First trimester Abnormalities Flashcards
___: bleeding into uterine wall and chorion
subchorionic hemorrhage
subchorionic hemorrhage can lead to what
spontaneous abortion
S/A subchorionic hemorrhage
- hypoechoic structure between chorion and uterine wall
- usually crescent shaped
what are some risk factors of ectopic pregnancy
- history of PID
- history of fertility treatment
- history of tubal surgery or trauma
- history of previous ectopic
- IUD
what is the number 1 risk for an ectopic pregnancy
history of tubal surgery or trauma
list the most common to least common locations for ectopics to occur
- ampulla
- isthmus
- interstitial
- c section scar
- ovary
- abdomen
- retroperitoneal
___: an ectopic pregnancy that implants at the upper lateral corner of the endometrial cavity near the opening of the Fallopian tube
angular pregnancy or corneal pregnancy
an ectopic pregnancy usually occurs on which side
the same side as the corpus luteal cyst
where is the most dangerous place for an ectopic to occur
interstitial portion of Fallopian tube
what is the classic triad of symptoms for ectopic pregnancy
- pain
- vaginal bleeding
- fever
what happens to the HCG levels with an ectopic pregnancy
will not increase as fast as in normal intrauterine pregnancy
___: ectopic and IUP coexisting with each other
heterotypic pregnancy
what is the drug that is used to treat early enraptured ectopics
methotrexate
S/A ectopic pregnancy
- free fluid in cul de sac or adnexa
- empty gestational sac
- single decidual layer
- complex adnexal mass
- adnexal tubal ring or bagel/donut sign
- ring of fire sign (increased vascularity)
___: hyperplasia and overgrowth of the trophoblastic material
hydatidiform mole or gestational trophoblastic disease
what causes gestational trophoblastic disease
two sperm fertilize a single egg
hydatidiform more is associated with what kind of ovarian cyst
theca lutein cyst
S/S hydatidiform mole
- excessively high levels of bHCG
- acute onset of maternal systemic HTN in the first trimester
what are the two forms of hydatidiform mole
complete and incomplete
which form of hydatidiform mole is the most common
complete
which type of hydatidiform mole does not involve a fetus
complete
S/A hydatidiform mole
- may be seen with theca lutein cyst
- enlarged uterus with heterogeneous endometrial cavity (snowstorm appearance)
- hydropic villi appear as multiple cystic structures within the uterine cavity
which form of hydatidiform mole includes a fetus and a molar pregnancy
partial mole
___: invasive malignant molar pregnancy that moves int the myometrium uterine wall and peritoneum
chorioadenoma destruens
___: malignant molar pregnancy that metastasizes usually to the liver
choriocarcinoma
S/A choriocarcinoma
- can see theca lutein cyst due to elevated bHCG levels
- may see masses in the cervix and vagina
- highly vascular complex mass
what is the most common solid mass found in pregnancy
fibroid
which type of fibroid has the highest rate for early pregnancy complications
submucosal
which type of fibroid has the highest risk for delivery complications
cervical fibroids
if surgical removal of a fibroid is required during pregnancy when should the procedure be preformed
between 16-20 weeks
what are some major anomalies seen in the 1st trimester
- acrania
- anecncephaly
- alobar holoprosencephaly
- body stalk anomaly
- ectopia cordis
- megacystitis
- omphalocele
- gastroschesis
at what gestational age should the NT be done
11-14 weeks
the optimal view for the NT includes what things
- echogenic tip of nose
- rectangualr palate
- translucent diencephalon
- nt
how is the NT measured
inner to inner
what mmt is considered abnormal for an NT
> 3mm
at what gestational age is the nuchal skin fold measured
15-21 weeks
what mmt is considered abnormal for the nuchal skin fold
> 6mm
S/A acrania
- no calvarium
- abnormal brain tissue
- Mickey Mouse sign
S/A anencephaly
- no calvarium
- absent brain tissue above orbits
- frog eyes
S/A lobar holoprosencephaly
- single ventricle
- fused thalami
- absent corpus collosum
what is the only type of holoprosencephaly that can be detected in the first trimester
alobar
S/A cephalocele
-bony defect with intracranial contents protruding
S/A ventriculomegaly
-dialted lateral ventricles with dangling choroid plexus
S/A open spina bifida
- small or absent IT space
- obliterated cisterna magna
- thickened brain stem
- skin defect
S/A dandy walker malformation
- enlarged intracranial translucency space
- compressed brainstem
- large posterior fossa
what are some of the major cranial anomalies seen in the 1st trimester
- acrania
- anencephaly
- alobar holoprosencephaly
- cephalocele
- ventriculomeglay
- open spina bifida
- dandy walker malformation.
what are some of the major abdominal anomalies seen in the 1st trimester
- omphalocele
- gastroschesis
- pentalogy of Cantrell
- ectopia cordis
- limb body wall complex
- bladder extrophy
S/A omphalocele
- midline wall defect
- covered by a membrane
S/A gastroschesis
- wall defect adjacent to cord insertion
- herniated bowel
- not covered by membrane
S/A pentalogy of cantrell
- midline supra umbilical wall defect
- diaphragmatic defect
- defect in pericardium
- intracardiac defect/ ectopia cordis
S/A ectopia cordis
-sternal defect with hear protruding out of chest
S/A limb body wall complex
- large wall defect
- short or no umbilical cord with fetus fixed to the placenta
S/A bladder exstrophy
- wall defect below the cord insertion
- bladder protrudes outside the body
what are the major chest/thorax anomalies seen in the first trimester
- malposition of the heart
- abnormal cardiac axis
- diaphragmatic hernia
- lung agenesis
S/A malposition if the heart
-heart in mid or right of chest
S/A abnormal cardiac axis
-rotation from axis
S/A diaphragmatic hernia
stomach and or liver in the chest cavity
S/A lung agenesis or hypoplasia
- absence of echogenic lung tissue surrounding the heart
- small thoracic circumference
- cardiac malpositon
what are the major first trimester skeletal dysplasia findings
- increased NT
- short, broken, bowed, absent long bones
- asymmetric extremities
- shortened ribs, narrow thorax
what are the most common neural tube defects
anencephaly and spina bifida
___: cephalic end of the neural tube fails to close
anencephaly
if cerebral tissue is present but the cranial vault is absent it is considered ___
acrania or exencephaly
anencephaly can be see with what other spinal defects
- exophthalmos
- macroglossia
- polyhydramnios
___: lack of cranial bone formation
acrania
what is the Mickey Mouse sign that is associated with acrania
-brain tissue droops to the side
what are the signs that are associated with spina bifida that are not usually seen in the 1st trimester
banana and lemon sign
what are some sonographic markers for trisomy 21
- hypoplasia/absence of nasal bone
- AV septal defect
- tricuspid regurgitation
- echogenic cardiac foci
- retrograde A wave on the ductus venosus
what are some sonographic findings associated with trisomy 13
- alobar holprosencephaly
- midline facial anomalies
- megacystitis
- severe hydrops
- tricuspid regurgitation
- retrograde A wave on ductus venous
which aneuploidy usually has the largest NT measurement
trisomy 18
what are some sonographic findings associated with trisomy 18
- dilated 4th ventricle
- choroid plexus cyst
- spina bifida
- omphalocele
- diaphragmatic hernia
- severe hydrops
- tricuspid regurgitation
- retrograde A wave on ductus venous
what are some sonographic findings associated with Turner syndrome
- normal nasal bone
- tachycardia
- hypoplastic left heart
- hydrops
- renal anomalies
- tricuspid regurgitation
- retrograde A wave on ductus venous
___: complete extra set of chromosomes
triploidy
what is the term for an extra paternal chromosome
diandric triploidy
what is the term for an extra maternal chromosome
dysgenic triploidy
with diandric triploidy:
- ___ NT thickness
- bhCG ___
- PAPP-A ____
- CRL ____
- increased NT
- HCG normal
- PAPP-A decreased
- normal or short CRL
with dysgenic triploidy
- ___ NT
- bhCG ____
- PAPP-A ___
- CRL ___
- normal NT
- bhCG decreased
- PAPP-A decreased
- severe growth restriction
what are some sonographic findings of dysgenic triploidy
- large head with small abdomen
- compressed posterior fossa
- small placenta
- cardiac anomalies
- echogenic bowel
- spina bifida
