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Son 241 mid term
SON 241 MIDTERM
| Question | Answer |
|---|---|
| Parts of the Decidua and locations; "Double decidual sign" | Decidua basalis / capsularis / parietalis "vera" |
| Maternal component of the placenta, part of maternal endometrium | Decidua |
| Anchors placenta, trophoblast (chorion) digs into it. REMAINING DECIDUA COVERING BLASTOCYST Maternal portion of placenta | Decidua Basalis |
| Clovers the Blastocyst after implantaion | Decidua Capsularis |
| Remaining poriton of decidua or endometrium also know as Vera | Decidua Parietalis |
| Decidua capsularis and parietalis fuse at | 20-22 wks |
| Formation of the placenta | Decidua basalis and chorion fondosum |
| placental appearance before 8wks | Chorionic sac covered by villi (seen as thickening around GS) |
| Placental apperance after 8wks | Villi of chorion laeve regress and leave a smooth avascular area know as chorion laeve. |
| Noramal thickness of Placenta | Thickness corresponds to menstrual age. Ex 20 wk = 20mm |
| Placenta and basal layer appear homogeneous; chorionic plate appears smooth | Grade 0 |
| Random echogenic densities are seen within the placenta; subtle undulation of the chorionic plate | Grade 1 |
| Basal echogenic densities within placenta and a markedly indented chorionic plate | Grade 2 |
| Compartmented divisions of the placenta; heavy calcification near chorionic/basal plate and echofree zones within the cotyledons. Should not be seen before 33wks | Grade 3 |
| How early can the Placenta be identifed on sonography | 9wks |
| Placenta present before the fetus; painless vaginal bleeding in 2nd or 3rd trimester. Common w/ mult pregnancies, uterine surgery,previous previa. | Placenta Previa |
| A total or central ( symmetrical) placenta previa is | a placenta that covers the cervical os completeley |
| Totally covers the os but placenta is on one side of uterus | Asymmetrical |
| A marginal placenta previa is | A lip of placenta that is situated at the cervical os |
| The placenta is within 2cm of os | Low lying |
| Never diagnose a previa before the | 3rd Trimester |
| Placenta migration | never happens |
| Abruptio placenta is | A placenta which is prematurely separating from the myometrial surface |
| Placenta abruption occures in 1% of pregnancies; risk factors | Hypertension/vascular disease/smoking/drugs/Fibroids/trauma/malformation/previous abruption |
| Name 3 classes of Abruption | Subchorionic/Retroplacental/marginal |
| Most common before 20wks, no bleeding, Fetal death may occur due to cord compressions. May have no symmtoms, below chorion | Subchorionic |
| Behind or beneath the placenta may or may not have vaginal bleeding | Retroplacental |
| Subchorionic, involves the placental margin of the basal side and will have vaginal bleeding | Marginal |
| Symptoms of Abruption | Tense, hard, painless uterus, fetus may have IUGR, Painful w/trauma, possible bleeding, thickened placenta |
| Causes of a thick placenta | Infection, hydrops, diabetes |
| Causes of thin placenta | POLYHYDRAMNIOS, hypertension |
| US can aid in the diagnosis of abruptio placenta. Careful examination of the placenta will reveal what in some cases | Retroplacental clots |
| The part of the Chorion in the region of the decidua basalis (chorion frondosum) becomes the | placenta |
| Placenta invades too far, invades past endometrium | Placental Accreta |
| List 3 types of Placental Accreta | Accreta/Increta/ Percreta |
| Placenta extends into myometrium | Accreta |
| Placenta extends through the myometrium | Increta |
| Placenta invades into the uterinw wall and may extend through the uterine wall into bladder | Percreta |
| Treament for Placental Accretas | Hysterectomy is performed after delivery due to infection and massive hemorrhaging |
| Chorionic plate is smaller than the basal plate, two types: circummarginate and circumvallate | Placenta Extrachorialis |
| The chorionic plate is flat | Circummarginate |
| Chorionic plate is folded | Circumvallate |
| Vealametous insertion of the umblical cord into the placenta, it does not insert into placetnal tissue | Velamentous |
| Condition where blood vessels maybe lodged between the fetus and the internal cervical os | Vasa Previa |
| Normal Placenta should never measure more than | 4cm |
| Is covered by villi, has two layers of trophoblast, is the fetal components of the placenta and implants into maternal endometrium | Chorion |
| Parts of the Chorion | Chorion Frondosum and Chorion Leaeve ( smooth chorion) |
| Part of the chorion that invades the endometrium | Chorion Frondosum |
| Part not in contact with the decidua basalis, after 8wks the villi degenerate and leave this area of the chorion smooth | Chorion Leaeve |
| The two membranes of pregnancy are | Chorion and amnion |
| When does chorion and amnion fuse? | about 16th wk of pregnancy |
| Is the outer part of the GS and part of it will become placenta | Chorion |
| Within the chorion is a thinner membrane called | amnion |
| This can intrap a fetus or cut a part off the baby, nothing can be done | amnion band |
| Not as sensitive, Pt can be as much as 2 months pregnant before the urine test is postive | Urine test |
| Most reliable, positive at 7-10 days post fertilization, highly sensitive RIA, used to detect hCG levels | Blood test |
| Name 2 different valuses | International Reference Prepartion and Second internantional standard |
| hCG levels DOUBLE | every 2 days ( 48hr) in a normal pregnancy |
| A hormone produced by the placenta | hCG |
| Produced by the fetal liver | AFP |
| Levels may indicate an open neural tube defect | High AFP |
| Levels may indicate Down syndrome | Low AFP |
| Is a fetal specific globulin, produced by fetus | AFP |
| AFP is produced by: | Liver (largest producer of AFP), Yolk sac,gastrointestinal tract |
| AFP present in the fetal blood peaks at | 10-13wks and peak at 28 to 32 wks |
| Most common solid mass encountered during pregnancy,grows due to estrogen, fibroids are echogenic | Leiomyoma |
| Where does fertilization 1st occur | Ampulla |
| Formed from layer of cells of the blastocyst and is also called | Heuser's membrane |
| Yolk sac detaches at | 6th wk |
| The yolk sac is | outside the amnion but inside the chorion |
| The functions of the yolk sac | Development of sex glands,hemopoiesis, formation of digestive tube, tranfer of nutrients |
| In about 2% of adults the yolk sac persists as a diverticulum of the ileum. This is known as | Meckel's diverticulum |
| The yolk sac has an important role in early pregnancy. It typically is largest | Between 5 and 9 wks, normal diameter is 5-6mm at 5-6 wks but never greater than 6mm |
| The methodology used in the assessment of the GS in the 1st trimester is | Measurment of GS and CRL |
| GS generally refers to a pregnancy | between 4-10 wks |
| Chorionic cavity contains fluid and becomes | GS |
| GS occurs 3wks | post-fertilization |
| GS grows in a normal gestation | 1-2 or (1.3mm) a day in 1st trimester and by wk 5 1cm |
| Embryo lies between the | primary yolk sac and amniotic cavity |
| GS can be seen transabdominally at | 5mm or GA of 5wks |
| GS can be seen TV at | 2 to 3mm or GA 4wks |
| GS growth in normal gestation | 1.13mm per day and .7mm in abnormal |
| Heart rate at 5-6wks | 100 to 115 BPM |
| Heart rate at 9 wks | 149 BPM |
| Heart rate at 3rd trimester? | |
| Placenta with extra lobe not contained within placenta, will be attached by vessels to main placenta | Succenturiate Lobe |
| What is a two vessel cord? | Associated with fetal anomalies in 14-62% of pregnancy |
| The most common tumor of the umbilical cord is a | chorioangioma |
| Chorioangioma is a benign tumor found near the umbilical cord that will cause | polyhydraminos, preterm labor, fetal hydrops, fetal demise, hemorrhage, IUGR |
| Too little amniotic fluid is present and occurs in 4% of all pregnancies | Oligohydramnios |
| Largest pocket of fluid will measure less than 1cm in two perpendicular planes, crowding the fetus at 2nd trimester up against uterine wall | Oligohydramnios |
| What can cause Oligohydramnios | PROM, IUGR, Chronic leak of amniotic fluid, post maturity, urinary track anomalies |
| AKA hydramnios, excessive volume of amniotic fluid during 3rd tri and occurs in about .7% of deliveries | Polyhdramnios |
| What are some characteristics of Polyhdramnios | Anterior uterine wall is displaced away from the fetus, fetal limbs are easily seen, umbilical is easy to see, Abnormal AFI |
| Some conditions of Polyhdramnios | Idiopathic, maternal diabetes, preeclampsia, Rh isoimmunization, Fetal anomalies |
| Gravida | number of pregnancy |
| Parity | Number of live births |
| Nyegeles rule | add 7 days and 9mon to 1st day of last LMP |
| Pelvic masses that can occur while pregnant | Cystic |
| Corpus Luteum cysts | can be 10cm, unulocular, occurs in 1st tri, regress after 14-15 wks |
| Theca Lutein cysts | GTD, multiple gestation, ovarian hyperstimulation, fetal hydrops, high levels of hCG, regress within 2-4 mon after pregnancy termination |
| Paraovarian cyst | not attached to ovary, may be small to huge |
| Ovarian neoplasm | 1-1,000 pregnancy, occurs in 3-5% of masses or 1 in 9,000, serous cystadenomas will enlarge during pregnancy, mucinous cystadenoma is much RARE DURING PREGNANCY |
| Hydrosalpinx | very rare associated with PID and reduces the chances of intrauterine pregnancy |
| Mesenteric cyst | rare but has been seen during pregnancy |
| Theca lutein cyst are associated with | molar pregnancy / trophblastic disease |
| Which hormones stimulate the development of follicles in the ovary | FSH & LH |
| What stimulates the GRH | hypothalumus |
| What stimulates the pituitary gland into action | Gonadotropin |
| What produces and releases follicle stimulating hormone (FSH) | Pituatary gland |
| LHRF is produced by the hypothalamus and released into the blood to signal pituitary gland to release | LH |
| Early follicular development, 5-12 primary follicles produce estrogen | FSH |
| Stimulated rupture of the 2nd Graafian follice | LH |
| Produced by interstial cell of ovary and developing follicles, stimulates myometrial growth and CONTRACTIONS OF THE FALLOPIAN TUBE, makes female contours, breast duct system and prepares endometrium for pregnancy | Estrogen |
| Produced by corpus luteum and continues to prepare endo for pregnancy, increases body temp and starts secretions of LH | Progesterone peak at 7 days post ovulation |
| Female Hormones | FSHRF/LHRF/FSH/LH/ESTROGEN/PROGESTERONE |
| MENSTRUAL CYCLE 1 | Hypothalamus secretes FSHRF into blood/which causes Pituitary gland to release FSH/FSH stimulates 5-12 primary follicles/follicles make estrogen/ |
| MENSTRUAL CYCLE 2 | Hypothalamus also releases LHRF into blood/Pituatary release LH/LH stimulates 2nd follicle to rupture releaseing OVUM (OVULATION) |
| MENSTRUAL CYCLE 3 | LHsurge triggers ovulation/one 2nd oocyte released/ ruptured follicel collapse and u have corpus luteum/ Corpus secreates estrogen but manily PROGESTERON WHICH PREPARES ENDO FOR IMPLANTAION |
| If no pregnancy occurs you have corpus of menstration which degenerates at | 10-12 days after ovulation |
| Corpus luteum with pregnancy are kept with secretions of | hCG which is active for 1st 20 wks |
| What hormone is secreated by the developing placenta | HCG |
| Ovulation occurs when __ erodes the follicular membrane | LH |
| Luteal phase of the ovarian cycle occurs during what days | 15-28 |
| Fibroids are dependant on what | FSH |
| What ovarian cyce occurs on day 1-14 | Follicular |
| Which day of the menstrual cycle does ovulation occur | 14 |
| What occurs on days 6-13 | Proliferation |
| Parity example | P4173 4= # OF LIVE BIRTH 1= # OF PREMATURE BIRTH 7= # OF ABORTIONS 3= # OF LIVING CHILDREN |
| The ovum is fertilzed by the sperm in the | ampullary portion of teh tube |
| Will not allow any further entry of genetic material | zona pelucida |
| The structure created by this fertiliazation is termed a | zygote |
| Carry genetic material | Chromosomes |
| genetic material that line up split longitudinally | Cleavage |
| One cell divides into | 2 blastomeres |
| Cells further divide until 12-16 cells exist in a solid ball called | Morula |
| Moural enter the uterus gathers fluid and becomes a | Blastocyst |
| Cells within the blastocyst divide into outer cell mass composed of | trophblast |
| And inner cell mass that give rise to the | 2nd yolk sac, amnion, cord, and embryo |
| What is contained in the umblical cord | 2 arteries=carries blood from fetus to placenta 1 vein= carries blood from placenta to fetus |
| Function of the umbilical cord | Carries nutrients and oxygenated blood to the fetus from mom and carries deoxygenated blood and wast away from fetus and to the mother |
| Umbilical cord insertion into fetus | abdomen and insertion of cord into placenta should be near the center of placenta |
| Most common type of cyst in a normal pregnancy | Corpus Luteum cyst |
| Implantation of a fertilized egg usually occurs ___after fertilization | 7-8 days |
| CRL most accurate if taken up to the | 14th menstrual wk |
| How early can the placenta be identified sonography | 9wks |
| Postive hCG with bleeding, LMP indicates 5-6 wk gestation,sonography indicates empty GS, diagnosis | Blighted ovum |
| Lucunae are structures within the | placenta |
| Functions of the placenta include | Nutrition, respiration, excretion and hormone production |
| Fetal surface of the placenta is known as | Chorionic plate |
| Basel Plate is the | maternal side of placenta |
| At 20 weeks, the decidua __ and ___ fuse | Capsularis and vera |
| A benign vascular tumor found near the umbilical cord and will cause: polyhydramnios, fetal hydrops | Chorioangioma |
| Three classifications of complications in the 1st trimester | Absent intrauterine sac/detection of sac w/out embryo or YS/ Detection of a sac w/an embryo but not developed |
| Absent GS will have a + Pregnancy test w/ no visible sac in uterus and | Endometrial stripe is prominent, no ectopic and hCG levels between 1000 & 2000 |
| GS w/out and embryo or YS will have a normal early IUP, abnormal IUP and | Pseudogestation sac in ectopic pregnancy |
| Double gestational sac sign | decidua parietalis and decidua capsularis (lining the gestational sac) and is seen as two concentirc rings aurrounding an anechoic gestational sac. Where the two adhere, is the decidua basalis, and is the site of future placental formation |
| MSAFP SCREENING Can help with detection of? | Open neural tube defects with a hign AFP/Down syndrome with a low AFP High HCGindicate Down and Low Estriol indicat Down |
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yovana2011
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