Obstetrics!

important medical HX… conditions….

  • cystic fibrosis

  • sickle cell disease

  • type 2 diabetes = close relatives w/it = gestational diabetes more likely

  • pre-eclampsia = if maternal mother or sister was affected, increased risk

4-5 wks = gestational sac, first sign

5.5 wks = yolk sac, Important role in human embryonic development. Transfer of nutrients to the developing embryo in the third and fourth weeks

6 wks = embryo pole, diamond ring, lil dot (embryo)

7-8 wks = amnion, Embryo is attached to yolk sac via vitelline duct but is within the Amnion. The YS is seen out of the Amnion. By 16 weeks the amnion will grow to fill the chorionic cavity completely

chorion (CORD/PLACENTA) vs amniotic sac

  • MO-MO = monochorionic + monoamniotic = usually separate during implantation

  • MO-DI = monochorionic + diamniotic = separate before implantation around hatching

  • DI-DI = dichorionic + diamniotic = usually split at the morula

Single gestational sac • Two yolk sac • Two fetal poles ( 2 mm ) with Cardiac activity

Viability exam - first trimester

  • Fetal number

  • Location of gestational sac (GS)

  • Measure Yolk sac

  • Measure GS

  • Crown rump length (CRL)

  • Fetal cardiac activity (m-mode)

  • Visualize the ovaries

  • Posterior cul de sac→ pouch of Douglas!

SCREENING → trisomy 21, 13, 18

  • maternal age

  • gestational age

  • nuchal translucency

  • maternal serum markers

additional things that are examined

  • EDD = estimated due date

  • fetal HR

  • brain structures & measurements

  • abdomen

  • placenta location

  • bladder

  • extremities

  • nasal bone

2nd trimester

  • Cervical assessment

  • Placental assessment

  • Fetal Cardiac activity using → M Mode

  • Detailed imaging of Fetal organs..What is included?

  • Fetal situs (position of organs - heart/bowels)

  • Amniotic fluid

3rd trimester

  • Cervical assessment <32 weeks

  • Placental Localization

  • Fetal Presentation Breech vs cephalic

  • Quick assessment of Fetal Biometry (BPD-biparietal diameter, HC- head circumference, AC-abdominal circumference, FL- femur length)

  • Amniotic fluid assessment (Polyhydramnios vs. Oligohydramnios)

  • Doppler assessment

MRI → may be used if additional imaging is necessary in pregnancy (cleft lip, club foot, heart defects

Amniocentesis

  • Prenatal diagnosis of chromosome defects as well as metabolic disorders

  • Family history or previous child with a genetic disease or metabolic disorder, such as Down syndrome

  • Risk of open neural tube defects, such as spina bifida

  • Maternal age over 35 years by the pregnancy due date

  • Abnormal maternal screening tests

Chorionic villus sampling = 10-12 wks, done as early as 8wks and as late as 16wks, examines placental cells for fetal abnormalities

Cordocentesis = done after 18wks quick results

Fetoscopic laser photocoagulation

  • allows the OB to see the fetus and intrauterine environment during pregnancy. Used to help diagnose anomalies that may be difficult to assess by US ex: NTD or to treat certain conditions ex: TTTS, fetal biopsies, spina bifida

TTTS = twin-to-twin transfusion syndrome, shared placenta between twins, uneven blood supply, one is more nourished and is larger