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Flashcards in First Trimester Complications Deck (31):
0

What is a threatened abortion?

< 20 weeks

viable embryo

documented fetal heartbeat

vaginal bleeding

cervix long and closed

approx 50% will miscarry

1

What is embryonic demise?

clear evidence of a non viable embryo

2

What is intrauterine fetal demise?


Spontaneous abortion/miscarriage prior to 20 weeks

can occur anytime throughout pregnancy

incidence in 1st trimester approx 15-20%

usually caused by chromosomal abnormalities

Approx half of all instance of perinatal mortality

3

What are the known causes for intrauterine fetal demise?

congenital/chromosomal anomalies

infection

placental abruption

IUGR

blood group isoimmunization

4

What is embryonic demise?

early IUP visualized

no heartbeat

5

When should you hear fetal heart tones with doppler?

10-12 weeks

*absence of a fetal heart rate with doppler and/or cessation of fetal movements after initially felt will usually prompt an immediate US examination*

6

What is the MOST definitive sign of fetal demise?

**absent heart motion**

absent fetal motion

overlap of skull bones (Spalding's sign)

exaggerated curvature of the spine

gas in fetal abdomen/echogenic fetal heart

fetal skin edema (may take 2-4 days to develop)

7

If there is a fetal death what should you try to do??

try to determine any obvious fetal anomaly or cause of fetal death

try to get some kind of measurement....femur length even

8

What is an anembryonic pregnancy?

early IUP - MSD >18mm - grows < 0.6mm/day

yolk sac

no embryo

FINISH SLIDE 12

9

What is the most common reason for bleeding in the first trimester?

***subchorionic hemorhage***

10

What is subchorionic hemorrhage?

low pressure bleed - result of implantation

symptoms:

bleeding spotting cramping

finish slide 13

11

What is an absent intrauterine sac?

BhCG level 1000-2000 mIU/mL

no IUP

Possibilities could include

slide 15

12

What are the four types of spontaneous abortions?

Complete

incomplete

threatened

inevitable

13

What is a complete abortion?

***Products of conception completely expelled***

Clinical:

bleeding/cramping
positive hCG

Sono Findings:

empty uterus - endo usually <5mm
no adnexal masses
no free fluid

***BhCG will decrease rapidly***

14

What is an incomplete abortion?

Clinical findings:

may or may not have bleeding/cramping

Sono findings:

*intact IUP*
no embryo heartbeat
gestational sac mis-shapen
**thickened endometrium >5**
obvious fetal parts - if after therapeutic abortion

15

What is a threatened abortion?

***1st trimeter pregnancy typically associated with bleeding***

embryo is still alive but often showing signs of distress

Sono findings:

lack of expected growth of gestational sac/embryo

decreased fetal heart rate <95 bpm

serial US are done to prove embryonic demise FINISH

16

Inevitable abortion is what?

Clinical:

Positive hCG
vaginal bleeding and cramping

Gestational sac with fetus in uterus

detached from uterus

may lie in lower uterine segment

gestational sac surrounded by hemorrahage

spontaneous abortion will happen within couple hours or less

17

What is gestational trophoblasic disease?

***Proliferative disease of the trophoblast after abnormal conception - molar pregnancy****

affects approx 1 of every 1000 pregnancies

usually women under 20 or over 40

vaginal bleeding

hyperemesis

extremely elevated BhCG often over 100,000 FINISH SLIDE 24

18

What are the different kinds of Hydatidiform Mole (H-Mole)?

Partial

complete (classic)

complete with co-existing fetus

19

Slide 25

finish

20

What is the most benign and most common form of trophoblastic disease?

Complete - "classic" H-Mole - egg with an absent or inactivated

Finish slide 26

21

What is a malignant trophoblastic disease?


Finish slide 29

***invasive mole (chorioadenoma destruens)****

Nonmetastic

may ben seen with molar pregnancy or after evacuation

22

What is Choriocarcinoma?

FINISH slide 30

**Highly metastatic trophoblastic tumor***

2-3% of trophoblastic disease

fast growing

METS TO LUNG (MOST COMMON) liver and brain

vaginal bleeding, dyspnea, abd. pain

23

What is absent or abnormal cardiac activity?

heart rate should be detected by 5.5 - 6.5 weeks or (5mm) on TV

should be able to hear fetal heart beat with doppler at 10-12 weeks (in the doctor office)

if absence after this tie period or no fetal movement felt after initially feeling immediate US

24

What is considered bradycardia for embryo?

heart rate below 90 bpm

usually poor prognosis

25

What is considered tachycardia in embryo?

heart rate over 170 bpm

finish slide 33

26

What is embryonic oligo and growth restriction?

gestational sac measures 5mm
demise highly likely

usually related to chromosomal abnormality

must have accurate dating to verify

27

What is a yolk sac evaluation?

normal max diameter 5.5mm between 5-10 weeks

yolk sac over 6mm increased risk for spontaneous abortion

finish slide 37

28

What is an ectopic pregnancy?

finish slide 40

implantation of a developing zygote outside the endometrial cavity

incidence 1/100-400

**higher incidence rate with infertility

29

Why do ectopic pregnancies occur?

finish slide 40

delayed transit of fertilized zygote secondary to Fallopian tube malformation

obstruction of passage of zygote through tube secondary to adhesions

30

What are the four maternal risk factors for ectopic pregnancy?

previous ectopic pregnancy (25% chance of reoccurence)

history of PID

tubal reconstructive surgery

recent ART