umbilical cord and AFI

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visualization of the cord w/ sono can be seen from approx. __ wks until term. the amniotic membrane covers the fetal surface of the placenta and the multiple vessels that branch from the umbilical vn and arts. cord should insert into center of placenta: 8
usually occurs in 2nd trimester; cervical dilation is usually painless, bloodness, sometimes recurring with each successful pregnancy; is the most significant predictor of preterm labor; dilation of cervical os; patients don't know when they are having it: cervical incompetence
patients usually present with a shortened cervical length and minimal symptoms; the width gets larger;: cervical incompetence
risk factors for incompetent cervix include history of it, cervical conization or surgery, cervical injury, traumatic injury to the cx, and DES exposure: cervical incompetence
sonogram may be used to evaluate the internal os and LUS for dilation and/or shortening abnormalities; cervical length <3c, or cervical width >2 cm before 34 weeks; bulging membranee: cervical incompetence
the best time to treat cervical incompetence is usually between __ and __ weeks of pregnancy before cervical dilation. the procedure is called ___ and is done 13-16 weeks.: 14-18 weeks cerglage
a surgical procedure in which pursestring sutures are applied to the cervix; can lead to puerperal infection. includes restriction of activities such as don't stand on feet for long period, no sex, and no heavy lifting. do lay in bed: cerglage
two types of cerclage: mcdonald and shikodar
the ___ is the essential link for oxygen and important nutrients among fetus, placenta and mother. the ___ covers the cord and blends with the fetal skin at the umbilicus.: *umbilical cord *amnion
the umbilical cord is covered by the ___. the cord includes two umbilical arteries and one umbilical vein that is surrounded by a homogeneous substance called wharton's jelly which is a ___ connective tissue.: *amniotic membrane *myxomatous
the diameter of the umbilical cord is __ to __ cm and the normal length of the cord measures __ to __ cm. it is difficult to assess the length with ultrasound though: *1-6 cm *40-60 cm
the umbilical artery arises from the fetal ___vessels, courses alongside the fetal bladder, and exits the umbilicus to form part of the umbilical cord. they courses the entire length of the cord in a ___ fashion along the chorionic plate: *internal iliac vessels *helicoidal
the umbilical vein is formed by the confluence of the ___veins of the placenta. it enters the umbilicus and joins the left portal vein as it courses through the liver: chorionic
in the second and third trimester the cord is constantly seen. sonographically, it is seen as three short axis vessels within the amniotic fluid; mickey mouse sign (1 large vein and 2 small arteries) color doppler can be used to determine the arts. & vn.: umbilical cord
the cord __ is also documented as the umbilical cord goes into the umbilicus. put color on it if unsure: insertion
the fetus GA and umbilical cord length coincide. a 20 week fetus has ___ long u.c. a 29 week fetus has a ___ long u.c.: 20 cm, 29 cm
the u.c. varies in length and width. specific problems assoc. with a cord that varies from normal ___. in the first trimester the length is approx. the same as the ___: *dimensions *CRL
__ of the u.c. is normal and related to fetal activity. the normal u.c. may coil as many as __ times usually to the left of near the fetal ___ site. absence of twisting is an indirect sign of ___ fetal movement: *coiling *40 *insertion *decreased
the diameter of the u.c. has been measured from __ to __ cm. variations in cord diameter are usually attributed to diffuse accumulation of whaton's jelly: 2.6-6 cm
a short cord measures < __ cm. a long cord measures >__cm: *35 cm *80 cm
is assoc. with oligohydramnios, restricted space, intrinsic fetal anomaly, tethering of the fetus (pulling), inadequate fetal descent during labor, ab wall defect and placental abruption: short cord
may be assoc. with or predisposed to polyhydramnios, nuchal cord, true cord knots, u.c. compression and decreased perfusion due to obstruction of venous return, prolapse of cord, uc striction or torision from excessive fetal motion: long cord
can occur in utero or delivery; assoc. with long cord, polyhydramnios, IUGR, and monoamniotic twins; may be single or multiple with an increased of congenital anomalies: true knot
may be formed when a loop of cord is slipped over the infant's head or shoulder during delivery; color doppler is useful in recording absence of blood flow within the u.c.: true knot
not a true knot; seen when the blood vessels are longer than the cord in which, they fold on themselves and produce nodulations on the surface of the cord; bundled together: false knot
the most common cord entanglement in the fetus; multiple coils around the fetal neck or a single loop of cord may be seen; common cause of fetal stillbirth: nuchal cord
trouble occurs when fetus descends into birth canal during delivery and the coils tighten to sufficiently reduce flow of cord.: nuchal cord
fetal hrt deceleration, meconium stained af, and babies needing cpr are seen. problem only during delivery not in utero: nuchal cord
eccentric insertioof the u.c. into the placenta. the cord implants into the edge of the placenta instead of the center; significant when the cord is inserted near the os because during labor the cord may prolapse or become compressed during contractions: battledore placenta/marginal insertion
occurs when the cord inserts into the chorionic membrane before entering the placenta instead of going directly in; seen most often with multiple pregnancy: velamentous insertion
inc. risk of thrombus, cord rupture, vasa previa, low birth wt, SGA, preterm labor, low apgar, abn hrt. rate, esophageal atresia, NTD, IUGR, and anomalies: velamentous insertion
sono demonstration of the relationship between cord and its insertion into the placenta is needed and __ may assist: doppler
presence of u.c. crossing and covering internal os. assoc with high mortality rate: vasa previa
may occur due to velamentous insertion, succenturiate lobe or low-lying placenta; color doppler is the best method of detection. if undetected the fetus will likely die at delivery from ruptured u.c.: vasa previa
occurs when the cord lies below the presenting part; when cx opens up the u.c. gets caught in it; problem occurs with delivery in which the fetus ruptures the membrane or comp. of the cord can reduce or cut off the blood supply leading to fetal demise: cord prolapse
assoc. with vasa previa(most common), breech and transverse presentation of fetus, leiomyomas, long cord, incompetent cx, and polyhydramnios. dx when you see head, cord,and then cx: cord prolapse
most common vascularity problem with umbilical cord; more frequent in miscarriage and autopsy series: single umbilical artery
most common cause is atrophy (usually left) of one of the umbilical arteries in early development stage; assoc with congenital anomalies, IUGR, increased perinatal mortality, chromosomal anomalies, musculoskeleta, GU, Cardiovascular, GI, and CNS anomalies: single umbilical artery (SUA)
sonographic demonstration of the SUA should prompt the investigation of further __: fetal anomalies
usually extrahepatic but still within abdomen; focal dilation of the umbilical vein; sonographically it appears as a dilated intraab, extrahepatic portion of the umbilical vein: varix of the umbilical cord
plays a vital role in fetal growth and serves several important functions during intrauterine life; it allows the fetus to move freely within the amniotic cavity while maintaining intrauterine temperature and protecting the developing fetus from injury: amniotic fluid
abnormalities of the amniotic fluid may interfere with the normal fetal development and cause ___ abnormalities or may represent an indirect sign of an __ anomaly, such as NTD or GI disorder (because directly related to kidney function): *structural*underlying
forms early in fetal life and is filled with a.f. that completely surrounds and protects the embryo and later the fetus; can be visualized as early as 4-5 weeks TV as a thin membrane separating the fetus from the extraembryonic coelom and 2ndary ys: amniotic cavity
in the first trimester the amniotic fluid is produced by __ and __. later it's produced by these 5: *yolk sac and coelom *kidneys, lungs, u.c., membranes, skin
the mechanism of production, consumptions, composition, and vol of a.f. depends on __. early in gestation, the maj. source of a.f. is amniotic membrane lined by a single layer of ___. later in preg the source dep. on _,_,_,_,_: *GA *epithelial cells *chorion frondosum *movement fluid across chorion frondosum, skin, urine outpul, swallowing, and gi absorption
six major functions of the amniotic fluid: cushion/protect fetus, allow fetal movement, prevents adherence to amniotic cavity, allows for symmetric growth, maintains a constant temp, acts as reservoir to fetal metabolites before excretion into maternal system
a.f. is composed of __% water, __% solid (proteins, enzymes, urea, fetal cells, and vernix): 98, 2
the vol. of the a.f. increases progressively until about __ weeks with the average increment of __ ml from 11-15 week and __ ml from 15-28 week.: *33 *25 *50
during the second and early third trimester, a.f. appears to surround the fetus and should be readily apparent. from 20 to 30 weeks, a.f. may appear somewhat __ although it is normal. by the end of the pregnancy the a.f. is scanty and isolated fluid __: *generous *pockets *decline
amniotic fluid is __ although occasionally fluid particles may be seen (more so later in pregnancy). vernix caseosa may be seen within the a.f.: echo-free
there are several methods to achieve a.f. measurements including subjective assessment, four quadrant assessment, or measurement of the single deepest pocket of fluid. normal 4 quadrant is __to __ cm. decreased is <__cm and increased is >__cm: *8-22cm *5cm (oligohydram) *22cm (polyhydramn)
not best way to determine a.f. is perfomed as the tech init. scans the entire ut to determine the visual eyeball assess. of the fluid present, the lie of the fetus, and the position of the placenta; this assessment is more successful for exp. techs: subjective assessment
uterine cavity is divided into four equal quadrants. the largest vertical pocket of a.f. excluding fetal limbs or umbilical cord loops are measured. the sum of the four quadrants are determined and called amniotic fluid index. normal afi are 10-20 cm.: four quadrant assessment
clinicians have described other criteria to define presence of abnormal fluid vol. measure the pocket that has the most fluid. oligo when pocket <3 cm. sometimes 1 and 2 cm. are used as bottom line number. poly when pocket >5 cm: single pocket assessment
defined as an a.f. vol greater than 2000ml (8.5 cups). excessive amt. of fluid that causes the uterine size to be larger than expected for gestational dates; assoc with increased mortality and morbidity and maternal complications; increased risk of prete: polyhydramnios
causes include both maternal and fetal complications; often assoc with CNS disorder, GI disorders, hydrops, skeletal anomalies, renal disorder, and pregnancy-induced htn, rh incompatibility, and diabetes: polyhydramnios
acronym for polyhydramnios: motherhouse: meningocele, osteogenesis imperfecta, twin reverse arterial perfusion, hydrops, esophageal atresia, retroperitoneal fibrosis, hydroencephalus, omphalocele, uretral stenosis, sacrococcygeal teratoma, erythroblastosis fetalis
sono it appears as freely floating fetus within the swollen amniotic cavity, accentuated fetal anatomy, and AFI greater than 20 cm.: polyhydramnios
overal reduction in the amount of a.f. resulting in fetal crowding and decreased fetal movement; defined as single pocket fluid <2cm or AFI <5cm.: oligohydramnios
acronym for oligohydramnios and what it stands for: DRIPP (demise, renal atresia, IUGR, preterm labor, PROM)
causes include congenital anomalies, IUGR, post-term pregnancies, ruptured membranes, and iatrogenesis (maybe from amniocentesis): oligohydramnios
poor prognosis with elevated MSAFP; sonographically there is limited anatomy survey and a small or absent of fluid seen surrounding fetus: oligohydramnios
is a common nonrecurrent cause of various fetal malformations involving the limbs, craniofacial region of the trunk; amnion comes away from chorion and can amputate part of the baby because bones aren't ossified: amniotic band syndrome
early rupture of amnion results in amniotic bands that stick, entangle, and disrupt fetal part resulting in congenital malformation; etiology is idiopathis; restriction of the fetal mobility due to entrapment by amniotic bands;: amniotic band syndrome
sonographically it appears as echogenic bands that attaches to fetus flaps with fetal movement: amniotic band syndrome
occurs in 2nd and 3rd trimester; caused by uterine scars from previous instrumentation in the uterus, or c-sections; develops when a pregnancy occurs in a uterus with an adhesion between the posterior and anterior wall of the uterus: amniotic synechiae
the amniotic membrane folds around the adhesion forming a sheet of amniotic membrane extending from the wall of the uterus to the adhesion site; not assoc. with fetal anomalies or morbidity: amniotic synechiae
sono it appears as fine echoe-dense line in uterine cavity separated from the uterine wall by a echolucent space; won't hurt baby: amniotic synechiae
the uc is identified at cord insert. into placenta & at junction of uc into umbilicus. tech documents both _. the arts. spirtal w/ vn. __ cord twists may be assoc w/ dec. fetal movement & poor preg _.: * insertion pts. * absent *outcome
the uc comprises two arts. and one vn. surrounded by gel stroma called _. the vascular connections w/i cord are reverse function in fetus; the _ carries oxy blood to fetus while the _ carry deoxy blood to placenta: *wharton's jelly *vein *arteries
the umb vn. diameter inc throughout gestation reaching max diameter of _cm by 30 wks. the uc is larger in fetuses in of mothers w/ _ than in normal population b/c of wharton's jelly: *0.9 *gestational diabetes

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