First Trimester complications

Question 1

Risk of malignancy GTN in complete molar pregnancy

in partial

Answer 1

complete: 2% risk of choriocarcinoma,

15-20% invasive moles

partial: rare assoc with choriocarcinoma, >2% invasive moles

Question 2

embryonic pole visible on ultrasoun

no cardiac activity

anembryonic demise - gestation sac without corresponding embryo indentified on ultrasound

Answer 2

missed abortion with embryonic demise =

with anembryoic demise =

Question 2

morphology+ appearance complete molar pregnancy

genotype

Answer 2

partial mole contains fetal tissue

arises from fertilizzatio of haploid ovum by two sperm or single sperm that then duplicates

Triploid (69,XXX) 69 XYY 69 XXY

Question 3

implantation complete by day

Answer 3

9-10

Question 3

missed abortion with embryonic demise =

with anembryoic demise =

Answer 3

embryonic polel visible on ultrasoun

no cardiac activity

anembryonic demise - gestation sac without corresponding embryo indentified on ultrasound

Question 3

risk factors of ectopic pregnancy

Answer 3

PID

gonorrhea or chlamydia

previous tubal ligation or pregnancy

assited reproductive technologies

smoking

pregnancy with IUD

Question 4

majority of tubal prgnancies located in

Answer 4

ampullary region

Question 5

morphology+ appearance complete molar pregnancy

genotype

Answer 5

trophoblastic proliferation and hrydropic grape like chrionic villi

snowstorm appearance on ultra sound

results from fertilization o fenucleate egg

paternally derived diploid genotype (46XX, some 46XY)

no fetal structures develope

Question 6

partial passage of products of conception

open os

variable bleeding

nonviable pregnancy

Answer 6

incomplete abortion

Question 6

finding consistent with all forms of gestational trophoblastic disease

Answer 6

high hCG

Question 8

can visual pregnancy with ultrasound at hCG levels of ___

this is called the ____

Answer 8

1500-2000

discriminatory zone of hCG

Question 9

recurrent pregnancy loss =

Answer 9

3 or more spontaneous losses before 20 weeks

Question 10

incomplete abortion

Answer 10

partial passage of products of conception

open os

variable bleeding

nonviable pregnancy

Question 12

structure and specificity of hCG

Answer 12

alpha subunit identiacal to LH, FSH, TSH

beta unit unique to hCG

Question 13

mechanism methotrexate

indications

Answer 13

binds dihydrofolate reductase (conpetitive antagonist)

interferes with DNA synthesis and cell replication

ectopic pregnancy, hydatiform molar pregnancy, choriocarcinoma

Question 15

bleeding or cramping with no passage of tissue

closed os

intrauterine pregnancy

heart tones present is age appropriate

Answer 15

threatened abortion =

Question 15

bleeding

open os

no passage of products of conception

non-viable prengnacy

Answer 15

inevitable abortion =

Question 16

inevitable abortion =

Answer 16

bleeding

open os

no passage of products of conception

non-viable prengnacy

Question 17

threatened abortion =

Answer 17

bleeding or cramping with no passage of tissue

closed os

intrauterine pregnancy

heart tones present is age appropriate

Question 19

peak hCG levels occur at (time)

level?

Answer 19

0 weeks

100,000mIU/ml

Question 21

complete abortion =

Answer 21

porducts of conception completely passed

closed os

minmal bleeding

uterus well contracted

Question 22

benign forms of gestational tropholbalstic disease

malingnant forms

Answer 22

hydatiform mole )benign)

persistent or invasive GTD

choriocarcinoma

placental site trophoblastic tumor disease

Question 23

mechanism urine pregnanyc test

Answer 23

MAB specific to beta unit of hCG

detection between 20-100mIU/ml hCG

(hCG at first missed period is 100mIU/mL)