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OB Review > First Trimester > Flashcards

First Trimester Flashcards

1
Q

Gravid (G)

A

the number of times a women is pregnant,

regardless of delivery

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2
Q

Para (P)

A

refers to a delivery of a fetus weighing 500 grams
or more and is over 20 weeks gestation regardless if fetus is alive at birth. Multiple births are considered a single para event

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3
Q

Fetus

A

a developing young in the human uterus > 8 weeks

menstrual age

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4
Q

Embryo

A

period is from 2nd through 8th menstrual weeks

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5
Q

Menstrual age or Gestational age

A

refers to the age of the pregnancy calculated from the first day of the LM

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6
Q

Conceptual age

A

refers to the age of the pregnancy from the calculated ovulation

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7
Q

Conceptual age used by who

A

Embryologist

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8
Q

Early embryology Step 1

Zygote

A

Ovum and sperm join in the distal fallopian tube (ampullary portion)

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9
Q

Early embryology Step 2

Morula

A

Cells of the zygote multiply, cluster

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10
Q

Early embryology Step 3

Blastocyte

A

enters uterus and fluid rapidly enters forming a blastocyst

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11
Q

Early embryology Step 4

Blastocyst implants into

A

endo

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12
Q

After 9 menstrual weeks, the embryo is called

A

a fetus

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13
Q

1st 9 menstrual w is called an

A

embyro

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14
Q

During a _____ day cycle, a mature ovum is realed at day ____

A

28

14

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15
Q

Fimbriae

A

ovum is swept into teh distal fallopian tube

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16
Q

Fertilizationg occurs

A

1-2 days after ovulation

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17
Q

hCG is produced by

A

trophoblastic cells of developing chorionic villa

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18
Q

hCG doubles every

A

30-48 hours

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19
Q

hCG peaks at

A

10th gest w

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20
Q

hCG declines

A

after 10th w and levels out at 18 w

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21
Q

hCG

GS should be identified TV at

A

1000 mIU/mL

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22
Q

hCG allows the

A

corpus luteum to continue to secrete progesterone

causes ut to not shed endo lining

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23
Q

Decidual reaction

A
  • 3 layers
  • double decidua sign
  • help defferentiate an IUP from ectopic
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24
Q

Deciduas capsularies

A

covers the surface of the blastocyte

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25
Q

Decidual basalis

A

located between the conceptus and the uterine wall

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26
Q

Decidual parietalis (or decidua vera)

A

covers the remainder of the uterus

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27
Q

Neural Plate begins to form around

A
  • 4th w
  • when closes, forms neural tube
  • if fails, result is neural tube defect
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28
Q

Primitive heart develops

A
  • 5th w

- by 8th should have definite form

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29
Q

vascular network begins to develop by the end of

A

8th w

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30
Q

peripheral vascular system is completed by end of

A

10th w

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31
Q

Kidneys ascend from pelvis starting at

A

8 w

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32
Q

When do the kidneys get into their final position

A

11th w

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33
Q

All limbs formed by

A
  • 10 w
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34
Q

almost all congenital abnormalities occur before or during

A

embryonic period

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35
Q

normal sac can be identified by

A

5 menstural weeks TA

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36
Q

Implantation implants in the ___ of the uterus

A

fundus

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37
Q

low implantation in ut has increased risk of

A

abortion

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38
Q

GS shape

A

starts out round and becomes kidney shaped

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39
Q

Secondary Yolk Sac present by

A

5.5 menstrual w

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40
Q

secondary yolk sac appears

A

round w. echogenic wall and sonolucent center

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41
Q

secondary yolk sac is contianed

A

in the chorionic cavity

42
Q

secondary yolk sac produced

A

alpha fetoprotien

43
Q

secondary yolk sac function

A

transfer of nutrients and hematopoiesis- production and development of blood cells

44
Q

secondary yolk sac connected to fetus by the

A

vitelline duct also known as omphalomesenteric duct

45
Q

Liver takes over of secondary yolk sac by

46
Q

eventually part of the yolk sac will become

A

primitive gut

47
Q

How many cavities are withing the GS?

A

2

chorion and amniotic

48
Q

Chorionic cavity

A

contains yolk sac and fluid

49
Q

Amniotic cavity contains

A

simple-appearing amniotic fluid and the developing embryo

50
Q

Amniotic membrane or amnion is a

A

thin echogenic line loosely surrounding the fetus

51
Q

Amnion and chorion typically fuses around

A

the middle of the first trimester, but may not totally fuse until 16 weeks gestation

52
Q

Cardiac Activity can be seen ____ w w/ a normal HR at

A

5-6 w

100-115 bpm

53
Q

Heart motion can be detected in

A

4mm

for sure in 5 mm

54
Q

CRL grows

55
Q

FHR increase to

A

140 bpm by 9 w

56
Q

Brachycardia

A

poor prog
under 90bpm
1st sign of fetal demise

57
Q

Fetal limb buds are identified by

58
Q

Fetal head is proportionally

A

larger than body

59
Q

w/in head, cystic structure is seen most often represnting

A

rhombencephalon or hindbrain

60
Q

rhombencephalon will develop into

A

4th ventricle

61
Q

Physiological bowl herniation begins at

A

8 w when bowl herniates into the base of the umbilical cord

62
Q

Physiological bowl herniation should resolve by

A

12 w

if not, followup needed

63
Q

By the end of 1st trimester, what can be seen

A
  • lateral ventricles containing echogenic choroid plexus
  • fetal movement
  • stomach
  • urinary bladder
  • umbilical cord
  • spine
64
Q

Placenta

A

seen as a well- defined crescent shaped homogeneous mass of tissue along margins of GS

65
Q

Placenta is formed by

A
  • decidua basalis (maternal contribution)

- chorion frondosum (fetal contribution)

66
Q

Umbilical cord visible during

A

the later half of the first trimester as a tortuous structure connecting the fetus to the developing placenta

67
Q

NT

A
  • 11w 0 d - 13 w 4 d

- detects chromosomal anomalies

68
Q

NT measurement

A
  • inner to inner
  • Sag
    > 3 mm is abnormal
69
Q

Ectopic contributing factors

A
  • Previous ectopic pregnancy
  • Previous tubal surgery
  • History of pelvic inflammatory disease
  • Undergoing infertility treatment
  • Previous or present use of and intrauterine device
  • Multiparity
  • Advanced maternal age
70
Q

negative hCG rules out

A

possibility of an ectopic

71
Q

Ectopic Pregnancy most common sites

A

ampulla of fallopian tubes

72
Q

Ectopic Pregnancy second most common sites

A

isthmis of fallopian tube

73
Q

Other Ectopic Pregnancy

A
  • Interstitial or corneal (2-5%)
  • Ovary (0.5-1%)
  • Cervix (.1%)
  • Fimbria: very rare
74
Q

Heterotopic pregnancy

A

both ectopic and IUP, most common with assisted reproductive therapy

75
Q

Ectopic Clinical Findings

A
  • Pain
  • Vaginal bleeding
  • Palpable abdominal/pelvic mass
  • Shoulder pain(secondary to intraperitoneal hemorrage and diaphragmatic irritation)
  • Low hematocrit (with rupture)
76
Q

Ectopic Sono findings

A
  • Extrauterine gestainal sac containing a yolk sac or embryo
  • Adnexal ring sign
  • Adnexal mass
  • Large amount of free fluid within the pelvis or in Morison pouch
  • Complex free fluid could represent hemoperitoneum
  • Pseudogestational sac
  • Poor decidual reaction
  • Endometrium containing blood
77
Q

Gestational Trophoblastic Disease (Molar)

A

A group of disorders that are the result of an abnormal combination of male and female gametes

78
Q

Tophoblastic cells produce

79
Q

Gestational trophoblastic disease results in the

A

excessive growth of the trophoblastic cells and excessive amounts of hCG are released in the maternal circulation

80
Q

Complete Molar Pregnancy Clinical Findings

A
  • Hyperemesis gravidarum
  • Markedly elevated hCG level
  • Vaginal bleeding
  • Enlarged uterus
  • Possible preeclampsia/or eclampsia
  • HTN
81
Q

Hydatidiform molar pregnancy complete

A
  • most common
  • characterized by hydropic chorionic villa
  • absence of fetus an amnion
  • benign with malignant potential
82
Q

Hydatidiform molar pregnancy partial (incomplete)

A
  • May be accompanied by a co-exiting triploid fetus, parts of fetus, or amnion
  • Minimal malignant potential
83
Q

Invasive molar pregnancy (chorioadenoma destruens)

A
  • Molar pregnancy that invades into the myometrium and may also invade through the uterine wall and into the peritoneum
  • Result of malignant progression of hydatidiform moles
84
Q

Choriocarcinoma

A
  • Most malignant form of trophoblastic disease with possible metastasis
  • Result of malignant progression of a hydatidiform molar pregnancy
  • Most common sites for metastasis are the liver, lungs and vagina
85
Q

GTD treatment

A
  • dilatation and curettage
  • hCG monitoring
  • hysterectomy
  • chemotherapy
  • chest xray to check for metastasis
86
Q

Blighted Ovum or Anemryonic Gestation is diagnostic when

A

there is no evidence of a fetal pole or yolk sac within the gestational sac

87
Q

Blighted Ovum or Anemryonic Gestation GS often has

A

irregular border with a poor decidual reaction

88
Q

Blighted Ovum or Anemryonic Gestation pt presents w/

A

vaginal bleeding, a low hCG, and reduction of pregnancy symptoms

89
Q

Fetal demise cardiac activity

A

should be present in a fetal pole that measures 4-5 mm

90
Q

Threatened abortion

A
  • Vaginal bleeding before 20 weeks gestation
  • closed cervical os
  • Low fetal heart rate
91
Q

Complete(spontaneous ) abortion

A
  • All products of conception expelled

- no IUP

92
Q

Incomplete abortion

A
  • Part of the products of conception expelled

- Thickened and irregular endo, enlarged uterus

93
Q

Missed abortion

A
  • Fetal demise with retained fetus

- No detectable FHR

94
Q

Inevitable abortion

A
  • Vaginal bleeding with dilated cervix
  • Low-lying gestational sac
  • Open internal os of cervix
95
Q

Subchorionic Hemorrhage

A

A bleed between the endometrium and the gestational sac

96
Q

Subchorionic Hemorrhage appears

A
  • an anechoic, crescent-shaped area adjacent to the gestational sac
  • resembles second GS
97
Q

Subchorionic Hemorrhage

Small bleeds vs large bleeds

A

small: benign
large: misscarriage and stillbirth

98
Q

Uterine Leiomyoma and Pregnancy two most important findings are

A

location and size

99
Q

Uterine Leiomyoma and Pregnancy location

A

determine type of delivery

100
Q

Uterine Leiomyoma and Pregnancy size

A

may increase due to stimulation of estrogen

101
Q

Uterine Leiomyoma and Pregnancy differentiated

A
  • focal myometrial contractions

- disappear w/in 20-30 mins

OB Review (12 decks)

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