First Trimester Flashcards
1
Q
Gravid (G)
A
the number of times a women is pregnant,
regardless of delivery
2
Q
Para (P)
A
refers to a delivery of a fetus weighing 500 grams
or more and is over 20 weeks gestation regardless if fetus is alive at birth. Multiple births are considered a single para event
3
Q
Fetus
A
a developing young in the human uterus > 8 weeks
menstrual age
4
Q
Embryo
A
period is from 2nd through 8th menstrual weeks
5
Q
Menstrual age or Gestational age
A
refers to the age of the pregnancy calculated from the first day of the LM
6
Q
Conceptual age
A
refers to the age of the pregnancy from the calculated ovulation
7
Q
Conceptual age used by who
A
Embryologist
8
Q
Early embryology Step 1
Zygote
A
Ovum and sperm join in the distal fallopian tube (ampullary portion)
9
Q
Early embryology Step 2
Morula
A
Cells of the zygote multiply, cluster
10
Q
Early embryology Step 3
Blastocyte
A
enters uterus and fluid rapidly enters forming a blastocyst
11
Q
Early embryology Step 4
Blastocyst implants into
A
endo
12
Q
After 9 menstrual weeks, the embryo is called
A
a fetus
13
Q
1st 9 menstrual w is called an
A
embyro
14
Q
During a _____ day cycle, a mature ovum is realed at day ____
A
28
14
15
Q
Fimbriae
A
ovum is swept into teh distal fallopian tube
16
Q
Fertilizationg occurs
A
1-2 days after ovulation
17
Q
hCG is produced by
A
trophoblastic cells of developing chorionic villa
18
Q
hCG doubles every
A
30-48 hours
19
Q
hCG peaks at
A
10th gest w
20
Q
hCG declines
A
after 10th w and levels out at 18 w
21
Q
hCG
GS should be identified TV at
A
1000 mIU/mL
22
Q
hCG allows the
A
corpus luteum to continue to secrete progesterone
causes ut to not shed endo lining
23
Q
Decidual reaction
A
- 3 layers
- double decidua sign
- help defferentiate an IUP from ectopic
24
Q
Deciduas capsularies
A
covers the surface of the blastocyte
25
Decidual basalis
located between the conceptus and the uterine wall
26
Decidual parietalis (or decidua vera)
covers the remainder of the uterus
27
Neural Plate begins to form around
- 4th w
- when closes, forms neural tube
- if fails, result is neural tube defect
28
Primitive heart develops
- 5th w
| - by 8th should have definite form
29
vascular network begins to develop by the end of
8th w
30
peripheral vascular system is completed by end of
10th w
31
Kidneys ascend from pelvis starting at
8 w
32
When do the kidneys get into their final position
11th w
33
All limbs formed by
- 10 w
34
almost all congenital abnormalities occur before or during
embryonic period
35
normal sac can be identified by
5 menstural weeks TA
36
Implantation implants in the ___ of the uterus
fundus
37
low implantation in ut has increased risk of
abortion
38
GS shape
starts out round and becomes kidney shaped
39
Secondary Yolk Sac present by
5.5 menstrual w
40
secondary yolk sac appears
round w. echogenic wall and sonolucent center
41
secondary yolk sac is contianed
in the chorionic cavity
42
secondary yolk sac produced
alpha fetoprotien
43
secondary yolk sac function
transfer of nutrients and hematopoiesis- production and development of blood cells
44
secondary yolk sac connected to fetus by the
vitelline duct also known as omphalomesenteric duct
45
Liver takes over of secondary yolk sac by
8th w
46
eventually part of the yolk sac will become
primitive gut
47
How many cavities are withing the GS?
2
| chorion and amniotic
48
Chorionic cavity
contains yolk sac and fluid
49
Amniotic cavity contains
simple-appearing amniotic fluid and the developing embryo
50
Amniotic membrane or amnion is a
thin echogenic line loosely surrounding the fetus
51
Amnion and chorion typically fuses around
the middle of the first trimester, but may not totally fuse until 16 weeks gestation
52
Cardiac Activity can be seen ____ w w/ a normal HR at
5-6 w
| 100-115 bpm
53
Heart motion can be detected in
4mm
| for sure in 5 mm
54
CRL grows
1mm/day
55
FHR increase to
140 bpm by 9 w
56
Brachycardia
poor prog
under 90bpm
1st sign of fetal demise
57
Fetal limb buds are identified by
7 w
58
Fetal head is proportionally
larger than body
59
w/in head, cystic structure is seen most often represnting
rhombencephalon or hindbrain
60
rhombencephalon will develop into
4th ventricle
61
Physiological bowl herniation begins at
8 w when bowl herniates into the base of the umbilical cord
62
Physiological bowl herniation should resolve by
12 w
| if not, followup needed
63
By the end of 1st trimester, what can be seen
- lateral ventricles containing echogenic choroid plexus
- fetal movement
- stomach
- urinary bladder
- umbilical cord
- spine
64
Placenta
seen as a well- defined crescent shaped homogeneous mass of tissue along margins of GS
65
Placenta is formed by
- decidua basalis (maternal contribution)
| - chorion frondosum (fetal contribution)
66
Umbilical cord visible during
the later half of the first trimester as a tortuous structure connecting the fetus to the developing placenta
67
NT
- 11w 0 d - 13 w 4 d
| - detects chromosomal anomalies
68
NT measurement
- inner to inner
- Sag
> 3 mm is abnormal
69
Ectopic contributing factors
- Previous ectopic pregnancy
- Previous tubal surgery
- History of pelvic inflammatory disease
- Undergoing infertility treatment
- Previous or present use of and intrauterine device
- Multiparity
- Advanced maternal age
70
negative hCG rules out
possibility of an ectopic
71
Ectopic Pregnancy most common sites
ampulla of fallopian tubes
72
Ectopic Pregnancy second most common sites
isthmis of fallopian tube
73
Other Ectopic Pregnancy
- Interstitial or corneal (2-5%)
- Ovary (0.5-1%)
- Cervix (.1%)
- Fimbria: very rare
74
Heterotopic pregnancy
both ectopic and IUP, most common with assisted reproductive therapy
75
Ectopic Clinical Findings
- Pain
- Vaginal bleeding
- Palpable abdominal/pelvic mass
- Shoulder pain(secondary to intraperitoneal hemorrage and diaphragmatic irritation)
- Low hematocrit (with rupture)
76
Ectopic Sono findings
- Extrauterine gestainal sac containing a yolk sac or embryo
- Adnexal ring sign
- Adnexal mass
- Large amount of free fluid within the pelvis or in Morison pouch
- Complex free fluid could represent hemoperitoneum
- Pseudogestational sac
- Poor decidual reaction
- Endometrium containing blood
77
Gestational Trophoblastic Disease (Molar)
A group of disorders that are the result of an abnormal combination of male and female gametes
78
Tophoblastic cells produce
hCG
79
Gestational trophoblastic disease results in the
excessive growth of the trophoblastic cells and excessive amounts of hCG are released in the maternal circulation
80
Complete Molar Pregnancy Clinical Findings
- Hyperemesis gravidarum
- Markedly elevated hCG level
- Vaginal bleeding
- Enlarged uterus
- Possible preeclampsia/or eclampsia
- HTN
81
Hydatidiform molar pregnancy complete
- most common
- characterized by hydropic chorionic villa
- absence of fetus an amnion
- benign with malignant potential
82
Hydatidiform molar pregnancy partial (incomplete)
- May be accompanied by a co-exiting triploid fetus, parts of fetus, or amnion
- Minimal malignant potential
83
Invasive molar pregnancy (chorioadenoma destruens)
- Molar pregnancy that invades into the myometrium and may also invade through the uterine wall and into the peritoneum
- Result of malignant progression of hydatidiform moles
84
Choriocarcinoma
- Most malignant form of trophoblastic disease with possible metastasis
- Result of malignant progression of a hydatidiform molar pregnancy
- Most common sites for metastasis are the liver, lungs and vagina
85
GTD treatment
- dilatation and curettage
- hCG monitoring
- hysterectomy
- chemotherapy
- chest xray to check for metastasis
86
Blighted Ovum or Anemryonic Gestation is diagnostic when
there is no evidence of a fetal pole or yolk sac within the gestational sac
87
Blighted Ovum or Anemryonic Gestation GS often has
irregular border with a poor decidual reaction
88
Blighted Ovum or Anemryonic Gestation pt presents w/
vaginal bleeding, a low hCG, and reduction of pregnancy symptoms
89
Fetal demise cardiac activity
should be present in a fetal pole that measures 4-5 mm
90
Threatened abortion
- Vaginal bleeding before 20 weeks gestation
- closed cervical os
- Low fetal heart rate
91
Complete(spontaneous ) abortion
- All products of conception expelled
| - no IUP
92
Incomplete abortion
- Part of the products of conception expelled
| - Thickened and irregular endo, enlarged uterus
93
Missed abortion
- Fetal demise with retained fetus
| - No detectable FHR
94
Inevitable abortion
- Vaginal bleeding with dilated cervix
- Low-lying gestational sac
- Open internal os of cervix
95
Subchorionic Hemorrhage
A bleed between the endometrium and the gestational sac
96
Subchorionic Hemorrhage appears
- an anechoic, crescent-shaped area adjacent to the gestational sac
- resembles second GS
97
Subchorionic Hemorrhage
| Small bleeds vs large bleeds
small: benign
large: misscarriage and stillbirth
98
Uterine Leiomyoma and Pregnancy two most important findings are
location and size
99
Uterine Leiomyoma and Pregnancy location
determine type of delivery
100
Uterine Leiomyoma and Pregnancy size
may increase due to stimulation of estrogen
101
Uterine Leiomyoma and Pregnancy differentiated
- focal myometrial contractions
| - disappear w/in 20-30 mins
