First Trimester Complications

Question 0

What is embryonic demise?

Answer 0

clear evidence of a non viable embryo

Question 1

What is a threatened abortion?

Answer 1

< 20 weeks

viable embryo

documented fetal heartbeat

vaginal bleeding

cervix long and closed

approx 50% will miscarry

Question 2

What is intrauterine fetal demise?

Answer 2

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

Question 3

What are the known causes for intrauterine fetal demise?

Answer 3

congenital/chromosomal anomalies

infection

placental abruption

IUGR

blood group isoimmunization

Question 4

What is embryonic demise?

Answer 4

early IUP visualized

no heartbeat

Question 5

When should you hear fetal heart tones with doppler?

Answer 5

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

Question 6

What is the MOST definitive sign of fetal demise?

Answer 6

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)

Question 7

If there is a fetal death what should you try to do??

Answer 7

try to determine any obvious fetal anomaly or cause of fetal death

try to get some kind of measurement….femur length even

Question 8

What is an anembryonic pregnancy?

Answer 8

early IUP - MSD >18mm - grows < 0.6mm/day

yolk sac

no embryo

FINISH SLIDE 12

Question 9

What is the most common reason for bleeding in the first trimester?

Answer 9

subchorionic hemorhage

Question 10

What is subchorionic hemorrhage?

Answer 10

low pressure bleed - result of implantation

symptoms:

bleeding spotting cramping

finish slide 13

Question 11

What is an absent intrauterine sac?

Answer 11

BhCG level 1000-2000 mIU/mL

no IUP

Possibilities could include

slide 15

Question 12

What are the four types of spontaneous abortions?

Answer 12

Complete

incomplete

threatened

inevitable

Question 13

What is a complete abortion?

Answer 13

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

Question 14

What is an incomplete abortion?

Answer 14

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

Question 15

What is a threatened abortion?

Answer 15

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

Question 16

Inevitable abortion is what?

Answer 16

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

Question 17

What is gestational trophoblasic disease?

Answer 17

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

Question 18

What are the different kinds of Hydatidiform Mole (H-Mole)?

Answer 18

Partial

complete (classic)

complete with co-existing fetus

Question 19

Slide 25

Answer 19

finish

Question 20

What is the most benign and most common form of trophoblastic disease?

Answer 20

Complete - “classic” H-Mole - egg with an absent or inactivated

Finish slide 26

Question 21

What is a malignant trophoblastic disease?

Finish slide 29

Answer 21

invasive mole (chorioadenoma destruens)*

Nonmetastic

may ben seen with molar pregnancy or after evacuation

Question 22

What is Choriocarcinoma?

FINISH slide 30

Answer 22

Highly metastatic trophoblastic tumor*

2-3% of trophoblastic disease

fast growing

METS TO LUNG (MOST COMMON) liver and brain

vaginal bleeding, dyspnea, abd. pain

Question 23

What is absent or abnormal cardiac activity?

Answer 23

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

Question 24

What is considered bradycardia for embryo?

Answer 24

heart rate below 90 bpm

usually poor prognosis

Question 25

What is considered tachycardia in embryo?

Answer 25

heart rate over 170 bpm

finish slide 33

Question 26

What is embryonic oligo and growth restriction?

Answer 26

gestational sac measures 5mm <CRL

demise highly likely

usually related to chromosomal abnormality

must have accurate dating to verify

Question 27

What is a yolk sac evaluation?

Answer 27

normal max diameter 5.5mm between 5-10 weeks

yolk sac over 6mm increased risk for spontaneous abortion

finish slide 37

Question 28

What is an ectopic pregnancy?

finish slide 40

Answer 28

implantation of a developing zygote outside the endometrial cavity

incidence 1/100-400

**higher incidence rate with infertility

Question 29

Why do ectopic pregnancies occur?

finish slide 40

Answer 29

delayed transit of fertilized zygote secondary to Fallopian tube malformation

obstruction of passage of zygote through tube secondary to adhesions

Question 30

What are the four maternal risk factors for ectopic pregnancy?

Answer 30

previous ectopic pregnancy (25% chance of reoccurence)

history of PID

tubal reconstructive surgery

recent ART