Abnormal First Trimester

Question 1

Abortion means the termination of a pregnancy prior to __ weeks gestation.

Answer 1

20

Question 2

_____ ______ usually occurs within 1 to 3 weeks after an embryonic demise.

Answer 2

Spontaneous abortion

Question 3

Approximately ___% of all pregnancies end in spontaneous abortion with ___% of them occurring before the 16th week.

Answer 3

12%, 75%

Question 4

Almost always a spontaneous abortion is caused by a _____ ____ in the fetus.

Answer 4

chromosomal abnormality

Question 5

What is a complete abortion and what would you see sonographically?

Answer 5

All products of conception are expelled. You would see an empty uterus with a normal endometrial cavity or maybe some fluid within the cavity.

Question 6

What is an incomplete abortion and what would you see sonographically?

Answer 6

Partial expelling of uterine contents but some products remaining. You may see thickened irregular endometrial echoes and some fluid within the cavity.

Question 7

Other possible causes for spontaneous abortion could be: ______, ________, ________

Answer 7

Failure of the corpus luteum
Low progesterone levels
Problems with implantation

Question 8

What is a missed abortion?

Answer 8

A pregnancy within the uterine cavity that is not viable.

Question 9

What is another name for missed abortion?

Answer 9

Fetal demise

Question 10

What are the three criteria used to establish a missed abortion/fetal demise?

Answer 10

1) An embryo with a crown/rump length greater than 10mm with no fetal heartbeat.
2) Serum beta hcg is 10,800 or greater and no fetal heartbeat.
3) A sac diameter of >8mm and no yolk sac.

Question 11

A spontaneous abortion in progress _____ be halted. There will be cervical dilation ___ ___ 3cm and rupture of _____.

Answer 11

CANNOT; greater than; membranes.

Question 12

What will you see sonographically during a spontaneous abortion?

Answer 12

A gestational sac low in the uterus or cervix, possibly even in the vaginal canal.

Question 13

What is a threatened abortion?

Answer 13

This is when a patient has vaginal bleeding with cramping and a closed cervix.

Question 14

What is an anembryonic pregnancy and what did it used to be called?

Answer 14

It is a gestational sac only, no embryo is present. Used to be called blighted ovum, but this term is no longer used.

Question 15

What is a septic abortion?

Answer 15

Infection due to retained products of conception or the result of an intentional abortion using nonsterile instruments.

Question 16

What are two signs of infection that a person with a septic abortion may exhibit?

Answer 16

Fever and elevated white count

Question 17

What is the definition of an ectopic pregnancy?

Answer 17

Implantation of a fertilized egg at any site other than the endometrium.

Question 18

Where is the most common ectopic pregnancy site and how do you scan to see this area?

Answer 18

Ampulla of the fallopian tube 90% of the time.

Look transverse from the fundus down along the lateral side of the uterus.

Question 19

The incidence of ectopic pregnancy has overall increased as a result of increased ___, assisted ___ programs, and ___ reconstructive surgeries.

Answer 19

PID, fertility, tubal

Question 20

___ and ___ pregnancies are rare and highly dangerous, and can progress further than ectopic pregnancies before being recognized.

Answer 20

Ovarian and abdominal

Question 21

What is a heterotopic pregnancy and how rare are they?

Answer 21

A coexsisting intrauterine pregnancy plus an ectopic pregnancy. One in 30,000

Question 22

If a patient is a fertility patient, there is a one in ___ chance of ectopic pregnancy.

Answer 22

2000-4000

Question 23

3 symptoms of ectopic pregnancy are? Whose responsibility is it to identify this pregnancy?

Answer 23

Pain, bleeding, positive pregnancy test.

Sonographer and Radiologist!

Question 24

5 sonographic findings of ectopic pregnancy:

Answer 24

1) Any live extrauterine embryo is a definitive confirmation of ectopic pregnancy.
2) A pseudogestional sac which is a large collection of fluid in the uterus. (a double decidual sign of intrauterine pregnancy will NOT be present)
3) Prominent decidual reaction due to hormone elevations, a very thick endometrium
4) Free fluid in the cul de sac (Check Morison’s pouch!! Fluid found here requires immediate surgery!! She is bleeding to death!!)
5) Adnexal mass which is highly vascular “ring of fire”

Question 25

DO NOT mistake the ring of fire around the corpus luteum as an ____ ectopic. Corpus luteum is only within the ___ and will exhibit the ___ ___ around the corpus luteum cyst indicating that it is ovarian.

Answer 25

adnexal; ovary; claw sign

Question 26

What is the name for a spectrum of pathologic conditions which result fro the abnormal proliferation of trophoblastic tissue?

Answer 26

Gestational trophoblastic disease

Question 27

Trophoblastic disease presents in what two forms?

Answer 27

Complete hydatidiform mole, partial mole

Question 28

The most common form of trophoblastic disease?

Answer 28

Complete hydatidiform mole

Question 29

What is complete hydatidiform mole?

Answer 29

The chorionic villi are hydropic (filled with water) without an identifiable embryonic or fetal pole. It can be persistant and aggressive, and can be in malignant form as well.

Question 30

What are the sonographic findings for complete hydatidiform moles?

Answer 30

Enlarged uterus filled with an echogenic, partially solid and partially cystic mass (bunch of grapes)

Question 31

What will be present bilaterally in complete hydatidiform moles?

Answer 31

Bilateral Theca-lutein cysts in the ovaries

Question 32

What is a partial mole?

Answer 32

An abnormal fetus with trophoblastic proiferation but it is more mild than an incomplete mole.

Question 33

What are the sonograhic findings for a partial mole?

Answer 33

A deformed gestational sac with a growth restricted fetus with abnormal chromosomes and abnormalities such as hydrocephalus. The placenta is large with multiple cystic areas.

Question 34

80% of the time, patients diagnosed with complete hydatidiform mole follow a ____ course with complete resolution after ____.

Answer 34

benign; evacuation

Question 35

In 12-15% of patients with complete hydatidiform mole, an ___ mole develops, and 5-8% of the time metastatic ____ develops.

Answer 35

invasive; choriocarcinoma

Question 36

An invasive mole penetrates the ___ and possibly into adjacent structures and may even cause uterine rupture.

Answer 36

myometrium

Question 37

The treatment for an invasive mole is ___ ____.

Answer 37

complete hysterectomy

Question 38

What are the sonographic findings of an invasive mole?

Answer 38

The presence of diffuse or focal echogenic material within the endometrial cavity, possibly seen extending to the myometrium.

Question 39

____ is the most malignant form of trophoblastic disease, occurring in one in 40,000 pregnancies in the US.

Answer 39

Choriocarcinoma

Question 40

Only 3-5% of all molar pregnancies result in choriocarcinoma, which can occur after a ___ pregnancy, after an ____, or even after a ___ pregnancy.

Answer 40

molar; abortion; normal

Question 41

Choriocarcinoma may metastasize to ___, ___, ___, ___, ___, and ___.

Answer 41

lung, liver, brain, bone, GI tract, and skin