Complications Flashcards
What is an embryonic demise?
Clear evidence of a nonviable embryo
What are THREATENED ABORTION complications?
Less than 20 wks Viable embryo Fetal heartbeat Vaginal bleeding Cervix long & closed
*if complications are present, 50% will miscarry or abort
What is a characteristic of a BLIGHTED OVUM/ANEMBRYONIC PREGNANCY?
GS with no visible embryo
Intrauterine fetal demise can occur _________ throughout a pregnancy.
Anytime
Intrauterine fetal demise incidence in 1st trimester occurs _________% of the time.
15-20
*usually caused by chromosomal abnormalities
Approximately half of all intrauterine fetal demises are _________ mortality.
Perinatal
50% of intrauterine fetal demise are of unknown cause, what can cause a fetal demise?
Congenital/chromosomal anomalies Infection Placental abruption IUGR Blood group isoimmunization
Spontaneous _________/_________ Prior to 20 weeks.
Abortion or miscarriage
_________ _________ After 20 weeks.
Fetal demise
What will be seen/not seen in an embryonic demise?
Early IUP visualized
No heart beat
Fetal heart tones should be heard with _________ 10-12 weeks menstrual age.
M mode
If there is no heart beat or cessation of fetal movement after initially felt, what should be done?
Immediate US exam
Sonographic findings of a fetal demise?
Absent of heart beat & motion
Overlap of skull bones - Spalding’s sign
Exaggerated curvature of the spine
Gas in fetal ABD/echogenic fetal heart
Fetal skin edema (may take 2-4 days to develop)
Secondary signs of a fetal demise may take up to _________ days to develop.
Several
What can be measured during an US to determine the time of death of a fetus?
Femur length (FL)
Describe an Anembryonic pregnancy…
Early IUP - MSD > 18 mm - grows < .6 mm/day
Yolk sac
No embryo
Also called a BLIGHTED OVUM
+hCG but doesn’t increase normally
GS echogenic
_________ _________ Is the most common reason for bleeding in the 1st trimester.
Subchorionic Hemorrhage
Symptoms of subchorionic hemorrhage…
Bleeding - low pressure bleed resulting from implantation
Spotting
Cramping
Subchorionic hemorrhage may lead to _________ _________ _________.
Spontaneous pregnancy loss
Subchorionic hemorrhage sonographic findings?
Separation between uterine wall & fetal membrane
Early echogenic - late hypoechoic
Color Doppler demonstrates no blood flow
Describe absent intrauterine sac…
Beta hCG level 1000-2000 mIU/ml
No IUP
Possibilities could include spontaneous abortion, ectopic, or incomplete abortion
Name the 4 types of spontaneous abortions.
Complete
Incomplete
Threatened
Inevitable
_________ _________ Products of conception are completely expelled.
Complete abortion
Clinical findings of complete abortion?
Bleeding/cramping
+ hCG
Beta hCG will decrease rapidly
Sonographic findings of complete abortion?
Empty uterus - endo usually < 5 mm
No adnexal masses
No free fluid
Clinical findings of an incomplete abortion?
May or may not have bleeding/cramping
Sonographic findings of an incomplete abortion?
Intact IUP
No embryo heartbeat
GS misshapen
Thickened endo > 5 mm
Obvious fetal parts
_________ _________ Is a 1st trimester pregnancy typically associated with bleeding.
Threatened abortion
With a threatened abortions, the embryo is still _________ but often is showing signs of _________.
Alive
Distress
Sonographic findings of threatened abortion?
Lack of expected growth of GS/embryo
Decreased fetal HR (<95 BPM)
Clinical findings of an inevitable abortion?
+ hCG
Vaginal bleeding/cramping
Describe an inevitable abortion…
GS with fetus in uterus
Detached from uterus
May lie in LUS
GS surrounded by hemorrhage
Spontaneous abortion will happen within couple hrs or less
_________ _________ _________ Is a proliferative disease of the trophoblast after abnormal conception - MOLAR PREGNANCY.
Gestational trophoblastic disease
Molar pregnancies affect approximately _________ pregnancies.
1 of every 1000
Women under _________ or over _________ years old are more likely to have a molar pregnancy.
20
40
Clinical symptoms of gestational trophoblastic disease?
Vaginal bleeding
Hyperemesis
Extremely elevated beta hCG
What diseases could gestational trophoblastic disease/molar pregnancy cause?
Hydatidform mole (h-mole)
Choriocarcinoma
Bilateral theca lutein cysts
_________ Is a partial, complete (classic), & complete with co-existing fetus.
Hydatidform mole or h-mole
H-mole partial usually _________ chromosomes.
Abnormal
Sonographic findings of h-mole?
“Snowstorm” appearance within GS
Echogenic tissue within sac with cystic spaces
Distorted sac
May or may not have coexisting fetus - partial
Increased blood flow around the sac
Theca lutein cyst seen
Treatment for h-mole is…
D&E (dilate & evacuate)
After treatment for h-mole, _________ should return to normal within 10-12 weeks.
Serum hCG
What is the most COMMON and most BENIGN form of trophoblastic disease?
H-mole of any kind…complete, partial, or complete with co-existing fetus
What is a complete or “classic” h-mole?
Egg with an absent or inactivated nucleus - only fathers chromosomes
What is a complete h-mole with co-existing fetus?
One normal/other is a mole
What is a partial h-mole?
Normal egg fertilized by 2 different sperm - triple chromosomes
_________ _________ _________ Is an invasive mole - chorioadenoma destruens.
Malignant trophoblastic disease
Describe non metastatic malignant trophoblastic disease…
May be seen with molar pregnancy or after evacuation
Hydropic villi invade myometrium
May even penetrate uterine wall
Clinical findings of non metastatic malignant trophoblastic disease?
Continued heavy bleeding
Highly elevated hCG
Theca lutein cysts beyond 4 months post evacuation
Sonographic findings of a non metastatic malignant trophoblastic disease?
Enlarged uterus
Multiple focal areas of GRAPELIKE clusters
_________ Is a highly metastatic trophoblastic tumor.
Choriocarcinoma
Describe choriocarcinoma…
Fast growing
Mets to lung (MOST COMMON), liver & brain
Vaginal bleeding, dyspnea, ABD pain, neurological symptoms
Persistent theca lutein cysts
Increased hCG levels
Heart rate should be detected by _________ weeks or _________ mm on TV.
5.5-6.5 wks
5 mm
Heart rate below 90 BPM is called _________.
Bradycardia
*poor prognosis
Heart rate over 170 BPM is called _________.
Tachycardia
- may lead to heart failure
- hydrops - pleural effusion, pericardial effusion, ascites
Describe embryonic oligo & growth restrictions…
GS measures 5 mm < CRL
Demise highly likely
Usually related to chromosomal abnormalities
Must have accurate dating to verify
Normal yolk sac diameter is _________ mm between 5-10 weeks.
5.5
Yolk sac over 5.6 mm has an increased risk for a _________ _________.
Spontaneous abortion
What 3 things about the yolk sac are early signs of pregnancy failure?
Too large
Mis-shapen
Echogenic
_________ _________ Is an implantation of a developing zygote outside the endometrial cavity.
Ectopic pregnancy
How often do ectopic pregnancies occur?
1 in every 100-400 pregnancies
Ectopic pregnancies have a higher incidence rate with infertility due to _________ _________.
Tubal pathology
Ectopic pregnancies are missed what percent of the time?
70%
Symptoms are nonspecific
3 reasons ectopic pregnancies occur?
Delayed transit of fertilized zygote secondary to fallopian tube malformation
Obstruction of passage of zygote through tube secondary to adhesions
Abnormal angulation of tube relative to cornua
4 maternal risk factors of ectopic pregnancy?
Previous ectopic pregnancy (25% reoccurrence)
History of PID
Tubal reconstructive surgery (re-anastamosis)
Recent ART - IVF
Locations of ectopic pregnancies?
MOST COMMON - tubal, majority in ampulla
ABD, ovary, cervix
Tubal ectopic pregnancies are more common on what side?
Right
33% of ectopics have corpus luteum on _________ side as ovum migrates from one ovary to opposite tube.
Contralateral
Clinical symptoms of ectopic pregnancy? These are called the “classic triad”.
Pain
Abnormal vaginal bleeding
Abnormal adnexal mass
Other symptoms of ectopic pregnancy are…
Diffuse ABD pain
Rebound tenderness
Right shoulder pain
Mild uterine enlargement
5 types of ectopic pregnancies?
Ampullary
Isthmus
Interstitial
Abdominal
Cervical
Describe ampullary ectopic pregnancy…
MOST COMMON tubal location
Adjacent to ovary
Describe isthmus ectopic pregnancy…
Tend to rupture early due to small diameter
Describe interstitial ectopic pregnancy…
MOST DANGEROUS tubal site
Located within muscular cornua; ectopic may grow 3-4 months; highly vascular area > hemorrhage could occur
Describe abdominal ectopic pregnancy…
Can grow to full term, but will need a c-section
Sac is attached to omentum
Fetus is abortd through the fimbrated
Describe cervical ectopic pregnancy…
MOST DANGEROUS location overall
High likelihood of hemorrhage if rupture occurs
Ectopic pregnancy is a GS with either yolk sac, embryo, and/or cardiac cavity _________ the endometrial cavity.
Outside
4 other signs that suggest an ectopic pregnancy…
Adnexal mass
Fluid in posterior cul de sac
Absence of IUP in the presence of a + beta hCG
Pseudogestational sac in endometrial cavity
What is a pseudogestational sac?
Intrauterine fluid collection that may mimic a GS in the endo cavity
What can a pseudogestational sac also be called?
Decidual cyst
Where is a pseudogestational sac located?
In the exact center of the uterus with only 1 ring of decidua > the near decidual reaction
Where is an IU GS located?
Eccentrically within endo cavity with 2 rings of decidua
What is a heterotrophic pregnancy?
Ectopic pregnancy & an IUP occurring at the same time
Increased incidence in women undergoing ART
Detection of hCG may occur with _________ days post conception.
10 days
HCG levels will be _________ with an ectopic pregnancy. Why?
Lower
*due to lesser amount of trophoblastic tissue around GS
What equipment is better with increased sensitivity?
TV or higher frequency transducers
Embryonic abnormalities that can occur end of 1st trimester or 2nd trimester?
Monoamniotic twins
Conjoined twins
Cardiac arrest
Cystic hygroma
ABD wall defects
Cranial & spinal abnormalities
Describe Nuchal translucency…
11 wks - 13 wks 6 days
Thickening if subcutaneous lucency at the back of neck
Should be less then 3 mm
Linked too trisomy 13, 18, 21 & fetuses with cardia issues
CRL 45-84 mm
Cardiac defects in general…
Will look for specific markers
Ectopia cordis
Limb body wall complex
Describe cranial anomalies in general…
Should be confirmed at 12-14 wks
Acrania Anencephaly Cephalocele Iniencephaly Ventriculomegaly Holoprosencephaly
Describe Dandy-Walker malformation…
Cystic dilation of 4th ventricle
Occurs 6th-7th wk gestation
Large posterior fossa cyst
Describe spina bifida…
Occurs after 6 weeks
May be detected at end of 1st trimester
Spinal irregularities of bulging
Extrusion of mass from vertebral column
Abnormal wall defects are?
Bowel herniation
Gastroschisis
Omphalocele
What is bowel herniation?
Echogenic mass at base of umbilical cord
May include liver
What is gastroschisis?
Anterior ABD wall mass usually to right of umbilical cord
What is omphalocele?
ABD contents into base of umbilical cord
May contain just bowel or bowel and organs
May contain just bowel - usually associated with chromosomal abnormalities
What is obstructive uropathy?
Bladder visualized at 10-12 wks gestation
Large urinary bladder visualized if obstruction at urethra
What is cystic hygroma?
One of the most common 1st trimester abnormality identified
Associated with trisomy 13, 18, 21 & Turners syndrome
Cystic mass posterior aspect fetal neck
What is an umbilical cord cyst?
Vary in size from 2-7.5 mm
May resolve in 2nd trimester
If persists, may be associated with other anomalies
May be innocent
What are 4 1st trimester pelvic masses?
Ovarian masses
Corpus luteum cyst
Uterine masses
Fibroids (MOST COMMON)
Describe corpus luteum cysts…
MOST COMMON
Less than 5 cm
Can become large
Should not be visualized past 18 wks
If persists after 18 wks surgery will fix it
High incidence of torsion
Why do fibroids grow rapidly?
Because of estrogen stimulation
What must be done if a mass is found in a 1st trimester patient?
Mass must be identified and relationship described to GS
