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1st Trimester Complications
Diagnostic Medical Sonography
108
Medical
11/14/2011

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Term
acrania
Definition
partial or complete absence of the cranium
Term
anembryonic pregnancy/blighted ovum
Definition
ovum without an embryo
Term
anencephaly
Definition
congenital abscence of the brain and cranial vault with the cerebral hemisphere missing or reduced to small masses
Term
bowel herniation
Definition
during the 1st trimester the bowel normally herniates outside the abdominal cavity btw 8 and 12 weeks
Term
cephalocele
Definition
protrustion of the brain from the cranial cavity
Term
complete abortion
Definition
complete removal of all products of conception, including the placenta
Term
corpus luteum cyst
Definition
a physiological cyst that dev'ps w/in the ovary after ovulation and secretes progesterone and prevents menses if fertilization occurs; may persist until the 16-18th week
Term
cystic hygroma
Definition
fluid-filled structure (often with septations) initally surrrounding the neck, may extend upward to the head or laterally to the body
Term
ectopic pregnancy
Definition
pregnancy outside the uterus
Term
gastroschisis
Definition
congenital fissure that remains open in the wall of the abdomen just to the right of the umbilical cord
Term
gestational trophoblastic disease
Definition
condition in which trophoblastic tissue overtakes the pregnancy and propagates throughout the uterine cavity
Term
heterotopic pregnancy
Definition
simultaneous intrauterine and extrauterine pregnancy
Term
holoprosencephaly
Definition
failure of forebrain to divide into cerbral heispheres, which results in a single large ventricle with varying amts of cerebral cortex that has been known to occur with trisomies 13-15 and trisomy 18
Term
incomplete abortion
Definition
retained products of conception
Term
iniencephaly
Definition
a congenitally deformed fetus in which the brain substance protrudes through a fissure in the occiput, so that the brain and spinal cord occupy a single cavity
Term
interstitial pregnancy
Definition
pregnancy occuring in the FT near the cornu of the uterus; also known as cornual pregnancy
Term
omphalocele
Definition
congenital hernia of the umbilicus that is covered with a membrane; the cord may be seen in the middle of the mass
Term
psuedogestational sac
Definition
decidual reaction that occurs w/in the uterus in a patient with an ectopic pregnancy
Term
Turner's Syndrome
Definition
non-lethal genetic abnormality in which chromosomal makeup is 45XO instead of the normal 46XX or XY. Cystic hygroma often is seen in affected fetusees in the first trimester. Survivors tend to be short in stature with low set ears, have webbing of the neck, shild-shaped chest, and infertility as a result of the endocrine disorder caused by failure of the ovaries to respind to pituitary changes
Term
ventriculomegaly
Definition
dilation of the ventricular system without enlargement of the cranium
Term
choroid plexus
lateral ventricles
cranial vault
Definition
dominate structure seen w/in the embryoinic cranium is the ? which fills the ? that in turn fill the ?
Term
hydrocephalus
Definition
impossible to dx in the first trimester
Term
hydranencephaly
Definition
brain necrosis from occlusion of the internal carotid a -- loss of all intracranial anatomy
Term
9 weeks
Definition
natural formation (ossification) of cranium begins after ? weeks
Term
echogenic (hyperechoic)
Definition
well mineralized fetal bone has what type of echo texture?
Term
acrania
Definition
micky mouse head
Term
cephalocele
Definition
midline cranial defect in which there is herniation of the brain and meninges
Term
occiptal
frontal
Definition
cephalocele is a geographical leasion where the western heipshere is primarily ? lobe whereas the Eastern hemisphere is usually ? lobe
Term
iniencephaly
Definition
lethal anomaly of the cranium dev'p
-defect in foramen magnum
-retroflexion of the spine where the fetus looks upward with its occiptal cranium directed toward the lumbar spine
-open spinal defects
Term
ventriculomegaly
Definition
increased cerebrospinal fluid accumulates in the bentricular system. Choroid plexus is shown to be dangling in the dilated dependent lateral ventricle
Term
holoprosencephaly
4-8th
Definition
failure of proencephalon to differntiate into cerebral hemispheres between the ?-?th gestational weeks
Term
falx cerebri
9 week
Definition
the normal fetal brain appears to have a single ventricle until the ? dev'ps after the ? week
Term
Dandy-Walker
Definition
cystic dilation of the 4th ventricle with dysgenesis or complete agenesis of the cerebellar vermis and freqently hydrocephaly
Term
6-7th
4th
Definition
Dandy Walker normally occurs around the ?-?th week gestation. Appears as a large posterior fossa cyst that is continuous with the ? ventricle
Term
spina bifida
Definition
spinal irregularities or a bulging within the posterior controur of the fetal spine
Term
bowel herniation
Definition
echogenic mass at the base of the umbilical cord btw 8-12 weeks
Term
10-12 weeks
Definition
the fetal bladder becomes sonographically apparent at ? weeks
Term
obstructive uropathy
Definition
bladder may be so large as to extend out of the pelvis into the fetal abdomen and may present as a cystic mass
Term
cystic hygroma
Definition
chromosomal abnormalities, one of the most commonly seen anomaly. Trisomes 21, 18, and 13 most common
Term
chomosomally normal
karyotypically abnormal
Definition
If the hygroma resolves after 18 weeks then ?. If persistent through term then ?
Term
cystic hygroma
Definition
appear on the posterior aspect of the fetal neck and upper thorax. Soft tissue thickening may also be present (nauchal thickening)
Term
2 - 7.5 mm
Definition
1st trimester umbilical cord cysts average size range is ? mm
Term
placental herniation
Definition
placental may become detached -- resulting in hematoma
Term
>50%
Definition
placental hematomas are reported to have a ? or greater fetal loss rate
Term
placental hematoma
Definition
? dont cause symptoms, bleeding, or spotting because they are within the chorionic sac w/o communication with the endometrium
Term
corpus luteum cyst
Definition
most common ovarian mass seen in the 1st trimester
Term
corpus luteum cyst
Definition
>5cm in size, internal septations/debris, increased vascularity
Term
uterine leiomyoma (fibroid)
Definition
increaed hormones stimulate growth, may compress gestational sac, increased size causes uterine enometrial deformity
Term
ectopic pregnancy
Definition
one of the most emergent dx, 10% of maternal deaths are related to ?
Term
beta hCG's normal
gestational sac
Definition
ectopic pregnancy should be suspected if the hCG's are ? but no intrauterine ? is seen
Term
psuedogestational sac
Definition
-don't contain a libing embryo or yolk sac
-centrally located within the endometrial cavity
-homogeneous level echoes
Term
low
high
Definition
normal peritrophoblastic flow demonstrates a ? resistive (high diastolic) pattern with ? peak velocities (20cm/sec)
Term
high
low
Definition
pseudogestational sac show ? resistive patter (low diastolic component) with ? peak velocities
Term
peritoneum
Definition
80% of patients with ectopic pregnancy demonstrate at least 25ml of blood in the ?
Term
adnexal mass and free pelvic fluid
Definition
what is the best sonographic correlation in the diagnosis of ectopic pregnancy
Term
interstitial pregnancy
Definition
what is the most life threatening of all ectopic gestations
Term
cervical pregnancies
Definition
? have an incrased risk of complete hysterectomy because of uncontrollable bleeding caused by increaesd vascularity of the cervix
Term
heart beat
Definition
what is the first sign of a normal viable pregnancy
Term
46
Definition
endovaginally a living embryo should be detected by no later than ? days
Term
90-170 bpm
Definition
variation of normal embryoninc cardiac rate during 1st trimester
Term
embryonic oligohydramnios
Definition
if the gestational sac is 4mm less than the CRL
Term
triploidy
Definition
chromosome abnormalities, such as ?, have been associated with embryonic growth restriction and embryonic oligohydramnios
Term
subchorionic hemorrhage
Definition
the most common occurrence of bleeding in 1st trimester
Term
subchorionic hemorrhage
Definition
low-pressure bleeds resulf from the implantation of the fertilized ovum into the uterine myometrial wall
Term
uterine wall
placenta
Definition
subchorionic hemorrhage are found between the ? and the membranes of the fetus and is not associated with the ?
Term
subchorionic hemorrhage
Definition
bleeding or spotting and uterine contractions, may lead to spontaneous abortion, demonstrate the avascular nature
Term
complete abortion
Definition
empty uterus with no adnexal masses or free fluid and a positive beta-hCG levels. Bleeding and cramping in 1st trimester
Term
8
16
Definition
yolk sac should be seen when the gestational sac reaches ? mm, and the embryo is seen when the MSD is greater than ?mm
Term
thickened endometrium
5mm
Definition
an incomplete abortion may show a ? of greater than ?mm
Term
scar tissue
Definition
this can mimic product of conception
Term
blighted ovum
Definition
large (>18mm), empty gestational sac that doesnt demonstrate a yolk sac, amnion, embryo, or cardiac activity
Term
gestational trophoblastic disease
Definition
proliferative disease of the trophoblast after a pregnancy
Term
gestational trophoblastic disease
Definition
examples include hydatidiform mole, invasive mole, choriocarcinoma
Term
vaginal bleeding
Definition
what is the clinical hallmark of gestational trophoblastic disease
Term
beta-hCG = dramatically
<100,000 IU/ml
Definition
what is elevated in gestational trophoblastic disease
Term
hyperemesis gravidarum
Definition
severe morning sickness
Term
preeclampsia
Definition
increased BP during pregnancy
Term
AFP
Definition
maternal serum ? levels will be notably low in pregnancies complicate dby a complete hydatidiform mole -- uterus size enlarged
Term
uterus
Definition
? is enlarged with gestational trophoblastic disease
Term
normal
Definition
complete hydatidiform mole = normal/abnormal diploid karyotype?
Term
abnormal
Definition
partial mole is normal/abnormal karyotype?
Term
triploidy
Definition
what is the most common abnormality of a partial mole
Term
snowstrorm appearance
Definition
what is the sonographic appearance of a hydatidiform mole?
Term
increased
Definition
what happens to the blood flow on a hydatidiform mole?
Term
curettage followed by hCG levels
Definition
what is the tx for a molar pregnancy?
Term
partial mole
Definition
has an identifiable placents, although grossly enlarged and engorged with cystic spaces
Term
bilateral theca lutein cyst
Definition
what makes up half of the molar pregnancies where the engorged ovaries may rupture or torqe = extreme pain
Term
invasive hydatidiform mole
Definition
occurs when the hydropic villi of a partial or complete mole invade the uterine myometrium and may further penetrate the uterine wall
Term
invasive hydatidiform mole
Definition
clinically = heavy bleeding and very elevated hCG levels
sonographically: enlarged uterus with multiple focal areas of grapelike clusters
Term
choriocarcinoma
Definition
malignant tumor that arises from the trophoblastic epithelium
Term
lungs liver brain
Definition
what are the most common metasizes of choriocarcinoma
Term
no
Definition
does a partial mole have a malignant potential
Term
15%
Definition
Approximately ? of clinically recognized pregnancies spontaneously miscarried
Term
vaginal spotting or frank bleeding
Definition
Most common presentation for complications is ? occurring in nearly 25% of patients during early stage of pregnancy
Term
frondosum
Definition
Embryonic placenta
Term
subchorionic hemorrhages
Definition
Sonographically, placental hematomas may be difficult to distinguish from ?
Term
avascular
Definition
subchorionic hemorrhages are vascular/avascular?
Term
vascular
Definition
are spontaeius abourtions vascular/avascular
Term
placenta
Definition
the trophoblastic tissue turns into the
Term
8 weeks
Definition
if the gestational sac is 8mm -- how far along is the mother?
Term
fast
Definition
Choriocarcinoma is a ? growing tumor
Term
5.6
Definition
Enlarged yolk sac, ? mm or greater, has increased risk for spontaneous pregnancy loss
Term
double
Definition
Generally, first IRP has hCG quantities ? those of 2IS
Term
2IS
first IRP
Definition
detecting IUP has been shown to be:
800 to 1000 IU/L based on ?
1000 to 2000 IU/L based on ?
Term
0.4
Definition
Color flow imaging and Doppler waveforms may also help diagnose extrauterine gestational sacs -- One study reported color flow detection in and around 95 of 106 ectopic gestations with Doppler resistive index of < ?
Term
Nuchal Translucency
Definition
Maximum thickness of subcutaneous lucency at back of neck in embryo at 11 to 14 weeks’ gestation
Term
NT
Definition
may be found with trisomy 13, 18, or 21 fetuses with cardiac defects and other genetic syndromes
Term
6
Definition
Any gut herniation >? mm should be considered suspicious