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Prenatal

US, Ultrafast MRI, Fetal Echo, NST, BPP, etc.

QuestionAnswer
US is diagnostic for... Anencephaly
US is NOT diagnostic for... trisomies!
Two types of US 1. transvaginal 2. transabdominal
First trimester Routine US measure 1. CRL 2. Placental location 3. Fetal number 4. AFV 5. Fetal HB 6. Maternal uterus and ovaries
First Trimster NT 11 weeks-13 weeks 6 days and if above 3mm is increased
How would you measure a 5 week gestation? CRL
Fetal Cardiac activity presents at 5 weeks gestation
NST monitors changes in fetal rate in association with fetal movement and maternal uterine contractions (fetal heart rate reactivity)
BPP usually performed is NST is abnormal
When is an NST/BPP performed? 30+ weeks
What is an NST/BPP used for? 1. Post-dates 2. IUGR 3. Polyhydr. 4. Oligohydr. 5. Maternal hypertension 6. Multiples 7. Maternal Diabetes 8. Maternal toxemia 9. Elevated MSAFP 10. Fetal arrythmia 11. Decreased fetal movement 12. Other maternal disease
BPP is scored based on... 1. NST then US assessment... 2. Fetal breathing 3. Fetal movement 4. Fetal tone 5. AFV
Fetoscopy Direct visualization of fetus, fetal anatomy, and/or umbilical cord using fiberoptics
When is a fetoscopy performed? 1. between 15 and 18 weeks for best visualization 2. between 18-20 weeks for blood sampling
Advantages of fetoscopy Direct visualization and sampling and therapy capabilities
Disadvantages of fetoscopy 1. High fetal loss rate due to wider gauge of endoscope compared to procedure needle 2. Inflexible canula 3. Limited availability 4. Declining usage
Second Trimester US Routinely looks for 1. Fetal number, position, heart rate 2. Placenta 3. AFV 4. Maternal uterus and ovaries 5. Gestational Age 6. Fetal Anatomy
Second Trimester trisomy markers 1.`Nuchal skin fold 2. ear length 3. middle phalanx of 5th digit 4. intestines 5. pelvic angle 6. humerus length 7. BPD 8. heart 9. kidneys foot length 10. femur length 11. cerebral lateral ventricles
Second Trimester targeted US Detailed US to detect specific anomalies or features associated with specific suspected syndromes
Third Trimester US Same as second
Advantages of US non-invasive and can be done throughout the pregnancy
Precautions of US Must define significance of early findings
Fetal MRi MRI technology continues to improve and helps with US.
Ultrafast MRi Advantages 1. Maternal obesity, oligohydramnios, or bad fetal lie don't effect it 2. Significant impact on eval of the brain 3. Eval of renal dysplastic changes may be better
Precautions for Ultrafast MRI 1. Closed for faster imaging 2. US still preferred for subtle spin and vertebral anomalies 3. Limitation if the mother is overwt
Fetal Echo evaluates 1. 4 chambers 2. Position in left chest 3. Wall thickness and contractility 4. Chamber size 5. Valves 6. Arrhytmia 7. 2 great vessels from appropriate ventricles 8. 2 pulmonary veins into left atrium 9. aortic arch 10. DA 11. coarctation of the aorta
Fetal Echo is best done at what time and to identify what? Between 20 and 24 weeks to identify 1. major structural cardiac defects 2 cardiac arrhythmias 3. Hemodynamics abn. with doppler 4. Situs inversus 5. Cardiomyopathy 6. Cardiac tumors
Created by: Kali Chatham Kali Chatham on 2010-03-09



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