OBGYN TEST #3
the following steps can be taken to prevent what? 1. Give adequate doses of Rh immunization within 72 of delivery 2. RhoGAM is also given at 28th week of pregnancy 3. RhoGAM treatment must be repeated w/ each pregnancy, miscarriage, abortion & chorionic villi sampling.
(prevention of) maternal sensitization
hydrocephalus can be monitored by ultrasound until when?
1 year of age
bilateral choroid plexus cysts greater than ___ mm have a higher association with abnormal karyotype
10mm
Vacterl can be associated with what trisomy?
18
a strawberry shaped skull is commonly associated with what trisomy?
18
How many fetal compartments are filled to be considered hydrops?
2
the echogenicity of a hemorrhage decreases within how long? sonolucent areas still remain.
2-3 weeks
Microcephaly is when the HC measures greater than ___ standard deviations below normal.
3
where is the luschka & magendie located?
4th ventricle
for infants 6 months-1 year, what transducer should be used for intracranial scanning?
5.0 mHz
Diaphragmatic hernia has a ___ to ___ % mortatlity rate due to pulmonary hypoplasia
50-80%
With fetal hydrops the placenta is thickened by how many cm?
6
a nuchal fold measurement of ___mm or larger is considered abnormal
6mm
transducer used for intracranial scanning ?
7.5-10 mHz
when do most intracranial bleeds usually happen?
72 hours after birth
with fetal hydronephrosis the renal pelvis is dilated greater than ___mm
8mm
Non-immune hydrops account for ___% of hydrops
90
which type of holoprosencephaly is this? -single horseshoe shaped ventricle -fused thalami -associated with craniofacial abnormalities NO LOBE, NO SEPARATION = CYCLOPS
Alobar
what are the three types of holoprosencephaly?
Alobar, Semilobar, Lobar
omphalocele is covered by
Amnion & Peritoneal Sac
-Absence of cerebral hemispheres & overlying skull & scalp -only structures at base of brain are present.
Anencephaly
US APPEARANCE OF WHAT? -cranial vault absent -intracranial contents absent -orbits & face present -bulging eyes -short neck -polyhydramnios present in half of the cases
Anencephaly
What is the most common fetal congenital anomaly in CNS?
Anencephaly
-Common type of hydrocephalus -associated with spina bifida -portion of spinal cord is tethered & ends below L2 -cerebellum is pulled through cisterna magna
Arnold Chiari Malformation
spina bifida has a high association with what?
Arnold chiari malformation
Fetal hydrops are synonymous to:
Ascites, anasarca & edema
Divergence of the posterior elements of the fetal spine is suggestive of a) encephalocele b) meningocele c) hydrocele d) infantocele
B
the "sunburst" of the cerebral sulci is a sonographic finding of: A) DWM B) agenisis of the corpus collosum c)colpocephaly d) apert syndrome
B
what is dilation of lateral ventricles bilateral & severe
BAT WING sign
Amniotic band syndrome can be defined as : A) the separation of amnion and chorion in early pregnancy B) complications that arise from abruptia placenta C) wrapping of torn amnion around fetal extremities D) none of the above
C
what is the most common fetal chest mass?
CAM (cystic adenomatoid malformartion)
-Lethal -Autosomal recessive or sporadic -RARE
Campomelic dysplasia
Characteristics of what? -shortening & bowing of long bones of legs (tibia & fibula most affected) -narrow chest -large calvarium w/ small face -hypoplastic scapulae *CLUBBED FOOT CAN BE ASSOCIATED W/ THIS*
Campomelic dysplasia
-Medial deviation of the sole of the foot -may be isolated inherited genetic predisposition
Club foot
the following are associated with: -genetic syndromes (Trisomy 18) -spina bifida -caudal regression -muscular dystrophy -oligohydramnios
Club foot
-Increase in terminal respiratory elements leading to development of cysts -involves part or all of a lung lobe
Cystic Adenomatoid Malformation (CAM)
Which of the following terms best describes a skeletal dysplasia in which the proximal extremity is shortened? A) micromelia B) acromelia C) mesomelia D) rhizomelia
D
-Congenital brain malformation -characterized by incomplete formation of cerebellar vermis & dilation of 4th ventricle & enlargement of posterior fossa.
Dandy Walker Malformation
US appearance of what? -cystic enlargment of 4th ventricle -dilated 3rd ventricle -variable dilation of lateral ventricles -cerebral lobes split apart & abnormal shape
Dandy Walker Malformation
thought to be a result of obstruction of foramina of luschka & magendie
Dandy Walker Malformation
-Bowel & abdominal organs herniate into the thoracic cavity -may be associated with other congenital anomalies like trisomy 13 & 18
Diaphragmatic Hernia
Excessive accumulation of clear watery fluid in any of the tissues or cavities of the body.
Fetal Hydrops
US signs of what? -polyhydramnios -fetal skin edema (anasarca) - pleural effusion -scalp edema -pericardial fluid collection -fetal ascites
Fetal hydrops
Fetuses with anencephaly are often referred to as?
Frog babies
macrocephaly w/ protruding forehead is called what?
Frontal bossing
omphalocele is associated with what two things?
GI & cardiac anomalies
most common anomaly associated with gastroschisis is associated with the ?
GI Tract
Neural tube defects can result from?
Genetic mutation or be can be acquired
The instance when Rh negative woman was exposed to mother's Rh positive blood during birth, is called?
Grandmother theory
Many fetuses with hydrops also have what?
Hepatosplenomegaly
Failure of the prosencephalon to divide into double lobes of cerebral hemisphere
Holoprosencephaly
-autosomal dominant -THUMBS ABSENT -also associated w/ congenital abnormalities of the heart -also associated with phocomelia (rare deformity in which hand an feet are close to the trunk)
Holt Oram Syndrome
Total or near total absence of cerebral hemispheres (not developed or partially developed) The midbrain, basal ganglia, thalamus, & cerebellum are present
Hydranencephaly
US APPEARANCE of what? -no cerebral parenchyma -large anechoic areas surrounding mid brain
Hydranencephaly
Abnormal accumulation of serous fluid in the fetal tissues
Hydrops
US does not always identify the cause of what?
Hydrops
Another name for fetal hydrops
Hydrops fetalis
-Autosomal recessive disease -lack of fusion varies -not compatible with life if severe
IPKD
US appearance of what? -Enlarged bilateral kidneys -homogenous hyperechogenicity -severe oligohydramnios -Bladder not visualized
IPKD
osteogenesis is a what type of disorder?
Inherited
-seen in premature infants -hemorrhage is into ventricles or subependymal -may cause brain damage -Neurosonography used as screening what is this describing?
Intracranial hemorrhage
which type of holoprosencephaly is this? -nearly complete separation of cerebral hemispheres TOTAL SEPARATION
Lobar
-usually unilateral -amniotic fluid is usually normal -may be associated with other kidney abnormalities such as contralateral UPJ obstruction
Multicystic Dysplastic kidney
if the baby has SEVERE hemolytic disease what type of prenatal care is required?
Multiple prenatal transfusions via cord until 26-32 weeks, multiple transfusions & phototherapy.
Anomalies of the fetal head, neck & spine can be referred to as what?
Neural Tube Defects
The following are causes of what? -cardiovascular abnormality -chromosomal abnormalities -fetal structure abnormalities -anemia -infections (hep A, rubella, varicella) -genetic disorders (skeletal dysplasia) -idiopathic causes - maternal disorders -placental disorders
Non immune hydrops
what is used to change bilirubin into products which can pass through the baby's system.
Phototherapy
-having more than 5 fingers or toes -may be a dominant inherited trait -may be linked w/ some genetic diseases like trisomy 13,18,21 -ellis-van creveld syndrome -rubinstein-taybi syndrome
Polydactyly
US appearance of what? -enlarged bladder, thickened bladder wall -dilated ureters -Keyhole appearance due to dilated urethra
Posterior urethral valves
-Deficient abdominal musculature -cryptoorchidism -GI tract anomaly (PUV) -distended fetal abdomen w/ wrinkled appearance
Prune belly triad
Most people have ___ postive blood
Rh
The following are fetal effects of what disease? 1. Jaundice 2. Anemia 3. Brain damage 4. Heart failure 5. Death
Rh Disease
What is the most common cause of immune related hydrops
Rh disease
caused by an incompatibility between the blood of mother and fetus
Rh disease
during the first pregnancy there is little danger to __ fetus
Rh+
Shortening of proximal extremity is called what?
Rhizomelia
What are the 4 types of short limb dysplasia?
Rhizomelia, acromelia, mesomelia, micromelia
Your doctor is prescribing ________ because you are Rh-negative. During pregnancy, it is normal for a small amount of the baby's blood to enter your bloodstream. When the blood from your Rh-positive baby enters your Rh-negative bloodstream, there will be a blood type mismatch. This is called Rh-incompatibility. Your immune system sees the baby's red blood cells as "foreign" and will produce antibodies that try to eliminate them. ___________ if given to you at the right time, will prevent your immune system from reacting to your baby's blood.
RhoGAM
what is the most common tumor in neonates?
Sacrococcygeal teratoma
which type of holoprosencephaly is this? -More cerbral tissue present -occipital lobe present -Associated with cleft palate & lip PARTIAL SEPARATION
Semilobar
triggering of mother's defense system is known as?
Sensitization
Abnormal development of the cartilage & bones
Skeletal dysplasias
-Bladder and Bowel Dysfunction -paralysis of lower extremities -hydrocephalus all of these are associated with what?
Spina Bifida
Condition in which spinal cord or its coverings are not fully developed
Spina Bifida
US detection of what? -Splaying (splitting) of posterior ossification centers -V or U shape -May see cystic dilation adjacent to spine -elevated maternal serum AFP levels
Spina Bifida
Anencephaly is common in areas where (what other disease) is common?
Spina Bifida (UK)
5% of choroid plexus cysts are associated with ?
Trisomy 18
true or false: Amniotic band syndrome may cause amputations of limbs or digits.
True
what type of osteogenesis imperfecta is this? -autosomal, dominant, fragile bones, loose joints & growth deficiency, fractures occur after birth. -Life expectancy is normal
Type 1
what is the WORST type of osteogenisis imperfecta?
Type 2
what type of osteogenesis imperfecta is this? -Lethal new dominant mutations prenatal bone shortening & bowing due to fractures affecting long bones & ribs, decrease in acoustic shadowing
Type 2
what type of osteogenesis imperfecta is this? -autosomal dominant or recessive -fractures present at birth or happen when child begins to walk -bones become progressively deformed throughout life.
Type 3
what is the mildest form of osteogenesis imperfecta?
Type 4
what type of osteogenesis imperfecta is this? -Mildest form -short stature -bones fracture more easily
Type 4
if the baby has MODERATE hemolytic disease what type of prenatal care is required?
Usually one prenatal transfusion or neonatal treatment with multiple transfusions & phototherapy.
Vertebral anomalies Anal Atresia Cardiac anomalies Tracheo Esophageal fistula Renal anomalies Limb Dysplasia (more common in diabetic mother)
Vacterl Association
fluid around fetal lungs is normal or abnormal?
abnormal
the following are characteristics of what? -severe shortening of limbs -narrow thorax -short trunk -large head
achondrogenisis
what is the name of the LETHAL dysplasia?
achondrogenisis
The following are characteristics of what? -autosomal dominant, or spontaenous -most common NON - lethal type of dwarfism -rhizomelic limb bowing -frontal head bossing -trident finger confiuration -sometimes macrocephaly, or hydrocephaly
achondroplasia
trident finger is associated with?
achondroplasia
Distal extremity shortening (phalanges, metacarpals) is called what?
acromelia
This occurs when amnion ruptures & wraps around fetal structures
amniotic band syndrome
Rh diseases causes fetal _____ in the baby
anemia
location of morgagni diaphragmatic hernia?
anterior
classification of hydrocephalus?
aqueductal stenosis, communicating hydrocephalus, over production of CSF
the fetal lip typically closes by : a) 18 weeks b) 8 weeks c) 13 weeks d) 6 weeks
b
this sign describes the way the cerebellum is wrapped tightly around the brain stem as a result of spinal cord tethering
banana sign
fetal hydronephrosis is usually bilateral or unilateral?
bilateral (in 1/3 of cases)
When RBC's break down there is an increase in what?
bilirubin
-congenital defect of abdominal wall to develop over bladder -bladder may protrude through wall
bladder extrophy
US appearance of what? -Normal amniotic fluid -lack of visualization of bladder -echogenic mass protruding from lower abdominal wall in close association w/ umbilical arteries
bladder extrophy
what are the two types of diaphragmatic hernia?
bochdalek & morgagni
what is a complication of intracranial hemorrhage?
brain damage
another name for osteogenesis imperfecta
brittle bone disease
first most common cause of non immune related hydrops is?
cardiovascular abnormalities
Bony defect in calvarium with herniation of brain, and or meninges is what?
cephalocele
banana sign refers to the shape of what (arnold chiari malformation)
cerebellum
the _______ _______ is within the midbrain & connects the 3rd & 4th ventricle. Also contains CSF
cerebral aqueduct
what is the second most common location for spina bifida?
cervical area
second most common cause of non immune hydrops is what?
chromosomal abnormalities
premature closure of coronal and lambdoidal sutures produces what sign?
clover leaf sign
are fetal hydrocele common or uncommon?
common
what type of hydrocephalus can still flow between ventricles which remain open?
communicating hydrocephalus
severe bleeds can rupture into ventricular system or into surrounding ______ _______
cortical tissue
-Benign of lymphatic origin -can be located in axilla, groin, mediastinum & thorax
cystic hygroma
US appearance of what? unilocular, or multiocular cystic mass
cystic hygroma
the most frequently encountered chromosomal abnormality associated with holoprosencephaly is: a)triploidy b) trisomy 21 c) trisomy 18 d) trisomy 13
d
which of the following may also be referred to as turner syndrome? a) down syndrome b) trisomy 15 c) trisomy 13 d) monosomy x
d
US findings of what? -stomach, bowel, or other organ located in thorax -an AC measurement that is smaller than normal -may be associated with polyhydramnios
diaphragmatic hernia
what is lack of adequate communication between duodenum & stomach
duodenal atresia
early hemorrhages are highly ______
echogenic
-rare defect in abdominal wall -heart protrudes through extrathoracic sac -covered by skin or membrane
ectopic cordis
a cephalocele is also known as?
encephalocele
when do choroid plexus cysts usually resolve by?
end of second trimester
US of the fetal limbs document what 4 things?
existence, length, position, whether properly formed & ossified
omphalocele is also known as?
exomphalos
failure of lip fusion prior to 35 days from conception is termed what? (may be associated with brain anomalies or trisomies)
facial clefts
what is occipital encephalocele caused by?
failure of mural tube to close completely
Fluid in the fetal peritoneal cavity is called ?
fetal ascites
what can be seen with fetal hydrops, bowel perforation, urinary ascites due to bladder obstruction, heart failure, & twin twin & transfusion syndrome?
fetal ascites
fluid around fetal testicles
fetal hydrocele
Maternal polyhydramnios is linked with:
fetal skeletal dysplasia
how long does it take for fetal hydroceles to typically resolve?
first 9 months of life
what type of effects does hydrocephalus have on the brain?
flattening of brain parenchyma & intraparenchymal effusion
herniation of the viscera through a fissure off of midline
gastroschisis
each subsequent pregnancy poses a _____ (greater or smaller) risk for Rh disease in the baby
greater
Ectopic Cordis means:
heart outside
this disease occurs when baby's RBC's break down at a faster rate.
hemolytic disease
thought to be caused by bilateral blockage of the internal carotid arteries
hydranencephaly
Dilation of the ventricles with accumulation of CSF is what?
hydrocephalus
This is usually caused due to blockage of CSF drainage pathways ?
hydrocephalus
what is an abnormal increase in fluid in cerebral ventricles? (overproduction of csf)
hydrocephalus
pleural effusion is usually seen with fetal ________
hydrops
What are the two types of fetal hydrops?
immune and non-immune
fetal hydrops caused by Rh incompatibility are what?
immune hydrops
what is the cause of diaphragmatic hernia?
improperly fused or formed diaphragm
Autosomal recessive disease?
infantile polycystic kidney disease
Suspicions of what? -Respiratory distress syndrome -dropping hematocrit -Prematurity (Less than 32 weeks or 1850 grams)
intracranial hemorrhage
The following are locations of what? -immature subependymal germinal matrix of the caudate nucleus, choroid plexus, cerebellar area
intracranial hemorrhage
narrower portion of anterior portion of head (arnold chiari malformation)
lemon sign
-severe form of amniotic band syndrome OR early vascular accident causing disruptive body wall events -anomalies may include lateral body wall defects, thorax, abdomen, face, limbs, & spine -not compatible with life
limb body wall complex
what is the most common location for spina bifida?
lumbar sacral area
what protrudes with spina bifida?
meningocele-meninges
what is associated with microcephaly?
mental retardation
middle limb segment shortening, (radial, ulna, tibia, fibula) is called what?
mesomelia
small head
microcephaly
refers to entire extremity being short:
micromelia
Location of omphalocele is?
midline
US appearance of what? -multiple large anechoic cysts -largest is not centrally located -reniform shape may be absent -differential diagnosis could be hydronephrosis
multicystic dysplastic kidney
what is the most common renal dysplasia?
multicystic dysplastic kidney
-Diagnose & follow up on intracranial hemorrhage -evaluate for hydrocephalus -diagnose congenital abnormalities these are uses for what?
neonatal head scanning
are choroid plexus cysts harmful to baby?
no
if the baby has MILD hemolytic disease what type of prenatal care is required?
no prenatal treament required
congenital leukemia is associated with what?
non immune hydrops
communicating hydrocephalus is also known as what?
non obstructive hydrocephalus
fetal hydrops that are caused by CONGENITAL fetal anomalies & infections are what??
nonimmune hydrops
with gastroschisis umbilical cord insertion is normal or abnormal?
normal
in the western world, what is the most common location for a cephalocele?
occipital
small defect with no protrusion of meninges or cord
occult spina bifida
gastroschisis is less serious than ?
omphalocele
herniation of abdominal contents into base of umbilical cord
omphalocele
bones become increasingly _______ as pregancy progresses
ossified
-inherited disorder -disorder of production or secretion of collagen -abnormal fragility of the bones due to hypo-mineralization of entire skeleton -bones can be fractured or deformed easily -still birth possible due to cranial fracture
osteogensis imperfecta
this is used to change bilirubin into products which can pass through the baby's system.
phototherapy
mortality due to underlying cause or pulmonary hypoplasia is a cause of what?
pleural effusion
having 5 or more fingers or toes on lateral or medial side
polydactyly
Cephalocele is associated with?
polyhydramnios
cyst arising from the ventricle that develops as a consequence of parenchymal hemorrhage
porencephalic cyst
possible reasons for what? -previous normal pregnancy -ectopic pregnancy -spontaneous abortion -inadequate RhoGAM dosage -previous transfusions with RH+ blood -sensitization in utero "grandmother theory"
possible maternal sensitization
location of bochdalek diaphragmatic hernia?
posteolateral on the left
-Results when thin leaflets obstruct fetal urethra -occurs in male fetuses
posterior urethral valves
80% of cystic hygromas originate from ________ portion of neck
posterolateral
pulmonary hypoplasia has a poor ________
prognosis
-Hypoechoic ring around abdominal wall may simulate ascites -it represents the muscles of the abdominal wall
pseudo ascites
Babies that have campomelic dysplasia can die from _______ _______ because of small chest
pulmonary hypoplasia
Skeletal dysplasias are very common or rare?
rare
gastroschisis is not covered by ____ or ____
sac or membrane
-made up of all 3 germ layers -seen as mass extending from sacrum -may be benign or malignant -may be solid, mixed, interspersed with cystic components
sacrococcygeal teratoma
-development of fluid filled clefts within the cerebrum is -may be described as "open lip" or "closed lip" -may have association with exposure to some illicit drugs.
schizencephaly
skeletal dysplasias may not manifest until late _____ ______
second trimester (may not be severe enough to be detected)
with skeletal dysplasia, bones may be (4 things)
shortened, deformed, thinned, absent
fetal hydrocele is not clinically _________
significant
osteochondrodysplasia is another term for what?
skeletal dysplasia
defect in spine due to lack of fusion of 2 halves of vertebral arch is what?
spina bifida
hydrocephalus is associated most commonly with what?
spina bifida
what is the treatment for cystic hygromas?
surgery (removal of entire cyst to prevent it from coming back)
what is another term for Club Foot?
talipes equinovarus
The following are characteristics of what? -severely flattened vertebral bodies -extreme rhizomelia -bowed long bones -narrow thorax w/ protruding abdomen champagne cork appearance
thanatophoric dysplasia
most common dysplasia that is lethal
thanatophoric dysplasia
the following are abnormalities associated with what? -Frontal bossing -horseshoe kidney -atrial septal defects of the heart -imperforate anus -clover leaf skull -massive polyhydramnios
thanatophoric dysplasia
CAM involves all, or part of what?
the lung lobe
gastroschisis is located where?
to the right of midline
what are causes of microcephaly?
trisomies, exposure to environmental teratogens, uterine infections
cystic hygroma can be associated with what?
turner's syndrome
what are the four types of osteogenesis imperfecta?
type 1-4
Is CAM usually bilateral or unilateral?
unilateral
Is hemorrhage treatable or untreatable?
untreatable
what is the most common cause of fetal hydronephrosis?
ureteropelvis junction obstruction (UPJ)
where does intracranial hemorrhage go into ?
ventricles & subependymal
another way to refer to hydrocephalus?
ventriculomegaly
what is another name for hydrocephalus?
ventriculomegaly