Module 6 : First Trimester Abnormal - Extrauterine Pregnancy Flashcards Preview

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Flashcards in Module 6 : First Trimester Abnormal - Extrauterine Pregnancy Deck (30)
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1

M mode determines ?

- only definitive way to determine abnormality/viability

2

Mean Sac Diameter (MSD)

- gestational sac is the first thing we see on us
- used when embryo NOT identified
- ensure you see double decidual sign
- used from 4 - 7 or 8 weeks
- length + width + height / 3

3

comparing MSD to Embryo

- used for early diagnosis of OLIGOHYDRAMNIOS (less amniotic fluid/not enough amniotic fluid)
- big red flag for abnormal pregnancy
- from 5.5 - 9 weeks if MSD(mm) - CRL(mm) = less than 5mm
+ oligohrydramnios suspected
- EFW still calculates MSD on all IVF pregnancies but only use CRL for dating of the pregnancy

4

first trimester ultrasound tests

- MSD
- CRL
- nuchal lucency

5

gestational sac sizes on EV

MSD 8mm = yolk sac seen
MSD 16mm = embyo seen

6

gestational sac sizes on transabdominal

MSD 20mm = yolk sac seen
MSD 25mm = embryo seen

7

gestational sac average growth

- 1.1mm/day
- up until 8 weeks

8

Crown Rump Length (CRL)

- used between 6 - 13 weeks
- MOST ACCURATE MEASUREMENT TO PREDICT GESTATIONAL AGE +/- 3 DAYS
- measure from tip of head to end of rump
- do not include yolk sac
- in a neutral position

9

ectopic pregnancy - definition

- pregnancy that occurs outside the uterine cavity

10

ectopic - Classical Clinical Triad

- pain
- bleeding
- adnexal mass
- 45% demonstrate these symptoms

11

other ectopic symptoms

- Amenorrhea
- adnexal tenderness
- cervical tenderness

12

timing of ectopic pregnancy

- usually present themselves between 5 - 8 weeks
+ to small to cause any pain before this time
+ also when they start to rupture because of lack of blood supply

13

factors increasing risk of ectopic

- tubal surgery
- pregnancy with an intrauterine contraceptive device
- pelvic inflammatory disease PID or STD
- previous ectopic
- endometriosis (endometrium travels to fallopians)
- previous appendicitis
- Khrons disease

14

common ectopic sites

- Fallopian tube (95%)
- cervix
- interstitial segment of tube
- ovary
- peritoneal cavity

15

highest risk ectopic locations

- cervix and cornua (interstitial) areas are the most dangerous
- high risk of hemorrhage because there are very vascular areas with little or no thickened endometrium for the embyo to burrow into
- also no coagulation takes place to bleeding out may occur

16

sonographic features of ectopic

- adnexal mass
- free fluid
+ in pouch of Douglas even up to kidneys in Morrisons pouch
- absence of and IUG (intrauterine gestational sac) or presents with pseudo sac
- may see a viable ectopic pregnancy instead of adnexal mass

17

viable ectopic pregnancy

- gestational sac with an embryo with a heart beat seen outside the uterus
- this is 100% accurate diagnosis of an ectopic
- may also indicate the at pregnancy has not yet ruptured

18

Menstrual history

- DONT trust info given by patient in case of ectopic
- knowing when first pregnancy test was positive is helpful
+ can assume patient was atlas 4 weeks pregnancy at this time
- good question to ask every OB patient

19

b hCG

- common to have lower than normal level of beta hCG or still be in normal range
- b hCG should double every 2 days in a normal pregnancy but should not with an ectopic pregnancy

20

DDx (differential diagnosis) using blood work

- early gestation
+ 5 weeks
+ b hCG should increase
- Spontaneous abortion
+ b hCG should decrease
- PID
+ pelvic inflammatory disease
+ b hCG negative - not pregnant

21

heterotopic pregnancy

- intrauterine pregnancy with a twin ectopic pregnancy
- 1/7000 incidence
- incidence has increase with ART (assisted reproductive technology/IVF)
+ 1/100

22

negative ultrasound results

- does not rule out ectopic
- may be to small to recognize with sonography
- MUST FOLLOW UP
+ EV if not done already
+ repeat bhCG in 2 days
+ repeat scan in 1 week

23

interstitial line sign

- echogenic line extending from the endometrial canal up to the centre of the interstitial sac or hemorrhagic mass
- used to help diagnose interstitial ectopic pregnancy

24

how much myometrium must be surrounding gestational sac

- MUST HAVE MINIMUM OF 5mm OF MYOMETRIUM SURROUNDING IT
- if not interstitial ectopic

25

cervical ectopic

- very low in uterus
- if moves with pressure from EV then its a spontaneous abortion if doesnt move then ectopic pregnancy

26

treatment for ectopic - surgery

- resection of diseased tube
- ow patient has an increased risk of repeat of ectopic

27

treatment for ectopic - medically

- with methotrexate
+ cell growth inhibitor
+ used in cancer patients to arrest growth of cancer
- injected IV, IM or directly into ectopic site
- or taken orally

28

treatment of acute ectopic - laparoscopy

- surgical removal with laparoscope
- when medical treatment has failed
- hemodynamically unstable
+ internal bleeding

29

treatment of acute ectopic - laparotomy

- may be required if ectopic is
+ abdominal
+ cornual
+ interstitial
+ cervical
+ patient is severely hemodynamically unstable or in shock

30

conservative management

- some early ectopics can resolve on their own
+ decreasing hCG
+ absent gestational sac
- medical treatment
+ methotrexate = single or multiple doses
- monitoring hCG