUCED BY THE FETUS AFTER 20 WEEKS OF GESTATION, ANYTHING THAT CAUSES BLOCKAGE OF THE FLOW OF URINE, OR THE LACK OF FUNCTIONING RENALS WILL RESULT IN DIMINISHED AMNIOTIC FLUID. +

WHAT IS OSTEOGENESIS IMPERFECTA

+ OSTEOGENESIS IMPERFECTA IS AN INHERITED DISORDER IN WHICH + THERE IS A LACK OF PRODUCTION OR SECRETION OF COLLAGEN. + THE RESULT IS AN ABNORMAL FRAGILITY OF THE BONES, DUE TO HYPOMINERALIZATION OF THE ENTIRE SKELETON. + THE BONES CAN BE FRACTURED OR DEFORMED EASILY. + STILLBIRTH IS POSSIBLE, DUE TO CRANIAL FRACTURE AT BIRTH. +

WHAT IS POVT AND THE ULTRASOUND FINDINGS ASSOCIATED WITH THIS COMPLICATION

+ OVARIAN VEIN THROMBOPHLEBITIS (POVT) IS AN INFLAMMATION OF THE OVARIAN VEIN DUE TO THROMBUS. THE OVARIAN VEIN ONLY MAY BE INVOLVED, BUT IT CAN EXTEND TO, OR INVOLVE THE PELVIC AND FEMORAL VEINS. + THIS IS A RARE CONDITION (.2%) IN NORMAL DELIVERIES. + IT IS HIGHER IN PATIENTS WHO HAVE HAD A CESAREAN SECTION. + THE DEVELOPMENT OF POVT IS RELATED TO VIRCHOW'S TRIAD. PATIENTS WHO HAVE UNDERGONE A C SECTION ARE HOSPITALIZED LONGER, AND HAVE MORE LIMITED MOBILITY, THUS THE RISK OF THROMBUS IS GREATER. IT IS ALSO POSSIBLE THAT INJURY TO THE VEINS MAY OCCUR AT THE TIME OF DELIVERY. IN MOST CASES, INFECTION IS PRESENT PRIOR TO THE ONSET OF OVARIAN VEIN THROMBOPHLEBITIS. THE RIGHT OVARIAN VEIN IS MORE COMMONLY AFFECTED THAN THE LEFT. THIS IS BECAUSE OF THE PRESSURE EXERTED ON THE RIGHT OVARIAN VEIN, DUE TO PHYSIOLOGIC RIGHT TORSION OF THE UTERUS AFTER DELIVERY. +

KEYHOLE APPEARANCE IS ASSOCIATED WITH WHAT CONDITION IN MALE FETUSES

+ POSTERIOR URETHRAL VALVES (PUV) ARE THE MOST COMMON CAUSE OF SEVERE OBSTRUCTIVE UROPATHY. + IT AFFECTS 1 IN 5,000 TO 8,000 MALE FETUSES. + THIS CONDITION OCCURS WHEN THERE ARE EXTRA (REDUNDANT) MEMBRANOUS FOLDS IN THE POSTERIOR URETHRA THAT BLOCK THE FLOW OF URINE FROM THE BLADDER, AND LEAD TO DIFFERENT DEGREES OF GU TRACT OBSTRUCTION. + ULTRASOUND FEATURES INCLUDE + AN ENLARGED BLADDER + WITH A THICKENED WALL, + DILATED URETERS, + A "KEYHOLE" APPEARANCE DUE TO THE DILATED URETHRA, AND + OLIGOHYDRAMNIOS. GENITOURINARY TRACT ANOMALIES ARE ASSOCIATED WITH OLIGOHYDRAMNIOS IN MOST CASES, DUE TO LACK OF FETAL URINATION RELATED TO BLOCKAGE OF URINE FLOW AT SOME LEVEL. +

PUV

+ POSTERIOR URETHRAL VALVES (PUV) ARE THE MOST COMMON CAUSE OF SEVERE OBSTRUCTIVE UROPATHY. + IT AFFECTS 1 IN 5,000 TO 8,000 MALE FETUSES. + THIS CONDITION OCCURS WHEN THERE ARE EXTRA (REDUNDANT) MEMBRANOUS FOLDS IN THE POSTERIOR URETHRA THAT BLOCK THE FLOW OF URINE FROM THE BLADDER, AND LEAD TO DIFFERENT DEGREES OF GU TRACT OBSTRUCTION. + ULTRASOUND FEATURES INCLUDE + AN ENLARGED BLADDER + WITH A THICKENED WALL, + DILATED URETERS, + A "KEYHOLE" APPEARANCE DUE TO THE DILATED URETHRA, AND + OLIGOHYDRAMNIOS. GENITOURINARY TRACT ANOMALIES ARE ASSOCIATED WITH OLIGOHYDRAMNIOS IN MOST CASES, DUE TO LACK OF FETAL URINATION RELATED TO BLOCKAGE OF URINE FLOW AT SOME LEVEL. +

WHAT IS POST PARTUM HEMORRHAGE

+ POSTPARTUM HEMORRHAGE IS DEFINED AS A + BLOOD LOSS OF GREATER THAN 500 ML. + THIS ONLY OCCURS IN LESS THAN 5% OF ALL DELIVERIES, + HOWEVER, IT CAN BE LETHAL AND IS + THE CAUSE OF 35% OF MATERNAL DEATHS. BLOOD TRANSFUSIONS MAY BE GIVEN IF WARRANTED. + POSTPARTUM HEMORRHAGE CAN BE BROKEN DOWN INTO TWO CATEGORIES. THE FIRST IS ACUTE. THIS OCCURS WITHIN THE FIRST 24 HOURS AFTER DELIVERY. THE SECOND TYPE IS DELAYED, AND OCCURS FROM 2 TO 31 DAYS AFTER DELIVERY. +

PULMONARY HYPOPLASIA

+ PULMONARY HYPOPLASIA IS A TERM THAT MEANS UNDERDEVELOPMENT OF THE FETAL LUNGS. + PULMONARY HYPOPLASIA CARRIES A POOR PROGNOSIS BECAUSE THE FETUS WILL BE UNABLE TO BREATHE AT BIRTH. + UNDERDEVELOPMENT OF THE LUNGS MAY BE DUE TO AN INTRATHORACIC MASS THAT COMPRESSES THE LUNGS, AN ABDOMINAL MASS THAT COMPRESSES THE LUNGS OR DIAPHRAGM, OLIGOHYDRAMNIOS, OR A SMALL THORAX RELATED TO CERTAIN TYPES OF SKELETAL DYSPLASIAS. +

CAUSES OF ECTOPIC (MORE)

+ SIGNS AND SYMPTOMS RELATING TO ECTOPIC PREGNANCY INCLUDE A POSITIVE PREGNANCY TEST (REMEMBER IF THE BLOOD PREGNANCY TEST IS NEGATIVE, AN ECTOPIC IS NOT A POSSIBILITY), POSSIBLE VAGINAL BLEEDING OR SPOTTING, POSSIBLE AMENORRHEA, PAIN IN THE ADNEXA OR A PALPABLE MASS, AND PAIN IN THE ABDOMEN. THE PAIN MAY REFER TO THE SHOULDER. THIS PAIN IS CAUSED BY BLOOD IN THE PERITONEUM, IF THE ECTOPIC HAS RUPTURED. THE BETA HCG MAY BE FOLLOWED FOR SEVERAL DAYS, AT TIMES, IF THE DIAGNOSIS IS UNCLEAR, AND THE PATIENT IS STABLE. IN A NORMAL PREGNANCY THE HCG INCREASES BY DOUBLING EVERY 2 TO 3 DAYS. THE HCG LEVELS MAY BE TRIPLE THE NORM IN A MOLAR PREGNANCY. A SLOWER RISE OR DECLINE IN HCG LEVELS MAY INDICATE SPONTANEOUS ABORTION OR AN ECTOPIC PREGNANCY. ECTOPIC PREGNANCIES ALWAYS HAVE LOWER LEVELS OF HCG THAN NORMAL.

HOW WE DIFFERENTIATE BETWEEN MYOMAS AND FOCAL MYOMETRIUM CONTRACTIONS

+ SMOOTH MUSCLE CONTRACTIONS OF THE MYOMETRIAL TISSUE + OCCUR THROUGHOUT PREGNANCY. THESE ARE CALLED BRAXTON HICKS CONTRACTIONS. ON ULTRASOUND THEY MAY APPEAR TO BE THICKENED AREAS OF THE MYOMETRIUM BULGING INTO THE AMNIOTIC CAVITY. + THESE ARE NORMAL AND WILL DISAPPEAR WITHIN 30-45 MINUTES. IF YOU THINK A CONTRACTION IS OCCURRING, ASK THE PATIENT TO GET UP, CHANGE POSITION, GO TO THE BATHROOM OR TAKE A LITTLE WALK. THAT SHOULD CAUSE THE CONTRACTION TO DISAPPEAR. CONTRACTIONS ARE HOMOGENEOUS. + TAKE CARE NOT TO CONFUSE CONTRACTIONS WITH FIBROID TUMORS OR PLACENTAL ABNORMALITIES. +

FOUR CHAMBER VIEW (HEART)

+ THE MOST IMPORTANT VIEW OF THE FETAL HEART FOR THE SONOGRAPHER IS THE FOUR CHAMBER VIEW. IN THE FETUS, THE SIZE OF THE ATRIA AND VENTRICLES SHOULD BE ABOUT THE SAME IN SIZE. THIS FOUR CHAMBER VIEW CAN BE ACHIEVED 99 % OF THE TIME IN FETUSES OVER 20 WEEKS OF AGE. IT CAN BE ACHIEVED BY IMAGING THE FETAL THORAX IN THE TRANSVERSE PLANE. + BY OBTAINING A FOUR CHAMBER VIEW OF THE FETAL HEART, 65% OF HEART ABNORMALITIES CAN BE RULED OUT. + THE HEART RATE SHOULD BE DOCUMENTED BY M MODE. THE FETAL HEART RATE VARIES WITH FETAL ACTIVITY AND SHOULD RANGE FROM APPROXIMATELY 120 TO 160 BPM. IN THIS VIEW THE HEART OCCUPIES 1/3RD OF THE FETAL THORAX.

WHAT IS THE NORMAL MEASUREMENT OF PLACENTA AND IN WHAT CONDITIONS ENLARGEMENT OF PLACENTA IS SEEN

+ THE PLACENTA IS A HOMOGENOUS GRANULAR STRUCTURE THAT IS LOCATED ON ONE SIDE OF THE UTERUS. + IT RANGES FROM 1.5 TO 5.0 CM IN THICKNESS. THE BROADER THE ATTACHMENT OF THE PLACENTA, THE THINNER THE PLACENTA WILL APPEAR, AND VICE VERSA. + A PLACENTA IS CONSIDERED TO BE ABNORMAL AND THICKENED WHEN IT MEASURES + GREATER THAN 5 CM IN THE ANTERIOR TO POSTERIOR DIMENSION. THE PLACENTA MEASUREMENT MUST BE TAKEN AT AN ANGLE THAT IS PERPENDICULAR TO THE MYOMETRIUM. THESE FACTORS MAY BE RESPONSIBLE FOR A THICKENED PLACENTA: + Maternal diabetes + Placenta hydrops (RH disease) + Cytomegalovirus + Abruption + Chorioangioma + Fluid overload + Umbilical vein thrombosis + Multiple gestations + Chromosomal abnormality +

WHAT IS PUERPERIUM AND HOW LONG IT LASTS

+ THE POSTPARTUM PERIOD IS ALSO KNOWN AS THE PUERPERIUM. + IT STARTS AFTER THE PLACENTA IS DELIVERED AND + EXTENDS UNTIL THE MOTHER'S ANATOMY AND PHYSIOLOGY HAS RETURNED TO THE PRE-PREGNANT CONDITION. + THIS TIME PERIOD USUALLY LASTS SIX TO EIGHT WEEKS. WHEN THE HIGH LEVELS OF ESTROGEN AND PROGESTERONE DROP AFTER BIRTH, THE MOTHER'S BODY UNDERGOES BOTH PHYSIOLOGIC AND BIOCHEMICAL CHANGES.

UTERINE ANOMALIES (BICORNIS)

+ UTERUS ARCUATUS IS THE MOST MINOR OF THE DEVELOPMENTAL ANOMALIES. IT REPRESENTS A SMALL INDENTATION IN THE FUNDUS OF THE UTERUS. + UTERUS SUBSEPTUS REPRESENTS THE FAILURE OF THE SEPTUM TO RESORB COMPLETELY, CAUSING A SEPARATION OF THE UTERINE CORPUS. + UTERUS BICORNIS HAS TWO PROMINENT UTERINE HORNS. A VARIATION OF UTERUS BICORNIS IS UTERUS UNICORNIS (ONE UTERINE HORN). + WITH UTERUS DIDELPHYS, TWO UTERI ARE PRESENT. TWO CERVICES AND TWO VAGINAS MAY ALSO BE PRESENT. THE PRIMARY DIFFICULTY IN ASSESSING THESE ABNORMALITIES WITH ULTRASOUND IS THE POSSIBILITY THAT THEY WILL NOT BE RECOGNIZED, AND MISINTERPRETATION WILL OCCUR. +

WHAT ARE THE CASES SONOHYSTEROGRAPHY CAN BE USEFUL

-BETTER EVALUATION OF THE UTERINE LINING. -THE SAME PATIENT POSITION AS FOR A TRANSVAGINAL EXAMINATION IS USED. -A SPECULUM IS INSERTED INTO THE VAGINA AND A CATHETER IS INSERTED. + THE INTRODUCTION OF 25-30 ML OF STERILE SALINE IS THEN PERFORMED. + THE FLUID ALLOWS FOR BETTER EVALUATION OF THE UTERINE LINING + WHEN THERE IS A QUESTION OF ENDOMETRIAL POLYPS, SUBMUCOSAL FIBROIDS, ENDOMETRIAL HYPERPLASIA VERSUS UTERINE CANCER, AND PATENCY OF THE FALLOPIAN TUBES. +

SIGNS AND SYMPTOMS OF ECTOPIC PREGNANCY

-LOW HCG LEVELS -POSITIVE BLOOD PREGANCY TEST -VAGINAL BLEEDING OR SPOTTING (POSSIBLE AMENORRHEA) -ADNEXAL MASS OR TENDERNESS -ABDOMINAL PAIN (MAY REFER TO SHOULDER)THIS PAIN IS CAUSED BY BLOOD IN THE PERITONEUM, IF THE ECTOPIC HAS RUPTURED

DIFFERENT TYPES OF FIBROIDS

-PEDUNCULATED FIBROIDS -SUBSEROSAL FIBROID -SUBMUCOSAL FIBROID

SIGNS, SYMPTOMS AND ULTRASOUND FINDINGS OF ENDOMETRIAL CARCINOMA

-POOR, GAINS, END, DELTOID, TRAINING -PULL UPS -HE, HYD, HEM, ENLARGED ,LOB, DIF, FOC, HYPERECHOIC ENDOMETRIAL THICKNESS -HOLCR -CLE

RANGE OF MACROSOMIC FETUS

. MACROSOMIA IS EVALUATED THROUGH FETAL MEASUREMENTS (BPD, AC, FL) AND ESTIMATED FETAL WEIGHT. A MACROSOMIC FETUS IS DEFINED AS A WEIGHT OF OVER 4000 GRAMS. + LINKED TO GESTATIONAL DIABETES

UMBILICAL CORD PROLAPSE (VASA PREVIA)

VASA PREVIA OCCURS WHEN THE FETAL VESSELS FROM THE PLACENTA ARE PRESENT BETWEEN THE INTERNAL OS AND THE PRESENTING FETAL PART. THIS CONDITION OCCURS IN APPROXIMATELY 1:1200 TO 1:15000 PREGNANCIES. FETAL EXSANGUINATION CAN OCCUR DUE TO COMPRESSION OR TEARING OF THE VESSELS DURING LABOR. COLOR DOPPLER IS NECESSARY FOR DEFINITIVE DIAGNOSIS. +

COMPONENTS OF VIRCHOW'S TRIAD

VIRCHOW'S TRIAD CONSISTS OF THREE FACTORS. THEY ARE: -HYPERCOAGUABILITY OF BLOOD, -VENOUS STASIS, -ALTERATIONS IN VEIN WALLS. PATIENTS WHO HAVE ANY OR ALL OF THESE FACTORS ARE AT HIGHER RISK FOR THE DEVELOPMENT OF VENOUS THROMBOSIS.

FETAL DEMISE CAUSES

15% OF RECOGNIZED PREGNANCIES END IN ABORTION. 43% OF ALL PREGNANCIES (RECOGNIZED OR NOT) END IN ABORTION. + WHEN A PREGNANCY FAILS EARLY (IN THE FIRST TRIMESTER), THE MOST COMMON CAUSE IS CHROMOSOMAL ABNORMALITIES OF THE FETUS. THE EARLIER THE LOSS THE MORE LIKELY THAT THE CAUSE IS A CHROMOSOMAL ABNORMALITY. MANY FETUSES STOP DEVELOPMENT AT AROUND 8-10 WEEKS. + OTHER POSSIBLE CAUSES FOR EARLY FETAL DEMISE INCLUDE THE PRESENCE OF AN IUD, VIRUSES, RADIATION EXPOSURE, CERTAIN MATERNAL DISEASES, OR CONGENITAL ANOMALIES OF THE FEMALE REPRODUCTIVE SYSTEM. +

SACROCCOGYGEAL TERATOMA

A SACROCOCCYGEAL TERATOMA IS THE MOST COMMON TUMOR SEEN IN NEONATES. + IT IS COMPOSED OF TISSUES FROM THE THREE PRIMARY LAYERS OF CELLS (GERM CELLS). + IT IS MOST OFTEN LOCATED NEAR THE SACRUM OR COCCYX, BUT DOES NOT INVOLVE THE SPINE. IT CAN BE BENIGN OR MALIGNANT. ON ULTRASOUND, + IT MAY APPEAR AS A MASS THAT IS SOLID, MIXED, OR INTERSPERSED WITH CYSTIC COMPONENTS PROTRUDING FROM THE SACRAL AREA. +

BLOOD FLOW IN FETUS

LET US TRACE THE PATHWAY OF BLOOD FLOW THROUGH THE FETAL CIRCULATORY SYSTEM. OXYGENATED BLOOD FROM THE PLACENTA ENTERS THE FETUS THROUGH THE UMBILICAL VEIN. PART OF THE BLOOD ENTERS THE LIVER AND FOLLOWS THE USUAL PATHWAY THROUGH THE ORGAN AND THROUGH THE HEPATIC VEINS TO THE IVC. THE REMAINDER OF THE BLOOD JOINS WITH BLOOD FROM THE HEPATIC PORTAL VEINS AND TAKES A SHORTCUT AROUND THE LIVER THROUGH THE DUCTUS VENOSUS AND DIRECTLY ENTERS THE IVC. +

WHAT IS KRUKENBERG TUMOR AND ITS ORIGINAL LOCATION

A CLASSIC FORM OF METASTATIC CARCINOMA, THAT INVOLVES THE OVARIES, IS THE KRUKENBERG TUMOR. THIS TUMOR IS COMPOSED OF SIGNET CELLS. + IT ARISES FROM A PRIMARY MALIGNANCY SOMEWHERE ELSE IN THE BODY. + THE MOST COMMON SITE IS THE GI TRACT, HOWEVER, THE PRIMARY MAY BE FROM THE BREAST, LUNG, PANCREAS, OR LYMPHOMA. ULTRASOUND IN UNABLE TO DISTINGUISH BETWEEN AN OVARIAN PRIMARY, AND METASTATIC DISEASE. BILATERAL INVOLVEMENT FAVORS METASTASES. + THE KRUKENBERG TUMOR IS USUALLY BILATERAL. + THE ULTRASOUND APPEARANCE IS VARIABLE. IT MAY APPEAR CYSTIC, MIXED, OR SOLID ON ULTRASOUND. WHEN SMALL, KRUKENBERG TUMORS ARE MORE OFTEN SOLID. AS THEY ENLARGE, THEY MAY BECOME MORE CYSTIC. + THIS NEOPLASM MAY DEMONSTRATE THE "MOTH EATEN SIGN". +

CYSTIC HYGROMA WHAT IS IT

A CYSTIC HYGROMA IS A BENIGN MASS + OF LYMPHATIC ORIGIN. + 80% OF CYSTIC HYGROMAS ORIGINATE FROM THE POSTEROLATERAL PORTION OF THE NECK. + OTHER POSSIBLE LOCATIONS INCLUDE THE AXILLA, GROIN, MEDIASTINUM, AND THORAX. CYSTIC HYGROMAS ARE THOUGHT TO OCCUR DUE TO FAILURE OF DEVELOPMENT OF NORMAL LYMPHATIC VENOUS COMMUNICATION CHANNELS. THIS MEANS THAT THE LYMPHATICS IN THE AFFECTED AREA DO NOT DRAIN PROPERLY. THESE MAY RESOLVE SPONTANEOUSLY PRIOR TO BIRTH, DUE TO FURTHER DEVELOPMENT OF THE LYMPHATIC AND VENOUS COMMUNICATION CHANNELS. IF THEY DO NOT RESOLVE, THE FETUS IS AT RISK FOR DEVELOPMENT OF ASCITES, PLEURAL EFFUSIONS, ETC. + CYSTIC HYGROMAS MAY BE AN ISOLATED FINDING, OR IN SOME CASES MAY BE ASSOCIATED WITH TURNER'S SYNDROME (45XO). TURNER'S SYNDROME RESULTS FROM AN ABNORMAL KARYOTYPE. SOME OF THE CHARACTERISTICS OF TURNER'S SYNDROME ARE LOW BIRTH WEIGHT, SHORT STATURE, EDEMA OF THE HANDS AND FEET, LOOSE SKIN FOLDS ON THE NECK, PROMINENT EARS, AND LACK OF SEXUAL MATURATION. + ON ULTRASOUND, A CYSTIC HYGROMA WILL APPEAR AS A UNILOCULAR OR MULTILOCULAR CYSTIC MASS. +

HORMONE USED TO TRIGGER OVULATION

LH

AMNIOTIC BAND SYNDROME

AMNIOTIC RUPTURE OR TEARING EARLY IN PREGNANCY CAN ALLOW + STRANDS OF AMNION TO WRAP AROUND THE DEVELOPING HAND OR LIMB OF THE FETUS, + LEADING TO ABNORMAL DEVELOPMENT, FUSIONS, OR AMPUTATIONS. IT OCCURS MORE OFTEN IN THE UPPER EXTREMITY, THAN THE LOWER EXTREMITY. IF THE BAND INVOLVES THE HEAD OR ABDOMEN, MORE SEVERE DEFORMITIES CAN OCCUR. AMNIOTIC BAND SYNDROME CAN BE DIAGNOSED WITH ULTRASOUND BY THE PRESENCE OF ASYMMETRICAL LYMPHEDEMA, OR AN AMPUTATED EXTREMITY. THE AMNIOTIC BANDS THEMSELVES ARE NOT ALWAYS VISUALIZED.

WHAT IS GIFT AND WHEN IT IS SUCCESSFUL

AN ALTERNATIVE TO IN-VITRO FERTILIZATION IS GAMETE INTRAFALLOPIAN TRANSFER (GIFT). THIS METHOD CAN BE USED IF THE WOMAN HAS AT LEAST ONE NORMAL TUBE THAT IS OPEN. THE OVA AND SPERM ARE PLACED TOGETHER WITHIN THE FALLOPIAN TUBE. THIS IS ACCOMPLISHED BY INJECTION WITH A CATHETER INTO THE FIMBRIATED END OF THE FALLOPIAN TUBE. IT IS CONSIDERED A MORE NATURAL ALTERNATIVE TO "IN VITRO" FERTILIZATION. GIFT MAY BE INDICATED IN THE PATIENT WHO HAS A HISTORY OF ENDOMETRIOSIS, CERVICAL STENOSIS, OLIGOSPERMIA (LOW SPERM COUNT), IMMUNOLOGIC INFERTILITY, OR UNEXPLAINED INFERTILITY OF GREATER THAN TWO YEARS. +

WHAT IS INVASIVE MOLE

AN INVASIVE MOLE (FORMERLY CALLED CHORIOADENOMA DESTRUENS) IS MALIGNANT, BUT IS CONSIDERED TO BE NONMETASTATIC.

SUBMUCOSAL LEIOMYOMAS AND THEIR AFFECT ON THE ENDOMETRIUM

AN SUBMUCOSAL MYOMA IS LOCATED NEAR THE MUCOSA OF THE ENDOMETRIUM AND MAY CAUSE MORE SYMPTOMS THAN OTHER TYPES -+ FIBROIDS OR MYOMAS ARE CLASSIFIED IN RELATION TO THEIR POSITION WITHIN THE UTERINE WALL. + THE MOST COMMON TYPE IS THE INTRAMURAL. THIS TYPE DEVELOPS INTERSTITIALLY WITHIN THE MYOMETRIUM. + THE SUBSEROSAL TYPE DEVELOPS CLOSE TO THE PERITONEAL SURFACE OF THE UTERUS AND MAY SIGNIFICANTLY DISTORT THE CONTOUR OF THE UTERUS. + THE SUBMUCOSAL TYPE FORMS AND GROWS NEAR THE ENDOMETRIUM AND MAY DISTORT THE ENDOMETRIAL STRIPE. SUBMUCOSAL FIBROIDS ARE LESS COMMON, BUT CAUSE THE MOST SYMPTOMS. + PEDUNCULATED FIBROIDS ARISE FROM SUBSEROSAL FIBROIDS. THEY CAN GROW AWAY FROM THE MYOMETRIUM ON A PEDICLE. TORSION CAN OCCUR CAUSING PAIN, INFARCTION, DEGENERATION AND NECROSIS. +

DUCTUS VENOSUS

THERE ARE THREE SHUNTS PRESENT IN THE FETAL CIRCULATORY SYSTEM. + THE FIRST IS THE DUCTUS VENOSUS. + THIS SHUNT IS A FETAL BLOOD VESSEL THAT CONNECTS THE UMBILICAL VEIN WITH THE IVC, THUS, SHUNTING BLOOD AWAY FROM THE FETAL LIVER. + THE FLOW IS REGULATED BY A SPHINCTER. + THE BLOOD IN THE DUCTUS VENOSUS IS HIGHLY OXYGENATED. THE LIVER DOES NOT NEED AS MUCH OXYGENATED BLOOD AT THIS TIME BECAUSE THE MOTHER'S LIVER IS DOING MUCH OF THE WORK FOR THE FETAL LIVER. WHAT

APPEARANCE, SIZE AND LOCATION OF UTERUS ONE WEEK AFTER DELIVERY

BY ONE WEEK AFTER BIRTH, THE FUNDUS OF THE UTERUS SHOULD BE JUST SUPERIOR TO THE UMBILICUS. + THE UTERUS IS SLIGHTLY RETROVERTED AND DEXTROVERTED (TO THE RIGHT) AFTER BIRTH. THIS IS KNOWN AS PHYSIOLOGIC RIGHT TORSION OF THE UTERUS. + REGRESSION OF THE UTERUS TO ITS NORMAL SIZE AND SHAPE IS PROGRESSIVE, AND IS USUALLY EVALUATED BY MANUAL EXAMINATION. + THE SIZE AND SHAPE OF THE UTERUS IS SOMEWHAT VARIABLE ON ULTRASOUND, AND DEPENDS UPON THE TIME AT WHICH THE UTERUS IS EXAMINED AFTER BIRTH. +

WHAT IS CAMPOMELIC DYSPLASIA

CAMPOMELIC DYSPLASIA IS A LETHAL SKELETAL DYSPLASIA AND + IS AUTOSOMAL RECESSIVE OR SPORADIC IN ITS OCCURRENCE. + IT IS VERY RARE, OCCURRING IN ONLY 1 OUT OF 200,000 PREGNANCIES. + IT IS CHARACTERIZED BY SHORTENING AND BOWING OF THE LONG BONES OF THE LEGS. THE TIBIA AND FIBULA ARE MOST AFFECTED. IT IS ALSO CHARACTERIZED BY A NARROW CHEST, LARGE CALVARIUM WITH A SMALL FACE, AND HYPOPLASTIC SCAPULAE. MOST PATIENTS DIE IN THE NEONATAL PERIOD, DUE TO PULMONARY HYPOPLASIA RELATED TO THE SMALL NARROW CHEST. +

FETAL HYDROPS ARE ASSOCIATED WITH

CHORIOANGIOMA PLEURAL EFFUSION FETAL ASCITES ACCORDING TO STEDMAN'S MEDICAL DICTIONARY, FETAL HYDROPS (AKA: HYDROPS FETALIS) IS + DEFINED AS THE EXCESSIVE ACCUMULATION OF CLEAR, WATERY FLUID IN ANY OF THE TISSUES OR CAVITIES OF THE BODY; SYNONYMOUS, ACCORDING TO ITS CHARACTER AND LOCATION, WITH ASCITES, ANASARCA (FETAL SKIN EDEMA), EDEMA, ETC. + HYDROPS FETALIS REFERS TO THE ABNORMAL ACCUMULATION OF SEROUS FLUID IN FETAL TISSUES. +

DOUBLE BUBBLE SIGN IS REFERRING TO

DUODENAL ATRESIA IS DEFINED AS LACK OF ADEQUATE COMMUNICATION BETWEEN THE DUODENUM AND STOMACH. DUODENAL ATRESIA IS THOUGHT TO REPRESENT A FAILURE OF RECANALIZATION OF THE BOWEL LUMEN THAT IS A SOLID TUBE EARLY IN FETAL LIFE. + IN 1/2 OF CASES, DUODENAL ATRESIA IS NOT AN ISOLATED FINDING, AND IS ASSOCIATED WITH OTHER ANOMALIES. THESE INCLUDE THE VACTERL ANOMALIES, BOWEL MALROTATION AND TRISOMY 21. APPROXIMATELY 30% OF CHILDREN WITH DUODENAL ATRESIA HAVE TRISOMY 21. THE VACTERL ASSOCIATION INCLUDES VERTEBRAL ANOMALIES, ANORECTAL ANOMALIES, CARDIAC ANOMALIES, TRACHEOESOPHAGEAL ANOMALIES, RENAL ANOMALIES, AND LIMB ANOMALIES. +

MOST COMMON TYPE OF CONGENITAL VIRAL INFECTION IN HUMAN

CYTOMEGALOVIRUS

UTERUS DIDELPHYS

FAILURE OF THE DUCTS TO FUSE

DIFFERENCES BETWEEN ADULT CIRCULTATION AND FETAL CIRCULATION

FETAL CIRCULATION PRIOR TO BIRTH DIFFERS FROM THE ADULT CIRCULATORY PATTERN. THIS IS BECAUSE THE PLACENTA DOES THE WORK OF EXCHANGING OXYGEN AND CARBON DIOXIDE THROUGH THE MOTHER'S CIRCULATION. + CERTAIN CHANGES IN FETAL CIRCULATION OCCUR AT BIRTH. + SINCE THE FETAL LUNGS ARE NOT NEEDED FOR BREATHING, THE FETAL CIRCULATORY SYSTEM THEREFORE SHUNTS MOST OF THE BLOOD AWAY FROM THE LUNGS. THE MATERNAL LIVER PERFORMS MOST OF THE FUNCTIONS OF THE FETAL LIVER, SO BLOOD IS SHUNTED AWAY FROM THE FETAL LIVER TO WHERE IT IS MOST NEEDED. + CHANGES IN FETAL CIRCULATION AT BIRTH OCCUR DUE TO PRESSURE CHANGES. IN ORDER TO UNDERSTAND HOW THE FETAL CIRCULATION WORKS, LET US FIRST REVIEW THE PATHWAY OF BLOOD FLOW THROUGH THE ADULT HEART. +

FIBROIDS IN ULTRASOUND

FIBROIDS HAVE A WIDE VARIETY OF ULTRASONIC APPEARANCES. ULTRASOUND EXAMINATION WILL REVEAL THE SIZE AND LOCATION OF UTERINE FIBROIDS AND THEIR IMPACT ON THE UTERINE LINING. POSITION IS MORE IMPORTANT IN MANY CASES THAN SIZE. A FIBROID ON THE OUTSIDE OF THE UTERUS HAS MUCH LESS IMPACT ON PREGNANCY OUTCOMES THAN A SUBMUCOSAL FIBROID WHICH MAY AFFECT THE IMPLANTATION SITE OF THE FETUS AND COMPRESS THE UTERINE CAVITY. + WHEN A FIBROID OUTGROWS ITS BLOOD SUPPLY, DEGENERATION WILL OCCUR. THIS DEGENERATIVE PROCESS GENERALLY CHANGES THE ULTRASOUND APPEARANCE OF THE FIBROID. + CYSTIC DEGENERATION INVOLVES THE CHANGE OF HYALINE TISSUE THROUGH LIQUIFICATION AND NECROSIS. THIS CAN HAVE AN ANECHOIC APPEARANCE ON ULTRASOUND. + CALCIFIC DEGENERATION USUALLY OCCURS IN OLDER PATIENTS (AFTER MENOPAUSE). THIS TYPE OF DEGENERATION APPEARS AS PUNCTUATE ECHOGENIC FOCI OR AS A SOLID MASS WITH DISTAL ACOUSTIC SHADOWING. + HYALINE DEGENERATION INVOLVES THE REPLACEMENT OF NORMAL SMOOTH MUSCLE WITH FIBROUS TISSUE. THIS MAY CAUSE AN INCREASE IN ECHOGENICITY WITHIN THE AREA. +

CHARACTERISTICS OF SYMMETRIC IUGR

HISTORICALLY, IUGR HAS BEEN CATEGORIZED AS SYMMETRIC OR ASYMMETRIC. + IN SYMMETRIC IUGR, THE FETUS IS SYMMETRICALLY SMALL. THERE IS EQUALLY POOR GROWTH VELOCITY OF THE HEAD, ABDOMEN, AND LONG BONES. + IN ASYMMETRIC (HEAD SPARING) IUGR, THE ASYMMETRY RELATES TO DISPROPORTION BETWEEN THE SIZE OF THE HEAD AND THE ABDOMEN. THE HEAD AND LONG BONES ARE SPARED, IN COMPARISON WITH ABDOMEN AND VISCERA. THE BRAIN RECEIVES OXYGEN RICH BLOOD AT THE EXPENSE OF THE BODY. THE HEAD CIRCUMFERENCE / ABDOMINAL CIRCUMFERENCE RATIO IS IMPORTANT IN DETERMINING THE PRESENCE OF ASYMMETRIC IUGR. THIS RATIO IS NOT HELPFUL IN DETERMINING SYMMETRIC IUGR. +

IUGR

INTRAUTERINE GROWTH RETARDATION IS ALSO KNOWN AS INTRAUTERINE GROWTH RESTRICTION. + IT IS DEFINED AS A BIRTH WEIGHT UNDER THE 10TH PERCENTILE. THIS MEANS THAT THE FETUS OR INFANT WEIGHS LESS THAN 10% OF THE PREDICTED FETAL WEIGHT FOR THE GESTATIONAL AGE. + THERE ARE 350,000 INFANTS BORN IN THE US EACH YEAR WHO WEIGH LESS THAN 2500 GRAMS (5 LB, 8 OZ). OF THESE, + ONE THIRD HAVE TRUE IUGR. + THE OTHER TWO THIRDS ARE CONSTITUTIONALLY SMALL. +

WHAT IS THE ETIOLOGY OF FIBROIDS

LEIOMYOMAS ARE ALSO KNOWN AS LEIOMYOMATAS, FIBROIDS, MYOMAS, OR FIBROMYOMAS. LEIOMYOMAS ARE BENIGN MUSCLE TUMORS OF THE UTERUS. THEY ARE THE MOST COMMON TUMOR OF THE FEMALE PELVIS. THEY CONSIST OF LOBULATIONS OF MYOMETRIAL TISSUE WHICH OFTEN DISTORT THE CONTOUR OF THE UTERUS AND THE ENDOMETRIAL STRIPE. IT IS ESTIMATED THAT 20% OF ALL WOMEN GREATER THAN 35 YEARS OF AGE HAVE LEIOMYOMAS. THEY ARE USUALLY MULTIPLE. +

COMMON SYMPTOMS OF FIBROIDS IN UTERUS

LEIOMYOMAS ARE MUCH MORE COMMON IN DARK SKINNED WOMEN. THE INCIDENCE IN THE AFRO-AMERICAN POPULATION IS THOUGHT TO BE AS HIGH AS 40%. + LEIOMYOMAS RANGE IN SIZE FROM 1 MM TO 20 CM. + SIGNS AND SYMPTOMS IN RELATION TO THE PATIENT INCLUDE + 1. PELVIC PAIN ( DUE TO SOME FORM OF DEGENERATION, TORSION OF A PEDUNCULATED MYOMA, OR TUMOR, OR LARGE UTERUS PRESSING ON PELVIC NERVES), + 2. MENORRHAGIA AND HEAVY PROLONGED BLEEDING, OFTEN WITH LARGE BLOOD CLOTS + 3. PATIENTS MAY BE COMPLETELY ASYMPTOMATIC, + 4. BLADDER OR RECTUM PRESSURE MAY OCCUR DUE TO THE LARGE SIZE OF THE FIBROID AND URGENCY MAY RESULT, + 5. LEIOMYOMAS MAY BE THE CAUSE OF INFERTILITY, + 6. SPONTANEOUS ABORTION CAN OCCUR IF THE FETUS IMPLANTS ON A MYOMA. +

REASONS OF INFERTILITY

LESS THAN 20 MILLION SPERM/ML= CLINICAL INFERTILITY

BENIGN OVARIAN TUMOR WHICH PRESENTS WITH ASCITES

MEIG'S SYNDROME MUCINOUS CYSTADENOMA

WHAT IS THE DRUG THAT TREATS ECTOPIC PREGNANCY IN EARLY GESTATION (UP TO 6 WEEKS)

METHOTREXATE

MORE SONOGRAPHIC APPEARANCE OF FIBROIDS

NOW LET'S DISCUSS MORE SONOGRAPHIC APPEARANCES OF FIBROIDS. A FIBROID OR FIBROIDS OF THE UTERUS HAVE A WIDE RANGE OF APPEARANCES AND MAY PRESENT AS: + Subtle changes in echogenicity of myometrium + Well defined masses + A whorled appearance + Hypoechoic to anechoic + Echogenic areas with distal shadowing + Uterine lobulation + Endometrial distortion + Uterine enlargement ALL OF THESE DESCRIPTIONS MAY INDICATE THE PRESENCE OF A FIBROID OR FIBROIDS. CAREFUL ATTENTION BY THE SONOGRAPHER SHOULD BE PAID TO NUMBER, LOCATION, AND ULTRASONIC APPEARANCE OF THE TUMORS. IF POSSIBLE, MEASURE ALL TUMORS IN SAG, TRV, AND AP. +

FORAMEN OVALE

NOW WE COME TO THE THIRD SHUNT FOUND IN THE FETAL CIRCULATORY SYSTEM. + THE THIRD SHUNT OF THE FETAL CIRCULATORY SYSTEM IS THE FORAMEN OVALE. THIS IS A FLAP COVERED OPENING LOCATED BETWEEN THE RIGHT AND LEFT ATRIUM. + BLOOD IS SHUNTED FROM THE RIGHT ATRIUM TO THE LEFT ATRIUM. + MOST OF THE BLOOD FROM THE IVC (HIGHLY OXYGENATED) IS DIRECTED THROUGH THE FORAMEN OVALE. + THIS RESULTS IN THE BRAIN RECEIVING BLOOD THAT IS HIGHLY OXYGENATED, + WHILE BLOOD THAT IS LESS RICH IN OXYGEN IS SHUNTED THROUGH THE DUCTUS ARTERIOSUS AND IS DIRECTED TO THE TRUNK AND LOWER BODY. BLOOD RICH IN OXYGEN IS NOT AS IMPORTANT TO THIS AREA. LET US NOW LOOK AT A DIAGRAM OF FETAL CIRCULATION, AND TRACE THE PATHWAY OF BLOOD FLOW. +

RISK OF DEVELOPING ENDOMETRIAL CARCINOMA

P G E D T

WHAT IS STEIN LEVENTHAL SYNDROME

POLYCYSTIC OVARIAN DISEASE WAS FIRST DESCRIBED IN 1935 BY STEIN AND LEVENTHAL. THIS CONDITION IS ALSO CALLED STEIN LEVENTHAL SYNDROME. + SIGNS AND SYMPTOMS SEEN IN THE PATIENT WITH POLYCYSTIC OVARIAN DISEASE INCLUDE OBESITY. MENSTRUAL ABNORMALITIES, VIRULIZATION WITH HIRSUTISM (HAIR GROWTH IN A MALE BODY PATTERN), AND INFERTILITY. DIAGNOSIS OF THIS SYNDROME IS MADE BY LABORATORY BLOOD VALUES ( LH/FSH RATIO) AND CLINICAL PRESENTATION. +

BOCHDALEK HERNIA IS LOCATED

POSTEROLATERAL ON THE LEFT

PRUNE BELLY TRIAD

PRUNE BELLY TRIAD INCLUDES + DEFICIENT ABDOMINAL MUSCULATURE, + CRYPTOORCHIDISM, AND A + GENITOURINARY ANOMALY (PUV). URINE CANNOT DRAIN FROM THE FETAL BLADDER AND THE BLADDER BECOMES DISTENDED. FETAL ASCITES MAY BE PRESENT AND IN THIS CASE IS NOT DUE TO FETAL HYDROPS, BUT TO URINARY ASCITES. + THE NAME "PRUNE BELLY", REFERS TO THE APPEARANCE OF THE ABDOMEN OF THE FETUS, WHICH IS DISTENDED AND WRINKLED WHEN DECOMPRESSION OF THE HYDRONEPHROSIS AFTER BIRTH IS PERFORMED . THE WRINKLED SKIN HAS A "PRUNE-LIKE" APPEARANCE. +

HYDROSALPINX

SALPINGITIS MAY ALSO PRESENT AS A HYDROSALPINX. A HYDROSALPINX RESULTS FROM THE RESOLUTION OF A PYOSALPINX. THE FALLOPIAN TUBE OR TUBES BECOME FILLED WITH SEROUS FLUID AFTER RESOLUTION HAS OCCURRED. ALTHOUGH PID IS A BILATERAL DISEASE, ULTRASOUND MAY ONLY SUGGEST ONE SIDED INVOLVEMENT. THE STRUCTURE IS LOCATED IN THE ADNEXAL AREA. IT APPEARS AS AN ANECHOIC STRUCTURE WITH GOOD THROUGH TRANSMISSION. THIS TUBULAR STRUCTURE USUALLY MEASURES 1-4 CM IN DIAMETER. THE WALLS ARE THIN. SOMETIMES THE OVARY CAN BE SEEN AS CLEARLY SEPARATE FROM THE HYDROSALPINX, AND SOMETIMES NOT. IT IS OFTEN DESCRIBED AS A SAUSAGE SHAPED OR TAIL SHAPED TUBULAR STRUCTURE. A HYDROSALPINX CAN BE CONFUSED WITH AN OVARIAN CYST OR A SMALL CYSTADENOMA. +

WHAT IS MICROPHTHALMIA AND ITS ASSOCIATION WITH WHAT CONDITIONS

SMALL EYES -ASSOCIATED WITH : -HERPES SIMPLEX -VARICELLA ZOSTER -FAS

IN WHAT CASES TRANSVAGINAL SCANNING IS NOT HELPUL

SMALLER MORE LIMITED OF VIEW DUE TO FREQUENCY AND LIMITATIONS IN PROBE MOVEMENTS -INVASIVE

ARNOLD CHIARI IS ASSOCIATED WITH

SPINA BIFIDA HYDROCEPHALUS CEREBELLUM IS PULLED THROUGH CISTERNA MAGNA PORTION OF SPINAL CORD IS TETHERED AND ENDS BELOW L2

DELAYED POSTPARTUM HEMORRHAGE

THERE ARE TWO POSSIBILITIES IN RELATION TO CAUSE WHEN DELAYED POSTPARTUM HEMORRHAGE OCCURS. THEY ARE + (1) SUBINVOLUTION OF THE UTERUS AND + (2) RETAINED SECUNDINES (RETAINED PRODUCTS OF CONCEPTION). SUBINVOLUTION OF THE UTERUS IS CAUSED BY LOCALIZED ENDOMETRITIS AT THE PLACENTAL SITE, WHICH CAUSES THE UTERUS NOT TO REGRESS IN SIZE. THE ULTRASOUND APPEARANCE IS THE SAME AS FOR UTERINE ATONY AND THE TREATMENT IS THE SAME AS WELL. WHEN THERE ARE RETAINED SECUNDINES, THE UTERINE CAVITY MAY BE EXPANDING. IF THERE ARE RETAINED PRODUCTS OF CONCEPTION, CONTINUED BLEEDING WILL OCCUR. THE ULTRASOUND APPEARANCE OF THE UTERUS IS VARIABLE. IT MAY DEMONSTRATE AN ECHOGENIC ENDOMETRIUM, A STIPPLED APPEARANCE OF THE ENDOMETRIUM, HYPERECHOIC FOCAL AREAS, SHADOWING OR A FLUID COLLECTION WITHIN THE CAVITY. TREATMENT FOR RETAINED SECUNDINES IS A D&C.

CAUSES OF NON HYDROPS

THICKENING OF THE SKIN IN THE NUCHAL REGION

TERATOLOGY OF FALLOT

TETRALOGY OF FALLOT IS DEFINED BY THE ASSOCIATION OF FOUR FACTORS. + THEY ARE A VENTRICULAR SEPTAL DEFECT, + OVERRIDING AORTA, + INFUNDIBULAR PULMONARY STENOSIS, AND + HYPERTROPHY OF THE RIGHT VENTRICLE. THE VENTRICULAR SEPTAL DEFECT AND OVERRIDING AORTA CAN BE SEEN IN THE FIVE CHAMBER VIEW. THE CHAMBERS MAY OR MAY NOT BE SYMMETRIC, DEPENDING ON THE SEVERITY OF THE CONDITION. WITH OVERRIDING AORTA THERE IS PERFUSION FROM BOTH THE LEFT AND RIGHT VENTRICLE. IN THE PICTURE ABOVE, THE OVERRIDING AORTA CAN BE SEEN IN THE FIVE CHAMBER VIEW. +

WHAT ARE DERMOIDS , APPEARANCE, BENIGN OR MALIGNANT

THE BENIGN CYSTIC TERATOMA IS + ALSO KNOWN AS A DERMOID CYST OR TERATOMA. + IT IS THE MOST COMMON OF THE GERM CELL TUMORS. + THESE TUMORS ARISE IN A YOUNGER PATIENT POPULATION THAN THE CYSTADENOMAS. + IT IS THE MOST COMMON OVARIAN TUMOR IN WOMEN LESS THAN 20 YEARS OF AGE. + THESE TUMORS HAVE VERY LITTLE MALIGNANT POTENTIAL (1-2 %). +

PRECLAMPSIA AND ECLAMPSIA AND THE MOST PROBABLE TREATMENT IF THE PATIENT IS BEYOND 34 WEEKS OF GESTATION

THE CAUSE OF TOXEMIA OF PREGNANCY + IS NOT CLEARLY UNDERSTOOD. + IT CAN BE BROKEN DOWN INTO TWO STAGES, PREECLAMPSIA AND ECLAMPSIA. + IN ECLAMPSIA THERE IS MATERNAL HYPERTENSION WITH ASSOCIATED PROTEINURIA AND/OR EDEMA, AND ONE OR MORE CONVULSIONS. + IN MOST CASES, IF POSSIBLE AND THE PATIENT IS STABLE, IMMEDIATE DELIVERY IS WARRANTED. + THE ASSOCIATED EFFECTS ON THE FETUS INCLUDE DECREASED PLACENTAL VOLUME AND ACCELERATED PLACENTAL MATURATION. THIS MAY CAUSE LOW BIRTH WEIGHT, FETAL DISTRESS OR DEMISE. THERE IS ALSO AN INCREASED POSSIBILITY OF PLACENTAL ABRUPTION IN THE PATIENT WHO HAS TOXEMIA. PREECLAMPSIA IS DESCRIBED BY THREE CHARACTERISTICS: PROTEINURIA, HYPERTENSION, AND EDEMA. PREECLAMPSIA OCCURS BEFORE TOXEMIA. +

COMMON TREATMENT FOR ERYTHROBLASTOSIS FETALIS

THE FETUS REQUIRES MULTIPLE BLOOD TRANSFUSIONS VIA THE CORD UNTIL 26-32 WEEKS OF GESTATION. MULTIPLE BLOOD TRANSFUSIONS AND PHOTOTHERAPY ARE REQUIRED AFTER BIRTH DURING THE NEONATAL PERIOD

WHAT IS THE MAXIMUM SIZE OF GRAAFIAN FOLICLE IN A NORMAL WOMAN

THE GRAAFIAN FOLLICLE USUALLY RUPTURES BETWEEN 1.8 TO 2.5 CM, WITH AN AVERAGE OF 2.0 CM.

UPJ

THE MOST COMMON CAUSE OF CONGENITAL OBSTRUCTIVE UROPATHY IS URETEROPELVIC JUNCTION OBSTRUCTION (UPJ). UPJ IS URINARY TRACT OBSTRUCTION AT THE CONFLUENCE OF THE KIDNEY AND THE URETER. UPJ IS BILATERAL IN 1/3 OF CASES, AND IS USUALLY DUE TO A COMPLETE DOUBLE COLLECTING SYSTEMS OF THE KIDNEYS. +

BLADDER FLAP HEMATOMA

THE MOST COMMONLY USED INCISION FOR A CESAREAN SECTION IS THE LOWER TRANSVERSE UTERINE SEGMENT INCISION. ON ULTRASOUND, THE SUTURE MATERIAL CAN SOMETIMES BE SEEN. THIS MAY APPEAR AS AN ECHOGENIC AREA. THE SURGEON EXCISES THE VESICOUTERINE REFLECTION OF THE PERITONEUM IN ORDER TO ACCESS THE LOWER UTERINE SEGMENT. THIS CREATES AN ARTIFICIAL SPACE BETWEEN THE LUS AND BLADDER. + A BLADDER FLAP HEMATOMA MAY FORM BETWEEN THE LUS AND BLADDER (VESICOUTERINE SPACE), OR AT THE INCISION SITE. + THE FLUID COLLECTION MAY EXTEND OVER THE BLADDER AND UTERUS. + THE ULTRASOUND APPEARANCE IS VARIABLE. MOST OFTEN, USING ULTRASOUND, A BLADDER FLAP HEMATOMA IS SEEN AS A SOLID OR COMPLEX MASS BETWEEN THE POSTERIOR BLADDER WALL AND THE ANTERIOR UTERINE WALL. + PATIENT SIGNS AND SYMPTOMS ASSOCIATED WITH A BLADDER FLAP HEMATOMA ARE: ELEVATED TEMPERATURE, A PALPABLE MASS IN THE AREA, AND A DROPPING HEMATOCRIT. +

ULTROSOUND APPEARANCE POVT

THE SONOGRAPHIC APPEARANCE OF THROMBOSIS OF THE OVARIAN VEIN IS A HYPOECHOIC, OR ANECHOIC OVAL OR ROUND MASS IN AREA OF THE MIDDLE, OR UPPER PORTION OF THE RETROPERITONEUM. THIS IS SEEN IN THE ULTRASOUND IMAGE ON THE UPPER LEFT. THE IMAGE AT THE BOTTOM DEMONSTRATES THE TUBULAR APPEARANCE OF THE RIGHT OVARIAN VEIN, EXTENDING SUPERIORLY FROM THE MASS TOWARDS THE IVC. BLOOD FLOW WAS VISUALIZED IN THE IVC, BUT NOT IN THE VEIN, USING COLOR DOPPLER. THE TRANSVERSE IMAGE ON THE UPPER RIGHT SHOWS THROMBUS IN THE RIGHT OVARIAN VEIN NEXT TO THE IVC. +

BLOOD FLOW IN ADULT

THIS DIAGRAM ILLUSTRATES THE PATHWAY OF BLOOD FLOW THROUGH THE ADULT HEART. DEOXYGENATED BLOOD IS RETURNED FROM THE LOWER PORTION OF THE BODY THROUGH THE INFERIOR VENA CAVA. DEOXYGENATED BLOOD FROM THE UPPER PORTION OF THE BODY IS RETURNED THROUGH THE SUPERIOR VENA CAVA. BLOOD FLOWS INTO THE RIGHT ATRIUM OF THE HEART. IT THEN FLOWS THROUGH THE TRICUSPID VALVE TO THE RIGHT VENTRICLE. FROM THE RIGHT VENTRICLE IT FLOWS THROUGH THE PULMONARY ARTERIES TO THE LUNGS. IN THE LUNGS, THE CARBON DIOXIDE IS REMOVED AND BLOOD IS REOXYGENATED. IT RETURNS TO THE LEFT ATRIUM VIA THE PULMONARY VEINS. FROM THE LEFT ATRIUM IT FLOWS INTO THE LEFT VENTRICLE. FROM THE LEFT VENTRICLE IT FLOWS OUT OF THE HEART THROUGH THE ASCENDING AORTA AND INTO THE AORTIC ARCH. FROM THE ARCH, BLOOD FLOWS EITHER INTO THE BRACHIOCEPHALIC ARTERY, LEFT COMMON CAROTID ARTERY, OR THE LEFT SUBCLAVIAN ARTERY. THE REMAINDER OF BLOOD FLOWS INTO THE DESCENDING AORTA TO SUPPLY THE BODY WITH OXYGEN RICH BLOOD. +

REASON FOR SHOULDER PAIN IN ECTOPIC PREGNANCY

THIS PAIN IS CAUSED BY BLOOD IN THE PERITONEUM

TOXOPLASMOSIS AND ITS INCIDENCE

TOXOPLASMOSIS IS A PARASITIC INFECTION CAUSED BY THE PARASITE, TOXOPLASMA GONDII. + THE INFECTION MAY OCCUR DUE TO INGESTION OF RAW MEAT OR CONTACT WITH CAT FECES. CONTACT WITH THE FETUS MAY OCCUR DUE TO PENETRATION OF THE PLACENTA, OR THROUGH THE BLOOD. + IT IS LESS LIKELY TO BE TRANSMITTED TO THE FETUS IN THE FIRST TRIMESTER DUE TO THE SMALL SIZE OF THE PLACENTA. IT IS MORE TRANSMITTABLE TO THE FETUS IN THE LAST TRIMESTER OF PREGNANCY. + POSSIBLE FETAL EFFECTS INCLUDE IUGR, HYDROCEPHALY, CEREBRAL CALCIFICATIONS, HEPATOSPLENOMEGALY, AND FETAL DEMISE.

WHAT ARE THE ABNORMALITIES THAT MIGHT HAPPEN WITH TWIN-TWIN TRANSFUSION SYNDROM

TWIN TWIN TRANSFUSION SYNDROME OCCURS WHEN ANASTOMOSES DEVELOP BETWEEN THE ARTERIAL AND VENOUS CIRCULATION WITHIN THE PLACENTA. THERE IS ABNORMAL SHUNTING OF BLOOD FROM ONE FETUS TO THE OTHER. THIS CONDITION OCCURS ONLY IN TWINS THAT SHARE ONE PLACENTA (MONOCHORIONIC). ULTRASOUND SIGNS THAT MAY INDICATE THIS CONDITION INCLUDE SIZE DISPARITY BETWEEN THE FETUSES AND POSSIBLE FETAL HYDROPS IN ONE OF THE TWINS.

VASA PREVIA

UMBILICAL CORD PROLAPSE MAY BE TYPED AS OCCULT, FRANK, OR VASA PREVIA. WITH OCCULT (HIDDEN) CORD PROLAPSE, THE CORD IS NEAR THE PRESENTING FETAL PART. WITH FRANK PROLAPSE, THE CORD PROTRUDES INTO THE CERVIX THROUGH THE RUPTURED MEMBRANES. WITH VASA PREVIA, THE CORD IS BETWEEN THE PRESENTING FETAL PART AND THE INTERNAL OS, WITH INTACT MEMBRANES. THESE CONDITIONS ARE DANGEROUS BECAUSE CORD COMPRESSION OR LACERATION MAY OCCUR. THIS MAY COMPROMISE FETAL CIRCULATION. THE RESULT MAY BE FATAL FOR THE FETUS. COLOR DOPPLER IS VERY HELPFUL, IF CORD PROLAPSE IS SUSPECTED.

US FINDINGS OF RETAINED POC

US appearance of endometrial cavity variable - echogenic, stippled, hyperechoic foci, shadowing, fluid collection

IN WHAT CASES TRANSPERINEAL ULTRASOUND IS HELPFUL

USEFUL WHEN TRANSVAGINAL US IS CONTRADICTED -CONCERNA ABOUT PLACENTA PREVIA THE PROBE IS PLACED BETWEEN THE LABIA AND THE PERINEUM

WHY DOES UTERINE ATONY OCCUR?

WHY DOES UTERINE ATONY OCCUR? + ALL OF THE THESE FACTORS ARE CONSIDERED TO BE POSSIBLE CAUSES OF UTERINE ATONY. Causes: Multiple gestation or polyhydramnios Multiparity Rapid expulsion of fetus Prolonged and difficult labor Macrosomic infant Inhalation general anesthetic Prior history of postpartum bleeding