Flashcards in Abnormal First Trimester Deck (41):
Abortion means the termination of a pregnancy prior to __ weeks gestation.
_____ ______ usually occurs within 1 to 3 weeks after an embryonic demise.
Approximately ___% of all pregnancies end in spontaneous abortion with ___% of them occurring before the 16th week.
Almost always a spontaneous abortion is caused by a _____ ____ in the fetus.
What is a complete abortion and what would you see sonographically?
All products of conception are expelled. You would see an empty uterus with a normal endometrial cavity or maybe some fluid within the cavity.
What is an incomplete abortion and what would you see sonographically?
Partial expelling of uterine contents but some products remaining. You may see thickened irregular endometrial echoes and some fluid within the cavity.
Other possible causes for spontaneous abortion could be: ______, ________, ________
Failure of the corpus luteum
Low progesterone levels
Problems with implantation
What is a missed abortion?
A pregnancy within the uterine cavity that is not viable.
What is another name for missed abortion?
What are the three criteria used to establish a missed abortion/fetal demise?
1) An embryo with a crown/rump length greater than 10mm with no fetal heartbeat.
2)Serum beta hcg is 10,800 or greater and no fetal heartbeat.
3) A sac diameter of >8mm and no yolk sac.
A spontaneous abortion in progress _____ be halted. There will be cervical dilation ___ ___ 3cm and rupture of _____.
CANNOT; greater than; membranes.
What will you see sonographically during a spontaneous abortion?
A gestational sac low in the uterus or cervix, possibly even in the vaginal canal.
What is a threatened abortion?
This is when a patient has vaginal bleeding with cramping and a closed cervix.
What is an anembryonic pregnancy and what did it used to be called?
It is a gestational sac only, no embryo is present. Used to be called blighted ovum, but this term is no longer used.
What is a septic abortion?
Infection due to retained products of conception or the result of an intentional abortion using nonsterile instruments.
What are two signs of infection that a person with a septic abortion may exhibit?
Fever and elevated white count
What is the definition of an ectopic pregnancy?
Implantation of a fertilized egg at any site other than the endometrium.
Where is the most common ectopic pregnancy site and how do you scan to see this area?
Ampulla of the fallopian tube 90% of the time.
Look transverse from the fundus down along the lateral side of the uterus.
The incidence of ectopic pregnancy has overall increased as a result of increased ___, assisted ___ programs, and ___ reconstructive surgeries.
PID, fertility, tubal
___ and ___ pregnancies are rare and highly dangerous, and can progress further than ectopic pregnancies before being recognized.
Ovarian and abdominal
What is a heterotopic pregnancy and how rare are they?
A coexsisting intrauterine pregnancy plus an ectopic pregnancy. One in 30,000
If a patient is a fertility patient, there is a one in ___ chance of ectopic pregnancy.
3 symptoms of ectopic pregnancy are? Whose responsibility is it to identify this pregnancy?
Pain, bleeding, positive pregnancy test.
Sonographer and Radiologist!
5 sonographic findings of ectopic pregnancy:
1) Any live extrauterine embryo is a definitive confirmation of ectopic pregnancy.
2) A pseudogestional sac which is a large collection of fluid in the uterus. (a double decidual sign of intrauterine pregnancy will NOT be present)
3)Prominent decidual reaction due to hormone elevations, a very thick endometrium
4)Free fluid in the cul de sac (Check Morison's pouch!! Fluid found here requires immediate surgery!! She is bleeding to death!!)
5) Adnexal mass which is highly vascular "ring of fire"
DO NOT mistake the ring of fire around the corpus luteum as an ____ ectopic. Corpus luteum is only within the ___ and will exhibit the ___ ___ around the corpus luteum cyst indicating that it is ovarian.
adnexal; ovary; claw sign
What is the name for a spectrum of pathologic conditions which result fro the abnormal proliferation of trophoblastic tissue?
Gestational trophoblastic disease
Trophoblastic disease presents in what two forms?
Complete hydatidiform mole, partial mole
The most common form of trophoblastic disease?
Complete hydatidiform mole
What is complete hydatidiform mole?
The chorionic villi are hydropic (filled with water) without an identifiable embryonic or fetal pole. It can be persistant and aggressive, and can be in malignant form as well.
What are the sonographic findings for complete hydatidiform moles?
Enlarged uterus filled with an echogenic, partially solid and partially cystic mass (bunch of grapes)
What will be present bilaterally in complete hydatidiform moles?
Bilateral Theca-lutein cysts in the ovaries
What is a partial mole?
An abnormal fetus with trophoblastic proiferation but it is more mild than an incomplete mole.
What are the sonograhic findings for a partial mole?
A deformed gestational sac with a growth restricted fetus with abnormal chromosomes and abnormalities such as hydrocephalus. The placenta is large with multiple cystic areas.
80% of the time, patients diagnosed with complete hydatidiform mole follow a ____ course with complete resolution after ____.
In 12-15% of patients with complete hydatidiform mole, an ___ mole develops, and 5-8% of the time metastatic ____ develops.
An invasive mole penetrates the ___ and possibly into adjacent structures and may even cause uterine rupture.
The treatment for an invasive mole is ___ ____.
What are the sonographic findings of an invasive mole?
The presence of diffuse or focal echogenic material within the endometrial cavity, possibly seen extending to the myometrium.
____ is the most malignant form of trophoblastic disease, occurring in one in 40,000 pregnancies in the US.
Only 3-5% of all molar pregnancies result in choriocarcinoma, which can occur after a ___ pregnancy, after an ____, or even after a ___ pregnancy.
molar; abortion; normal