Abnormal First Trimester

What are some causes of first trimester bleeding?

-abruption -previa -abnormal pregnancy -IUCD and IUP -myoma -loss of twin

complete abortion

-complete removal of all products of conception, including the placenta -rapid decline of hCG levels -closed cervical os

gestational trophoblastic disease

-condition in which trophoblastic tissue overtakes the pregnancy and propagates throughout the uterine cavity -elevated hCG levels

gastroschisis

-congenital fissure that remains open in the wall of the abdomen just to the right of the umbilical cord -bowel and other organs protrude from the opening

omphalocele

-congenital hernia of the umbilicus that is covered with a membrane -cord may be seen in the middle of the mass

iniencephaly

-congenitally deformed fetus in which the brain substance protrudes through a fissure in which the occiput -brain and spinal cord occupy a single cavity -retroflexion of the spine

Dandy-Walker malformation

-cystic dilation of the 4th ventricle with dysgenesis or complete agenesis of the cerebellar vermis -large psoterior fossa cyst that is continuous with the 4th ventricle -elevated tentorium dilated 3rd and lateral ventricles

ventriculomegaly

-dilation of the ventricular system without enlargement of the cranium -choriod plexus appears to be dangling

theca-lutein cysts

-exaggerated corpus luteum in response to increased hCG levels -3-20 cm -bilateral with multiple septations

holoprosencephaly

-failure of the forebrain to divide into cerebral hemispheres -results in a single large ventricle with varying amounts of cerebral cortex -alobar, semilobar, lobar -known to occur with trisomies 13-5 and 18

choriocarcinoma

-invasive mole with rapid metastasis to lungs, liver, brain -occurs after molar pregnancy, spontaneous abortion

cystic hygroma

-most common abnormality seen sonographically in the first trimester -fluid-filled structure initially surrounding the neck, may extend upward to the head or laterally to the body

Turner's syndrome

-nonlethal genetic abnormaility where chromosomal makeup is 45 XO instead of 46 XX or XY -most common karyotype abnormality -survivors are short in stature, low-set ears, webbing of the neck, shield-shaped chest, infertility

hydatidiform mole

-placental villi have become swollen with fluid -complete: 1-2 sperm fertilize an empty egg -partial: 2 sperm fertilize a normal egg -invasive: grown into the myometrium

interstitial pregnancy

-pregnancy occurring in the fallopian tube near the cornu of the uterus -most life-threatening

ectopic pregnancy

-pregnancy outside the uterus -95% within the fallopian tubes -decidual cast - thick and echogenic decidual reaction -ring of fire

incomplete abortion

-retained products of conception -multiple appearances: intact gestational sac with nonliving embryo, collapsed gestational sac -cervical os is open -placenta generally remains

Presence of an embryo without visualization of the amnion is considered: a. a normal finding b. suspicious of fetal demise c. a precursor for an impending abortion d. suspicious for amniotic band syndrome e. a precursor for an abdominal wall defect

a. a normal finding

The most malignant form of gestational trophoblastic disease is: a. choriocarcinoma b. hydatidiform mole c. anembryonic d. hydropic villi

a. choriocarcinoma

The most common cuse of pelvic pain with pregancy is: a. ectopic pregnancy b. heterotopic pregnancy c. missed abortion d. molar pregnancy

a. ectopic pregnancy

Typically, with anencephaly, the maternal serum AFP will be: a. elevated b. decreased c. this lab finding is not helpful d. unchanged

a. elevated

Typically, with gastroschisis, the maternal serum AFP value will be: a. elevated b. decreased c. this lab finding is not helpful d. unchanged

a. elevated

The triple screen typically includes an analysis of: a. hCG, AFP and estriol b. fetal nuchal translucency, AFP and inhibin A c. hCG, AFP and inhibin A d. hCG, AFP and pregnancy-associated plasma protein A

a. hCG, AFP and estriol

Subcutaneous accumulation of fluid behind the fetal neck measuring 3 mm in thickness is a(n): a. normal finding in the late first trimester b. abnormal finding in the late first trimester c. normal finding in the late second trimester d. abnormal finding in the early first trimester e. abnormal finding regardless of gestational age

a. normal finding in the late first trimester

Which of the following would not typically produce an elevation in hCG? a. down syndrome b. blighted ovum c. triploidy d. molar pregnancy

b. blighted ovum

Typically, with a miscarraige, the serum hCG value will be: a. elevated b. decreased c. this lab finding is not helpful d. unchanged

b. decreased

Pseudocyesis is a condition associated with: a. endometriosis b. false pregnancy c. embryonic demise d. heterotopic pregnancy e. gestational trophoblastic disease

b. false pregnancy

Subchorionic hemorrhage is a common consequence of: a. fertilization of the ovum b. implantation of the conceptus c. amniotic cavity expanding d. ectopic location of the conceptus e. obliteration of the chorionic cavity

b. implantation of the conceptus

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

b. molar pregnancy

The premature separation of the placenta from the uterine wall before the birth of the fetus desctribes: a. placenta previa b. placental abruption c. ectopic cordis d. subchorionic hamartorna

b. placental abruption

A patient presents with a positive pregnancy test and an hCG level of 750 mIU/ml. On the basis of this clinical history, which of the following best describes the expected sonographic findings? a. small gestational sac on TA imaging b. possible small gestational sac on TV imaging c. yolk sac within a gestational sac on TV imaging d. gestational sac with viable embryo on TV imaging e. yolk sac within a gestational sac on TA imaging

b. possible small gestational sac on TV imaging

A rapid decline in serial hCG levels will most likely correlate with a(n): a. ectopic pregnancy b. spontaneous abortion c. blighted ovum d. heterotopic pregnancy e. normal IUP

b. spontaneous abortion

All of the following are associated with an abnormal nuchal translucency except: a. trisomy 21 b. trisomy 16 c. trisomy 18 d. Turner syndrome

b. trisomy 16

Retained products of conception can be a contributing factor of: a. an ectopic pregnancy b. trophoblastic disease c. a heterotropic pregnancy d. polycystic ovarian disease e. ovarian hyperstimulation syndrome

b. trophoblastic disease

Which of the following is an abnormal finding in a first-trimester pregnancy? a. prominent cystic structure in the posterior brain b. visualization of the amnion without an embryo c. fetal heart rate of 100 bpm d. yolk sac measuring 5 mm in diameter e. herniation of the fetal bowel into the umbilical cord

b. visualization of the amnion without an embryo

All of the following are sonographic findings consistent with the ectopic pregnancy except: a. decidual thickening b. complex free fluid within the pelvis c. bilateral, multiloculated ovarian cysts d. complex adnexal mass separate from the ipsilateral ovary

c. bilateral, multiloculated ovarian cysts

Which of the following is an abnormal sonographic finding during the first trimester? a. failure to visualize an amnion adjacent to an embryo b. failure to demonstrate cardiac activity by 5 gestational weeks when utilizing a TA approach c. failure to demonstrate a yolk sac within a MSD of 10 mm when using the TV approach d. failure to demonstrate a yolk sac within a MSD diameter of 15 mm when using the TA approach e. failure to demonstrate an embryo within a MSD of 20 mm when using a TA approach

c. failure to demonstrate a yolk sac within a MSD of 10 mm when using the TV approach

A sonographic examination was performed on a pregnancy patient who complained of vaginal bleeding. Sonographically, a crescent-shaped anechoic area is noted adjacent to the gestational sac. The gestational sac contained a 6 week single live IUP. What is the most likely diagnosis? a. ectopic pregnancy b. molar pregnancy c. subchorionic hemorrhage d. anembryonic gestation

c. subchorionic hemorrhage

Hyperemesis is a common clinical finding assocaited with: a. ectopic pregnancy b. embryonic demise c. trophoblastic disease d. heterotopic pregnancy e. subchorionic hemorrhage

c. trophoblastic disease

anencephaly

congenital absence of the brain and cranial vault with the cerebral hemispheres missing or reduced to small masses

All of the following are clinical features of an ectopic pregnancy except: a. pain b. vaginal bleeding c. shoulder pain d. adnexal ring

d. adnexal ring

All of the following are contributing facotrs for an ectopic pregnancy except: a. PID b. assisted reproductive therapy c. IUCD d. advanced paternal age

d. advanced paternal age

The most common location of an ectopic pregnancy is the: a. ovary b. interstitial portion of the uterine tube c. cornual portion of the uterine tube d. ampullary portion of the uterine tube

d. ampullary portion of the uterine tube

The most common plevic mass associated with pregnancy is the: a. uterine leiomyoma b. dermoid cyst c. theca luteum cyst d. corpus luteum cyst

d. corpus luteum cyst

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

A corpus luteum is most likely misdiagnosed as a(n): a. hydrosalpinx b. ovarian torsion c. missed abortion d. ectopic pregnancy e. blighted ovum

d. ectopic pregnancy

All of the following are consistent with a hydatidiform mole except: a. heterogenous mass within the endometrium b. bilateral theca lutein cysts c. hyperemesis gravidarum d. low hCG

d. low hCG

Which of the following locations is most likely with metastatic gestational trophoblastic disease? a. rectum b. brain c. spleen d. lungs

d. lungs

The quadruple screen includes an analysis of all of the following except: a. hCG b. AFP c. Inhibin A d. pregnancy-associated plasma protein A

d. pregnancy-associated plasma protein A

All of the following are clinical findings consistent with a molar pregnancy except: a. vaginal bleeding b. hypertension c. uterine enlargement d. small for dates

d. small for dates

psuedogestational sac

decidual reaction that occurs within the uterus in a patient with an ectopic pregnancy

blighted ovum (anembryonic pregnancy)

ovum without an embryo

acrania

partial or complete absence of the cranium

cephalocele

protrusion of the brain from the cranial cavity

subchorionic hemorrhage

result from implantation of the fertilized ovum into the uterine myometrial wall

heterotopic pregnancy

simultaneous intrauterine pregnancy and extrauterine pregnancy

What is the most common cause of the bleeding in the first trimester?

subchorionic hemorrhage