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Cords, Membranes and Fluid, image, image, image, image, image, image,…

- - - - Outer: covered with amnion
      - Inner: contains Wharton`s Jelly
    - - Coiled
      - 1-2cm diameter up to 4cm at term
      - 40-60cm long
  - - - Ductus Arteriosus >> lig teres
      - Foramen Ovale
- - - - Two Vessel Cord
      - Single Umbilical Artery
    - - 1% of all singletons
      - Anomalies (Trisomy 13 and 18)
      - IUGR
  - - - 3rd Trimester
      - “Mickey Mouse”
      - Cross Section of the Umbilical Cord
      - Pitfall: Avoid assessing too close to Placental CI (UAs anastomosis)
    - - 2ndTrimester
      - Umbilical arteries visualized around fetal bladder
      - STEPS:
        
        Transverse abdomen at cord level ( CI)
        
        Anchor ANT
        
        Pivot POST aspect of probe more inferior in fetus (OBLIQUE)
        
        Look for 2 arteries that run lateral to bladder
        
        Can be seen on 2D, CDI or Power doppler
- - - - 20-30% prevalence
      - reduced during delivery
      - usually excellent outcome
    - - Multiple loops
      - Tightness of loops
      - Oligohydramnios
    - - Divot Sign
      - Assess from different angles
  - - - True knots
        
        long cords
        
        Mortality ≈10%
      - False knots (Tortuous vessel)
      - US
        
        Difficult Dx on US
    - - Uncommon
      - Types
        
        UmbArtery Aneurysm
        
        UmbVein Varix
        
        Hematoma
        
        Knots
        
        Hemangioma
        
        Teratoma
        
        Omphalocele
        
        Gastroschisis
        
        Allantoiccysts near fetal end (often resolve)
      - US
        
        Check for compression effect
        
        Check growth and fluid level
- - - - Incomplete vs complete
      - Associated with aneuploidy
    - - Post amniocentesis
      - Often resolves with no issues
  - - - Ensure fetus is free of synechiae
    - - Amniotic band syndrome
        
        Ruptured Amnion
        
        Entrapment of fetus
        
        Isolated or multiple defects
        
        Minor to Severe
      - Extrachorial Placentation
        
        Placenta extending beyond the limits of the chorionic plate
        
        Membranes attach at fetal surface of placenta(remote from the edge)
        
        Associated with
        
        IUGR
        
        PROM
        
        Abruption
        
        (but usually no complications)
        
        Types
        
        Circummarginate
        
        Flat transition of membranes
        
        Insert “far” from edge
        
        Circumvallate
        
        Rolled peripheral edge of membranes
        
        Insert “far” from edge
        
        US
        
        Short band of tissue at periphery, “shelf”
      - CAS
- - - - Maintains constant temperature
      - Reservoir for fetal metabolites
      - Cushions/ protects the Fetus
      - Allows fetal movement
      - Prevents amnion/fetus adherence
  - - - Probe is placed perpendicular to the uterine contour Don’t over angle
      - 2 x 1 cm pocket (1 cm in width)
      - Normal between 20-80mm
      - Largest pocket of fluid, Free of cord and fetal parts, Color box to r/o cord in pocket
      - Single Deepest Pocket
    - - Done when the SDP is > 80mm
      - DVP in all 4 quardrants
      - Referral to BCWH if > 250mm
      - Amniotic Fluid Index
    - - Deepest pocket with pt supine and probe perpendicular to floor
  - - - Perform 1)Biometry
        2)Cord doppler
    - - Genito-urinary**
      - Aneuploidy
      - IUGR
      - PROM
      - Postdates (>42w)
      - Maternal Conditions
  - - - AFI:
        
        4 quadrants
        
        250mm = referral ?poly
    - - Idiopathic (2/3)
      - Gastrointestinal
      - Neural tube defects (swallowing problem)
      - Maternal Diabetes
  - - - SFD, SGA, low SFH
      - LFD, LGA, high SFH