First Trimester Complications Powerpoint first 1/2

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1

Implantation

Unlikely

First Trimester Bleeding:

Often inconsequential; results from ____ of conceptus into decidualized endometrium

If accompanied by severe pain, uterine contractions, or dilated cervix, pregnancy ____ to progress

2

Subchorionic

Chorionic; endometrium

Placental Hematomas:

Sonographically, placental hematomas may be difficult to distinguish from ____ hemorrhages

Placental hematomas do not cause symptoms, bleeding, or spotting because they are within the ____ sac, without communications with _____

3

Gestational; nondeveloping

Intrauterine Sac:

If patient presents with positive pregnancy test, uterus appears normal and endometrial complex shows no sign of ____ sac, differential diagnosis would include very early intrauterine pregnancy, ____ pregnancy, or possible ectopic pregnancy

4

Empty

Free fluid

Positive

Absent Intrauterine Sac: Characteristics for sonographic diagnosis of absent intrauterine sac consists of:

  • ____ uterus with no evidence for endometrial fluid collection (early gestational sac)
  • Absence of adnexal masses or ___ ___
  • ____ beta-hCG levels
5

Intact; misshapen

Intrauterine Sac:

Incomplete spontaneous abortion may show several sonographic findings, ranging from ___ gestational sac with nonviable embryo to collapsed gestational sac grossly ____

6

8

Vascularization

Color Doppler

Spontaneous Abortion: Sonographic signs of retained products may be subtle

  • Thickened endometrium greater that ___ mm
  • Increased ____ of endometrial complex
  • ___ ___ strongly predictive
7

5

Pseudogestational

Anembryonic Pregnancy (Blighted Ovum) - Gestational Sac without an embryo or yolk sac: May present one of three conditions:

  1. Normal early intrauterine pregnancy less than __ weeks
  2. Abnormal intrauterine pregnancy
  3. ____ sac in patient with ectopic pregnancy
8

Fails; stops

Trophoblastic

Gestational

hCG

Blighted Ovum or Anembryonic Pregnancy: Is a gestational sac in which embryo ____ to develop or ___ developing at such an early stage that it is imperceptible by ultrasound

____ tissue may continue to proliferate despite failed embryonic growth

____ sac will continue to grow

____ levels may continue to rise, but not at rapid rate

9

5

6.5

Sonographic Findings of Gestational Sacs Associated with Abnormal Intrauterine Pregnancies: Embryo

Absence of cardiac motion in embryos __ mm or larger

Absence of cardiac motion after ___ menstrual weeks

10

Large

Calcified

Sonographic Findings of Gestational Sacs Associated with Abnormal Intrauterine Pregnancies: Yolk Sac and Amnion

___ yolk sac or amnion without visible embryo

____ yolk sac

11

18; 8

Misshapen

Cervical Os

Sonographic Findings of Gestational Sacs Associated with Abnormal Intrauterine Pregnancies:

Large Gestational Sac: Greater than ___ mm lacking viable embryo; Greater than ___ mm lacking visible yolk sac

Shape: Irregular or ____

Position: Cornual, low, or hourglassing though ____ __

12

Absent; 2; intratrophoblastic

0.6; absent

sac

Sonographic Findings of Gestational Sacs Associated with Abnormal Intrauterine Pregnancies:

Trophoblastic Reaction: Irregular; ____ double decidual sac finding; thin trophoblastic reaction less than ___ mm; ____ venous flow

Growth: gestational sac growth of less than ___ mm/day; ____ embryonic growth

hCG correlation: discrepancy in ___ size with hCG levels

13

Proliferative

Gestational Trophoblastic Disease:

____ disease of trophoblast after abnormal conception

Represents spectrum of disease from relatively benign form, hydatidiform (partial, complete or coexistent) mole, to more malignant form, invasive mole, or choriocarcinoma

14

Gestational age

Snowstorm; echogenic; cystic

Gestational Trophoblastic Disease: Sonographic Findings

Varies with ___ __

Characteristic "____" appearance of hydatidiform mole includes moderately ____ soft tissue mass filling uterine cavity marked with small ___ spaces representing hydropic chorionic villi. Also known as grapelike clusters

Color doppler shows high-velocity flow throughout the abnormal tissue

15

Incomplete; blighted

Gestational Trophoblastic Disease: Appearance of first trimester molar pregnancy may simulate:

Missed abortion; ____ abortion; ____ ovum; and hydropic degeneration of placenta associated with missed abortion

16

Echogenic

Double decidual sac

10

Gestational Trophoblastic Disease: On transvaginal sonography, abnormal appearing choriodecidual or trophoblastic reaction consists of:

  • Distorted sac shape
  • Thin, weakly ____ or irregular choriodecidual reaction
  • Absence of ___ ____ ___
  • MSD exceeds ___ mm
17

Placenta; enlarged; engorged

Embryo; aborted

Structural

Gestational Trophoblastic Disease:

Partial mole on sonography has identifiable ____. Placental tissue grossly ___ and ____ with cystic spaces

____ or embryonic tissue may be identified. Often embryo is abnormal and ____ in first trimester

In later stages of pregnancy (>12 weeks) careful analysis should be made to look for ____ defects

18

Malignant

Heavy bleeding

Elevated

Enlarged

Gestational Trophoblastic Disease:

____ forms of trophoblastic disease include invasive mole and choriocarcinoma

Clinically, patient presents with continued ___ ____

Very ____ hCG levels

Sonographic appearance of ____ uterus with multiple focal areas of grapelike clusters throughout

19

IUP; viability

46

Normal

Abnormal or Absent Cardiac Activity:

Identifying ___ with cardiac activity is first conclusive sonographic sign of ____

With TV sonography, living embryo should be detected by __ menstrual days

More than one sonogram may be necessary to establish ____ pregnancy

20

90; poor

170

Embryonic Bradycardia and Tachycardia:

Embryonic cardiac rates of less than ___ bpm at any gestational age within first trimester shown to have ___ prognostic finding

Fetus with heart rate above ___ bpm shows signs of tachycardia, which may lead to heart failure and fetal hydrops (pleural effusion, pericardial effusion, ascites)

21

Oligohydramnios; poor

5

Embryonic Oligohydramnios and Growth Restriction:

Growth delay and _____ within first trimester have ___ outcomes

If gestational sac __ mm less than CRL, embryonic oligohydramnios may be suspected and demise highly probable

22

0.3

5.5

5.6

Embryonic Yolk Sac Evaluation:

Expected yolk sac growth ___ mm/day

Normal yolk sac has maximal diameter of ___ mm between 5 and 10 weeks' gestation

Enlarged yolk sac, __ mm or greater, has increased risk for spontaneous pregnancy loss

23

5th and 7th; amnion and yolk sac

Thinner

Amnion and yolk sac

Amnion Evaluation:

Best visualized with transvaginal sonography between ___ and ___ weeks of gestation as double bleb sign, simultaneous side by side appearance of ___ and __ __

Amnion should appear as __ of the two concentric structures

Embryonic disk lies between ___ and __ __

24

Emergent

Outside

10%

Ectopic Pregnancy:

Ectopic pregnancy is one of the most ____ diagnoses made with sonography

Is pregnancy located ___ central/fundal location of uterus

Approximately ___% of maternal deaths are related to ectopic pregnancy

25

Does not

90%

Gestational age

Ectopic Pregnancy:

___ ___ produce hCG at normal levels (normal hCG levels double every 2 days)

___% of ectopic gestations not viable

May not reflect typical correlation between ____ ____ and hCG levels

26

Normal

Adnexal mass

Sonographic Findings in Ectopic Pregnancy: Most important finding when scanning for ectopic pregnancy is to determine -

  • If ___ intrauterine gestation (reducing probability of ectopic pregnancy)
  • If uterine cavity is empty and ___ ___ is present
27

Extrauterine; adnexa

Extrauterine; separate; embryo

Sonographic Findings in Ectopic Pregnancy:

Identification of ___ sac within ___ one of the most frequent findings of ectopic pregnancy

____ gestational sacs often demonstrate thickened echogenic ring, ___ from ovary, which represents trophoblastic tissue or chorionic villi and possibility that ____ or yolk sac will be seen