SON218 FINAL EXAM

Pulsatility index (PI)

(maximum systolic velocity - diastolic velocity)/mean velocity

Resistivity Index (RI)

(maximum systolic velocity - diastolic velocity)/systolic velocity

Cisterna magna

(posterior fossa cistern filled with CSF) lies directly behind cerebellum

Asplenia (absence of spleen)

-Abnormally positioned stomach and gallbladder -More centrally positioned liver -Abnormal positioning of aorta and IVC on same side

Vein of Galen Aneurysm

-Also known as vein of Galen malformation -Rare arteriovenous malformation -Vein will be enlarged and communicate with normal-appearing arteries.

Aqueductal Stenosis

-Approximately 90% of survivors have IQ <70. -Infants with X-linked form profoundly mentally retarded

Amniotic Sheets

-Are thicker than bands associated with amniotic band syndrome -Do not cause fetal malformations -Most likely signify uterine synechiae

Polyhydramnios

-Associated with increased perinatal mortality and morbidity and maternal complications -Patient will present with clinical finding of uterus greater than dates. -Sonography ordered to rule out multiple gestation, molar pregnancy, or fetal size greater than dates

Vasa previa

-Associated with velamentous cord insertion or succenturiate lobe -Color Doppler to evaluate any structures in front of cervical os to see if vascular

Hydranencephaly

-Cause involves congenital infection or ischemia -Infections associated include cytomegalovirus and toxoplasmosis -Brain ischemia may result from maternal hypotension, twin-to-twin embolization, or vascular agenesis; has been associated with cocaine abuse

Spina Bifida

-Changes shape of cerebellum, giving it "banana" appearance -Leads to obliteration of cisterna magna -Caudal displacement of cranial structures causes scalloping of frontal bones of skull, making fetal head resemble lemon

Dandy-Walker Malformation

-Chromosomal anomalies that may be associated include trisomies 13, 18, 21, triploidy. -Associated with several syndromes: Meckel-Gruber, Walker-Warburg, Aicardi -Is linked to congenital infections and maternal diabetes

Choledochal Cyst

-Close proximity of cyst to neck of gallbladder -Ovoid right upper quadrant cyst with entering bile duct -Cyst and gallbladder that enlarge as gestation progresses -Absence of peristaltic activity in cyst

Vein of Galen Aneurysm

-Considered sporadic event -Male predominance -Usually isolated anomaly; has been associated with congenital heart defects, cystic hygromas, and hydrops -Can be associated with neurologic damage, which may result from ischemia, hemorrhage, or mass effect

Hydranencephaly

-Destruction of cerebral hemispheres by occlusion of internal carotid arteries -Brain parenchyma destroyed and replaced by cerebrospinal fluid

Atresias

-Develop when portion of bowel grows and infarcts -Occurs anywhere in gastrointestinal tract -Polyhydramnios evident on ultrasound

Anterior Urethral Valves

-Dilated anechoic urethra seen proximal to valve -Valve usually not appreciated in obstetric examinations -Obstruction may be complete, partial, or intermittent.

Obstructive Cystic Dysplasia

-Early sonographic findings may only be hydronephrosis or hydroureter (depending on level of obstruction) -Kidney will most likely appear enlarged. -Early sign is presence of hydronephrosis with cortical cysts.

Cysts

-Echo-free masses that replace normal lung parenchyma -Vary in size, ranging from small isolated lesions to large masses -May cause notable shifts of intrathoracic structures -Simple form may be surgically excised after delivery.

Pulmonary Sequestration

-Echogenic solid mass resembling lung tissue -Rarely occurs below diaphragm -Associated with hydrops and polyhydramnios, diaphragmatic hernia, gastrointestinal anomalies -Normal intraabdominal anatomy

Ectopic Cordis

-Exposed heart presents outside chest wall through cleft sternum. -Most dramatic finding is presence of heart outside thoracic cavity.

Meconium Peritonitis

-Extruded meconium may calcify. -Scattered amorphous or curvilinear calcifications throughout peritoneum. -Snowstorm ultrasound appearance.

gastroschisis

-Free-floating herniated small bowel -Large bowel, stomach, gallbladder, urinary bladder, pelvic organs may be involved. -When organs other than small or large bowel seen, body stalk anomalies should be suspected -Herniated bowel may be mildly dilated with bowel wall thickening.

Spleen

-Homogeneous in texture -Similar in echogenicity to kidney -Slightly less echogenic than liver -Increases in size during gestation -Imaged on transverse plane posterior and to left of fetal stomach

Stomach

-Identified as fluid-filled structure in left upper quadrant inferior to diaphragm -Most fetuses older than 14 to 16 weeks should have fluid within

Cephalocele

-Involves occipital bone -Is located in midline in 75% of cases May also involve: -Parietal -Frontal -Temporal regions -Other bones of calvarium

Esophageal Atresia

-Is a congenital blockage of the esophagus resulting from faulty separation of foregut into its respiratory and digestive components -Most common form occurs in conjunction with a fistula, communication between trachea and esophagus (tracheoesophageal fistula) allows passage of amniotic fluid into stomach

Anterior Urethral Valves

-Is a congenital defect resulting in obstruction of anterior urethral valve in males -Valves are located in multiple locations in anterior urethra -Exact cause of obstruction is unclear.

Congenital Cystic Adenomatoid Malformation (CCAM)

-Is a multicystic mass within the lung -Consists of primitive lung tissue and abnormal bronchial and bronchiolarlike structures -is one of the bronchopulmonary foregut malformations.

Beckwith-Wiedemann Syndrome

-Is a rare group of disorders having in common coexistence of omphalocele, macroglossia, and visceromegaly -Most cases are sporadic.

Agenesis of the Corpus Callosum

-Is also known as callosal agenesis -Occurs sporadically -May be associated with other CNS malformations -May be transmitted in autosomal-dominant or autosomal-recessive manner -X-linked syndromes have been identified

Ellis-van Creveld Syndrome

-Is also known as chondroectodermal dysplasia -Narrow thorax, causing pulmonary hypoplasia -Heart defects, the most common of which is atrial septal defect (ASD) -Abnormal teeth -Hypoplastic nails -Thin hair

Porencephalic Cysts

-Is also known as porencephaly -Cysts filled with cerebrospinal fluid that communicate with ventricular system or subarachnoid space -No known associated anomalies

Patent urachus

-Is associated with posterior urethral valves and prune-belly syndrome -After fetus born, urine discharge or drainage from umbilicus frequently noted

Anencephaly

-Is caused by failure of closure of neural tube at cranial end -Result is absence of cranial vault, complete or partial absence of forebrain, presence of brainstem, midbrain, skull base, facial structures

Infantile Polycystic Kidney Disease (IPKD)

-Is characterized by development of small cysts in both kidneys and liver cysts -Cysts in kidney thought to be caused by tubular malformation and ectasia of collecting ducts

Multicystic Dysplastic Kidney Disease (MCDK)

-Is characterized by multiple, smooth-walled, nonfunctioning, noncommunicating cysts of variable size and number -Renal tissue replaced by cysts of varying sizes throughout the kidney -Entire kidney or only portion of kidney may be affected. -Affected kidney is nonfunctional -Usually unilateral

Jeune's Syndrome

-Is known as asphyxiating thoracic dysplasia -Is a skeletal dysplasia characterized by very narrow thorax

Partial situs inversus

-Is more severe disorder -May develop in two different combinations of organ reversals -Thoracic viscera usually reversed -Abdominal viscera may or may not be reversed.

Posterior Urethral Valve Obstruction (PUV)

-Is most common urethral anomaly -In males is most common cause of infravesical obstruction -Obstruction causes backup of urine in bladder, ureter, and, in most severe cases, kidneys.

Fibrin

-Is protein derived from fibrinogen -Is found throughout the placenta -Most pronounced in floor of placenta -Increases continuously throughout pregnancy

Adult Dominant Polycystic Kidney Disease (ADPKD)

-Is thought to be caused by defective gene that does not allow for normal epithelial cell development -Results in cystic development of cortex and medulla -Cysts typically do not enlarge or impair renal function until adulthood. -Usually bilateral

Trisomy 18

-Karyotype demonstrates extra chromosome 18 -Associated with abnormal quadruple screen

Hypertelorism

-May be diagnosed by orbital distances that fall above normal ranges for gestational age -May provide evidence for particular genetic syndrome or concurrent anomalies -Frontal cephaloceles may widen space between eyes

Anorectal Atresia

-May be diagnosed sonographically by observing dilated colon and calcified meconium -Amniotic fluid typically normal or may be decreased with associated renal problems.

Circle of Willis

-May be seen anterior to midbrain -Appears as triangular region -Highly pulsatile as result of midline-positioned anterior cerebral artery and lateral convergence of middle cerebral arteries

Amniotic Sheets

-May show fine echo-dense line in uterine cavity separated from uterine wall by echo-lucent space -Membrane may either completely surround fetus or be freely mobile in amniotic cavity

Chorioangioma

-Most common "tumor" of placenta -Small, benign vascular tumor -Consists of benign proliferation of fetal vessels

Hemangioendothelioma

-Most common symptomatic, vascular hepatic tumor of infancy (although rare) -May cause nonimmune hydrops in fetus

Alloimmune Thrombocytopenia

-Mother may develop immune response to fetal platelets in manner similar to that of RBCs -Result can be fetus with dangerously low platelet count (thrombocytopenia) -Rare

Porencephalic Cysts

-No known associated anomalies Postnatal problems may include: -Seizures -Developmental delays -Motor deficits -Visual and sensory problems -Hydrocephalus

Posterior Urethral Valve Obstruction (PUV)

-Obstruction produced by abnormal congenital membrane within posterior urethra -Membrane thought to be valve-like and derived from Wolffian duct tissue.

Bronchogenic Cysts

-Occur as result of abnormal budding of foregut -Lack any communication with trachea or bronchial tree -Typically occur within mediastinum or lung -Infrequently found inferior to diaphragm

Acrania

-Occurs at beginning of fourth gestational week -Mesenchymal tissue fails to migrate and does not allow bone formation over cerebral tissue.

Hydrocele

-Occurs in male fetus -Is seen as accumulation of serous fluid surrounding testicle, resulting from communication with peritoneal cavity

Limb-Body Wall Complex

-Occurs with fusion of amnion and chorion -Amnion does not cover umbilical cord normally. -Extends as sheet from margin of cord -Is continuous with both body wall and placenta -Left-sided body wall defects three times more common than right-sided defects

Cleft Sternum

-On sonographic examination, heart may be seen to lie outside normal thoracic cavity or bulge through defective sternum. -Is common to see pericardial and pleural effusions

Limb-Body Wall Complex

-On sonographic examination, the defects large and involve abdomen and thorax -Eviscerated organs form complex, bizarre-appearing mass entangled with membranes. -Umbilical cord short and adherent to placental membranes

Schizencephaly

-Open-lip lesions and bilateral clefts carry worse prognosis -Long-term effects include blindness; motor deficits may include spastic quadriparesis, hemiparesis, hypotonia. -Seizures, mental retardation, and language impairment are possible. -Hydrocephalus may be progressive and require shunt placement.

placental lakes

-Placental sonolucencies -Are often a normal finding -May change in shape and size during course of ultrasound examination -Frequently blood flow will not be detected with color Doppler. -Real-time sonography shows slow swirling flow

Chorion frondosum

-Portion of chorion that develops into fetal portion of placenta -Site where water exchanged freely between fetal blood and AF across amnion

Pentalogy of Cantrell

-Presence of pericardial effusion may be found. -May be associated with various cardiac defects, cleft lip/palate, encephalocele, exencephaly, sirenomelia -In first trimester, cystic hygroma may be present. -Has also been associated with trisomies 13 and 18 and 45 X

Anorectal Atresia

-Presents as complex disorder of bowel and genitourinary tract -May present as part of VACTERL association or in caudal regression

Pulmonary Sequestration

-Probably develops from separate outpouching of foregut or by separation of segment of developing lung from tracheobronchial tree -Extra lung tissue nonfunctional; receives its blood supply from systemic circulation -Arterial supply usually from thoracic aorta, with venous drainage into vena cava

Trisomy 13

-Prognosis for this is extremely poor, with 80% of infants dying within first month -Considered lethal anomaly -Survivors profoundly retarded, with multiple deficits and problems

Roberts Syndrome

-Rare condition characterized by phocomelia and facial anomalies -Autosomal-recessive disorder -Also known as pseudothalidomide syndrome -May present with associated chromosomal abnormalities

Congenital Bronchial Atresia

-Rare pulmonary anomaly that results from focal obliteration of a segment of the bronchial lumen -Most common in left upper lobe -Appears on ultrasound as echogenic pulmonary mass lesion

Pulmonary Hypoplasia

-Reduction in lung volume results in small, inadequately developed lungs. -Decreased ratio of lung weight to body weight is consistent method of diagnosing

Liver

-Relatively large compared with other intraabdominal organs -Occupies most of upper abdomen in fetus -Accounts for 10% of total weight of fetus at 11 weeks and 5% of total weight at term

Meckel's Diverticulum

-Remnant of proximal part of yolk stalk that fails to degenerate and disappear during early fetal period -Usually small fingerlike sac, about 5 cm long, projects from border of ileum.

Polysplenia

-Represented as transposition of liver, spleen, stomach, and absence of gallbladder. -Interruption of IVC and azygos vein directly posterior to heart and in front of spine

Trisomy 13

-Result of extra chromosome 13 -Extremely severe anomaly consists of multiple anomalies; many involve brain

Achondroplasia

-Results from decreased endochondral bone formation -Produces short, squat bones -Most commonly results from spontaneous mutation but can transmitted in autosomal fashion -Homogeneous form deadly

Congenital Cystic Adenomatoid Malformation (CCAM)

-Results from embryogenetic alteration in developing lung during first 8 to 9 gestational weeks -Lesion may involve one or more lobes of lung or entire lung or be bilateral -Malformation may communicate with bronchial tree. -Usually unilateral

Amniotic Band Syndrome

-Rupture of amnion leads to entrapment or entanglement of fetal parts by "sticky" chorion. -May cause amputation or defects in random sites -Early entrapment by bands may lead to severe craniofacial defects and internal malformations

Esophagus

-Short in beginning -Rapidly lengthens as body grows -Reaches its final length by 7th week

Microcephaly

-Small biparietal diameter -Small head circumference -Abnormal head circumference/abdomen circumference and head circumference-to-femur length ratios

Ureterocele

-Sonographic appearance is anechoic cystic appearance, surrounded by thin echogenic membrane within bladder. -Best visualized when bladder somewhat full

Pleural Effusion (Hydrothorax)

-Sonographically, appear as echo-free peripheral masses on one or both sides of fetal heart -Conform to thoracic cavity and often compress lung tissue -Lung appears to float in fluid.

Ureterovescial Junction Obstruction (UVJ)

-Sonographically, collection of anechoic urine located medially within renal pelvis that communicates with calyces (caliectasis) -Renal pelvis may take on "bullet shape" appearance surrounded by dilated or normal calyces. -Duplication of renal collecting system is common

Holoprosencephaly

-Three forms -Most severe form classified as alobar; intermediate form as semilobar; mildest as lobar -Identification of specific form depends on degree of failed hemispheric division.

Duodenal Atresia

-Two echo-free communicating structures (stomach and duodenum) found in upper fetal abdomen. -Sonographic appearance termed "double bubble sign."

Cystic dilation of intravesical (bladder) segment of distal ureter

-Ureter typically inserts into ectopic location on bladder and can easily become obstructed. -Lower pole of duplicated kidneys more prone to reflux -Upper pole more prone to obstruction -Hydronephrotic, nonfunctioning upper pole may cause downward displacement of lower pole calyces.

Congenital Diaphragmatic Hernia

-Usually found on left side of diaphragm, and left-sided organs (stomach, spleen, portions of liver) enter chest through opening -Abnormally positioned abdominal organs shift heart and mediastinal structures to right side of chest.

Acrania

-Usually progresses to anencephaly as brain slowly degenerates as result of exposure to AF -May be confused with anencephaly -Presence of significant brain tissue and lack of froglike appearance should establish diagnosis -Identification of additional findings, such as long bone fractures

Aqueductal Stenosis

-Usually sporadic anomaly -May result from intrauterine infections -Cranial masses and ventricular hemorrhage also contributing factors of acquired obstruction -Primarily usually X-linked and has autosomal-recessive inheritance

Spina Bifida

-Wide range of vertebral defects that result from failure of neural tube closure -Meninges and neural elements may protrude through defect. -Defect may occur anywhere along vertebral column but most commonly along lumbar and sacral regions

Pseudoascites

-always confined to anterior fetal abdomen and centrally located -never outlines falciform ligament like true ascites

Frontal bone

-appears as curvilinear surface with differentiation of nose, lips, chin. -Allows diagnosis of anterior cephaloceles

Spina bifida

-has been associated with multiple syndromes and chromosomal anomalies, including trisomy 18. -Fetuses exposed to teratogens, such as valproic acid

Meconium Ileus

-is a small-bowel disorder marked by presence of thick meconium in distal ileum -occur in newborns with cystic fibrosis

Cross-fused ectopic

-kidney lies on opposite side of abdomen relative to its ureteral insertion into bladder -Kidneys usually fused together and found on right side of abdomen -In rare incidences, kidney may be located in thoracic cavity, more commonly on left side.

3rd ventricle

1

Anterior horn

1

Binocular diameter (BD)

1

Bladder

1

Cavum septum pellucidum

1

Cavum septum pellucidum (CSP)

1

Cerebellum

1

Cerebrum

1

Esophagus

1

Fibula

1

Lateral ventricle

1

Lateral ventricles

1

Nose

1

Portal vein

1

Systole

1

Thalamus

1

Ulna

1

Umbilical vein

1

Wharton's jelly

1

Ulna

1(Arm)

Fibula

1(Leg)

2 parts of the brain

1) Cerebrum (cerebral cortex) 2) Cerebellum

3 shunts in fetal circulation

1) Ductus venosus 2) Forman ovale 3) Ductus arteriosus

Three types of mechanical macrosomia

1) Fetuses generally large 2) Fetuses generally large but with especially large shoulders 3) Fetuses with normal trunk but large head

3rd ventricle

2

Cerebellum

2

Choroid plexus

2

Cisterna magna

2

Diaphragm

2

Diastole

2

Foramen of monro

2

Formen of Monro

2

Frontal horn

2

Hypocampal gyrus

2

Inner orbital diameter (IOD)

2

Radius

2

Stomach

2

Tibia

2

Umbilical artery

2

Vermis

2

Mass

2 (general)

Radius

2(Arm)

Tibia

2(Leg)

4th ventricle

3

Anterior horn

3

Atrium

3

Cerebellum

3

Choroid plexus

3

Liver

3

Occipital horn

3

Orbital diameter (OD)

3

Posterior fossa

3

Spine

3

Vermis

3

3rd ventricle

4

Choroid plexus

4

Cisterna magna

4

Heart

4

Temporal horn

4

Thalamus

4

Perpendicular

4 chamber view taken with sound beam __________________ to spine

Aqueduct of Sylvius

5

Atrium

5

Choroid plexus

5

Hippocampus

5

Stomach

5

Gestational sac

500 mIU/ml beta-hCG = __________________ seen

Fornices

6

Posterior horn

6

Thalamus

6

Cerebral aqueduct

7

Coronal suture

7

Vermis

7

Cisterna magna

8

Embryo

>16-mm gestational sac = ____________ seen

Yolk sac

>8mm gestational sac = ________________ seen

Abdomen

A

Ductus Arteriosus

A portion of blood in the right ventricle escapes to the descending AO via the

Portal vein

AC is measured in transverse where the umbilical vein joins the

decreases

AFAFP ________________ with fetal age

20-24

AFI values of __________cm indicate increased fluid

5-10

AFI values of ________cm indicate low fluid

twice

AFP level in twin pregnancy will be _____________ that of singleton pregnancy because two fetuses make twice the AFP

gastroschisis

AFP levels higher in fetus with ___________________ than in fetus with omphalocele

NT (Nuchal Translucency)

Abnormal fluid collection behind fetal neck strongly associated with aneuploidy

annular pancreas

Abnormal migration of the ventral pancreatic bud, Can compress duodenum, causing vomiting -gastro obstruction in fetus

Placental Invasion

Abnormal penetration of placental tissue beyond endometrial lining of uterus

>8mm

Abnormal yolk sac size is

ventricular dilation

Abnormalities linked with _____________________ include: -Aqueductal stenosis -Arachnoid cysts -Vein of Galen aneurysms

Microcephaly

Abnormally small head that falls two standard deviations below the mean -Occurs because brain reduced in size

Hypertelorism

Abnormally wide-spaced orbits

21

About 30% of fetuses with duodenal atresia have trisomy ____

7-8

Absence of cardiac activity by ______ weeks indicates fetal demise

Hemopoiesis

Accounts for large size of liver between seventh and ninth weeks of development

Pleural Effusion (Hydrothorax)

Accumulation of fluid within pleural cavity that may appear as isolated lesion or secondary to multiple fetal anomalies

Parenti-Fraccaro

Achondrogenesis Type I AKA

Langer-Saldino

Achondrogenesis Type II AKA

recessive

Achondrogenesis type I considered more severe; is transmitted in autosomal-______________ mode

Isoechoic

Acute hemorrhage ____________ to placenta

amniocentesis

Advanced maternal age is common reason for performing

meconium

After 14 weeks of gestation, lipid absorbed from fetal colon and remaining contents collect in colon as __________________

first

After ________ trimester, posterior portion of body grows beyond vertebral column and spinal cord; growth of spinal cord lags behind growth of vertebral column

32-34

After ________ weeks, the distal femoral epiphysis should be visualized

15-16

After _________ week, meconium begins to accumulate in distal part of small intestine

20

After _____weeks gestation, intraplacental sonolucencies and placental calcification may begin to appear.

27

After _____weeks, peristalsis of normal small bowel increasingly observed.

7

After ____th week, most progesterone produced by syncytiotrophoblast from maternally derived cholesterol precursors

ligamentum teres

After birth, umbilical vein collapses and becomes

24

After___ weeks, progressive flattening of epithelial cells lining air spaces

2-2.5

Alpha-fetoprotein (AFP) evaluation usually based on x___________ multiples of median (MOM)

Anencephaly

Also known as aprosencephaly and atelencephaly

Kidney

Alternative area to watch for breathing is _______________ movement in longitudinal plane

Both

Amniocentesis technique for multiple gestations similar to singleton method, except _________ fetal sac entered

14

Amnion and chorion should be fused by ____wks

28

Amnion develops at _____ menstrual day; is attached to margins of embryonic disc

anteriorly

Amnion seen as an echogenic line unattached from the chorion _________________

Kidney

Amniotic fluid level is directly related to __________ function

<1-2cm

Amniotic fluid pocket <_______ may represent IUGR

18-20

Amount of urine produced is most significant at approximately __________ weeks gestation.

Inferior

Angle transducer ___________ toward base of skull to image posterior fossa

Cistern magnum

Angle transducer slightly more inferior from cerebellum to record __________________ and nuchal fold area

horseshoe

Anomalies occurring with ____________ kidneys include: -Central nervous system disorders -Cardiac abnormalities -Urogenital abnormalities -Incidence of trisomy 18 and 45,X also increased

middle cerebral artery (MCA)

Another ultrasound tool to predict fetal anemia is Doppler evaluation of

cephaloceles

Anterior _____________________ may cause widely spaced orbits

cloacal

Anterior abdominal wall defect may be primary sonographic finding of _______________ exstrophy.

spleen

Apex of heart should be directed toward

Cranium

Appears as circle at highest levels and as oval at ventricular, peduncular, basal levels

Stomach

Appears as fusiform dilation of caudal part of foregut

unfused

Apron of greater omentum is small and remains ____________ in fetus

mesenchymal

Arches are separated by branchial grooves and composed of core of __________________ cells

hypertrophy

Areas of rich blood supply toward the fundus and mid portion of the uterus cause the placenta to

Hemangioma

Arises from transepithelial cells of vessels of umbilical cord Pathologically, angiomatous nodule surrounded by edema and myxomatous degeneration of Wharton's jelly

Distal femoral point (DFP)

Arrow(Leg)

Bowel (clumping)

Arrows

Bowel obstruction (meconium filled)

Arrows

Cleft lip (unilateral)

Arrows

Diaphragmatic hernia

Arrows

Eyelids

Arrows

Gastroschisis

Arrows

Herniated bowel

Arrows

Herniated bowel (gastroschisis)

Arrows

Periventricular calcifications

Arrows

Bowel obstruction

Arrows (general)

yolk sac

As embryo folds at cranial end, base of ____________________ partially incorporated as foregut

umbilicus

As embryo grows and folds ventrally, junction of amnion reduced to small area on ventral surface of embryo to form

increased

As gestation progresses, trend is toward ________________ pulmonary echogenicity relative to liver

Single pocket

Assessment maximum vertical pocket (fluid should measure >1 cm "rule") assessment of AF done by identifying largest pocket of AF

Spina Bifida

Associated sonographic cranial findings include: -Flattening of frontal bones, head "lemon" shape -Obliteration of cisterna magna -Inferior displacement of cerebellar vermis, giving cerebellum rounded, "banana" shape -Ventriculomegaly

VACTERL

Association is group of anomalies that may occur together: -Vertebral defects -Anal atresia -Cardiac anomalies -Tracheoesophageal fistula -Renal anomalies -Limb dysplasia

Nuchal

Association of first trimester with aneuploidy is well established and depends on size and extent of nuchal abnormality

6

At ____ months, fetus displays sucking reflex

37

At ______weeks gestation, AF is mixed with particulate matter (vernix)

15

At approximately ____ weeks of gestation, overall kidney echogencity will decrease; renal pelvis may be seen as sonolucent areas within central kidney

Bowel

B

Deviation of bladder (gastroschisis)

B

Thalamus

BPD is measured at the level of the

Inner

BPD is measured from outer to

Inner

BPD is measured from the outer border of the proximal skull to the ___________ borders of the distal skull (leading edge to leading edge)

Cardiac nonstress test (NST)

BPP Parameter? At least two episodes of fetal heart rate changes of 15 bpm and at least 15 seconds duration in 20-minute period

Fetal tone (FT)

BPP Parameter? one or more episodes of extension of a fetal extremity with return to flexion, or opening or closing of a hand

Gross fetal body movements (FM)

BPP Parameter? three or more discrete body or limb movements within 30 minutes, unrpovoked

0-2

BPP score of _______ indicates either immediate delivery or extending test to 120 minutes

4-6

BPP score of ________ has no immediate significance

8-10

BPP score of _________ considered normal

diaphragm

Base of heart lies horizontal to

symmetric and asymmetric

Basic classifications of IUGR

twin-to-twin transfusion (TTS)

Because circulations of monozygotic twins communicate through single placenta, they are at increased risk for syndrome known as

amniotic fluid

Because hemolysis results in breakdown of red blood cells, a by-product, bilirubin, stains the

24

Because microcephaly may manifest later in pregnancy, diagnosis before _____weeks of gestation may be impossible.

heart area

Best determination for predicting pulmonary hypoplasia is chest area (CA) minus _____________ (HA) times 100 divided by chest area (CA)

hyperechoic

Between 18 and 20 weeks of gestation, kidneys slightly _________________ compared to surrounding tissues

4-5

Between _______ months, fetus can grip objects and is capable of weak respiratory movements

16-24

Between ________ weeks, increase in number and complexity of air spaces and vascular structures

16-20

Between ________ weeks, normal number of bronchi have formed

Potter syndrome

Bilateral renal agenesis often referred to as

450 nm

Bilirubin absorbs light at the ___________ wavelength

Outer

Binocular diameter (BD) measured outer to

trisomy 21

Biochemical screening in ________________ fetuses reveals high hCG levels and decreased AFP and estriol levels.

urogenital sinus

Bladder is derived from hindgut derivative known as

placental anomalies

Bleeding in second and third trimesters can be associated with

Extrahepatic biliary atresia

Blockage of bile ducts results from failure to recanalize following solid stage of development.

color flow

Blood clots from abruption will not exhibit

Ductus venosum

Blood that does NOT circulate the liver, is shunted directly into the IVC via the

Foramen Ovale

Blood that does not go to the RV, bypasses straight into the Left Atrium via the

amniotic sacs

Both monozygotic and dizygotic twins may have two

shoulder dystocia

Brachial plexus nerve injuries may result if ______________________ occurs during vaginal pregnancies

Corpus Callosum

Brain structure? -Begins to develop at 12 weeks of gestation -Is not complete until 20 weeks

frontal

Bridge of nose originates from _______________ prominence

9

By ___ weeks, the yolk sac has diminished to less than 5 mm in diameter

8

By ____ week of development, fingers longer

12

By ____ weeks, neural sensitivity has spread across surface of body except at the back and top of the head

12

By _____ week, bile formation by hepatic cells has begun.

12

By _____ weeks of gestation, 86% of fetal kidneys may be imaged.

25

By ______ weeks, it is possible to distinguish the renal cortex from the medulla, outline the renal capsule clearly, and see a central echogenic area in renal sinus region.

20

By _____weeks gestation, AF volume increases by 10 ml/day

6

By ____weeks, right umbilical vein regresses and left umbilical vein enlarges to accommodate increasing flow.

5

By end of _____ week of development, embryo is flat disc consisting of three layers: -Ectoderm -Mesoderm -Endoderm

Umbilical

By term approximately 40% of fetal cardiac output is directed through _______________ circulation

5

By the ___th week of development, five prominences are identified: -Frontal nasal prominence -Paired maxillary prominences of first branchial arch -Paired mandibular prominences

6-12

By transvaginal sonography CRL can be measured from _________ gestational weeks

Chin

C

Umbilical cord cyst

C

III

CCAM Type? large, bulky, noncystic lesions producing mediastinal shift; poor prognosis -Usually only one lobe affected -Associated polyhydramnios and anasarca have poor prognosis.

II

CCAM Type? multiple small cysts, <1 cm in diameter, echogenic; high incidence of other congenital anomalies (renal, gastrointestinal)

I

CCAM Type? single or multiple large cysts 2 cm in diameter; good prognosis after resection of affected lung

18

CNS arises from ectodermal neural plate around _____ gestational days

swallowing

CNS disorders cause depressed

6-12

CRL can be measured from ____________ gestational weeks

translucency

Calipers are placed on borders of nuchal ________________, not in nuchal fluid area

beta-hCG (Free Beta Human Chorionic Gonadotropin)

Can be assessed in maternal serum in first trimester to evaluate for increased risk of Down syndrome

>7mm

Cardiac activity should be seen when the CRL meas

Nonimmune Hydrops (NIH)

Cardiovascular lesions often most frequent causes of _____

spinal cord

Caudal end of neural plate forms

trisomy

Cause of ______________ usually nondisjunction, failure of normal chromosomal division at time of meiosis

Pregnancy-induced hypertension

Cause of condition includes preeclampsia, severe preeclampsia, and eclampsia

Pulmonary Hypoplasia

Caused by decrease in number of lung cells, airways, and alveoli, with resulting decrease in organ size and weight

Anencephaly

Causes of Condition?: -Meckel-Gruber -Chromosomal (T-13, T-18) -Diabetes -Environmental and dietary factors -Amniotic band syndrome

cystic hygroma

Cavernous lymphangioma of the neck. Associated with Turner syndrome.

BPD/OFD x 100

Cephalic index (CI) formula

BPD/OFD x 100

Cephalic index formula

forebrain

Cephalic neural plate develops into

Encephalomeningocele

Cephalocele containing meninges and brain tissue

Encephalomeningocystocele

Cephalocele containing meninges, brain tissue, lateral ventricles

Cerebellar vermis

Cerebellar hemispheres joined together by

Cystic hygroma

Ch

Hypotelorism

Characterized by decreased distance between orbits

Poly-Oli Sequence

Characterized by diamniotic pregnancy with polyhydramnios in one sac

cephaloceles

Chromosomal anomalies and syndromes have been identified with ___________________, including trisomy 13 and Meckel-Gruber syndrome

Arnold-Chiari malformation

Cisterna magna almost always effaced (thinned out) or obliterated in fetuses with the _____________________________ changes associated with spina bifida

IUGR

Clinical signs of? -decreased fundal height and fetal motion

primary sex cords

Coelomic epithelium that covers primitive gonads proliferates and forms cords of cells called -These grow into mesenchyme of developing gonads

nostrils

Color flow Doppler may be used to detect fetal breathing through

ventriculomegaly

Common causes of __________________________ include spina bifida and encephaloceles

Amniotic Band Syndrome

Common findings due to?: facial clefts, asymmetric encephaloceles, constriction or amputation defects of extremities, clubfoot deformities

incorrect dates

Common reason for AFP elevations is

Midgut

Communicates with yolk sac via yolk stalk

18

Communications between fourth ventricle and cistern magna not complete until week _____ of gestation

Complete breech

Complete flexion of the thighs and the legs extending over the anterior surfaces of the body

ADPKD (adult dominant polycystic kidney disease)

Condition

Acrania

Condition

Agenesis of Corpus Callosum

Condition

Agenesis of Corpus Callosum (w/absent CSP)

Condition

Alobar holoprosencephaly

Condition

Ambiguous genitalia

Condition

Anencephaly

Condition

Bladder exstrophy

Condition

Bladder obstruction

Condition

Cystic adenomatoid malformation (type I)

Condition

Cystic adenomatoid malformation (type II)

Condition

Cystic adenomatoid malformation (type III)

Condition

Dandy-Walker Malformation

Condition

Dandy-Walker Malformation (w/ventricular megaly)

Condition

Diaphragmatic hernia

Condition

Dilated renal pelvis (ureterocele)

Condition

Dilated ureters

Condition

Duplicate kidney (ureterocele)

Condition

Encephalocele

Condition

Enlarged bladder & urethra ("keyhole" sign)

Condition

Gastroschisis

Condition

Gastroschisis (secondary amniotic bands)

Condition

Herniated bowel (gastroschisis)

Condition

Holoprosencephaly

Condition

Hydraencephaly

Condition

Hydrocephaly (aqueductal stenosis)

Condition

Hydronephrosis

Condition

Hydronephrosis (R-mild, L-severe)

Condition

IPKD (Infantile polycystic kidney disease)

Condition

MCDK (multicystic dysplastic kidney disease)

Condition

Microcephaly (w/bilateral cleft lip)

Condition

Microcephaly (w/semilobar holoprosencephaly)

Condition

Obstructive cystic dysplasia (bladder outlet obstruction)

Condition

Omphalocele

Condition

Omphalocele (bowel)

Condition

Patient urachus

Condition

Pyelectasis (mild)

Condition

Renal agenesis

Condition

Renal agenesis (left)

Condition

Renal agenesis (unilateral)

Condition

Renal dysplasia (obstructive cystic dysplasia)

Condition

Renal ectopia

Condition

Schizencephaly

Condition

Spina bifida

Condition

UPJ (uteropelvic junction obstruction)

Condition

UVJ (uterovesical junction obstruction)

Condition

Ureterocele

Condition

Ventricularmegaly

Condition

Ventriculomegaly

Condition

Ventriculomegaly (lemon head)

Condition

Small for Gestational Age (SGA)

Condition can be due to: -Chromosomal anomalies -Intrauterine infection -Genetics -Placental insufficiency

Macrosomia

Condition is a common result of poorly controlled maternal diabetes mellitus

Arthrogryposis Multiplex Congenita

Condition marked by severe contractures of extremities because of abnormal innervation and disorders of muscles and connective tissue

Renal agenesis

Condition occurs when ureteric buds fail to develop or when they degenerate before they can induce metanephric mesoderm to form nephrons.

Congenital Hypophosphatasia

Condition that presents with diffuse hypomineralization of bone caused by alkaline phosphatase deficiency -Inherited condition transmitted in autosomal-recessive manner

"Hitchhiker thumb" (diastrophic dysplasia)

Condition?

Absent helix

Condition?

Absent nasal bone (trisomy 21)

Condition?

Achieropodia

Condition?

Amniotic band syndrome

Condition?

Amniotic sheet

Condition?

Arthrogryposis Multiplex Congenita

Condition?

Ascites (immune hydrops)

Condition?

Battledore placenta

Condition?

Bilateral femoral bowing (camptomelic displasia)

Condition?

Bilateral fractured femora (osteogenesis imperfectal)

Condition?

Brachiocephalic

Condition?

Caudal regression syndrome

Condition?

Chorioangioma

Condition?

Cleft (lip & palate)

Condition?

Cleft lip (unilateral)

Condition?

Cleft lip and palate

Condition?

Cleft palate

Condition?

Clover-leaf skull (thanatophoric dysplasia)

Condition?

Conjugated twins

Condition?

Cyclopia

Condition?

Cyclopia (w/ no nose)

Condition?

Cyclopia (w/holoprosencephaly)

Condition?

Cystic hygroma

Condition?

Demise

Condition?

Diaphragmatic hernia

Condition?

Dolichocephaly

Condition?

Duodenal atresia

Condition?

Duodenal atresia ("double bubble" sign)

Condition?

Encephalocele (hypertelorism)

Condition?

Esophageal atresia

Condition?

Ethmocephaly (no nose w/holoprosencephaly)

Condition?

Fetus papyraceous

Condition?

Frontal bossing & Midface hypoplasia (aneuploidy)

Condition?

Gallstones

Condition?

Gastroschisis

Condition?

Goiter (thyroid)

Condition?

Holoprosencephaly

Condition?

Hydronephrosis

Condition?

Hypomineralization (osteogenesis imperfectal)

Condition?

Hypotelorism

Condition?

Incompetent cervix

Condition?

Increased NT

Condition?

Intervillous thrombosis

Condition?

Lemon-shaped skull (trigonocephaly)

Condition?

Macroglossia (beckwith-wiedemann)

Condition?

Macrosomic

Condition?

Marginal abruption

Condition?

Meconium Ileus

Condition?

Micrognathia

Condition?

Micromelia (Thanatophoric Dysplasia)

Condition?

Midface hypoplasia (aneuploidy)

Condition?

Midface hypoplasia (progeroid syndrome)

Condition?

Omphalocele

Condition?

Placental invasion

Condition?

Placental previa

Condition?

Plantar flexion (camptomelic displasia)

Condition?

Pleural effusion

Condition?

Pleural effusion (bilateral)

Condition?

Polydactyly

Condition?

Polyhydraminos

Condition?

Pseudoascites

Condition?

ROM

Condition?

Retroplacental abruption

Condition?

Scalp adema

Condition?

Scalp edema

Condition?

Septated cystic hygroma

Condition?

Single umbilical artery

Condition?

Situs inversus (partial)

Condition?

Skin edema (nonimmune hydrops)

Condition?

Stuck twin

Condition?

Tachycardia (nonimmune hydrops)

Condition?

Talipes (Bilateral)

Condition?

Talipes (clube foot)

Condition?

Thanatophoric Dysplasia ("champagne cork")

Condition?

Thanatophoric Dysplasia (protuberant abdomen)

Condition?

Thanatophoric Dysplasia (short ribs)

Condition?

Thanatophoric Dysplasia (small thorax)

Condition?

Thickened nuchal fold

Condition?

Thickened placenta (immune hydrops)

Condition?

Umbilical herniation

Condition?

Varix

Condition?

Vasa previa

Condition?

Ventricular spetal defect

Condition?

Ventriculomegaly

Condition? "Dangling choroid sign," as gravity-dependent choroid plexus falls into increased ventricular space -Possible dilation of third and fourth ventricles -Fetal head enlargement when biparietal and head circumference measurements exceed those for established gestational age

Turner's syndrome (45 X)

Condition? -Cystic -Heart (coarctation of AO) -Hydrops -Renal -Short femurs

Twin-twin transfusion syndrome (TTS)

Condition? -Exists when there is arteriovenous shunt within placenta -Arterial blood of one twin is pumped into venous system of other twin. -Donor twin becomes anemic and growth restricted

Turner's syndrome (45 X)

Condition? -Female infants who survive will have immature sexual development, amenorrhea, short stature, webbed neck, cubitus valgus (abnormal elbow angle), shield chest with widely spaced nipples. -May have poor hearing -Hormone replacement necessary for sexual development -Usually have normal intelligence

Trisomy 18

Condition? -Fetus will often spontaneously abort. -Infants profoundly retarded -Considered lethal anomaly, with 90% of infants dying within first year of life

Bladder exstrophy

Condition? -Fluid-filled bladder not visualized; however, normal kidneys and amniotic fluid evident -Small irregular mass representing everted atrophied bladder identified in lower abdomen below umbilical cord insertion -Sonographer should note abnormally low cord insertion when anomaly present

Trisomy 18

Condition? -Heart defects -Choroid plexus cysts -Clenched hands -Micrognathia -Talipes -Renal anomalies -Cleft lip and palate -Omphalocele -CDH -Cerebellar hypoplasia

Trisomy 13

Condition? -Holoprosencephaly -Heart defects -Cleft lip and palate -Omphalocele -Polydactyly -Talipes -Echogenic chordae tendineae -Renal anomalies -Meningomyelocele -Micrognathia

Triploidy

Condition? -Hydatidiform placental degeneration -Heart defects -Renal anomalies -Omphalocele -Cranial defects -Facial defects

Trisomy 21

Condition? -Nuchal thickness -Hygroma -Heart defects -Duodenal atresia -Shortened femurs -Mild pyelectasis -Mild ventriculomegaly -Echogenic bowel

Poly-Oli Sequence

Condition? -Severe oligohydramnios -Smaller twin in other sac -Majority involve monochorionic gestations

Bronchogenic Cysts

Condition? -Sonographically, appear as small circumscribed masses without evidence of mediastinal shift or heart failure -Amniotic fluid volume within normal range

Asymmetric IUGR

Condition? -begins late in second or third trimester and usually results from placental insufficiency. -Fetus usually shows head sparing at expense of abdominal and soft tissue growth. -Fetal length (FL) exhibits varying degrees of compromise.

Symmetric IUGR

Condition? -usually result of first trimester insult, such as chromosomal abnormality or infection -Results in fetus proportionately small throughout pregnancy -20% to 30% of all IUGR

Battledore Placenta

Condition? Differential proliferation of placenta villi may result in eccentric insertion of umbilical cord into placenta. Cord implants into edge of placenta instead of into middle of placenta.

Placenta previa

Condition? If cervical os dilates with labor, is significant risk of placenta detaching from uterus, resulting in maternal hemorrhage, loss of oxygen and blood supply to fetus

Macrosomia

Condition? Placentas can become significantly large and thick because not immune to growth-enhancing effects of fetal insulin

Achondrogenesis

Condition? Sonographic findings: -Severe micromelia -Decreased or absent ossification of spine -Macrocephaly -Short trunk -Short thorax and short ribs -Micrognathia -Polyhydramnios -Hydrops possibly identified

Macrosomia

Condition? fetus has increased incidence of morbidity and mortality as a result of head and shoulder injuries and cord compression

Small thoracic cavity (osteogenesis imperfectal)

Condition? (Arrows)

Micromelia

Condition? (general)

Acardiac anomaly

Condtion?

Foramen of Bochdalek

Congenital Diaphragmatic Hernia is the most common type of diaphragmatic defect occurs posteriorly and laterally in diaphragm herniating through the

micrognathia

Congenital ___________________ should be suspected when small chin observed.

Anophthalmia

Congenital absence of one or both eyes

Foramen of Morgagni

Congenital diaphragmatic hernia occur anteriorly and medially in diaphragm, through _______________________, and may communicate with pericardial sac

neural tube

Cranial and caudal neuropores represent unfused regions of

12

Cranial bones ossify by _____th week

prostaglandin

Currently, pregnancy-induced hypertension considered to be caused by _________________ abnormalities

Ureterocele

Cystic dilation of intravesical (bladder) segment of distal ureter

Omphalomesenteric Cyst

Cystic lesion of cord caused by persistence and dilation of segment of omphalomesenteric duct Lined by epithelium of gastrointestinal origin

Gestational age (SGA)

DO NOT confuse IUGR with term small for

Vanishing Twin

Death & reabsorption of twin -Once reabsorbed, products of conception of this twin will no longer be seen on ultrasound

viscosity

Decrease in _____________ results in decrease in resistance to flow

middle cerebral artery (MCA)

Decrease in resistance to flow is detected by increase in velocity in

Polyhydramnios

Defined as AF volume of >2000 ml

Cephalic Index (CI)

Defines the normality of the head shape

Umbilical arteries

Deoxygenated blood returns to the placenta via the ______________________ which arise from the fetal iliac vessels

Monozygotic

Depending on whether fertilized egg divides early or late, there may be one or two placentas, chorions, and amniotic sacs in _______________ twins

Midface Hypoplasia

Depressed or absent nasal bridge is underdevelopment of middle structures of face -may be seen in fetuses with chromosome anomalies.

eyeball

Determine visual "__________" -Fluid present -Lie of fetus -Position of placenta

6-11

Development and rotation of the midgut from the _____________ weeks

9

Development of cerebellar vermis begins during ______ week

9

Development of feet and toes essentially complete by _____ week

Persistent Intrahepatic RPV

Development of venous drainage complex At 5 to 6 weeks gestational age, there are paired umbilical veins that carry blood from placenta to primitive heart.

Duodenum

Develops from caudal part of foregut and cranial part of midgut

Pancreas

Develops from dorsal and ventral pancreatic buds of endodermal cells that arise from caudal part of foregut

18

Diagnosis of agenesis and hypoplasia of cerebellar vermis should not be made prior to week ____

Right

Diaphragm defects on the _______ side of the diaphragm allow the the abdominal viscera including the liver, gallbladder, & intestines to enter the chest

Hydronephrosis

Dilation of renal pelvis occurs in response to blockage of urine at some junction in urinary system. -Commonly occurs when there is obstruction in ureter, bladder, or urethra -Is generally end result of obstruction at lower level in urinary tract

Hydrops

Disparity between amounts of serous fluid being produced and absorbed -Leads to accumulation of fluid, or edema, within fetus

Gestational sac

Distended urinary bladder has effect on _________________ measurement

20

Distinction of large bowel from small bowel possible after _____ menstrual weeks

Gallbladder

Distinguished by location to right of portal-umbilical vein and as oblong, more oval structure than "tubular" intrahepatic umbilical vein

diamniotic

Documentation of membrane separating fetuses confirms presence of _________________ pregnancy

autosomal dominant

Dominant genetic disorder is condition caused by single defective gene -Usually inherited from one parent, but may arise as new mutation

Trisomy 21

Down syndrome AKA

Cleft Sternum

Dramatic pulsations of anterior chest wall occur from heart beating against chest without presence of sternum to protect it.

3

During ___ week of early development, omphalomesenteric duct joins embryonic gut and yolk sac

7

During ____ week, hepatic bud enlarges and right umbilical vein atrophies

5-6

During _________, dorsal border (greater curvature) grows faster than ventral border (lesser curvature)

5-6

During __________ weeks, lumen of duodenum becomes partly or totally occluded (depending on proliferation of its lining of epithelial cells)

8-12

During __________weeks of development, fetal bowel normally migrates into umbilical cord from abdominal cavity

placenta

During an amniocentesis, avoid _________________ in Rh-negative patients

6

EHR age accurate to within ±_____ days

6

EHR age that trails CRL age more than ____ days may be associated with impending first trimester failure and warrants follow-up

5-9

EHR can be measured by M-mode from early________ gestational weeks when CRL <25 mm

Uriniferous

Each ______________ tubule consists of two parts: a nephron and a collecting tubule.

allantois

Early in development, urinary bladder is continuous with ________________ -regresses to become a fibrous cord, the urachus.

less

Early in gestation, lungs similar to or slightly ______ echogenic than liver

37-38.6

Early term delivery occurs __________ weeks

Echogenic Interacardiac Focus (EIF)

Echogenic structure as bright as bone seen in a heart chamber

Trisomy 18

Edwards syndrome

Gestational Trophoblastic Disease

Encompasses disease processes that originate in placenta

3

End of ____ week: Cephalic end of neural tube bends into shape of C (cephalic flexure).

Ventriculomegaly

Enlargement of ventricles occurs with obstruction of cerebrospinal fluid flow.

Tracheoesophageal fistula

Esophageal atresia will not be diagnosed in majority of cases because of

lower

Everted bladder becomes exposed on ____________ abdominal wall.

Death

Exaggerated curvature of fetal spine and gas in fetal abdomen is indication of fetal

cloaca

Excretory ducts of urogenital systems initially enter common cavity called

12

External genital organs are fully differentiated by _____ week of gestation

Congenital nephrosis

Extremely high levels of AFP are excreted by kidneys

Frontal bone

F

Chest

FC

mesovarium

Female genital ridge becomes

Epiphysis

Femur length is measured from the diaphysis (calcified portion) and does NOT include the

goiter

Fetal _________ (thyromegaly) usually appears as a symmetrical (bilobed), solid, and homogeneous mass, arising from the anterior fetal neck in the region of the fetal thyroid gland.

breathing

Fetal _________________ movements documented if characteristic seesaw movements of fetal chest or abdomen sustained for at least 20 seconds

larger

Fetal abdomen _____________ relative to body length

Bladder exstrophy

Fetal anomaly with eversion of the posterior bladder through the anterior bladder wall and Lower abdominal wall

30

Fetal bladder usually takes at least ______ minutes to fill and empty

Cordocentesis

Fetal blood obtained through needle aspiration of umbilical cord

20

Fetal breathing movements considered absent if no such fetal activity noted during _____ minute observation period

3

Fetal cervical length should be >___cm

MSAFP

Fetal death is frequent cause of high _____________ level

13

Fetal kidneys and bladder should be seen by _____ weeks of gestation

14-16

Fetal kidneys begin to excrete urine after 11th week but do not become major contributor of fetal urine until _________ weeks of pregnancy

Long axis

Fetal lie described in relation to maternal

Echogenic

Fetal lung tissue is more _______________ than the liver

small

Fetal pelvic cavity is ________ in size

Cytotrophoblastic shell

Fetal placenta anchored to maternal placenta by __________________________________ and anchoring villi

8-11

Fetal production of urine and ability to swallow begins between ___________ weeks of gestation

24-26

Fetal skin permeable to water and solutes allows direct exchange between fetus and AF until keritinization occurs at _________ weeks

androgens

Fetal testes produce ________________ that cause masculinization of external genitalia

Ventriculomegaly

Fetal ventricles important to assess because _____________________ or hydrocephalus (dilated ventricular system) may be sign of central nervous system abnormalities

4

Fetus begins to have defined periods of activity and inactivity at end of ____ month

11

Fetus capable of swallowing sufficient amounts of amniotic fluid to permit visualization of stomach by ____ menstrual weeks

microcephaly

Fetus with encephalocele may have __________________ because of amount of brain tissue protruding outside calvarium

asphyxiating thoracic dystrophy

Fetus with significant narrow diameter of chest may have

myelomeningocele

Fetuses with ___________________________ often present with cranial defects associated with Arnold-Chiari (type II) malformation

Aneuploidy

Fetuses with thickened nuchal skin at increased risk for

Lateral

Fibula ___________ to tibia and thinner

49

Fingers distinctly evident by day _____, but still webbed

Mandibular arch

First branchial arch known as ______________________ -Forms the jaw, zygomatic bone, ear, temporal bone

Pronephros

First pair of "kidneys," are rudimentary and nonfunctional.

PAPP-A (Pregnancy-Associated Plasma Protein A)

First trimester serum marker used to detect anomalies

Nonimmune hydrops fetalis (NIHF)

Fluid condition associated with: -Cardiac insufficiency -Trisomy 21 -45X -Fetal infections (TORCH)

Lungs

Fluid in ______________ at birth clears via three routes: 1.Through mouth and nose 2.Into pulmonary capillaries 3.Into lymphatics and pulmonary vessels

rugae

Fluid within stomach should be anechoic with linear __________

Placenta Infarct

Focal discrete lesion caused by ischemic necrosis

prosencephalon

Forebrain continues to develop into

Horseshoe Kidney

Form when inferior poles of kidney fuse while in pelvis

Umbilical Hernia

Forms when: -Intestines return normally to abdominal cavity -Herniate either prenatally or postnatally through inadequately closed umbilicus

Down syndrome

Free beta-hCG and PAPP-A being evaluated in combination with nuchal translucency measurements in first trimester as sensitivity screening tool for

Left portal vein

From the abdomen, the umbilical vein courses toward the liver where it connects to the

Microcephaly

Frontal slanting seen in

39-40.6

Full term delivery occurs ___________ weeks

Placenta

Function of the ? -Respiration -Nutrition -Excretion -Protection -Storage -Hormonal Production

7

Fusion of midline begins during ____ week

8

Fusion of midline completed by ____ week

blockage (atresia)

GI abnormalities result in ineffective swallowing that is often caused by a _________________ of the esophagus, stomach, duodenum, or small bowel

500

GS should be seen in uterine cavity when BHCG is above ________mIU.ml with TV

20

Gallbladder may be seen sonographically after ____weeks of gestation

Apex

Gallbladder on right side and _________ of heart pointing toward fetal left side may be verified by their relationship to stomach

12

Gender can be appreciated as early as _____ weeks, but care should be taken not to mistake the UC as a penis

Boy

Gender?

Hydrops (abdominal ascites)

General condition?

Hydrops (bilateral pleural effusion)

General condition?

Hydrops (pericardial effusion)

General condition?

Hydrops (skin edema)

General condition?

Hydrops (skull edema)

General condition?

distal

General rule: The more ___________ the obstruction, the less severe the hydramnios, and the later it will develop.

autosomal recessive

Genetic disorder that with each pregnancy, parents have 25% chance of having fetus with disorder

autosomal recessive

Genetic recessive disorder caused by pair of defective genes -One inherited from each parent

Branchial apparatus

Group that includes branchial arches, branchial grooves and membranes, pharyngeal pouches.

midline

Growth compresses medial nasal prominences together toward

cloaca

Growth of neural tube causes embryo to fold at caudal end, incorporating part of yolk sac as hindgut, which turns into ______________

Heart

H

BPD

HC is measured at the same level as the

Yolk sac

Has role in the transfer of nutrients to the embryo during 2nd and 3rd weeks of gestation while uteroplacental circulation developing

True Knots

Have been associated with: Long cords Polyhydramnios Intrauterine growth restriction Monoamniotic twins may be single or multiple; increased incidence of congenital anomalies

BPD

Head compression can alter accurate __________ measurements

Vertical cranial diameter (VCD)

Height of triangle is the

Left

Helix direction?

Right

Helix direction?

6

Hemopoiesis (blood formation) begins during _____ week

Septum transversum

Hemopoietic cells, Kupffer cells, connective tissue cells derived from mesenchyme in

hypoechoic

Hemorrhage subacute and chronic bleed becomes more

first

Hepatic veins and fissures formed by end of ________ trimester

12

Herniated loops of bowel normally return and rotate into position within abdominal cavity by ______ week of pregnancy

Pentalogy of Cantrell

High or superumbilical omphalocele usually primary finding

rhombencephalon

Hindbrain forms

13

Holoprosencephaly is frequently sporadic but has been associated with chromosomal anomalies, most specifically trisomy ___; however, trisomy 18 and triploidy have been identified and anomalies of chromosomes 7, 3, and 11.

chylothorax

Hydramnios often accompanies ______________ (lung condition) resulting from esophageal compression

left

Hydrops usually not present with _______-sided congenital diaphragmatic hernias unless associated fetal malformations are present

1

Hyperechoic bowel grade? mildly echogenic and typically diffuse

2

Hyperechoic bowel grade? moderately echogenic and typically focal

3

Hyperechoic bowel grade? very echogenic; similar to that of bone structures

Femoral diaphysis

Hyperechoic linear structure represents ossified portion of _______________________ and corresponds to femoral length measurement from greater trochanter to femoral condyles

cyclopia

Hypotelorism may be so severe that a single orbit is demonstrated with fused or single eye, as seen in

10%

IUGR commonly defined as fetal weight at or below ________ for given gestational age

Arachoid cysts (multiple)

Identify

Battledore placenta

Identify

Branchial cleft cyst

Identify

Bronchogenic cyst

Identify

Calcifications (liver)

Identify

Calcifications (placenta)

Identify

Choroid plexus cyst (bilateral)

Identify

Choroid plexus cysts

Identify

Circumvallate placenta

Identify

Dermoid cyst

Identify

Echogenic bowel

Identify

Epignathus

Identify

Gallbladder

Identify

Herniated bowel (mild dilation, gastroschisis)

Identify

Hyaloid artery

Identify

Kidney

Identify

Mandible

Identify

Molar pregnancy

Identify

Nose

Identify

Nuchal cord

Identify

Omphalomesenteric cyst

Identify

Ovarian cyst

Identify

Pancreas

Identify

Placental infarct

Identify

Placental lake

Identify

Porencephalic cyst

Identify

Proboscis

Identify

Pulmonary sequestration

Identify

Succenturiate placenta

Identify

True knot

Identify

Velamentous cord

Identify

Wilm's Tumor

Identify

Lacrimal duct cyst

Identify (anomaly)

Mass

Identify (general)

Tumor (Liver)

Identify (general)

diaphragmatic hernia

If ____________________ present, bowel visible in chest cavity

Twin-twin transfusion syndrome (TTS)

If _____________________ exists, both twins at risk of dying -Smaller one because its nutritional and oxygen rich blood supply is severely restricted -Larger one because of heart failure

10

If atrium measures >_____mm, it warrants serial imaging and further evaluation

pyelonephritis

If bacteriuria (UTI) not treated, 25% develop

twin-to-twin transfusion (TTS)

If both twins of same sex and growth discordance exists, _______________ may be possibility

symmetrically

If chromosomal anomalies are etiology for fetus measuring small, growth often ___________________ affected

atretic

If cord completely ________, fetus attached directly to placenta at umbilicus, and omphalocele is always present

8

If division occurs after ______days Two fetuses present, One chorion, & One amnion (monochorionic, monoamniotic)

4-8

If division occurs at ________ days, there will be one chorion and two amniotic sacs (monochorionic, diamniotic)

0-4

If division occurs early, _________ days postconception, there will be two amnions and two chorions (dichorionic, diamniotic)

twin-to-twin

If fetus anemic because of _________________ transfusion, intrauterine transfusion will not solve anemia problem because most of fetal blood being shunted to recipient twin

left

If fetus is in vertex presentation with spine up, both aorta and stomach should be seen to ________ of spine.

Vertex or breech

If fetus lying longitudinal or parallel to maternal long axis, described as ________ (head down) presentation or _________ (head up) presentation

Transverse fetal lie

If fetus lying perpendicular to long axis of mother, described as

effusion

If fluid collection measures >2 mm, pericardial cavity is considered

One

If gestational sac round, measure ______ diameter inner to inner

Ventriculomegaly

If glomus appears to float or dangle within cavity, it is sign of abnormally enlarged or dilated ventricles called

twin-to-twin transfusion (TTS)

If growth discordance is between twins but one is male and one is female, then ___________ cannot exist

hyperechoic

If hematoma is new, mass is ________________ on ultrasound

hypoechoic

If hematoma is old, mass is ________________ and septated

patent urachus

If larger portion of lumen persists, may cause urachal sinus to develop that may open at umbilicus or into urinary bladder and is called a

urachal fistula

If lumen of allantois persists while urachus forms, ___________________ develops, which causes urine to drain from bladder to umbilicus.

Cervix

If maternal bladder full, ___________ is falsely elongated

macrosomic

If maternal glucose levels very high and uncontrolled, fetus may also become

calcifications

If multiple ___________________ seen within liver, other organs such as brain and spleen may be affected

keyhole bladder

If obstructive disease bilateral, bladder outlet obstruction ("___________________") may be apparent as well as severe oligohydramnios

urachal cyst (vesicoallantoic cyst)

If only small part of lumen of allantois persists, is called

fluorescence in situ hybridization (FISH)

If rapid amniocentesis results desired, ______________________________ provides limited analysis within 24 hours

Two

If sac gestational ovoid, make _______ measurements inner to inner

situs inversus

If stomach seen in right upper quadrant, condition is called

16

If the amnion/chorion separation extends beyond ____ weeks gestation, it may be associated with polyhydramnios, aneuploidy, or prior amniocentesis. Hemorrhage may also have this appearance.

amniotic sac

If there is only one ____________, twins may entangle their umbilical cords, cutting off their blood supplies

13

If twin division occurs after _____days, division may be incomplete, resulting in conjoined twins

Epiphyseal cartilages

Imaged as rounded hypoechoic masses at each end of diaphysis called _________________________; should not be included in femoral length measurement

RhoGAM

Immune hydrops can be prevented, if _______________ given

Microcephaly

Impaired cranial growth should coincide with appropriate growth of abdominal circumference and femur length. -Serial measurements for fetus at risk should be performed at monthly intervals.

White-matter tracts

Important to recognize that the _____________________________ are positioned above level of lateral ventricles of cranium

Spina bifida

Important to recognize usual configuration of cerebellum because distortion may represent findings suggestive of open

Placenta accreta

Improper placement of placenta where chorionic villi attach to myometrium without muscular invasion

Placenta increta

Improper placement of placenta where it is further extension of the chorionic villi into the myometrium

Placenta percreta

Improper placement of placenta where it is penetration of the chorionic villi through the uterus

I

In CCAM type____ (macrocystic), one or more large cysts replace normal lung tissue -single or multiple cysts measuring >2 cm and up to 10 cm).

II

In CCAM type_____ (macrocystic with microcystic component) lesions consist of multiple small cysts (<1 cm) -associated with fetal and/or chromosomal abnormalities in 25% of cases -Anomalies may include renal agenesis, pulmonary anomalies, or diaphragmatic hernia.

III

In CCAM type_______ (microcystic) malformations characterized as bulky, large, noncystic lesions appearing as echo-dense masses of the entire lung lobe

increased

In IUGR, assess umbilical artery Doppler for ______________ resistance to flow.

6

In ____ week, process called folding helps embryo transform itself into cylindrical shape -This transformation is critical part of process of closing abdominal wall.

Lobar

In ____________ holoprosencephaly, almost complete division of ventricles with corpus callosum that may be normal, hypoplastic, or absent -Cavum septum pellucidum will still be absent.

mono-di

In _____________ pregnancies, only two layers of amnion separate twins

heart failure

In ____________________, faulty diffusion of AFP may lead to abnormal AFP increase when hydrops, ascites, or lymphangiectasia present

gastroschisis

In _____________________, AFP diffuses directly into serum and amniotic fluid from herniated bowel, which lacks covering membrane

Polyhydramnios

In ________________________, largest single vertical pocket reported to be more accurate

AC

In addition to adipose tissue, the liver, heart, and adrenal glands are disproportionately increased in size, which can be reflected by an increased

Angiomatous stroma (cerebrovasculosa)

In anencephaly, remnant brain covered by thick membrane called

Veins

In fetal circulation, the ___________ carry oxygenated blood

Ascites

In fetus, ____________ fluid collects between two leaves of unfused omentum, resulting in cystlike appearance in abdomen.

falciform ligament

In fetus, umbilical vein courses cephalically in free, inferior margin of

notched

In first trimester, flow-velocity waveform shows ____________ appearance in early diastole

external genital tubercle

In first trimester, gender differentiation hard to determine due to protrusion of -appears the same in both genders

bone marrow

In immune hydrops, fetal ________________ then replaces destroyed RBCs -if it cant keep up - extramedullary

IgG

In immune hydrops, mixing occurs, mother develops antibody, maternal _______ able to cross maternal fetal barrier and enter fetal circulation

Multicystic Dysplastic Kidney Disease (MCDK)

In isolated cases of unilateral involvement, disease will regress with time and disappear, or a small collection of cysts with calcified border will be present in renal fossa.

4

In its ___th week, the embryo has characteristic external features of the head and neck area in the form of a series of branchial arches, pouches, grooves, and membranes.

higher

In multiple gestations with death of co-twin (fetus papyraceous) or one acardiac twin, AFP may be __________ than normal

oligohydramnios

In poly-oli sequence, the stuck twin has less blood flow through kidneys, urinates less, develops

polyhydramnios

In poly-oli sequence, the unstuck twin has excess blood flow through kidneys and urinates too much, leading to

amniotic

In polyhydramnios, equilibrium shifts so that the net transfer of water is into the ______________ space

female

In second trimester, identification of ____________ fetus should only be determined when major and minor labia seen "Hamburger"

Nuchal skin fold

In second trimester, thickness of _________________________ measured in plane containing cavum septi pellucidi, cerebellum, and cisterna magna

Anemia

In subsequent pregnancies, antibodies pass through placenta and destroy fetal blood cells, resulting in fetal ___________

24

In the UK, parity is defined as the number of times that she has given birth to a fetus with a gestational age of _______weeks or more, regardless of whether the child was born alive or still

hypoplasia

In the presence of oligohydramnios, resultant pulmonary _______________ may be seen with a reduction in overall thoracic size

BPD

In third trimester, ________ not as accurate in predicting fetal age

Placenta previa

In this condition, placenta covers internal cervical os and prohibits delivery of fetus

2

In twin pregnancy with _______ placentas, membrane extends between fetuses obliquely across uterus from edge of placenta to contralateral edge of other placenta

1

In twin pregnancy, if _____ placental site exists, membrane extends between fetuses away from central portion of placental site

low

Inadequate lung development may occur when amount of AF severely ______.

Age

Incidence of Down syndrome increases with

Caudal Regression Syndrome

Includes range of malformations of caudal end of neural tube

NT (Nuchal Translucency)

Increased _____ associated with increased incidence of structural defects -Cardiac -Diaphragmatic -Renal -Abdominal wall anomalies

bilateral renal agenesis

Infants born with ________________________ exhibit Potter facies (flat nose, recessed chin, abnormal ears, and wide-set eyes) and abnormal or malpositioned limbs -These deformities are caused by lack of amniotic fluid.

Alloimmune Thrombocytopenia

Infants born with this condition at increased risk for intracerebral hemorrhage in utero and spontaneous bleeding

Atrium of lateral ventricles

Inferior portion of lateral ventricles connects with temporal (inferior) and posterior horns is called the

Inner

Inner orbital diameter (IOD) measured inner to

gastroschisis

Insertion of umbilical cord is normal in fetuses with

7

Intestines herniate into proximal umbilical cord at ___ weeks

10

Intestines herniation remains there until approximately ___ weeks gestation

12

Intestines return to abdominal cavity by _____ week of gestation.

7mm

Intrapelvic diameter >_____, considered mild hydronephrosis

15mm

Intrapelvic diameter measuring >_________, considered marked dilation or severe hydronephrosis

7-15mm

Intrapelvic diameter measuring ________________, considered moderate hydronephrosis

Meconium Peritonitis

Intrauterine intestinal perforation from bowel obstruction or ischemia.

Pulmonary Sequestration

Is a supernumerary lobe of lung, separated from normal tracheobronchial tree -Extra pulmonary tissue present within pleural lung sac (intralobar) or connected to inferior border of lung within its own pleural sac (extralobar)

Gastroschisis

Is an opening in the layers of the abdominal wall with evisceration (herniation) of bowel and, infrequently, stomach and genitourinary organs (rarely the liver)

Amniotic Band Syndrome

Is associated with abnormality in fetal membranes -Is a common, nonrecurrent cause of various fetal malformations involving limbs, craniofacial region, trunk

Immune Hydrops

Is associated with alloimmune hemolytic disease (erythroblastosis fetalis) or rhesus (Rh) isoimmunization

Achondrogenesis

Is caused by cartilage abnormalities that result in abnormal bone formation and hypomineralization.

Blader exstrophy

Is characterized by protrusion of posterior wall of urinary bladder -Is caused by defective closure of inferior part of anterior abdominal wall during fourth week of gestation -No muscle or connective tissue forms in anterior abdominal wall to cover urinary bladder. -Therefore, bladder is formed external to abdominal wall. -Primarily in males

Prune Belly Syndrome

Is characterized by three features: -Cryptorchidism -Agenesis or hypoplasia of abdominal wall muscle -Dilation of collecting system -Is thought to result from embryologic defect of mesoderm or as urethral obstruction malformation complex

Pena-Shokeir Syndrome

Is characterized by: -Abnormal joint contractures -Facial abnormalities -Polyhydramnios -Intrauterine growth restriction -Pulmonary hypoplasia

Macrosomia

Is classically defined as birth weight of 4000 g or greater or above 90th percentile for estimated gestational age

Congenital Diaphragmatic Hernia

Is herniation of abdominal viscera into chest that results from congenital defect in fetal diaphragm

Immune Hydrops

Is initiated by the presence of maternal serum immunoglobulin G (IgG) antibody against one of the fetal RBC antigens (known as sensitization)

Acrania

Is lethal anomaly; also known as exencephaly

Frontonasal Dysplasia

Is median-cleft face syndrome consisting of range of midline facial defects involving the eyes, forehead and nose.

Multicystic Dysplastic Kidney Disease (MCDK)

Is most common form of renal cystic disease in childhood; is one of the most common abdominal masses in neonates -Is linked to maternal diabetes

Thanatophoric Dysplasia

Is most common lethal skeletal dysplasia

Achondroplasia

Is most common nonlethal skeletal dysplasia

Prune Belly Syndrome

Is referred to as Eagle Barrett syndrome

Frontal bossing

Is seen in skeletal dysplasias

Meckel's Diverticulum

Is the most common malformation of midgut

AFP (alpha-fetoprotein)

Is transported into AF by fetal urination and reaches maternal circulation or blood through fetal membranes

left

Isolated cleft lip may occur as unilateral or bilateral defect; when unilateral, commonly originates on _______ side of face

Secondary yolk sac

It forms on the ventral surface of the embryonic disc at 28 menstrual days

ureteropelvic (UPJ)

Junction of ureter entering renal pelvis

ureterovesical (UVJ)

Junction of ureter where it enters bladder

Kidneys

K

Nephroma

K

36

Key IUGR sonographic markers: grade 3 placenta before ______weeks or decreased placental thickness

9

Kidneys normally complete migration by ____ week of gestation

Lens

L

Liver

L

Liver (omphalocele filled)

L

Lung

L

Omphalocele (liver)

L

Lower lip

LL

cranial

Large _________ part is primordium of parenchyma of liver

Macroglossia

Large tongue that persistently protrudes outside of mouth called

Nonimmune Hydrops (NIH)

Large vascular tumors functioning as arteriovenous shunts can also result in

Amniotic Band Syndrome

Late entrapment leads to amputations or limb restrictions.

41-41.6

Late term delivery occurs __________ weeks

hydronephrosis

Late urinary tract obstruction produces

Venous

Lateral and parallel to midline falx in superior plane, two linear echoes representing deep ____________ structures (white-matter tracts) are viewed

nose

Lateral nasal prominences form alae of

Syncytiotrophoblast

Layer is composed of capillary wall, trophoblastic basement membrane, and thin rim of cytoplasm of

epiploic foramen

Lesser sac communicates with main peritoneal cavity or greater peritoneal sac through small opening, called

Short-Rib Polydactyly Syndrome

Lethal skeletal dysplasia characterized by short ribs, short limbs, and polydactyly

megacystis

Level of urethra

26-27

Limb development begins _________ day after conception with appearance of upper limb buds.

4

Liver, gallbladder, biliary ducts arise as bud from most caudal part of foregut in ____week

80

Long umbilical cord measures >_____ cm

half

Lungs at birth about _________ filled with fluid from amniotic cavity, tracheal glands, and lungs

Spleen

Lymphatic organ derived from mass of mesenchymal cells located between layers of dorsal mesogastrium. -Lobulated in fetal period

15-18

MSAFP levels increase with advancing gestational age and peak from ___________weeks of gestation

L x H x W / 3

MSD formula

mesorchium

Male genital ridge becomes

4-5

Mandibular prominences merge at end of ________ week and form lower lip, chin, and mandible

Acrania

Manifests as absence of cranial bones with presence of complete, although abnormal, development of cerebral hemispheres

Dandy-Walker Malformation

Manifests with agenesis or hypoplasia of cerebellar vermis with resulting dilation on fourth ventricle and enlargement of posterior fossa.

CNS

Many of congenital malformations of _______ result from incomplete closure of neural tube

obesity

Maternal _____________ associated with increased incidence of neural tube defects

Intervillous

Maternal blood enters _________________ space near the central part of each placental lobule

Basal plate

Maternal blood vessels from endometrium run behind ________________; may be confused with placental abruption

Oligoyhydramnios

Maternal conditions associated with oligiohydramnios -Hypertension -Preeclampsia -Chronic cardiac or renal disease -Connective tissue disorders -Patients receiving indomethacin

polyhydramnios

Maternal conditions associated with? -Diabetes mellitus -Obesity -Rh incompatibility -Anemia -Congestive cardiac failure

1/3

Mature fetus spends almost ________ of its time breathing

5-8

Maxillary prominences grow medially between _______weeks

Cleft Sternum

May be either partial or absent without ectopia cordis; is typically a superior or total cleft

Situs Inversus

May present as total reversal of thoracic and abdominal organs or as partial reversal (mirror image)

trisomy 18

May suggest _____________ when hCG, AFP, and estriol levels are all decreased

Skin edema

Measurement of >5 to 6 mm for soft tissue thickness is used for diagnosis in

FL

Measurement(Leg)

BPD

Measurement?

CRL

Measurement?

Cerebellum

Measurement?

Choroid plexus

Measurement?

MSD

Measurement?

hypoechoic

Meconium within lumen of colon appears ___________________ relative to fetal liver and in comparison with bowel wall

lip

Medial nasal prominences form medial aspect of

Oligoyhydramnios

Medications associated with? -Nonsteroidal antiinflammatory drugs -Angiotensin-converting enzyme inhibitors -Calcium channel blockers -Nitrous oxide

omphalocele

Membrane consisting of peritoneum and amnion forms ________________________ sac encasing herniated organs

mesencephalon

Midbrain becomes

Down syndrome

Mild pyelectasis is common feature associated with

Triploidy

Mosaic form of _____________ may be compatible with survival; infants affected with mental retardation

Binocular orbital diameter (BOD)

Most accurate orbital measurement is ______ and is strongly related to BPD

Thanatophoric Dysplasia

Most cases are sporadic occurrences and the result of mutations in fibroblast growth factor receptor 3 (FGFR3) gene

Nuchal Cord

Most common cord entanglement in fetus Multiple coils around fetal neck have been reported.

Ovarian Cyst

Most common cystic mass in female fetuses -Usually located on one side of abdomen or lower pelvis

Anencephaly

Most common neural tube defect

chylothorax

Most common reason of pleural effusion is ___________________ occurring as right-sided unilateral collection of fluid secondary to malformed thoracic duct

Mesoblastic nephroma (harmartoma)

Most common renal tumor -Is a benign tumor composed of a collection of oddly arranged tissue indigenous to the area

Marginal

Most common type of abruption Known as subchorionic bleeds Hemorrhage results from tears of the marginal veins and represents "low-pressure" bleed

Pulmonary Hypoplasia

Most commonly occurs from prolonged oligohydramnios or secondary to small thoracic cavity as result of structural or chromosomal abnormality

Atrium of lateral ventricles

Most inferior portion of choroid plexus body, or glomus, marks site of

Congenital Diaphragmatic Hernia

Most posterior aspect of diaphragm, derived from the body wall, forms last and is the most commonly defective

fetal weight (EFW)

Most reliable estimated ___________________________ formulas incorporate several fetal parameters, such as BPD, HC, AC, and FL

Infantile Polycystic Kidney Disease (IPKD)

Most severe forms found prenatally and associated with: -Renal failure -Oligohydramnios -Absent urinary bladder -In some cases, kidneys are so massive they fill entire abdomen. -may occur as part of a genetic syndrome, such as Meckel-Gruber syndrome or Trisomy 13

Amniotic Band Syndrome

Most widely accepted theory is rupture of amnion during early pregnancy development leads to subsequent entanglement of various embryonic or fetal parts by fibrous mesodermic bands, which emanate from chorionic side of amnion

16-20

Mother should perceive fetal movements on daily basis beginning between __________weeks of gestation

4-5

Movement of gastric musculature begins in approximately ________ month of gestation

Holoprosencephaly

Multiple syndromes have been associated with ________________________, including: -Meckel-Gruber syndrome -Aicardi's syndrome -Fryns syndrome -Hydrolethalus syndrome

Nose

N

increases

NT ______________ with gestational age.

3mm

NT measurement >______ abnormal

10-14

NT reported as late first trimester finding identified between __________ weeks of gestation

pits

Nasal _____ form as the surface ectoderm thickens into nasal placodes on each side of the frontal nasal prominence and the placodes invaginate

Cordocentesis

Needle placed into fetal umbilical vein and blood sample obtained -Lab evaluates sample for fetal blood type, hematocrit and hemoglobin

face

Neural crest cells develop skeletal parts of the

6

Neural function begins at ___ weeks of gestation

Cephalocele

Neural tube defect in which meninges alone or meninges and brain herniate through defect in calvarium

AFP (alpha-fetoprotein)

Neural tube defects, such as anencephaly and open spina bifida, common reasons for high _________________________ levels

AF

Nitrazine paper and fern test used as screening test to determine presence of _______in vaginal secretions

7

No morphological indication of gender until ____ week of development

10-20

Normal AF correlates with AFI of _______cm

8-22cm

Normal AFI measurment

3.3

Normal EHR accelerates linearly _____bpm/day

Bowel

Normal ___________can be seen peristalsing and echogenicity should be slightly greater than the liver

6.5

Normal atrium measures ______mm

<5mm

Normal diameter of small bowel lumen (near term)

Straight

Normal femur has ____________ lateral border

Curved

Normal femur has _____________ medial border

always

Normal fetal bladder should ___________ be seen

Hypoechoic

Normal fetal brain parenchyma appears ___________________ because of small size reflectors and high water content in tissue

not

Normal fetal ureters usually _______ seen

46

Normal karyotype consists of _______ chromosomes

15mm

Normal length of small bowel (near term)

2mm

Normal measurement of bladder wall is ______ or less

20

Normal measurements of colon diameter range from 3 to 5 mm at _____weeks to 23 mm or larger at term

Normal

Normal or abnormal?

4

Normal placenta rarely exceeds ____cm

bell

Normal thoracic cavity is symmetrically _____ shaped

low-resistance

Normal trophoblastic invasion of spiral arteries produces _____________________ Doppler pattern.

1-2cm

Normal umbilical cord diameter

<6mm

Normal yolk sac size should be

8

Normally duodenum recanalized by end of ____ week

IUGR

Not all oligohydramnios associated with

Omphalocele

O

Orbit

O

Orbits

O

Orbits (hypotelorism)

O

Outer

OFD is measured outer to

noncommunicating

Obstruction may be caused by ventricular defect like aqueductal stenosis; is referred to as _______________________ hydrocephalus

communicating

Obstruction may be outside of ventricular system, such as with arachnoid cyst; is referred to as _________________________ hydrocephalus

Hydrometrocolpos

Obstruction of uterus and vagina resulting in collections of fluid referred to as -Appears as hypoechoic "cystlike" ovoid mass posterior to bladder in area of uterus

AFP (alpha-fetoprotein)

Obstructions of gastrointestinal tract may cause reduced clearance of

Nonimmune Hydrops (NIH)

Obstructive vascular problems occurring outside of the heart can cause

Cerebellum

Obtain length of _________________ at level of the vermis & fourth ventricle

Thrombus

Occlusion of one or more cord vessels Primarily occurs in umbilical vein Incidence higher in infants of diabetic mothers

Conjoined twin

Occur from incomplete division of embryo after 13 days from conception

Immune Hydrops

Occurs anytime mother exposed to RBCs antigens different from her own, as under these conditions: -Father and fetus Rh+ -Mother Rh- -Is maternal-fetal hemorrhage (mixing of blood) -Maternal antibodies are produced against Rh antigen

Esophageal stenosis

Occurs from incomplete recanalization of esophagus during 8th week of development

Velamentous cord

Occurs when cord inserts into membranes before it enters placenta rather than inserting directly into placenta

Umbilical Herniation

Occurs when intestines return normally to abdominal cavity Herniate either prenatally or postnatally through inadequately closed umbilicus

Renal Ectopia

Occurs when kidney lies outside of its normal position in the renal fossa

Triploidy

Often occurs as result of ova being fertilized by two sperm

Hypoechoic

Older hematomas tend to be ______________ compared to placenta

5

Oligohydramnios correlates with AFI of <____ cm, with largest single vertical pocket measuring 2 cm or less

<5cm

Oligohydramnios when AFI is

21

One of most common aneuploid conditions is Down syndrome; individual has extra chromosome number _____

Incomplete breech

One or both of baby's feet are near cervix and will deliver before the rest of the body

craniofacial

Orbital architecture important in evaluation of ___________________ anomalies

12

Orbital diameter increases from 13 mm at _____ weeks to 59 mm or greater at term

dominant

Osteogenesis Imperfecta type I and IV transmitted in autosomal-______________ fashion

II

Osteogenesis Imperfecta type _____ considered the most severe

II & III

Osteogenesis Imperfecta type_____ and _____ inherited in autosomal-dominant or recessive fashion or may result from spontaneous mutation

Elevated AFP (alpha-fetoprotein)

Other anomalies that may present with? -Bladder or cloacal exstrophy -Ectopia cordis -Limb-body wall complex -Amniotic band syndrome

amniocentesis

Other indications for? -History of balance rearrangement in parent or previous child with chromosomal abnormality -History of unexplained abnormal AFP level or abnormal triple screen -Fetus with congenital anomaly

Urachus

Outpouching from urinary bladder forms

Ovarian Cyst

Ovarian mass that results from maternal hormonal stimulation -Are usually benign

Oligoyhydramnios

Overall reduction in amount of AF resulting in fetal crowding and decreased fetal movement

Umbilical vein

Oxygen rich blood passes through _____________________________ into fetal abdomen.

Spiral arteries

Oxygenated maternal blood brought to placenta through end

Placenta

Oxygenation occurs in the _______________, where small vessels of the villi are bathed in maternal blood in the intervillous spaces

Proboscis

P

Observation of fetal breathing movements (FBM)

Parameter of BPP? one or more episodes of rhythmic fetal breathing movements of 30 seconds or more within 30 minutes

Cardiac nonstress test (NST)

Parameter of BPP? the baby's heart rate is monitored to see how it responds to the baby's movements

Biophysical profile (BPP)

Parameters for? 1.Cardiac nonstress test (NST) 2.Observation of fetal breathing movements (FBM) 3.Gross fetal body movements (FM) 4.Fetal tone (FT) 5.Amniotic fluid volume (AFV)

Trisomy 13

Patau syndrome AKA

neural tube defects

Patient with elevated MSAFP may present for a scan to rule out _____________________________________ and be found to be carrying twins

25-35

Perinatal death rate for Rh-sensitized pregnancies ____________% before intrauterine transfusions performed

Metanephros

Permanent kidney aka

5

Permanent kidneys (metanephros) begin to develop early in ____ week while mesonephroi still developing

lower

Placement of ear appears __________ in many craniofacial malformations and syndromes

previa

Placenta ________ main cause for third trimester bleeding

ROM

Placenta abruption is associated with

8

Placenta can be identified with sonography as early as ______menstrual weeks

2-3cm

Placenta thickness varies with gestational age, but is usually _________ in fetuses >23 weeks

edema

Placental ________ can be identified as a thickened placenta measuring >4 to 4.5 cm in true anterior-posterior diameter

Barrier

Placental membranes called a "________________" because there are a few compounds unable to cross placental membranes in detectable amounts

LUS (lower uterine segment)

Placental position appears changed because of physiologic changes in the

placental lakes

Placental sonolucencies referred to as

>5cm

Placental thickness _________ considered thick when measurement taken at right angles to its long axis

Dizygotic

Placentas may implant in different parts of uterus and be distinctly separate or may implant adjacent to each other and fuse in __________________ twins

15

Pleural effusion is rarely encountered before ______week of gestation, except in association with Down or Turner syndrome

Stuck twin

Poly-Oli Sequence AKA

16-26

Poly-Oli Sequence usually manifests between _________ weeks gestation

AFP (alpha-fetoprotein)

Polycystic kidneys and urinary tract obstruction may lead to higher levels of__________? -Abnormal clearance or filtration

24

Polyhydramnios correlates with AFI of >_____ cm, largest single vertical pocket of 8 cm or more

>22cm

Polyhydramnios when AFI is

42

Post term delivery occurs _______ weeks

42

Postterm pregnancy defined as gestational age of _____ weeks or more

fetal anemia

Potential of _________________ can be determined by: -Ultrasound surveillance -Amniocentesis -Cordocentesis

37

Pre-terms delivery occurs before ______ weeks

oligohydramnios

Pregnancies complicated by ____________________________ may have higher concentrations of AFP because there is less amniotic fluid to diffuse the protein

Insulin-dependent diabetic mellitus (IDDM)

Pregnancies may be complicated by frequent hospitalizations for -Glucose control -Serious infections such as pyelonephritis

Cephalocele

Presence of brain in the defect indicates poor prognosis; microcephaly and other associated anomalies worsen outcome.

hematoma

Presence of echogenic mass in fetal stomach in patient who demonstrates clinical or sonographic evidence of placental abruption should raise possibility of ____________________ formation associated with intraamniotic hemorrhage

Succenturiate Placenta

Presence of one or more accessory lobes connected to body of placenta by placental vessels

Vasa previa

Presence of umbilical cord vessels crossing internal os of cervix

Umbilical vein

Primary purpose is to transport oxygenated blood back to fetus

mouth

Primitive ___________ is indentation on surface of ectoderm (stromodeum)

4

Primitive gut forms during ____ week of gestation as dorsal part of yolk sac incorporated into embryo during folding

5

Prior to ___ menstrual weeks, the amniotic sac and secondary yolk sac have been pressed together with the embryonic disc between them

Absent end diastolic

Problem?

Complete reversal of end diastolic

Problem?

Increased vascular resistance

Problem?

Amniocentesis

Procedure?

CVS (chorionic villus sampling)

Procedure?

Estrogen

Production of placental ________________ involves pathway requiring maternal, placental, and fetal contributions.

Acardiac

Proposed that this occurs due to artery to artery connection in placenta that leads to perfusion of abnormal twin via co-twin

Amniotic fluid

Protects fetus from injury, allows for fetal movement, maintains intrauterine pressure

24

Pulmonary immaturity major reason why fetuses younger than ____weeks of gestation generally considered nonviable

solid

Pulmonary sequestration and certain types of cystic adenomatoid malformations (CAMs) appear as _______ lung masses.

Nephroma

R

Holoprosencephaly

Range of abnormalities resulting from abnormal cleavage of prosencephalon (forebrain)

Pentalogy of Cantrell

Rare and in association with: -Cleft distal sternum -Diaphragmatic defect -Midline anterior ventral wall defect -Defect of apical pericardium with communication into peritoneum -Internal cardiac defect

Acardiac

Rare anomaly occurring in monochorionic twins where one twin develops without a heart and often absence of upper half of body

Schizencephaly

Rare disorder characterized by clefts in cerebral cortex -Clefts unilateral or bilateral, open-lip or closed-lip defects, and usually in area of Sylvian fissure -thought to result from abnormal migration of neurons. -Clefts can extend from ventricle to outer surface of brain and are lined with abnormal gray matter.

Osteogenesis Imperfecta

Rare disorder of collagen production leading to: -Brittle bones -Manifestations in teeth, skin, ligaments -Blue sclera

Abruption

Refers to separation of normally implanted placenta prior to term delivery

Ambiguous Genitalia

Refers to sonographic inability to delineate fetal gender -Several congenital malformations attribute to finding. -Malformations typically result from chromosomal defects or abnormal hormone levels.

hyperechoic

Region of small bowel is slightly ______________, compared with liver

Smokes

Respiration decreases if mother

Sugar

Respiration increases when mother eats

Triploidy

Result of complete extra set of chromosomes

Esophageal atresia

Results from abnormal deviation of tracheoesophageal septum in posterior direction

Omphalocele

Results from failure of intestines to return to abdomen Hernia may consist of single loop of bowel or may contain most of intestines. Covering for hernia sac is epithelium from cord.

Intervillous Thrombosis

Results from intraplacental hemorrhage caused by breaks in the villous capillaries Usually little risk to fetus

Cystic Hygroma

Results from malformation of lymphatic system that leads to single or multiloculated lymph-filled cavities around neck

Aqueductal Stenosis

Results from obstruction, atresia, or stenosis of aqueduct of Sylvius, causing ventriculomegaly

exstrophy

Results in _________________ of bladder in which two hemibladders are separated by intestinal mucosa

Normal situs

Right and left sides of fetus need to be conceptualized to ensure __________________ (positioning) of fetal organs

gastroschisis

Right paraumbilical defect of abdominal wall (rarely left-sided defect)

Choroid Plexus Cysts

Round or ovoid anechoic structures found within choroid plexus -Contain cerebrospinal fluid and cellular debris trapped within neuroepithelial folds

Stomach

S

2

Score? -Two fetal heart rate accelerations of 15 bpm or more -Accelerations lasting at least 15 seconds -Gross fetal movements noted over 20 minutes without late decelerations

2

Score? one episode of breathing lasting 30 seconds within 30-minute period noted by practitioner.

first or second

Screening for fetal anomalies performed in either ___________________ trimester

hyoid

Second branchial arch contributes to _______ bone

Mesonephros

Second pair of "kidneys," function for short time during early fetal period

Oligoyhydramnios

Second trimester ___________________ often has poor prognosis, especially if maternal serum alpha-fetoprotein level also elevated

False Knots

Seen when blood vessels are longer than cord Often folded on themselves and produce nodulations on surface of cord

anemia

Severe ____________ may occur in donor twin of twin-to-twin transfusion syndrome, thalassemia, or significant fetomaternal hemorrhage

gastroschisis

Severe body wall defects may be seen in ______________________ with secondary band formation

pleural effusion

Shape of lung appears normal in presence of

35

Short umbilical cord measures <___ cm in length.

Saldino-Noonan syndrome

Short-Rib Polydactyly Syndrome Type I AKA

Majewski syndrome

Short-Rib Polydactyly Syndrome Type II AKA

Naumoff syndrome

Short-Rib Polydactyly Syndrome Type III AKA

Beemer-Langer dysplasia

Short-Rib Polydactyly Syndrome Type IV AKA

embryo fold

Sides of ___________________, leading to formation of lateral and anterior abdominal wall

Fetal breathing

Signifies?

4

Six branchial arches, but only first _____visible externally

dysplasia

Skeletal _____________ describes abnormal growth and density of cartilage and bone.

Small bowel

Sm

caudal

Small __________ part gives rise to gallbladder and cystic duct

prenatally

Small ears (Roberts' syndrome) and inadequate development of the ear (Nager acrofacial dysostosis syndrome and Treacher Collins syndrome) may be observed ______________

Down syndrome

Small nose and mid-face hypoplasia recognized components of ____________________ facies

Mother

Sonographer should initially determine position of fetus in relationship to position of

Holoprosencephaly

Sonographic Features: -Common C-shaped ventricle that may or may not be enlarged -Brain tissue with horseshoe shape as it surrounds monoventricle -Fusion of thalamus with absence of third ventricle -Absence of interhemispheric fissure -Dorsal sac with expansion of monoventricle posteriorly -Absence of corpus callosum -Absence of cavum septum pellucidum

Prune Belly Syndrome

Sonographic Findings -Absent abdominal musculature -Undescended testes -Large urinary bladder -Dilated prostatic urethra -Dilated and tortuous ureters -Kidneys can be normal, hydronephrotic, or dysplastic.

Microcephaly

Sonographic diagnosis depends on accurate assessment of fetal age. -Biparietal diameter, occipitofrontal diameter, and head circumference should be used. -Ratios comparing head perimeter to abdominal perimeter and head perimeter to femur length are useful.

Hydranencephaly

Sonographic features -Absence of normal brain tissue with almost complete replacement by cerebrospinal fluid -Absent or partially absent falx -Presence of midbrain, basal ganglia, cerebellum -Choroid plexus may be identified. -Macrocephaly may occur.

Porencephalic Cysts

Sonographic features -Cyst within brain parenchyma without mass effect -Communication of cyst with ventricle or subarachnoid space -Reduction in size of affected hemisphere -May cause midline shift and contralateral ventricular enlargement

Vein of Galen Aneurysm

Sonographic features -Cystic space—may be irregular in shape and located midline and posterosuperior to third ventricle -Turbulent flow with Doppler evaluation -Male predominance -sporadic event

Choroid Plexus Cysts

Sonographic features -Cysts within choroid plexus ranging in size from 0.3 to 2 cm -Unilateral or bilateral cysts -Solitary or multiple -Unilocular or multilocular -Enlargement of ventricle with large cyst

Schizencephaly

Sonographic features -Fluid-filled cleft in cerebral cortex extending from ventricle to calvarium -Ventriculomegaly may be observed.

Aqueductal Stenosis

Sonographic features -Ventricular enlargement of lateral ventricles (may be severe) -Third ventricular dilation -Flexion and adduction of thumb (in X-linked form)

Agenesis of the Corpus Callosum

Sonographic features: -Absence of corpus callosum -Elevation and dilation of third ventricle -Widely separated lateral ventricular frontal horns with medial indentation of medial walls -Dilated occipital horns (colpocephaly), giving lateral ventricles teardrop shape -Absence of cavum septum pellucidum

Posterior Urethral Valve Obstruction (PUV)

Sonographic features: -Severe bladder dilation -Massive hydronephrosis with dysplastic changes in renal tissue -Dilated tortuous ureters -Oligohydramnios -Bladder wall severely thickened with dilated posterior urethra—the "keyhole sign"

Thanatophoric Dysplasia

Sonographic features?: -Severe micromelia especially of proximal bones (rhizomelia) -Cloverleaf deformity occurs as result of premature craniosynostosis and may be associated with ACC. -Narrow thorax with shortened ribs

Meconium Ileus

Sonographic findings -Ileum dilates because of impacted meconium (which appears echogenic). -Increased production of mucus by GI organs and electrolyte imbalance explains overproduction of meconium (characteristic of cystic fibrosis).

Pena-Shokeir Syndrome

Sonographic findings -Limb abnormalities (contractures, clinched hands, talipes, rocker-bottom feet) -Facial abnormalities (micrognathia and cleft palate) -Polyhydramnios and hydrops may be identified.

Arthrogryposis Multiplex Congenita

Sonographic findings -Rigid extremities -Flexed arms -Hyperextension of knees -Clenched hands -Talipes

Renal Agenesis

Sonographic findings -Severe oligohydramnios after 13 to 15 weeks menstrual age -Persistent absence of urine in fetal bladder (observe for period of 1 hour) -Failure to visualize kidneys or renal arteries (use color flow to outline renal arteries) -Abnormally small thorax

intestinal obstruction

Sonographic findings -appear as cystic bowel loops discontinuous with stomach. -should be suspected when clear cystic structures found in pelvis. -vascular restriction may lead to obstruction secondary to gastroschisis.

hydrops

Sonographic findings of _______________: -Scalp edema -Pleural effusion -Pericardial effusion -Ascites -Polyhydramnios -Thickened placenta

Nonimmune Hydrops (NIH)

Sonographic findings of? -Fetus may appear similar to sensitized baby. -Scalp edema, pleural and pericardial effusions, ascites

Camptomelic Dysplasia

Sonographic findings: -Bowing of long bones with lower extremities affected most severely -Small thorax -Hypoplastic fibulas -Hypoplastic scapulae -Hypertelorism -Cleft palate -Micrognathia -Talipes -Hydrocephalus -Polyhydramnios -Hydronephrosis

Ellis-van Creveld Syndrome

Sonographic findings: -Limb shortening -Narrow thorax -Polydactyly -Heart defects (50%)

Diastrophic Dysplasia

Sonographic findings: -Micromelia -Talipes -Fixed abducted thumb (hitchhiker thumb) -Scoliosis -Talipes (clubfoot) -Micrognathia (small chin) -Cleft palate

Short-Rib Polydactyly Syndrome

Sonographic findings: -Narrow thorax with short ribs -Polydactyly -Micromelia -Midline facial cleft

Roberts Syndrome

Sonographic findings: -Phocomelia, with upper extremities more severely affected -Bilateral cleft lip and palate -Hypertelorism -Microcephaly -Cardiovascular, renal, and gastrointestinal anomalies may be identified

Caudal Regression Syndrome

Sonographic findings: -Sacral agenesis -Talipes -Abnormal lumbar vertebrae, pelvic abnormalities, contractures, or decreased movement of lower extremities

Jeune's Syndrome

Sonographic findings: -Small thorax -Rhizomelia -Renal dysplasia -Polydactyly (less common)

Sirenomelia

Sonographic findings: -Variable fusion of lower extremities -Bilateral renal agenesis -Oligohydramnios -Single umbilical artery

omphalocele

Sonographic signs of _______________________: -Central abdominal wall defect with evisceration of bowel or combination of liver and bowel into base of umbilical cord -Stomach may be involved. -Bowel version appear echogenic and must be distinguished from umbilical hernia

Infantile Polycystic Kidney Disease (IPKD)

Sonographically, individual cysts not identified; instead kidneys massively enlarged because of hundreds of dilated tubules

Osteogenesis imperfecta (type II)

Specific sonographic features of __________________________ include: -Generalized hypomineralization of bones, especially calvarium -Multiple fractures of long bones, ribs, and spine -Narrow thorax -Micromelia

Stomach

St

Femur

Structure

Umbilical cord

Structure

Humerus

Structure(Arm)

Middle cerebral artery

Structure?

Accessory lobe placenta

Succenturiate aka

Echogenic

Sulcus and gyrus of the cranium appear more

omphalomesenteric

Superior mesenteric artery formed from right _________________________ artery

Is median-cleft face syndrome consisting of range of midline facial defects involving the eyes, forehead and nose.

Syndrome include abnormalities include: -Ocular hypertelorism -Variable bifid nose -Broad nasal bridge -Midline defect of frontal bone -Extension of frontal hairline to form widow's peak

Tounge

T

placental

TV sonography best way to evaluate relationship of cervical os to _____________ edge

cerebral hemispheres

Telencephalon becomes

Holoprosencephaly

Teratogens reported to produce

pelviectasis

Term commonly used in conjunction with hydronephrosis

TPAL

Term deliveries Preterm deliveries Abortions Live births

triple screen

Test for serum markers: -AFP -Human chorionic gonadotropin (hCG) -Unconjugated estriol

Amniocentesis

Test offered to patients at risk for chromosomal abnormality or biochemical disorder that may be prenatally detectable

CVS (Chorionic Villus Sampling )

Test? Advantages -Performed early in pregnancy (10 to 14 weeks) -Results available within 1 week -Earlier results allow more options for parents

28

Testes not visible within scrotal sac until approximately ____ weeks of gestation

28

Testes remain near deep inguinal rings until _____ week

AC

The _______ measurement should be taken from round transverse image, perpendicular to fetal spine, with umbilical portion of left portal vein midline within liver

Liver

The _________ is a primary glucose storage site and is sensitive to disturbances in growth. Therefore the abdominal measurement is taken at the level of the umbilical v.

Pedicles

The _____________ appear splayed in V-, C-, or U-shaped configuration in fetus with spinal defect

midgut

The _______________ is the primordium of the small intestines, cecum, appendix, ascending colon, and right half to two thirds of the transverse colon.

Midline

The _________________ brain structures include cavum septum pellucidum, midline echo; paired thalamus lies on either side

Ductus venosum

The ___________________ closes after birth becoming the ligamentum venosum

Fetal eye orbits

The ____________________ observed and measured in two planes: (1) Coronal scan posterior to glabella-alveolar line (2) Transverse scan at level below biparietal diameter (along orbitomeatal line)

longitudinal

The ____________________ view demonstrates the nasal bones, soft tissue, and mandible (useful to rule out micrognathia, anterior encephalocele, or nasal bridge defects; examine upper lip)

fetal movement

The absence of cord twisting is an indirect sign of decreased

umbilicus

The amnion is contiguous with the fetal skin at the ______________; is thought to protect fetus from contact with the chorion

umbilical cord

The connection of the yolk sac and body stalk will form the ____________________ at the ventral region of the embryo

Frank breech

The fetal legs are flexed at the hips and extend toward the shoulders; this is the most common type of breech presentation. The buttocks present at the cervix

Infantile Polycystic Kidney Disease (IPKD)

The malformation results in cystic dilation of the renal tubules measuring 1-2 mm, usually arranged in a symmetrical pattern leading to overall enlargement of the kidneys.

cystic hygroma colli

The most common neck mass is _________________________________________ (lymphatic obstruction)

hydropic

The unstuck twin in poly-oli sequence may go into heart failure (to much blood) and become

1 & 2

There should be _______ umbilical veins & _____ umbilical artery wrapped around each other (3 vessel cord)

Standard fetal biometry

These measurements are included in a______________ -BPD -HC -AC -FL -FHB -AFI

Gastroschisis

This periumbilical defect nearly always located to right of umbilicus

smaller

Thorax normally slightly ____________ than abdominal cavity

Longer

Tibia ___________ than fibula

Medial

Tibia is __________ to the fibula

Nonimmune Hydrops (NIH)

To make diagnosis of ___________________, isoimmunization ruled out with antibody screen

Beckwith-Wiedemann

Tongue protrusion may suggest macroglossia, a condition found in ____________________________ syndrome

Hematoma

Trauma to umbilical vessels may cause extravasation of blood into Wharton's jelly. Usually near fetal insertion of cord Umbilical vein most frequently involved

Poly-oli sequence

Treatments for ___________________ include: -Serial amniocentesis -Selective feticide -Umbilical cord ligation of one twin -Laser occlusion of anastomosing placental vessels

MSAFP

Twin pregnancies, by virtue of having two fetuses rather than one, are associated with elevations of

A

Twin sac and fetus directly over internal os labeled

Monochorionic

Twins that are ___________________ are at risk for placental vascular anastomosis

Monoamniotic

Twins that are ____________________ are at risk for entanglement of umbilical cord

immune and nonimmune

Two classifications of fetal hydrops

AFP (alpha-fetoprotein)

Two common abdominal wall defects, omphalocele and gastroschisis, produce elevations of

upper lip

Two medial nasal prominences and two maxillary prominences fuse to form

mechanical and metabolic

Two terms relating to macrosomic fetuses are

oligohydramnios

Two-diameter pocket measurement appears to be better predictor of __________________ than AFI or largest vertical pocket

15-50

Two-diameter pocket of _______cm is normal

Alobar

Type of Holoprosencephaly? -Singular monoventricle brain tissue that is small -Cup, ball, pancake configuration -Fusion of thalamus -Absence of interhemispheric fissure -Absence of cavum septum pellucidum -Absence of corpus callosum -Absence of optic tracts -Absence of olfactory bulbs

I

Type of Thanatophoric Dysplasia? characterized by short, curved femurs and flat vertebral bodies

II

Type of Thanatophoric Dysplasia? characterized by straight, short femurs, flat vertebral bodies, and cloverleaf skull

Single

Type of pocket assessment?

Two-diameter

Type of pocket assessment?

Di-Di

Type?

Mono-Di

Type?

Dizygotic

Type? Each ovum implants separately in uterus and develops its own placenta, chorion, and amniotic sac (diamniotic, dichorionic).

Upper lip

UL

Proximally

Ulna longer than radius _______________

hernias

Umbilical _____________ may be confused with liver omphaloceles; normal cord insertion suggests not.

5

Umbilical cord forms during first _____weeks of gestation

5

Umbilical cord forms during first ____weeks of gestation

intersegmental

Umbilical cord joins umbilical portion of left portal vein at caudal margin of left _________________ fissure of liver

2

Umbilical cord transforms into the ligamentum venosum ____ weeks after birth

Wharton's jelly

Umbilical vessels are surrounded by

8

Umbilication hernia of bowel occurs during ______ week of development as midgut extends to extraembryonic coelom in proximal portion of umbilical cord.

24-26

Until _________days of gestation, stomodeum is separated from pharynx by membrane that then ruptures to place the primitive gut in communication with the amniotic fluid.

Bud

Ureteric _____ gives rise to: -Ureter -Renal pelvis -Calyces -Collecting tubules

11-12

Urine formation begins toward end of first trimester, around ________ week, and continues actively throughout fetal life.

Gastroschisis

Usually a right paraumbilical defect involving all layers of abdominal wall Small bowel always eviscerates through defect. Loops of bowel never covered by membrane Directly exposed to AF and elevated alpha-fetoprotein levels

low-resistance

Uterine artery in second trimester should show ___________________ flow pattern.

high-resistance

Uterine artery sonographically reveals ________________________ flow pattern first trimester

Wharton's jelly

Variations in umbilical cord diameter attributed to diffuse accumulation of

sirenomelia

Vascular hypoperfusion is thought to be a causative factor in ________________, with a single umbilical artery commonly associated that may divert blood flow to the caudal end.

10

Ventricle considered dilated when its diameter exceeds ____mm

Cephalic

Vertex aka

Cardiac activity

View ___________________ at beginning of each study to ensure that fetus is alive

Amniotic Sheets

Visualization of ______________ believed to be caused by: -Uterine scars from previous instrumentation used in uterus -Cesarean section -Episodes of endometritis

Occipital frontal diameter

What does OFD stand for?

halved

When AFP elevated (>3 MOM) and cranium (ventricles and cisterna magna) and spine appear normal, risk of fetus actually having small spinal defect is approximately ______________

VACTERL-H syndrome

When VACTERL association seen with accompanying hydrocephalus, condition termed

low

When ______ omphalocele is observed, consider bladder or cloacal exstrophy

scoliosis

When __________________ is found, consider limb-body wall complex (or body-stalk anomaly), a lethal disorder

>8mm

When a GS meas __________, a yolk sac should be seen

omphalocele

When bowel loops fail to return to abdomen, bowel-containing __________________ occurs

occulta

When covered with skin or hair, referred to as spina bifida ______________; this anomaly associated with normal spinal cord and nerves and normal neurologic development

chorion

When disruption of amnion occurs, fetus may adhere to and fuse with the

Oblique

When fetal lie is ______________, generally described by stating which quadrant of uterus contains fetal head and direction and position of fetal spine

Transverse

When fetus lie is _________________, sonographer typically reports position of fetal head (maternal right or left) and position of fetal spine (inferior, superior, anterior, or posterior)

Poly-Oli Sequence

When oligohydramnios exists in one sac and polyhydramnios in other

Beckwith-Wiedemann

When organomegaly and macroglossia observed, ______________________________ syndrome is suspected

asymmetrical

When placental insufficiency is cause, fetuses often develop _________________ intrauterine growth restriction pattern

pulmonary hypoplasia

When pleural effusion large, lung development impaired, which may result in

urogenital ridge

While embryo bends and folds in horizontal plane during fourth week, intermediate mesoderm forms a longitudinal mass on both sides of aorta called the -Both urinary and genital systems develop from mesoderm in this

2mm

With TV, cardiac activity may be seen when CRL meas

9

With TVS, fetal kidneys have been documented as early as ______ weeks of gestation

bladder

With _________________ exstrophy, normal urinary bladder not visible upon sonographic evaluation

omphalocele

With ____________________, AFP leaks through membrane encasing herniated bowel or liver

Macrosomia

With respect to delivery, any fetus too large for pelvis through which it must pass is considered

Falx cerebelli

Within cisterna magna space echogenic structures represent dural folds that attach

Maxilla

X

5.5mm

YS should not meas more than

Gestational age

Yolk sac is NOT associated with

Zygomatic bone

Z

Mid-zone

Zone? -Horizontal or rising trend within indicates fetus in danger of death -Preterm delivery or intrauterine transfusion and preterm delivery indicated.

Mid-zone

Zone? Downward trend within indicates fetus probably affected but will survive -delivery should occur at 38 weeks of gestation

High zone

Zone? Fetal death zone -Requires immediate treatment or death will result

Low zone

Zone? Rh-negative and mildly affected fetuses -Should be followed expectantly -Delivered at term

16

____ weeks gestation—amnion fuses with chorion

Ear

______ malformation may be observed in Goldenhar's syndrome with anophthalmia (absent eye) and hemifacial microsomia (abnormal smallness of one side of the face).

NT (Nuchal Translucency)

_______ measurement should be compared with gestational age or CRL to determine risk for aneuploidy and combined with maternal age and first trimester serum screening

After

_________ 6 weeks of gestational age, determining pregnancy number easily accomplished by counting embryos in uterus

True

_________ breathing movement described as simultaneous inward movement of chest wall with outward movement of anterior abdominal wall during inspiration.

Male

_________ fetus in second trimester determined by visualization of penis and scrotal sac "Turtle"

True

__________ ascites identified within peritoneal recesses; is interspaced between loops of small bowel

Alar

__________ plate region matures into sensory region of cord, and basal plate region develops into motor region of cord

Long

__________ umbilical cords more likely to prolapse, become twisted around fetus, or tie in true knots

Varix

___________ of umbilical vein nearly always intraabdominal, extrahepatic in location

Before

____________ 6 weeks, embryo not consistently visualized; sonographer must count gestational sacs and small yolk sacs

Anemia

____________ is condition in which there are fewer red blood cells, so blood viscosity is decreased

Short

____________ umbilical cords may result in traction during labor and delivery, leading to tearing of cord, abruption, or inversion of uterus

Obese

____________ women also at increased risk for: -Severe eclampsia -Multiple births -Urinary tract infections -Hypertenison

Hydrops

_____________ can be due to fetal anemia

Basal

_____________ cephaloceles are internal lesions that occur within the nose, pharynx, and orbit (type of anterior)

Median

_____________ cleft lip caused by incomplete merging of the two medial nasal prominences in the midline

Sigmoid

_____________ colon retains its mesentery

Outer

_____________ margin of abdominal wall should be measured

lateral

_____________ nasal prominences form sides, or alae

Diencephalon

______________ eventually develops into: •Epithalamus •Thalamus •Hypothalamus •Infundibulum

Oblique

______________ facial cleft: failure of maxillary prominence to merge with the lateral nasal swelling, with exposure of the nasolacrimal duct

Premature

______________ infants at greater risk for having problems: -Respiratory distress syndrome -Intracranial hemorrhage -Bowel immaturity -Feeding problems

Mesoderm

______________ of each arch develops musculature of face and neck

Maxillary

______________ prominences arise from first branchial arch and grow cranially under the eyes and mandibular prominence.

Nuchal

______________ skin thickness of 5 mm or less up to 20 weeks' gestational age normal

Bilateral

_______________ renal agenesis is lethal disorder due to renal insufficiency and hypoplasia of lungs.

Coronal

_______________ section of fetal cerebellum can be used when traditional views cannot be obtained.

Hemolysis

________________ can result in fetal anemia, leading to CHF and edema of fetal tissues (anasarca)

Occipital

________________ cephaloceles occur when defect lies between the lambdoid suture and foramen magnum

Quad screen

________________ looks at following serum markers: -Alpha-fetoprotein (AFP) -Human chorionic gonadotropin (HCG) -Unconjugated estriol (uE3) -Inhibin-A

First

________________ trimester testing looks for the pattern of biochemical markers associated with plasma protein A (PAPP-A) and free beta-hCG3

Complete

_________________ bilateral cleft lip and palate: large gap in upper lip on modified coronal view; nose is flattened and widened; a premaxillary mass may be present

Everted

_________________ bladder becomes exposed on lower abdominal wall. -May be mild or severe (accompanied by omphalocele, inguinal hernia, undescended testes, anal problems)

Frontal

_________________ cephaloceles are always external lesions that occur near root of nose (type of anterior)

Mandibular

_________________ length, or AP diameter, assessed by measuring from mentum of mandible to bisection of lateral width line

Poly-Oli Sequence

_________________ may result due to: -Fetal anomaly in one sac resulting in polyhydramnios -Compressing blood flow in normal twin's placenta, resulting in oligohydramnios -Placental insufficiency in one placenta -TTS

Unilateral

_________________ obstructive cystic dysplasia disease can be caused by ureteropelvic or ureterovesical junction obstruction

Placenta

_________________ problems in general may explain prevalence of growth restriction, fetal death, abruption in patients with unexplained AFP elevations.

Second

_________________ trimester screening performed with maternal serum quad screen lab value and targeted ultrasound exam

Targeted

_________________ ultrasound is detailed evaluation of all fetal anatomy seen at time of exam

transverse

_________________ view shows orbital abnormalities and intraorbital distances (useful to evaluate the maxilla, mandible, and tongue)

Anterior

__________________ cephaloceles lie between anterior aspect of ethmoid bone

Permanent

__________________ kidneys develop from two different sources: -Metanephric diverticulum or ureteric bud -Metanephric mesoderm

Bilateral

__________________ obstructive dysplasia caused by severe bladder outlet obstruction, usually urethral atresia or posterior urethral valves

Prolapse

__________________ of umbilical cord occurs when cord lies below presenting part. May exist whenever presenting part does not fit closely and fails to fill pelvic inlet

Parietal

___________________ cephaloceles occur between bregma and lambda

Intrauterine

___________________ fetal death accounts for roughly half of all perinatal mortality

Compression

___________________ of cord reduces or cuts off blood supply to fetus; may result in fetal demise

Cloacal

____________________ exstrophy rare and more complex than bladder exstrophy

Semilobar

____________________ holoprosencephaly presents with: -Singular ventricular cavity with partial formation of occipital horns -Partial or complete fusion of thalamus -Rudimentary falx and interhemispheric fissure -Absent corpus callosum -Absent cavum septum pellucidum -Absent olfactory bulbs

Females

____________________ more likely to present with ureteroceles in presence of renal duplication

Dysgenesis

____________________ of corpus callosum describes range of complete to partial absence of callosal fibers that cross the midline

Hypertensive

____________________ pregnancies may be associated with small placentas

Incomplete

_____________________ cleft: nose is intact; modified coronal view of lip

Unilateral

_____________________ complete cleft lip and palate: incomplete fusion of maxillary prominence to the medial prominence on one side; modified coronal view

Preeclampsia

_____________________ is pregnancy condition in which high blood pressure develops with proteinuria (protein in urine) or edema (swelling)

Spectrophotometric

______________________ analysis of fluid indirectly measures amount of bilirubin present in amniotic fluid and therefore gives measure of degree of hemolysis

Single umbilical artery

_______________________ has been associated with the following: -Congenital anomalies in 20% to 50% of cases -Increased incidence of intrauterine growth restriction (small placenta) (Figure 56-21) -Increased perinatal mortality -Increased incidence of chromosomal abnormalities (trisomies 18, 13, and 21; Turner's syndrome; and triploidy)

Dandy Walker Complex

__________________________ encompasses the three main types of posterior fossa malformations -DWM with an elevated tentorium -DWV -MCM

Amniotic band syndrome

__________________________________________ may represent a milder form of limb-body wall complex

Pentalogy of Cantrell

___________________________________________ considered when large omphalocele, diaphragmatic hernia, ectopia cordis (evisceration of heart), and other heart defects are observed

20

______weeks of gestation -Uterine fundal height should have risen to umbilicus. -Uterus should measure approximately 20 cm above symphysis pubis.

<75

a CI of __________ is considered dolichocephalic

>85

a CI of _____________ is considered to be brachycephalic

Aqueduct of Sylvius

a channel that connects the third ventricle with the fourth ventricle and allows cerebrospinal fluid to pass between them

micromelia

a condition characterized by abnormally small and imperfectly developed extremities

ethmocephaly

a condition in which there is no nose and a proboscis separating two close-set orbits; associated with holoprosencephaly

Weaver's syndrome

a condition that involves tall stature with or without a large head size (macrocephaly ), a variable degree of intellectual disability (usually mild), and characteristic facial features

Sulcus

a groove or furrow, especially one on the surface of the brain

Beckwith-Wiedemann syndrome

a growth disorder syndrome caused by changes on chromosome 11, synonymous with enlargement of several organs including the skull, tongue, and liver

Aneurysm

a localized weak spot or balloon-like enlargement of the wall of an artery

Marshall-Smith syndrome

a malformation syndrome characterized by accelerated skeletal maturation, relative failure to thrive, respiratory difficulties, mental retardation, and unusual facies, including prominent forehead, shallow orbits, blue sclerae, depressed nasal bridge, and micrognathia

Gyrus

a ridge or fold between two clefts on the cerebral surface in the brain

2cm

a single pocket of amniotic fluid exceeding _______ in 2 perpendicular planes is considered evidence of adequate amniotic fluid

Urachus

a tubular structure that is a remnant of embryonic development, which extends from the umbilicus to the apex of the bladder

Hydronephrosis

abnormal condition of water in the kidney (UTI)

Hydronephrosis

abnormal intrapelvic anteroposterior (AP) diameter measurement suggests

Macroglossia

abnormally large tongue

Micrognathia

abnormally small chin

Microcephaly

abnormally small head -a HC of 3 standard deviations below the mean for the gestational age

Retroplacenta

abruption results from rupture of spiral arteries and is "high-pressure" bleed -Is associated with HTN and vascular disease -Hematoma is between placenta and uterus. -Patient may have no vaginal bleeding

5-22cm

adequate AFI total fluid measures

RhoGAM

administered to all Rh-negative patients within 72 hours of amniocentesis procedure

Ligamentus Teres

after birth, the umbilical cord becomes the fibrous cord known as the ligament teres

Glomus

aka body of choroid plexus

Clubfoot

also known as talipes, describes deformities of foot and ankle -Male predominance

limb-body wall complex

anomaly with large cranial defects, facial cleft, large body wall defects, and limb abnormalities

Lungs

appear as solid, homogenous mass of tissue superior to diaphragm and medial to ribs

Venous structures

appear sonographically as white-matter tracts in cranium

Uterine Fibroids

are benign tumors of uterine smooth muscle -stimulated by estrogen

Gonads

are first parts of genital system to develop

Chorionic villi

are functional endocrine units of placenta

Umbilical

arteries arise from fetal internal iliac arteries

Umbilical

arteries branch along chorionic plate of placenta

Hyaloid

artery may be observed within fetal eye in a laterally approached axial plane -regressis in 3rd trimester

Ascites

as

thanatophoric dwarfism

asphyxiating thoracic dystrophy is associated with

Macroglossia

associated with Beckwith-Wiedeman syndrome and aneuploidies

Bowel

b

Bowel obstruction (secondary to gastroschisis)

b

Esophagus

be visualized in thorax during second and third trimesters as two or more parallel echogenic lines ("multilayered" pattern).

Branchial apparatus

bear a resemblance to gills

allantoic vessels

become the umbilical vessels

Metencephalon

becomes cerebellum and pons

Kidneys

begin production of a large amount of the amniotic fluid

Intrauterine growth restriction (IUGR)

best described as decreased rate of fetal growth

dimeric inhibin A

biochemical marker added to improve sensitivity in detecting Down fetuses

Marginal abruption

bleed arises from edge of placenta, dissects beneath placental membranes and is associated with little placental detachment aka subchorionic

Umbilical vein

blood enters the ____________________ & goes into the liver where it splits 2 ways

Crossed ectopia

both kidneys may be fused or appear to be fused, as they are located on same side of body; is considered form of horseshoe kidney

Calcifications

c

Umbilical cord dilation

c

Indigo carmine dye

can be injected into first sac during amniocentesis of twins to show that both sacs sampled

Ventricles

carry cerebral spinal fluid

Craniosynostosis

causes fetal cranium to become abnormally shaped.

Bladder exstrophy

characterized by defect in lower abdominal wall and anterior wall of urinary bladder

Rocker-bottom foot

characterized by prominent heel and convex sole -Trisomy 18

hydropic

characterized by swelling and taking up of fluid

cebocephaly

close-set eyes (hypotelorism) and a nose with a single nostril

Heart block

common in polysplenia syndrome

Trisomy 21

condition in which an individual has three number 21 chromosomes, resulting in Down syndrome

Hydrops fetalis

condition in which excessive fluid accumulates within fetal body cavities

Hypertelorism

condition in which eye orbits are spaced widely apart

Hypotelorism

condition in which the eye orbits are close together

Multifactorial

condition is abnormal event that arises because of interaction of one or more genes and environmental factors

Ventriculomegaly

condition is more commonly identified with encephalocele

pseudohermaphroditism

condition of having gonads of one sex but the physical characteristics of both sexes

Dolichocephaly

condition where CI <75%

Brachicephaly

condition where CI >85%

amelia

congenital absence of one or more limbs

esophageal atresia

congenital absence of part of the esophagus

Syncephalus

conjoined twins with one head

Corpus callosum

consists of bands of fibrous tissue that send nerological messages between the two hemispheres (halves) of the brain

Cebocephaly

consists of combination of hypotelorism with normally placed nose with single nostril

Ethmocephaly

consists of severe hypotelorism with proboscis superior to eyes

Fetal ventricular system

consists of two paired lateral ventricles, midline third ventricle, fourth ventricle adjacent to cerebellum

Ventricular system

contains cerebrospinal fluid (CSF), which coats brain and spinal cord

1

continuous fetal movement for 30 minutes should be counted as _______ movement

Velamentous placenta

cord insertion at the membranes of the placenta

Battledore placenta

cord insertion into the margin of the placenta

Strawberry-shaped

cranium bulging of frontal bones and wide occiput

Branchial cleft

cyst in anterolateral neck

Decidua basalis

decidual reaction that occurs between blastocyst and myometrium

fetus papyraceous

defined as a compressed fetus, the mummified, parchment-like remains of a dead twin that is retained in-utero after intrauterine death in the second trimester.

shoulder dystocia

delayed or difficult birth of the fetal shoulders after the head is born

ROM

describe conditions in which membranes rupture ("water breaks") abnormally, resulting in loss of AF and/or oligohydramnios.

small for gestational age (SGA)

describes fetus with weight below 10th percentile without reference to cause

Nonimmune Hydrops (NIH)

describes group of conditions in which hydrops present in fetus but is not result of fetomaternal blood group incompatibility

Polyhydramnios

develops if fetus cannot swallow

Chronic hypertension

diagnosed in patients in whom high blood pressure found before 20 weeks of gestation

Placental abruptions

difficult to diagnose because clotted blood has same sonographic appearance as placental tissue

Varix

dilated, tortuous vein

20mm

discordance of growth between twins when difference in AC of

6mm

discordance of growth between twins when difference in BPD of

>20%

discordance of growth between twins when difference in estimated fetal weight of _____%

5mm

discordance of growth between twins when difference in femur length of

X-linked

disorder where affected males do not transmit disorder to sons, but all daughters will be carriers for disorder

Partial situs

divided into asplenia and polysplenia

Prosencephalon

divides into telencephalon and diencephalon

Colon

does not have peristalsis like small bowel

Hyperemesis gravidarum

exists when pregnant woman vomits so much she develops dehydration and electrolyte imbalance

Hyperemesis

extreme, persistent vomiting that can cause dehydration

Duodenal atresia

failed recanalization of the duodenum resulting in polyhydramnios, bile-containing vomitus, and a distended stomach

ectopia cordis

fetal anomaly of congenital malposition of the heart outside the thoracic cavity

Hypertelorism

fetal eyes spaced widely apart

Hypotelorism

fetal eyes too close together

Brachycephaly

fetal head is elongated in the transverse diameter (BPD) and shortened in the anteroposterior (OFD) diameter

Dolichocephaly

fetal head is relatively narrow in the transverse plane (BPD) and elongated in the anteroposterior (OFD) plane

Vertex

fetal head positioned down

Ductus venosus

fetal heart shunt that by passes the liver

Ductus arteriosus

fetal heart shunt that bypasses the lungs

Foramen ovale

fetal heart shunt that bypasses the right ventricle

hamartomas

fetal liver tumors

34

fetal presentation changes less frequently after ____weeks

Chorionic plate

fetal surface of placenta

Vertex

fetus head down

Breech

fetus head up

Haustral

folds of colon help to differentiate it from small bowel

Umbilical vein

formed by confluence of chorionic veins of placenta

Chorion frondosum

forms fetal part of placenta; contains villi

Mesenchyme

forms the cartilages, bones, muscles, and blood vessels.

AFP (alpha-fetoprotein)

found in fetal spine, GI tract, liver, kidneys

Inherited dominant

genetic disorder carries 50% chance that each time pregnancy occurs, fetus will have conditions

Sotos' syndrome

genetic disorder characterized by excessive growth before and after birth, a large, elongated (dolichocephalic) head, distinctive facial configuration, and a non-progressive neurological disorder with intellectual disability

X-linked

genetic disorders inherited by boys from mothers

amniotic band syndrome

group of abnormalities associated with the entrapment of fetal parts in the amnion, often resulting in fetal amputations or clefting

Heart

h

Hydronephrosis (gastroschisis)

h

extramedullary hematopoiesis (EMH)

hematopoiesis occurring outside of the medulla of the bone (bone marrow)

Pleural effusions

hydramnios accompanies chylothorax (esophageal compression)

Placenta previa

implantation of the placenta over the cervical opening or in the lower region of the uterus

Left portal vein

in the fetus, the left umbilical vein connects directly to the

Radial ray defects

include hypoplasia or aplasia of radius and thumb

pyelonephritis

inflammation of the renal pelvis and the kidney (UTI)

Central nervous system

initiates and regulates frequency of fetal breathing movements; patterns vary with sleep-wake cycles

Cytotrophoblast

inner layer of trophoblast

Allantois

involved in early fluid exchange between the embryo and the yolk sac

Hirschsprung's Disease

is a birth defect. This disorder is characterized by the absence of particular nerve cells (ganglions) in a segment of the bowel in an infant -the absence of ganglion cells causes the muscles in the bowels to lose their ability to move stool through the intestine (peristalsis).

Midline falx

is a double-fold of dura mater that descends through the interhemispheric fissure in the midline of the brain to separate the two cerebral hemispheres

PAPP-A (Pregnancy-Associated Plasma Protein A)

is a glycoprotein derived from trophoblastic tissue that is diffused into maternal circulation. -levels increase in maternal serum throughout pregnancy.

Choroid plexus

is a plexus of cells that arises from the tela choroidea in each of the ventricles of the brain

Cavum septum pellucidum

is a potential cavity between the membranous leaves of the septum pellucidum

Otocephaly

is a rare anomaly where absence of the mandible causes the ears to form close together anteriorly and toward the neck

Septum pellucidum

is a thin, triangular, vertical double membrane separating the anterior horns of the left and right lateral ventricles of the brain

Aneuploidy

is abnormality of number of chromosomes

Chorion frondosum

is active trophoblastic tissue that becomes the placenta

Sirenomelia

is anomaly in which there is fusion of lower extremities

Adult Dominant Polycystic Kidney Disease (ADPKD)

is associated with cystic dilation of nephrons and of collecting tubule walls in both kidneys

Fetal tone (FT)

is characterized by the presence of at least one episode of extension and immediate return to flexion of an extremity or the spine.

Systemic lupus erythematosus (SLE)

is chronic autoimmune disorder that can affect almost all organ systems in body -most common in women of childbearing age -multiple peripartum complications -placenta effected -monitored to rule out congenital heart block & pericardial effusion

Oligoyhydramnios

is common complication of postdate pregnancies. -Is associated with diminished placental function and arterial redistribution of fetal blood flow with brain-sparing effect

Megacolon

is congenital disorder in which there is abnormal innervation of large intestine

Hyperechoic bowel

is considered bowel as bright as bone. It is associated with increased risk for aneuploidy

Megacisterna magna (MCM)

is defined as an enlarged cistern magna.

Imperforate anus

is disorder that occurs when membrane covers anus, prohibiting expulsion of meconium

Corpus callosum

is echopenic structure seen in transverse plane as band of tissue between frontal ventricular horns

Corpus callosum

is fibrous tract that connects the cerebral hemispheres -Aids in learning and memory

Turner's syndrome (45 X)

is genetic abnormality marked by absence of X or Y chromosome -Not associated with advanced maternal age

beta-hCG (Free Beta Human Chorionic Gonadotropin)

is glycoprotein derived from placenta

Hydrops

is identified on ultrasound by presence of abnormal collections of fluid

Midline falx

is important landmark to visualize because its presence implies that separation of cerebrum has occurred

Camptomelic Dysplasia

is known as bent bone. -Is a group of lethal skeletal dysplasias characterized by bowing of long bones

Congenital lobar emphysema

is lobar overinflation of lung without destruction of alveolar septa -Usually occurs in upper left or middle lobe; is located within normal pleural envelope -May appear identical to microcystic CCAM, presenting as large solid mass

AFP (alpha-fetoprotein)

is major protein in fetal serum; is produced by yolk sac in early gestation and later by fetal liver.

Neuroblastoma

is malignant adrenal gland tumor that develops from nerve tissue in adrenal gland -usually present in third trimester and occur more often on right side

Septum transversum

is mass of mesoderm between pericardial cavity and yolk stalk -Forms major part of diaphragm and ventral mesentery

CRL

is most accurate fetal age measurement

Hydronephrosis

is most common fetal anomaly

Ureterovescial Junction Obstruction (UVJ)

is most common reason for hydronephrosis in neonate -males -unilateral

Mosaicism

is occurrence of gene mutation or chromosomal abnormality in portion of individual's cells

Premature Labor

is onset of labor before 37 weeks of gestation

Frontal slanting

is opposite of frontal bossing; is characterized by forehead that slopes backward

Amniotic fluid

is produced by umbilical cord, membranes, lungs, skin, and kidneys

Thalamus

is seen in ultrasound within the ventricles

Epignathus

is teratoma located in oropharynx -Swallowing may be impaired -Small stomach

Encephalocele

is term used to describe herniation of meninges and brain through defect

Cisterna Magna

is the space between the inferior margin of the vermis and the posterior rim of the foramen magnum

Succenturiate

is when additional placental lobes are joined to main placenta by blood vessels

Liver

l

Maternal serum alpha-fetoprotein (MSAFP)

lab screening performed routinely to detect neural tube defects

Maximum Vertical Pocket (MVP)

largest amniotic fluid area

Cytotrophoblast

layer produces neuropeptides

Syncytiotrophoblast

layer produces protein hormones: hCG, hPL, estrogen, & progesterone

PAPP-A (Pregnancy-Associated Plasma Protein A)

levels found to be decreased in pregnancies affected by aneuploidy

left

lobe of liver larger in utero secondary to greater supply of oxygenated blood

Cerebellum

located in back of cerebral peduncles within posterior fossa

left portal vein

lpv

Dandy-Walker variant (DWV)

manifests with cystic dilation of the fourth ventricle and hypoplasia of the cerebellar vermis without an enlarged posterior fossa

Basal plate

maternal surface of placenta

Systolic/diastolic Ratio (S/D)

maximum systolic velocity/diastolic velocity

Frontal bossing

may appear as lemon-shaped skull or absent, depressed nasal bridge

AFP (alpha-fetoprotein)

may be measured in maternal serum (MSAFP) or from amniotic fluid (AFAFP)

Frontal bossing

may be observed in fetus with lemon-shaped skull or skeletal dysplasias.

Diaphragm

may be observed on sonography as echogenic, smooth hypoechoic muscular margin -Between fetal liver or spleen and lungs

Suprasellar cistern

may be recognized in center of circle of Willis

Trigonocephaly

may cause forehead to have elongated appearance in sagittal plane and appear triangular shaped in axial plane.

Facial cleft

may involve only upper lip or may extend to involve alveolus, posterior hard palate, and soft palate.

Spina Bifida

means there is cleft, or opening, in spine

BPD

measurement can be misleading in cases associated with unusual head shapes

CRL

measurement is the most accurate form of dating in the first trimester

AC

measurement least accurate for fetal age

FL

measurement may be used with same accuracy as BPD to predict gestational age

FL

measurement may indicate skeletal dysplasias or intrauterine growth restriction

BPD

measurement used alone, poor indicator of IUGR

AC

measurement used to predict fetal weight and detecting growth disturbances (such as IUGR)

Cisterna magna

measures 3 to 11 mm, with average size of 5 to 6 mm

Cordocentesis

more commonly used for guidance for transfusions to treat fetal isoimmunization

Bronchogenic cysts

most common lung mass; unilocular or multilocular; usually within mediastinum or lung; normal amniotic fluid

Four chamber

most heart abnormalities are detected in the ______ chamber view

Insulin-dependent diabetic mellitus (IDDM)

mothers at increased risk for pregnancy-related complications, including early and late trimester pregnancy loss and congenital anomalies

Wharton's jelly

mucoid connective tissue that surrounds the vessels within the umbilical cord

Dolichocephaly

narrow head. Long in OFD, short in BPD

Fetal heart rate (FHR)

nonstress test (NST) AKA

Chorion laeve

nonvillious part of chorion around gestational sac

15-20cm

normal placental diameter

4cm

normal placental diameter <

40-60cm

normal umbilical cord length

Gravidity

number of times, pregnant, regardless of the duration or outcome

Cleft lip

occurs because of failure to fuse primary and secondary palate

Oligohydramnios

occurs if fetal urine output reduced

Obstructive Cystic Dysplasia

occurs secondary to kidney obstruction in first or early second trimester of pregnancy.

Dwarfism

occurs secondary to skeletal dysplasia and refers to disproportionately short stature

blighted ovum

occurs when a fertilized egg implants in the uterus but doesn't develop into an embryo

Cleft palate

occurs when lateral palatine processes fail to fuse in midline

Hydrocephalus

occurs when ventriculomegaly coupled with enlargement of fetal head

Polyhydramnios

often associated with central nervous system (CNS) disorders and/or gastrointestinal (GI) problems

16

omphalomesenteric duct closed by ___ week of gestation

Infantile Polycystic Kidney Disease (IPKD)

or autosomal-recessive polycystic kidney disease (ARPKD), is an autosomal-recessive congenital disorder that affects both fetal kidneys and liver.

Chorion

originates from trophoblastic cells and remains in contact with trophoblasts throughout pregnancy.

Syncytiotrophoblast

outer layer of trophoblast

estimated fetal weight (EFW)

overall reduction in size and mass of parameters naturally gives below-normal __________________

HC-to-AC ratio

parameter has high false-positive rate for use in screening general population

FL-to-AC ratio

parameter has poor positive predictive value

FL

parameter may decrease in size with symmetric IUGR

AC

parameter measure at level of portal-umbilical venous complex

FL-to-AC ratio

parameter not dependent on knowing gestational age

HC-to-AC ratio

parameter useful in determining type of IUGR

0

parameters are arbitrarily assigned score of ___ when abnormal

2

parameters are arbitrarily assigned score of ___ when normal

Tracheoesophageal septum

partitions trachea from esophagus

Circumvallate Placenta

placenta is attachment of placental membranes to fetal surface of placenta rather than to underlying villous placental margin -associated with PROM, preterm labor, IUGR, and placental abruption

Subplacental venous complex

placenta is separated from myometrium by

Liley Curve

plot of optical density of amniotic fluid shows sensitization of Rh -good test after 27 wks

Nonimmune hydrops fetalis (NIHF)

presence of abnormal accumulations of fluid in fetal body and/or skin -Cardiac insufficiency one of the most common causes

Choroid plexus

produces most of the cerebrospinal fluid (CSF) of the central nervous system

Progesterone

production is a maternal-placental interaction; no contribution from fetus

Frontal horns

prominent in presence of ventricular dilation

Frontal bossing

protrusion or bulging of the forehead

Wilms tumor (nephroblastoma)

rapidly developing malignant neoplasm of the kidney thought to be derived from abnormal renal cells -more common in females

Vasa previa

rare condition in which umbilical cord is presenting part

Decidua vera (parietalis)

reaction except for areas beneath and above implanted

Decidua capsularis

reaction occurring over blastocyst closest to endometrial cavity

Hemorrhage

refers to bleeding from placenta from any cause

Hydronephrosis

refers to dilation of renal pelvis and calyces.

Pylectasis

refers to dilation of renal pelvis without dilation of calyces.

Ventriculomegaly

refers to dilation of ventricles within brain

Situs

refers to fetal positioning

placentation type

refers to number of chorions (chorionicity) and amnions (amnionicity)

Advanced Maternal Age (AMA)

refers to patient who will be 35 or older at time of delivery

Spalding's sign

refers to the overlapping of the fetal skull bones caused by collapse of the fetal brain -it appears usually a week or more after fetal death in utero

Eclampsia

represents occurrence of seizures or coma in preeclamptic patient

Thalamus

resembles heart with apex projected toward fetal occiput

Placenta increta

results from underdeveloped decidualization of endometrium

Brachicephaly

round head. Short in OFD, wide in BPD

Stomach

s

delta optical density 450 (ΔOD450)

scan of amniotic fluid allows for the assessment of bile pigments at 450 nm -predicts the severity of Rh-negative pregnancy

Trisomy 18

second most common chromosomal trisomy

Colon

seen near end of second trimester as long tubular hypoechoic structure with well-defined walls

Tentorium

separates the cerebellum from the cerebral cortex

Diaphragm

separates the thorax from the abdomen. appears as a linear structure

Lungs

serve as lateral borders for heart and lie superior to diaphragm

Ductus venous

serves as conduit between portal veins and systemic veins

Anasarca

severe generalized edema

anasarca

severe generalized edema of the entire body

Amniotic Sheets

shelves, or folds identified as echogenic, nonfloating bands crossing through amniotic cavity

Unilateral pulmonary agenesis (hypoplasia)

should be considered in differential diagnosis of every fetus with mediastinal shift and apparent chest mass.

Ears

show as lateral protuberances emerging from parietal bones

Formen ovale

shunts majority (2/3) blood from the right atrium directly into the left atrium by allowing most blood to bypass the baby's developing lungs

AC

single most sensitive indicator of IUGR

Clover-leaf

skull associated with numerous skeletal dysplasias and ventriculomegaly.

Pseudoascites

sonolucent band near the fetal anterior abdominal wall from the abdominal wall muscles in the fetus over 18 weeks

Rhombencephalon

subdivides into metencephalon and myelencephalon

Antigen

substance that elicits immunologic response such as production of antibody to that substance

amniocentesis

test for genetic reasons ideally performed between 15 and 20 weeks of gestation

amniocentesis

test may be done as early as 12 weeks, but may lead to development of fetal scoliosis or clubfoot secondary to reduced amount of AF

Meningocele

that describes herniation of meninges only

1mm

the GS will grow at a rate of _______per day during the first trimester

Femur length (FL)

the ________________ measurement is the best choice to predict gestational age

Left atrium

the ______________________ of the fetal heart is the closest to the spine

Right ventricle

the _______________________ of the fetal heart is the closest to the chest wall

Left

the apex of the heart should point to the fetal ______ side

Transverse

the fetal heart lies more __________ than in adults -lungs are not inflated

Ductus venosus

the left branch of the umbilical vein is called the _____________ and shunts blood directly to the IVC

Parity

the number of pregnancies that end/delivered after 20 weeks gestation. The number of fetuses in a pregnancy does NOT change this number.

Liver

the right branch of the umbilical vein courses through the

fluorescence in situ hybridization (FISH)

this assay most commonly evaluates for numeric abnormalities of chromosomes 21, 13, 18, X, Y

Acceleration time (ACC)

time from beginning of systole to peak systole

Deceleration time (DCC)

time from peak systole to end diastole

Choroid plexus

tissue located within roofs of each ventricle except at frontal ventricular horns

Choroid plexus

tissue within lateral ventricles produces CSF

Myelencephalon

transforms into medulla

Complete moles

tumors generally have diploid karyotype and no fetal tissue

incomplete moles

tumors usually have a triploid karyotype and fetal tissue is often present

Monozygotic

twins arise from a single fertilized egg that divides, resulting in two genetically identical fetuses

Dizygotic

twins arise from two separately fertilized ova

Ischiopagus

twins attached at the buttocks

Omphalopagus

twins joined at the anterior wall (abdomen)

Craniopagus

twins joined at the cranium

Pygopagus

twins joined at the ischial region (sacrum)

Thoracopagus

twins joined at the thorax

medial

two _______________ nasal prominences form crest and tip of nose

3

type of mechanical macrosomia? can be caused by genetic constitution or pathologic process, such as hydrocephalus

1

type of mechanical macrosomia? can result from genetic factors, prolonged pregnancy, or multiparity

2

type of mechanical macrosomia? type found in diabetic pregnancy

asymmetrical iugr

type of pattern results in a normal head measurement with small abdominal circumference and smaller-than-expected limb growth.

Railway sign

uDouble line appearance of spine referred to as "_______________" and generated by echoes from posterior and anterior laminae and spinal cord

CVS (Chorionic Villus Sampling )

ultrasound directed biopsy of placenta or chorionic villi (aka chorion frondosum)

lateral ligaments of bladder

umbilical arteries become

first

umbilical cysts that persist beyond ______trimester usually associated with other fetal anomalies and aneuploidy

round ligament

umbilical vein becomes

Vermis

unpaired, median portion of the cerebellum that connects the two hemispheres

M

use ________ mode to get fetal heart beat

Potter's classification (Potter's sequence)

used to describe diseases associated with renal failure, oligohydramnios, and Potter facies

migration

used to describe how the placenta changes position within uterine cavity

toxemia

was used to describe hypertensive disorders, because believed that "toxin" in mother's bloodstream caused hypertension

OFD and BPD

what two measurements will give you the HC

quadruple screen

when dimeric inhibin A is added to a triple screen is called

3

when geting FHB you must show _______ beats

>7mm

when the fetal pole measures ________ positive cardiac activity

Transverse

widest ________________ diameter of skull and therefore proper level to measure biparietal diameter and head circumference

Glomus

will fill lateral ventricle in normal pregnancy

Cortical cyst

will not communicate with anechoic cystic-like appearance of hydronephrosis

Cleft lip

with or without cleft palate represents most common congenital anomaly of face