OB 2 Ch 56

______ covers the umbilical cord and merges with fetal skin at umbilicus.

Umbilical vein (1) carries ______ blood to fetus from placenta

Umbilical arteries (2) carries ______ blood from fetus to placenta

The umbilical cord is seen with ultrasound around ___ weeks.

The umbilical cord is formed by merger of yolk stalk and _____

_________ surrounds vessels in umbilical cord

Size of cord (diameter) is variable. Depends on amount of ______

Arteries spiral around the cord. Lack of coiling implies lack of ______________

Cord needs to keep baby off wall of _______, elongates as pregnancy progresses. Average length towards the end of preg is 40-60 cm

After birth, umbilical arteries become _______ ligaments of bladder. Contain superior vesicle arteries.

Umbilical vein heads to fetal liver. Ties into ___ portal vein. Ductus venosus transports most of blood to fetal IVC. Remainder will be used to feed liver.

After birth, umbilical vein becomes _______ or the round ligament

A short cord is less than ___ cm. Length of cord believed to be determined by amount of amniotic fluid in 1st and 2nd trimester. Short cord is associated with
-oligohydramnios
-restricted space (multiples)
-fetal anomalies
-tethering of fetus by amniotic bands
-inadequate fetal descent
-cord compression
-fetal distress

A long cord is more than ___ cm. Associated with
-polyhydramnios
-nuchal cord
-true knots: vascular compromise
-compression, prolapse, and presentation
-stricture or torsion

Cord diameter is variable. Seen with diabetes (____ Wharton's jelly), edema from fetal hydrops, Rh incompatibility, fetal demise

Left twist (upper left to lower right) is preferable. This one is _____

Right twist (upper right to lower left). Associated with _____

With ____ of umbilical cord, fetal abd connects directly to placenta. Omphalocele always present

Cord ______ are not common. Small cysts may be seen, usually allantois in origin. Usually resolve by end of 1st trimester. If they persist usually associated with anomalies and aneuploidy.

________- failure of intestines to return after 12 weeks. Covered by umbilical cord membrane. Seen in base.

____________- bowels free floating. Increased AFP levels (open defect)

With _______, bowels return to abd normally and end up protruding back out either pre or postnatally. Umbilicus is inadequately closed. Babies with "outies" are more prone to this.

With _________ cyst, dilated, residual remnant of a duct. Lined with epithelium of GI origin. Usually found near cord insertion site of baby's abd. May meas up to 6 cm. Associated with Meckel's diverticulum
-outpouching of bowel wall (terminal ileum)
-remnant of fetal yolk stalk
-may mimic appendicitis

________________ of cord arises from cells of the vessels, nodule surrounded by edema, Wharton's jelly disintegrates, size variable, may lead to nonimmune hydrops.

__________ of cord caused by trauma to cord (cordocentesis), usually occurs near cord insertion of fetal abd, appearance is variable
-early on: anechoic
-later: more echogenic
-complex as liquefies to be absorbed
-anechoic

______ of umbilical vessels- blood clot in an umbilical vessel (usually the vein), rate is higher in diabetic mother, may be primary or secondary
-torsion
-knots
-hematoma
-aneurysmal dilation of vessel leading up to clot. Hydrops sets in. Prognosis is poor

____ knots associated with long cords, polyhydramnios, IUGR, and monoamniotic twins. Single or multiples. Caused by dissipation of Wharton's jelly, venous congestion near the knot, thrombus can develop. Use color flow (decreased or absent flow). Assess cord in multiple locations.
True False

______ knots- vessels are longer than the cord. They can fold over themselves creating illusion of knot. Flow may appear constricted but will be present
True False

_______ cord- most common cord entanglement. During delivery, coils can tighten, fetal heart rate decreases, meconium staining of amniotic fluid (turns white on u/s), placenta may be difficult to visualize.

_________ placenta, insertion off to side of placenta. Near os, bad.

Membranous/velamentous placenta- exposed ______

With ________, cord sitting on os. Can hemorrhage

______ of cord, cord is beneath the presenting part. Occurs with abnormal fetal lie (Transverse, breech). Cord becomes compressed during delivery, cutting off blood supply to baby.

________ prolapse- cord lies alongside presenting part. Seen with premature labor: baby can be too small to fill pelvis, multiples, obstetric procedures (external version).

_________ is seen frequently in miscarriages and at autopsy. Seen also with marginal or velamentous insertion. Due to atrophy of one artery early in development. Associated with chromosomal abnormality, IUGR (small placenta), congenital anomalies. Congenital anomalies can affect multiple organ systems.

_________ umbilical artery- 2 arteries but one is 50% smaller than the other. Smaller artery will be higher resistance (may have no flow at end diastoole). If only one artery present, it will be larger in size.

_______ of umbilical vein- dilation of umbilical vessels, usually intrabdominally, but extrahepatic. With color flow, it should be seen as continuous with umbilical vein.

Persistent intrahepatic right portal vein- earlyin development there are 2 umbilical veins. Left goes to left portal vein, right goes to right portal vein. Around ___  weeks gestation, right umbilical vein should regress. Due to issue on left umbilical vein. Associated with congenital anomalies.