Chapter 50: First Trimester Complications

most common first trimester complication

vaginal bleeding

possibly bleeding that indicates that there may be concern thye baby may not stay viable

threatened abortion

vaginal bleeding can be based on how rough implantation into the endometrium was resulting in blood. this blood resolves by…

being absorbed or exiting through the cervix

vaginal bleeding with pain, contractions, and/or dilation is concern for ___.

miscarriage

miscarriage is also termed ___.

spontaneous abortion

spontaneous abortion is also termed ___.

embryonic demise

what is the most common reason for bleeding in the first trimester?

subchorionic hematoma

a fresh bleed may appear ___.

isoechoic

an older bleed may appear ___.

more hypoechoic

T/F placental hematomas and placental abruption require immediate attention.

true

placenta completely pulls away from the uterine wall; baby must be delivered immediately

placental abruption

a MSD measuring ____ should have embryo/fetal pole with cardiac activity.

25 mm

a MSD measuring 25 mm with a fetal pole with no cardiac activity =

failed pregnancy

an embryo with a CRL measurement of ___should have cardiac activity, if no cardiac activity, it becomes a failed pregnancy.

greater than or equal to 7 mm

if there is an absent IUP with a positive pregnancy test, what are the 3 reasons this could be occurring?

very early pregnancy, ectopic pregnancy, RPOC

an early pregnancy should be able to be visualized transvaginally when hCG levels are __.

1000-2000

pregnancy that occurs outside of the uterine fundus

ectopic pregnancy

RPOC stands for ___.

retained products of conception

RPOC will appear sonographically as…

thickened endometrium with heterogeneous texture; patient will likely have a positive pregnancy test

growth of a gestational sac should be ____.

1 mm/day

a yolk sac with a measurement of ___ will have an ominous outcome and probably will not be a viable pregnancy.

greater than 7 mm

a gestational sac without an embryo or yolk sac is considered to be a normal finding of an early IUP of ____ weeks.

less than 5 weeks

an amnion and YS that are almost the same size is called a ___.

double bleb sign

in cases of an abnormal IUP, the yolk sac is ____ and there is no embryo seen in the ___.

enlarged; amnion

a gestational sac without an embryo or yolk sac could be an abnormal IUP or ____.

pseudogestational sac with an ectopic pregnancy

a blighted ovum is also called ____.

anembryonic pregnancy

gestational sac is present but no embryo or yolk sac; trophoblastic tissue will still continue to develop, hCG levels continue to rise but at a slower rate

blighted ovum

what continues to develop in cases of blighted ovum that causes the lab values to correspond to a pregnancy?

trophoblastic tissue

hCG levels should ___ every ___.

double every two days

gestational trophoblastic disease is also called ____.

molar pregnancy

molar pregnancy causes hCG levels to be…

exponentially high

molar pregnancy usually results in a ___.

spontaneous abortion

if a molar pregnancy continues into the 2nd trimester with a live embryo, there is high risk of…

trisomy 13, 18, 21

what are the types of molar pregnancy?

partial/complete, coexistent, malignant form

the malignant form of molar pregnancy is ___.

choriocarcinoma

how do the ovaries appear sonographically in cases of molar pregnancy?

enlarged, with theca lutein cysts

what type of cysts are common to see on the ovaries in cases of molar pregnancy?

theca lutein

in molar pregnancy, how does the endometrium appear?

thickened with grape-like cysts within

what is the coexistent form of molar pregancy?

a live fetus is present along with molar pregnancy

typically, a normal case of molar pregnancy does not invade the ____.

myometrium

typically, a normal case of molar pregnancy does/does not invade the myometrium.

does not

in cases of molar pregnancy, if it does invade the myometrium, it is then called ____.

invasive gestational trophoblastic disease

invasive molar pregnancy, think ___.

choriocarcinoma

how will the patient present clinically in cases of invasive gestational trophoblastic disease?

elevated hCG levels and vaginal bleeding

metastases of invasive gestational trophoblastic disease is usually to the ____, ____, and ____.

lung, liver, and brain

cardiac activity visualized in an embryo when the CRL measures ____.

greater than or equal to 7 mm

cardiac activity is measured in ____.

M-mode

heart rate of _____ is suspicious for an abnormal outcome.

less than 90 bpm

heart rate of ____ is tachycardia and may result in failure or fetal hydrops.

greater than 170 bpm

what is most critical for diagnosing pregnancy failure?

absent cardiac activity

when the gestational sac measures too small in the first trimester

embryonic oligo and growth restriction

in cases of embryonic oligo, the gestational sac will measure ____.

5 mm less than the CRL

if there is embryonic oligo, there is a(n) ____ outcome.

ominous

which yolk sac do we see on US?

secondary yolk sac

how does a normal yolk sac appear on US?

nice, round, echogenic, should measure less than 7 mm

a normal yolk sak should measure ____.

<7mm

normal growth of a yolk sac is ____.

0.3 mm/day

an abnormal yolk sac measures ___.

greater than 7 mm

an abnormal yolk sac can be…

enlarged, too small, echogenic, misshapened

what is the most emergent diagnosis made in US in the first trimester?

ectopic pregnancy

future ____ is affected in cases of ectopic pregnancy.

fertility

if a patient has an ectopic pregnancy, they are at higher risk of…

getting pregnant again, having another ectopic

risk factors for ectopic pregnancy include…

IUDs, fallopian tube surgery, history of ectopics

what are the 5 findings of ectopic pregnancy?

positive pregnancy test, vaginal bleeding, pelvic pain (97%), empty uterus/thickened endometrium, adnexal mass

findings of an extrauterine pregnancy include…

echogenic ring separate from the ovary; may have an embryo with YS and may even have cardiac activity

usually the type/where an ectopic occurs

tubal ectopic

in cases of tubal ectopic pregnancies, what could be seen in the uterus?

pseudogestational sac

how does a tubal ectopic appear sonographically?

echogenic ring that is separate from the ovary, adnexal mass separate from the ovary, no embryo; clinical history helps to point to ectopic pregnancy

always make sure to see the ____ of a pregnant uterus, or any uterus.

fundus of the uterus

how does a C-section scar appear sonographically?

misshapen gestational sac at the level of the C-section scar

if c-section scar pregnancy continues and continues to push the uterus out, there is risk of ___.

uterine rupture

condition that occurs when the placenta grows too deeply into the uterine wall; doesn’t pass through the wall of the uterus or impact the muscles of the uterus

placenta accreta

condition in which the placenta is more deeply embedded into the uterine wall but still does not pass through the wall; embedded further than accreta

placenta increta

occurs when the placenta passes through the uterine wall

placenta percreta

ovarian ectopics are ___.

rare

findings of an ovarian ectopic pregnancy

positive pregnancy test, vaginal bleeding, pelvic pain, adnexal mass that is NOT separate from the ovary

what is a heterotopic pregnancy?

rare condition where an IUP and an ectopic pregnancy occur simultaneously

which patients are at a higher risk for a heterotopic pregnancy?

those that do ovulation induction or IVF

fluid collection between skin and soft tissue over the spine

nuchal translucency

nuchal translucency is measured to assess ___.

genetic risk

when is NT measured?

11+0-13+6

an increased NT = genetic risk factors for…

trisomy 13, 18, 21; cardiac defects and other genetic syndromes

U/S findings of NT are combined with ___ and ___.

free beta-hCG and PAPP-A

requirements of NT measurement =

should be between ___ and ___ weeks.

11+0-13+6

requirements of NT measurement =

CRL measurement of ___.

45-84 mm

requirements of NT measurement =

___ plane

midsagittal

requirements of NT measurement =

embryo away from ___.

amnion

requirements of NT measurement =

head in a __ position.

neutral

NT measurement is considered abnormal when it measures ___.

greater than 3 mm

differential diagnosis from cystic NT (abnormal NT) =

cystic hygroma

partial or complete absence of cranium

acrania

in cases of acrania, the fetus as a ___ head.

“Mickey Mouse”

acrania is possibly the predecessor of ____.

anencephaly

congenital absence of brain and cranial vault

anencephaly

anencephaly is absence of the brain above the ___.

orbits

anencephaly presents with a ____ appearance.

frog-like

anencephaly is usually seen in which trimester?

2nd

midline defect causing herniation of the brain and the meninges; could be in different locations

cephalocele

normal ventricle measurement

less than or equal to 10 mm

dilation of the ventricles

ventriculomegaly