first trimester complications

Question 1

What is the most common occurrence of bleeding in the first trimester from?

Answer 1

Subchorionic hemorrhage

Question 2

Signs of pregnancy failure

Answer 2

Severe pain, uterine contractions, dilated cervix

Question 3

What percent of pregnancies spontaneously miscarry?

Answer 3

15%

Question 4

What are the clinical findings of a subchorionic hemorrhage?

Answer 4

Bleeding, spotting, cramping (large enough will lead to spontaneous abortion)

Question 5

Sonographic appearance of subchorionic hemorrhage

Answer 5

Later: anechoic between uterine wall and fetal membrane

Question 6

Don’t cause bleeding or spotting because they are within the chorionic sac, without communication with the endometrium

Answer 6

Placenta hematomas

Question 7

Empty uterus with no evidence of endometrial fluid collection, absence of adnexal masses and free fluid with positive beta-hCG levels

Answer 7

Absent intrauterine sac

Question 8

Intrauterine sac should be identified when?

Answer 8

4.5 weeks

Question 9

How fast does the gestational sac grow in the first trimester?

Answer 9

1 mm/day in first trimester

Question 10

Yolk sac should be visualized when the gestational sac reaches what size?

Answer 10

8 mm

Question 11

Embryo should be visualized when mean sac diameter is?

Answer 11

> 16 mm

Question 12

Normal embryos grow how fast?

Answer 12

1 mm/day

Question 13

Cardiac activity should be visible by when?

Answer 13

5.5-6.5 weeks (with hCG of 2000)

Question 14

A thickened endometrium could be because of what?

Answer 14

Intrauterine blood, retained products of conception after incomplete spontaneous abortion, decidual reaction associated with pregnancy

Question 15

Sonographic findings of a intaruterine sac after a spontaneous abortion

Answer 15

Intact gest sac to nonviable embryo to collapsed/mishapen gest sac

Question 16

Sonographic signs of retained products

Answer 16

Thickende endo (>8mm) increased vascularization of endometrial complex with color doppler

Question 17

Signs of a spontaneous abortion/retained products?

Answer 17

Visible embryonic parts/sacs, QhCG levels don’t decline normally, thickened endometrium with increased vascular flow

Question 18

At what week should an embryo be seen?

Answer 18

6.4 weeks (6weeks3days)

Question 19

Gestational sac where an embryo fails to develop or stops developing at such an early stage that it is imperceptible by ultrasound. Gest sac continues to grow along with trophoblastic tissue.

Answer 19

Blighted ovum or anembryonic pregnancy

Question 20

Sonographic appearance of an anembryonic pregnancy

Answer 20

Large empty gestational sac with no yolk sac, amnion or embryo

Question 21

Findings associated with abnormal IUP

Answer 21

Absence of cardiac motion after 6.5 menstrual weeks, large or calcified yolk sac, empty amnion, >18mm gest sac with no embryo, >8mm with no yolk sac, abnormmal shape and/or position of gest sac, absent or irregular trophoblastic reaction (<2mm), absent embryo/sac growth, hCG level discrepancy

Question 22

Proliferative disease of trophoblast after abnormal conception

Answer 22

Trophoblastic disease

Question 23

Occurs when an egg without a nucleus is fertilized by one sperm. Trophoblastic tissue proliferates but no fetal parts develop.

Answer 23

Complete hydatidiform moles

Question 24

Occurs when a normal egg is fertilized by 2 sperm, fetal parts may develop but often aborted in 1st trimester. Has an identifiable placenta

Answer 24

Partial mole

Question 25

Signs of gestational trophoblastic disease

Answer 25

Dramatically elevated beta-hCG levels, hyperemesis gravidarum, or preeclampsia, maternal serum AFP levels will be low

Question 26

Sono appearance of gestational trophoblastic disease

Answer 26

distorted sac shape, thin, weakly echogenic decidual reaction, absence of double decidual sac, MSD=10mm

Question 27

Malignant forms of gestational trophoblastic disease

Answer 27

Invasive mole and choriocarcinoma

Question 28

Occurs when hydropic villi of a partial or complete mole invades uterine myometrium and may further penetrate uterine wall

Answer 28

Invasive hydatidiform mole

Question 29

Signs/Symptoms of invasive moles

Answer 29

Continued heavy bleeding, very elevated hCG levels, enlarged uterus with multiple focal areas of grape-like clusters throughout

Question 30

malignant form of trophoblastic disease that occurs in 2-3% of molar pregnancies.

Answer 30

Choriocarcinoma

Question 31

Where does choriocarcinoma metastasize to?

Answer 31

Lungs, liver and brain

Question 32

First conclusive sign of viability

Answer 32

Cardiac activity

Question 33

When should cardiac activity be seen by?

Answer 33

5.5-6.5 weeks and hCG 2000 and embryo measures 4mm

Question 34

If gestational sac in 5mm less than CRL what can be suspected?

Answer 34

Oligohydraminos

Question 35

Yolk sac should grow how much per day?

Answer 35

0.3 mm/day

Question 36

Yolk sac maximum diameter?

Answer 36

5.5 mm

Question 37

When is the double bleb sign best seen?

Answer 37

Transvaginally between the 5th and 7th weeks gestation

Question 38

One of the most emergent diagnoses made with sonography, is a pregnancy located outside of the central/fundal location of the uterus

Answer 38

Ectopic pregnancy

Question 39

What percent of maternal deaths are related to ectopic pregnancy?

Answer 39

10%

Question 40

Clinical findings of an ectopic pregnancy

Answer 40

Nonspecific pain, vaginal bleeding, positive pregnancy test, with an empty uterus, adnexal mass, pseudo sac(20% of patients), free fluid and a ring of fire appearance

Question 41

Most common place for an ectopic pregnancy to occur.

Answer 41

Fallopian tube (95%)

Question 42

Ectopic pregnancy that has increased risk of massive hemorrhage with rupture that may lead to hysterectomy or even death.

Answer 42

Interstitial portion of fallopian tube

Question 43

Increased risk of complete hysterectomy because of uncontrollable bleeding

Answer 43

Cervical ectopic pregnancy

Question 44

Maximum thickness of subcutaneous lucency at back of neck in embryo at 11 to 14 weeks gestation

Answer 44

Nuchal translucency

Question 45

Nuchal translucency is increased in these patients.

Answer 45

Trisomy 13, 18 or 21 or fetuses with cardiac defects or other genetic syndromes

Question 46

Age of a fetus when nuchal translucency can be performed

Answer 46

11 weeks and 13 weeks 6 days

Question 47

Criteria for performing a nuchal translucency

Answer 47

CRL must be between 45-84 mm, 11-14 weeks gestation, embryo must be away from amniotic membrane with head in a neutral position,

Question 48

Four chamber view of the heart can be seen as early as when?

Answer 48

12 weeks

Question 49

Markers for cardiac defects

Answer 49

Increased nuchal translucency, tricuspid regurgitation, reversal or absence of flow in ductus venosus, ectopia cordis and limb body wall complex

Question 50

When can the embryonic head be identified sonographically?

Answer 50

7 weeks

Question 51

Partial or complete absence of cranium, a predecessor of anencephaly

Answer 51

Acrania

Question 52

When does ossification of the cranium begin?

Answer 52

After 9 weeks

Question 53

How early can acrania be reported?

Answer 53

12 weeks

Question 54

What is the signcalled when a fetus has an abnormally shaped head?

Answer 54

Mickey mouse head

Question 55

Congenital absence of the brain and cranial vault, cerebral hemispheres are either missing or reduced to small masses

Answer 55

Anencephaly

Question 56

A midline cranial defect in which there is a herniation of the brain and meninges, may involve occipital, frontal, parietal, orbital, nasal or nasopharyngeal region of the head

Answer 56

Cephalocele

Question 57

A rare, lethal anomaly of cranial development whose primary abnormalities include a defect in foramen magnum, retroflexion of spine and open spinal defects.

Answer 57

Iniencephaly

Question 58

A dilation of ventricular system without enlargement of cranium, generally seen after 11 weeks

Answer 58

Ventriculomegaly

Question 59

A malformation sequence that results from failure or prosencephalon to differentiate into cerebral hemispheres and lateral ventricles between 4th and 8th weeks

Answer 59

Holoprosencephaly

Question 60

Holoprosencephaly three types

Answer 60

Alobar, semilobar, and lobar

Question 61

Most serious form of holoprosencephaly, consists of a single ventricle, small cerebrum, fused thalami, agenesis of corpus cllosum, and falx cerebri

Answer 61

Alobar holoprosencephaly

Question 62

Ventricles develop when?

Answer 62

after 9 weeks

Question 63

Results from cystic dilation of fourth ventricle with dysgenesis or complete agenesis of cerebellar vermis and frequently hydrocephaly. Occurs around 6-7 weeks

Answer 63

Dandy-Walker malformation

Question 64

Sonographic presentation of a dandy-walker malformation in the first trimester

Answer 64

Large posterior fossa cyst with contiuous fourth ventricle, absent cerebellum and dilated third and lateral ventricles

Question 65

Occurs when there is a failure of neural tube to close after 6 weeks gestation

Answer 65

Spina bifida

Question 66

Abdominal wall defects

Answer 66

Omphalocele, gastroschisis and limb-body wall complex

Question 67

One of the most common abnormalities seen in the first trimester, has a high association with chromosomal abnormalities, appear on the posterior aspect of the featal neck and upper thorax

Answer 67

Cystic Hygroma

Question 68

Most common mass seen in first trimester of pregnancy, secretes progesterone necessary to preserve embryo. Should measure \<5 cm with no septations

Answer 68

Corpus luteum cyst

Question 69

partial or complete absence of the cranium

Answer 69

acrania reported as early as 12 weeks predecessor to anencephaly

Question 70

congenital absence of the brain and cranial vault with the cerebral hemispheres missing or reduced to small masses

Answer 70

anencephaly "frog face" seen at the end of the first trimester

Question 71

gestational sac without an embryo

Answer 71

blighted ovum (anembryonic pregnancy)

Question 72

during the first trimester, the bowel normally herniates outside the abdominal cavity between 8 and 12 weeks

Answer 72

bowel herniation

Question 73

protrusion of the brain from the cranial cavity

Answer 73

cephalocele midline cranial defect herniation of brain tissue and/or meninges (brain membranes)

Question 74

complete expulsion of all products of conception, including embryo and deciduas

Answer 74

complete abortion

Question 75

a physiologic cyst that develops within the ovary after ovulation, secretes progesterone, and prevents menses if fertilization occurs; may persist until the 16th to 18th week of pregnancy

Answer 75

corpus luteum cyst

Question 76

fluid-filled structure (often with septations) initially surrounding the neck; may extend upward to the head or laterally to the body

Answer 76

cystic hygroma one of the most common abnormalities seen in the 1st trimester most common: Turner's Syndrome Trisomy 21, 18, and 13 If the hygroma resolves by week 18, the chromosomes are usually normal

Question 77

a pregnancy that implants in a location other than the center of the uterus

Answer 77

ectopic pregnancy

Question 78

congenital defective opening in the wall of the abdomen just to the right of the umbilical cord; bowel and other organs may protrude outside the abdomen from this opening

Answer 78

gastroschisis difficult to diagnose in the first trimester

Question 79

condition in which trophoblastic tissue overtakes the pregnancy and propagates throughout the uterine cavity; partial and complete

Answer 79

gestational trophoblastic disease –

Question 80

simultaneous intrauterine and extrauterine pregnancy

Answer 80

heterotopic pregnancy

Question 81

failure of forebrain to divide into two cerebral hemispheres, resulting in a single large ventricle with varying amounts of cerebral cortex; has been known to occur with trisomies 13, 15, and 18

Answer 81

holoprosencephaly should divide into cerebral hemispheres and lateral ventricles between week 4 and 8 3 types: Alobar (most serious), lobar, semilobar

Question 82

pregnancy loss with products of conception remaining in the uterus

Answer 82

incomplete spontaneous abortion

Question 83

a rare neural tube defect in which the brain tissue protrudes through a fissure in the occiput, so that the brain and the spinal cord occupy a single cavity

Answer 83

iniencephaly occupital defect involving the foramen magnum retroflexed spine fetus looks upward open spinal defects are present

Question 84

pregnancy occurring in the fallopian tube near the cornu of the uterus; also known as cornual pregnancy

Answer 84

interstitial pregnancy

Question 85

congenital defect of the abdominal wall with protrusion of abdominal contents into the base of the umbilical cord; the cord appears to enter the mass

Answer 85

omphalocele difficult to diagnose in the first trimester

Question 86

decidual reaction with fluid occurring within the uterus in a patient with an ectopic pregnancy

Answer 86

pseudogestational sac

Question 87

additional term for missed abortion or miscarriage

Answer 87

spontaneous pregnancy loss (SPL)

Question 88

a nonlethal genetic abnormality; chromosomal makeup is 45XO instead of the normal 46XX or 46XY. Cystic hygroma often is seen in affected fetuses in the first trimester. Survivors tend to be short in stature with low-set ears, webbing of the neck, a shield-shaped chest, and infertility as a result of an endocrine disorder caused by failure of the ovaries to respond to pituitary hormone

Answer 88

Turner’s syndrome

Question 89

dilation of the cerebral ventricles without enlargement of the cranium

Answer 89

ventriculomegaly

Question 90

results from a cystic dilation of the 4th ventricle with dysgenesis or complete agenesis of the cerebellar vermis and frequently hydrocephaly

Answer 90

Dandy Walker 6 to 7 week of gestation

Question 91

spinal irregularities with bulging within the contour of the spine

Answer 91

spina bifida can be detected late 1st trimester