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Abnormal OB > Test 1 (1st tri. & ectopic) > Flashcards

Test 1 (1st tri. & ectopic) Flashcards

1
Q

what are the weeks in the first trimester?

A

the first 13 weeks following LMP

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2
Q

how big does the embryo grow in the first trimester?

A

80 mm

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3
Q

what are the phases of the 1st trimester?

A
  • conceptus phase
  • embryonic phase
  • fetal phase
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4
Q

conceptus phase

A

3-5 weeks

-occurs about 2 weeks after a women’s last menstraul period

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5
Q

embryonic phase

A

6-10 weeks

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6
Q

fetal phase

A

10-12 weeks

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7
Q

Stomodeum

A

precursor to the mouth

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8
Q

Vitelline artery

A

circulates blood from the primitve aorta of the early developing embryo to the yolk sac

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9
Q

allantois

A

collect liquid waste from the embryo, as wel as to exchange gases used by the embryo. Involved in the development of the urinary bladder

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10
Q

cloaca

A

structure for the intestinal, urinary, and genital tracts

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11
Q

what is seen in 4.3-5 weeks?

A
  • possible small GS
  • possible double decidual sac sign (DDSS)
  • possible intradecidual sac sign (IDSS)
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12
Q

what is seen in 5.1-5.5 weeks?

A

gestational sac

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13
Q

what is seen in 5.5-6 weeks?

A
  • YS
  • GS should be around 6 mm in diamter
  • double bleb sign
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14
Q

what should be seen over 6 weeks?

A
  • fetal pole on endovag
  • fetal heart rate 100-115 bpm
  • GS should be around 10mm in diameter
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15
Q

what should we see at 6.5 weeks?

A

-CRL about 5 mm

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16
Q

what should we see at 7-8 weeks?

A
  • CRL between 11-16 mm

- cephalad and caudal poles identified

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17
Q

what should we see at 8-9 weeks?

A
  • CRL between 17-23 mm
  • limb buds appear
  • head is seen seperate from body
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18
Q

what should we see 9-10 weeks?

A
  • CRL between 23-32 mm
  • FHR 170-180 bpm
  • fetal movement
  • rhombencephalon
  • nuchal transluceny
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19
Q

what should the b-hCG be at when we see GS transabdominally?

A

> 1800mIU/mL

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20
Q

what should the b-hCG be at when we see GS transvaginally?

A

> 1000mIU/mL

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21
Q

how fast does b-hCG grow?

A

double every 2-3 days

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22
Q

what should MSD measure when a yolk sac should be visable?

A

20mm

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23
Q

what should MSD measure when an embryo should be visable?

A

25mm

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24
Q

what should CRL measure when a cardaic activity should be visable?

A

7mm

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25
Q

An embryo should be seen ______days after a scan with a gestational sac without a yolk sac

A

= 14 days

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26
Q

An embryo should be seen _______ days after a scan with a gestational sac and a yolk sac

A

=11

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27
Q

pseudocyesis

A

false pregnancy
belief that you are carrying a baby when you are not really carrying a child becasue you have all or many of the symotoms

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28
Q

couvade

A

men experience sympathetic pregnancy

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29
Q

what symptoms happen with couvade?

A
  • weight gain
  • nausea
  • backache
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30
Q

what is useful to confirm an early intrauterine pregnancy?

A

DDSS

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31
Q

what does the DDSS consist of?

A

-decidua parietalis
-decidua capsularis
(where they adhere is the decidua basalis)

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32
Q

pseudogestational sac

A
  • intrauterine anechoic sac-like structure that may be mistaken for an early viable pregnancy.
  • represents endometrial breakdown of a decidual cast cyst
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33
Q

how do you differentiate a pseudogestational sac from an true GS sac?

A
  • central location
  • oval shape
  • lack of a thick chorionic ring
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34
Q

double bleb sign

A
  • visualization of a GS containing a yolk sacand an amniotic sac giving an appearance of two small bubbles.
  • embryonic disc is located between the two bubbles.
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35
Q

why os double bleb sign an important feature?

A

important featre of intrauterine pregnancy becuase it distinguishes a pregnancy from a psedogestational sac or a decidual cast cyst
-should not be confused with the DDSS

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36
Q

anembryonic pregnancy (blighted ovum)

A

gestational sac which develops without an embryo

-no fetal pole on endovag when MSD >25mm

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37
Q

what is the first sign of early pregnancy on US?

A

gestational sac

  • seen on endovag at about 5 weeks
  • MSD=2-3mm
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38
Q

how do you distinguisg a true GS from a pserdogestational sac?

A
  • normal eccenteric location
  • presence of yolk sac
  • presence of DDSS
  • postive beta-hCG shows its a good sign its a pregnancy
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39
Q

how fast does the normal gestatonal sac grow per day?

A

1mm

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40
Q

what plays a critical role in embryogenesis?

A

yolk sacq

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41
Q

what are the functions of the yolk sac?

A
  • provision of nutrients to the embryo before placenta
  • embryonic hematopoiesis
  • origin of the epithelium lining of the gastro-intestinal and respiratory tracts
  • production of albumin, AFP, and other proteins during embryonic period
  • becomes incorporated into gut on embryo
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42
Q

what is the maximmun diameter of the yolk sac?

A

6mm and 10 weeks menstral age

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43
Q

what does an abnormally large yolk sac indicate?

A

a poor OB outcome

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44
Q

when does the yolk sac decline?

A

after 9 weeks

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45
Q

what is abnormal yolk sac size or shape caused by?

A

poor embryonic development or demise

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46
Q

what is indicative of a long standing embryonic demise?

A

calcified YS without blood flow

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47
Q

what do slow growing tumors develop from?

A

trophoblastic cells

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48
Q

what are the 4 types of gestationa tropho blastic disease?

A
  1. hydatidiform mole
  2. invasive mole
  3. choricarcinoma
  4. placetal-site trophoblastic tumor (PSTT)
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49
Q

what is another name for molar pregnancy?

A

hydatidiform mole

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50
Q

what is the most common type of trophoblastic tumor?

A

hydatidiform mole (molar pregnancy)

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51
Q

which gestational trophoblastic diseases are bengin and which are malignant?

A 
BENIGN
-hydatidiform mole
-invasive mole
MALIGNANT
-choriocarcinoma
-invasive mole
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52
Q

what is the normal blood flow of intrauterine arteries in a normal pregnancy?

A

1st trimester-high resistance, low diastolic veloicites except implantation site
2nd / 3rd trimester-resistance reduces

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53
Q

what is the blood flow in a molar pregnancy and why?

A

-high velocity
-low impedance waveforms
because arterial invasion by abnormally proliferating trophoblast

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54
Q

what do Arterio-venous shunts associated with neovascularization within the invasive myometrial mass result in?

A

appearance of chaotic vasculature with colour aliasing

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55
Q

what does colour and spectral doppler look like for a gestational trophoblastic disease?

A

reveals a mosaic pattern within the cystic spaces representing turbulent flow. Spectral analysis reveals high velocity and low impedance pulsatile flow

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56
Q

what is the swiss cheese appearance associated with?

A

complete hydatidiform mole representing the hydropic villi

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57
Q

what is complete hydatidiform mole associated with?

A

theca lutein cysts

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58
Q

what causes the swiss cheese appearance?

A

cystic degeneration of chorionic villi

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59
Q

Chorioadenoma Destruens

A
  • malignant

- invasive mole

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60
Q

Choriocarcinoma

A
  • malignant

- wil metastisize

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61
Q

what is the etiology theories of trophoblastic disease?

A
  1. Pathologic pregnancy with the primary defect the BLIGHTED OVUM
    - Non active chromosomes in the ovum therefore no fetus
  2. Neoplastic proliferation of trophoblast resulting in early fetal demise
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62
Q

what increases the incidence of trophoblastic disease?

A
  • south asia
  • recurrent
  • increases with age. poverty, malnutrituon
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63
Q

what are clinical and sonographic features of trophoblastic disease?

A
  • increased beta HCG levels
  • hyperemesis gravidarum
  • theca lutein cysts
  • hypertendsion with PreEclampsia
  • excessive uterine size
  • toxemia (pregnancy induced hypertension)
  • hyperthyroidism
  • VAGINAL BLEEDING
  • large for dates
  • absence of fetus
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64
Q

is having a twin pregnancy, 1 molar and one not possible?

A

no

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65
Q

complete hydatiform mole

A

sperm fertilizes an egg that does not contain maternal DNA (DNA only from father)

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66
Q

what is the chromosomal pattern for complete hydatiform mole?

A

46 xx with all the chromosomes of paternal origin (diploid karyotype)

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67
Q

how is complete hydatiform mole characterized?

A
  • proliferation of the trophoblast

- absence of fetus , cord, and amniotic membrane

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68
Q

what is the sonographic appearance of a complete hydatiform mole?

A

-enlarged uterus
-central heterogenous echogenic mass expands endo canal
-mass conatins multiple cysts of varrying size=hydropic villi
(BUNCH OF GRAPES)

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69
Q

partial hydatiform mole

A
  • 2 haploid sperm fertlizes a normal egg but there are 2 sets of DNA from father in fertilized egg
  • fetus forms but placenta cells are abnormal
70
Q

how is partial hydatiform mole characterized?

A
  • marked focal swelling of villi
  • trophoblastic hyperplasia
  • normal villi
  • presence of fetus, cord, amniotic membrane
71
Q

what is the chromosomal pattern for partial hydatiform mole?

A

69 XXX (triploid karyotype)

72
Q

what mole are sonographers more acccurate diagnosing?

A

complete over partial

73
Q

true mole

A

absent fetus with soft tissues mass filling the uterus

74
Q

partial mole

A
  • fetal parts also seen (anomolous fetus)
  • triploidy
  • focal placental hydropic degeneration
75
Q

what is the treatment for hydatiform mole pregnancy?

A 
evauation of uterine contents
-Pharmacological (methotrexate)
-D & C
-hysterectomy
Follow up
-repeated beta hCG levels
-repeated sonogram
BOTH TO AVOID PERISISTAMT TROPHOBLASTIC NEOPLASIA (PTN)
76
Q

what does Persistent Trophoblastic Neoplasia (PTN) include?

A 
life threatening complication
includes:
-invasive mole
-choriocarcinoma
-placental-site trophoblastic disorder
77
Q

what is the most common Persistent Trophoblastic Neoplasia (PTN)?

A

invasive mole

78
Q

what are some evidence of malignancy?

A
  • elevated beta hCG
  • invasive moles persistant elevation within 1-3 months
  • irregular bleeding
  • pulmonary haemoptysis (bloody cough)
  • pelvic symptoms of a mass lesion
79
Q

Chorioadenoma Destruens/Invasive Mole

A

Intermediate stage between a benign mole and a highly malignant choriocarcinoma

80
Q

what are the features for Chorioadenoma Destruens/Invasive Mole?

A
  • Excessive trophoblastic overgrowth
  • Extensive penetration of trophoblastic elements including whole villi, into the myometrium and even peritoneum and vaginal vault
  • Lack the tendency to widespread metastases
81
Q

what are Chorioadenoma Destruens/Invasive Mole complications?

A

intra-abdominal bleeding and uterine perforation

82
Q

what is the Chorioadenoma Destruens/Invasive Mole treatment?

A

hysterectomy and chemotherapy (methotrexate)

83
Q

what are distant metastases for choriocarcinoma?

A
  • LUNGS
  • liver
  • brain
  • GI tract
  • kidney
84
Q

what is the treatment for Choriocarcinoma?

A

hysterectomy and chemotherapy

85
Q

what is a Choriocarcinoma?

A

malignant tuor that forms from trophpoblast cells

-spreads to the muscle layer of the uterus and nearby blood vessels

86
Q

whre else may Choriocarcinoma spread?

A
  • brain
  • lungs
  • liver
  • kidney
  • spleen
  • intestines
  • pelvis
  • vagina
87
Q

what is the most rare gestational trophoblastic disease?

A

Placental-site trophoblastic tumour (PSTT)

88
Q

what is the most fatal tyoe of gestational trophoblastic neoplasia?

A

Placental-site trophoblastic tumour (PSTT)

89
Q

where does Placental-site trophoblastic tumour (PSTT) form?

A

where placenta attaches to the uterus. Forms from trophoblastic cells and speads into the muscle of the uterus and into blood vessels. May also spread to lung, pelvis, or lymph nodes

90
Q

Epithelioid trophoblastic tumours (ETT)

A

very rare type of gestational trophoblastic neoplasia that may be benign or malignant.

91
Q

what happens when Epithelioid trophoblastic tumours (ETT) is malignant?

A

may spread to lungs

92
Q

how are hydatiform moles treated?

A

evacuating the uterus by uterine suction or by surgicalcurettageas soon as possible after diagnosis, in order to avoid the risks ofchoriocarcinoma

93
Q

patients are advised not to conceieve ______________ after normal hCG reached after treatment of trophblastic disease?

94
Q

what is a subchorionic hematoma?

A

subchorionic hemorrhage (bleed or hematoma) collects between the uterine wall and the chorionic membrane and may leak through the cervical canal

95
Q

when a subchorionic hematoma is shown, the outcome of the fetus depends on:

A
  • size of hematoma
  • mothers age
  • fetus’s gestational age
96
Q

what does subchorionic hematoma increase the risk of?

A
  • miscarriage
  • stillbirth
  • placental abruption
  • preterm labour
97
Q

when may Maternal serum screening be done?

A
  • with NT
  • 9w-13w6d
  • measures free bhCG and PAPP-A
98
Q

when is trisomy 21 considered a factor?

A

higher concentration of bhCG and lower concentration of PAPP-A

99
Q

what does 1st trimester US screening involve?

A
  • measurment of CRL
  • measurment of NT
  • results are combined with serum screening
100
Q

when must 1st trimester scanning be done?

A

11w0d - 13w6d

CRL measures 45-84mm

101
Q

what is a normal NT?

A

<3mm nut must be matched with maternal and gestational age

102
Q

why is maternal serum screening used in the 2nd trimester?

A

to help evaluate the risk that a fetus has certain chromosomal abnormalities

103
Q

trisomy 18

A

Edwards syndrome

104
Q

when is 2nd trimester screening done?

A

between 15th and 20th weeks

105
Q

what is preformed by itself and not as part of a triple or quad screen?

A

an AFP test, especially when 1st trimester down syndrome screening has alreast been used to assess risk

106
Q

2nd trimester maternal serum screening table

A

1st trimester slide 72 powerpoint

107
Q

what is nuchal transluceny?

A

collection of fluid under the skin behind the fetal neck in the first trimester of pregnancy

108
Q

when is nuchal fold done?

A

2nd trimester

109
Q

what may the NT evolve into?

A
  • nuchal edema

- cystic hygromas with or without generalized hydrops

110
Q

what does increased nuchal transucency indicate?

A
  • aneuploidy (chromosomal abnormalities)

- non-aneuploidy structural defects and syndromes

111
Q

Non-aneuploidy structural defects and syndromes

A
  • Congenital diaphragmatic herniation
  • Congenital heart disease
  • Omphalocoele
  • Skeletal dysplasias
  • Smith-Lemli-Opitz syndrome
112
Q

what is the first direct imaging manifestation of the fetus?

A

fetal pole (seen as a thickening on the margin of the yolk sac)

113
Q

when should a fetal heart beat be detected?

A

fetal pole = 7mm

114
Q

what are sonographic findings of pregnacy failure?

A
  • CRL >7mm and no heart rate
  • MSD >25mm and no embryo
  • absence of embryo with HB >2 weeks
  • absence of embryo with HB >11 days after scan showed GS with YS
115
Q

whta are causes of miscarriages?

A
  • Drug and alcohol abuse
  • Exposure to environmental toxins
  • Hormone problems
  • Infection
  • Obesity
  • Physical problems with the mother’s reproductive organs
  • Problem with the body’s immune response
  • Serious body-wide (systemic) diseases in the mother (such as uncontrolleddiabetes)
  • Smoking
116
Q

when do most miscarriages occur?

A

during first 7 weeks of pregnancy

117
Q

Threatened miscarriage

A

referring to pain, bleeding or contractions during the first 20 weeks of gestation, with a closed cervical os.(symptoms)

118
Q

Missed miscarriage/missed abortion/early fetal demise

A

situation when there is a non-viable fetuswithin the uterus, without the patient presenting with frank abortion-like features.

119
Q

Spontaneous Abortion

A

refers to naturally occurring events, not to medical or surgical abortions.

120
Q

Inevitable Abortion

A
  • refers to the presence of an open internal os in the presence of bleeding in the first trimester of pregnancy.
  • Most often intra cervical contents are present at the time of examination.
121
Q

Incomplete Abortion

A

miscarriage where there are retained products of conception still within the uterus

122
Q

Septic Abortion

A

lining of the womb (uterus) and any remaining products of conception become infected

123
Q

Complete Abortion

A
  • final stage of a miscarriagewhere all products of conception have passed out of the uterus
  • Shows an empty uterus with no fetal components or products of conception.
124
Q

what does a threatened miscarriage progess into?

A

inevitable miscarriage if cervical dilation occurs

125
Q

when is incomplete miscarriage termed?

A

tissue has passed through the cervical os

126
Q

what are 1st trimester complications related to uterus?

A
  • fibroids
  • synechiae
  • IUCD
  • Cervical cerlage due to history in incompetent cervix
127
Q

Uterine fibroids are associated with an increased rate of:

A
  • Spontaneous miscarriage
  • Preterm labour
  • Placenta abruption
  • Malpresentation of the fetus
  • Labour dystocia (abnormal or difficult labour)
  • Cesarean delivery
  • Postpartum hemorrhage
128
Q

Complications Attributed to Fibroids

A
  • prevent conception by blocking the fallopian tubes
  • interfere with implantation of the blastocyst
  • cause an early miscarriage if blastocyst implants at the fibroid site
  • cause intrauterine growth retardation (IUGR)
  • cause abnormal labour
  • cause post partum hemorrhage
  • contribute to retained placenta after birth
129
Q

Synechiae

A
  • adhesions or fibrous scars
  • idiopathic
  • may mimin amniotic band syndrome
  • do not interfere with development of fetal growth
130
Q

Asherman Syndrome

A

Intrauterine adhesions resulting from the uterine trauma or interventions such as:

  • Curretage
  • Caesarian section
  • Myomectomy.
131
Q

what does asherman’s syndrome lead to?

A

to amenorrhea, hypomenorrhea, habitual abortion and secondary infertility

132
Q

what is the US diagnosis of synechie?

A
  • thick bands connected to uterine wall

- blood flow in majority of synechial bands

133
Q

incompetent cervix or weakened cervix

A

During pregnancy, as the baby grows and gets heavier, it presseson the cervix. This pressure may cause the cervix to start to open before the baby is ready to be born.

134
Q

what can incompetent cervix or weakened cervix lead to?

A

miscarriage or premature delivery

135
Q

what is the classic history that raises the suspicion of cervical insufficiency?

A

recurrent mis-trimester pregnancy loss

136
Q

what are cusses of an incompetent cervix?

A
  • Malformed cervix or uterus from a birthdefect
  • Damage during a difficult birth
  • Previous surgery on the cervix such as LEEP procedure
  • Previous trauma to the cervix, such as aD&C (dilation and curettage) from a termination or amiscarriage
  • DES (Diethylstilbestrol) exposure
137
Q

what was DES linked to?

A

occurnece of vaginal clear cell adenocarcinoma in female offspring

138
Q

Treatment of Incompetent Cervix

139
Q

when is cerlage preformed?

A

between 12-14 weeks of pregnancy

140
Q

Hormonal IUCD

A
  • Creates a thick and sticky mucus in the cervix which limits the sperm’s ability to pass through into the uterus
  • Prevents the endometrium from thickening which creates a poor environment for the blastocyst to implant and grow
141
Q

Copper IUCD

A

makes the uterus and fallopian tubes produce fluid that kills sperm and prevents implantation of the blastocyst.

142
Q

what do fluids with copper IUCD contain?

A
  • WBC
  • cooper ions
  • enzymes
  • prostaglandins
143
Q

prostaglandins

A

regulate the female reproductive system, and are involved in the control of ovulation, the menstrual cycle and the induction oflabour

144
Q

pregnancy with an IUCD is in place - increased likelihood of

A
  • vaginal bleeding
  • uterine infections
  • ectopic pregnancy
  • miscarriage
  • placental abruption (separation of the placenta from the uterus)
  • premature delivery
145
Q

majoity of adnexal masses in pregnancy are _________

146
Q

what is corpus luteum always associated with?

147
Q

corpus luteum cyst

A

corpus luteum may fill with fluid or blood, causing the corpus luteum to expand into a cyst

148
Q

what is the most common cause to an enlargment of ovary and torsion

A

corpus luteum cyst (usually regresses by 2nd trimester)

149
Q

which side is more prone to ovarian torsion?

A

right adnexa and in forst trimester

150
Q

what is ovarian/adnexal torsion sonographically?

A
  • unilateral ovarian enlargment
  • solid, cystic, or complex
  • may have collections in pouch of douglas
  • no colour doppler
151
Q

what is free fluid and acsites associated with?

A

-ruptured and unruptured ectopic pregnancies

152
Q

how can we use free fluid to diagnose ectopic pregnanacy?

A

the presence of free fluid in the hepatorenal space of a symptomatic patient without an intrauterine pregnancy is virtually diagnostic of a ruptured ectopic pregnancy

153
Q

molar pregnancy b-hCG levels

154
Q

symptoms of an ectopic pregnancy

A
  • Light vaginal bleeding
  • Nausea and vomiting with pain
  • Lower abdominal pain
  • Sharp abdominal cramps
  • Pain on one side of the body
  • Dizziness or weakness
  • Pain in your shoulder, neck, or rectum
155
Q

if the ectopic implantation site ruptures, it is a _________

A

medical emergency

156
Q

classic triad for ectopic pregnancy?

A

-pain
-abnormal vaginal bleeding
-amenorrhea
may have
-adnexal tenderness
-cervical motion tenderness

157
Q

Risk of An Ectopic

A
  • Tubal abnormality
  • Previous ectopic pregnancy
  • Hx of tubal reconstructive surgery
  • PID
  • Chlamydial salpingitis
  • IUCD
  • Increased maternal age
  • Increased parity
  • Previous Caesarean section
158
Q

fertility risks of ectopic

A
  • ovulation induction
  • IVF
  • Embryo transfer
159
Q

cornual ectopic

A

intramural-interstitial

  • Myometrium covers the tube in this region
  • Later presentation because the pregnancy has room to grow
  • Late rupture at 3-4 months with excessive bleeding
  • Higher morbidity rate
160
Q

Interstitial Line Sign (Cornual ectopic)

A
  • thin, echogenic line extending from the endo canal to the interstitial sac or ectopic site
  • no double-decidual sign
161
Q

Cornual ectopic treatment

A
  • Surgical laparotomy & Cornual resection

- Or methotrexate therapy

162
Q

cervical ectopic pregnancy vascularity?

A
  • implantation=vascular

- incomplete abortion=non-vascular

163
Q

treatment of cervical pregnancy

A

medical injection of KCl (potassium chloride)

164
Q

Cervical scar implantation ectopic

A
  • Painless vaginal bleeding
  • Hx of cesarean sections
  • Can look similar to spontaneous abortion
165
Q

Heterotopic Gestation

A

Intrauterine pregnancy and an ectopic pregnancy occurring simultaneously

166
Q

when may heterotopic gestation be suspected?

A

patient had IVF or ovulation induction

167
Q

what is the most common finding of ectopic pregnancy?

A

adnexal mass

-solid/heterogenous=comppsed of blood products

168
Q

sonographic findings of ectopic pregnancy?

A
  • adnexal mass
  • tubal ring
  • ring of fire
  • free fluid
  • BLOOD TESTS ARE IMPORTANT
169
Q

tubal ring

A

concentric ring of trophoblast

170
Q

pseudogestational sac

A

endometrial fluid collections surrounded by echogenic endometrium

171
Q

what finding of ectopic pregnancy is considered urgent surgery?

A

free fluid

Abnormal OB (7 decks)

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