OB/GYN Final Exam Review

The female pelvis is in the ___ cavity

peritoneal

The pelvis extends from the ____ to the ____

iliac crests; pelvic diaphragm

What are the 3 layers of the uterine walls?

inner- endometrium

middle- myometrium

outer- serosa

What is serosa also called?

perimetrium

The endometrial cavity is continuous with the ___

vaginal canal

What are the 2 layers of the endometrium?

1. functionalis

2. basalis

The functionalis layer is a ___ layer that ___

superficial; sheds during menstrual cycle

The basalis layer is a ___ layer that is ___

deep; permanent

What is the widest and most superior part of the uterus?

fundus

What is the largest part of the uterus?

corpus / body

What is the uterine isthmus also called?

lower uterine segment

The cervix is ___ long

2 to 4 cm

Infantile / prepubertal uterus:

- length:

- width:

- thickness:

2.5 cm long

2 cm wide

1 cm thick

Postpubertal, nulliparous uterus:

- length:

- width:

- thickness:

7 to 8 cm long

3 to 5 cm wide

3 to 5 cm thick

Multiparous uterus:

- length:

- width:

8.5 cm long

5 cm wide

In a postmenopausal uterus, size significantly ___ and the uterus assumes a ___ shape again

decreases; prepubertal

Verted = ___

Flexed = ___

tilt

bend

What is the most common uterine position?

anteverted

What is an anteverted uterus?

fundus and body tilt forward, cervix and vagina form 90 degree angle

What is an anteflexed uterus?

fundus and body bend forward, cervix and vagina form 90 degree angle

What is a retroverted uterus?

fundus and body tilts backward, fundus and vagina are aligned

A retroverted uterus is common with ___

multiparity

What is a retroflexed uterus?

body and fundus bend backward; fundus is adjacent to cervix and points down

What uterine condition is seen when only one malarian is formed?

unicornuate uterus

What are fallopian tubes also called?

uterine tubes

oviducts

The fallopian tubes are ____, muscular tubes

coiled

The fallopian tubes emerge from the ____ margins of the uterine cornua

superolateral

The fallopian tubes direct mature ___ to the ___ through ___

ovum; uterus; peristalsis

The fallopian tubes are ___ long with a diameter of ___

10 to 12 cm

1 to 4 mm

What are the 4 segments of the fallopian tubes?

1. interstitial

2. isthmus

3. ampulla

4. infundibulum

What part of the fallopian tube is the widest segment where fertilization occurs?

ampulla

What part of the fallopian tube is the most dangerous to have an ectopic pregnancy?

interstitial bc most vascular

Ovaries are located in the ___ within the ___

adnexa; true pelvis

Ovaries are ___ to the internal iliac arteries and ___ to ureters

medial; anterior

Ovary size varies depending on patient:

age

menstrual cycle phase / status

Ovaries are ___ at birth with little change until age ___

large; 5-6

Prepubertal ovaries have a volume of ___

3 mL

Postpubertal ovaries are ___ long, ___ wide, and ___ thick

3 x 2 x 2

Postpubertal ovaries have a volume of ___

9.8 mL

Postpubertal ovaries volume ___ during ovulatory phase and ___ during luteal phase

increase; decrease

Postmenopausal ovaries have a volume of ___

5.8 mL

How do you find the volume of ovaries?

length x width x height x 0.5

Psoas muscles extend from the ___ aspects of the lumbar vertebrae across the ___ abdominal wall to the ___

lateral; posterior; iliac crest

Illiopsoas muscles travel ___ from the psoas to insert into the ___ of the femur

anteroinferior; lesser trochanter

Rectus abdominis muscle extends from the ___ and ___ down to the ___

6th rib; xiphoid; pubis symphysis

Obturator internus muscles line the ___ walls of the true pelvis

lateral

Piriformis muscles are in the ___ region of the true pelvis behind the ___

posterior; uterus

What muscle is often mistaken for ovaries?

piriformis

What are the 3 levator ani muscles?

pubococcygeus

iliococcygeus

puborectalis

The broad ligaments extend between the ___ and ___

uterine body; ovary

What is positioned between the 2 layers of the broad ligaments?

fallopian tubes

round ligament

ovarian ligament vascular structures

The round ligaments are located ___ to the fallopian tubes and insert into the ___ to help maintain the ___ of the uterus

anteroinferior; labia majora; position

The ovarian ligaments are located ___ at the ___ of the uterus

bilaterally; cornua

The suspensory ligaments extend from the ___ to the ___

infundibulum; pelvic sidewall

What is another name for anterior cul de sac?

vesicouterine pouch

What is another name for posterior cul de sac?

pouch of douglas

rectouterine pouch

What is another name for space of retzius?

prevesical

retropubic space

The space of retzius is located between the ___ and ___

pubic symphysis; bladder

Menstrual cycle phases:

Days 1-5

Days 6-13

Day 14

Days 15-28

menstrual phase

proliferative phase (preovulatory)

ovulation

secretory phase (postovulatory)

Days 6-13 of the menstrual cycle

- endometrium thickens to prepare for implantation

- estrogen rises

- FSH rises

During the menstrual phase, the endometrium appears ___ and ___

thin; bright

During the early proliferative phase, the endometrium appears ___ and measures ___

bright; 4-8 mm

During the late proliferative phase, the ___ is visible and endometrium thickens to ___

3 line sign; 6-10 mm

During the secretory phase, the endometrium appears ___ and ___ and measures ___

thick; echogenic; 7-14 mm

Days 15-28 of the menstrual cycle

- endometrium is at its thickest

- ruptured dominant follicle (Graafian) becomes corpus luteum

- estrogen and progesterone decrease

When a ruptured dominant follicle becomes corpus luteum:

- with pregnancy, it remains and secretes ___

- without pregnancy, it becomes ___

progesterone; corpus albicans

How long does the corpus luteum persist?

until the end of the 1st trimester

Ovarian cycle phases:

Days 1-5

Days 6-13

Day 14

Days 15-28

follicular phase

follicular phase

ovulatory phase

luteal phase

TV sagittal image orientation

TV coronal image orientation

In polycystic ovarian syndrome (PCOS) ___ do not develop normally preventing normal ___

follicles; ovulation

How does PCOS appear sonographically?

normal ovary with multiple small immature follicles; "string of pearls"

What are symptoms of PCOS?

1. oligomenorrhea

2. hirsutism

3. obesity

What is gamete intrafallopian transfer (GIFT)?

ovum inserted into fallopian tube and fertilized inside woman's body

What is zygote intrafallopian tube transfer (ZIFT)?

zygote (fertilized egg) inserted into fallopian tube

What are complications with assisted reproductive technology?

1. ovarian hyperstimulation

2. multiple gestations (25% chance)

3. ectopic pregnancy

After ___ weeks, hCG levels off and then ___ while the gestational sac and embryo continue to grow

9-10; declines

A normal gestational sac can be seen transabdominally when the hCG level is ___ or ___ weeks

greater than or equal to 1800 mIU/mL; 6-7

A normal gestational sac can be seen transvaginally when the hCG level is ___ or ___ weeks

500 mIU/mL; 4.5-5

An hCG of ___ indicates pregnancy should be seen transvaginally OR transabdominally

1000 to 2000 mIU/mL

If hCG is 1000 to 2000 mIU/mL and pregnancy is not seen within uterus, rule out ___

ectopic pregnancy

What components can the echogenic ring around the gestational sac be divided into?

decidua basalis

decidua capsularis

double decidual sac sign

The decidua basalis is the ___ on the ___ or burrowing side of the embryo

villi; myometrial (mother's side)

The decidua capsularis is the ___ covering the rest of the ___

villi; developing embryo (baby side)

The double decidual sac sign is an interface between the ___ and the ___

decidua capsularis; endometrium

The double decidual sac sign is a reliable sign of ___

viable gestation

During the 5th week, what is decidua wall thickness?

greater than 3 mm

The yolk sac is seen on ultrasound when the gestational sac measures ___

greater than 8 mm

In early pregnancy, the gestational sac grows ___ a day

1 mm

What is gastroschisis?

herniation of intestines, not encapsulated

At what stage does the normal bowel herniation (gastroschisis) resolve?

12 weeks

What is omphalocele?

herniation of intestines and other organs, encapsulated

Once the rhombencephalon divides with its corresponding flexure, the ___ forms

cystic rhomboid fossa

When is the cystic rhomboid fossa seen on ultrasound?

8-11 weeks

The cystic rhomboid fossa appears in the ___

posterior cranium

What is the most widely accepted means of measuring fetal head and estimating fetal age?

BPD

What part of the skull do you measure BPD?

midline echo complex

How do you find midline echo complex on ultrasound?

move the transducer caudally from lateral ventricles

When measuring BPD, paired ___ will be seen on either side

thalamus

When measuring BPD, what is located between the thalamus?

3rd ventricle