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