OB first trimester abnormalities registry review

Question 1

Ectopic pregnancy

Answer 1

A pregnancy located anywhere other than the central uterine cavity

Question 2

Most common cause of pelvic pain with positive pregnancy test

Answer 2

Ectopic pregnancy

Question 3

Most common location of ectopic pregnancy

Answer 3

Ampulla of fallopian tube

Question 4

Most dangerous location of ectopic pregnancy

Answer 4

Interstitial/corneal because of rupture and hemorrhage

Question 5

Heterotopic pregnancy

Answer 5

IUP and coexisting ectopic. Rare. Most often associated with assisted reproduction. Risk: hx PID, endometriosis, previous ectopic

Question 6

hCG level 1,000-2,000 with no IUP

Answer 6

Suspect ectopic

Question 7

Clinical presentation of ectopic pregnancy

Answer 7

-Pain, bleeding, palpable mass
-Lower than expected hCG, low hematocrit, shoulder pain

Question 8

Sonographic appearance of ectopic pregnancy

Answer 8

-Extrauterine GS “live” pregnancy
-Complex adnexal mass or adnexal ring sign
-Free or complex fluid in pelvis
-Pseudogestational sac
-Poor decidual reaction in endo

Question 9

Gestational trophoblastic disease (molar pregnancy)

Answer 9

Abnormal combination of male and female gametes resulting in rapid proliferation of trophoblastic cells

Question 10

Trophoblastic hCG production in molar pregnancy

Answer 10

Excessive levels of hCG or rapidly rising levels; placenta grows out of control, takes over, undergoes degeneration becoming complex with cystic changes

Question 11

Complete hydatidiform mole

Answer 11

Absence of fetus or gestational sac. Benign with malignant potential, clear defined boarders contained within myometrium

Question 12

Partial hydatidiform mole

Answer 12

Coexisting IUP/GS and possibly fetus. Minimal malignant potential

Question 13

Most common gestational trophoblastic disease

Answer 13

Complete hydatidiform mole

Question 14

Invasive molar (chorioadenoma destruens)

Answer 14

Molar pregnancy that becomes malignant and invades into myometrium through uterine wall and into peritoneum

Question 15

Choriocarcinoma

Answer 15

Most malignant progressive form with possible mets to lung (most common), liver, brain

Question 16

Clinical presentation of molar pregnancy

Answer 16

Hyperemesis, markedly elevated hCG, bleeding, enlarged uterus, hypertension

Question 17

Sonographic appearance of molar pregnancy

Answer 17

Large complex mass within uterus, multiple cystic areas throughout, loss of myometrium or boarders if invasive, bilateral theca lutein cyst

Question 18

Non progressive pregnancies/miscarriages

Answer 18

Either hCG or sonographic appearances do not match what is expected. LMP not reliable, base of hCG + sono or sono alone

Question 19

Low hCG or S<D

Answer 19

-Incorrect dating
-Ectopic
-Non progressive/failed pregnancy

Question 20

High hCG or S>D

Answer 20

-Incorrect dating
-Multiple gestations
-Gestational trophoblastic disease (molar pregnancy)

Question 21

Sonographic indication of abnormal pregnancy development

Answer 21

-GS greater than 10mm MSD without visible yolk sac
-GS greater than 25mm MSD without fetal pole
-Enlarged YS greater than or equal to 6mm
-Collapsed GS/ poor decidual reaction

Question 22

Blighted ovum (Anembryonic pregnancy)

Answer 22

Large gestational sac without yolk sac or embryo, usually shows poor decidual reaction

Question 23

Sonographic appearance of blighted ovum

Answer 23

GS > 10mm + no YS
GS > 25mm + no FYP

Question 24

Clinical presentation of blighted ovum

Answer 24

Vaginal bleeding, low b-hCG

Question 25

Embryonic/fetal demise

Answer 25

Death of embryo or fetus

Question 26

Confirmation of embryonic/fetal demise

Answer 26

Fetal pole greater than or equal to 5mm with no cardiac activity

Question 27

Early sonographic indication of early/impending demise

Answer 27

Irregular shaped GS, enlarged YS

Question 28

Clinical appearance of embryonic/fetal demise

Answer 28

Bleeding, small for dates, low hCG

Question 29

Abortion

Answer 29

Termination of pregnancy before viability whether elective or not

Question 30

Spontaneous abortion

Answer 30

Naturally occurring miscarriage

Question 31

Clinical/sono findings for threatened miscarriage

Answer 31

Spotting, low FHR

Question 32

Clinical/sono findings for missed miscarriage

Answer 32

Spotting/low hCG, intact demise

Question 33

Clinical/sono finding for incomplete miscarriage

Answer 33

Heavy bleeding/+hCG, RPOC

Question 34

RPOC

Answer 34

Retained products of conception

Question 35

Clinical/sono findings for complete miscarriage

Answer 35

Bleeding/ - hCG, normal endometrium

Question 36

Clinical/sono findings for inevitable miscarriages

Answer 36

Cramping/spotting, low lying GS

Question 37

Incomplete miscarriage

Answer 37

Miscarriage is still in process and there are retained products of conception with internal flow within the cavity

Question 38

Complete miscarriage

Answer 38

Finished miscarriage, cavity is empty and endometrium is thin, similar to early proliferative endo

Question 39

Subchorionic hemorrhage (SCH)

Answer 39

Bleed between endometrium and gestational sac

Question 40

NON poor prognosis of SCH

Answer 40

If hemorrhage is 50% or greater than GS and close to internal os

Question 41

Clinical presentation of SCH

Answer 41

Vaginal bleeding or spotting, possible cramping

Question 42

Sonographic appearance of SCH

Answer 42

Crescent-shaped, hypoechoic or medium level echoed area adjacent to GS

Question 43

Myomas (fibroids) during pregnancy

Answer 43

Location and size are important to document because they can complicate delivery

Question 44

Fibroid growth during pregnancy

Answer 44

Stimulated by estrogen, grow during pregnancy due to increased estrogen... *Don't confuse with contractions

Question 45

Sonographic appearance of contractions

Answer 45

Round, masslike within the myometrium but will disappear within 30 mins

Question 46

Corpus Luteum of pregnancy

Answer 46

Physiological, functional cyst that maintains endo by secreting progesterone, usually 2-3cm but may grow up to 10cm

Question 47

Most common pelvic mass of 1st trimester

Answer 47

Corpus luteum

Question 48

What maintains corpus luteum

Answer 48

hCG

Question 49

Clinical presentation of corpus luteum

Answer 49

Asymptomatic or pain due to size or hemorrhage

Question 50

Sonographic appearance of corpus luteum

Answer 50

Simple or complex/hemorrhagic cyst