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Spring 2014 - OB TEST 10 - 1st TRIMESTER COMPLICATIONS ✔️ > Complications > Flashcards

Complications Flashcards

0
Q

What is an embryonic demise?

A

Clear evidence of a nonviable embryo

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1
Q

What are THREATENED ABORTION complications?

A 
Less than 20 wks
Viable embryo
Fetal heartbeat
Vaginal bleeding
Cervix long & closed

*if complications are present, 50% will miscarry or abort

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2
Q

What is a characteristic of a BLIGHTED OVUM/ANEMBRYONIC PREGNANCY?

A

GS with no visible embryo

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3
Q

Intrauterine fetal demise can occur _________ throughout a pregnancy.

A

Anytime

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4
Q

Intrauterine fetal demise incidence in 1st trimester occurs _________% of the time.

A

15-20

*usually caused by chromosomal abnormalities

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5
Q

Approximately half of all intrauterine fetal demises are _________ mortality.

A

Perinatal

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6
Q

50% of intrauterine fetal demise are of unknown cause, what can cause a fetal demise?

A 
Congenital/chromosomal anomalies
Infection
Placental abruption
IUGR
Blood group isoimmunization
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7
Q

Spontaneous _________/_________ Prior to 20 weeks.

A

Abortion or miscarriage

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8
Q

_________ _________ After 20 weeks.

A

Fetal demise

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9
Q

What will be seen/not seen in an embryonic demise?

A

Early IUP visualized

No heart beat

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10
Q

Fetal heart tones should be heard with _________ 10-12 weeks menstrual age.

A

M mode

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11
Q

If there is no heart beat or cessation of fetal movement after initially felt, what should be done?

A

Immediate US exam

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12
Q

Sonographic findings of a fetal demise?

A

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)

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13
Q

Secondary signs of a fetal demise may take up to _________ days to develop.

A

Several

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14
Q

What can be measured during an US to determine the time of death of a fetus?

A

Femur length (FL)

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15
Q

Describe an Anembryonic pregnancy…

A

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

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16
Q

_________ _________ Is the most common reason for bleeding in the 1st trimester.

A

Subchorionic Hemorrhage

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17
Q

Symptoms of subchorionic hemorrhage…

A

Bleeding - low pressure bleed resulting from implantation
Spotting
Cramping

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18
Q

Subchorionic hemorrhage may lead to _________ _________ _________.

A

Spontaneous pregnancy loss

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19
Q

Subchorionic hemorrhage sonographic findings?

A

Separation between uterine wall & fetal membrane

Early echogenic - late hypoechoic

Color Doppler demonstrates no blood flow

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20
Q

Describe absent intrauterine sac…

A

Beta hCG level 1000-2000 mIU/ml

No IUP

Possibilities could include spontaneous abortion, ectopic, or incomplete abortion

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21
Q

Name the 4 types of spontaneous abortions.

A

Complete

Incomplete

Threatened

Inevitable

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22
Q

_________ _________ Products of conception are completely expelled.

A

Complete abortion

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23
Q

Clinical findings of complete abortion?

A

Bleeding/cramping

+ hCG

Beta hCG will decrease rapidly

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24
Q

Sonographic findings of complete abortion?

A

Empty uterus - endo usually < 5 mm

No adnexal masses

No free fluid

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25
Q

Clinical findings of an incomplete abortion?

A

May or may not have bleeding/cramping

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26
Q

Sonographic findings of an incomplete abortion?

A

Intact IUP

No embryo heartbeat

GS misshapen

Thickened endo > 5 mm

Obvious fetal parts

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27
Q

_________ _________ Is a 1st trimester pregnancy typically associated with bleeding.

A

Threatened abortion

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28
Q

With a threatened abortions, the embryo is still _________ but often is showing signs of _________.

A

Alive

Distress

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29
Q

Sonographic findings of threatened abortion?

A

Lack of expected growth of GS/embryo

Decreased fetal HR (<95 BPM)

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30
Q

Clinical findings of an inevitable abortion?

A

+ hCG

Vaginal bleeding/cramping

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31
Q

Describe an inevitable abortion…

A

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

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32
Q

_________ _________ _________ Is a proliferative disease of the trophoblast after abnormal conception - MOLAR PREGNANCY.

A

Gestational trophoblastic disease

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33
Q

Molar pregnancies affect approximately _________ pregnancies.

A

1 of every 1000

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34
Q

Women under _________ or over _________ years old are more likely to have a molar pregnancy.

A

20

40

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35
Q

Clinical symptoms of gestational trophoblastic disease?

A

Vaginal bleeding

Hyperemesis

Extremely elevated beta hCG

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36
Q

What diseases could gestational trophoblastic disease/molar pregnancy cause?

A

Hydatidform mole (h-mole)

Choriocarcinoma

Bilateral theca lutein cysts

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37
Q

_________ Is a partial, complete (classic), & complete with co-existing fetus.

A

Hydatidform mole or h-mole

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38
Q

H-mole partial usually _________ chromosomes.

A

Abnormal

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39
Q

Sonographic findings of h-mole?

A

“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

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40
Q

Treatment for h-mole is…

A

D&E (dilate & evacuate)

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41
Q

After treatment for h-mole, _________ should return to normal within 10-12 weeks.

A

Serum hCG

42
Q

What is the most COMMON and most BENIGN form of trophoblastic disease?

A

H-mole of any kind…complete, partial, or complete with co-existing fetus

43
Q

What is a complete or “classic” h-mole?

A

Egg with an absent or inactivated nucleus - only fathers chromosomes

44
Q

What is a complete h-mole with co-existing fetus?

A

One normal/other is a mole

45
Q

What is a partial h-mole?

A

Normal egg fertilized by 2 different sperm - triple chromosomes

46
Q

_________ _________ _________ Is an invasive mole - chorioadenoma destruens.

A

Malignant trophoblastic disease

47
Q

Describe non metastatic malignant trophoblastic disease…

A

May be seen with molar pregnancy or after evacuation

Hydropic villi invade myometrium

May even penetrate uterine wall

48
Q

Clinical findings of non metastatic malignant trophoblastic disease?

A

Continued heavy bleeding

Highly elevated hCG

Theca lutein cysts beyond 4 months post evacuation

49
Q

Sonographic findings of a non metastatic malignant trophoblastic disease?

A

Enlarged uterus

Multiple focal areas of GRAPELIKE clusters

50
Q

_________ Is a highly metastatic trophoblastic tumor.

A

Choriocarcinoma

51
Q

Describe choriocarcinoma…

A

Fast growing

Mets to lung (MOST COMMON), liver & brain

Vaginal bleeding, dyspnea, ABD pain, neurological symptoms

Persistent theca lutein cysts

Increased hCG levels

52
Q

Heart rate should be detected by _________ weeks or _________ mm on TV.

A

5.5-6.5 wks

5 mm

53
Q

Heart rate below 90 BPM is called _________.

A

Bradycardia

*poor prognosis

54
Q

Heart rate over 170 BPM is called _________.

A

Tachycardia

  • may lead to heart failure
  • hydrops - pleural effusion, pericardial effusion, ascites
55
Q

Describe embryonic oligo & growth restrictions…

A

GS measures 5 mm < CRL

Demise highly likely

Usually related to chromosomal abnormalities

Must have accurate dating to verify

56
Q

Normal yolk sac diameter is _________ mm between 5-10 weeks.

A

5.5

57
Q

Yolk sac over 5.6 mm has an increased risk for a _________ _________.

A

Spontaneous abortion

58
Q

What 3 things about the yolk sac are early signs of pregnancy failure?

A

Too large

Mis-shapen

Echogenic

59
Q

_________ _________ Is an implantation of a developing zygote outside the endometrial cavity.

A

Ectopic pregnancy

60
Q

How often do ectopic pregnancies occur?

A

1 in every 100-400 pregnancies

61
Q

Ectopic pregnancies have a higher incidence rate with infertility due to _________ _________.

A

Tubal pathology

62
Q

Ectopic pregnancies are missed what percent of the time?

A

70%

Symptoms are nonspecific

63
Q

3 reasons ectopic pregnancies occur?

A

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

64
Q

4 maternal risk factors of ectopic pregnancy?

A

Previous ectopic pregnancy (25% reoccurrence)

History of PID

Tubal reconstructive surgery (re-anastamosis)

Recent ART - IVF

65
Q

Locations of ectopic pregnancies?

A

MOST COMMON - tubal, majority in ampulla

ABD, ovary, cervix

66
Q

Tubal ectopic pregnancies are more common on what side?

A

Right

67
Q

33% of ectopics have corpus luteum on _________ side as ovum migrates from one ovary to opposite tube.

A

Contralateral

68
Q

Clinical symptoms of ectopic pregnancy? These are called the “classic triad”.

A

Pain

Abnormal vaginal bleeding

Abnormal adnexal mass

69
Q

Other symptoms of ectopic pregnancy are…

A

Diffuse ABD pain

Rebound tenderness

Right shoulder pain

Mild uterine enlargement

70
Q

5 types of ectopic pregnancies?

A

Ampullary

Isthmus

Interstitial

Abdominal

Cervical

71
Q

Describe ampullary ectopic pregnancy…

A

MOST COMMON tubal location

Adjacent to ovary

72
Q

Describe isthmus ectopic pregnancy…

A

Tend to rupture early due to small diameter

73
Q

Describe interstitial ectopic pregnancy…

A

MOST DANGEROUS tubal site

Located within muscular cornua; ectopic may grow 3-4 months; highly vascular area > hemorrhage could occur

74
Q

Describe abdominal ectopic pregnancy…

A

Can grow to full term, but will need a c-section

Sac is attached to omentum

Fetus is abortd through the fimbrated

75
Q

Describe cervical ectopic pregnancy…

A

MOST DANGEROUS location overall

High likelihood of hemorrhage if rupture occurs

76
Q

Ectopic pregnancy is a GS with either yolk sac, embryo, and/or cardiac cavity _________ the endometrial cavity.

A

Outside

77
Q

4 other signs that suggest an ectopic pregnancy…

A

Adnexal mass

Fluid in posterior cul de sac

Absence of IUP in the presence of a + beta hCG

Pseudogestational sac in endometrial cavity

78
Q

What is a pseudogestational sac?

A

Intrauterine fluid collection that may mimic a GS in the endo cavity

79
Q

What can a pseudogestational sac also be called?

A

Decidual cyst

80
Q

Where is a pseudogestational sac located?

A

In the exact center of the uterus with only 1 ring of decidua > the near decidual reaction

81
Q

Where is an IU GS located?

A

Eccentrically within endo cavity with 2 rings of decidua

82
Q

What is a heterotrophic pregnancy?

A

Ectopic pregnancy & an IUP occurring at the same time

Increased incidence in women undergoing ART

83
Q

Detection of hCG may occur with _________ days post conception.

A

10 days

84
Q

HCG levels will be _________ with an ectopic pregnancy. Why?

A

Lower

*due to lesser amount of trophoblastic tissue around GS

85
Q

What equipment is better with increased sensitivity?

A

TV or higher frequency transducers

86
Q

Embryonic abnormalities that can occur end of 1st trimester or 2nd trimester?

A

Monoamniotic twins

Conjoined twins

Cardiac arrest

Cystic hygroma

ABD wall defects

Cranial & spinal abnormalities

87
Q

Describe Nuchal translucency…

A

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

88
Q

Cardiac defects in general…

A

Will look for specific markers

Ectopia cordis

Limb body wall complex

89
Q

Describe cranial anomalies in general…

A

Should be confirmed at 12-14 wks

Acrania
Anencephaly
Cephalocele
Iniencephaly
Ventriculomegaly
Holoprosencephaly
90
Q

Describe Dandy-Walker malformation…

A

Cystic dilation of 4th ventricle

Occurs 6th-7th wk gestation

Large posterior fossa cyst

91
Q

Describe spina bifida…

A

Occurs after 6 weeks

May be detected at end of 1st trimester

Spinal irregularities of bulging

Extrusion of mass from vertebral column

92
Q

Abnormal wall defects are?

A

Bowel herniation

Gastroschisis

Omphalocele

93
Q

What is bowel herniation?

A

Echogenic mass at base of umbilical cord

May include liver

94
Q

What is gastroschisis?

A

Anterior ABD wall mass usually to right of umbilical cord

95
Q

What is omphalocele?

A

ABD contents into base of umbilical cord

May contain just bowel or bowel and organs

May contain just bowel - usually associated with chromosomal abnormalities

96
Q

What is obstructive uropathy?

A

Bladder visualized at 10-12 wks gestation

Large urinary bladder visualized if obstruction at urethra

97
Q

What is cystic hygroma?

A

One of the most common 1st trimester abnormality identified

Associated with trisomy 13, 18, 21 & Turners syndrome

Cystic mass posterior aspect fetal neck

98
Q

What is an umbilical cord cyst?

A

Vary in size from 2-7.5 mm

May resolve in 2nd trimester

If persists, may be associated with other anomalies

May be innocent

99
Q

What are 4 1st trimester pelvic masses?

A

Ovarian masses

Corpus luteum cyst

Uterine masses

Fibroids (MOST COMMON)

100
Q

Describe corpus luteum cysts…

A

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

101
Q

Why do fibroids grow rapidly?

A

Because of estrogen stimulation

102
Q

What must be done if a mass is found in a 1st trimester patient?

A

Mass must be identified and relationship described to GS

Spring 2014 - OB TEST 10 - 1st TRIMESTER COMPLICATIONS ✔️ (1 decks)

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