Early Pregnancy

Question 1

In early pregnancy scanning what does mechanical index indicate?

Answer 1

The potential for adverse bioeffect from non-thermal effects of ultrasound.

Question 2

What is a safe MI for early pregnancy scanning?

Answer 2

MI < 1.0 but aim for <0.7 ideally

Question 3

What does a TI indicated in early pregnancy scannning?

Answer 3

Thermal index - indicates potential for adverse effects from a potential rise in tissue temperature.

Question 4

The TIS on a scan is <0.7. What is the maximum length of scan time with this setting?

Answer 4

No restriction in early pregnancy

Question 5

A woman presents to EPAU approx 6 weeks from LMP. TVUS shows a gestational sac (max diameter 15mm), no yolk sac or embryo. How would you manage her?

Answer 5

Rescan > 7 days

MSD<25mm, therefore rescan

Question 6

A woman presents to EPAU at 6 weeks post LMP. TV US shows visible fetal pole with CRL 10mm with no FH. How would you manage her?

Answer 6

Diagnose miscarriage

CRL> or equal to 7mm with no FH

Question 7

At what gestation is a small gestational sac usually visible?

Answer 7

4+3 - 5+0

Question 8

What is the karyotype of a normal zygote?

Answer 8

46XX or 46XY

Question 9

What are the possible karyotypes of a complete hydatiform mole?

Answer 9

46XX (75-80%) or 46XY (20-25%)

2 x paternal sets (2 sperm, empty oocyte)

Question 10

What are the possible karyotypes of partial hydatiform mole?

Answer 10

69XXY, 69XXX, 69XYY (triploid karyotype 90%)
2 sets of paternal chromosomes + 1 set maternal
OR
92XXXY (tetraploid karyotype 10%) due to mitosis failure

Question 11

Which is more common, partial hydatiform mole or complete hydatiform mole?

Answer 11

Partial hydatiform mole

3:1000 pregnancies vs 1:1000

Question 12

What is the risk of developing GTN in the case of complete hydatiform molar pregnancy?

Answer 12

15%

Question 13

In cases of partial molar pregnancies, how long should follow up be for?

Answer 13

Serum and urine hCG every 2 weeks

If reducing, continue every 2 weeks until normal then 4 weeks after normal result

Question 14

In cases of complete hydatiform molar pregnancy, what should the follow up be?

Answer 14

2 weekly hcg
If normal at 56 days (8 weeks), monthly hcg levels for 6 months from evacuation
If still raised at 56 days, hcg monthly for 6 months since normal hcg

Question 15

What proportion of ectopic pregnancies are tubal?

Answer 15

95% - most common in ampulla