C6: 1st Trimester Abnormal Flashcards
When is the MSD used?
from 4-7 or 8 weeks, only if you dont see an embryo
what is oligohydramnios?
low fluid
when is oligohydramnios suspected? (dates and MSD and CRL)
from 5.5-9 weeks
if MSD - CRL is <5mm
what 3 measurements do we do in 1st trimester?
MSD
CRL
Nuchal lucency
when is the CRL used?
between 6 and 13 weeks (3 times)
when looking for an ectopic pregnancy, which structure in the ovary is most often mistaken for a GS?
corpus luteum
what does free fluid commonly indicate if theres no IUP and instead an ectopic?
the ectopic pregnancy had ruptured
definition of ectopic preg
preg that occurs outside the uterine cavity
wheres the most common place for an ectopic to occur?
what are the 2 most dangerous place for it to occur?
ampullar portion of Fallopian tube (95%)
cornua of the uterus and cervix
whats the clinical trade of symptoms for an ectopic and what percent show these symptoms?
- pain
- bleeding
- adnexal mass
45%
other possible symptoms of ectopic?
amenorrhea
adnexal tenderness
cervical tenderness
when do ectopic preg usually present themselves and why?
5-8 weeks…. before this the preg is too small to cause any pain or problems
when does an ectopic often rupture?
around 5-8 weeks
list the risk factors for ectopics
tubal surgery preg with IUCD PID previous ectopic endometriosis previous appendicitis
what are the most common site of ectopics?
fallopian tube cervix (rare) interstitial segment of tube/cornua (most serious) ovary (rare) peritoneal cavity
why are the cornua and cervix the most dangerous places for an ectopic?
high risk of hemorrhage in these areas due to high vascularity with little endometrium for implantation
what are common US features of an ectopic?
adnexal mass or viable ectopic
free fluid
no IUG or has a pseudo sac
where does FF often accumulate with an ectopic?
pouch of Douglas, even up to morisons pouch
what US finding is 100% accurate for diagnosing an ectopic?
if you see this might it indicate that the pregnancy has not yet ruptured?
a GS with an embryo that has a heart beat seen outside the uterus
yes
if you see an ectopic, how far along in the preg can you assume the patient must be (the minimum)?
4 weeks
whats the Ddx for an ectopic?
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
what is a heterotopic preg?
how often does it occur?
an IUP with a twin ectopic
1 in 100 or 1%
does a negative US result for ectopic rule out the possibility and why or why not?
no. because preg may just be too small to see (must do follow up)
whats one obvious US appearance for an interstitial ectopic?
unequal myometrium around all sides of the ectopic
whats the interstitial line sign?
an echogenic line extending from the endometrial canal up to the centre of the interstitial sac
whats the minimum amount of myometrium that should be surrounding the GS?
5mm ALL THE WAY AROUND
how can you tell if a preg located in the cervix is an ectopic or a spontaneous abortion on its was out?
if its fixed then its an ectopic, if not fixed then its a spontaneous abortion
whats the treatment for ectopic pregnancies (not acute)?
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
whats the treatment for acute ectopic pregnancies?
laparoscopy… if medical treatment didnt work or patient is hemodynamically unstable
laparotomy, required if ectopic is: abdominal cornua interstitial cervical patient severely hemodynamically unstable
