Ch. 23 The First Trimester Flashcards
Graafian follicle
the name for the dominant follicle before ovulation
fimbria
the fingerlike extension of the fallopian tube located on the infundibulum
infundibulum
the distal segment of the fallopian tube
the combination of a female ovum with a male sperm to produce a zygote; also referred to as fertilization
Conception
the longest and most tortuous segment of the fallopian tube; area of the tube in which fertilization takes place and a common location for ectopic pregnancies to implant
ampulla
the cell formed by the union of two gametes; the first stage of a fertilized ovum
zygote
the developmental stage of the conceptus following the zygote
morula
the stage of the conceptus that implants within the decidualized endometrium
blastocyst
the cells that surround the gestation that produce human chorionic gonadotropin
trophoblastic cells
hormone produced by the trophoblastic cells of the early placenta; may also be used as a tumor marker in nongravid patients and males
human chorionic gonadotropin (hCG)
term given to the developing fetus before 10 weeks’ gestation
embryo
the wall of the inner sac (amniotic cavity) that contains the embryo and amniotic fluid; echogenic curvilinear structure that may be seen during the first trimester within the gestational sac
amnion
the outer membrane of a gestation that surrounds the amnion and the developing embryo
chorion
Sound Off:
The _____ are the cells that produce the pregnancy hormone hCG.
trophoblastic cells
fingerlike projections of gestational tissue that attach to the decidualized endometrium and allow the transfer of nutrients from the mother to the fetus
chorionic villi
a bleed that occurs at the time in which the conceptus implants into the decidualized endometrium
implantation bleeding
the gestational sac; also see key term chorion
chorionic sac
the structure responsible for early nutrient transfer to the embryo; the yolk sac seen during a sonographic examination of the early gestation
secondary yolk sac
the space between the chorionic sac and the amniotic sac that contains the secondary yolk sac; also referred to as the extraembryonic coelom
chorionic cavity
Sound Off:
The ____ is also referred to as the chorionic sac.
gestational sac
the way in which a pregnancy can be dated based on the first day of the last menstrual cycle; also referred to as menstrual age
menstrual age or gestational age
Sound Off:
In the first trimester, ____maintains the corpus luteum of the ovary so that the corpus luteum can continue to produce progesterone.
hCG, *the sustained production of progesterone maintains the thickness of the endometrium, thus allowing implantation to occur
physiologic ovarian cyst that develops after ovulation has occurred
corpus luteum cyst
the level of human chorionic gonadotropin beyond which an intrauterine pregnancy is consistently visible
discriminatory zone
Sound Off:
A gestational sac, the earliest definitive sign of an IUP, should generally be visualized between ____ with transvaginal sonography.
1,000 and 2,000 mIU per mL with
Sound Off:
Normal hCG levels ____ every 48 hours in the first trimester.
double
the physiologic effect on the endometrium in the presence of a pregnancy
decidual reaction
a pregnancy located outside the endometrial cavity of the uterus
ectopic pregnancy
Sound Off:
The first definitive sonographic sign of an IUP is identification of the ____ within the decidualized endometrium.
gestational sac
the appearance of a small gestational sac in the uterine cavity surrounded by the thickened, echogenic endometrium
intradecidual sign
the appearance of an abnormally shaped false gestational sac within the uterine cavity as a result of an ectopic pregnancy; this often corresponds with the accumulation of blood and secretions within the uterine cavity
pseudogestational sac
the normal sonographic appearance of the decidua capsularis (inner layer) and decidua parietalis (outer layer), separated by the anechoic fluid-filled uterine cavity
double sac sign or double decidual sign
the measurement of the gestational sac to obtain a gestational age; achieved by adding the measurements of the length, width, and height of the gestational sac and dividing by 3
mean sac diameter
Sound Off:
By adding ____to the MSD (measurement in millimeter), sonographers can obtain an estimate for the gestational age in days.
30
the development of blood cells
hematopoiesis
the structure that connects the developing embryo to the secondary yolk sac
vitelline duct
Sound Off:
The yolk sac is connected to the embryo by the ____, also referred to as the omphalomesenteric duct, which contains one artery and one vein.
vitelline duct
the cavity that contains simple-appearing amniotic fluid and the developing embryo
amniotic cavity
Sound Off:
The ____ is located within the chorionic cavity.
yolk sac
a low heart rate
Bradycardia
the measurement of the embryo/fetus from the top of the head to the rump
crown rump length (CRL)
early embryonic structures that will eventually give rise to the extremities
limb buds
Sound Off:
The most accurate sonographic measurement of pregnancy is the ____.
CRL
the primary brain vesicle also referred to as the hindbrain; becomes the cerebellum, pons, medulla oblongata, and fourth ventricle
rhombencephalon
Sound Off:
Within the fetal head, a cystic structure may be noted. This most often represents the _____, which will develop into the _______ and other essential brain structures.
rhombencephalon; fourth ventricle
the normal developmental stage when the midgut migrates into the base of the umbilical cord
Physiologic bowel herniation
Sound Off:
If physiologic bowel herniation does not resolve by ____ weeks, a follow-up examination is often warranted.
12
specialized cells within the ventricular system responsible for cerebrospinal fluid production
choroid plexus
a double fold of dura mater located within midline of the brain
falx cerebri
the endometrial tissue at the implantation site, and the maternal contribution of the placenta
decidua basalis
the part of the chorion, covered by chorionic villi, that is the fetal contribution of the placenta
chorion frondosum
the anechoic space along the posterior aspect of the fetal neck
nuchal translucency (NT)
chromosomal aberration in which there is a third chromosome 21; also referred to as Down syndrome
trisomy 21
chromosomal aberration in which there is a third chromosome 18; also referred to as Edwards syndrome
trisomy 18
a chromosomal aberration where one sex chromosome is absent; may also be referred to as monosomy X
Turner syndrome
Sound Off:
The NT is optimally measured between ____ and ____ weeks ____ days’ gestation, when the CRL measures between 45 and 84 mm.
11 and 13 weeks and 6 days
Sound Off:
Sonographers can obtain ____ in NT, nasal bone, ductus venosus flow, tricuspid flow, and other fetal and maternal assessments through the Fetal Medicine Foundation.
certification
Conception usually occurs within ______hours after ovulation.
The combination of the sperm and ovum produces a structure referred to as the ______. The zygote undergoes rapid cellular division and eventually forms into a cluster of cells called the ______. The morula continues to differentiate and form a structure referred to as the ______. The outer tissue layer of the blastocyst is composed of syncytiotrophoblastic tissue, also referred to as _______.The inner part of the blastocyst will develop into the embryo, amnion, umbilical cord, and the primary and secondary yolk sacs. The outer part, the trophoblastic tissue, will develop into the _____and______.
24; zygote; morula; blastocyst; trophoblastic cells; placenta and chorion
On day 20 or 21 of the menstrual cycle, the blastocyst begins to implant into the decidualized endometrium at the level of the uterine fundus. By ____ days, complete implantation has occurred, and all early connections have been established between the gestation and the mother. The blastocyst makes these link with the maternal endometrium via small projections of tissue called _______.
28; chorionic villi
The _______ week of gestation is an extremely dynamic stage in the pregnancy. The primary yolk sac regresses during week 4, and two separate membranes are formed. The outer membrane is the chorionic sac or ________. Within the gestational sac is the amnion or amniotic sac. By the end of week 4, the secondary yolk sac becomes wedged between these two membranes in an area called the _________or extraembryonic coelom.
fourth; gestational sac; chorionic cavity
The developing embryo is located between the yolk sac and the amnion at ____weeks. At this time, the alimentary canal is formed. It will become the _____, _______, and _____. The neural tube also begins to develop at this time.
4; foregut, midgut, and hindgut
By ______ weeks, suspicion of pregnancy abounds, because the woman misses the scheduled onset of menses for the month. By ___ weeks, all internal and external structures are in the process of forming.
5; 6
The laboratory test used to detect pregnancy is ______. This hormone is produced throughout pregnancy by the ______.
hCG; placenta
Both blood, or serum, and urine tests can be _______, answering the question, “Is the patient pregnant?” But only blood can be _______, answering the question, “How pregnant is the patient?” hCG is detected in the maternal blood as early as 23 days’ menstrual age. hCG can be detected in the urine at 20 mIU/mL or greater, whereas serum can detect levels greater than ___ mIU/mL.
qualitative; quantitative;
The period given to describe the earliest sonographic detection of an IUP is termed the _________or level.
discriminatory zone
Typically, a 5-mm gestational sac will be seen at approximately 5 menstrual weeks. Normal hCG levels _______ every 48 hours in the first trimester. High and low levels of hCG compared with LMP and sonographic findings can be indicative of an abnormal pregnancy.The hCG level will continue to rise until the end of the first trimester, at which time it plateaus and slowly _________with advancing gestation.
double; decreases
the use of ______ exposure in the first trimester should be limited, and the _______principle (as-low-as-reasonably achievable) be practiced. The thermal index, which is the amount of energy required to raise tissue temperature 1°C, should be kept below ____. The mechanical index should also be kept below _____.
color Doppler; ALARA; 1; 1
A decidual reaction is considered to be a nonspecific sonographic finding of pregnancy because the endometrium can also appear thick and echogenic during the_______ phase of the endometrial cycle and in the presence of an ________.
secretory; ectopic pregnancy
(*decidual reaction seen in weeks 3 and 4)
The blastocyst gives rise to the ________, or chorionic sac. The early gestational sac, which is first seen at _____ weeks, appears as a small, anechoic sphere within the decidualized endometrium. It will grow at a rate of _____ per day in early pregnancy.
gestational sac; 5; 1mm
The measurement of the ___________is the earliest sonographic measurement that can be obtained to date the pregnancy.
gestational sac
The gestational sac measurement is a relatively accurate form of dating that can be used until a _________ is sonographically recognized.
fetal pole
An irregularly shaped gestational sac and an MSD of greater than _______that does not contain a _______are both signs of potential pregnancy failure.
25 mm; fetal pole
The first structure seen with sonography within the gestational sac is the ________. It appears within the gestational sac as a round, anechoic structure surrounded by a thin, echogenic rim. It is located within the chorionic cavity, between the amnion and the chorion. This cavity (chorionic) may also be referred to as the ___________ or extracelomic space.
secondary yolk sac; extraembryonic coelom
The yolk sac produces ________and plays an important role in ________ and _________during early embryologic development.
alpha-fetoprotein (AFP); angiogenesis and hematopoiesis
The yolk sac is connected to the embryo by the _______, also referred to as the omphalomesenteric duct, which contains one artery and one vein.
vitelline duct
The yolk sac can be measured during the first trimester. It should be measured from the __________ aspects of the yolk sac wall. The yolk sac should not exceed _____, and it should also be evaluated for irregular shape and echogenicity.
inner-to-inner; 7mm
The gestational sac consists of what 2 cavities?
chorionic and amniotic cavity
The _______ cavity lies between the amnion and the chorion. It contains the yolk sac and fluid.
chorionic
The amniotic cavity contains simple-appearing amniotic fluid and the developing ________. The amniotic membrane, or _______, can be seen within the gestational sac as a thin, echogenic line loosely surrounding the embryo
embryo, amnion
The amnion and chorion typically fuse around the middle of the first trimester, but may not be totally fused until __________ gestation.
16 weeks
By _____ weeks, the embryo can be seen located within the amniotic cavity adjacent to the yolk sac, with transvaginal sonography. The documentation of fetal heart activity is performed using _______
6; motion mode(M-mode)
Occasionally, a tiny heartbeat is often seen before an embryo can be measured, with sonographic documentation of heart activity being present between ___ and ____ weeks. Heart motion can be detected in a ___-mm embryo, with motion certainly evident within the ____-mm embryo. The embryo will grow at a rate of ______ per day in the first trimester.
5 and 6; 4; 5; 1mm
Embryonic heart rate is considered normal at _____ to ____ bpm between 5 and 6 weeks. The heart rate increases to ____ bpm by 9 weeks. From the second trimester to term, the fetal heart rate is typically around 150 bpm, although it will vary with gestation age.
100 to 110, 150
The most accurate sonographic measurement of pregnancy is the _________. The CRL can be taken when a fetal pole is identified and should not include the ____ or _______within the measurement
crown rump length (CRL); yolk sac or fetal limb buds
Fetal limb buds are readily identified by 7 weeks. The fetal head at this time is proportionally ______ than the body.
larger
Physiologic bowel herniation begins at _____weeks, which marks the developmental stage when the midgut migrates into the base of the umbilical cord. This phenomenon is developmentally normal
8
The developing placenta may be noted at the end of first trimester as a well-defined, crescent-shaped ________ mass of tissue, along the margins of the gestational sac. The placenta is formed by the ________, the maternal contribution of the placenta, and the _________, the fetal contribution.
homogenous; decidua basalis; chorion frondosum
The ________is visible during the latter half of the first trimester as a tortuous structure connecting the fetus to the developing placenta.
umbilical cord
The most common abnormalities associated with increased NT are trisomy ____, trisomy ____, ______syndrome, and ________.
21; 18; Turner syndrome; congestive heart failure
The normal range of thickness of the NT is based on the gestational age, although, most often, a measurement greater than _______between 11 and 13 weeks 6 days is considered abnormal and warrants a follow-up examination, referral for fetal echocardiography, and fetal karyotyping.
3mm
For NT measurement of this area is performed in the ________ plane to the fetus, with the fetus in a ________position.
sagittal; neutral
In a normal fetus(nasal bone assessment), this will provide an “_______” in the area of the nasal bone and overlying nasal skin.
equal sign
Ductus venosus flow is analyzed with color and pulsed Doppler to evaluate for signs of ________impedance in the fetal ductus venosus at 11 to 13 weeks’ gestation. This ________impedance has been shown to be associated with fetal aneuploidies and cardiac defects. It is the ___-wave that is analyzed, and studies have revealed that the a-wave is normal when it is positive during atrial contraction and abnormal when the a-wave is absent or reversed.
increased; increased; a
*this is not routinely assessed
Tricuspid flow, which is again not a routine sonographic assessment in the low-risk population, is analyzed for signs of tricuspid ________ between 11 and 13 weeks, a common malady in fetuses with trisomies 21, 18, and 13 and those with cardiac defects.
regurgitation
*this is not routinely assessed
The most common pelvic mass associated with pregnancy is the ovarian _________.
corpus luteum cyst
Typically, the corpus luteum measures between 2 and 3 cm and regresses near the _____ of the first trimester, although it may continue to grow as large as ____cm.
end; 10
Clinical Findings of the _________of Pregnancy
1.Asymptomatic
2.Pain associated with hemorrhage and enlargement of cyst
Corpus Luteum
Sonographic Findings of the Corpus Luteum of Pregnancy
1.Simple cyst appearance
2.A cysts with a thick, echogenic rim around it (may be difficult to differentiate from other solid and cystic adnexal masses)(increased color flow with color Doppler; this rim of vascularity often produces a low-resistance spectral doppler waveform)
2.Hemorrhagic cyst appearance, including complex components or entirely echogenic depending on the amount of blood and stage of lysis
The________ is a functional cyst that is maintained during the first trimester by hCG, which is produced by the developing placenta.
corpus luteum of pregnancy
An ectopic pregnancy, also referred to as an extrauterine pregnancy (EUP), is the most common cause of _________ with a positive pregnancy test. It can lead to pregnancy loss and, in some cases, maternal death.
pelvic pain
An ______ is defined as a pregnancy located anywhere other than the endometrial or uterine cavity. Women with a history of assisted reproductive therapy (technology), fallopian tube scarring, and/or pelvic inflammatory disease are among the list of patients who are at high risk for an _______
EUP (extrauterine pregnancy)
pelvic inflammatory disease
complication of pregnancy in which both extrauterine and intrauterine pregnancy occur simultaneously
heterotopic pregnancy
The most common location of an EUP is within the fallopian tube, specifically the _______ portion of the tube. Other locations for ectopic implantation include the isthmus of the tube, the fimbria, abdomen, interstitial portion of the fallopian tube (cornu of the uterus), ovary, and cervix, with the least common locations being the latter two
ampullary
Contributing factors for __________
Previous ectopic pregnancy
Previous tubal surgery (including tubal sterilization)
History of pelvic inflammatory disease (salpingitis)
Undergoing infertility treatment
Previous or present use of an intrauterine contraceptive device
Multiparity
Advanced maternal age
ectopic pregnancy
What is the classic clinical triad of EUP?
pain, vaginal bleeding, and a palpable abdominal/pelvic mass
Clinical Findings of _________
1.Classic clinical triad—pain, vaginal bleeding, palpable abdominal/pelvic mass
2.Amenorrhea
3.Positive pregnancy test
4.Low beta-hCG compared with normal intrauterine gestation
5.Shoulder pain (secondary to intraperitoneal hemorrhage with diaphragmatic irritation)
6.Low hematocrit (with rupture)
7.Cervical motion tenderness
Ectopic Pregnancy
Sonographic Findings of ________
1.Extrauterine gestational sac containing a yolk sac or an embryo
2.Adnexal ring sign (may be surrounded by rim of vascularity—“ring of fire”)
3.Complex adnexal mass
4.Large amount of free fluid within the pelvis or in Morison pouch
5.Complex free fluid could represent hemoperitoneum
6.Pseudogestational sac
7.Poor decidual reaction
8.Endometrial cavity containing blood
Ectopic Pregnancy
the sonographic sign that describes the appearance of an ectopic pregnancy within the fallopian tube; may be referred to as the tubal ring sign, bagel sign, or blob sign
adnexal ring sign
the space between the liver and right kidney; also referred to as the right subhepatic space or hepatorenal space
Morison pouch
An EUP that implants within the intramural portion of the fallopian tube may be referred to as an___________, and in the past, it was referred to as a cornual pregnancy. This portion of the uterus is ______ vascular and is prone to excessive hemorrhage. Interstitial pregnancies are considered potentially life-threatening because the pregnancy may progress normally until spontaneous rupture occurs. In the presence of an interstitial pregnancy, sonography will yield a gestational sac that is located in the _______portion of the uterus.
interstitial pregnancy; highly; superolateral
_______ is a drug used to medically treat an EUP. It can be either injected into the ectopic pregnancy with sonographic guidance or taken intramuscularly.
Methotrexate
a disease associated with an abnormal proliferation of the trophoblastic cells during pregnancy; may also be referred to as a molar pregnancy
gestational trophoblastic disease (GTD)
Benign ________, often referred to as a _________or a hydatidiform mole, is a group of disorders that result from an abnormal combination of male and female gametes
gestational trophoblastic disease (GTD); molar pregnancy
The common forms of GTD can be described as either a complete molar pregnancy or partial (incomplete) molar pregnancy, with __________being the most common.
complete
The term trophoblast relates to the cells that surround the developing gestation. As stated earlier, trophoblastic cells are those cells that produce ______. GTD results in the _______ growth of the trophoblastic cells. Therefore, there are excessive amounts of _______ in the maternal circulation. Although the cause of molar pregnancy is unknown, it has been speculated that perhaps in these situations, a normal sperm fertilizes an empty ovum.
hCG; excessive; hCG
The _______ molar pregnancy has a higher malignant potential compared to the partial molar pregnancy. The most common forms of malignant GTD are the _______ and __________.The most common sites of metastatic involvement are the lungs, liver, and vagina. However, other organs may be affected.Treatment for GTD includes dilation and curettage, hCG monitoring, hysterectomy, and, possibly, chemotherapy.
complete; invasive mole and choriocarcinoma
a type of gestational trophoblastic disease in which a molar pregnancy invades into the myometrium and may also invade through the uterine wall and into the peritoneum
invasive mole
the most malignant form of gestational trophoblastic disease with possible metastasis to the liver, lungs, and vagina
choriocarcinoma
excessive vomiting during pregnancy
hyperemesis gravidarum
pregnancy-induced maternal high blood pressure and excess protein in the urine after 20 weeks’ gestation
preeclampsia
a sequela of preeclampsia in which uncontrollable maternal hypertension and proteinuria lead to maternal convulsions and, possibly, fetal and maternal death
eclampsia
Clinical Findings of _____ Pregnancy
1.Hyperemesis gravidarum
2.Markedly elevated hCG level (potentially >100,000 mIU per mL)
3.Heavy vaginal bleeding (with the possible passage of grape-like molar clusters)
4.Enlarged uterus
Possible 5.preeclampsia or eclampsia
6.Hypertension
7.Hyperthyroidism
Molar
Sonographic Findings of __________
1.Complex mass within the uterus
2.Color Doppler may reveal hypervascularity around the mass, but not within it
3.“Vesicular snowstorm appearance” secondary to placental enlargement
4.Multiple, variable-sized cysts replacing the placental tissue (hydropic chorionic villi)
5.Bilateral ovarian theca lutein cysts (large, bilateral, multiloculated ovarian masses)
Complete Molar Pregnancy
Clinical Findings of ______ Molar Pregnancy
1.Normal physical examination
2.Normal or slightly elevated hCG level
3.Smaller-than-normal uterus or, possibly, normal-sized uterus based on gestational age
4.Possible vaginal bleeding
Partial
Sonographic Findings of _______Molar Pregnancy
1.Complex mass within the uterus partially filling the uterine cavity adjacent to the gestational sac
2.“Vesicular snowstorm appearance” secondary to placental enlargement
3.Multiple, variable-sized cysts replacing the placental tissue (hydropic chorionic villi)
4.Triploid fetus
Partial
The ovarian mass associated with a molar pregnancy and elevated hCG is the _________.
theca lutein cyst
an abnormal pregnancy in which there is no evidence of a fetal pole or yolk sac within the gestational sac at the appropriate time of development; also referred to as a blighted ovum
anembryonic gestation
the death of an embryo before 10 weeks’ gestation
embryonic demise
from an unknown origin
idiopathic
Clinical Findings of _________
1.Vaginal bleeding
2.Reduction of pregnancy symptoms
3.Low hCG
Blighted Ovum/anembryonic gestation
Sonographic Findings of _________
1.Large, irregular gestational sac without an embryo or a yolk sac
2.Absent or minimal gestational sac growth
3.Poor decidual reaction
Blighted Ovum/anembryonic gestation
Embryonic demise, sometimes referred to as ______, is defined as the death of the embryo or fetus. With transvaginal imaging, cardiac activity should be detected in the pole that measures ___ to ____mm. The causes are often idiopathic but may be linked with chromosomal abnormalities.
fetal demise; 4 to 5 mm
Clinical Findings of ________
1.Vaginal bleeding
2.Small for dates
3.Closed cervix
4.Low (based on LMP) hCG
Embryonic or Fetal Demise
The normal embryonic heart rate at 6 weeks is typically between _____ and _____ beats per minute (bpm). By 7 weeks, the rate should be at least 120 bpm. Between 8 and 9 weeks, the rate can increase slightly and then plateau at approximately _____ bpm.
100 and 100; 150
An impending embryonic demise is associated with embryonic ________. A heart rate that is less than _____ bpm at around 6 weeks is considered abnormal. In addition, the majority of pregnancies with less than 80 bpm will eventually go on to miscarry.
bradycardia; 90
Sonographic Findings of __________
1.No detectable fetal heart activity in a pole that measures 4 to 5 mm
2.Irregularly shaped fetus
3.Irregularly sized or shaped gestational sac (Ex: an abnormally small gestational sac, in relation to the CRL, is also an indicator of a poor prognosis)
4.Irregular-appearing yolk sac (misshapen, calcified, large, or echogenic) *specifically a yolk sac that measures over 7mm in diameter has been linked with a high rate of pregnancy failure)
Embryonic or Fetal Demise
a gestational sac that has an MSD of between ____ and ____ mm with no evidence of an embryo can be a suspicious sign of early pregnancy failure. A follow-up sonogram in 7 to 10 days is often recommended to confirm viability.
16 and 24
the complete expulsion or partial expulsion of the conceptus
abortion
the spontaneous end of a pregnancy before viability
miscarriage
The termination of a pregnancy before viability is termed a _______ or an _______. There are several categories of abortions, including threatened, complete, incomplete, missed, inevitable, septic, and elective
miscarriage; abortion
Clinical findings consistent with a _______ include vaginal bleeding, pelvic cramping, and the passage of the products of conception. Many miscarriages are ________. However, first-trimester miscarriages have been linked with ovarian abnormalities, aneuploid fetuses, maternal infections, physical abuse, trauma, drug abuse, maternal endocrine abnormalities, and anatomic factors.
miscarriage; idiopathic
a bleed between the endometrium and the gestational sac at the edge of the placenta
subchorionic hemorrhages; may also be referred to as a perigestational hemorrhage
Clinical Findings of ____________
1.Vaginal bleeding or spotting
2.Uterine cramping
3.Closed cervix
Subchorionic Hemorrhage
Sonographic Findings of __________
1.Crescent-shaped anechoic, echogenic, or hypoechoic area adjacent to the gestational sac at the margin of the placenta (depends on the age of the hemorrhage)(recent bleeds are often hyperechoic or isoechoic to the placenta; older bleeds may appear anechoic or even hypoechoic depending on the age of the hemorrhage)
2.May resemble a second gestational sac
Subchorionic Hemorrhage
With subchorionic hemorrhage large bleeds may be associated with ______ and _____, fetal activity is often a reassuring sign that the pregnancy will progress normally.
miscarriage and stillbirth
A uterine _______, also referred to as a fibroid, is a common benign pelvic mass that can often be identified during a first-trimester sonographic examination. These tumors, although benign, have been associated with an increased risk for early pregnancy failure, especially in women who are pregnant with multiple gestations.
leiomyoma
Fibroids are stimulated by ________ and can consequently experience rapid growth during pregnancy.
estrogen
localized, painless contractions of the myometrium in the gravid uterus that should resolve within 20 to 30 minutes
focal myometrial contractions
Fibroids must be differentiated from ________, which are smooth muscle contractions that can be noted during a sonographic examination. Fibroids will consistently alter the shape of the myometrium, whereas true myometrial contractions typically disappear within 20 to 30 minutes.
focal myometrial contractions
Clinical Findings of a ________ (With Pregnancy)
1.Positive pregnancy test
2.Pelvic pressure
3.Menorrhagia
4.Palpable pelvic mass
5.Enlarged, bulky uterus (if multiple)
6.Urinary frequency
7.Dysuria
8.Constipation
Uterine Leiomyoma
Sonographic Findings of ______
1.Hypoechoic mass within the uterus
2.Posterior shadowing
3.Degenerating fibroids may have calcifications or cystic components
4.Multiple fibroids appear as an enlarged, irregularly shaped, diffusely heterogeneous uterus
Uterine Leiomyoma
Occasionally, an intrauterine contraceptive device (IUCD) may not be effective and thus allow pregnancy to occur and implant within the uterus. If this occurs, the IUCD will be seen as an ________ structure within the uterine cavity adjacent to the gestational sac. The IUCD will often produce acoustic ________. Its location to the ________should be reported.
echogenic; shadowing; gestational sac
Types of Abortion:
__________
Description:
Vaginal bleeding before 20 weeks’ gestation; closed cervical os
Sonographic Findings:
Low fetal heart rate
Threatened abortion
Types of Abortion:
__________
Description:
All products of conception expelled
Sonographic Findings:
-No intrauterine products of conception identified
-Prominent endometrium, which may contain hemorrhage
Complete (spontaneous) abortion
Types of Abortion:
__________
Description:
Part of the products of conception expelled
Sonographic Findings:
-Thickened and irregular endometrium
-Enlarged uterus
Incomplete abortion
Types of Abortion:
__________
Description:
Fetal demise with retained fetus
Sonographic Findings:
-No detectable fetal heart motion detected
-Abnormal fetal shape
Missed abortion
Types of Abortion:
__________
Description:
Vaginal bleeding with dilated cervix
Sonographic Findings:
-Low-lying gestational sac
-Open internal os of cervix
Inevitable abortion
Nature of Pregnancy:
Ectopic pregnancy
Will hCG level be increased or decreased?
hCG↓
Nature of Pregnancy:
Anembryonic pregnancy
Will hCG level be increased or decreased?
hCG↓
Nature of Pregnancy:
Abortion(miscarriage)
Will hCG level be increased or decreased?
hCG↓
Nature of Pregnancy:
Twin pregnancy
Will hCG level be increased or decreased?
hCG↑
Nature of Pregnancy:
Complete molar pregnancy
Will hCG level be increased or decreased?
hCG (markedly) ↑
Classification of Gestational Trophoblastic Disease:_________
Important facts:
Most common form of gestational trophoblastic disease
Characterized by hydropic chorionic villi
Absence of the fetus and amnion
Benign with malignant potential
Markedly elevated hCG
Hydatidiform molar pregnancy: complete
Classification of Gestational Trophoblastic Disease:_________
Important facts:
May be accompanied by a coexisting triploid fetus, parts of fetus, or amnion
Minimal malignant potential
Normal or minimally elevated hCG
Hydatidiform molar pregnancy: partial or incomplete
Classification of Gestational Trophoblastic Disease:_________
Important facts:
Molar pregnancy that invades into the myometrium and may also invade through the uterine wall and into the peritoneum
Result of malignant progression of hydatidiform moles
Invasive molar pregnancy (chorioadenoma destruens)
Classification of Gestational Trophoblastic Disease:_________
Important facts:
Most malignant form of trophoblastic disease with possible metastasis
Result of malignant progression of a hydatidiform molar pregnancy
Most common sites for metastasis are the liver, lungs, and vagina
Choriocarcinoma
Embryologic Tissue:
_________
Description:
The space between the gestational sac and the amniotic sac. The location of the secondary yolk sac.
Chorionic cavity
Embryologic Tissue:
_________
Description:
The decidualized tissue at the implantation site containing the chorionic villi. The fetal contribution of the placenta.
Chorion Frondosum
Embryologic Tissue:
_________
Description:
The portion of the chorion that does not contain chorionic villi.
Chorion laeve
Embryologic Tissue:
_________
Description:
Fingerlike extension of trophoblastic tissue that invades the decidualized endometrium.
Chorionic villi
Embryologic Tissue:
_________
Description:
The endometrial tissue at the implantation site.
The maternal contribution of the placenta.
Decidua basalis
Embryologic Tissue:
_________
Description:
The portion of the decidua opposite the uterine cavity, across from the decidua basalis.
Decidua capsularis
Embryologic Tissue:
_________
Description:
The decidualized tissue along the uterine cavity adjacent to the decidua basalis.
Decidua parietalis (vera)
What membrane in the early gestation is located across from the placenta?
a. Chorion frondosum
b. decidua vera
c. chorion laeve
d. decidua capsularis
d. decidua capsularis
With a normal pregnancy, the first structure noted within the decidualized endometrium is the:
a. yolk sac
b. chorionic sac
c. amniotic cavity
d. embryo
b. chorionic sac
What is the stage of the conceptus that implants within the decidualized endometrium?
a. blastocyst
b. morula
c. zygote
d. ovum
a. blastocyst
In the first trimester, normal hCG levels will:
a. double every 48 hours
b. triple every 24 hours
c. double every 24 hours
d. double every 12 hours
a. double every 48 hours
Which of the following locations for an ectopic pregnancy would be least likely?
a. isthmus of the tube
b. ampulla of the tube
c. ovary
d. interstitial of the tube
c. ovary
The first sonographically identifiable sign of pregnancy is the:
a. amnion
b. yolk sac
c. decidual reaction
d. chorionic cavity
c. decidual reaction
In the early gestation, where is the secondary yolk sac located?
a. chorionic cavity
b. base of the umbilical cord
c. embryonic cranium
d. amniotic cavity
a. chorionic cavity
The most common cause of pelvic pain with pregnancy is:
a. ectopic pregnancy
b. heterotopic pregnancy
c. missed abortion
d. molar pregnancy
a. ectopic pregnancy
All of the following are sonographic findings consistent with ectopic pregnancy except:
a. decidual thickening
b. complex free fluid within the pelvis
c. bilateral, multiloculated ovarian cysts
d. complex adnexal mass separate from the ipsilateral ovary
a. decidual thickening
All of the following are consistet with a complete hydatidiform mole except:
a. heterogeneous mass within the endometrium
b. bilateral theca lutein cysts
c. hyperemesis gravidarum
d. low hCG
d. low hCG
Which of the following is the most likely metastatic location for GTD?
a. rectum
b. pancreas
c. spleen
d. lungs
d. lungs
All of the following are clinical findings consistent with a complete molar pregnancy except:
a. vaginal bleeding
b. hypertension
c. uterine enlargement
d. small for dates
d. small for dates
All of the following may be sonographic findings in the presence of an ectopic pregnancy except:
a. pseduogestational sac
b. corpus luteum cyst
c. adnexal ring
d. low beta-hCG
d. low beta-hCG
