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Gynecology > Ectopic Pregnancy > Flashcards

Ectopic Pregnancy Flashcards

1
Q

What ultrasonic features suggest ectopic pregnancy?

A 
Adnexal mass
Free fluid
Absence of intrauterine gestation 
Possible pseudo gestational sac 
Always check kidneys for free fluid
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2
Q

How often do you only see a pseudo gestational sac in ectopic pregnancies?

A

20%

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3
Q

What are the differential diagnosis for ectopic pregnancies?

A

Early gestation- <5 weeks/bHCG increase

Aborted pregnancy- bHCG decrease

PID- bHCG negative

Ovarian cyst- bHCG negative

Endometriosis- bHCG negative

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4
Q

What are some abnormal reasons to bleed during pregnancy?

A 
Malignancies
Fibroids
Polyps
Adenomyosis
PID
Endometriosis
Ectopic pregnancy
Hydatidiform mole (choriocarcinoma)
Ovarian tumors
Placenta Previa
Abruptio placenta
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5
Q

When can the gestational sac be seen?

A

4 weeks

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6
Q

When is the gestational sac reliable when seen?

A

6 weeks

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7
Q

By how many weeks should the gestational sac take up half the total uterine volume?

A

8 weeks

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8
Q

Describe threatened abortion

A
  • vaginal bleeding
  • US shows normal pregnancy
  • may have cramping
  • possible implantation bleed
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9
Q

Describe anembryonic pregnancy

A
  • gestational sac develops but the embryo doesnt
  • slight bleeding
    • pregnancy test due to HCG
  • grow of sac stops and usually aborts
  • doctors may intervene with D&C
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10
Q

What is another name for a anembryonic pregnancy?

A

Brightened ovum

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11
Q

What is the sonographic appearance for an anembryonic pregnancy?

A
  • see small for dates given
  • see large sac without presence of fetus
  • trophoblastic ring with irregular borders
  • see blood fluid levels
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12
Q

When are you supposed to follow up when you see an embryo <2.5cm?

A

10 days

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13
Q

Describe a embryonic demise

A

Fetus dies but remains in the embryo
Some bleeding may occur
The uterus is small for dates

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14
Q

What is another name for a embryonic demise?

A

Missed abortion

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15
Q

When do embryonic demise usually occur between?

A

10-14 weeks

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16
Q

What is the sonographic appearance of a embryonic demise?

A

No FHB
Macerated fetus- edematous tissue
Spaulding sign- overlapping of the skull bones
Placenta and sac may be in process of digestion

17
Q

Describe inevitable abortion?

A

Pt appears with active bleeding and an open cervix

Cramping is common

18
Q

What is the sonographic appearance of a inevitable demise?

A 
Open cervix
Possibly containing clot
Detached placenta 
May see viable fetus
Sac may be in the lower uterine segment
19
Q

What is a incomplete abortion?

A

A threatened abortion that has progressed

20
Q

Describe a incomplete abortion

A

Some of the products of conception have been passed as tissue with the bleeding
Parts remain resulting in continual bleeding
Enlarged uterus

21
Q

What is the sonographic appearance of a incomplete abortion?

A

Empty ill-defined gestational sac with some internal echos no resembling a fetus
May see a hyperechoic area in the lower segment

22
Q

What is a complete abortion?

A

All products of conception have been passed

23
Q

What is the sonographic appearance of a complete abortion?

A

Bleeding
Cramping
Passing of tissue
Open cervix

24
Q

What is a habitual abortion?

A

Having 3 or more consecutive abortions

25
Q

What is a septic abortion?

A

Infected products may occur after a spontaneous abortion or induced abortion

26
Q

What are the symptoms of a septic abortion?

A

Pain
Fever
Bleeding
Discharge

27
Q

What is the sonographic appearance of a septic abortion?

A

May seen retained products

Enlarged uterus - increased echos with gas producing organisms

28
Q

What are some malformations detectable in utero that are classified as selectable abortions?

A
  • Anencephaly
  • Porencephly
  • Encephalocele
  • severe hydrocephalus
  • severe chromosomal abnormalities
  • renal agenesis or bilateral polycystic dx
  • inherited chromosomal, metabolic and hematologic abnormalities
29
Q

What is the method of termination less then 14 weeks?

A

D&C

30
Q

What is the method of termination when greater then 14 weeks?

A

Induce labor with hypertonic saline urea
prostaglandin
D&C

31
Q

When terminating a pregnancy greater then 14 weeks, what are the increased risks?

A

Retained products
Endometrisis
Uterine perforation with D&C

Gynecology (4 decks)

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