1st trimester complications pp- test 3 Flashcards
symptoms
mild cramps with vaginal bleeding
cervix long and closed
threated AB
how many threated AB progress to inevitable AB
50%
symptoms
- Impending abortion in which the bleeding is usually profuse and
the gestational sac is mobile in the uterine cavity
AB in progress
symptoms
- Retained products of conception in the uterus causing cramping
and excessive bleeding. - Ranges from an intact GS with a nonviable embryo to a collapsed
GS that is grossly misshapen.
Incomplete AB
symptoms
- Entire conceptus expelled with ceasing of cramps and bleeding
Complete AB
symptoms
- Products of conception retained 3 or more weeks after fetal
death.
missed AB
Septic AB
- Any of the above with an elevated temperature
- abdominal and uterine tenderness as well as purulent discharge
and possibly shock.
- Hormonal assays (quantitative hCG, estrogen,
progesterone, alpha-fetoprotein) - Sonography- best method of evaluation
Assessment
high risk for AB
- Loss rates are highest between 5 and 6 weeks
- Slow embryonic heart rates (embryonic bradycardia)
- Disproportional sac-size
- Abnormalities of yolk-sac (too large)
- Presence of an intrauterine hematoma
An embryonic ________________- overrides any
simultaneous finding
that suggests
impending pregnancy
loss
heart beat
the most specific evidence
of embryonic death?
sonographic
demonstration of an
embryo that lacks
cardiac motion
Suggestive of Non-Viability
(Suspicious)
- Unacceptably large sac size that lacks an embryo
- Irregular sac shape
- Subchorionic hemorrhage
- Abnormally large or abnormally small yolk sac
- Small gestational sac (MSD relative to CRL)
- Abnormally thin and/or weakly echogenic decidual
tissue/reaction - Absence of the double decidual sac sign
- Decreased hCG levels- hCG frequently falls before spontaneous
expulsion of non-viable gestations
Sonographic Findings for Definitive
Intrauterine Pregnancy Failure
Three categories:
- Embryo of a certain
size with no visible
heartbeat - Gestational sac above
a certain size with no
visible embryo - No embryo with a
heartbeat visible after
a certain time interval
since the initial scan.
What CRL should have fetal heart tones?
7mm
if less than 7mm then follow up
more than 7mm- not viable
if there is not enough fluid around embryo in gestational sac then it is probably a ____________
demise
if you see an amnion, should you see an embryo
yes
if you see an amnion, but embryo has no cardiac activity what should you do?
it is probably a demise
enlarge yolk sac increase risk for AB
what size is considered enlarged
- YS > 7 mm
- Book states 5.6 mm or greater has an increased risk
for AB
- Heart rates below _______________ are associated with a poor
outcome.
90 bpm
when should a heart beat be observed Transabdominal according to embryo size or GS size
- No cardiac activity in an embryo > 9 mm
- Failure to identify cardiac activity in a GS > 25 mm
when should a heart beat be observed Transvaginal according to embryo size or GS size
- No cardiac activity in an embryo > 7 mm
- Failure to identify cardiac activity in a GS > 16 mm
Suspicious for Failure
* No embryo with heartbeat on a follow-up
scan 7-13 days after an initial scan that
showed a gestational sac without a yolk
sac.
* No embryo with heartbeat on a follow-up
scan 7-10 days after an initial sacn that
showed a gestational sac with a yolk sac.
* No embryo with heartbeat at least 6
weeks after LMP
Definitive for Failure
* No embryo with heartbeat on a follow-up
scan at least 2 weeks after an initial scan
that showed a gestational sac without a
yolk sac
* No embryo with heartbeat on a follow-up
scan at least 11 days after an initial scan
with showed a gestational sac with a yolk
sac.
Abnormal sac growth can be diagnosed confidently if
the gestational sac fails to grow by at least ________________
0.6 mm/day.
you should be able to detect a DDSS when the MSD _____________
> 10 mm
Transabdominal you should be able to identify a YS with an MSD ____________
> 20 mm
transabdominal you should be able to identify an embryo in a GS ____________
> 25 mm
Transvaginal you should be able to identify a YS with an MSD_____________
> 8 mm
Transvaginal you should be able identify an embryo in a GS ________________
> 16 mm
Anembryonic Pregnancy AKA
(also known as
blighted ovum)
D&E is short for
dilation and evacuation
D&C stands for
dilation and curettage
but most doctors now
use a vacuum-type tool instead of a sharp curette.
A D&E is usually done in a more advanced pregnancy
(second trimester) where the vacuum is more effective at
extracting the contents
what is it
- Usually hypoechoic
- Attenuates ultrasound
beam - Hypovascular
- Distort serosal and
endometrial contours - Heterogeneous
Uterine Fibroids
what is it
- Common in the first
trimester - Usually < 2 cm
- Regress as placenta
develops - Rarely seen after 16
weeks GA
Corpus Luteum Cysts
what is it
- Isoechoic with uterus
- No attenuation
- Distorts only
endometrial surface
Myometrial Contractions
