Ch. 10 Abnormal First Trimester

Question 1

Abortion is the termination of pregnancy prior to —- weeks of gestation

Answer 1

20

Question 2

Spontaneous AB usually occurs – to – weeks after embryonic or fetal demise

Answer 2

1-3

Question 3

Term for when all products of conception are expelled

Answer 3

complete abortion

Question 4

sono finds of a complete AB

Answer 4

empty uterus with normal endo cavity, possible small trace of fluid in endo cavity, the uterus may remain enlarged for up to 2 weeks following SAB

Question 5

Term for an abortion in which there are remaining products of conception in the uterus

Answer 5

Incomplete Abortion

Question 6

Sono finds of incomplete AB

Answer 6

thickened or irregular endo echoes, possible fluid in endo cavity, increased endo vascularity on color doppler

Question 7

Define missed abortion

Answer 7

the presence of an embryo without cardiac activity (the embryo may be retained for several weeks before the pt experiences symptoms)

Question 8

List clinical symptoms of a missed AB

Answer 8

Low hCG levels in comparison to dates, loss of pregnancy symptoms, decrease in uterine size, brownish vaginal discharge without frank bleeding

Question 9

Sono finds of a missed AB

Answer 9

embryo > 7mm without cardiac activity

Question 10

Term for a SAB that is imminent and cannot be halted

Answer 10

Inevitable AB/ AB in progress

Question 11

Inevitable AB clinical signs

Answer 11

cervical dilatation > 3 cm, rupture of membranes, bleeding for more than 7 days, persistent cramping

Question 12

Sono finds of Inevitable AB

Answer 12

GS low in uterus or in cx (distinguished from Cx ectopic using color doppler) cervical dilatation, downward mvmt of GS during scan, anechoic crescent surrounding GS

Question 13

A condition in which the future of the pregnancy may be at risk but the pregnancy continues

Answer 13

Threatened AB

Question 14

Sono finds of a threatened AB

Answer 14

not able to diagnosis on US

Question 15

Gestation in which the embryo does not develop or stops early in development and cannot be visualized

Answer 15

Anembryonic pregnancy aka Blighted ovum

Question 16

List clinical signs of a blighted ovum

Answer 16

BhCG may rise but not as rapidly as expected
uterus is small for dates
vaginal spotting
closed cx

Question 17

sono finds of a anembryonic pregnancy

Answer 17

no identifiable embryo in a GS measuring 25mm or larger
fluid-fluid level indicates blood and is positive evidence of embryonic death

Question 18

Term for an abortion that results from the use of non-sterile instruments or from infection of retained products of conception

Answer 18

Septic AB

Question 19

List clinical symptoms and sono finds of a septic AB

Answer 19

clinical- signs of infection such as fever and leukocytosis
sono - enlarged uterus with heterogeneous contents, endo may have shadowing due to gas bubbles

Question 20

Implantation of the fertilized ovum at any site other than the endometrium

Answer 20

ectopic pregnancy

Question 21

Where is the most common site of ectopic pregnancies

Answer 21

in the ampulla of the oviduct (90% of cases)

Question 22

List reasons why the incidence of ectopic pregnancies has increased over the years

Answer 22

increased occurrence of PID, tubal reconstructive surgeries, assisted fertility programs

Question 23

T or F, Ov ectopics are common

Answer 23

F. They are rare

Question 24

Type of ectopic that is associated with high mortality rate due to risk of hemorrhage

Answer 24

Cervical ectopic. If treatment with methotrexate is unsuccessful, cervical artery embolization or total hysterectomy may be necessary.

Question 25

Type of ectopic that may progress further into gestation that other ectopics before it is recognized

Answer 25

Abdominal ectopic

Question 26

Coexisting intrauterine and extrauterine pregnancies

Answer 26

Heterotopic pregnancy

Question 27

In what types of pts do heterotopic pregnancies occur more in

Answer 27

Fertility pts who have undergone zygote or gamete transfer

Question 28

List clinical symptoms of an ectopic gestation

Answer 28

amenorrhea, vaginal bleeding or spotting, adnexal tenderness/ pelvic pain, shoulder pain (referred pain from intraperitoneal bleeding)

Question 29

Sono finds of an ectopic pregnancy

Answer 29

empty uterus, adnexal mass, "SLIDING SAC SIGN" (gentle pressure with TV transducer moves GS. Presence of endometrial decidual reaction or pseudosac, FF in posterior cul de sac, adx, pericolic gutters or morrisons pouch.

Question 30

Sonographic pitfalls of ectopic pregnancies

Answer 30

The presence of fluid in the endo cavity known as 'Pseudogestational sac'. The absence of the double sac sign eliminates this pitfall. Misidentification of corpus luteal cyst as an adnexal ectopic Misidentification of a cornual/interstitial ectopic as an IUP.

Question 31

Which ectopic site is the most dangerous due to potential of hemorrhage

Answer 31

Cornual, interstitial

Question 32

Describe the characteristics you would expect to see on color doppler with an ectopic pregnancy

Answer 32

"ring of fire" surrounding the GS. High velocity, low resistance waveform.

Question 33

List treatment options for an ectopic

Answer 33

Methotrexate (MTX) Laparoscopy Exploratory laparotomy (less frequent) Expectant management (no treatment if the pt is hemodynamically stable)

Question 34

Spectrum of pathologies resulting from the abnormal proliferation of trophoblastic tissue

Answer 34

Gestational trophoblastic disease

Question 35

List clinical finding of GTD

Answer 35

uterus large for dates, extremely elevated hCG levels, hyperemesis gravidarum, early onset of pre-eclampsia, hyperthyroidism, theca lutein cysts

Question 36

The most common form of GTD, The chorionic villi are hydropic without identifiable embryonic or fetal tissue

Answer 36

Complete hydatidiform mole

Question 37

Sono finds of a complete hydatidiform mole

Answer 37

enlarged ut filled with echogenic mass, hypervascular, low resistance flow, ov theca lutein cysts

Question 38

A form of GTD in which fetal and or embryonic tissue is frequently identified

Answer 38

Partial mole

Question 39

Sono finds of a partial mole

Answer 39

deformed GS, growth-restricted fetus with triploid anomalies, includinf syndactyly, and hydrocephalus, enlarged placenta with multiple cystic areas

Question 40

Gestation in which two conceptions occur, one normal and the other with GTD

Answer 40

Mole with coexisting normal fetus

Question 41

A patient has just had a normal term birth, her hCG levels still have yet to decline, what do you expect

Answer 41

Persistent Trophoblastic Neoplasia (PTN)

Question 42

Type of PTN that is most common, may cause uterine rupture, is a malignant NON-Metastatic GTD

Answer 42

Invasive mole aka chorioadenoma destruens

Question 43

Type of PTN that is malignant, metastatic, and very rare

Answer 43

Choriocarcinoma

Question 44

Sono finds of a choriocarcinoma

Answer 44

Elevated hCG levels in a nonpregnant pt, enlarged uterus, irregular complex mass with increased vasculature