Ch. 23 The First Trimster

Sono findings of a blighted ovum:

- LG, irregular gestational sac without embryo or yolk sac -absent or minimal gestational sac growth -poor decidual reaction

Sono findings of subchorionic hemorrhage:

- crescent shaped anechoic, echogenic, or hypoechoic area adjacent to gestational sac. (depends on age of hemorrhage) -may resemble a second gestational sac

Sono findings of embryonic/fetal diemise:

- no cardiac activity in fetal pole 4-5mm -irregular shaped fetus -irregular sized gestational sac -irregular appearing yolk sac

Clinical findings of lieomyoma with pregnancy:

- positive UPT -pelvic pressure -menorrhagia -palpable pelvic mass -enlarged, bulky uterus -urinary frequency -dysuria -constipation

Sono findings or lieomyoma:

-hypoechoic mass within uterus -posterior shadowing -degeneration fibroids may have calcifiations or cystic components -multiple appear as LG, irregular, diffusely heterogenous uterus

Sono findings of theca lutein cyst:

-large -bilateral -multiloculated ovarian masses -may contain hemorrhagic components

Sono findings of complete molar pregnancy:

-large complex mas within uterus -snowstorm appearance, secondary to placental enlargement -multiple variable sized cyst replacing placental tissue (hydropic chorionic villi) -bilateral ovarian theca lutein cyst

Types of Abortion

-threatened abortion -complete (spontaneous) abortion -incomplete abortion -missed abortion -inevitable abortion

Clinical findings of a blighted ovum:

-vaginal bleeding -reduction of pregnancy symptoms -low hCG

Clinical findings of embryonic/fetal demise:

-vaginal bleeding -small for dates -closed cervix - low hCG based on LMP

Clinical findings of subchorionic hemorrhage:

-vaginal bleeding -uterine cramping -closed cervix

triploid

3 times the amount of normal chromosomes

Most common location for ectopic pregnancy:

Ampullary portion of the fallopian tube

All of the following would be associated with a lower than normal hCG level except: A. Ectopic pregnancy B. Molar Pregnancy C. Blighted Ovum D. Spontaneous Abortion

B. Molar Pregnancy

All of the following are sonographic findings consistent with ectopic pregnancy except: A.decidual thickening B. complex free fluid in pelvis C. bilateral multiloculated ovarian masses D. complex adnexal mass separate from the ipsilateral ovary.

C. Bilateral, multiloculated ovarian masses

The most malignant form of trophoblastic disease:

Choriocarcinoma

The most common pelvic mass associated with pregnancy is:

Corpus Luteum Cyst

All of the following are clinical features of an ectopic except: A. Pain B. Vaginal bleeding C. Shoulder pain D. adnexal ring

D. Adnexal ring

All of the following are contributing factors to ectopic pregnancy except: A. PID B. Assistive reproductive therapy C. IUD D. advanced paternal age

D. Advanced paternal age

All of the following may be sonographic findings in the presence of an ectopic pregnancy except: A. Pseudogestational sac B. Corpus Luteum Cyst C. Adnexal Ring D. Double sac sign

D. Double sac sign

Which of the following locations is most likely with metastatic gestational trophoblastic disease? A. Rectum B. Brain C. Spleen D. Lungs

D. Lungs

All of the following clinical findings are consistent with a molar pregnancy except: A. Vaginal Bleeding B. Hypertension C. Uterine Enlargement D. Small for dates

D. Small for dates

All are consistent with hydatidiform mole, except: A.heterogenous mass within endometrium B. bilat theca lutein cyst C. hyperemisis gravidarum D. low hCG

D. low hCG

During a 1st trimester US exam you note a cystic structure within the fetal head. This most likely represents the:

Rhombencephalon

US was performed on a pregnancy PT who complained of vaginal bleeding. Sonographically, a crescent shaped anechoic area is noted adjacent to the gestational sac. The gestational sac contains a 6 wk single IUP. What is the most likely diagnosis?

Subchorionic Hemorrhage

Which is not associated with an abnormal nuchal translucensy: A. Trisomy 21 B. Trisomy 16 C. Trisomy 18 D. Turner Syndrome

Trisomy 16

uterine lieomyoma

a benign smooth muscle tumor of the uterus (fibroid/myoma)

subchorionic hemorhage

a bleed between the endometrium & gestational sac at the edge of the placenta

implantation bleeding

a bleed that occurs at the time in which the conceptus implants into the decidualized endometrium

methotrexate

a chemotherapy drug often used to attack rapidly dividing cells like those seen in an early pregnancy; often used to manage ectopic pregnancies.

intrauterine contraceptive device (IUD)

a reversible form of contraception that is manually placed in the uterine cavity to prevent implantation of a fertilized ovum

invasive mole

a type of gestational trophoblastic disease in which a molar pregnancy invades into the myometrium and may also invade into the uterine wall & perimetrium

menstrual age

a way in which a pregnancy can be dated based on first day of LMP.

complete (spontaneous) abortion

all products of conception expelled Sono: no intrauterine products of conception identified, prominent endometrium (may contain hemorrhage)

nuchal translucensy

anechoic space along the posterior fetal neck

intradecidual sign

appearance of small gestational sac in the uterine cavity surrounded by the thickened echogenic endometrium

zygote

cell formed by the union of two gametes; the first stage of a fertilized ovum

heterotopic pregnancyc

co-existing ectopic and intrauterine pregnancies

hematopoiesis

development of blood cells

morula

developmental stage of the conceptus following the zyogote

infundibulum

distal segment of the fallopian tube

Most comon cause of pelvic pain with pregnancy:

ectopic pregnancy

hyperemesis gravidarum

excessive vomiting during pregnancy

Missed abortion

fetal demise with retained fetus Sono: no cardac activity, abnormal fetal shape

multiloculated

having more than one internal cavity

human chorionic gonadotrophin (hCG)

hormone produced by the trophoblastic cells of the early placenta; may also be used as a tumor marker in non-gravid PT and males

pelvic inflammatory disease (PID)

infection of the female genital tract that may involve the ovaries, uterus, fallopian tubes.

hematocrit

lab value that indicates the amount of RBC's in blood

mean sac diameter

measurement of the gestational sac to obtain a gestational age (L x W x H x 3)

physiologic bowel herniation

normal developmental stage when the midgut migrates in to the base of the umbilical cord

idiopathic

of unknown origin

Turner Syndrome

one sex chromosome is absent; may also be referred to as monosomy X

Incomplete abortion

part of the products of conception expelled Sono: enlarged uterus, thickened & irregular endometrium.

The herniation of the embryologic bowel into the base of the umbilical cord at 9 weeks is reffered to as:

physiologic herniation of bowel

preeclampsia

pregnancy induced maternal high BP, proteinuria, after 20 wk gestation.

rhombencephalon

primary brain vesicle also reffered to as the hindbrain; becomes the cerebellum, pons, medulla oblongata, & 4th ventricle

miscarriage

spontaneous end of a pregnancy before viability

secondary yolk sac

structure responsible for early nutrient transfer to the embryo

vitelline duct

structure that connects the developing embryo to the secondary yolk sac

pseudogestational sac

the appearance of an abnormally shaped false gestational sac withing the uterine cavity as a result of an ectopic pregnancy; corresponds with blood and secretions within cavity

trohphoblastic cells

the cells that surround the gestation that produce hCG

hydatidiform mole

the most common form of gestational trophoblastic in which there is excessive growth of the placenta and high levels of hCG; typically benign

trisomy 18

third chromosome 18; Edwards sydrome

trisomy 21

third chromosome 21; Down syndrome

threatened abortion

vaginal bleeding before 20wks, closed cervival OS Sono: low FHR

Inevitable abortion

vaginal bleeding with dilated cervix Sono: low-lying gestational sac, open internal os of cervix