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OBSTETRICAL DMS 114 > first trimester complications > Flashcards

first trimester complications Flashcards

1
Q

What is the most common occurrence of bleeding in the first trimester from?

A

Subchorionic hemorrhage

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2
Q

Signs of pregnancy failure

A

Severe pain, uterine contractions, dilated cervix

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3
Q

What percent of pregnancies spontaneously miscarry?

A

15%

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4
Q

What are the clinical findings of a subchorionic hemorrhage?

A

Bleeding, spotting, cramping (large enough will lead to spontaneous abortion)

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5
Q

Sonographic appearance of subchorionic hemorrhage

A

Later: anechoic between uterine wall and fetal membrane

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6
Q

Don’t cause bleeding or spotting because they are within the chorionic sac, without communication with the endometrium

A

Placenta hematomas

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7
Q

Empty uterus with no evidence of endometrial fluid collection, absence of adnexal masses and free fluid with positive beta-hCG levels

A

Absent intrauterine sac

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8
Q

Intrauterine sac should be identified when?

A

4.5 weeks

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9
Q

How fast does the gestational sac grow in the first trimester?

A

1 mm/day in first trimester

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10
Q

Yolk sac should be visualized when the gestational sac reaches what size?

A

8 mm

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11
Q

Embryo should be visualized when mean sac diameter is?

A

> 16 mm

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12
Q

Normal embryos grow how fast?

A

1 mm/day

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13
Q

Cardiac activity should be visible by when?

A

5.5-6.5 weeks (with hCG of 2000)

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14
Q

A thickened endometrium could be because of what?

A

Intrauterine blood, retained products of conception after incomplete spontaneous abortion, decidual reaction associated with pregnancy

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15
Q

Sonographic findings of a intaruterine sac after a spontaneous abortion

A

Intact gest sac to nonviable embryo to collapsed/mishapen gest sac

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16
Q

Sonographic signs of retained products

A

Thickende endo (>8mm) increased vascularization of endometrial complex with color doppler

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17
Q

Signs of a spontaneous abortion/retained products?

A

Visible embryonic parts/sacs, QhCG levels don’t decline normally, thickened endometrium with increased vascular flow

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18
Q

At what week should an embryo be seen?

A

6.4 weeks (6weeks3days)

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19
Q

Gestational sac where an embryo fails to develop or stops developing at such an early stage that it is imperceptible by ultrasound. Gest sac continues to grow along with trophoblastic tissue.

A

Blighted ovum or anembryonic pregnancy

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20
Q

Sonographic appearance of an anembryonic pregnancy

A

Large empty gestational sac with no yolk sac, amnion or embryo

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21
Q

Findings associated with abnormal IUP

A

Absence of cardiac motion after 6.5 menstrual weeks, large or calcified yolk sac, empty amnion, >18mm gest sac with no embryo, >8mm with no yolk sac, abnormmal shape and/or position of gest sac, absent or irregular trophoblastic reaction (<2mm), absent embryo/sac growth, hCG level discrepancy

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22
Q

Proliferative disease of trophoblast after abnormal conception

A

Trophoblastic disease

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23
Q

Occurs when an egg without a nucleus is fertilized by one sperm. Trophoblastic tissue proliferates but no fetal parts develop.

A

Complete hydatidiform moles

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24
Q

Occurs when a normal egg is fertilized by 2 sperm, fetal parts may develop but often aborted in 1st trimester. Has an identifiable placenta

A

Partial mole

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25
Q

Signs of gestational trophoblastic disease

A

Dramatically elevated beta-hCG levels, hyperemesis gravidarum, or preeclampsia, maternal serum AFP levels will be low

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26
Q

Sono appearance of gestational trophoblastic disease

A

distorted sac shape, thin, weakly echogenic decidual reaction, absence of double decidual sac, MSD=10mm

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27
Q

Malignant forms of gestational trophoblastic disease

A

Invasive mole and choriocarcinoma

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28
Q

Occurs when hydropic villi of a partial or complete mole invades uterine myometrium and may further penetrate uterine wall

A

Invasive hydatidiform mole

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29
Q

Signs/Symptoms of invasive moles

A

Continued heavy bleeding, very elevated hCG levels, enlarged uterus with multiple focal areas of grape-like clusters throughout

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30
Q

malignant form of trophoblastic disease that occurs in 2-3% of molar pregnancies.

A

Choriocarcinoma

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31
Q

Where does choriocarcinoma metastasize to?

A

Lungs, liver and brain

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32
Q

First conclusive sign of viability

A

Cardiac activity

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33
Q

When should cardiac activity be seen by?

A

5.5-6.5 weeks and hCG 2000 and embryo measures 4mm

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34
Q

If gestational sac in 5mm less than CRL what can be suspected?

A

Oligohydraminos

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35
Q

Yolk sac should grow how much per day?

A

0.3 mm/day

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36
Q

Yolk sac maximum diameter?

A

5.5 mm

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37
Q

When is the double bleb sign best seen?

A

Transvaginally between the 5th and 7th weeks gestation

38
Q

One of the most emergent diagnoses made with sonography, is a pregnancy located outside of the central/fundal location of the uterus

A

Ectopic pregnancy

39
Q

What percent of maternal deaths are related to ectopic pregnancy?

A

10%

40
Q

Clinical findings of an ectopic pregnancy

A

Nonspecific pain, vaginal bleeding, positive pregnancy test, with an empty uterus, adnexal mass, pseudo sac(20% of patients), free fluid and a ring of fire appearance

41
Q

Most common place for an ectopic pregnancy to occur.

A

Fallopian tube (95%)

42
Q

Ectopic pregnancy that has increased risk of massive hemorrhage with rupture that may lead to hysterectomy or even death.

A

Interstitial portion of fallopian tube

43
Q

Increased risk of complete hysterectomy because of uncontrollable bleeding

A

Cervical ectopic pregnancy

44
Q

Maximum thickness of subcutaneous lucency at back of neck in embryo at 11 to 14 weeks gestation

A

Nuchal translucency

45
Q

Nuchal translucency is increased in these patients.

A

Trisomy 13, 18 or 21 or fetuses with cardiac defects or other genetic syndromes

46
Q

Age of a fetus when nuchal translucency can be performed

A

11 weeks and 13 weeks 6 days

47
Q

Criteria for performing a nuchal translucency

A

CRL must be between 45-84 mm, 11-14 weeks gestation, embryo must be away from amniotic membrane with head in a neutral position,

48
Q

Four chamber view of the heart can be seen as early as when?

A

12 weeks

49
Q

Markers for cardiac defects

A

Increased nuchal translucency, tricuspid regurgitation, reversal or absence of flow in ductus venosus, ectopia cordis and limb body wall complex

50
Q

When can the embryonic head be identified sonographically?

A

7 weeks

51
Q

Partial or complete absence of cranium, a predecessor of anencephaly

A

Acrania

52
Q

When does ossification of the cranium begin?

A

After 9 weeks

53
Q

How early can acrania be reported?

A

12 weeks

54
Q

What is the signcalled when a fetus has an abnormally shaped head?

A

Mickey mouse head

55
Q

Congenital absence of the brain and cranial vault, cerebral hemispheres are either missing or reduced to small masses

A

Anencephaly

56
Q

A midline cranial defect in which there is a herniation of the brain and meninges, may involve occipital, frontal, parietal, orbital, nasal or nasopharyngeal region of the head

A

Cephalocele

57
Q

A rare, lethal anomaly of cranial development whose primary abnormalities include a defect in foramen magnum, retroflexion of spine and open spinal defects.

A

Iniencephaly

58
Q

A dilation of ventricular system without enlargement of cranium, generally seen after 11 weeks

A

Ventriculomegaly

59
Q

A malformation sequence that results from failure or prosencephalon to differentiate into cerebral hemispheres and lateral ventricles between 4th and 8th weeks

A

Holoprosencephaly

60
Q

Holoprosencephaly three types

A

Alobar, semilobar, and lobar

61
Q

Most serious form of holoprosencephaly, consists of a single ventricle, small cerebrum, fused thalami, agenesis of corpus cllosum, and falx cerebri

A

Alobar holoprosencephaly

62
Q

Ventricles develop when?

A

after 9 weeks

63
Q

Results from cystic dilation of fourth ventricle with dysgenesis or complete agenesis of cerebellar vermis and frequently hydrocephaly. Occurs around 6-7 weeks

A

Dandy-Walker malformation

64
Q

Sonographic presentation of a dandy-walker malformation in the first trimester

A

Large posterior fossa cyst with contiuous fourth ventricle, absent cerebellum and dilated third and lateral ventricles

65
Q

Occurs when there is a failure of neural tube to close after 6 weeks gestation

A

Spina bifida

66
Q

Abdominal wall defects

A

Omphalocele, gastroschisis and limb-body wall complex

67
Q

One of the most common abnormalities seen in the first trimester, has a high association with chromosomal abnormalities, appear on the posterior aspect of the featal neck and upper thorax

A

Cystic Hygroma

68
Q

Most common mass seen in first trimester of pregnancy, secretes progesterone necessary to preserve embryo. Should measure <5 cm with no septations

A

Corpus luteum cyst

69
Q

partial or complete absence of the cranium

A

acrania reported as early as 12 weeks predecessor to anencephaly

70
Q

congenital absence of the brain and cranial vault with the cerebral hemispheres missing or reduced to small masses

A

anencephaly “frog face” seen at the end of the first trimester

71
Q

gestational sac without an embryo

A

blighted ovum (anembryonic pregnancy)

72
Q

during the first trimester, the bowel normally herniates outside the abdominal cavity between 8 and 12 weeks

A

bowel herniation

73
Q

protrusion of the brain from the cranial cavity

A

cephalocele midline cranial defect herniation of brain tissue and/or meninges (brain membranes)

74
Q

complete expulsion of all products of conception, including embryo and deciduas

A

complete abortion

75
Q

a physiologic cyst that develops within the ovary after ovulation, secretes progesterone, and prevents menses if fertilization occurs; may persist until the 16th to 18th week of pregnancy

A

corpus luteum cyst

76
Q

fluid-filled structure (often with septations) initially surrounding the neck; may extend upward to the head or laterally to the body

A

cystic hygroma one of the most common abnormalities seen in the 1st trimester most common: Turner’s Syndrome Trisomy 21, 18, and 13 If the hygroma resolves by week 18, the chromosomes are usually normal

77
Q

a pregnancy that implants in a location other than the center of the uterus

A

ectopic pregnancy

78
Q

congenital defective opening in the wall of the abdomen just to the right of the umbilical cord; bowel and other organs may protrude outside the abdomen from this opening

A

gastroschisis difficult to diagnose in the first trimester

79
Q

condition in which trophoblastic tissue overtakes the pregnancy and propagates throughout the uterine cavity; partial and complete

A

gestational trophoblastic disease –

80
Q

simultaneous intrauterine and extrauterine pregnancy

A

heterotopic pregnancy

81
Q

failure of forebrain to divide into two cerebral hemispheres, resulting in a single large ventricle with varying amounts of cerebral cortex; has been known to occur with trisomies 13, 15, and 18

A

holoprosencephaly should divide into cerebral hemispheres and lateral ventricles between week 4 and 8 3 types: Alobar (most serious), lobar, semilobar

82
Q

pregnancy loss with products of conception remaining in the uterus

A

incomplete spontaneous abortion

83
Q

a rare neural tube defect in which the brain tissue protrudes through a fissure in the occiput, so that the brain and the spinal cord occupy a single cavity

A

iniencephaly occupital defect involving the foramen magnum retroflexed spine fetus looks upward open spinal defects are present

84
Q

pregnancy occurring in the fallopian tube near the cornu of the uterus; also known as cornual pregnancy

A

interstitial pregnancy

85
Q

congenital defect of the abdominal wall with protrusion of abdominal contents into the base of the umbilical cord; the cord appears to enter the mass

A

omphalocele difficult to diagnose in the first trimester

86
Q

decidual reaction with fluid occurring within the uterus in a patient with an ectopic pregnancy

A

pseudogestational sac

87
Q

additional term for missed abortion or miscarriage

A

spontaneous pregnancy loss (SPL)

88
Q

a nonlethal genetic abnormality; chromosomal makeup is 45XO instead of the normal 46XX or 46XY. Cystic hygroma often is seen in affected fetuses in the first trimester. Survivors tend to be short in stature with low-set ears, webbing of the neck, a shield-shaped chest, and infertility as a result of an endocrine disorder caused by failure of the ovaries to respond to pituitary hormone

A

Turner’s syndrome

89
Q

dilation of the cerebral ventricles without enlargement of the cranium

A

ventriculomegaly

90
Q

results from a cystic dilation of the 4th ventricle with dysgenesis or complete agenesis of the cerebellar vermis and frequently hydrocephaly

A

Dandy Walker 6 to 7 week of gestation

91
Q

spinal irregularities with bulging within the contour of the spine

A

spina bifida can be detected late 1st trimester

OBSTETRICAL DMS 114 (21 decks)

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