Chapter 18: Sonographic Evaluation of First Trimester Complications Flashcards
(110 cards)
1
Q
the spontaneous or induced termination of an early pregnancy and expulsion of fetal and placental tissues
A
abortion
2
Q
An invasive procedure in which a quantity of amniotic fluid is removed from the amniotic sac for analysis of the fetal cells or for the presence of certain chemicals in the fluid itself. May also be performed as a palliative measure in patients with severe polyhydraminos
A
amniocentesis
3
Q
A pregnancy which has failed prior to the development of an identifiable embryo, or in which embryonic tissue has been resorbed after early embryo demise
A
anembryonic pregnancy
4
Q
a deficiency of red blood cells
A
anemia
5
Q
having an abnormal number of chromosomes
A
aneuploidy
6
Q
the empty gestational sac seen in an anembryonic pregnancy
A
blighted ovum
7
Q
an abnormally slow heart rate
A
bradycardia
8
Q
an invasive procedure in which the chorionic villi of an early pregnancy are removed for analysis
A
chorionic villus sampling
9
Q
abnormal fertilization of an oocyte that contains no maternal chromosomes, resulting in the proliferation of swollem chorionic villi and the absence of identifiable embryonic structures
A
complete hydatidform mole
10
Q
a spectrum of disorders that begins at fertilization and involves abnormal proliferation of the trophoblasts that in a normal pregnancy would have gone on to form the placenta. May become invasive and metastasize.
A
gestational trophoblastic disease
11
Q
the invasive or metastatic form of gestational trophoblastic disease
A
gestational trophoblastic neoplasia
12
Q
a form of gestational trophoblastic disease resulting from abnormal fertilization, in which there is proliferation of swollen chorionic villi; also called a molar pregnancy
A
hydatatidform mole
13
Q
excessive vomiting
A
hyperemesis
14
Q
excessive activity of the thyroid
A
hyperthyroidism
15
Q
a spontaneous abortion in which some products of conception remain in the uterus
A
incomplete abortion
16
Q
A failed early pregnancy that is in the process of being expelled from the uterus
A
inevitable abortion
17
Q
the spontaneous failure and expulsion of an early pregnancy
A
miscarriage
18
Q
hydatidform mole
A
molar pregnancy
19
Q
abnormal fertilization resulting in one maternal and two paternal sets of chromosomes (tripoloidy), leading to the development of an abnormal embryo and placenta
A
partial hydatidform mole
20
Q
inadequate absorption of oxygen and/or inadequate expulsion of carbon dioxide
A
respiratory insufficiency
21
Q
a crescent-shaped sonolucent collection of blood between the gestational sac and the uterine wall
A
subchorionic hemorrhage
22
Q
subchorionic hemorrhage
A
subchorionic hematoma
23
Q
abnormally rapid heart rate
A
tachycardia
24
Q
large, often bilateral ovarian cysts, the formation of which is usually stimulated by excessive levels of circulating hcG
A
theca lutein cysts
25
threatened miscarriage, vaginal bleeding in a pregnancy of less than 20 weeks; may be accompanied by pain or cramping
threatened abortion
26
pregnancy-induced hypertension, proteinuria, edema, and headache (preeclampsia), which may progress to the development of seizures (eclampsia)
toxemia of pregnancy
27
having three copies of each chromosome
triploid; tripoloidy
28
empty gestational sac >20 mm , smaller than expected sac size
anembryonic pregnancy
29
lack of heart motion, expanded amnion sign, lack of double bleb sign
embryonic demise
30
thickened endometrium, increased flow in myometrium
incomplete abortion
31
empty low-lying gestational sac, open cervix
inevitable abortion
32
crescent-shaped sonolucent or complex fluid collection between the gestational sac and uterus
subchorionic hemorrhage
33
May have appearance of a blighted ovum, threatened abortion, or variable echogenicity filling the entire uterus without characteristic vesicular appearance
hydatidform mole (first trimester)
34
Large soft tissue mass of low- to moderate- amplitude echoes filling the uterine cavity and containing fluid filled spaces.
hydatatidform mole (after first trimester)
35
this may present as a gestational sac that is relatively large and intact, surrounded by a thick rim of placenta-like echoes with well-defined sonolucent spaces within. It may be empty or may contain a disproportionately small viable or nonviable embryo. Echogenic fetal parts may be visualized with or without normal placenta
incomplete or partial mole
36
concurrent presence of normal-appearing placenta and embryo and a separate area of cystic vesicular appearance
coexisting mole and embryo
37
enlarged uterus with foci of increased echogenicity and cystic spaces in the myometrium
invasive mole
38
cystic to solid areas of necrosis, coagulated blood, or tumor tissue invading and extending as a mass outside the uterine wall with metastatic lesions located in the liver
choriocarcinoma
39
Where can bleeding originate in a threatened abortion?
uterus, cervix, vagina
40
most reliable criteria for early nonviable pregnancies
1. empty gestational sac with a mean sac diameter up to 25 mm
2. a crown-rump diameter of 7 mm for embryos without a detectable heartbeat
41
Reasons uterus smaller than expected
1. incorrect dates
2. early pregnancy failure
3. ectopic pregnancy
42
defined as crown rump length at least 2 standard deviations below the mean for the expected gestational age
early onset intrauterine growth restriction
43
Reasons uterus larger than expected
incorrect dates
multiple gestation
molar pregnancy
uterine fibroids
44
Uterine fibroids may be associated with:
preterm labor
premature rupture of membranes
fetal malposition
45
___ - ___% of clinically recognized pregnancies result in spontaneous abortion occurring before 20 weeks gestational age, with most occurring before 12 weeks
10-20
46
___ - ___% of pregnancy failures caused by genetic abnormalities
50-70
47
sometimes called a blighted ovum
anembryonic pregnancy
48
first structure to be sonographically recognized
secondary yolk sac
49
no cardiac activity in an embryo measuring 5 mm or more; absence of cardiac activity in a less than 5 mm embryo seen within an enlarged amniotic sac; instead of "double bleb sign", there is an obvious yolk stalk between yolk sac and embryo and amniotic sac
embryo demise
50
patient with an anembryonic pregnancy or embryo demise that has not yet been expelled from uterus
missed or delayed abortion
51
occurs when some placental or fetal tissue has been expelled but some products of conception remain in the uterus
incomplete abortion
52
crescent-shaped sonolucent fluid collection between gestational sac and uterine wall
subchorionic hemorrhage
53
increases risk of:
spontaneous miscarriage
preeclampsia
placental abnormalities
preterm delivery
subchorionic hemorrhage
54
pregnancy loss
abortion or miscarriage
55
pregnancy that is no longer viable; uterus has not expelled contents
missed miscarriage
56
miscarriage that is in progress
impending miscarriage
57
miscarriage in which a portion of the fetal contents have been expelled with a portion remaining in the uterus
incomplete miscarriage
58
encompasses disorders that begin at fertilization and involve abnormal proliferation of the trophoblasts that in a normal pregnancy would have gone on to form the placenta
gestational trophoblastic disease
59
Most common forms of gestational trophoblastic disease
molar pregnancies
60
anuclear oocyte is fertilized by a haploid sperm carrying an X chromosome, and the sperms chromosomes undergo duplication, the genetic result is a 46XX gestation of entirely paternal origin
complete hydatadidform molean
61
anuclear oocyte may be fertilized by two spermatozoa, resulting in either a 46XX or 46XY gestation
complete hydatatidform mole
62
occurs when an apparently normal oocyte is fertilized by sperm that duplicates itself or, rarely, by two spermatozoa
partial hydatidform mole
63
triploid pregnancy with 69 chromosomes
partial hydatidform mole
64
identifiable embryo or fetus may develop, along with a thick, hydropic placenta with focal areas of vesicular swelling
partial hydatatidform mole
65
usually bilateral, measure between 6 and 12 cm, associated with molar pregnancies
theca lutein cysts
66
complex echogenic intrauterine mass with multiple small cystic spaces
molar pregnancy
67
may be recognized by measuring crown-rump length, NT, and maternal serum biochemisity
fetal aneuploidy
68
acranial/anencephaly
holoprosencephaly
Dandy-Walker malformation
encephalocele
spina bifida
central nervous system abnormalities
69
ectopia cordis, hypoplastic left heart syndrome, atrioventricular septal defect, conduction disorders, heart failuer
cardiac anomalies
70
Hydatadidform moles are the result of:
abnormal fertilization
71
Which of the following is the failure of a pregnancy to develop?
a. abortion
b. blighted ovum
c. inevitable abortion
d. anembryonic
d
72
What term describes an abnormally slow heart rate?
bradycardia
73
Select the term describing an abormal triploidy chromosomal number, fetus, and placenta.
a. molar pregnancy
b. partial hydatidform mole
c. hydatidiform mole
d. complete hydatidform mole
b
74
Sonographic appearance of an inevitable abortion
empty low-lying gestational sac and an open cervix
75
During the sonographic examination on a first-trimester pregnancy, a crescent complex fluid collection images between the gestational sac and uterus. What is the most likely differential?
subchorionic hemorrhage
76
How does a second trimester hydatidform mole image during the sonographic examination?
large soft tissue mass of low- to moderate-amplitude echoes filling the uterine cavity and containing fluid-filled spaces
77
Which of the following central nervous system malformations is identifiable in the first trimester?
a. spina bifida
b. ectopia cordis
c. cystic hygroma
d. omphalocele
a
78
Uterine size estimation by physical examination, to determine pregnancy age, may be inaccurate owing to all except:
a. uterine fibroids
b. maternal obesity
c. surgical scars
d. parity
d
79
What laboratory value is useful when a smaller than expected gestational sac is seen with ultrasound?
hCG
80
Early-onset intrauterine growth restriction is defined as crown-rump length at least ___ standard deviations below the mean for the expected gestational age.
2
81
Spontaneous pregnancy loss before 20 weeks (of clinically recognized gestations) is as high as:
10-20%
82
A pregnancy less than 20 weeks with vaginal bleeding is termed:
threatened abortion
83
A gestational sac without an embryo or yolk scan with a mean sac diameter greater than ____ (EV) generally predicts pregnancy failure.
20mm
84
Select the yolk sac with the healthiest characteristics.
a. oblong
b. round
c. less than two standard deviations below the mean yolk sac diameter for gestational age
d. more than two standard deviations above the mean yolk sac diameter for a gestational age
b
85
Pregnancy failure is most likely to occur when the fetal heart rate is:
a. 150 bpm at 8 weeks
b. greater than or equal to 155 bpm at 6.3 to 7 weeks
c. 120 to 130 bpm at 9 weeks
d. less than 110 bpm at 6.3 to 7 weeks
d
86
Select the statement which does not indicate probable embryonic demise.
a. 6 mm embryo without cardiac activity
b. no double bleb sign with a less than 5 mm embryo
c. no cardiac activity with a less than 5 mm embryo and double bleb sign
d. enlarged amniotic sac with less than 5 mm embryo
c
87
The risk of spontaneous miscarriage, preeclampsia, placental abnormalities, or preterm delivery is increased by crescent shaped sonolucent fluid between the gestational sac and the uterine wall as is called:
subchorionic hematoma
88
A complete hydatidform mole usually results in:
a. large-for-dates uterus and vaginal bleeding
b. a triploid pregnancy with 69 chromosomes
c. vaginal bleeding and a small-for-dates or normal-sized uterus
d. a thick, hydropic placenta
a
89
Select the measurement not usually included in a first-trimester screening for assessing risk in a chromosomally abnormal fetus.
a. CRL
b. NT
c. MSD
d. Ductus venous Doppler velocitmetry
b
90
Hydaditidform moles are caused by:
abnormal fertilization
91
Select the correct sonographic appearance for impending abortion.
a. early empty gestational sac
b. crescent-shaped fluid collection between the gestational sac and uterus
c. oval-shaped gestational sac
d. empty low-lying gestational sac, open cervix
d
92
Theca lutein cysts are usually stimulated by excessive levels of hCG and are related to:
complete molar pregnancy
93
The recommended first-trimester screening tests for assessing the risk of carrying a chromosomally abnormal embryo include all except:
a. measuring CRL
b. measuring NT
c. measure FHR
d. testing maternal serum biochemistry levels
c
94
Select a first trimester fetal central nervous system abnormality.
a. Dandy-Walker malformation
b. Dysplastic kidney
c. Ectopia cordis
d. Gastroschisis
a
95
When the uterus is smaller than expected, ultrasound is used to rule out incorrect dates, early pregnancy failure, or _____ pregnancy.
ectopic
96
In women with vaginal ______ or _____, the risk of pregnancy loss increases.
bleeding
pain
97
Genetic abnormalities cause ____ of pregnancy failure.
50-70%
98
A patient with an anembryonic pregnancy or embryo demise that has not yet been expelled from the uterus is labeled as a ______ or _______.
missed
delayed abortion
99
A blighted ovum is also called a(n) _____.
anembryonic pregnancy
100
Visualization of an amnion without sonographic evidence of an embryo is called ______.
empty amnion sign
101
Routine obstetric ultrasound done between approximately 6 and 12 weeks divulging a normal singleton fetus, demonstrates a miscarriage rate of ____.
1.6%
102
An embryo measureing ____ or greater should demonstrate cardiac activity.
5 mm
103
A failed early pregnancy that is in the process of being expelled from the uterus is called an ______.
impending abortion
104
Uterine fibroids may be associated with _____ labor, premature _____ of membranes, and fetal ______.
preterm
rupture
malposition
105
Enlarged ovaries are frequenty seen during complete molar pregnancy as a result of elevated _____ levels.
hCG
106
Molar pregnancy has the ability to develop into_______.
either locally or metastatic GTN
107
Holoprosencephaly is a _____ system abnormality.
central nervous
108
A patient diagnosed with molar pregnancy should have a weekly blood test for ___ consecutive weeks until her hCG levels return to normal.
3
109
Toxemia of pregnancy presents as a pregnancy induced hypertension, proteinuria, edema, and headache (preeclampsia) and may progress to ______.
eclampsia (seizures)
110
