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46 menstrual days (6 weeks)

When should FHT be seen by transvag imaging?

no

Does seeing FHT always predict a good pregnancy outcome?

90, poor

Embryonic bradycardia is a fetal heart rate below ______ bpm and is usually indicative of a ________ pregnancy outcome.

170, heart failure, fetal hydrops

Embryonic tachycardia is a fetal heart rate above _______ and can lead to _______ and ________.

oligohydramnios

A less than normal amount of amniotic fluid, which can be determined by comparing GS size to the CRL.

4

If the MSD is _______mm smaller than the CRL, then oligohydramnios should be suspected. Poor prognosis

blighted ovum

Another term for anembryonic pregnancy is _________, where there is a GS with no embryo visualized.

12

About _____% of clinically recognized pregnancies are spontaneously miscarried.

fall

Serum progesterone may _______ with a failed pregnancy.

conversion of endometrium to deciduas, maintenance of the endometrium, and inhibits uterine contractility

What affects does progesterone have on the uterus in early pregnancy?

spontaneous abortion, 24-26

Termination of the pregnancy prior to viability; usually ______wks

1-3 weeks

When will a spontaneous abortion occur after embryo death?

incomplete abortion

This occurs when some of the products of conception remain; blood clot may surround conceptus.

subchorionic bleed

When the embryonic placenta or frondosum becomes detached, resulting in a hematoma which typically causes vaginal bleeding (this is most common cause of vaginal bleeding during pregnancy).

threatened abortion

Pregnancies of fewer than 20 weeks when the patient has a viable embryo, documented FHT and bloody vaginal discharge. We CANNOT diagnosis this sonographically.

placental

________ hematomas do not cause symptoms, bleeding or spotting because they are within the chorionic sac and have no communication with the endometrium.

inevitable abortion

SAB is imminent when 2 or more of the following are noted: moderate effacement of cx, cx dilation >3mm, rupture of membranes, bleeding for more than 7 days, persistent cramping

inevitable ab

If you see a sonolucent crescent surrounding the GS, what might be occuring?

make sure the uterus is empty and there are no adnexal masses

What is the sonographer's job in evaluating a complete spontaneous abortion?

incomplete ab

Partial evacuation of products of conception; will be diagnosed EARLY after clinical event.

incomplete ab

A pt experienced a SAB a week prior and is back complaining of persistent, heavy bleeding. What might be going on?

air bubbles or retained bony fragments

In evaluating an incomplete ab, what would the presence of a complex collection of echoes within the endo. cavity represent?

missed ab

The presence of an embryo in uterus without cardiac activity.

fallopian tube, right

Where is the most common site of ectopic pregnancies? Which side is more common?

Isthmus

Where is the 2nd most common ectopic implantation site?

cornual, b/c of high vascularity of the uterus if it ruptures

Where is the most life threatening ectopic implantation site? Why?

cervical

What site of ectopic implantation might require a total hysterectomy if methotrexate treatment fails?

1. a normal intrauterine preg. of <5 weeks
2. an abnormal intrauterine pregnancy
3. A pseudogestational sac in a pt with an ectopic pregnancy

A gestational sac without an embryo or yolk sac on sonography may represent one of three conditions:

vaginal bleeding, empty uterus, adnexal mass, positive pregnancy test

What are the classic clinical findings associated with an ectopic pregnancy?

ID of an extrauterine GS with yolk sac

What is the sonographic diagnosis of an ectopic pregnancy?

30,000, 7,000

In the normal population, the chance of a heterotopic pregnancy is 1:_________. This changes to 1:______ for the ovulation induction population.

pseudogestation sac

The presence of a ___________ is a pitfall when trying to rule out an ectopic pregnancy.

ring of fire, low

Color Doppler will show the "________" color flow around an ectopic GS, and have a ______ resistive waveform.

gestational trophoblastic disease

A proliferative disease of the trophoblast that occurs after an abnormal conception where one egg is fertilized by two sperm or a sperm with duplicated chromosomes, or a normal sperm fertilizes an egg with no chromosomes (nucleus).

Hydatidiform mole
Incomplete or partial mole
Mole with coexisting fetus
Invasive mole
Choriocarcinoma

What are the types of Molar pregnancies?

Hydatidiform mole

What is the most common type of GTD?

hydatidiform mole

This type of GTD results from fertilization of an ovum with no genetic material by a single sperm with duplication of the paternal material

Incomplete or Partial Mole

This type of GTD results from one set of maternal chromosomes and 2 sets of paternal chromosomes; characterized by presence of a fetus or fetal parts.

Mole with coexisting fetus

This type of GTD is not really a true GTD; it is the result of a twin pregnancy with normal development of 1 fetus and placenta, and molar degeneration of the other ovum.

Invasive mole

This type of GTD is also known as Chorioadenoma Destruens, and is a molar pregnancy that invades the uterine wall and leads to life threatening bleeding. This is also considered the Malignant, non-metastatic form of GTD.

Choriocarcinoma

This is the malignant form of GTD, and will metastasize to the lung, brain, liver, bone, GI tract and skin. Elevated hCG levels in the non-pregnant patient.

theca lutein

Bilateral __________ cysts have been reported in as many as half of molar pregnancies.

evacuation of molar preg
serial hCG levels
chemotherapy
eval for mets

Treatment for choriocarcinoma includes:

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