which of the following conditions is not associated with vasa previa

velementous cord insertion

long umbilical cord

placenta accreta succenturiate lobe

which of the following has the highest risk for mortality

MC/DA

MC/MA

DC/MA

DC/DA

which of the following is not true about transposition of the great vessels

a. the aorta arises from the right ventricle

b. the 4CH view will be normal

c. the IVC view is necessary to rule this out

d. the great vessels will not cross they will be parallel

congenital absense of esophagus; fails to develop as a continuous passage

occurs with a tracheo-esophageal fistula

VACTERL sequence: anomaly grouping

V: vertebral defects caudal regression, shortened spine with absent vertebral bodies

A: anal atresia (rarely seen in utero)

C: cardiac anomalies. CHD

TE: TE fistula, absent or small stomach

R: Renal/hydronephrosis, multicystic disease

L: limb defects, absent, small radius, polydactyly

overall mortalitiy: 22%

75% mortality with associated anomalies

surgical repair - 90% success rate

symptoms of newborn - gagging, coughing, vomiting, failure to thrive

*inability to see stomach and presence of polyhydramnios

proximal esophageal pouch

not always diagnosed due to fistula

always check face/mouth for anomalies preventing swallowing

constricted duodenum located distal to the ampulla of vater

dilation of the dudenum due to stenosis or atresia

amniotic fluid enters stomach and upper deudenum resultiong in dilatation of both

associations: trisomy 21. VACTERL

isolated prognosis excellent, 15% mortality with associatons

*double bubble sign

polyhydramnios

AC will appear enlarged

most commonly found in 3rd trimester

surgery to treat, fatal if untreated

birth defect that affects part of the small intestine

associated with other anomalies 42% of the time, 25% cystic fibrosis (mucous from CF backs up bowel)

surgery required to open up blocked end of bowel

dilated loops of bowel, most frequently w/o dilated stomach and sometimes hyper peristalsis

bowel segments > 7mm

polyhydramnios

increased loops of bowel

blockage of the anus (imperforate anus)

part of the VACTERL sequence

Chromosomal

surgery to open the blockage to allow feces to pass through

difficult to diagnose with US (seen 7-24% of the time)

fluid filled colon

Normal AFI

enteroliths - echogenic calculi in GI system

usually discovered during the newborn exam

dilated ureter or urethral obstruction can look like bowel obstruction

fetal bowel produces meconium

meconium - sticky, viscous, dark olive green colored substance that should be completely passed in the first few days of life. composed of materials ingested in utero (mucous, amniotic fluid, water, bile)

meconium gets released into the amniotic fluid prior to birth or during labor and delivery

this is a sign of fetal distress

can go into baby's lungs.

US: debree filled fluid

occurs when the meconium is thicker and stickier than normal causing a blockage in the ileum of the fetus

cause: most infants with this have cystic fibrosis

treatment: enemas containing medication are given to try and break up meconium. if necessary bowel resection and ileostomy placement

US: usually apparent in 3rd trimester, echogenic bowel

echogenicity similar to bone (compare to iliac crest)

associated with:

intra amniotic hemorrhage

meconium peritonitiss

cystic fibrosis

chomosomal defects - trisomy 21

some of the gut migrates to the base of the cord

by 12 weeks it rotates and turns then turns into the abdomen

midline defect of abdominal muscles, fascia, and skin resulting in herniation of intra-abdominal structures into the base of the umbilical cord.

covered by membrane

trisomy 13,18,21,45

beckwith-wiedemann syndrome

cardiac abnormalities

GI and GU abnormalities

CNS abnormalities

increased AFP

prognosis: better with liver rather than bowel, worse with more organs involved

deliver by c-section

abd wall mass continuous with umb. cord

identify membranous sac

document size and contents

bowel involvement has higher risk of chromosomal abnorm.

doppler to show intrahepatic umbilical vein 

defect in the abdmonial wall allowing protrusion of the fetal bowel

1/4000 M>F

cord insertion is normal! defect is adjacent to cord, always to the right with no membrane or skin

always has small bowel, sometimes has large bowel, and rarely contains liver

substance abuse

increased AFP

deliver by c-section

90% survive, can be surgically repaired

MSAFP will be elevated with all of the following except:

multiple gestations

anenchephaly

omphalocele

trophoblastic disease

spina bifida

a group of malformations caused by amniotic strands that entangle/trap fetal parts and restrict blood flow affecting fetal development

1/1200 live births

amputated limbs

cleft lip/palate

encephalocele, spina bifida, scoliosis

omphaloceles, gastroschisis

 limited fetal motion

complex anomalies

increased AFP

thick straight fold of amnion and chorion

most likely signifies uterine synechiae (asherman's syndrome)

not restrictive

may result in infertility but should not harm developing fetus

AKA: body stalk anomaly, short umbilical sord syndrome

rare malformation caused by failure of closure of the ventral body wall

2 or more of the following: lim or spinal defects, wall defects, thoracic/abd wall defects, craniofacial defects, scoliosis

1/10,000-14,000 preg, increased AFP, fatal

extremely variable

large central wall defect of abd and thorax (usually lt side)

scoliosis, missing segments, anencephaly, cephalocele, hypotelerism, olig, limb defects, short ub cord, fetus appears stuck to placenta

rare syndrome causing defects involving 5 abnormalities.

anterior diaphragmatic hernia

omphalocele

intracardiac defects

ectopia cordis

defect of diaphragmatic pericardium

increased AFP, fatal

results in an overgrown fetus

macroglossia, ventral wall defects

neonatal hypoglycemia

ear creases/pits

best clue - large for dates with enlarged kidneys, omphalocele, macroglossia

extrenilization of the bladder onto the anterior abdominal wall

caused by incomplete closure of inferior part of abd wall

findings: absense of fluid filled bladder, lower abd bulge, undescended testicles, normal or low cord insertion, normal AFI and kidneys

60-80% are repairable. closure of bladder within first 3 days of life

longterm: chronic UTI's, urinary reflux, infertility

congenital abd wall defect including exstrophy of bladder, omphalocele, and lower abd wall defect. sometimes imperforate anus

portion of large intestine lies outside of the body and on the sides of the intestines are the two halves of the bladder

called "elephant trunk"