Pregnancy of Unknown Location and Viability

Question 1

If the ultrasound showed a gestational sac only, and the next ultrasound showed NO embryo with a FHR, how much time has to have passed to call it a fetal demise?

Answer 1

At least two weeks needs to have passed to call this pregnancy a fetal demise

Question 2

What percentage of gestational sac must the bleed be to be considered a large subchorionic bleed?

Answer 2

20-40% the size of the GS is considered a large s/c bleed

Question 3

It is considered fetal demise if there is no FHR on a CRL of at least __mm. (TV)

Answer 3

CRL must be at least 7mm with no FHR to be a fetal demise

Question 4

A dating ultrasound demonstrates a gestational sac and yolk sac. At the follow-up viability exam, there was still no embryo with a FHR. How much time must have passed between the initial dating and f/u viability scan for this to be called a fetal demise?

Answer 4

At least 11 days must have passed to call this pregnancy a fetal demise.

Question 5

What structure indicates the gestational age is six weeks a least?

Answer 5

CRL and FHR

Question 6

If a viability scan demonstrates a pregnancy of unknown location, when should this pregnancy be followed up?

Answer 6

Pregnancy of unknown location should be followed up in 48 to 72 hours.

Question 7

What are three important reasons to obtain an accurate dating?

Answer 7

Knowing a proper due date means:

• doctor and ultrasound visits are booked at the appropriate time
• reduces post-term induction
• not mistakenly SGA or LGA

Question 8

When the inner diameter of the YS is ___mm, it is considered an abnormal YS.

Answer 8

6mm inner diameter of the YS is considered abnormal

Question 9

What is the EDD based on for IVF twins?

Answer 9

Date of Embryo Transfer

Question 10

Only if an empty GS is at least ___mm, can a fetal demise be called.

Answer 10

The empty GS must be 25mm at least to be called a fetal demise.

Question 11

For twins, how do we avoid missing IUGR in the smaller twin?

Answer 11

Use the larger twin to date the pregnancy.

Question 12

What EFW percentile indicates IUGR?

Answer 12

EFW below 10th percentile indicates IUGR

Question 13

The CRL must be ___mm at least, with no FHR to be called a fetal demise TRANSABDOMINALLY.

Answer 13

To diagnose a fetal demise transabdominally, the CRL must be 15mm or more with no FHR.

Question 14

What is a large subchorionic bleed a risk factor for?

Answer 14

A large s/c bleed indicates a risk of miscarriage

Question 15

When is the best GA for a dating US? What is the best CRL size for a dating US?

Answer 15

8-10 weeks gestational age is the best GA for dating. 10mm CRL at least is the best CRL for dating.

Question 16

What structure indicates GA is five weeks at least?

Answer 16

A gestational sac indicates the pregnancy is at least 5 weeks.

Question 17

If there is suspicion of IUGR, what should you check next? What type of IUGR is this?

Answer 17

If you suspect IUGR, check the MCA PI, if it has a lowered PI, it indicates brain sparing. This is EARLY IUGR

Question 18

What values indicates a positive pregnancy test? Is it the bHcG# or difference between two bHcG #’s that matters?

Answer 18

Beta above 5 mIU/mL is a positive pregnancy test. The difference between two blood test bHcG numbers is what matters

Question 19

When can a gestational sac be diagnosed as small?

Answer 19

A GS is considered small if there is LESS THAN 5mm difference between the GS and CRL

Question 20

What are chorionic bumps associated with?

Answer 20

Chorionic bumps are associated with subchorionic bleeds.

Question 21

If you suspect IUGR, but the MCA PI is normal, what could this mean? What should you check next?

Answer 21

The IUGR phase is passed early IUGR, and the MCA PI has normalized. You must check RUTA and LUTA.

Question 22

What could a chorionic bump actually be?

Answer 22

A chorionic bump could actually be another appearance of hemorrhage.

Question 23

Do small to moderate subchorionic or implantation bleeds matter?

Answer 23

No, small to moderate subchorionic and implantation bleeds do not matter.

Question 24

What structure indicates the gestational age is 5 1/2 weeks at least?

Answer 24

Visualization of a YS