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OBSTETRIC PATHOLOGY > FIRST TIMESTER COMPLICATIONS > Flashcards

FIRST TIMESTER COMPLICATIONS Flashcards

1
Q

First trimester bleeding most common complication

A

Vaginal spotting
Frank bleeding
25% of patients

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2
Q

Pregnancy unlikely to progress if bleeding

A

Accompanied by severe pain
Uterine contractions
dilated cervix

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3
Q

Benefits from early TV examination

A

Carfully examine ,uterine cavity
Investigate of presence embryo
Fetal heart beat
Yolk sac
Retained products of conception

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4
Q

Placental hemáromas and subchorionic hemorrhage

A

Placental hematoma do not cause bleeding or spotting bcs it is in the chorionic sac without communication with endometrium

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5
Q

Most common occurrence of bleeding in first trimester

A

Subchorionic hemorrhage

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6
Q

Low pressure bleeding

A

Results from process of implantation of ovum into endometrial cavity and myometrium wall
Hematoma btw nyometrium and G sac

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7
Q

Clinical finding in sub chorionic hemorrhage

A

Bleeding
spotting
uterine cramping
If hemorrhage become large enough can lead spontaneous abortion

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8
Q

Distinguish subchorionic from abruption placenta

A

Occurs in second trimester abruption
Lucency posterior to the placenta retroplacental hemorrhage or abruption
Edge of the placenta subcharionic

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9
Q

Patient present with active vaginal bleeding

A

Sub chorionic bleeding is easily seen by
US adjacent o the G sac

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10
Q

Separation of the anterior placenta from uterine wall

A

Sub chorionic hemorrhage

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11
Q

Positive test no signal G SAC differential will be

A

Very early intrauterine pregnancy
Non developing pregnancy
Ectopic pregnancy
Absence of adnexal masses or free fluid

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12
Q

Grows of sac in first trimester for each day

A

1 mm/day

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13
Q

Normal embryo grows

A

At rate of 1mm/day

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14
Q

Yolk sac should be visualized TV when G SAC

A

Reaches 8 mm

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15
Q

Embryo should be seen when sac diameter

A

> 16 mm

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16
Q

If endometrium abnormal thick or irregularly echogenic different diagnosis

A

Intrauterine blood
Retained product of conception from incomplete abortion
Decidual reaction of ectopic pregnancy
Ar early intrauterine pregnancy

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17
Q

Incomplete spontaneous abortion US

A

From intact gestational sac with nonviable embryo to collapsed gestational sac grossly misshaped

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18
Q

Pregnancy failure when

A

The embryo is 7 mm or greater without heart beat
Or
MSD is 25 mm but no embryois visible

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19
Q

Spontaneous abortion

A

US of retained products may be subtle
Thickend endometrium>8mm
Increased vascularity of endometrium
Color Doppler strongly predictive bcs of throphablastic reaction
Presence of visible embryonic parts,g sac
Embryonic disc

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20
Q

Distinguish retained products of conception from blood clot

A

With color Doppler
clot= - No vascularity

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21
Q

Discriminating evidence for retained products

A

Quantitative hCG levels that da no decline normally
Thickened endlemétrium

Increased vascular flow

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22
Q

G sac without embryo or yolk sac 3possible conditions

A

Normal early intrauterine pregnancy <5werk)
Abnormal intrauterine pregnancy
Pseduogesiational sac in ectopic pregnancy

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23
Q

Criteria for abnormal gestational sac

A

Should be imaged TV or TA us when mean diameter is 5 mm
Correspond of age of 4 to 5 weeks
Interval growth of 1 mm per day
Lack means abnormal sac

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24
Q

Typical appearance of blighted or an . embryonic pregnancy is

A

Large
Empty
Gestational sac
Do not demonstrate York sac amnion embryo
MSD increase 1.1 mm per day but abnormal only 0.7 mm per day

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25
Q

US finding of G sac with abnormal intrauterine pregnancy

A

Embryo
Yolk sac amnion
Large G sac
Position
Shape
Throphoblastic reaction
Growth
MSG level

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26
Q

Abnormal embryo

A

Absence of cardiacmation in embryo 5mm or larger
Absence of cardiac motion after 6.5 mensiral weeks

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27
Q

Abnormal sac position

A

Cornual
Low
Hour glassing through cervical os

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28
Q

Abnormal throphoblasti c reaction

A

Absence of decidual sac
Thin trophoblastic reaction <2mm
Intra trophoblastic venous flow

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29
Q

Gestational trophoblastic disease

A

Prolifrative disease from benign form to malignant form from hydatiform (partial, complete or coexisíani
Mole
To invasive mole or choriocarcinoma

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30
Q

Coexistent molar pregnancy

A

Molar with normal intrauterine pregnancy

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31
Q

The first and most common of coexistent molar pregnancy

A

Twin pregnancy with normal fetus and normal placenta and complete mole

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32
Q

Second type of coexistent molar

A

Twin pregnancy with normal fetus am places an partial mole

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33
Q

The third and most uncommon type of coexistent

A

Singleton normal fetus with partial mole

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34
Q

Clinical landmark of trophoblastic disease

A

Is vaginal bleeding in first or early
Second trimester
Beía_hcg dramatically elevated > 100000
Hypermesis gravidarum or preeclampsia
AFT maternal notably low by complete mole

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35
Q

U S characteristic appearance of mole

A

Snow storm
Moderate echogenic soft tissue mass filling the uterus
Marked with small cystic spaces representing
Hydropic chorionic villi
Uterus filled with tiny grapelike clusters of tissue

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36
Q

Appearance of first trimester molar may simulate

A

Missed abortion
Incomplete abortion
Blighted ovum
Hydropic degeneration of placenta

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37
Q

Sonographic examination of thophoblastic disease

A

Uterine larger than date
Filled with heterogenous complex
Bilateral adnexal fullness
Ovarian enlargement of theta Lutron cyst

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38
Q

Partial mole appearance in US

A

Has identifiable placenta
Placenta enlarged with cystic spaces
Embryo arembryo tissue may seen
Often embryo abnormal and aborted in first trimester triploidy 69chromosome

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39
Q

Clinically symptoms in trophoblastic disease

A

Heavy bleeding
Very elevated hCG
Enlarged uterus with multiple focal areas of grapelikesters

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40
Q

in TV living embryo detects by

A

46 menstrual days

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41
Q

Cardiac rate less than … have poor prognosis

A

< 90 bpm away gestational age within first trimester

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42
Q

Tachicardia

A

> 170 bpm
Lead to heart failure
hydros
Pleural effusion
Pericardial effusion
Ascities

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43
Q

Oligohydrammous firsítrimesíer

A

G Sac 5 mm less tha CRL

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44
Q

Chromosomal abnormality with embryonic growth restriction and embryonic Oligohydramnios

A

Such as triploidy

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45
Q

Expected yolk sac growth

A

Maxima diameter of 0.3 mm/ day

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46
Q

Enlarged Yolk sac

A

5.6 mm or greater increased risk for spontaneous pregnancy loss.

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47
Q

Amnion best visualized with

… Td. Btw Month

A

Trans vaginal
5 to 7 weeks

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48
Q

Double bleb sign

A

Amnion and yolk sac in us
Simultaneous sis de by
Side the yolusac appearance
Amnion should appear as thinner of the two concentric structures
Embryonic lies btw amnion , , and yolk sac

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49
Q

How does look like abnormal amnion

A

Amnion becomes very easy to see
Thickness “echogenicity approach to yolk sac

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50
Q

Mean amniotic sac

A

Equal -to crown rump length

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51
Q

Anembryonic or failed pregnancy if

A

Mean sac diameter
>25 mm without embryo

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52
Q

One of the most emergent diagnoses with US

A

Ectopic pregnancy

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53
Q

Ectopic pregnancy

A

Pregnancy located outside central or fundal location of uterus

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54
Q

Clinical finding in ectopic pregnancy

A

Vaginial bleeding
empty uterus
Adnexal mass
Positive pregnancy test

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55
Q

May lead to hysterectomy or death ectopic pregnancy

A

Interstitialportion of tanupian tube near uterine Cornu
Massive hemorrhage

56
Q

Level of hCG in ectopic pregnancy

A

Discriminatory levels met or surpass and no intrauterine sac seen ectopic should be suspected

Not at levels of normal pregnancy
HCG levels double every 3.5 days
90% ectopic not viable

57
Q

Falling hCG levels indicate

A

Missed or incomplete abortion

58
Q

US in. ectopic pregnancy

A

As manyas 20% of patients with ectopic pregnancy demonstrate intrauterine pseudo gestational sac

59
Q

Pseudosac

A

Fluid collection aften blood in endometrium cavity
Decidualcysis
EMS thinner in EP compared to normal IUP and spontaneous abortion
BCS of lower bhcg LEVELS
Ring like cystic mass.
Do not contain either living embryo or yolk sac
Central located within endometria’s cavity
, G SAC eccentrically placed
Homogenous echoes in psedosaC
Presence of yolk sac indicates intrauterine

60
Q

Most specific for ectopic in adnexa

A

Live embryo
Free fluid in adnexa
Extra. Uterine gestational sac thickened echogenic ring
Separate from ovary which represent trophoblastic tissue or chorionic vili

61
Q

Color flow in ectopic pregnancy

A

Color flow shows RI <0.4 low resistance

62
Q

Adnexal mass with ectopic pregnancy

A

Usually within fallopian tube
Hemato salpinx
Broad ligament

63
Q

Complex adnexal mass aside from
Ectopic represent

A

Hematoma within peritonealcavity
Usually within fallopian tube hemãnosalpinx

64
Q

Increased risk of ectopic.with

A

Moderate to large amount of free fluid in intraperitoneal space
Adnexal mass
Echogenic Free fluid 92% risk ectopic

65
Q

Most life threatening of all ectopic

A

Intersristial pregnancy or cornual
In segment of Fallopian tube that enters uterus
Parauterine and myometrial vasculature - hemorrhage

66
Q

US of interstitial pregnancy

A

Ecentric placed G SAC
Incomplete MYOMETRIAL mantle surrounding sac

67
Q

Cervical pregnancy

A

Î riskof complete hysterectomy BCS of uncontrollable bleeding

68
Q

Embryonic Abnormalities in the first trimester

A
  1. Nuchal translucency
    2.cardiac anomalies
    3.cranial “
  2. Abdominal wall defects
    5.Obstetric uropathy
69
Q

Nuchal translucency

A

Maximum thickness of subcutaneous lucency ‘ at back of neck 11-14 weeks

70
Q

Î Nuchal translucency with

A

Trisomy,13,18,21
Cardiac defects
Genetic syndromes

71
Q

To assess risk for aneuploidy

A

NT combined with biochemical markers
Beta hCG

PAPPA

72
Q

Condition for NT measurement

A

Btw 11weeks and 13 weeks and 6 days
CRL BTW 45mm and 84mm
Mid sagittaL plane
Away from amniotic membrane
Neutral head position
No flexion a extension

73
Q

Hind brain

A

Cerebellum
Medulla ablongata
Pons

74
Q

By FMF
First trimester fetus check for

A

Nuchal translucency
Abnormalities of hind Brain
Nasal bone
Tricuspid regurgitation
Flow in ductus venousus

75
Q

markers for cardiac
defects

A

incread nuchal Translucency
Tricuspid Regurgitation
Reversal of flow in ductus Venus
Ectopic cordis and
limb wall Complex
Four-chamberview and great vessels out flow 12 weeks

76
Q

Dominant structure
Seen within
embryonic in
cranium
first Trimesier

A

choroid plexus wich fills lateral
venitricle that in turn fill cranial vault

77
Q

Acrania

A

Partial or complete absence of cranium
Predecessor of anencephaly

78
Q

Ossification of cranium begins

A

After 9 weeks
Biparietal diameter

79
Q

Acrania cause identified as early as

A

12 weeks

80
Q

Micky mouse head

A

In acrania head shap
ALP level increase
Ammniotic bands possible reason

81
Q

Anencephaly

A

Absence of brain and cranial vault
Cerebra al hemispheres either missing or reduced to small masses
Near end of first trimester
Absence of the cranium superior to the orbits
Base of skull is present
Brain may see as it projects from open cranial vault
Facial features

82
Q

Cephalocele

A

Midline cranial defect
There is herniation of the brain and meninges

83
Q

Cephalócele in western and eastern hemisphere

A

Western_occipital defect
Eastern_ frontal defect

84
Q

Cephancel may involve

A

Occipital
Frontal
Parietal
Orbital
Nasal
Nasopharyngeal

85
Q

Cranial cephalócele in US

A

Enlarged cisternal magna
Enlarged third ventricle

Absent brain tissue

86
Q

Iniencephaly

A

Rare lethal
Anomaly
Of cranial development
Defect in occiput involving foreman magnum
Retroflexion of spine fetus looks upward
Open spinal defects

87
Q

Ventriculomegally or

A

dilation of ventricular system Without enlargement cranium after il weeks

88
Q

Ventriculamegaly in us

A

Choroid plexus dangling in dilated dependent lateral ventricle

89
Q

Holoprosensephaly

A

Failure of prosencephalon to differentiate into cerebral hemispheres and lateral ventricles and thalamus btw 4-8 weeks
Variable degrees of facial dimorphism
Butterfly sign , is absent single ventricle is present on the biparieral diameter plane

90
Q

Most serious type of holoprosencephaly

A

Alobar single ventricle small cerebrum fused thalami genesis
Of corpus canosum and falx cerebry

91
Q

Before 9 weeks normal fetal brain has. Ventricle

A

Single ventricle until fa lx
Cerebri develops after 9 weeks

92
Q

Dandy _walker

A

Cystic dilation of 4 ventricle
Complet or partial genesis of cerebral vermis
Hydrocephay
6-7 -weeks

93
Q

US of dandy

A

Large posterior _ fossa cyst
Continuous with a ventricle
Absent of cerebellum vermis
Dilated third and lateral ventricles

94
Q

Spina bifida

A

Failure of neural tube to close after 6 weeks

95
Q

US of spina bifida

A

Spinal irregularities
Bulging within posterior fetal spine
Extrusion of the mass from vertebral column
Cranial signs
Leman sign
Banana sign
Closer to 12 weeks

96
Q

Normal bowel herniation

A

Btw 8-12 week
As an echogenic mass
At the base of the umbrical Cord

97
Q

Abdominal was defects types

A

‘emphalócele
gastroschisis
Limb-body
Complex
Midgut herniation

98
Q

Normal gut herniarien measure

A

6 - 9 mm a t8 weeks
5-6 mm at 9 weeks
Gut herniation >6 mm abnormal

99
Q

Feral bladder formation

A

10 _12 weeks

100
Q

Obstructive urophathy

A

At the he level of urethra results in very large bladder
Extended from pelvic to abdomen
Cystic mass
Bladder extrophy

101
Q

Key hole sign

A

Obstructed urethra
In connection of bladder and ureathra

102
Q

One of the most common abnormalities seen in us in first trimester

A

Cystic hygroma
Chromosomalabnormalitis
Sonolucent cystic hygroma with nuchal thickening

103
Q

If cystic hygroma detected in second or third trimester

A

Turner’s syndrome is most common karyotype

104
Q

Differentiation btw cystic hygroma with

A

Nuchal thickening
Encephalócele
Cervical meningomyelocele
Teratoma
Hemangioma

105
Q

Umbria cord cysts

A

Not persist throughout second trimester

106
Q

Umbrical cord cysts differential

A

Amniotic cysts
Emphalomesantric duct cysts
Allantoic cysts
Vascular anomalies
neoplasm
Whavion’s jelly abnormalities

107
Q

Most common ovarian mass in first trimester

A

Corpus lutem cyst

108
Q

Typical corpus luteum cyst. Cm

A

<5 Cm in diameter
Does not contain separations

109
Q

Corpus lutem abnormal cyst

A

Large more than 10 Cm
Internal separations echogenic debris
BCS of internal hemorrhage
Color flow ring of increased vascularity

110
Q

Corpus lutem cyst may mistaken with

A

Hemato salpinx
Distal tubal ectopic pregnancy
Ovarian ectopic pregnancy
Ovarian neoplasm
Fishnet pattern
Reticular pattern
Fibrin strands

111
Q

Uterin mass

A

Leiomyomas
Fibroids

Relationship to placenta and cervix

112
Q

• Sometimes difficult to distinguish retained products of conception from blood clots

A

• Sometimes difficult to distinguish retained products of conception from blood clots Novascu
Quantitative hCG levels that do not decline normally, thickened endometrium, and increased vascular flow will be discriminating evidence for retained products.

113
Q

Spontaneous Abortion

A

This patient had been diagnosed with spontaneou
miscarriage 3 weeks before this examination.
Patient had bled and passed tissue.
Sagittal and coronal images of the uterus show highly vascularized endometrial contents, consistent with retained products of conception.

114
Q

Theca lutein cysts.

A

‏Transvaginal grayscale image of the pelvis demonsti simple bilateral ovarian cysts in this patient with a hy
mole. A pocket of free fluid is present between the two ovaries

115
Q

tational Trophoblastic Disease

A

• Malignant forms of trophoblastic disease includ invasive mole and choriocarcinoma.
• Invasive hydatidiform mole occurs when villi of partial or complete mole invades myometrium and may further penetrate wall.

116
Q

Gestational Trophoblastic Disease

A

• Choriocarcinoma malignant form of trophoblastic disease that occurs in 2% to 3% of molar pregnancies.
• Tumor fast growing; commonly metastasizes to lungs, liver, brain
• Clinical symptoms include vaginal bleeding in addition to dyspnea, abdominal pain, and neurologic symptoms, depending on where metastasis spread.

117
Q

91 Embryonic Oligohydramnios and
Growth Restriction

A

9) Embryonic Oligohydramnios and
Growth Restriction
• Embryonic growth restriction can be determined only by relative sonographic dating, either by reliable menstrual history or by growth delay of embryo or gestational sac in relation to serial sonograms.
• Chromosome abnormalities, such as triploidy, have been associated with embryonic growth restriction and embryonic oligohydramnios.

118
Q

Embryonic Yolk Sac Evaluation

A

• Expected yolk sac growth 0.3 mm/day
• Normal yolk sac has maximal diameter of 5.5 mm between 5- and 10-weeks gestation.
• Enlarged yolk sac, 5.6 mm or greater, has increased risk for spontaneous pregnancy loss.

119
Q

Ectopic Pregnancy

A

• Associated risk factors:
• Rise in incidence of pelvic infections
• Use of intrauterine contraceptive devices
• Fallopian tube surgeries
• Infertility treatments
• History of ectopic pregnancy

120
Q

Ectopic Pregnancy

A

• Using transvaginal techniques, hG discriminatory level in detecting IUP has been shown to be:
• 800 to 1000 IU/L based on 215
• 1000 to 2000 IU/L based on first IRP

121
Q

Sonographic Findings in Ectopic
Pregnancy

A

A
B
A. Sagittal sonogram demonstrating high-velocity color flow in the left adnexa that surrounded the ectopic gestational sac. Other images demonstrated an empty uterus with normal endometrial canal.
B. Coronal sonogram demonstrating uterus (UT) and right ovary (Rt OV), with an echogenic concentric ring and embryo seen centrally with fetal heart motion consistent with ectopic pregnancy.
Arrows, Decidua/trophoblastic villi.

122
Q

Endometrium

A

• Pseudosac-
- Fluid collection, often blood in endometrial cavity
- Occurs in up to 20%
• Decidual cysts
• Appearance and thickness of endometrium: not very useful
- EMS usually thinner in patients with EP compared to normal
IUP and spontaneous AB, because of lower B-HCG levels
Abortion
Copyright © 2012, 2006, 2001, 1995, 1989,

123
Q

Sonographic Findings in Ectopic
Pregnancy

A

• Pseudogestational sacs do not contain either living embryo or yolk sac.
• Pseudogestational sacs centrally located within endometrial cavity, unlike burrowed gestational sac, which is eccentrically placed.
• Homogeneous level echoes commonly observed in pseudogestational sacs, unlike normal gestational sacs
• Presence of yolk sac positively indicates intrauterine gestation..

124
Q

Sonographic Findings in Ectopic Pregnancy

A

• Examining adnexa sonographically is critical in evaluation of ectopic pregnancy.

125
Q

Sonographic Findings in Ectol
Pregnancy one of most frequent findings of ectopic pregnancy

A

• Identification of extrauterine sac within adnexa one of most frequent findings of ectopic pregnancy
• Extrauterine gestational sacs often demonstrate thickened echogenic ring, separate from ovary, which represents trophoblastic tissue or chorionic villi and possibility that embryo or yolk sac will be seen.

126
Q

Adnexal Mass with Ectopic
Pregnancy

A

• Risk of ectopic pregnancy can be greater than 90
• when intrauterine gestation absent and there is
• corresponding adnexal mass.
Complex adnexal masses, aside from extrauterint gestational sacs, often represent hematoma with peritoneal cavity.
• Usually contained within fallopian tube (hematosalpir or broad ligament

127
Q

Adnexal Mass with Ectopic
Pregnancy

A

• Studies have correlated increased risk of ectopic pregnancy with:
• Moderate to large quantities of free intraperitoneal fluid
• Associated adnexal mass

128
Q

Adnexal Mass with Ectopic
Pregnancy
• 92% risk of ectopic pregnancy with

A

echogenic free fluid reported, with 15% of cases demonstrating echogenic free fluid as only sonographic finding.

129
Q

• When fluid present, sonographer should also look

A

• When fluid present, sonographer should also look at abdominal gutters and right and left upper quadrants to evaluate extent/volume of fluid present.

130
Q

Cranial Anomalies

• Embryonic head

A

• Embryonic head can be sonographically identified
77 weeks.

131
Q

C, Fetal profile of an anencephalic
fetus at 13-weeks.

A

The fetus is lying in a vertex position with the spine down. The face is pointing toward the anterior placenta; the skull is absent from the fetal forehead to the top of the cranium

132
Q

Cranial Anomalies

• Holoprosencephaly is malformation

A

sequence tI results from failure of prosencephalon to differentiate into cerebral hemispheres and later ventricles between fourth and eighth gestational weeks.
• Anomaly ranges from complete to partial failure of cleavage of prosencephalon with variable degrees of facial dysmorphism. fused thalamus

133
Q

Holoprosencephaly is divided into three typts: alobar, semilobar, and lobar.

A

Alobar most serious and consists of single ventricle, small cerebrum, fused thalami, agenesis of corpus callosum, and falx cerebri
imnartant to

134
Q

Holoprosencephaly

A

(A) Ultrasonography of a normal fetus at 12 weeks of gestation shows the butterfly sign of the choroid plexus on the biparietal diameter plane.
(B) A fetus with holoprosencephaly at 13 weeks of gestation. The butterfly sien is absent, and a single ventricle is present on the biparietal diameter plane.

135
Q

Cystic Hygroma

A

• Cystic hygroma and nuchal thickening may be concordant; differentiation may be difficult.
• Any posterior neck thickness >3 mm, with or without septations, should be followed.
• Differentiation between cystic hygroma, encephalocele, cervical meningomyelocele, teratoma, or hemangioma should be assessed.

136
Q

Corpus Luteum Cyst
• Color flow imaging may

A

Corpus Luteum Cyst
• Color flow imaging may demonstrate ring of increased vascularity surrounding corpus luteum, displaying low-resistance (high-diastolic) waveforms on pulsed Doppler imaging.
• Such findings are similar to decidual flows characterized in ectopic pregnancies but are intraovarian in location

137
Q

Corpus Luteum Cyst appeared

A

fishnet pattern

  • patten
    Reticular pattern
    fibrin strands

OBSTETRIC PATHOLOGY (7 decks)

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