Normal First Tri Powerpoint First 1/2

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1

Embryonic

4-10

All

Normal Pregnancy Progression:

___ phase between weeks ___ to ___.

During this phase, ___ major internal and external structures begin to develop.

2

Cardiovascular; 5.5, 6

35

Normal Pregnancy Progression:

_____ system undergoes rapid development, with initial heartbeat occurring between ___ and ___ weeks.

Crown-rump length (CRL) develops rapidly, measuring ___ mm by the end of the 10th week.

3

Fetal Period

Head, 1/2

Fetal Period:

Last two weeks of first trimester (weeks 11 and 12) constitute beginning of _____. Continued growth of organs and structures formed during embryonic period.

At this stage, fetal ____ disproportionately larger than the rest of the fetus, constituting ___ of the CRL.

4

Body

Late first trimester; anomaly detection

Normal Pregnancy Progression:

As fetus grows, ___ growth accelerates and then disproportionately becomes less pronounced.

Fetal anatomy fully developed in the ____ ___ ___, goal of sonography at this stage includes ____ ____.

5

Progesterone

Corpus luteum in pregnancy produces ____ to support the pregnancy.

6

1800

500

Ectopic

Maternal Serum Biochemistry in Early Pregnancy:

TA: Normal gestational sac seen in hCG level ____mIU/ml (second international standard) or greater.

TV: may be as low as ___ mIU/ml.

At these levels, if gestational sac not seen within uterus, ___ pregnancy may be considered.

7

Ectopic, lower

Ectopic

Maternal Serum Biochemistry in Early Pregnancy:

____ pregnancies demonstrate ___ hCG levels than intrauterine pregnancies.

Rate of rise or increase in hCG during early pregnancy may help detect ___ pregnancies.

8

Doubles; 66

Fall

Ectopic

Maternal Serum Biochemistry in Early Pregnancy:

Normal IUP < 7 weeks serum hCG ___ every 3.5 days or increase of __% within 48 hours.

hCG levels ___ before spontaneous expulsion of nonviable gestations.

Vaginal bleeding and pelvic pain are suspicion of ____ pregnancy.

9

hCG levels in mIU/ml

  • 35-50
  • 45-426
  • 518-7340
  • 61,080-56,500
  • 7,650-229,000
  • 25,700-288,00

Beta hCG Levels During Pregnancy:

Menstrual Weeks

  • 3
  • 4
  • 5
  • 6
  • 7-8
  • 10-12
10

Plateau

21; slowly

Maternal Serum Biochemistry in Early Pregnancy:

At 9-10 weeks, hCG levels ____ and subsequently decline while gestation continues to grow.

In pregnancies where fetus is trisomy ___, hCG levels plateau later and fall much more ____. Levels of hCG increased in these pregnancies as compared to normal pregnancies. Difference increases as gestation advances.

11

Risk

Down Syndrome

Aneuploidy

Maternal Serum Biochemistry in Early Pregnancy:

hCG is component of first trimester ____ assessment and component of triple screen testing performed during second trimester.

Sensitivity of hCG for ___ ____ assessment improved by measurement of free beta subunit.

Both total hCG and free beta-hCG used for ____ screening in the United States.

12

Trophoblastic

Bone and tissue

PAPP-P

Maternal Serum Biochemistry in Early Pregnancy:

Pregnancy-associated with plasma protein-A (PAPP-A), also known as pappalysin-1, is an insulin-like growth factor produced by ____ (placental) cells during pregnancy.

Involved in proliferative growth processes such as ___ and ____ formation.

Maternal serum ____ increases with advancing gestation.

13

21; lower

Down Syndrome

Maternal Serum Biochemistry in Early Pregnancy:

In trisomy ___ affected pregnancies, PAPP-A levels initially ___ than in normal pregnancies, but difference decreases with increasing gestational age.

Decreased values for maternal serum PAPP-A may be a marker for ___ ____ during the first trimester but not useful in second trimester.

14

9-11; Down Syndrome

Maternal Serum Biochemistry in Early Pregnancy:

PAPP-A analysis at __ to __ weeks of gestational age is strongest biochemical marker for ___ ___.

PAPP-A not sensitive enough to be useful by itself, combined with hCG levels for serum biochemistry screening or with hCG and sonographic markers for combined screening.

15
  • Gestational sac
  • Embryo; sac
  • Cardiac activity
  • Number

Sonographic Technique and Evaluation of the First Trimester: Major components of routine 1st trimester examination -

  • Uterus and adnexa evaluated for the presence of ____ ____
  • Sonographic measurements of ___ and/or ___ recorded
  • Presence or absence of ___ ____ documented
  • Fetal ___ documented and chorionicity assessed in multiple pregnancies
  • Uterus, adnexal structures, cul-de-sac evaluated
16
  • Oval
  • Fundal
  • Middle
  • 3

Visualization of the Early Gestation: Normal sonographic features of gestational sac

  • Round or ___ shape
  • ___ position in uterus
  • Eccentrically placed position in ___ position of uterus
  • Smooth contour
  • Decidual wall thickness greater than ___ mm
17

Lower uterine segment; accreta; previa

Yolk sac; 12; 18

1

Visualization of the Early Gestation:

Implantation in the ___ ___ ___ may be associated with placenta ___ or placenta ____.

____ ____ should be seen when the mean sac diameter greater than ___ mm. Embryo should be seen with MSD greater than ___ mm.

Gestational sac grows at predictable rate of a ___mm/day in early pregnancy.

18

Earliest

5

Visualization of the Early Gestation: Yolk Sac

____intragestational sac anatomy seen

Normally seen from __ weeks of gestation

19
  • Nutrients
  • Hematopoesis
  • Endoderm

Visualization of the Early Gestation: Yolk Sac

Functions of the secondary, or sonographic, yolk sac in embryonic development -

  • Provide ____ to the developing embryo
  • _____ - the formation and development of blood cells
  • Development of embryonic ____, which forms the primitive gut
20

Spine; primitive; 6th

Spine; 6; spine

Visualization of the Embryo: 6-10 weeks gestational age

Embryonic Cranium and Spine

___. which develops from the ectoderm, initially evolves from the ___ neural tube, which closes about the __ week of gestation.

Developing ___ may be visualized as parallel echogenic lines at ___ weeks of gestation. Sonolucent center is _____.

21

2

2

Overview of First Trimester

Conceptional age, also known as embryologic age

  • Subtract ___ weeks from GA

Gestational age, also known as menstrual age

  • Add ____ weeks to gestational age
22

90

6

Amnions

12

Yolk Sac

Visualization predicts IUP in ___% of cases

Normal yolk sac should not exceed __ mm

Number of yolk sacs correlates to the number of ____

Yolk sac no longer seen by ___ weeks