Study Guide to Ob/Gyn Registry Review

Study Guide to Ob/Gyn Registry Review

Introduction

  • Author: Melessa Cizik RDMS, RVT
  • Website: www.myultrasoundtutor.com
  • Edition: 2022
  • Provider: myUltrasound Tutor

Table of Contents

  • Gynecology
    • Normal anatomy and physiology
    • Clinical history and malformations
    • Uterine and endometrial pathology
    • Adnexal pathology
    • Pelvic inflammatory disease
  • Obstetrics
    • Normal 1st trimester
    • Abnormal 1st trimester
    • 2nd trimester intro
    • Heart and chest
    • Brain and Neural tube
    • Face and neck
    • Skeletal
    • Abdomen
    • Multiple gestations
  • Maternal Health and Fetal environment
    • Placental
    • OB Dopplers
    • Maternal conditions
  • Physics Review
  • Trisomy matching game

Gynecology

Normal Anatomy of the Pelvis

  • Bony Boundaries:

    • Sacrum
    • Coccyx
    • Innominate bones (ilium, ischium, pubic symphysis)
    • Linea Terminalis: Imaginary line from pubic symphysis to sacral prominence.
    • TRUE PELVIS: Deep and below the linea terminalis.

  • Structures Visualized by Transvaginal Imaging:

    • Bladder
    • Small bowel
    • Ascending and descending colon
    • Rectum
    • Uterus
    • Ovaries
    • Fallopian tubes
    • Internal iliacs
    • Muscles (5 true pelvic muscles)
    • Musculature:
      • Pelvic diaphragm: levator ani and coccygeus.
      • Provides support to pelvic organs.
      • Weakening leads to uterine prolapse.
Muscles and Ligaments

  • Pelvic Muscles:

    • True Pelvic Muscles:

    • Obturator Internus: Lateral to bladder

    • Piriformis: Posterolateral

    • Iliopsoas: Anterolateral

    • Uterine Ligaments:

    • Broad Ligaments: Support organs; visualized on sono when pelvic ascites present.

    • Round Ligaments: Maintain position of the fundus of the uterus.

    • Cardinal Ligaments: Contain uterine vasculature.

Gynecology Spaces
  • Intraperitoneal Cavities for Fluid Collection:
    • Retropubic Space: Space of Retzius anterior to bladder.
    • Adnexa: Lower quadrants and lateral spaces to uterus.
    • Anterior CDS (vesicouterine pouch): Between bladder and uterus.
    • Posterior CDS (rectouterine pouch/Pouch of Douglas): Between uterus and rectum.
Uterine Anatomy and Physiology

  • Uterus:

    • Pear-shaped, retroperitoneal organ
    • Comprised of four divisions:
    • Fundus
    • Corpus
    • Isthmus
    • Cervix

  • Three Layers of the Uterus:

    • Serosa (Perimetrium): Outermost layer.
    • Myometrium: Muscular layer.
    • Endometrium: Mucosal layer consisting of:
    • Basal Layer: Deep
    • Functional Layer: Superficial, shed during menses.

  • Uterine Dimensions:

    • Vary based on age, parity, pathology.
    • Neonatal: Enlarged cervix.
    • Prepubertal: Tubular shape.
    • Puberty: Increase in fundal diameter.
    • Reproductive age: 6-8cm size.
    • Menopause: Decrease in size (4-6cm).

  • Uterine Positions/Orientation:

    • Anteversion: Uterine body tilts forward (90° angle with cervix)
    • Anteflexion: Body folds anteriorly (contacts cervix).
    • Retroflexion: Body tilts backwards (contacts cervix).
    • Retroversion: Body tilts backwards without bending.
Fallopian Tubes and Ovaries

  • Fallopian Tubes:

    • Known as oviducts/uterine tubes; length varies 7-12 cm.
    • Transport fertilized ovum; structure includes:
    • 5 Segments:
      • Interstitial
      • Isthmus
      • Ampulla: Most common for fertilization.
      • Infundibulum

  • Ovaries:

    • Paired, oval-shaped structures.
    • Major functions include hormone production: estrogens and progesterone, controlled by FSH and LH.
    • Ovarian Volume Formula: extOvarianVolume=LimesWimesHimes0.523ext{Ovarian Volume} = L imes W imes H imes 0.523

  • Physiology of Ovaries:

    • Follicles develop in response to FSH, culminating in ovulation.
    • Corpus Luteum: Derived from Graafian follicle, produces progesterone post-ovulation.
Normal Menstrual Cycle
  • Purpose: Preparation for potential pregnancy (egg release and endometrial preparation).
  • Hormonal Control:
    • Hypothalamus releases gonadotropin-releasing hormone to influence the pituitary gland.
    • Anterior pituitary releases FSH and LH.
  • Key Cycle Phases:
    • Days 1-14 (Follicular Phase): Folliclear development, ovulation at approximately day 14.
    • Endometrial Changes: Menstrual phase (day 1-5), proliferative phase (days 6-14), secretory phase (days 15-28).
    • Endometrial Measurements: Early proliferative (4mm), late proliferative (6-10mm, “three-line sign”), secretory (>16mm).
Clinical History and Examination
  • Importance: Prior exams and patient history shape imaging approaches.
  • Pregnancy History Terms:
    • Gravida: Number of pregnancies.
    • Para: Number of pregnancies carried to term.
Scanning Techniques and Equipment
  • Transabdominal Imaging:
    • 2-6 MHz curvilinear transducer, requires filled bladder.
  • Transvaginal Imaging:
    • 6-9 MHz endocavity transducer, requires empty bladder.
  • Indications for Imaging:
    • Range from acute pain to menstrual irregularities, concerning clinical findings.
Common Terminology
  • Mittelschmertz: Pain near ovulation.
  • Amenorrhea Terms:
    • Primary: No menstruation by age 16.
    • Secondary: Menses stopped after onset.
Congenital Malformations
  • Müllerian Duct Abnormalities: Congenital defects linked to uterine structure, associated with various reproductive issues.
  • Common Types:
    • Arcuate uterus, bicornuate uterus, septate uterus, unicornuate uterus, didelphys.
Uterine Pathology
  • Adenomyosis: Endometrial tissue invading myometrium.
    • Symptoms: dysmenorrhea, enlarged uterus.
    • Sonographic Findings: Thickened posterior uterus, cystic spaces.
  • Leiomyoma: Common benign tumor (fibroids).
    • Symptoms vary based on location.
    • Sonographic Findings: Hypoechoic, heterogeneous masses.
Endometrial Pathologies
  • Endometrial Hyperplasia: Thickening due to unopposed estrogen.
  • Endometrial Carcinoma: Most common GYN malignancy.
  • Endometrial Atrophy: Common postmenopause finding, presenting as thin endometrium.
Ovarian and Adnexal Pathology
  • Polycystic Ovarian Disease: Hormonal imbalance leading to chronic anovulation, linked to infertility.
  • Endometriosis: Ectopic endometrial tissue causing pelvic pain and infertility.
  • Benign Cysts: Follicular, corpus luteum, paraovarian masses.
Maternal Health and Fetal Environment
  • Placental Function: Key to fetal health, nutrient exchange.
  • Doppler Studies: Assess blood flow and resistance, indicating fetal wellbeing.
  • Uteroplacental Blood Flow: Low resistance patterns indicate normal placental function.
    • Indicators of Abnormality: Decreased diastolic flow, abnormal resistance patterns.
Physics Review
  • ALARA Principle: Minimizing patient exposure while ensuring image quality.
Trisomy Matching Game
  • A strategy activity for understanding association between abnormalities and chromosomal conditions.

Conclusion

This study guide comprehensively covers key topics in obstetrics and gynecology as outlined in the provided materials. It encompasses anatomical structures, physiological functions, common pathologies, diagnostic approaches, and clinical management considerations pertinent to the Ob/Gyn field.