First Trimester Complications Flashcards
What is embryonic demise?
clear evidence of a non viable embryo
What is a threatened abortion?
< 20 weeks
viable embryo
documented fetal heartbeat
vaginal bleeding
cervix long and closed
approx 50% will miscarry
What is intrauterine fetal demise?
Spontaneous abortion/miscarriage prior to 20 weeks
can occur anytime throughout pregnancy
incidence in 1st trimester approx 15-20%
usually caused by chromosomal abnormalities
Approx half of all instance of perinatal mortality
What are the known causes for intrauterine fetal demise?
congenital/chromosomal anomalies
infection
placental abruption
IUGR
blood group isoimmunization
What is embryonic demise?
early IUP visualized
no heartbeat
When should you hear fetal heart tones with doppler?
10-12 weeks
absence of a fetal heart rate with doppler and/or cessation of fetal movements after initially felt will usually prompt an immediate US examination
What is the MOST definitive sign of fetal demise?
absent heart motion
absent fetal motion
overlap of skull bones (Spalding’s sign)
exaggerated curvature of the spine
gas in fetal abdomen/echogenic fetal heart
fetal skin edema (may take 2-4 days to develop)
If there is a fetal death what should you try to do??
try to determine any obvious fetal anomaly or cause of fetal death
try to get some kind of measurement….femur length even
What is an anembryonic pregnancy?
early IUP - MSD >18mm - grows < 0.6mm/day
yolk sac
no embryo
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What is the most common reason for bleeding in the first trimester?
subchorionic hemorhage
What is subchorionic hemorrhage?
low pressure bleed - result of implantation
symptoms:
bleeding spotting cramping
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What is an absent intrauterine sac?
BhCG level 1000-2000 mIU/mL
no IUP
Possibilities could include
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What are the four types of spontaneous abortions?
Complete
incomplete
threatened
inevitable
What is a complete abortion?
Products of conception completely expelled
Clinical:
bleeding/cramping
positive hCG
Sono Findings:
empty uterus - endo usually <5mm
no adnexal masses
no free fluid
BhCG will decrease rapidly
What is an incomplete abortion?
Clinical findings:
may or may not have bleeding/cramping
Sono findings:
*intact IUP* no embryo heartbeat gestational sac mis-shapen **thickened endometrium >5** obvious fetal parts - if after therapeutic abortion
What is a threatened abortion?
1st trimeter pregnancy typically associated with bleeding
embryo is still alive but often showing signs of distress
Sono findings:
lack of expected growth of gestational sac/embryo
decreased fetal heart rate <95 bpm
serial US are done to prove embryonic demise FINISH
Inevitable abortion is what?
Clinical:
Positive hCG
vaginal bleeding and cramping
Gestational sac with fetus in uterus
detached from uterus
may lie in lower uterine segment
gestational sac surrounded by hemorrahage
spontaneous abortion will happen within couple hours or less
What is gestational trophoblasic disease?
Proliferative disease of the trophoblast after abnormal conception - molar pregnancy*
affects approx 1 of every 1000 pregnancies
usually women under 20 or over 40
vaginal bleeding
hyperemesis
extremely elevated BhCG often over 100,000 FINISH SLIDE 24
What are the different kinds of Hydatidiform Mole (H-Mole)?
Partial
complete (classic)
complete with co-existing fetus
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What is the most benign and most common form of trophoblastic disease?
Complete - “classic” H-Mole - egg with an absent or inactivated
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What is a malignant trophoblastic disease?
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invasive mole (chorioadenoma destruens)*
Nonmetastic
may ben seen with molar pregnancy or after evacuation
What is Choriocarcinoma?
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Highly metastatic trophoblastic tumor*
2-3% of trophoblastic disease
fast growing
METS TO LUNG (MOST COMMON) liver and brain
vaginal bleeding, dyspnea, abd. pain
What is absent or abnormal cardiac activity?
heart rate should be detected by 5.5 - 6.5 weeks or (5mm) on TV
should be able to hear fetal heart beat with doppler at 10-12 weeks (in the doctor office)
if absence after this tie period or no fetal movement felt after initially feeling immediate US
What is considered bradycardia for embryo?
heart rate below 90 bpm
usually poor prognosis
What is considered tachycardia in embryo?
heart rate over 170 bpm
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What is embryonic oligo and growth restriction?
gestational sac measures 5mm <CRL
demise highly likely
usually related to chromosomal abnormality
must have accurate dating to verify
What is a yolk sac evaluation?
normal max diameter 5.5mm between 5-10 weeks
yolk sac over 6mm increased risk for spontaneous abortion
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What is an ectopic pregnancy?
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implantation of a developing zygote outside the endometrial cavity
incidence 1/100-400
**higher incidence rate with infertility
Why do ectopic pregnancies occur?
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delayed transit of fertilized zygote secondary to Fallopian tube malformation
obstruction of passage of zygote through tube secondary to adhesions
What are the four maternal risk factors for ectopic pregnancy?
previous ectopic pregnancy (25% chance of reoccurence)
history of PID
tubal reconstructive surgery
recent ART
