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OB 1 > Chapter 18: Sonographic Evaluation of First Trimester Complications > Flashcards

Chapter 18: Sonographic Evaluation of First Trimester Complications Flashcards

1
Q

the spontaneous or induced termination of an early pregnancy and expulsion of fetal and placental tissues

A

abortion

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2
Q

An invasive procedure in which a quantity of amniotic fluid is removed from the amniotic sac for analysis of the fetal cells or for the presence of certain chemicals in the fluid itself. May also be performed as a palliative measure in patients with severe polyhydraminos

A

amniocentesis

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3
Q

A pregnancy which has failed prior to the development of an identifiable embryo, or in which embryonic tissue has been resorbed after early embryo demise

A

anembryonic pregnancy

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4
Q

a deficiency of red blood cells

A

anemia

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5
Q

having an abnormal number of chromosomes

A

aneuploidy

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6
Q

the empty gestational sac seen in an anembryonic pregnancy

A

blighted ovum

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7
Q

an abnormally slow heart rate

A

bradycardia

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8
Q

an invasive procedure in which the chorionic villi of an early pregnancy are removed for analysis

A

chorionic villus sampling

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9
Q

abnormal fertilization of an oocyte that contains no maternal chromosomes, resulting in the proliferation of swollem chorionic villi and the absence of identifiable embryonic structures

A

complete hydatidform mole

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10
Q

a spectrum of disorders that begins at fertilization and involves abnormal proliferation of the trophoblasts that in a normal pregnancy would have gone on to form the placenta. May become invasive and metastasize.

A

gestational trophoblastic disease

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11
Q

the invasive or metastatic form of gestational trophoblastic disease

A

gestational trophoblastic neoplasia

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12
Q

a form of gestational trophoblastic disease resulting from abnormal fertilization, in which there is proliferation of swollen chorionic villi; also called a molar pregnancy

A

hydatatidform mole

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13
Q

excessive vomiting

A

hyperemesis

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14
Q

excessive activity of the thyroid

A

hyperthyroidism

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15
Q

a spontaneous abortion in which some products of conception remain in the uterus

A

incomplete abortion

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16
Q

A failed early pregnancy that is in the process of being expelled from the uterus

A

inevitable abortion

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17
Q

the spontaneous failure and expulsion of an early pregnancy

A

miscarriage

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18
Q

hydatidform mole

A

molar pregnancy

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19
Q

abnormal fertilization resulting in one maternal and two paternal sets of chromosomes (tripoloidy), leading to the development of an abnormal embryo and placenta

A

partial hydatidform mole

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20
Q

inadequate absorption of oxygen and/or inadequate expulsion of carbon dioxide

A

respiratory insufficiency

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21
Q

a crescent-shaped sonolucent collection of blood between the gestational sac and the uterine wall

A

subchorionic hemorrhage

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22
Q

subchorionic hemorrhage

A

subchorionic hematoma

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23
Q

abnormally rapid heart rate

A

tachycardia

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24
Q

large, often bilateral ovarian cysts, the formation of which is usually stimulated by excessive levels of circulating hcG

A

theca lutein cysts

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25
Q

threatened miscarriage, vaginal bleeding in a pregnancy of less than 20 weeks; may be accompanied by pain or cramping

A

threatened abortion

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26
Q

pregnancy-induced hypertension, proteinuria, edema, and headache (preeclampsia), which may progress to the development of seizures (eclampsia)

A

toxemia of pregnancy

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27
Q

having three copies of each chromosome

A

triploid; tripoloidy

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28
Q

empty gestational sac >20 mm , smaller than expected sac size

A

anembryonic pregnancy

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29
Q

lack of heart motion, expanded amnion sign, lack of double bleb sign

A

embryonic demise

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30
Q

thickened endometrium, increased flow in myometrium

A

incomplete abortion

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31
Q

empty low-lying gestational sac, open cervix

A

inevitable abortion

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32
Q

crescent-shaped sonolucent or complex fluid collection between the gestational sac and uterus

A

subchorionic hemorrhage

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33
Q

May have appearance of a blighted ovum, threatened abortion, or variable echogenicity filling the entire uterus without characteristic vesicular appearance

A

hydatidform mole (first trimester)

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34
Q

Large soft tissue mass of low- to moderate- amplitude echoes filling the uterine cavity and containing fluid filled spaces.

A

hydatatidform mole (after first trimester)

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35
Q

this may present as a gestational sac that is relatively large and intact, surrounded by a thick rim of placenta-like echoes with well-defined sonolucent spaces within. It may be empty or may contain a disproportionately small viable or nonviable embryo. Echogenic fetal parts may be visualized with or without normal placenta

A

incomplete or partial mole

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36
Q

concurrent presence of normal-appearing placenta and embryo and a separate area of cystic vesicular appearance

A

coexisting mole and embryo

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37
Q

enlarged uterus with foci of increased echogenicity and cystic spaces in the myometrium

A

invasive mole

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38
Q

cystic to solid areas of necrosis, coagulated blood, or tumor tissue invading and extending as a mass outside the uterine wall with metastatic lesions located in the liver

A

choriocarcinoma

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39
Q

Where can bleeding originate in a threatened abortion?

A

uterus, cervix, vagina

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40
Q

most reliable criteria for early nonviable pregnancies

A
  1. empty gestational sac with a mean sac diameter up to 25 mm
  2. a crown-rump diameter of 7 mm for embryos without a detectable heartbeat
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41
Q

Reasons uterus smaller than expected

A
  1. incorrect dates
  2. early pregnancy failure
  3. ectopic pregnancy
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42
Q

defined as crown rump length at least 2 standard deviations below the mean for the expected gestational age

A

early onset intrauterine growth restriction

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43
Q

Reasons uterus larger than expected

A

incorrect dates
multiple gestation
molar pregnancy
uterine fibroids

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44
Q

Uterine fibroids may be associated with:

A

preterm labor
premature rupture of membranes
fetal malposition

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45
Q

___ - ___% of clinically recognized pregnancies result in spontaneous abortion occurring before 20 weeks gestational age, with most occurring before 12 weeks

A

10-20

46
Q

___ - ___% of pregnancy failures caused by genetic abnormalities

A

50-70

47
Q

sometimes called a blighted ovum

A

anembryonic pregnancy

48
Q

first structure to be sonographically recognized

A

secondary yolk sac

49
Q

no cardiac activity in an embryo measuring 5 mm or more; absence of cardiac activity in a less than 5 mm embryo seen within an enlarged amniotic sac; instead of “double bleb sign”, there is an obvious yolk stalk between yolk sac and embryo and amniotic sac

A

embryo demise

50
Q

patient with an anembryonic pregnancy or embryo demise that has not yet been expelled from uterus

A

missed or delayed abortion

51
Q

occurs when some placental or fetal tissue has been expelled but some products of conception remain in the uterus

A

incomplete abortion

52
Q

crescent-shaped sonolucent fluid collection between gestational sac and uterine wall

A

subchorionic hemorrhage

53
Q

increases risk of:
spontaneous miscarriage
preeclampsia
placental abnormalities
preterm delivery

A

subchorionic hemorrhage

54
Q

pregnancy loss

A

abortion or miscarriage

55
Q

pregnancy that is no longer viable; uterus has not expelled contents

A

missed miscarriage

56
Q

miscarriage that is in progress

A

impending miscarriage

57
Q

miscarriage in which a portion of the fetal contents have been expelled with a portion remaining in the uterus

A

incomplete miscarriage

58
Q

encompasses disorders that begin at fertilization and involve abnormal proliferation of the trophoblasts that in a normal pregnancy would have gone on to form the placenta

A

gestational trophoblastic disease

59
Q

Most common forms of gestational trophoblastic disease

A

molar pregnancies

60
Q

anuclear oocyte is fertilized by a haploid sperm carrying an X chromosome, and the sperms chromosomes undergo duplication, the genetic result is a 46XX gestation of entirely paternal origin

A

complete hydatadidform molean

61
Q

anuclear oocyte may be fertilized by two spermatozoa, resulting in either a 46XX or 46XY gestation

A

complete hydatatidform mole

62
Q

occurs when an apparently normal oocyte is fertilized by sperm that duplicates itself or, rarely, by two spermatozoa

A

partial hydatidform mole

63
Q

triploid pregnancy with 69 chromosomes

A

partial hydatidform mole

64
Q

identifiable embryo or fetus may develop, along with a thick, hydropic placenta with focal areas of vesicular swelling

A

partial hydatatidform mole

65
Q

usually bilateral, measure between 6 and 12 cm, associated with molar pregnancies

A

theca lutein cysts

66
Q

complex echogenic intrauterine mass with multiple small cystic spaces

A

molar pregnancy

67
Q

may be recognized by measuring crown-rump length, NT, and maternal serum biochemisity

A

fetal aneuploidy

68
Q

acranial/anencephaly
holoprosencephaly
Dandy-Walker malformation
encephalocele
spina bifida

A

central nervous system abnormalities

69
Q

ectopia cordis, hypoplastic left heart syndrome, atrioventricular septal defect, conduction disorders, heart failuer

A

cardiac anomalies

70
Q

Hydatadidform moles are the result of:

A

abnormal fertilization

71
Q

Which of the following is the failure of a pregnancy to develop?
a. abortion
b. blighted ovum
c. inevitable abortion
d. anembryonic

A

d

72
Q

What term describes an abnormally slow heart rate?

A

bradycardia

73
Q

Select the term describing an abormal triploidy chromosomal number, fetus, and placenta.
a. molar pregnancy
b. partial hydatidform mole
c. hydatidiform mole
d. complete hydatidform mole

A

b

74
Q

Sonographic appearance of an inevitable abortion

A

empty low-lying gestational sac and an open cervix

75
Q

During the sonographic examination on a first-trimester pregnancy, a crescent complex fluid collection images between the gestational sac and uterus. What is the most likely differential?

A

subchorionic hemorrhage

76
Q

How does a second trimester hydatidform mole image during the sonographic examination?

A

large soft tissue mass of low- to moderate-amplitude echoes filling the uterine cavity and containing fluid-filled spaces

77
Q

Which of the following central nervous system malformations is identifiable in the first trimester?
a. spina bifida
b. ectopia cordis
c. cystic hygroma
d. omphalocele

A

a

78
Q

Uterine size estimation by physical examination, to determine pregnancy age, may be inaccurate owing to all except:
a. uterine fibroids
b. maternal obesity
c. surgical scars
d. parity

A

d

79
Q

What laboratory value is useful when a smaller than expected gestational sac is seen with ultrasound?

A

hCG

80
Q

Early-onset intrauterine growth restriction is defined as crown-rump length at least ___ standard deviations below the mean for the expected gestational age.

A

2

81
Q

Spontaneous pregnancy loss before 20 weeks (of clinically recognized gestations) is as high as:

A

10-20%

82
Q

A pregnancy less than 20 weeks with vaginal bleeding is termed:

A

threatened abortion

83
Q

A gestational sac without an embryo or yolk scan with a mean sac diameter greater than ____ (EV) generally predicts pregnancy failure.

A

20mm

84
Q

Select the yolk sac with the healthiest characteristics.
a. oblong
b. round
c. less than two standard deviations below the mean yolk sac diameter for gestational age
d. more than two standard deviations above the mean yolk sac diameter for a gestational age

A

b

85
Q

Pregnancy failure is most likely to occur when the fetal heart rate is:
a. 150 bpm at 8 weeks
b. greater than or equal to 155 bpm at 6.3 to 7 weeks
c. 120 to 130 bpm at 9 weeks
d. less than 110 bpm at 6.3 to 7 weeks

A

d

86
Q

Select the statement which does not indicate probable embryonic demise.
a. 6 mm embryo without cardiac activity
b. no double bleb sign with a less than 5 mm embryo
c. no cardiac activity with a less than 5 mm embryo and double bleb sign
d. enlarged amniotic sac with less than 5 mm embryo

A

c

87
Q

The risk of spontaneous miscarriage, preeclampsia, placental abnormalities, or preterm delivery is increased by crescent shaped sonolucent fluid between the gestational sac and the uterine wall as is called:

A

subchorionic hematoma

88
Q

A complete hydatidform mole usually results in:
a. large-for-dates uterus and vaginal bleeding
b. a triploid pregnancy with 69 chromosomes
c. vaginal bleeding and a small-for-dates or normal-sized uterus
d. a thick, hydropic placenta

A

a

89
Q

Select the measurement not usually included in a first-trimester screening for assessing risk in a chromosomally abnormal fetus.
a. CRL
b. NT
c. MSD
d. Ductus venous Doppler velocitmetry

A

b

90
Q

Hydaditidform moles are caused by:

A

abnormal fertilization

91
Q

Select the correct sonographic appearance for impending abortion.
a. early empty gestational sac
b. crescent-shaped fluid collection between the gestational sac and uterus
c. oval-shaped gestational sac
d. empty low-lying gestational sac, open cervix

A

d

92
Q

Theca lutein cysts are usually stimulated by excessive levels of hCG and are related to:

A

complete molar pregnancy

93
Q

The recommended first-trimester screening tests for assessing the risk of carrying a chromosomally abnormal embryo include all except:
a. measuring CRL
b. measuring NT
c. measure FHR
d. testing maternal serum biochemistry levels

A

c

94
Q

Select a first trimester fetal central nervous system abnormality.
a. Dandy-Walker malformation
b. Dysplastic kidney
c. Ectopia cordis
d. Gastroschisis

A

a

95
Q

When the uterus is smaller than expected, ultrasound is used to rule out incorrect dates, early pregnancy failure, or _____ pregnancy.

A

ectopic

96
Q

In women with vaginal ______ or _____, the risk of pregnancy loss increases.

A

bleeding
pain

97
Q

Genetic abnormalities cause ____ of pregnancy failure.

A

50-70%

98
Q

A patient with an anembryonic pregnancy or embryo demise that has not yet been expelled from the uterus is labeled as a ______ or _______.

A

missed
delayed abortion

99
Q

A blighted ovum is also called a(n) _____.

A

anembryonic pregnancy

100
Q

Visualization of an amnion without sonographic evidence of an embryo is called ______.

A

empty amnion sign

101
Q

Routine obstetric ultrasound done between approximately 6 and 12 weeks divulging a normal singleton fetus, demonstrates a miscarriage rate of ____.

A

1.6%

102
Q

An embryo measureing ____ or greater should demonstrate cardiac activity.

A

5 mm

103
Q

A failed early pregnancy that is in the process of being expelled from the uterus is called an ______.

A

impending abortion

104
Q

Uterine fibroids may be associated with _____ labor, premature _____ of membranes, and fetal ______.

A

preterm
rupture
malposition

105
Q

Enlarged ovaries are frequenty seen during complete molar pregnancy as a result of elevated _____ levels.

A

hCG

106
Q

Molar pregnancy has the ability to develop into_______.

A

either locally or metastatic GTN

107
Q

Holoprosencephaly is a _____ system abnormality.

A

central nervous

108
Q

A patient diagnosed with molar pregnancy should have a weekly blood test for ___ consecutive weeks until her hCG levels return to normal.

A

3

109
Q

Toxemia of pregnancy presents as a pregnancy induced hypertension, proteinuria, edema, and headache (preeclampsia) and may progress to ______.

A

eclampsia (seizures)

110
Q
A

OB 1 (16 decks)

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