Term
| what is ectopic pregnancy |
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Definition
| is the implantation of the conceptus outside the endometrial cavity |
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Term
| what is ectopic pregnancy also known as? |
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Definition
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Term
| what are the 2 important observations in ectoic pregnancy? |
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Definition
direct visualization of the ectopic gestation
absence of an intrauterine gestation |
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Term
| what is the sonographic appearance of extrauterine gestational sac? |
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Definition
extrauterine gestational sac has sonographic appearance and characteristics similar to the intrauterine gestational sac
extrauterine gestational sacs often demonstrate a thickened echogenic ring, separate from the ovary, which represents trophoblastic tissue or chorionic villi |
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Term
| what firmly makes the diagnosis of an ectopic pregnancy? |
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Definition
| the demonsation of a live embryo, outside the endometrium with cardiac activity |
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Term
| where is free fluid seen with ectopic pregnancy? |
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Definition
| free fluid in the cul-de-sac, adnexa or pericolic gutters |
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Term
| where else must you look for when you're looking for an ectopic pregnancy? |
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Definition
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Term
| what are the sonographic pitfalls while checking for ectopic pregnancy? |
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Definition
presence of fluid in the endometrial cavity, known as a pseudogestational sac (they will not contain embryos or yolk sacs)
absence of the double sac sign eliminates this pitfall
misidentification of a corpus luteum cyst as an adnexal ectopic |
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Term
| What is the doppler criteria for an ectopic pregnancy? |
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Definition
color doppler will surround the gestational sac which represents the metabolically active trophoblastic flow
A high velocity, low resistance spectral waveform indicates typical trophoblastic flow patterns, but this may be mimicked by flow at the margins of a corpus luteum cysts
absence of a doppler signal cannot be used to exclude an ecopic pregnancy |
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Term
| what it is called when color doppler will surround the gestational sac which represents the metabolically active trophoblastic flow |
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Definition
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Term
| What is the most common side of an ectopic implantation? |
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Definition
| ampullary part of the fallopian tube (90%) |
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Term
| which are the other sites that can have an ectopic pregnancy? |
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Definition
| ovary, broad ligament, peritoneum and cervix |
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Term
| where can adnexal pregnancy occur? |
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Definition
in any portion of the fallopian tube or ovary
sites in the tube include
isthmus, ampulla, fimbria, interstitial |
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Term
| what is interstitial ectopic pregnancy aka? |
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Definition
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Term
| why is interstitial ectopic pregnancy the most life threatening? |
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Definition
due to its location, which lies in the segment of the fallopian tube that enters the uterus
this site involves the parauterine and myometrial vasculature, creating life threatening hemorrhage when rupture occurs |
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Term
| when does uterine ectopic pregnancy exists? |
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Definition
| whent he conceptus implants on any site within the uterus but outside the endometrial cavity |
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Term
| when is the diagnosis for uterine ectopic pregnancy suggested? |
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Definition
| suggested by visualization of an intrauterine gestational sac or decidual reaction located high in the fundus, that is not surrounded by more than 5mm of myometrium in all planes |
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Term
| what is the risk factors for cervical ectopic pregnancy? |
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Definition
| previous uterine curretage |
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Term
| what problems does cervical ectopics carry |
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Definition
| high morbidity and morality rates, and attempts to evacuate the conceptus can cause massive hemorrhage |
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Term
| How does an abdominal preganancy form? |
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Definition
| a concetus may leave the pelvis and implant in the peritoneum |
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Term
| what are the sonographic finding of an abd pregnancy? |
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Definition
absence of myometrium surrrounding the pregnancy
poor visualizaion of the placenta
usually diagnosed later in gestation
presence of an emtpy uterus separate ffrom the develping feus
oligohydramnios
unusual fetal presentation |
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Term
| what are the clinical finding of an abdominal pregnancy? |
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Definition
positive pregnancy test
abnormal rate of rise of serum hCG levels
palpation of an adnexal mass
pelvic pain or bleeding withing 1-8 weeks
leukocytosis or slight fever
pain referred to the shoulder caused by intraperitoneal hemorrhage |
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Term
| what is an heterotopic gestation? |
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Definition
| a concomitant intrauterine implanation and an extrauterine implantation |
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Term
| when does ectopic pregnancy in the isthmus tend to rupture? why? |
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Definition
| pregnancies in the fallopian tube isthmus tend to rupure earliest at 6 to 8 weeks gestation, due to the small diameter of this portion of the tube |
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Term
| when does ectopic pregnancy in the ampullary tend to rupture? |
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Definition
| later, generally at 8-12 weeks. |
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Term
| when does ectopic pregnancy in the interstitial tend to rupture? |
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Definition
| the last usually at 12-16 weeks, as the myomerium allows more room to grow han the tubal wall |
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Term
| why is interstitial rupture quite dangerous? |
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Definition
| because of its proximity to uterine and ovarian vessels can result in massive hemorrhage |
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Term
| what happens to the conceptus after it ruptures? |
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Definition
| the conceptus may be reabsorbed or remain as a mass in the abd cavity or cul-de-sac. Rarely if not damaged during rupture, it may implant elsewhere in the abd cavity and continue to grow |
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Term
| what has been shown to destroy proliferating trophoblast and may be effective in the medical management of small, unruptured ectopic pregnancies in asymptomatic women |
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Definition
| methotrexate (MTX) a folic acid antagonist |
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Term
| what is grey turner sign? |
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Definition
ecchymosis on the side of the abdomen,
usually associated with intraperitoneal bleeding from hemorrhagic pancreatitis, ruptured abdominal aorta or ruptured ectopic pregnancy |
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Term
| what are the other diagnostic procedures if sonography fails? |
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Definition
culdocentesis (needle into free fluid to determine if it's blood)
laparoscopy (direct visualization)
exploratory laparotomy (definitive diagnosis not used very often) |
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Term
| what represents a spectrum of disease from a relatively benign form, like a hydatidiform mole, to a more malignant form, like an invasive mole or choriocarcinoma |
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Definition
| gestational tryphoblastic disease |
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Term
| why do molar gestation which is a complication of pregnancy occur? |
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Definition
| due to an abnormal firtilization process |
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Term
| when is a molar gestation seen? |
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Definition
| in older women (over 40) and very yound females of reproductive age and in those with a history of prior molar pregnancy |
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Term
| what is a risk factor for a complete molar pregnancy? |
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Definition
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Term
| what is the clinical indications for molar gestation? |
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Definition
vaginal bleeding in the first or early second trimester
serum levels of beta-hCG are dramatically elevated |
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Term
| what symptomes does the patient experience? |
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Definition
symptoms of hyperemesis or preeclampsia and pregnancy induced HTN
maternal serum alpha fetoprotein levels will be notablly low
the clinical exam may reveal a uterus that is larger in size than dates with bilateral fullness that may represent ovarian enlargement of theca lutein cysts
no identifiable embryonic or fetal tissue is present
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Term
| how is molar pregnancy seen sonographically |
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Definition
varies with the gestational age
the characterisic snowstorm appearance, which includes a moderately echogenic soft tissue mass filling the uterine cavity and studded with small cystic spaces represents hydropic chorionic villi |
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Term
| what must be done when a molar prenancy is diagnosed and has been confirmed? |
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Definition
| should be terminated. suction curettage is the method of choice |
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Term
| what are the different types of GTD |
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Definition
complete hydatidiform mole
partial mole
mole with coexisting normal fetus
invasive mole
choriocarcinoma |
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Term
| what is the most common form of GTD |
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Definition
| complete hydatidiform mole |
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Term
| what is not identifiable in a complete mole |
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Definition
| no identifiable embryonic or fetal tissue is present |
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Term
| how does a complete molar pregnancy occur? |
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Definition
| when a sperm fertilizes an empty ovum, resulting in the development of only placental parts. a complete mole is completely paternal in origin |
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Term
| who are at risk factors for a complete mole pregnancy? |
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Definition
women under 20 & above 40
women of low economic status
women with diets deficient in protein and folic acid |
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Term
| what are the 1st trimester sonographic findings? |
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Definition
filling of endometerial cavity with echogenic mostly homogenous material
presents a vesicular appearance with multiple small scattered cysstic spaces
may be fluid collections surrounding molar mass
bilateral ovarian theca lutein cysts
hypervascular, high velocity, low resistance flow pattern with doppler |
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Term
| what is the 2nd trimester sonographic findings |
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Definition
filling of endometrial cavity with areas of sonolucency surrounded by areas of mixed echogenicity
increased uterine size
ovarian theca lutein cysts
there is more necrosis in the 2nd trimester
the blood supply cannot kee up with the growth of trophoblastic tissue |
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Term
| how is partial mole commonly found? |
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Definition
| commonly found to have 1 set of maternal chromosomes and 2 sets of paternal chromosomes, resulting in a triploid karyotype |
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Term
| when does partial mole occur? |
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Definition
| when the mass contains both the abnormal cells and an embryo that has severe defects. in this case the fetus will be overcome by the growing abnormal mass rather quickly |
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Term
| when does partial mole result? |
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Definition
| when 2 sperms fertilize a single ovum and results in development of certain or all fetal parts. A partial mole predominantly has triploid karyoype of 69xxx or 69xxy or 69xyy |
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Term
| what are the sonographic findings of a partial mole? |
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Definition
frequently deformed gestational sac
growth restricted fetus with triploidy anomalies, including syndactyly and hydrocephalus
excessive placental size with numerous cysic spaces irregularly distributed
appearance similar to a missed or incomplete abortion |
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Term
| what is a mole with coexisting normal fetus? |
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Definition
| 2 conceptions occur - one develops normally and one develops into GTD |
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Term
| what is the sonographic findings for a mole with coexising normal fetus |
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Definition
similar to partial mole, but normal placenta & membranes may be identified
fetus usually has a normal karyotype |
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Term
| what is a complication of pregnancy that most commonly follows GTD, but can also occur after normal term delivery, spontaneous abortion, or even ectopic pregnancy? |
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Definition
| persistent trophoblastic neoplasia (PTN) |
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Term
| what are the high and low risk for persistent trophoblastic neoplasia? |
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Definition
severe degrees of trophoblastic proliferation are at high risk for PTN
lowest risk is associated with partial molar pregnancy |
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Term
| what is invasive mole aka |
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Definition
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Term
| what is the most common form of persistent trophoblastic neoplasia? |
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Definition
| invasive mole / chorioadenoma destruens |
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Term
| what does the invasive mole do? |
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Definition
| it penetrates the myometrium or adjacent structures. it may even penetrate the uterine wall and cause uterine rupture and hemoperitoneum |
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Term
| what is considered malinant, non metastatic form of GTD? |
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Definition
| invasive mole aka chorioadenoma destruens |
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Term
| microscopically how does the invasive mole aka chorioadenoma destruens look like |
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Definition
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Term
| sonographically how does invasive or choriadenoma destruens look like |
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Definition
presence of focal or diffuse echogenic material within the endometrial cavity
may be seen extending into the myometrium
irregular, sonolucent areas may be seen surrounding trophoblastic tissue |
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Term
| what is considered the malignant metastatic form of GTD? |
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Definition
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Term
| what are the common occurences of chorioocarcinoma? |
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Definition
| vascular invasion, hemorrhage and necrosis of the myometrium |
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Term
| what are the sonographic finding of choriocarinoma? |
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Definition
elevated hCG in a non pregnant patient
enlarged uterus
eccentrically situated irregular, complex mass with marked vascularity |
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Term
| what advise is given to the patient who has choriocarcinoma? |
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Definition
| to avoid pregnancy for atleat a year to minimize the risk of missing persistent trophoblastic neoplasia |
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