Ectopic & GTD Flashcards
What’s the risk of recurrence with ectopic pregnancy?
12-18%
What is the chance of an ectopic in the normal population?
1/8000
What is the chance of an ectopic in the fertiligy patient population?
1/1800
Where should you always look for an ectopic pregnancy?
morrison’s pouch
What is the ‘ring of fire’ sign?
Color doppler signal surrounding the gestational sac
What is the most common site for an ectopic implantation?
ampulla of the ovaduct
Adnexal implantation includes the…
isthmus, ampulla, fimbria, and interstitial areas.
Which is the most life-threatening of all ectopic gestations?
interstitial ectopic
This exists when the conceptus implants on any site within the uterus that is outside the endometrial cavity.
‘uterine’ ectopic pregnancy
‘Uterine’ ectopic pregnancy is suggested by a gestational sac that high in the fundus and NOT surrounded by at least ___ of myometrium in all planes.
5 mm
Cervical ectopics carry high ___ rates and attempts to evacuate the conceptus can cause ___.
morbidity and mortality, massive hemorrhage
Why might a woman with an ectopic pregnancy have pain in her shoulder?
because of intraperitoneal hemorrhage
This is a concomitant intrauterine implantation AND an extrauterine implantation.
heterotopic gestation
About when does an isthmus ectopic rupture?
6-8 weeks
About when does an ampullary ectopic rupture?
8-12 weeks
About when does an interstitial ectopic rupture?
12-16 weeks
This folic acid antagonist has been shown to destroy proliferating trophoblast and may be effective in small unruptured ectopics.
Methotrexate (MTX)
This physical sign is usually associated with intraperitoneal bleeding from hemorrhagic pancreatitis, ruptured abd aorta or ruptured ectopic.
Grey-Turner sign
What constitutes a Grey-Turner sign?
ecchymosis on the side of the abdomen
This is when the conceptus trophoblast layers proliferates and not the embryoblast; no embryo develops.
gestational trophoblastic disease
This abnormal fertilization process is a complication of pregnancy that is increased in older and very young women.
molar gestation
Name two clinical indicators of molar gestation.
- vaginal bleeding in the first or early second trimester
2. serum levels of beta-hCG are DRAMATICALLY elevated
T/F? Women with a molar pregnancy may experience hyperemesis, preeclampsia, and PIH.
true
T/F? Women with a molar pregnancy have AFP levels that are very high.
FALSE, very low
T/F? Women with a molar pregnancy have a fundal height that is higher than dates.
true
GTD affects how many pregnancies in the US?
1/1500 or 2000
What is the characteric sonographic appearance of GTD?
the ‘snowstorm’, an echogenic mass containing cystic spaces
This is the most common form of GTD.
Complete hydatidform mole
How often does a complete mole happen in the US?
1:1500
This is the most common form of GTD, occuring in 1/1500 and 5% risk of recurrence.
complete hydatidifom mole
T/F? In a complete mole no identifiable fetal tissue is present.
true
A complete mole occurs when sperm fertilizes an ___ ovum.
empty.
A complete mole is completely ___ in origin.
paternal
What are the risk factors for a complete mole?
- under 20 or over 40
- low economic status
- deficient in protein & folic acid
T/F? In the 2nd trimester, a complete mole is hypervascular, with high velocity and low resistance.
FALSE, 1st trimester
T/F? In the 1st trimester, a complete mole will present with unilateral theca lutein cysts.
FALSE, bilateral
T/F? In the 2nd trimester, a complete mole has areas of necrosis.
true
In complete moles, these are an ovarian response to excess hCG secretion by the GTN.
theca lutein cysts
This form of GTD is commonly found to have 1 set of maternal chromosomes and 2 sets of paternal chromosomes.
Partial mole
This GTD occurs when the mass contains a severely defective embryo and abnormal cells.
Partial mole
What is a triploid karyotype?
Three sets of chromosomes
A partial mole results when…
Two sperms fertilize a single ovum.
Partial miles present with…
- Deformed gest. sac
- Growth restricted triploid fetus
- Large cystic placenta
- Similar to a missed abortion
This GTD is similar to a partial mole but with a normal karyotype fetus.
Mole with coexisting normal fetus
This condition most commonly follows GTD.
Persistent trophoblastic neoplasia (PTN)
This is another phrase for PTN.
Recurrence of molar tissue
This is the most common form of PTN.
Invasive mole
This GTD penetrates the myometrium; may cause rupture and hemoperitoneum.
Invasive mole
This is considered a malignant, non metastatic form of GTD.
Invasive mole
What’s another term for invasive mole?
Chorioadenoma destruens
This GTD presents as echogenic material that may extend into the myometrium with irregular sonolucent areas; ‘lights up like a Christmas tree’.
Invasive mole
This form of GTD is considered malignant and metastatic.
Choriocarcinoma
This form of GTD is very rare, 1:30,000 pregnancies.
Choriocarcinoma
How many GTD pregnancies give rise to choriocarcinoma?
1:40
The GTD that leads to vascular invasion, hemorrhage, and necrosis of the myometrium is…
Choriocarcinoma
This GTD presents with an enlarged uterus with a vascular irregular complex mass.
Choriocarcinoma
T/F? Choriocarcinoma presents in non pregnant patients with an elevated hCG.
True
Patients with choriocarcinoma are often counseled to avoid pregnancy for at least ___ to minimize the risks.
One year
