Ardms: Ob 1St Trimester Complications

Front 1

what is the percentage of pregnancies that spontaneously abort?

Back 1

15

Front 2

what is the percent of patients that have vaginal bleeding or frank bleeding as a complication during the early stage of pregnancy?

Back 2

25%

Front 3

define threatened abortion?

Back 3

a term used for pregnancies of fewer than 20 weeks when the patient has a viable embryo, documented fetal heartbeat and vaginal bleeding.

Front 4

when is the diagnosis of threatened abortion made?

Back 4

when the cervix is long and closed in a patient with vaginal bleeding. 50% of pregnant women ith these complications will go on to spontaneously abort.

Front 5

define embryonic demise?

Back 5

a term used when there is clear evidence of a nonviable embryo.

Front 6

what is a blighted ovum or anembryoic pregnancy?

Back 6

a term used to describe a uterus containing a gestational sac but no visible embryo.

Front 7

what is another name for an embryonic placenta?

Back 7

frondosum

Front 8

what is a placental hemaatoma?

Back 8

when the placenta becomes detached resulting in the formation of a hematoma which can cause vaginal bleeding. Usually contiguous with the placenta edge.

Front 9

what is a subchorionic hemorrhage??

Back 9

the most common occurrence of bleeding in the first trimester. Low pressure bleed resulting from the implantation of the fertilized ovum into the endometrial cavity and myometrial walll.

Front 10

where is a subchorionic hemorrhage found?

Back 10

between the myometrium and the margins of the gestational sac and may or may not be associated with the placenta

Front 11

what can occur if a subchorionic hemorrhage becomes too large?

Back 11

spontaneous pregnancy loss (SPL)

Front 12

what is the sonographic appearance of a subchorionic hemorrhage?

Back 12

early bleed: slightly echogenic
over time: becomes more anechoic and may be between the uterine wall and the fetal membrane. color doppler is avascular

Front 13

what is an incomplete spontaneous abortion?

Back 13

when products of conception are retained in the uterus. a thickened endometrium greater than 8mm and increased vascularization of te endometrial complex.

Front 14

what constitutes embryonic brradycardia?

Back 14

< 60 beats per minute

Front 15

what constitutes embryonic tachycardia??

Back 15

> 170 beats per minute

Front 16

what would the sonographic findings of a complete abortion be?

Back 16

empty uterus
no adnexal mass
no free fluid
positive hCG levels with rapid decline

Front 17

what would the sonographic findings of an incomplete abortion be?

Back 17

intact gestational sac with nonviable embryo to collapse sac
thickened endometrium >8mm
retained embryonic parts

Front 18

what are the sonographic findings of an an embryonic pregnancy?

Back 18

large (>18mm) empty gestational sac with failure to develop
no yolk sac, amnion or embryo

Front 19

what are the sonographic findings of a molar pregnancy?

Back 19

uterus larger than dates
"snowstorm" of multiple tiny clusters of grape like echoes within the uterine cavity
theca lutein cysts may be present

Front 20

what are the three conditions of a gestational sac w/o an embryo or yolk sac?

Back 20

1. normal early IUP or less than 5 weeks
2. abnormal IUP
3. pseudo gestational sac in a patient with an ectopic pregnancy.

Front 21

what is the threshold level for a gestational sac?

Back 21

4.3 weeks

Front 22

what is the discriminatory level for a gestational sac?

Back 22

5.2 weeks

Front 23

what is a threshold level?

Back 23

a level that tells us when we might be able to discern early pregnancy structure

Front 24

what is a discriminatory level?

Back 24

a level that tells us when we should be able to visualize an embryonic structure.

Front 25

at what measurement of a gestational sac should a definitive yolk sac be demonstrated?

Back 25

8mm or >

Front 26

at what measurement of a gestational sac should an embryo or cardiac activity be seen?

Back 26

16-20mm

Front 27

what is a blighted ovum?

Back 27

aka an an embryonic pregnancy.
a gestational sac in which the embryo fails to develop or stops developing at such an early state that it is imperceptible by ultrasound.

Front 28

what is the sonographic appearance of a blighted ovum?

Back 28

a large , empty gestational sac that does not demonstrate a yolk sac, amnion or an embryo.

Front 29

what is gestational trophoblastic disease?

Back 29

a proliferative disease of the trophoblast that occurs after an abnormal conception.

Front 30

what are the two categories of molar pregnancies?

Back 30

partial and complete

Front 31

what is a partial mole?

Back 31

a karyotypically abnormal, usually triploid, and commonly occurs when a normal egg is fertilized by two sperm

Front 32

what is a complete hydatiform mole?

Back 32

it has a normal diploid karyotype of 46xx, which is usually derived from the father,
a complete mole occurs when an egg without a nucleus is fertilized by one normal sperm. trophoblastic tissue proliferates, but no fetal parts develop.

Front 33

what is the characteristic appearance of a molar pregnancy?

Back 33

snowstorm

Front 34

what are the sonographic findings of gestational sacs associated with abnormal intrauterine pregnancies for an embryo?

Back 34

absence of cardiac motion in embryos 5mm or larger
absence of cardiac motion after 6.5 menstrual weeks.

Front 35

what are the sonographic findings of gestational sacs associated with abnormal intrauterine pregnancies for a yolk sac and amnion?

Back 35

large yolk sac or amnion without a visible embryo
calcified yolk sac

Front 36

what are the sonographic findings of gestational sacs associated with abnormal intrauterine pregnancies for a large gestational sac?

Back 36

> 18mm lacking a viable embryo
> 8 mm lacking aa visible yolk sac

Front 37

what are the sonographic findings of gestational sacs associated with abnormal interutterine pregnancies regarding the shape?

Back 37

irregular or misshapen

Front 38

what are the sonographic findings of gestational sacs associated with abnormal intrauterine pregnancies regarding position?

Back 38

cornual, low or hour-glassing through the cervical os.

Front 39

what are the sonographic findings of gestational sacs associated with abnormal intrauterine pregnancies regarding trophoblastic reaction?

Back 39

irregular
absent double decimal sac finding
thin trophoblastic reaction <2mm
intratrophoblastic venous flow

Front 40

what are the sonographic findings of gestational sacs associated with abnormal intrauterine pregnancies regarding growth?

Back 40

gestational sac growth of < 0.6 mm/day
absent embryonic growth

Front 41

what are the sonographic findings of gestational sacs associated with abnormal intrauterine pregnancies regarding hCG correlation?

Back 41

discrepancy in sac size with hCG levels.

Front 42

describe the placenta in a partial mole pregnancy?

Back 42

the placenta tissue is grossly enlarged and engorged with cystic spaces

Front 43

a partial mole pregnancy is most associated with which trisomies?

Back 43

13, 18 and 21

Front 44

by what number day should a living embryo be detected by transvaginal sonography?

Back 44

46th day

Front 45

during what week period is the heart tube formed?

Back 45

3.5 to 5 weeks

Front 46

at what measurement of the embryonic sac should presence of cardiac activity be seen?

Back 46

9mm

Front 47

what are two common pelvic masses that can be seen during pregnancy?

Back 47

corpus luteum cyst (>5cm)
fibroids

Front 48

what is oligohydramnios

Back 48

insuffienct amount of amniotic fluid

Front 49

what is suspected when the gestational sac measures 5mm < the CRL?

Back 49

oligohydramnios
prognosis is poor

Front 50

what is triploidy?

Back 50

an embryo has three copies of every chromosome instead of 46 the embryo has 69 chromosomes

Front 51

growth restriction and embryonic oligohydramnios are associated with?

Back 51

chromosomal abnormalities such as triploidy

Front 52

what is the expected daily growth rate for a normal yolk?

Back 52

0.3 mm/day

Front 53

what is the maximum diameter for a normal yok sac?

Back 53

5.5 mm between 5-10 weeks gestation

Front 54

when is the amnion best visualized?

Back 54

between the 5-7th week, transvaginally

Front 55

what is the double bleb sign?

Back 55

the appearance of the yolk sac and the amnion side-by-side.

Front 56

when is the amnion considered abnormal?

Back 56

when the amnion becomes very easy to see, or when the thickness and echogenicity approaches that of the yolk sac

Front 57

the mean amniotic sac diameter should be approximately equal to ?

Back 57

the CRL

Front 58

what are the associated risk factors with an ectopic pregnancy?

Back 58

PID, IUD's, fallopian tubal surgery, infertility treatments, history of ectopic pregnancies

Front 59

what are the classical findings of ectopic pregnancies?

Back 59

vaginal bleeding, empty uterus, adnexal mass, positive pregnancy test, pain in 97% of cases

Front 60

what percentage of ectopic pregnancies occur in the fallopian tubes?

Back 60

95%

Front 61

other than the fallopian tubes where are common sites for ectopic pregnancies??

Back 61

broad ligament, ovary, peritenium, cervix, cornua

Front 62

what is a pseudo gestational sac?

Back 62

a intrauterine saclike structure, can be found in ectopic pregnancies.

Front 63

what does an extrauterine gestational sac normally demonstrate?

Back 63

a thickened echogenic ring, separate from the ovary, which represents trophoblastic tissue or chorionic villi, the embryo or yolk sac can possibly be seen

Front 64

complex adnexal masses, aside from extrauterine gestational sacs, often represent what?

Back 64

hematoma within the peritoneal cavity, which is normally contained in the fallopian tubes (hematosalpinx)

Front 65

the presence of echogenic free fluid has been shown to be highly specific for _________ and highly correlated with ___________?

Back 65

hemoperitoneum
ectopic pregnancy

Front 66

an interstitial pregnancy is also known as?

Back 66

a cornual pregnancy, which is also considered the most life threatening.

Front 67

what is the incidence of cervical pregnancy?

Back 67

1 in 16,000 and have an increased risk of complete hysterectomy due to uncontrollable bleeding.

Front 68

what is the percentage of ovarian pregnancies?

Back 68

less than 3%, they are very rare.

Front 69

what is nuchal translucency?

Back 69

the maximum thickness of the subcutaneous lucency at the back of the neck in an embryo at 11 to 14 weeks gestation. used to assess genetic risk.

Front 70

what are the FMF criteria for nuchal measurements?

Back 70

fetus between 11-13 weeks 6 days
CRL must be between 45mm & 84mm
sonographer must obtain an optimal image of the mdsagittal plane
embryo must be away from the amniotic membrane with the head in a neutral position, with no hyperextension or flexion.

Front 71

what are the markers for cardiac defects?

Back 71

increased nuchal translucency, tricuspid regugitation, reversal or absence of flow in the ductus venosus.
*other cardiac associations such as ectopia cordis and limb body wall complex may be detected.

Front 72

what is the dominant structure that can be seen in the embryonic cranium in the first trimester?

Back 72

the choroid plexus