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
