Ch. 10 Abnormal First Trimester Flashcards
Abortion is the termination of pregnancy prior to —- weeks of gestation
20
Spontaneous AB usually occurs – to – weeks after embryonic or fetal demise
1-3
Term for when all products of conception are expelled
complete abortion
sono finds of a complete AB
empty uterus with normal endo cavity, possible small trace of fluid in endo cavity, the uterus may remain enlarged for up to 2 weeks following SAB
Term for an abortion in which there are remaining products of conception in the uterus
Incomplete Abortion
Sono finds of incomplete AB
thickened or irregular endo echoes, possible fluid in endo cavity, increased endo vascularity on color doppler
Define missed abortion
the presence of an embryo without cardiac activity (the embryo may be retained for several weeks before the pt experiences symptoms)
List clinical symptoms of a missed AB
Low hCG levels in comparison to dates, loss of pregnancy symptoms, decrease in uterine size, brownish vaginal discharge without frank bleeding
Sono finds of a missed AB
embryo > 7mm without cardiac activity
Term for a SAB that is imminent and cannot be halted
Inevitable AB/ AB in progress
Inevitable AB clinical signs
cervical dilatation > 3 cm, rupture of membranes, bleeding for more than 7 days, persistent cramping
Sono finds of Inevitable AB
GS low in uterus or in cx (distinguished from Cx ectopic using color doppler) cervical dilatation, downward mvmt of GS during scan, anechoic crescent surrounding GS
A condition in which the future of the pregnancy may be at risk but the pregnancy continues
Threatened AB
Sono finds of a threatened AB
not able to diagnosis on US
Gestation in which the embryo does not develop or stops early in development and cannot be visualized
Anembryonic pregnancy aka Blighted ovum
List clinical signs of a blighted ovum
BhCG may rise but not as rapidly as expected
uterus is small for dates
vaginal spotting
closed cx
sono finds of a anembryonic pregnancy
no identifiable embryo in a GS measuring 25mm or larger
fluid-fluid level indicates blood and is positive evidence of embryonic death
Term for an abortion that results from the use of non-sterile instruments or from infection of retained products of conception
Septic AB
List clinical symptoms and sono finds of a septic AB
clinical- signs of infection such as fever and leukocytosis
sono - enlarged uterus with heterogeneous contents, endo may have shadowing due to gas bubbles
Implantation of the fertilized ovum at any site other than the endometrium
ectopic pregnancy
Where is the most common site of ectopic pregnancies
in the ampulla of the oviduct (90% of cases)
List reasons why the incidence of ectopic pregnancies has increased over the years
increased occurrence of PID, tubal reconstructive surgeries, assisted fertility programs
T or F, Ov ectopics are common
F. They are rare
Type of ectopic that is associated with high mortality rate due to risk of hemorrhage
Cervical ectopic. If treatment with methotrexate is unsuccessful, cervical artery embolization or total hysterectomy may be necessary.
Type of ectopic that may progress further into gestation that other ectopics before it is recognized
Abdominal ectopic
Coexisting intrauterine and extrauterine pregnancies
Heterotopic pregnancy
In what types of pts do heterotopic pregnancies occur more in
Fertility pts who have undergone zygote or gamete transfer
List clinical symptoms of an ectopic gestation
amenorrhea, vaginal bleeding or spotting, adnexal tenderness/ pelvic pain, shoulder pain (referred pain from intraperitoneal bleeding)
Sono finds of an ectopic pregnancy
empty uterus, adnexal mass, “SLIDING SAC SIGN” (gentle pressure with TV transducer moves GS. Presence of endometrial decidual reaction or pseudosac, FF in posterior cul de sac, adx, pericolic gutters or morrisons pouch.
Sonographic pitfalls of ectopic pregnancies
The presence of fluid in the endo cavity known as ‘Pseudogestational sac’. The absence of the double sac sign eliminates this pitfall.
Misidentification of corpus luteal cyst as an adnexal ectopic
Misidentification of a cornual/interstitial ectopic as an IUP.
Which ectopic site is the most dangerous due to potential of hemorrhage
Cornual, interstitial
Describe the characteristics you would expect to see on color doppler with an ectopic pregnancy
“ring of fire” surrounding the GS. High velocity, low resistance waveform.
List treatment options for an ectopic
Methotrexate (MTX)
Laparoscopy
Exploratory laparotomy (less frequent)
Expectant management (no treatment if the pt is hemodynamically stable)
Spectrum of pathologies resulting from the abnormal proliferation of trophoblastic tissue
Gestational trophoblastic disease
List clinical finding of GTD
uterus large for dates, extremely elevated hCG levels, hyperemesis gravidarum, early onset of pre-eclampsia, hyperthyroidism, theca lutein cysts
The most common form of GTD, The chorionic villi are hydropic without identifiable embryonic or fetal tissue
Complete hydatidiform mole
Sono finds of a complete hydatidiform mole
enlarged ut filled with echogenic mass, hypervascular, low resistance flow, ov theca lutein cysts
A form of GTD in which fetal and or embryonic tissue is frequently identified
Partial mole
Sono finds of a partial mole
deformed GS, growth-restricted fetus with triploid anomalies, includinf syndactyly, and hydrocephalus, enlarged placenta with multiple cystic areas
Gestation in which two conceptions occur, one normal and the other with GTD
Mole with coexisting normal fetus
A patient has just had a normal term birth, her hCG levels still have yet to decline, what do you expect
Persistent Trophoblastic Neoplasia (PTN)
Type of PTN that is most common, may cause uterine rupture, is a malignant NON-Metastatic GTD
Invasive mole aka chorioadenoma destruens
Type of PTN that is malignant, metastatic, and very rare
Choriocarcinoma
Sono finds of a choriocarcinoma
Elevated hCG levels in a nonpregnant pt, enlarged uterus, irregular complex mass with increased vasculature
