First Trimester Abnormal: Ectopic Pregnancies

Question 1

three things we check for in first trimester scan

Answer 1

1. mean sac diameter
2. crown rump length
3. nuchal

Question 2

MSD

Answer 2

mean sac diameter

Question 3

CRL

Answer 3

crown rump length

Question 4

when is MSD measured

Answer 4

when the embryo is identified

Question 5

when can the double decidual reaction be seen

Answer 5

starting at 4-5 weeks

Question 6

mean sac diameter formula

Answer 6

(lenght x width x height)/3

Question 7

endovaginal scan MSD size when yolk sac seen vs when embryo seen

Answer 7

8mm
vs
16mm

Question 8

transabdominal scan MSD size when yolk sac seen vs when embryo seen

Answer 8

20mm
vs
25mm

Question 9

GS grows how much every day

Answer 9

1.1mm

Question 10

what is the purpose of comparing MSD to embryo

Answer 10

for early diagnosis of oligohydramnios (low fluid)

Question 11

from 5.5-9 weeks, if the MSD - CRL is less than _____, oligohydramnios is suspected

Answer 11

5mm

Question 12

CRL is used between ___ and ___ weeks

Answer 12

6
13

Question 13

what is the most accurate measurement to predict gestational age and how many days off may it be

Answer 13

CRL
+/- 3 days

Question 14

PUL

Answer 14

pregnancy of unknown location

Question 15

three main differential diagnoses when b-HCG is positive but no pregnancy seen on US

Answer 15

very early intrauterine pregnancy
miscarriage
ectopic pregnancy

Question 16

what are the three main symptoms of an ectopic pregnancies and how many cases present with these symptoms

Answer 16

pain, bleeding, adnexal mass

45%

Question 17

other three symptoms of ectopic pregnancy (not the three main ones)

Answer 17

amenorrhea
adnexal tenderness
cervical tenderness

Question 18

ectopic pregnancies usually present around what weeks

Answer 18

5 and 8 weeks

Question 19

six risk factors of ectopic pregnancies

Answer 19

history of: ectopic pregnancy, gyn surgery, PID
endometriosis
IUCD use
congenital anomalies
assisted reproductive techniques
increased maternal age

Question 20

PID

Answer 20

pelvic inflammatory disease

Question 21

four ectopic sites

Answer 21

fallopian tube
cervix
ovary
peritoneal cavity

Question 22

____ of ectopic cases occur in the isthmus or ampulla of tube

Answer 22

95%

Question 23

what is the most common location for an ectopic pregnancy

Answer 23

ampulla

Question 24

2 most dangerous places to have an ectopic pregnancy and why

Answer 24

cervix
interstitial segment of fallopian tubes

high risk of hemorrhage as very vascular areas

Question 25

2 places free fluid may be seen with ectopic pregnancy

Answer 25

pouch of Douglas morrison's pouch

Question 26

PCDS

Answer 26

pouch of douglas

Question 27

4 sonographic features of an ectopic pregnancy

Answer 27

adnexal mass free fluid absence of IUP/has pseudo sac live ectopic pregnancy instead of adnexal mass

Question 28

you can assume the patient was at least ___ weeks pregnant at their first positive pregnancy test

Answer 28

4 weeks

Question 29

what happens to b hCG levels with ectopic pregancies

Answer 29

same or lower

Question 30

the b hCG should double every ___ days (up to ___ weeks) with a normal pregancy

Answer 30

2 8

Question 31

early gestation (less than 5 weeks) b hCG should

Answer 31

increase

Question 32

spontaneous abortion b hCG should

Answer 32

decrease

Question 33

PID b hCG should be

Answer 33

negative (not pregnant)

Question 34

complex ovarian cyst b hCG should be

Answer 34

negative

Question 35

endometriosis b hCG should be

Answer 35

negative

Question 36

Ring of Fire

Answer 36

increased blood flow around ectopic gestation but also more often seen around corpus luteum

Question 37

aborting GS doppler vs ectopic

Answer 37

aborting = avascular ectopic = well perfused

Question 38

sliding sac sign

Answer 38

when gentle pressure from the transducer can move the GS = likely abortion in progress

Question 39

heterotopic pregnancy

Answer 39

intrauterine pregnancy with a twin ectopic pregnancy

Question 40

chances of a heterotopic pregnancy

Answer 40

1 in 30 000 natural pregnancies

Question 41

ART

Answer 41

assisted reproductive technology

Question 42

heterotopic pregnancy incidence in IVF pregnancies

Answer 42

1-3%

Question 43

if ectopic isnt ruled out, b hCG repeated in ___, scan repeated in ___

Answer 43

2 days 2-7 days

Question 44

if the intial b hCG level is low (less than ___) and the patient is stable, a further blood test can be taken ___ hours after

Answer 44

1500 iU 48

Question 45

viable pregnancy = HCG ____ every 48 hours miscarriage = HCG ____ every 48 hours if outside these limits =

Answer 45

double halve ectopic pregnancy cant be excluded

Question 46

pseudo sac is seen in ___ percent of ectopic pregnancies

Answer 46

20

Question 47

interstitial line sign (what/diagnoses)

Answer 47

hyperechoic line (fallopian tube) extending from endo canal up to center of interstitial sac or hemorrhagic mass helps diagnose interstitial ectopic pregancies

Question 48

GS must have a minimum of ___ of myometrium surrounding them

Answer 48

5mm

Question 49

interstitial ectopic pregnancies will be located very ____ in the uterine fundus and have ____ of tissue surrounding the GS

Answer 49

superiorly less than 5mm

Question 50

c section scar ectopic occurs where

Answer 50

where c section scar is in uterus, implanted in myometrium not endometrium

Question 51

methotrexate

Answer 51

cell growth inhibitor

Question 52

salpingostomy vs salpinectomy

Answer 52

incision in tube to remove ectopic vs removal of fallopian tube

Question 53

if ectopic pregnancy ruptures = blood loss called

Answer 53

hypovolemic shock

Question 54

laparatomy is what/needed when

Answer 54

incision into abdominal cavity if ectopic is interstitial, cervical, abdominal, or if patient is severely unstable (going into shock)

Question 55

what is the most accurate measurement to predict gestational age

Answer 55

CRL