Professional Documents
Culture Documents
and Cervix
I have no relevant financial relationships
Judy A. Estroff, MD with the manufacturer(s) of any commercial
product(s) and/or provider(s) of any
commercial services discussed in this CME
activity.
I do not intend to discuss unapproved or
Boston Childrens Hospital
investigative use of a commercial
Harvard Medical School product/device in my presentation.
Boston, MA
Overview
Everything you need to know in
Amniotic fluid
15 minutes!
Placenta
Umblical cord
Cervix
Membranes
1
Measurement of amniotic fluid
27w DVP=13.3 cm
Oligohydramnios
Oligohydramnios
Definition: Condition in which the
amniotic fluid volume (AFV) is Almost always associated with an
decreased relative to gestational age. increased risk of fetal morbidity and
mortality
Or: AFI < 300-500 mL in 2nd trimester
MVP < 1-2 cm
AFI < 5 cm
AFI < 5% of expected
2
Oligohydramnios
Oligohydramnios: Causes
Renal: agenesis, obstruction Associated with guarded outcome
Uteroplacental insufficiency/ IUGR Highly associated with anomalies
Ruptured membranes
Not universally fatal, depends upon
Post term pregnancy gestational age at onset (after 26
Unknown weeks, fetus may have enough
pulmonary development to survive)
Branchio-Oto-Renal Syndrome:
History BOR; Melnick-Fraser Syndrome
19w2d 19w2d
3
Polyhydramnios
Definition: Excessive accumulation of
amniotic fluid at some time during
pregnancy
Greater than 1500-2000 mL
Deepest vertical pocket > 8 cm
4
Placenta
Placenta: normal appearance
Normal sonographic appearance
Thickness: less than 5 cm
Normal thickness
Attachment site: anywhere
Previa types
Matures during gestation (Type 0-3)
Accreta types
Placental lakes
Cysts, masses, molar change
Accessory lobes
Chorioamniotic separation
Amniotic bands, senechiae
5
Abnormal placenta Umbilical Cord
Trophoblastic disease
Masses: cystic and solid
Hydropic change
6
Abnormal cord insertion sites Cord
Eccentric 2 vessel, 3 vessel, more
Marginal Umbilical cord cysts
Velamentous Umbilical cord varix
Short cord
Coiled, uncoiled
Nuchal cord
Nuchal cord
Nuchal cord
22w
Cervix
Single umbilical artery
7
Cervix x
Normal anatomy
Expected changes during pregnancy
Normal length
Short cervix
Open cervix
Imaging of the cervix: TA US, TV US,
MRI
Normal cervix= 3 cm or longer
22w Cervix: long and closed, no funneling Cervix length can change!
23w6d
Warning!
Evaluation of placenta, cervix and
amniotic fluid is not just for coding
1.8 cm purposes
Critical to good outcome for the
pregnancy
Treat woman carrying an anomalous
fetus like any other pregnant woman:
maternal and fetal well-being first and
Gold standard=transvaginal sonography foremost, before anomaly evaluation
23w6d
8
Report of major impact:
Universal cervical length screening
Asymptomatic short cervix
and vaginal progesterone
Vaginal progesterone in women with
an asymptomatic sonographic short Prevents preterm births
cervix in the midtrimester decreases Reduces neonatal morbidity
preterm delivery and neonatal Reduces health care costs
morbidity: a systematic review and
metaanalysis of individual patient data
Doing nothing is no longer an
Roberto Romero, MD, Kypros Nicolaides, MD, Agustin Conde- option.
Agudelo, MD, MPH, et al. American Journal of Obstetrics and
Gynecology 206(2):124.e1124.e19, February 2012 -Stuart Campbell
Significance of chorioamniotic
separation Review
Amniotic fluid
Guarded outcome
Placenta
Depends upon whether it is
spontaneous (worse) or after an Umblical cord
intervention (better) Cervix
Can re-seal Membranes