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DMST 244 Obstetrics and Gyn Sonography 1 > Module 6: 1st Trimester Abnormal; Ectopic Pregnancies > Flashcards

Module 6: 1st Trimester Abnormal; Ectopic Pregnancies Flashcards

1
Q

When do we use mean sac diameter (MSD)?

A

When the embryo is not identified

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2
Q

What do you need ensure to use mean sac diameter?

A

Ensure you can see the double decidual reaction

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3
Q

What is the time frame for use of mean sac diameter?

A

Used from 4 to 7 or 8 weeks

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4
Q

What is the formula for mean sac diameter?

A

(length + width + height)/3

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5
Q

What is the use for Mean sac diameter?

A

Early diagnosis of oligohydramnios or low fluids

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6
Q

When do we expect oligohydramnios?

A

From weeks 5.5-9 weeks if the MSD mm - CRL mm is <5mm

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7
Q

What measurements can we do in the 1st trimester of sonography? 3

A
  1. Mean sac diameter
  2. Crown rump length
  3. Nuchal
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8
Q

For a endovaginal scan what is the MSD size where the yolk sac is seen?

A

8mm MSD

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9
Q

For a endovaginal scan what is the msd size where the embryo is seen?

A

16mm MSD

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10
Q

For a transabdominal scan what is the MSD size we will see the yolk sac?

A

MSD 20 mm

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11
Q

For a transabdominal scan what is the MSD size we will see the embryo?

A

25mm

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12
Q

What timeframe should we use Crown rump length? (Weeks)

A

Between 6 and 13 weeks

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13
Q

What is the accuracy of Crown rump length?

A

+/- 3 days

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14
Q

How should we measure for Crown rump length?

A

Measure from the tip of the head to end of the rump

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15
Q

Should we include the yolk sac for the crown rump length measurement?

A

no

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16
Q

What position should the fetus/ embryo be in?

A

Neutral position

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17
Q

What the classical clinical triad?

A
  1. Pain
  2. Bleeding
  3. Adnexal mass
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18
Q

How many people demonstrate the classical clinical triad?

A

45%

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19
Q

Others that do not demonstrate the classical clinical triad, demonstrate what other symptoms? 3

A
  1. Amenorrhea
  2. Adexal tenderness
  3. Cervical tenderness
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20
Q

When do ectopic pregnancies usually present? (Weeks)

A

5 and 8 weeks

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21
Q

What are some historic risk factors for ectopic pregnancies? 3

A
  1. Previous ectopic pregnancies
  2. Gynecologic surgery
  3. Pelvic inflammatory disease
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22
Q

What are some risk factors for ectopic that does not have to do with history? 5

A
  1. Endometriosis
  2. IUCD use
  3. Congenital anomalies
  4. Assisted reproductive techniques/ infertility
  5. Increased maternal age
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23
Q

What are some normal sites for ectopic pregnancies? 4

A
  1. Fallopian tubes
  2. Cervix
  3. Ovary
  4. Peritoneal cavity
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24
Q

95% of ectopic pregnancies occur where?

A

Isthmus or ampulla of tube

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25
Q

What is the most common location for ectopic pregnancies?

A

Ampulla

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26
Q

What is the most dangerous areas to have a ectopic pregnancy?

A

The cervix and interstitial segment of the fallopian tube areas

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27
Q

Why is the Cervix and interstitial segment of the fallopian tubes bad areas for ectopic pregnancies?

A

High risk of hemorrhage because they are very vascular areas with little or no thickened endometrium for the embryo to burrow into

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28
Q

What are some sonographic features of ectopic pregnancies? 3

A
  1. Adnexal mass
  2. Free fluid
  3. Absence of IUP or presents with a pseudo sac
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29
Q

Is it possible to see a viable ectopic pregnancy instead of a adnexal mass?

A

Yes, Some times we can see a gestational sac with an embryo with a heart beat seen outside of uterus.
This may also indicate that the pregnancy has not yet ruptured

30
Q

In a ectopic pregnancy what is the common levels for beta hCG levels?

A

Lower, but still can be in normal range

31
Q

What is the beta hCG levels trend normally and what is it with ectopic pregnancies?

A

It should double every 2 days but will not with ectopic pregnancies

32
Q

What is the DDX for determining a ectopic pregnancy in early gestation?

A

In pregnancies under 5 weeks beta hCG should increase

33
Q

What is the DDX for ectopic pregnancy for spontaneous abortion?

A

beta hCG should decrease

34
Q

What is the DDX for ectopic pregnancy for P.I.D (pelvic information disease)?

A

beta hCG should be negative - not pregnant
pelvic inflammatory disease

35
Q

What is the DDX for ectopic pregnancy for a complex ovarian cyst?

A

beta hCG negative

36
Q

What is the DDX for ectopic pregnancy for endometriosis?

A

beta hCG negative

37
Q

What does the term “ring of fire” mean?

A

Common term to describe increased blood flow around ectopic gestation

38
Q

What is the most common lesion mistaken for a ectopic pregnancy?

A

Corpus luteal cyst

39
Q

In practice a hyper vascular ring tends to be seen when/where?

A

Surrounding a corpus luteum than ectopic

40
Q

What is a useful tool for determining if a gestation is an intrauterine abortion in progress vs an ectopic?

A

Doppler

41
Q

How do we know if a GS is plausible?

A

Avascular vs ectopic pregnancy is well perfused

42
Q

Doppler is also helpful for determining what?

A

Pseudosac vs Viable IUP

43
Q

What is a sliding sac sign?

A

When gentle pressure from the transducer can move the gestation sac

44
Q

When is Sliding sac sign useful?

A

Useful for assessing a GS within the cervix determining abortion in progress vs. cervical ectopic

45
Q

If gentle pressure can move the GS, what does this mean?

A

It is not implanted and is likely an abortion in progress

46
Q

What is a heterotopic pregnancy?

A

An intrauterine pregnancy with a twin ectopic pregnancy

47
Q

When does heterotopic pregnancy occurs?

A

When two fertilized ova implant

48
Q

How common is heterotopic pregnancy occurs?

A

1 in 30,000 incidence in natural pregnancies

49
Q

When would the incidence of heterotopic pregnancies increase?

A

Increased due to assisted reproductive technology

50
Q

Heterotopic pregnancy incidences from Assisted reproductive technology increase by what rate?

A

1-3% of IVF pregnancies

51
Q

What does negative ultrasound results mean for ectopic pregnancies?

A

Does not rule it out, it may just be too small to recognize with sonography

52
Q

Just because the negative ultrasound results is negative (for ruling out ectopic pregnancies) what must we do? 4

A
  1. Follow up!
  2. EV - if not done already
  3. Repeat beta hCG in 2-3 days
  4. Repeat scan as recommended 2-7 days
53
Q

What is the interstitial line sign?

A

Hyperechoic line extending from the endometrial canal up to the center of the interstitial sac or hemorrhagic mass

54
Q

What is the interstitial line sign used for?

A

To help diagnose interstitial ectopic pregnancies

55
Q

Gestational sacs must have a minimum of how much myometrium surrounding them?

A

5mm

56
Q

Interstitial ectopic pregnancies will be located where?

A

Very superiorly in the uterine fundus and have <5mm of tissue surrounding the gestational sac

57
Q

What should we look for in terms of interstitial pregnancies on ultrasound?

A

Look for a band of myometrium between sac and endometrium

58
Q

What are treatment (TX) for ectopic pregnancies? 3

A
  1. Conservative management
  2. Medical therapy
  3. Surgery
59
Q

What is the conservative management treatment plan for ectopic pregnancies? 3

A

Some very early ectopic pregnancies can resolve on their own.
1. Failure to progress
2. Serial monitoring of beta hCG - looking for a decrease
3. Follow up with ultrasound

60
Q

What is the greatest success for conservative management treatment?

A

If initial beta hCG is low, levels decrease and absent gestational sac

61
Q

What is the medical therapy for ectopic pregnancies?

A

Methotrexate

62
Q

What is methotrexate?

A

A cell growth inhibitor

63
Q

What is methotrexate also used for?

A

Cancer

64
Q

How is methotrexate administered?

A
  1. Administered systemically or injected directly into ectopic site
  2. Can be given orally as well
  3. Single or multiple doses
65
Q

How can we get the greatest success for medical therapy for ectopic pregnancies?

A

If beta hCG less than 5,000 monitored after treatment, and not fetal cardiac activity

66
Q

What is the surgical treatment for ectopic pregnancies? 3

A
  1. Laparoscopy or laparotomy
  2. Salpingostomy
  3. Salpingectomy
67
Q

What is a salpingostomy?

A

Incision into the tube to remove ectopic/ restore patency
Preferred for women desiring future fertility

68
Q

What is a salpingectomy?

A
  1. removal of the fallopian tube
  2. Required tubal rupture, recurrent ectopic in the same tube, damaged tube, or GS >5mm
69
Q

What does surgery do for a patients risk for a repeat ectopic?

A

It increases it

70
Q

What is hypovolemic shock?

A

Life threatening condition due to decreased blood volume
patient is hemodynamically unstable with internal bleeding

71
Q

What is a laparoscopy?

A

Surgical removal with laparoscope

72
Q

When would a laparotomy be required? 4

A

If the ectopic is
1. Interstitial
2. Cervical
3. Abdominal
4. If the patient is severely hemodynamically stable - going into shock

DMST 244 Obstetrics and Gyn Sonography 1 (22 decks)

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