OB first trimester registry review Flashcards
First trimester embryology
Zygote –> morula –> blastocyst
First trimester
Weeks 1-12
Fertilization
Usually occurs in the ampulla, within 24 hrs of ovulation (~day 14 of 28 day cycle)
Zygote
A fertilized egg, undergoes rapid cell division
Morula
Cluster of cells formed 3-4 days after fertilization
Blastocyst
First time cell differentiation occurs by day 5
Trophoblast
Outer ring of trophoblastic cells that begin to produce hCG. Will eventually become the chorion and placenta
Embryoblast
Inner cell mass that will develop into embryo, amnion, cord, yolk sac
hCG released by trophoblast
Maintains corpus luteum therefore maintaining endo via progesterone
Decidualized (decidual reaction)
Endometrium prepares for implantation
Implantation
Occurs 7-9 days after fertilization
Chorionic villi
Finger like projections of trophoblast that form links into decidualized endo
Yolk sac
Primary sac regressed by day 28 from LMP, secondary sac replaces
hCG levels post implantation
Double every 48 hours until week 9
Endometrium @ 4 weeks gestation
Multilayered appearance due to increased progesterone (decidualized), possible tiny anechoic sac
5 weeks gestation
-1,000-2,000 hCG level
-GS seen by transvaginal
-double decidual sign confirms 2 layers of decidua
hCG level for transabdominal GS seen
3,500 mIU/mL
2 layers of decidua
Capsularis and parietalis
Mean sac diameter (MSD)
L + H + W/ 3
Grows 1mm per day
Gestational sac first seen with MSD
10mm
Extraembryonic coelem
Space of the chorionic cavity between the amnion and chorion where the gestational sac is found
5.5 weeks gestation
Gestational sac and yolk sac appear and are the first definitive sign of an IUP
Secondary yolk sac
-Responsible for producing AFP, angiogenesis, hematopoiesis
-Is round, anechoic with thin echogenic rim measuring <6mm
-Connects to embryo
Vitelline duct
Duct that connects the yolk sac to the embryo, consists of 1 artery and 1 vein
Angiogenesis
The process of new blood vessels forming from existing blood vessels
Hematopoiesis
The production of blood cells and platelets
Enlarged yolk sac
Indicates impending demise (double bleb)
Double bleb sign
Large yolk sac next to amnion
6 weeks gestation
Embryo now seen within amniotic cavity adjacent to yolk sac. Must be seen by MSD 25mm. Fetal pole grows 1mm per day after 6 weeks
Crown rump length (CRL)
MOST reliable estimation of gestational age in first trimester
Fetal cardiac of fetus
-Must be noted by 5mm CRL, possibly earlier
-Approx 100bpm increasing to 140 later in 1st trimester
7 weeks gestation
Formation of limb buds and fetal head appears larger than body
8 weeks gestation
Cystic structure noted within head-rhombencephalon
Rhombencephalon
Eventually 4th ventricle
9-12 weeks gestation
Normal for physiological bowel herniation migration of midgut and bowel at base of umbilical cord–> should be completed by 12 weeks
10 weeks
No longer an embryo–> FETUS
11+ weeks gestation
Fetal limbs and facial profile/cranium clearly evaluated and normalized
Lateral ventricles
Filled with echogenic choroid plexus on either side of falx cerebri
Placenta and umbilical cord
Well defined, crescent shaped and slightly echogenic mass of the tissue. Formed by decidua basalis and chorion frondosum
Decidua basalis
Maternal component of placenta and umbilical cord
Chorion frondosum
Fetal component of placenta and umbilical cord
Hormones produced by placenta and umbilical cord
Several hormones + pregnancy-associated plasma protein a (PAPP-A)
First trimester screening
-11-13w6d
-Primarily for Trisomy 21 and 18
-Evaluate NT measurement + hCG + PAPP-A
Nuchal tranlucency
Fluid filled layer between the fetus and the skin layer, SHOULDN’T measure >3mm
Enlarge NT associated with
Trisomy 18, trisomy 21, trisomy 13, turners, cardiac defects; require karyotyping
Karyotyping
Genetic test that analyzes the number, shape, and size of chromosomes in a sample of cells
Guideline for 1st trimester screening
-CRL between 45-84mm
-Midsagittal view
-Fetal head in neutral position
-Magnified image, head occupies most of image
Midsagittal view landmarks
Rectangle shaped palate and mandible, nasal bone, thalamus, and brain stem
NT measurement
INNER TO INNER at widest section in the back of neck when fetus is in neutral position, include entire fluid section but not skin
Chorionic cavity
Area between amnion and chorion, typically fuse during first trimester but fully fused by 16 weeks
Abnormal NT
Pocket of fluid visibly enlarged