ob class 3 - first tri complications

first trimester complications

what percent of clinically recognized pregnancies are miscairrages?

about 15%

what is the most common sign of miscarriage?

vaginal spotting or frank bleeding

normal bleeding in the first trimester is a result of what?

implantation bleeding

if bleeding is accompanied by severe pain, contractions or dilated cervix, what is likely?

nonviable pregnancy

what is the most common reason for first trimester bleeding?

subchorionic hemorrhage

what is subchorionic hemorrhage a result of?

the implantation process; hemorrhage between myometrium and gest sac

what are clinical findings of subchorionic hemorrhage?

bleeding, spotting, cramping

what do you need to diagnose an absent intrauterine sac?

empty uterus

absence of adnexal masses or free fluid

positive beta hCG

what is being shown in this picture?

large subchorionic hemorrage

large subchorionic hemorrage can be an indicator of what?

miscarriage

if a patient has positive pregnancy test and no gestational sac is visualized, what does

early intrauterine pregnancy

nondeveloping pregnancy

possible ectopic pregnancy

how will subchorionic hemorrhage present sonographically?

early bleed → slightly echogenic

older hemorrhage → anechoic

no blood flow

what are the characteristics for absent intrauterine sac

empty uterus

absence of adnexal mass

positive beta hCG

what is spontaneous abortion

unexpected termination of pregnancy in first 20 weeks of gestation

what is missed abortion

unknown pregnancy loss, no symptoms but no heartbeat

what is complete abortion

complete pregnancy loss, empty uterus

mom may bleed and pass fetal tissue

what is threatened abortion

bleeding and cramping with closed cervix

pregnancy may resume with no complications

what is inevitable abortion

bleeding and cramping with dilated cervix

complete abortion likely

if beta hCG levels are progressively decreasing with repeated sampling, what does that indicate

pregnancy loss

what does incomplete spontaneous abortion look like?

ranges from intact gestational sac with nonviable embryo

to collapsed gestational sac

what is the biggest indicator of retained products?

thickened endometrium (greater than 8mm)

increased vascularization of endometrial complex

hCG levels that do not decline

what are the differential diagnoses for gestational sac without embryo/yolk sac

normal early intrauterine pregnancy (less than 5 weeks

abnormal intrauterine pregnancy

pseudogestational sac in patient with ectopic pregnancy

why is it important to reevaluate if abnormal sac is visualized?

could be early pregnancy

what is a blighted ovum/anembryonic pregnancy?

gestational sac in which embryo fails to develop or stops developing so early its undetectable by US

what is the typical appearance of an anembryonic pregnancy?

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

what is gestational trophoblast disease?

a spectrum of disease from benign form, hydatitform mole, or malignant form/invasive mole

what can dramatically elevated beta hCGs indicate?

gestational trophoblastic disease or twins

does a complete molar pregnancy have normal fetal parts?

no, no fetal parts present

does a partial molar pregnancy have normal fetal parts?

will possibly have fetal parts (gest sac, placenta, embryo)

what could this picture indicate?

hydatitiform mole/molar pregnancy

what could this picture indicate?

hydatitiform mole/molar pregnancy

partial mole is said to have __________ on ultrasound.

identifiable placenta

what could this picture indicate?

partial molar pregnancy

what are some malignant forms of trophoblastic disease

invasive mole and choriocarcinoma

why is it necessary to treat choriocarcinoma immediately?

malignant trophoblastic tumor that’s fast growing and commonly metastasizes to liver, lungs, and brain

what is the first conclusive sonographic sign of viability

cardiac activity

what is considered bradycardic for an embryo

less than 90 bpm

what is considered tachycardic for an embryo

over 170 bpm

what sonographic sign does this represent and what does that sign actually show?

double bleb sign; yolk sac and amnion within gestational sac

what is nuchal translucency?

what nuchal translucency value is considered normal?

what is acrania

partial or complete absence of cranium

what is anencephaly?

congenital absence of brain and cranial vault

what is cephalocele?

cranial defect in which there is herniation of the brain and meninges

what is iniencephaly?

what is ventriculomegaly?

dilation of ventricular system leading to enlargement of ventricles

what is holoprosencephaly?

malformation that causes incomplete separation of ventricles

what is dandy-walked malformation?

cystic dilation of fourth ventricle

what is spina bifida?

failure of neural tubes to close; herniation of spinal cord

what is cystic hygroma?

one of the most common first tri abnormalities, high association with chromosomal abnormalities

what does this picture indicate?

thickened nuchal translucency