C6: 1st Trimester Abnormal

Question 1

When is the MSD used?

Answer 1

from 4-7 or 8 weeks, only if you dont see an embryo

Question 2

what is oligohydramnios?

Answer 2

low fluid

Question 3

when is oligohydramnios suspected? (dates and MSD and CRL)

Answer 3

from 5.5-9 weeks

if MSD - CRL is <5mm

Question 4

what 3 measurements do we do in 1st trimester?

Answer 4

MSD
CRL
Nuchal lucency

Question 5

when is the CRL used?

Answer 5

between 6 and 13 weeks (3 times)

Question 6

when looking for an ectopic pregnancy, which structure in the ovary is most often mistaken for a GS?

Answer 6

corpus luteum

Question 7

what does free fluid commonly indicate if theres no IUP and instead an ectopic?

Answer 7

the ectopic pregnancy had ruptured

Question 8

definition of ectopic preg

Answer 8

preg that occurs outside the uterine cavity

Question 9

wheres the most common place for an ectopic to occur?

what are the 2 most dangerous place for it to occur?

Answer 9

ampullar portion of Fallopian tube (95%)

cornua of the uterus and cervix

Question 10

whats the clinical trade of symptoms for an ectopic and what percent show these symptoms?

Answer 10

1. pain
2. bleeding
3. adnexal mass

45%

Question 11

other possible symptoms of ectopic?

Answer 11

amenorrhea
adnexal tenderness
cervical tenderness

Question 12

when do ectopic preg usually present themselves and why?

Answer 12

5-8 weeks…. before this the preg is too small to cause any pain or problems

Question 13

when does an ectopic often rupture?

Answer 13

around 5-8 weeks

Question 14

list the risk factors for ectopics

Answer 14

tubal surgery
preg with IUCD
PID
previous ectopic
endometriosis
previous appendicitis

Question 15

what are the most common site of ectopics?

Answer 15

fallopian tube
cervix (rare)
interstitial segment of tube/cornua (most serious)
ovary (rare)
peritoneal cavity

Question 16

why are the cornua and cervix the most dangerous places for an ectopic?

Answer 16

high risk of hemorrhage in these areas due to high vascularity with little endometrium for implantation

Question 17

what are common US features of an ectopic?

Answer 17

adnexal mass or viable ectopic
free fluid
no IUG or has a pseudo sac

Question 18

where does FF often accumulate with an ectopic?

Answer 18

pouch of Douglas, even up to morisons pouch

Question 19

what US finding is 100% accurate for diagnosing an ectopic?

if you see this might it indicate that the pregnancy has not yet ruptured?

Answer 19

a GS with an embryo that has a heart beat seen outside the uterus

yes

Question 20

if you see an ectopic, how far along in the preg can you assume the patient must be (the minimum)?

Answer 20

4 weeks

Question 21

whats the Ddx for an ectopic?

Answer 21

early gestation

• 5 wks
• b hCG should increase

spontaneous abortion
- b hCG should decrease

PID
- b hCG is negative and not pregnant but can have similar symptoms

Question 22

what is a heterotopic preg?

how often does it occur?

Answer 22

an IUP with a twin ectopic

1 in 100 or 1%

Question 23

does a negative US result for ectopic rule out the possibility and why or why not?

Answer 23

no. because preg may just be too small to see (must do follow up)

Question 24

whats one obvious US appearance for an interstitial ectopic?

Answer 24

unequal myometrium around all sides of the ectopic

Question 25

whats the interstitial line sign?

Answer 25

an echogenic line extending from the endometrial canal up to the centre of the interstitial sac

Question 26

whats the minimum amount of myometrium that should be surrounding the GS?

Answer 26

5mm ALL THE WAY AROUND

Question 27

how can you tell if a preg located in the cervix is an ectopic or a spontaneous abortion on its was out?

Answer 27

if its fixed then its an ectopic, if not fixed then its a spontaneous abortion

Question 28

whats the treatment for ectopic pregnancies (not acute)?

Answer 28

surgery:
resection of diseased tube (increases risk for repeat ectopic)

Medically:
with methotrexate (a cell growth inhibitor)... can be an IV, IM, injected into ectopic site or orally given

Question 29

whats the treatment for acute ectopic pregnancies?

Answer 29

laparoscopy… if medical treatment didnt work or patient is hemodynamically unstable

laparotomy, required if ectopic is:
abdominal
cornua
interstitial
cervical
patient severely hemodynamically unstable