OB first trimester abnormalities registry review Flashcards
Ectopic pregnancy
A pregnancy located anywhere other than the central uterine cavity
Most common cause of pelvic pain with positive pregnancy test
Ectopic pregnancy
Most common location of ectopic pregnancy
Ampulla of fallopian tube
Most dangerous location of ectopic pregnancy
Interstitial/corneal because of rupture and hemorrhage
Heterotopic pregnancy
IUP and coexisting ectopic. Rare. Most often associated with assisted reproduction. Risk: hx PID, endometriosis, previous ectopic
hCG level 1,000-2,000 with no IUP
Suspect ectopic
Clinical presentation of ectopic pregnancy
-Pain, bleeding, palpable mass
-Lower than expected hCG, low hematocrit, shoulder pain
Sonographic appearance of ectopic pregnancy
-Extrauterine GS “live” pregnancy
-Complex adnexal mass or adnexal ring sign
-Free or complex fluid in pelvis
-Pseudogestational sac
-Poor decidual reaction in endo
Gestational trophoblastic disease (molar pregnancy)
Abnormal combination of male and female gametes resulting in rapid proliferation of trophoblastic cells
Trophoblastic hCG production in molar pregnancy
Excessive levels of hCG or rapidly rising levels; placenta grows out of control, takes over, undergoes degeneration becoming complex with cystic changes
Complete hydatidiform mole
Absence of fetus or gestational sac. Benign with malignant potential, clear defined boarders contained within myometrium
Partial hydatidiform mole
Coexisting IUP/GS and possibly fetus. Minimal malignant potential
Most common gestational trophoblastic disease
Complete hydatidiform mole
Invasive molar (chorioadenoma destruens)
Molar pregnancy that becomes malignant and invades into myometrium through uterine wall and into peritoneum
Choriocarcinoma
Most malignant progressive form with possible mets to lung (most common), liver, brain
Clinical presentation of molar pregnancy
Hyperemesis, markedly elevated hCG, bleeding, enlarged uterus, hypertension
Sonographic appearance of molar pregnancy
Large complex mass within uterus, multiple cystic areas throughout, loss of myometrium or boarders if invasive, bilateral theca lutein cyst
Non progressive pregnancies/miscarriages
Either hCG or sonographic appearances do not match what is expected. LMP not reliable, base of hCG + sono or sono alone
Low hCG or S<D
-Incorrect dating
-Ectopic
-Non progressive/failed pregnancy
High hCG or S>D
-Incorrect dating
-Multiple gestations
-Gestational trophoblastic disease (molar pregnancy)
Sonographic indication of abnormal pregnancy development
-GS greater than 10mm MSD without visible yolk sac
-GS greater than 25mm MSD without fetal pole
-Enlarged YS greater than or equal to 6mm
-Collapsed GS/ poor decidual reaction
Blighted ovum (Anembryonic pregnancy)
Large gestational sac without yolk sac or embryo, usually shows poor decidual reaction
Sonographic appearance of blighted ovum
GS > 10mm + no YS
GS > 25mm + no FYP
Clinical presentation of blighted ovum
Vaginal bleeding, low b-hCG
Embryonic/fetal demise
Death of embryo or fetus
Confirmation of embryonic/fetal demise
Fetal pole greater than or equal to 5mm with no cardiac activity
Early sonographic indication of early/impending demise
Irregular shaped GS, enlarged YS
Clinical appearance of embryonic/fetal demise
Bleeding, small for dates, low hCG
Abortion
Termination of pregnancy before viability whether elective or not
Spontaneous abortion
Naturally occurring miscarriage
Clinical/sono findings for threatened miscarriage
Spotting, low FHR
Clinical/sono findings for missed miscarriage
Spotting/low hCG, intact demise
Clinical/sono finding for incomplete miscarriage
Heavy bleeding/+hCG, RPOC
RPOC
Retained products of conception
Clinical/sono findings for complete miscarriage
Bleeding/ - hCG, normal endometrium
Clinical/sono findings for inevitable miscarriages
Cramping/spotting, low lying GS
Incomplete miscarriage
Miscarriage is still in process and there are retained products of conception with internal flow within the cavity
Complete miscarriage
Finished miscarriage, cavity is empty and endometrium is thin, similar to early proliferative endo
Subchorionic hemorrhage (SCH)
Bleed between endometrium and gestational sac
NON poor prognosis of SCH
If hemorrhage is 50% or greater than GS and close to internal os
Clinical presentation of SCH
Vaginal bleeding or spotting, possible cramping
Sonographic appearance of SCH
Crescent-shaped, hypoechoic or medium level echoed area adjacent to GS
Myomas (fibroids) during pregnancy
Location and size are important to document because they can complicate delivery
Fibroid growth during pregnancy
Stimulated by estrogen, grow during pregnancy due to increased estrogen… *Don’t confuse with contractions
Sonographic appearance of contractions
Round, masslike within the myometrium but will disappear within 30 mins
Corpus Luteum of pregnancy
Physiological, functional cyst that maintains endo by secreting progesterone, usually 2-3cm but may grow up to 10cm
Most common pelvic mass of 1st trimester
Corpus luteum
What maintains corpus luteum
hCG
Clinical presentation of corpus luteum
Asymptomatic or pain due to size or hemorrhage
Sonographic appearance of corpus luteum
Simple or complex/hemorrhagic cyst
