Abnormal First Trimester

Front 1

Spontaneous Abortion

Back 1

Termination of pregnancy prior to 20 weeks Gestation.
Usually occurs 1-3 weeks after embryonic or fetal demise.
Approximately 12% of all pregnancy end in SAB, 75% occuring before 16th weeks.
Etiology includes: endocrine factors, failure of corpus luteum cyst, myllerian duct anomalies, interruption of embryonic development, and specific chromosomal causes.

Front 2

Complete Abortion

Back 2

All products of conception expelled

Front 3

Sonographic findings for Complete Abortions.

Back 3

-empty UT normal endometrium
-may have fluid within endo.
-UT may remain enlarged for up to 2 weeks
-trophoblastic wave form patterns may stay for up to 3 days

Front 4

Incomplete Abortion

Back 4

Contained products of conception

Front 5

Sonographic findings for Incomplete Abortion

Back 5

-trophoblastic wave form patterns remains for up to 5 days past events.
-thickened or irregular endometrial cavity
- may have fluid within endometrial cavity

Front 6

Missed Abortion

Back 6

Embryo without cardiac activity

Front 7

Clinical Symptoms for Missed Abortion

Back 7

-loss of pregnancy symptoms
-brownish vaginal discharge without flank pain
-hcg levels less than expected dates
-decrease in uterine size

Front 8

Inevitable Abortion

Back 8

Abortion in progress

Front 9

Sonographic findings for Inevitable Abortion

Back 9

-anechoic cresent surrounding GS
-downward movement of GS during exam
-GS low in uterus or CX
-dilated cervix

Front 10

Threatened Abortion

Back 10

Pregnancy that is in jeopardy but pregnancy continues.
Can not diagnosis sonographically.
Patient present with vaginal bleeding or cramping and a closed CX.

Front 11

Aembryonic Pregnancy

Back 11

Gestation in which the embryo did not developed or stop developing early and can be visualized.
Also known as a blighted ovum.

Front 12

Sonographic Findings for an Aembryonic Pregnancy

Back 12

-sac enlarges slightly on serial scans
- no identifiable embryo in a GS 25mm or larger.

Front 13

Septic Abortion

Back 13

An abortion that was performed with non sterile instruments or from infection from retained products of conception.

Front 14

Sonographic findings for Septic Abortion

Back 14

-may have shaddowing due to gas bubbles within endometrial cavity.
-Enlarged UT with heterogeneous content

Front 15

Ectopic Pregnancy

Back 15

Pregnancy that occur at any site other than the endometrial cavity.
The most common site for ectopic pregnancy is the ampulla of the fallopian tube.
The incident of ectopic pregnancy has increased with an increase in PID, tubal constructive surgery, and assited fertility programs.

Front 16

Adnexal Ectopic

Back 16

May occur at any site within the fallopian tubes or ovaries.
Most common site is ampulla of the Fallopian tube.
May also occur in the isthmus, interstitial, or fimbrial portion of the fallopian tube.
Ovarian ectopics are very rare.

Front 17

Uterine Ectopic

Back 17

Fertilized ovum implants at any site within the uterus except endometrium.
May impant in cornua, uterine scar or CX.
Most dangerous location is cornua pregnancy due to the high risk of hemorrhage.

Front 18

Sonographic findings of a cornual/interstitial ectopic

Back 18

For identificatio of an ectopic pregnancy there is less than 5mm of myometrium surrounding any side of the gestational sac.

Front 19

Cervical Ectopic

Back 19

Rare occurence.
Risk factors include previous uterine curettage.
Carry high mortality and mobidity rates due to risk of hemorrhage.

Front 20

What is used to treat Ectopic Pregnancy?

Back 20

Methotrexate
If treatment with Methotrexate is unsuccessful than cervical artery embolism or complete hysterectomy may be necessary.

Front 21

Abdominal Ectopic

Back 21

When fertilized ovum implants into the peritoneal cavity.
Abdominal ectopic pregnancy may progess further into gestation before it is recognized.

Front 22

Sonographic Findings for Abdominal Ectopic

Back 22

-empty UT separate from developing fetus
-poor placenta visualization
-unusual fetal presentatiin
-oligohydramnios
-absence of myometrium surrounding pregnancy

Front 23

Heterotopic Pregnacy

Back 23

Coexisting extra and intrauterine pregnancy.
Most common with patient who has undergone zygote or gamete transfer.

Front 24

Clinical Symptoms of Ectopic pregnancy

Back 24

-amenorrhea
-positive pregnancy test
-vaginal bleeding or spotting
-adnexal pain/tenderness
-shoulder pain
-pelvic pain

Front 25

Sonographic findings for Ectopic Pregnancy

Back 25

-adnexal mass
-empty UT
- free fluid in pericolic gutters, cul-de-sac, adnexea, morrisons pouch
Misidentification of a corpus luteum cyst for an ectopic pregnancy when depending on the ring of fire.
Absence of a doppler signal can not be used to exclude ectopic pregnancy.

Front 26

Gestational Trophoblastic Disease

Back 26

A spectrum of pathological condition resulting from abnormal proliferation of trophoblastic tissue.
GTD can occur during or after implantation of a fertilized ovum.
Can occur months to a year after any type of pregnancy.

Front 27

Paternal Genomes

Back 27

Controls the proliferation of trophblastic tissue and the growth of the embryo.
Excessive paternal material from duplicated chromosomes , lack of chromosomes in ovum, or an ovum being fertilized my 2 sperms may be the cause of GTD.

Front 28

Clinical Finding in GTD

Back 28

-Enlarged UT
-Absence of fetal heart tone
-Theca luteum cyst
-hyperthyroidism
-hyperemesis gravidium
-vaginal bleeding or passage of tissue
-markedly elevated HCG levels
-early on set of pre-clampsia

Front 29

Complete Hydatiform Mole

Back 29

Most common type of GTD
Chorionic villis are hydropic with no identifiable embryonic or fetal tissue

Front 30

Sonographic Findings for Complete Hydatiform Mole

Back 30

-Enlarged UT filled with echogenic mass
-endometrial cavity is filled with echogenic material that appears homogenous in the 1st teimester and cystic in the 2nd
-ovarian theca lutein cyst
- hypervascular, low resistance flow pattern with doppler

Front 31

Partial Mole

Back 31

Pregnancy most commonly has one set of maternal chromosomes and two sets of paternal chromosomes resulting in a triploid karyotype .
Has both hydropic and normal choronic villis.
Fetal and embryonic tissue is frequently identified.

Front 32

Sonographic Findings for Partial Mole

Back 32

-deformed Gs
-growth restricted fetus with triploid karyotype such as syndactly and hydrocephalus
-enlarged placenta with multiple cystic areas

Front 33

Mole with Coexisting Normal Fetus

Back 33

Two conception occurs.
One developed normally the other into GTD.
This is a rare occurence

Front 34

Sonographic findings for Mole with Coexisting Normal Fetus

Back 34

-similar to partial mole, but normal placenta and membrances.
fetus usually has a normal karyotype

Front 35

Persistent Trophblastic Neoplasia

Back 35

Most commonly follows GTD
Can uncommonly follow, normal term pregnancy, spontaneous abortion, ectopic pregnancy.
Clinically suspected when HCG levels do not decline after evacuation of pregnancy.
Patient my present clinically with persistence heavy vaginal bleeding.

Front 36

Invasive Mole

Back 36

Also known as chrioadenoma destruens.
Penetrates the myometrium and adjacent structures and may cause uterine rupture.
It is a malignant non-metastic gestational trophoblastic disease.

Front 37

Choriocarcinoma

Back 37

Is very rare.
Vascular invasion, hemorrhage, necrosis of the myometrium are common occurences.
It is an malignant metastatic trophoblastic disease that may metastasize to lung, liver, bone, skin, GI tract.