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OBGYN Ultrasound > First trimester complications > Flashcards

First trimester complications Flashcards

1
Q

when should the gestation sac be present

A

1800 mIU/ml TA

1000 mIU/mL TV

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2
Q

gestational sac diameter

A

l+ W+ H /3 = #

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3
Q

CRL

A 
Most accurate  (+/- .5 wks) (3 days) 
              used b/t 6- 12 wks 
             longest length excluding legs
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4
Q

what does crown-rump length plus 6 equal

A

gestational weeks

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5
Q

normal Gestational Sac

A

A normal GS grows 1.1mm/day from 5 to 8 weeks

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6
Q

what is the GS meaurement

A

Reliable indicator of gestational age prior to identification of CRL

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7
Q

when is the GS used to determine GA

A

Used to determine GA up to 6 weeks then MSD is primarily used to correlate GS size to CRL

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8
Q

Crown rump length

A

Embryo grows at a rate of 1 mm/day in the 1st trimester
Curled position
GA from 5.5 weeks +
Measurement from the top of head to the lower edge of torso
reflects embryonic growth

Highly accurate - Error of +/- 3 to 5 days

CRL used until 12 to 13 weeks

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9
Q

when should embryo be seen

A 
TA = 25mm MSD
EV = 16mm MSD
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10
Q

what percent of clinically recognized pregnancies are spontaneously miscarried

A

15%`

; loss rate may be even higher for early, clinically unrecognized pregnancies.

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11
Q

most common presentation for complications

A

Most common presentation for complications is vaginal spotting or frank bleeding, occurring in nearly 25% of patients during early stage of pregnancy.

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12
Q

implantation bleed

A

Appears post implantation (21days LMP)
Visible at 6-10 weeks
Sonographically may appear as a sonolucent space outside the gestational sac
Patient may be asymptomatic or present with painless spotting

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13
Q

subchorionic hemorrhage

A

Most common occurrence of bleeding in first trimester is from subchorionic hemorrhage.
Low-pressure bleeds result from process of implantation of fertilized ovum into endometrial cavity and myometrial wall.
Hemorrhage found between myometrium and margins of gestational sac; may or may not be associated with placenta

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14
Q

clinical findings of subchorionic hemorrhage

A

bleeding, spotting or uterine cramping; if hemorrhage becomes large enough, can lead to spontaneous abortion

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15
Q

findings can distinguish subchorionic hemorrhage from what

A

abruption placentae

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16
Q

subchorionic hemorrhage appearance

A

Crescent-shaped sonolucent fluid collection between the gestational sac and the uterine wall

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17
Q

if subchorionic hemorrhage is symptomatic (bleeding) increased chance of

A

miscarriage,
preeclampsia,
placental abnormalities,
preterm delivery

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18
Q

Size date discrepancy

A 
Unsure LMP (incorrect dates)
Presence of 
Fibroids
Scarring
Obesity
Multiple gestation
Molar pregnancy
Pregnancy failure
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19
Q

diagnosis of a true GS may be made only in the presence of

A

yolk sac or embryo

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20
Q

without findings of intrauterine pregnancy, an intrauterine fluid collection could represent

A

pseudogestational sac associated with ectopic pregnancy

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21
Q

embryonic heart rates

A

5 - 6 weeks - 100 BPM

6+ weeks - 120 to 160 BPM

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22
Q

findings diagnostic of pregnancy failure

A

CRL of >7mm and no heartbeat

Mean sac diameter of >25mm and no embryo

Absence of embryo with heartbeat of >2wk after a scan that showed gestational sac without a yolk sac
``
Absence of embryo with heartbeat >11 days after a scan that showed a gestational sac with a yolk sac

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23
Q

Abortion

A

Spontaneous or induced termination of an early pregnancy and expulsion of fetal and placental tissues.

24
Q

Anembryonic pregnancy (Blighted ovum)

A

Pregnancy that has failed prior to the development of an identifiable embryo or in which embryonic tissue has been resorbed after early embryo demise

25
Q

Incomplete abortion

A

Spontaneous abortion in which some products of conception remain in the uterus

26
Q

Inevitable abortion

A

Failed early pregnancy that is in the process of being expelled from the uterus

27
Q

Miscarriage

A

Spontaneous failure and expulsion of an early pregnancy

28
Q

Missed abortion

A

Early failed pregnancy that remains in the uterus

29
Q

gestational trophoblastic disease

A

Abnormal trophoblastic proliferation
Abnormal chromosome number
46 XX or 46 XY
69 XXX, 69 XXY, 69 XYY…..

30
Q

Ectopic pregnancy

A

Implantation of a fertilized ovum in any area outside of the endometrial cavity

31
Q

Associated risk factors if ectopic pregnancy

A 
Rise in incidence of pelvic infections
Use of intrauterine contraceptive devices (IUCDs)
Fallopian tube surgeries
Infertility treatments
History of ectopic pregnancy
32
Q

clinical presentation of ectopic pregnancy (most common)`

A

Vaginal bleeding
Pain
Palpable adnexal mass

33
Q

other clinical presentations of ectopic pregnancy

A 
non
amenorrhea
hypotension
shoulder pain
rebound tenderness
guarding
hypovolemic shock
34
Q

ectopic b-HCG levels

A

Lower than normal value
Nonvisulaization of pregnancy at discriminatory level
1500 – 2500 mIU/mL

35
Q

sites of ectopic pregnancy

A 
fallopian tube -95%
ampulla (70%)
isthmus (12%)
fimbria (11%)
Intramyometrial (Interstitial) – 2-4% 
nual, Cervical, Intramural, Ovarian, Abdominal – 1%
36
Q

most important finding when scanning for ectopic pregnancy is to determine

A

If normal intrauterine gestation (reducing probability of ectopic pregnancy)
If uterine cavity empty and adnexal mass present
As many as 20% of patients with ectopic pregnancy demonstrate intrauterine saclike structure known as pseudogestational sac.

37
Q

Pseudogestational sac

A

Normal appearance
Thickened endometrium to 8 mm
Pseudosac vs normal Double decidual sac sign (DDSS)

38
Q

Sonographic findings of ectopic pregnancy

A

Identification of extrauterine sac within adnexa one of most frequent findings of ectopic pregnancy
Extrauterine gestational sacs often demonstrate thickened echogenic ring, separate from ovary, which represents trophoblastic tissue or chorionic villi and possibility that embryo or yolk sac will be seen.

39
Q

Color dopplere ectopic pregancy

A

Ring of fire sign
Due to increased flow surrounding the ectopic
Spectral Doppler shows low flow
Corpus luteal flow has similar characteristics

40
Q

what is the most life-threatening ectopic gestation

A

Interstitial pregnancy, or cornual pregnancy

Location of this ectopic pregnancy is in segment of fallopian tube that enters uterus.

41
Q

Cervical ectopic pregnancy

A

Hourglass shaped sac in cervix
Pending abortion vs. ectopic
Sliding sac sign (sliding of the gestational sac within the cervix when the transducer is gently pressed against the cervix)

42
Q

Ovarian ectopic pregnancy

A

Normal tube
Gestational sac on ovary
Ovary and gestational sac connected by the ovarian ligament
Placental tissue mixed with ovarian cortex

43
Q

Abdominal ectopic pregnancy

A

Fetus outside of the uterus
Failure to image uterine wall between fetus and urinary bladder
Close proximity to maternal anterior abdominal wall
Localization of placenta outside of the uterus

44
Q

Heterotopic pregnancy

A

Ectopic coexisting with intrauterine (IUP) pregnancy
Incidence
1:30,000 natural pregnancies
1-3% with ovulation induction
IUP may go to term when ectopic has been resolved

45
Q

Acute rupture

A 
Formation of a complex mass
Large adnexal mass
Free fluid
Hematosalpinx
Hemoperitoneum
Morison’s pouch
Pelvic cul-de-sacs
46
Q

Alternate modalities ectopic pregnancy

A

Defines ectopic
Maturity of present blood
Gold standard

47
Q

treatment ectopic pregnancy

A 
Expectant
Spontaneous regression
Tubal abortion
Methotrexate (MTX)
Surgery
48
Q

fetal aneuploidy

A

Chromosomally abnormal

49
Q

risk of fetal aneuploidy determined by

A

Maternal Serum biochemistry levels
Nuchal lucency measurements
Ductus venosus Doppler

50
Q

when is NT measurement taken

A

45-84mm

51
Q

what does NT meaurement do

A

Single most powerful marker available to differentiate euploid pregnancies from Down syndrome

52
Q

Nuchal lucency meaurements

A

“avalue of less than ~2.2-2.8 mm in thickness is not associated with increased risk,however it is maternal age dependent and needs to be matched to exact gestational age and(CRL)”

53
Q

Anembryonic pregnancy (Blighted ovum)

A

Gestational sac in which embryo fails to develop at an early stage that it is unseeable by ultrasound

54
Q

what occurs in blighted ovum

A

trophoblast tissue continues to grow, gestational sac continues to grow, BHCG levels continue to increase (but not at expected rates)

55
Q

what is the findings associated with blighted ovum

A

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

OBGYN Ultrasound (5 decks)

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