Ch 49 Obstetrics Sonography, Ch.49 First Trimester

_____system is the first organ to develop rapidly

Cardiovascular

_____is the first day of the pregnancy

Conception

What happens on day 54 of pregnancy?

Digital rays are distinct

_____ age dates the pregnancy with the first day of the LMP as the beginning of gestation

Gestational

What happens on day 36 of pregnancy?

Heart beat begins

__________________ hCG is sign of down syndrome.

Increased

IUP stands for

Intrauterine Pregnancy

What happens in week 6 of pregnancy?

Neuropores close and neural tubes form

PAPP-A stands for

Pregnancy associated plasma protein A

What happens in week 5 of pregnancy?

Prominent neural folds/grooves

____________________ secrete hCG

Trophoblastic cells

What happens on day 41 of pregnancy?

Upper and lower limb buds are present

What happens on day 52 of pregnancy?

Upper lip is formed

Within the conceptus, the inner cell mass matures into the ____,___,&_____

bilaminar embryonic disk, the future embryo, and the primary yolk sac.

During implantation, proteolytic enzymes produced by the trophoblasts erode endometrial mucosa and maternal capillaries develop a primitive_______ between mother and conceptus

blood exchange network

What happens on day 48 of pregnancy?

cerebral vesicles are distinct

Embryologists state time in ________ age

conceptual

the follicle that released the mature ovum hemorrhages and collapses to form the_____

corpus luteum

What happens on day 42 of pregnancy?

crown-rump length is 4.0 mm

Demise means

death

hCG causes the uterine endometrium to convert to _____________.

decidua

The echogenic ring around the gestational sac can be divided embryologically into several components. The portion on the myometrial or burrowing side of the conceptus is known as the _______

decidua basalis.

Villi covering the rest of the developing embryo are referred to as the _______

decidua capsularis

Villi normally______ over the area of the sac where implantation does not occur

degenerate

DNA stands for

deoxyribonucleic acid

A Reliable sign of a viable gestation is called

double decidual sac sign

After 7 weeks hCG should be ______________ every 3.5 days.

doubling

When the hCG level is elevated and an intrauterine gestational sac is not seen an _____ should be considered

ectopic pregnancy

1st 9 weeks the conceptus is called

embryo

In the first 9 weeks the conceptus is called an____

embryo

conceptual age is also known as ______age

embryologic

Conceptual age is also known as

embryologic age

hCG levels ____before spontaneous expulsion of nonviable gestation

fall

Fertilization occurs in

fallopian tube

The last 2 weeks of the first trimester (11 and 12) constitute the beginning of the ____period

fetal

After 9 weeks embryo is called a

fetus

After the first 9 weeks the embryo is called the ____

fetus

Sonographers need to obtain quantitative hCG levels whenever possible before_____ obstetric examinations are performed

first-trimester

Clinicians and sonographers use _____age

gestational

When implantation is complete, the trophoblast has formed primary villi, which initially encircle the early _____

gestational sac.

hCG stands for

human chorionic gonadotropin

An intimate relationship between the sonographic findings and quantitative serum____________________ levels normally exist during early pregnancy

human chorionic gonadotropin (hCG)

12 days after conception is:

implantation process (zygote)

PAPP-A _____________ during gestation.

increases

Amniotic means

inner

Abnormal pregnancies demonstrate a____ hCG level relative to gestational sac development

low

Ectopic pregnancies have ______________ hcG.

lower

Trisomy 21 pregnancies have ___________ PAPP-A levels

lower

Adnexa is

made up of fallopian tubes and ovaries

gestational age is also known as ____ age

menstrual

Gestation age is also known as

menstrual age

If the hCG isn't rising could result in _________________ in the 1st trimester.

miscarriage

Zygote undergoes rapid cell division to form a ___________.

morula

What happens on day 50 of pregnancy?

oral and nasal cavities are confruent

Chorionic means

outer

What happens on day 46 of pregnancy?

paddle shaped hand plates are present

At 8 weeks hCG levels ______________ and __________________.

plateau, decrease

Corpus Luteum secretes_____&_____

progesterone and estrogen

The _____ is seen sonographically throughout the first trimester

secondary yolk sac

What type of transducer do you use in the first trimester?

transvaginal

See the____before the beating embryonic heart

yolk sac

What are the Goals for sonography in the first trimester?

- Visualization and localization of the gestational sac - Identification of embryonic demise or living embryonic gestation - Identification of embryos that are still alive but at increased risk for embryonic or fetal demise - Determination of the number of embryos and the chorionicity and amnionicity in multifetal pregnancies - Estimation if the duration or menstrual age of the pregnancy - Early diagnosis of fetal anomalies including identification of embryos that are more likely to be abnormal based on secondary criteria

Normal sonographic features of a gestational sac are? - _____ or ____-shape - Fundal position or an eccentrically placed position in the middle portion of the____ - _____contours - Decidual wall thickness greater than ____ - A yolk sac can be seen with a mean sac diameter (MSD) greater than____ - Gestational sac size grows at a predictable rate of ____ in early pregnancy

-Round, oval - uterus -Smooth -3mm - 18mm -1 mm/day

In a intrauterine pregnancy ultrasound image, • the Sonolucent center represents the _____ cavity • Circumferential echogenic rim surrounding the gestational sac represents _____ associated with decidual reaction

-chorionic -trophoblastic tissue

The interface between the ______and the echogenic highly vascularized_______forms the double decidual sac sign

-decidua capsularis - endometrium

After 8 weeks the hCG levels plateau and ____ while the gestational sac continues to ___

-decline -grow

All embryonic dates reflect _____age rather than _____age

-menstrual -embryologic

Fertilized ovum, now referred to as a ____, undergoes rapid cellular division to form the ____

-zygote -morula

What are your hCG levels for week 3?

0-5

fertilization occurs within _to ___days after ovulation.

1 2

Fertilization occurs how many days after ovulation?

1-2 days

What are your hCG levels for week 6?

1080-56,500

During a 28-day menstrual cycle, a mature ovum is typically released at day ___.

14

Ovulation is the ________ day of a normal 28 day cycle

14th

What are your hCG levels for week 5?

18-7340

Normal gestational sac is visible when the hCG is ___________________.

1800

A normal gestational sac can be consistently demonstrated when the hCG level is _______(Second International Standard) or greater when using TA

1800mIU/ml

Conceptual age is the

1st day of pregnancy (conception)

Gestation age is the :

1st day of the last menstrual cycle

The intrauterine pregnancy (IUP) Appears as a____ sac with an echogenic ring having a sonolucent center

1‐2mm

the gestational age would add __ weeks onto the conceptual age.

2

At approximately __ days of menstrual age, the primary yolk sac is pinched off by the extraembryonic coelom, forming the secondary yolk sac.

23

What are your hCG levels for week 10-12?

25,700-288,000

The gestational sac is approximately____ mean sac diameter (MSD)

25mm

The Crown Rump Length measures ____by the end of the 10th week

30mm

The blastocyst typically enters the uterus __to __days after fertilization.

4 5

Secondary yolk sac is routinely seen between_____ weeks

5 - 5 ½

How many weeks does the initial heartbeat happen?

5 1/2 to 6 wks

Initial heart beat between____and___weeks

5 ½ 6

Between_____ weeks of gestation the amniotic cavity and membrane, chorionic cavity, yolk sac, and embryo should be seen

5 ½ and 6

What are your hCG levels for week 4?

5-426

What frequency is used with transvaginal?

5-8 MHz

The hCG level is significantly reduced by EV and may be as low as _____

500 mIU/ml

The intrauterine pregnancy (IUP) can be visualized in the___ week of embryonic development

5th

Embryonic phase is between week ___-__

6‐10

What are your hCG levels for week 7-8?

7650-229,000

Implantation occurs __-___days after ovulation

7‐9

Gestational sac size and hCG levels increase proportionately until___menstrual weeks

8

PAPP-A analysis is strongest at how many weeks?

9 to 11 weeks

What is trisomy 21?

A form of down syndrome (common)