Ob/Gyne > Module 7.2 : Detailed Scan > Flashcards

Module 7.2 : Detailed Scan Flashcards

(50 cards)

Study These Flashcards
1
Q

overall sagittal sweep

A
  • sag plane to the other sweep from cervix to fundus of uterus to assess th position of fundus
  • image sag fundus/cervix pic
  • check for fetal heart motion
  • check for number of fetus
  • assess for presence of amniotic fluid
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2
Q

overall transverse sweep

A
  • transverse sweep along the lateral aspect of the uterus to include adnexa
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3
Q

overall transverse assessment

A 
- fibroids 
   \+ document in 2 planes 
   \+ measure in 3 dimensions 
   \+ doppler 
- assess for adnexal masses usually arising from ovary 
   \+ corpus luteal cyst
   \+ dermoid cyst 
      - two planes 3 dimensions
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4
Q

need to establish

A
  • viable fetus
  • fetal lie
  • fetal number
  • placental localization
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5
Q

placenta

A
  • look at placenta position
  • asses placental texture
  • decide if placenta is low or not
    + placenta previa = placenta over cervix
    + LOWER PLACENTAL EDGE SHOULD BE A MINIMUM OF 2 CM AWAY FROM INTERNAL OS OF CERVIX
  • document cervix length measure
  • document and measure placental edge to internal is
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6
Q

what to start with in OB scanning

A
  • start with whatever is up
  • if fetus with back up anterior start with spine and kidneys
  • if fetus laying with chest up always start with heart and face profile
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7
Q

cranium

A
  • asses head shape
  • high on fetal head or cephalic on the fetus the head the shape is round
  • at BPD level fetal had more oval
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8
Q

cranial images

A
  • BPD, OFD, HC
  • ventricular image
  • bilateral choroid image
  • cerebellar image
  • orbital image
  • nose lip image
  • profile
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9
Q

BPD assesses

A
  • cavum septum pellucidi
  • third ventricle
  • ambient cistern
  • falx cerebri
  • shape
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10
Q

ventricular image

A 
- assesses the dependent ventricle 
   \+ ventricle farthest from transducer
- measure ventricular atrium size
  \+ upper normal is 10mm
- assess echo texture of dependent choroid
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11
Q

bilateral choroid image

A
  • assess echo texture of both choroid together
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12
Q

cerebellar image / posterior fossa

A 
- used to assess the cerebellar shape and size 
   \+ if vermis is present
- presence and size of cisterna magna
   \+ what is upper limit of normal 10mm
- nuchal fold thickness 
   \+ 10mm
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13
Q

orbital image

A 
- assess for
   \+ hyper telorism = to far
   \+ hypoterlorism = to close
- size of orbits 
   \+ micropthalmia (small eyes)
- seeing lenses on the eyes rules out 
   \+ anopthalima (no eyes)
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14
Q

nose lip image

A
  • image skims the nose and slip
  • rule out
    + cleft lip and abnormal nostrils
  • want 2 nostrils and septum between
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15
Q

profile

A
  • line up forehead nose and chin on image
  • assess chin
    + micrognathia (small mandible)
    + retrognathia (receding chin)
  • assess nasal bone
    + present >2.5mm
    + absent or hypoplastic
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16
Q

ossification

A
  • anterior ossification center is the vertebral body
  • posterior ossifications laminar junction
  • THESE ARE ONLY VISIBLE AREAS OF THE FETAL SPINE ON ULTRASOUND
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17
Q

spinal ossification

A
  • as the gestational age increases the lamina ossifies into a linear structure rather than circular
  • ossification is not complete until 18 weeks gestation
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18
Q

spine

A
  • must be viewed in 2 planes
    + trans and sag
  • if you can not view in a sag plan than coronal acceptable
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19
Q

imaging spine

A
  • one image at distal end to include sacrum
  • on image at cephalic end to include cervical spine into cranium
  • include as many vertebral ossifications in image as possible
  • MOST IMPORTANT IS TO SWEEP THROUGH SPINE IN TRANSVERSE
  • only image taken in trans is at lumbosacral junction (spina bifida)
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20
Q

trans spine at sacrum

A
  • ideal image include both iliac crests and all 3 ossifications centers
  • transducer directly over spine
  • fetal bladder included as well
  • looking for herniation
  • should see amniotic fluid behind spine
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21
Q

abdominal circumference (AC)

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A
  • assesses presence of stomach and position of organs
  • is the stomach on the left side
  • should only see one stomach bubble
  • the GB may be seen
    + do not confuse with stomach
    + ovoid looking on right side
22
Q

what is a good AC

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A
  • umbilical vein runs in the falciform ligament and becomes ligamentum teres after birth
  • confluence of umbilical vein and left portal vein
  • referred to as portal sinus
23
Q

heart

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A
  • 4 chamber view
  • assess the size of all chambers and valve placement
  • M-MODE ADN MEASURE THE FETAL HEART RATE
  • could do chest circumference if needed
24
Q

heart size and placement

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A
  • size of heart should be 1/3 of chest

- toward the left 45’

25
outflow images
- done to rule out great vessel abnormalities - RVOT - LVOT - not lung tissue around the heart
26
LVOT
- should see valve in aortic sinus | - probe more cephalic
27
RVOT
- need to take long axis | - should see branches
28
3 vessel view
- see SVC, aortic arch and pulmonary artery
29
cine clip 6-12 seconds
- beginning at fetal stomach in trans - sweeping cephalic - demonstrate + stomach + 4 chamber + LVOT + RVOT + 3 vessel view
30
fetal heart cine clip
- fetal heart in horizontal plane - while performing the cine clip LVOT should appear with and change to probe plane - RVOT should follow - 3 vessel should be just superior to RVOT
31
longitudinal image of abdomen and chest
- assess location of stomach in relation to diaphragm - assess echotexture of lungs compared to liver + should be isoechoic to lung sin 2nd semester + slightly increased echogenicoty to liver in 3rd trimester
32
longitudinal abd and chest image
- heart - diaphragm (hypo echoic) - stomach + look for diaphragmatic hernia
33
bowel
- small bowel appears as cluster of rings bordered by large bowel - colon (large bowel) in 3rd trimester may contain meconium particles and appear hypo echoic and prominent - LARGE BOWEL 17mm DIAMTER AT TERM * hyper echoic bowel may be trisomy 21 or CF
34
kidneys
- located on either side of spine - lack of distinction in 2nd trimester - renal pelvis hypo echoic and minimally dilated up to 3mm - over 5mm is the upper limit - 3rd trimester calyces are well seen - kidneys relate to gestational age
35
kidney images
- spine in middle - freeze over renal pelvis - longitudinal images are included if any abnormality is detected in kidney + hydronephrosis + renal cysts
36
adrenals
- superior and medial to kidneys - hypo echoic with echogenic centres - do not confuse adrenals with kidneys
37
bladder
- anehoic structure between iliac crests - should fill and empty every 20 minutes - always see a little urine - just slide down from kidneys
38
umbilical arteries at bladder
- 2 arteries at this level - identify right and left umbilical arteries around the bladder - document this view - add color doppler or power doppler - deoxygenated blood in the arteries - soft marker for aniploidy
39
umbilical cord
- 2 arteries 1 vein - image cord in a trans plane to document all three vessles - image cord insertion into fetal abdomen wall defects +omphalocele (liver out body) - also image cord into placenta + cord should insert into placenta more than 3 cm away for edge of planets
40
genitalia
- can be seen if fetus is lying face up with legs seperated - important to document in twins and sex linked syndromes - labia can be swollen and look like scrotum - testicle do not descend until 28 weeks gestation - scrotum can be tucked up between legs
41
girls
- hamburger sign
42
boy
- sticks and berries | - turtle
43
bones
- all bones can be assessed on ultrasound - routinely femur is measured - humerus also measured at second rimester detail scan
44
upper limbs
- forearm + radius and ulna + ulna is medial (thinner and longer) + radius is lateral (shorter and thicker) - take and image with and open hand if you see - right and left
45
lower limbs
- tibia and fibula should be imaged with the foot pointing in the correct direction - should not see all toes and tie/fib in same image - tibia>fibula - not arch of foot
46
rt and lt ankle image
- rule out club foot | - rocker bottom feet
47
long bones
- with certain syndromes or chromosomal abnormalities required to measure all long bones - femur - tibia - fibula - humerus - radius - ulna - right and left sides and clavicles
48
amniotic fluid
- and AFI is not performed at the detailed 18 week assessment - a subjective assessment observed + subjectively decreased + subjectively increased - amniotic fluid volume increases until 34 weeks than slowly diminishes - fluid is produced by fetal urinary system + to lesser extents by the umbilical cord, lungs, skin in early pregnancy
49
vernix
- skin cells floating in the fluid | - waxy substance that protects baby frombein surrounded by fluid
50
supine hypotension
- mother may feel hot or light headed nauseous or faint - ROLL ON HER SIDE + left side is best + if twins then left then right - roll away from you
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