Chapter 23 The First Trimester Flashcards
What is the most likely metastatic location for GTD?
Lungs
What is associated with a lower-than normal hCG level:
- Ectopic pregnancy
- Blighted ovum
- Spontaneous abortion
A malignant form of GTD is:
Choriocarcinoma
Consistent with a complete hydatidiform mole:
- Heterogenous mass within the endometrium
- Bilateral theca lutein cysts
- Hyperemesis gravidarum
In the early gestation, where is the secondary yolk sac location?
Chorionic cavity
Contributing factors for an ectopic pregnancy:
- PID
- Assisted reproductive therapy
- IUCD
The structure created by the union of sperm and egg is the:
Zygote
The trophoblastic cells produce:
hCG
Another name for the chorionic sac is the:
Gestational sac
What is often used to medically treat an ectopic pregnancy?
Methotrexate
What structure lies within the extraembryonic coelim?
Yolk sac
What is the most common form of GTD?
Complete molar pregnancy
In the first trimester normal hCG levels will:
Double every 48 hours
What location for an ectopic pregnancy would be least likely?
Ovary
The first sonographically identifiable sign of pregnancy is the:
Decidual reaction
NT measures are typically obtained between:
11 and 14 weeks
The normal gestational sac will grow:
1mm per day
The most common pelvic mass associated with pregnancy is the:
Corpus luteum cyst
What hormone maintains the corpus luteum during pregnancy?
hCG
What is associated with an abnormal NT?
- Trisomy 16
- Trisomy 18
- Turner syndrome
The most common location of an ectopic pregnancy is the:
Ampullary portion of the uterine tube
The most common cause of pelvic pain with pregnancy is:
Ectopic pregnancy
Fertilization typically occurs within ______after ovulation
24 hours
What is the name of the dominant follicle prior to ovulation?
Graafian
What structure connects the embryo to the yolk sac?
Vitelline duct
Compared with a normal IUP, the ectopic pregnancy will have a:
Low hCG
The first structure noted within the gestational sac is the:
Yolk sac
During a 12 week sonogram, bilateral echogenic structures are noted within the lateral ventricles of the fetal cranium. These structures most likely represents:
Choroid plexus
With a normal pregnancy the first structure noted within the decidualized endometrium is the:
Chorionic sac
What is the stage of the conceptus that implants within the decidualized endometrium?
Blastocyst
The migration of the embryologic bowel into the base of the umbilical cord at 9 weeks is referred to as:
Physiologic bowel herniation
During a first-trimester sonogram, you note a round, cystic structure within the fetal head. This most likely represents:
Rhombencephalon
What hormone, produced by the corpus luteum, maintains the thickened endometrium?
Progesterone
Normal hCG levels ______every 48 hours in the first trimester
Double
______is a bleed between the endometrium and the gastational sac
Subchorionic hemorrhage (perigestational hemorrhage)
_____is coexisting ectopic and intrauterine pregnancies
Heterotopic pregnancy
By 7 weeks, the bpm should be at least ______
120
Treatment for GTD includes:
- D&C
- hCG monitioring
- Hysterectomy
- Possibly chemotherapy
The alimentary canal will become the:
- Foregut
- Midgut
- Hindgut
The normal embryonic heart rate at 6 weeks is typically between _______
100 and 110 bpm
The most common abnormalities associated with increased NT are:
- Trisomy 21
- Trisomy 18
- Turner syndrome
- Congestive heart failure
The placenta is formed by the:
*Decidual basalis
*Maternal contribution of the placenta
*Chorion frondosum
*Fetal contribution
The embryonic heart rate increases to ______by 9 weeks
150 bpm
Embryonic heart rate is considered normal at _____between 5 and 6 weeks
100-110 bpm
The embryo will grow at a rate of _____per day in the first trimester
1mm
The _____contains simple-appearing amniotic fluid and the developing embryo
Amniotic cavity
The chorionic cavity lies between the:
Amnion and chorion
The gestational sac consists of two cavities:
*Chorionic cavity
*Amniotic cavity
Conception usually occurs within ______after ovulation
24 hours
_____also referred to as fertilization, is the union of an ovum and a sperm
Conception
The most common pelvic mass associated with pregnancy is the:
Ovarian corpus luteum cyst
Fetal limb buds are readily identified by:
7 weeks
hCG is detected in the maternal blood as early as:
23 days menstrual age
The neural tube will become:
Fetal head and spine
The inner part of the blastocyst will develop into the:
*Embryo
*Amnion
*Umbilical cord
*Primary and secondary yolk sac
The outer part, the trophoblastic tissue, will develop into the:
Placenta and chorion
The blastocyst makes these link with the maternal endometrium via small projections of tissue called:
Chorionic villi
_____is associated with a poor prognosis and is often the first sonographic sign of an eminent embryologic demise
Bradycardia
The thermal index, which is the amount of energy required to raise tissue temperature 1 Celsius, should be kept at:
Below 1
The _____will eventually develop into the fourth ventricle and several other essential brain structures
Rhombencephalon
_____begins at 8 weeks, which marks the developmental stage when the midgut migrates into the base of the umbilical cord
Physiologic bowel herniation
The combination of the sperm and ovum produces a structure referred to as the:
Zygote
The zygote undergoes rapid cellular division and eventually forms into a cluster of cells called the:
Morula
The _____is visible during the latter half of the first trimester as a tortuous structure connecting the fetus to the developing placenta
Umbilical cord
______is a group of disorders that result from an abnormal combination of male and female gametes
Benign gestational trophoblastic disease (GTD)
_____is a chemotherapy drug used to attack rapidly dividing cells like those seen in an early pregnancy, used to manage ectopic pregnancies
Methotrexate
______or______ is diagnosed when there is no evidence of a fetal pole or yolk sac within the gestational sac
*Blighted ovum
*Anembryonic gestation
_____denotes the appearance of the small gestational sac in the uterine cavity surrounded by the thickened, echogenic endometrium
Intradecidual sign
_______is the normal sonographic appearance of the decidua capsularis and decidua parietalis, separated by the anechoic fluid-fluid uterine cavity
Double decidual sign
Clinical findings of molar pregnancy
- Hyperemesis gravidarum
- Markedly elevated hCG level
- Heavy vaginal bleeding
- Enlarged uterus
- Possible preeclampsia or eclampsia
- Hypertension and/or hyperthyroidism
Clinical findings of partial molar pregnancy
- Normal physical exam
- Normal or slightly evaluated hCG level
- Smaller than normal uterus
- Possible vaginal bleeding
Clinical findings of the corpus luteum of pregnancy
- Asymptomatic
- Pain associated with hemorrhage and enlargement of cyst
Clinical findings of blighted ovum
- Vaginal bleeding
- Reduction of pregnancy symptoms
- Low hCG
Clinical findings of embryonic or fetal demise
- Vaginal bleeding
- Small for dates
- Closed cervix
- Low (based on LMP) hCG
Clinical findings of subchorionic hemorrhage
- Vaginal bleeding or spotting
- Uterine cramping
- Closed cervix
Clinical findings of a uterine leiomyoma (with pregnancy)
- Positive pregnancy test
- Pelvic pressure
- Menorrhagia
- Palpable pelvic mass
- Enlarged, bulky uterus
- Urinary frequency
- Dysuria
- Constipation
Sonographic findings of blighted ovum
- Large, irregular gestational sac without an embryo or yolk sac
- Absent or minimal gestational growth
- Poor decidual reaction
Sonographic findings of embryonic or fetal demise
- No detection fetal heart activity in a pole that measures 4-5mm
- Irregular shaped fetus
- Irregular sized gestational sac
- Irregular appearing yolk sac
Sonographic findings of subchorionic hemorrhage
- Crescent-shaped anechoic, echogenic, or hypoechoic area adjacent to the gestational sac
- May resemble a second gestational sac
Sonographic findings of uterine leiomyoma
- Hypoechoic mass within the uterus
- Posterior shadowing
- Degenerating fibroids may have calcifications or cystic components
- Multiple fibroids appears as an enlarged, irregularly shaped, enlarged heterogeneous uterus
Sonographic findings of partial molar pregnancy
- Complex mass within the uterus partially filling the uterine cavity adjacent to the gestational sac
- “Vesicular snowstorm appearance” secondary to placental enlargement
- Multiple, variable-sized cysts replacing the placental tissue (Hydropic chorionic villi)
- Triploid fetus
Sonographic findings of the corpus luteum of pregnancy
- Simple cyst appearance
- A cyst with a thick, echogenic rim around it
- Hemorrhagic cyst appearance, including complex components or entire echogenic depending on the amounts of blood and stage of lysis
Sonographic findings of complete molar pregnancy
- Complex mass within the uterus
- Color doppler may reveal hypervascularity around the mass but not within it
- “Vesicular snowstorm appearance” secondary to placental enlargement
- Multiple variable-sized cysts replacing the placental tissue
- Bilateral ovarian theca lutein cysts
