Fetal Heart

fetal heart occupies approximately ____ of the total chest area

1/3

the remainder ______-_______ % of blood shunt from the ______ _______ through the _______ ________ to the IVC

10-50% portal sinus ductus venosus

what should the fetal beats per minute be?

130 - 160 BPM

The fetal heart is best evaluated on ultrasound between _____ and ___ weeks.

18 - 34

atria ventricles av valves septums are all views of?

4 chamber heart view

the perpendicular line from the spine to the apex line should not exceed what degree? What is this a measurement of?

45 degrees cardiac axis of 4 chamber view

when does the cardiac tube form?

5-6 weeks gestation

the fetal heart is fully developed when?

8 weeks gestation

Systole

Contraction of the heart

T/F the fetus receives blood from the placenta through the umbilical arteries

False umbilical veins

the 4 chambers are divided by the ____________ and ___________-

IAS (interatrial septum) and IVS (interventricular septum)

what empties into the RA?

IVC and SVC

what does the moderator band connect?

IVS to papillary muscle

is pulmonary maturity predicted sonographically?

No

FO is the opening from?

RA to LA

Diastole

Relaxation of the heart

the remainder of blood that enters the RA mixes with blood from....

Superior vena cava to tricuspid valve to right ventricle to pulmonary artery to ductus arteriosus to descending aorta to rest of body

TORCH infections:

Toxoplasmosis Rubella Cytomegalovirus Herpes

fetal breathing movements

airless mechanical thoracic movement each minute

the stomachs echogencity appears ___________ and is on the _______ side of the body.

anechoic left

the ventricles extend to the ___________ and both should squeeze simultaneously during _________

apex systole

When viewing the 4 chambers what can you see? (4)

atria ventricles av valves septums

aortic valve

between left ventricle and aorta into ascending aorta

What is checked to ensure the lungs of the fetus are developing properly?

check if there is an adequate amniotic fluid volume

Fetal indications for fetal echo includes?

chromosomal and anatomic anomalies (such as a break in the septum) arrhythmia non immune hydrops (NIH)- fluid collection in fetal chest, abdomen,neck, etc suspected cardiac anomaly on basic scan

when the ventricles squeeze at the same what can you use to see this?

color doppler

to confirm the blood is flowing properly in the ductus venosus, what can you do?

color doppler reversal of flow is related to downsyndrome

Maternal indications for fetal echo includes?

congenital heart disease alcohol abuse diabetes sever polyhydraminos (too much amniotic fluid) TORCH infections: Toxoplasmosis Rubella Cytomegalovirus Herpes

what do valves do?

control the direction of blood flow they open and close in pairs give distinct sounds of heartbeat during systole (contraction) and diastole (relaxation)

is the base of the heart directed cranially or caudally?

cranially

the later the scan the more _________ it is to evaluate the fetal heart.

difficult (more bones are developed and create shadowing, theres less amniotic fluid, etc.)

what bypasses the lungs?

ductus arteriosus

what bypasses the liver?

ductus venosus

septums appear?

echogenic

when the fetal tube thickens, what is the inner portion form into?

endocardium

what are some (3) indications for fetal echo?

familial maternal fetal

During development of the fetal lungs, what are you looking out for?

fluid

the ventricles are bypassed by the...

foramen ovale

once the fetal blood enters the RA of the heart, what is the rest of the flow? and what does this supply?

foramen ovale to left atrium to mitral valve to then exit left ventricle to aorta supplies the cranial portion of the brain with highly oxygenated blood

what are the 3 standard views to rule out cardiac anomalies?

four chamber view left ventricular outflow tract (LVOT) Right ventricular outflow tract (RVOT)

in later gestation the parenchyma of the lungs are ___________ than the ____________

greater liver

From the IVC, the blood passes through the ___________________________ and enters the ________

heart RA

MOST fetal blood filters through the liver through the ________ and ________

hepatic veins and IVC

a diabetic mother is automatically considered a ________ ________ pregnancy

high risk

Familial indication for fetal echo includes

history of congenital heart disease

The fetal lungs appear ___________ and moderately ________

homogeneous echogenic

the liver is __________ to the lungs

hypoechoic

If a fetus needs to be delivered prematurely, what is important to be looked at prior in lung development?

if the fetal lungs are matured enough to sustain life after delivery

foramen ovale (FO)

in between the right and left atrium, there is a hole/communication between the cavities

The apex of the heart is the ____________ end directed toward the ___________

inferior left

the fetal stomach and liver are __________ the diaphragm

inferior or below

most posterior chamber where the pulmonary veins empty

left atrium

ascending aorta arises from here

left ventricle

at what level is the thoracic circumference done at?

level of the 4 chamber heart

after birth the ductus arteriosus becomes

ligamentum arteriosum

After birth the umbilical vein becomes

ligamentum teres

After birth the ductus venosus becomes

ligamentum venosum

in early gestation the parenchyma of the lungs are similar to the ____________

liver

shunting of blood: ductus venosus bypasses....

liver

the umbilical veins enters the fetal ___________ and joins the ________ _________

liver portal sinus

LVOT is seen in a ______axis view

long

RVOT is seen in a ________ axis view

long

shunting of blood: ductus arteriosus bypasses...

lungs

the fetal heart is located in the ____________ anatomically between the ________

mediastinum lungs

What is the atrial septum?

muscular division between right and left atria

When the fetal heart is fully developed, the tube will thicken and form the?

myocardium endocardium epicardium

amniocentesis

needle puncture of the amniotic sac to withdraw amniotic fluid for analysis

the apex is 65 degrees from the line perpendicular to the spine, is this normal?

no, it shouldnt exceed 45 degrees

Does the fetus use their lungs during development?

no, not until their born

LVOT highlights....

path from LV into ascending aorta

RVOT highlights...

path from RV to pulmonary trunk

What are the 2 semilunar valves?

pulmonary and aortic

the IAS and IVS separate the?

right and left side of the heart

the ventricular septum is a true separation between...

right and left ventricles

the base of the fetal heart is a broad end directed to the __________ and __________

right and posteriorly

contains moderator band appears larger to its corresponding structure Main pulmonary artery arises here ductus arteriosus arises from the distal MPA

right ventricle

Where is the moderator band located?

right ventricular apex as a thickened area

after birth ______ close and a normal pattern is assumed

shunts

the fetal heart is __________ the diaphragm

superior or above

what is a good marker to find the apex?

the aorta aorta is on left side so if the aorta is found you know the apex is on that same side

the measurement of cardiac axis from 4 chamber view is the measurement between?

the perpendicular line from the spine to the apex line

where does the fetus receive blood from/through?

the placenta through the umbilical vein

are both ventricles different in size?

they are approximately the same size

Later on in pregnancy, what is done to check the fetal breathing?

they will mimic respiration to see if the fetal lungs are able to do their job for when they are outside of the womb

Atrioventricular valves (AV) consist of what 2 valves?

tricuspid and bicuspid (mitral)

5-6 weeks of gestation, what is formed?

tube

bicuspid valve

valve between the left atrium and the left ventricle.

tricuspid valve

valve between the right atrium and the right ventricle

pulmonary valve

valve positioned between the right ventricle and the pulmonary artery

shunting of blood: formane ovale bypasses....

ventricles

what is Lecithin Sphingomyelin (L/S Ratio)??

when an amniocentesis (withdrawing amniotic fluid to test lung maturity) is performed after 36 weeks for fetal lung maturity