First Trimester Complications Flashcards
In the first trimester, a series of complex sequenced growth events make up the early stage if _______ development
Interruption in the sequenced growth developments may lead to _______ or _______ of the embryo
Approx. 15% of documented pregnancies spontaneously miscarry; the actual loss rate may be _______ because of the undocumented pregnancies in early trimester
Most common presentation for early pregnancy complications is vaginal _______ and/or _______ which occurs approx. 25% of patients and may or may not cause miscarriage
_______ is a diagnostic tool used in the evaluation of bleeding in pregnant pts, in differentiation of normal/abnormal appearances; distinguishing living from nonliving gestations on US is crucial and may be suttle; recent studies have shown demonstration of a living embryo does not necessarily mean that the pregnancy will be a normal outcome
embryonic complications abnormalities higher spotting bleeding sonography
Viability of Embryo and Bleeding with Pregnancy
In the first trimester, the viability of the pregnancy is a primary concern. _______ is defined, as the capability of living, in the is case, determining if the fetus/embryo,gestation will develop to live outside the uterus. A fetus is considered viable at ____ weeks of gestation and/or when the fetus is approx. 500 grams in weight
The term _______ is used when the pregnancy is 20 weeks GA (prior to 20 weeks=____)
In many cases bleeding is inconsequential and results from _______ of the conceptus (GS) into the decidualized endometrium
If bleeding is _______ in color, it often relates to a non acute situation and is from plantation
If bleeding is _______ in color, accompanies severe pain and/or cramping, it often correlates to uterine contractions and cervical dilation and the pregnancy is unlikely to progress meaning miscarriage is a higher risk
Ultrasound (_______ if in first trimester) plays a key role in evaluating women with a threatened pregnancy and is easily correlated with hCG levels, although US may dx before hCG levels show a change
Sonographers have to be familiar with normal first trimester landmarks in order to diagnose a failing or nonviable pregnancy; must carefully examine the _______, _______, _______(internal os, external os, cervical canal dilation) for presence of an embryo and its location within the endometrial cavity, fetal heartbeat, yolk sac or retained products of conception
viability 20 fetus embryo implantation brownish red transvaginal uterus endometrium cervix
Placenta Hematomas
_______ (embryonic placenta) is the term used in the early first trimester description of the placenta instead of term placenta because it’s not thickened and easily seen until mid-later first trimester.
Frondosum may become detached resulting in formation of a _______ which may cause vaginal bleeding
Most of these hematomas are found on the edges of the placenta and are usually seen in ____/____ trimesters but may be seen in first trimester
Some hematomas will resolve over time but may become _______ and most risky for the pregnancy in later trimesters
Correlation has been documented that 50% of hematomas cause greater risk factors but still depends on _______ and resolve
SONO Findings:
_______ and/or _______ area at the edges of the frondosum/placenta
- _______ usually represents ealy hemorraghe before clotting stage
- _______ represents clotting stage of a hemorrhage because of stasis of the platelets in blood = clot = hypoechoic
_______ = represents old clot
_______ varies
frondosum hematoma 2nd 3rd larger size anechoic hypoechoic anechoic hypoechoic hyperechoic size
Subchorionic Hemorrhage
“_____ pressure” hemorrhage (bleeds) “behind” (sub) the chorionic membrane
seen between _______ and _______ margins; may mimic another GS
Most common cause of first trimester vaginal _______
results from implantation of fertilized ovum into the _______ cavity
May not be assoc. with _______
Clinical Findings: vag _______/_______ with or without uterus contractoins
may spontaneous regress or may lead to spontaneous pregnancy loss (SPL); the _______ hematomas are more likely to result in the loss of the pregnancy
SONO Findings:
Varies depending on ____/____ of hemorrhage/bleeding
Early bleed = _______ or _______ blood/fluid located adjacent to the GS and at the margin of the placenta; when anechoic, it may resemble a second GS
Lack of vascularity with CF Doppler can help to differentiate _______ from a neoplasm
low endometrium GS bleeding endometrial placenta bleeding spotting larger age size echogenic anechoic hematoma
Absent Intrauterine/Endometrial Sac and Miscarriage a.k.a. Abortion
_______ is routinely used to evaluate for the presence or absence of an IUP with the history of positive pregnancy test with or without clinical history of vaginal bleeding, pain, passage of tissue, etc
Characteristics of SONO findings of an absent IUP: empty _______ (endometrial cavity), absence of _______ _______ cyst, absence of _______ FF, _______ B-hCG (hCG); correlation with sono findings and hCG must be used to confirm diagnosis.
In the medical sense, the term _______ and _______ both refer to the termination of pregnancy before the fetus is capable of survival outside the T.
_______ - term often used to denoted a natural spontaneous abortion
_______- term often used to denote decision to induced expulsion of an early pregnancy
-removal of products of conception may be performed to insure maternal life
Pathophysiology: A natural miscarriage can occur in several stages and in no particular order: _______ abortion, _______, abortion, _______ abortion, _______ abortion, _______ abortion, _______ abortion
Terms used to document concerning conditions by US and treatment:
_______ demise: absence of FHB = nonviable embryo
_______ ovum/_______ pregnancy: describes an endometrial cavity which contains a GS but no visible embryo
Open _______: internal os or external os is open OR BOTH are open; document and describe the cervical opening and measure the opening; If internal os is open but external os is closed, pregnancy can be viable unless external os opens; depending on GA, patient may be put on bedrest to keep pressure of pregnancy from opening the entire cervical canal; if entire cervical canal opens, pregnancy will be expelled (miscarriage)
D and C (_______and _______) : a brief surgical procedure in which the cervix (cervical canal) is dilated; a special instrument is inserted into vagina and through cervical canal openings to cut and/or scrape the endometrial layers to expel remaining conception of pregnancy left after a miscarriage or elected abortion
ultrasound uterus corpus luteual adnexal positive miscarriage abortion miscarriage abortion threatened inevitable incomplete complete spontaneous missed embryonic blighted anembryonic cervix dilation cutterage
Types of Abortions
\_\_\_\_\_\_\_ abortion \_\_\_\_\_\_\_ abortion \_\_\_\_\_\_\_ abortion \_\_\_\_\_\_\_ abortion \_\_\_\_\_\_\_ abortion \_\_\_\_\_\_\_ abortion
Threatened Inevitable incomplete complete spontaneous missed
Threatened Abortion (TAB)
Clinical entity of possible miscarriage has begun but not yet impossible for pregnancy to continue
defined by clinical history of vaginal _______, “absence” of “passed tissue”, a closed _______ (Diffuse uterus tenderness and/or adnexal tenderness may be present. These findings differentiate threatened abortion from later stages of abortion
very common; approx. ____ of all pregnant women have some degree of vaginal bleeding during first trimester
rarely presents with severe vaginal _______
SONO Findings:
embryo with _______
vaginal bleeding with _______ os closed
_______ motion tenderness with probe
no _______ seen on probe after exam and no history of tissue passage
may be a _______ exam
may have placenta/_______ hemorrhage
_______ exams
bleeding cervix 1/4 bleeding FHB cervical cervical tissue normal subchorionic followup
Inevitable Abortion
Characterized by rupture of _______/_______ membranes or _______ os and _______ os cervical dilation in the presence of uterine contractions and vaginal bleeding
Pregnancy will be lost
S and S:
Vaginal bleeding is accompanied by dilatation of cervical canal and _______ in cervical canal
Patients feeling like they peed on themself
Bleeding usually is more severe than with threatened abortion; often is associated with _______ pain (cramping)
SONO Findings:
Open cervix (both _______ os and _______ os)
vaginal bleeding with _______
Low lying ____/____
may or may not have _______
_______ (low/nl AF)
chorionic amniotic fluid abdominopelvic internal external cramping GS embryo FHB oligohydramnios
Incomplete Abortion
_______ Abortion = A natural miscarriage OR chosen abortion has only been partially successful; pregnancy has ended- no fetus identified, but only part of products of conception/pregnancy has been expelled and some remain within the endometrial cavity
S and S:
Intense vaginal _______ usually and _______ pain
SONO Findings:
Cervical os (_______ or _______ or both) open
Some products of conception are present and some are expelled from the _______ (confirmed by either patient report from clinical examination or evidence upon US examination) and US reveals that some products of conception still are present in the endometrial cavity
Thickened Heterogenic/echogenic _______
Vascularity more than ______ with non pregnant condition
Potential Complications:
Maternal death because the uterus thinks it’s still pregnant, _______ is continuing to flow to the endometrial cavity more than a non with a pregnant condition
_______ or _______ shock
Treatment:
_____ and ____
Incomplete bleeding abdomen internal external uterus endometrium normal blood hypovolemic septic D, C
Complete Abortion
_______ Abortion = complete expulsion of all products of conception
S and S:
Pts usually present with a history of vaginal _______, _______ pain, and _______ passage
By the time miscarriage is complete, _______ and _______ usually have subsided
Correlation with hCG reveals significant _______ of levels and/or back to normal non pregnant level
SONO Findings:
Empty _______ cavity
_______ os may or may not be dilated
complete bleeding abdominal tissue bleeding pain decreasing endometrial cervical
Spontaneous Abortion (SAB)
noninduced embryonic/fetal death or passage of products of conception before _____ weeks gestation
May be _______ or _______ abortion
may occur in a woman with a confirmed viable _______ pregnancy (IUP) and _______ os (canal) is dilated causing the pregnancy to be expelled (miscarried)
Diagnosis is by clinical criteria, _____ levels and _____
Treatment: Observation and/or follow up by _____; endometrial cavity evacuation if needed (_______ and _______ of cavity- D and C)
Embryonic death occurs with expulsion of all products of conception
Risk factors include:
Age > _____
History of previous _______ abortion
_______ smoking
Use of certain drugs (eg, _______, _______, high doses of _______)
poorly controlled chronic disorder (eg, _______, _______, overt _______ disorders) in the mother
Subclinical _______ disorders, a _______ uterus, and minor trauma have not been shown to cause spontaneous abortions.
S and S
crampy _______ pain, _______, and eventually expulsion of tissue. Late spontaneous abortion may begin with a gush of fluid when the membranes rupture. _______ is rarely massive; dilated cervix indicates that abortion is inevitable.
If products of conception remain in endometrial cavity after spontaneous abortion, vaginal bleeding may occur, sometimes after a delay of hours to days. _______ may also develop, causing fever, pain, and sometimes sepsis.
Diagnosis
Clinical criteria _______, _______ B-hCG
SONO Findings:
Cervical os may or may not be _______; may close immediately after miscarriage so that when US is performed, cervix os may already be closed
No _____ seen
endometrial cavity may be normal or _______
depending upon _______ or _______ abortion
20 complete incomplete intrauterine cervical hCG sonography US Dilate, Cutterage 35 spontaneous cigarette cocaine alcohol caffeine diabetes hypertension thyroid thyroid retroverted pelvic bleeding Hemorrhage Infection ultrasound quantitative open IUP thickened complete incomplete
Missed Abortion (MAB)
_______ Abortion = Embryonic death occurs without expulsion of the products of conception
Prolonged retention of a fetal demise within endometrial cavity may cause _______ and/or _______
May occur at any stage in _______ trimester
S and S
Usually no symptoms of vaginal _______
Greatly _______ hCG levels
SONO Findings:
IUP with absence of a _______
May look like a normal IUP at first but no _______ and no _______
missed sepsis infection first bleeding decrease FHR HR Vascularity
Anembryonic Pregnancy a.k.a Blighted Ovum
GS in which an _______ fails to develop or stops developing at an early stage
_______ tissue may continue to proliferate
_______ will continue to grow
hCG levels may continue to _______ but may be at a slower _______
SONO Findings:
Large empty _______
Absence of _______, _______, _______
Normal to Abnormal looking _______
followup needed and/or correlation with ______ to confirm diagnosis
embryo trophoblastic GS increase increase GS YS FP Amnion DDSS hCG
Gestational Sac without and Embryo or Yolk Sac
A GS without an embryo or yolk sac on US may represent one of 3 conditions:
1) Normal early IUP of < ________ weeks (too early for US visibility)
2) abnormal ________
3) Pseudo Sac with an ________ pregnancy
Criteria for NORMAL GS….. if below is not the findings = abnormal
Imaged both ________ and ________
Transvaginal may demonstrate a GS as early as ________ weeks
Measure, document GS Shape and position - should be ________, not irregular; eccentrically located within endometrial cavity toward uterus fungus
GS grows ________ mm/day
GS at ________mm should have a YS
YS should measure < ________mm; not large nor calcified
GS at ________-________mm should have an embryo and FHR
5 Pregnancy Ectopic Transabdominal Transvaginal 4 Round 1 8 15 16 20
Cardiac Detection by Ultrasound
M-mode VS Pulse Wave VS Color Doppler
AIUM suggests recording cardiac activity by a ______-dimensional video clip or _____-mode imaging.
“Use of ________ Doppler imagine is discouraged”; the reason for the concern is the focused concentration of US power in the sample gate
______-mode collects information along the length of the beam so this disperses energy along the way and reduces the risk for heat cavitation in the fetus.
The use of pulse Doppler does not outweigh the ________
So, suggestion is to remove the ________ wave Doppler from your first trimester assessment except for the conditions in which M-mode isn’t successful in obtaining a good FHR and for demonstrating a beating heart and sound for the pt
Color Doppler emits more ________/________ and greatly increases heat cavitation to fetus and should only be used if M-mode and PW can not obtain a FHB
2 M Spectral M Risk Pulse Power Heat
