ch. 48 1st Tri. Complications

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rbeacr
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ch. 48 1st Tri. Complications
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2012-03-03 16:50:28
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1st trimester complications
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1st trimester complications
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  1. Most common 1st trimester complication
    Vaginal bleeding (25% of patients)
  2. Threatened abortion
    • under 20 weeks
    • viable embryo with heart beat and vag. bleeding
    • cervix closed
    • 50% will abort
  3. Inevitable abortion
    • immenent pregnancy loss
    • bleeding, clots, cramps, dilated cervix
    • HCg plateau and decline
    • distorted gest sac, low location of sac, cervical funneling
    • rupture of membranes
  4. Incomplete abortion
    • incomplete passage of products
    • clots and cramping
    • HCd plateau or decline
    • irregular gest sac with rpoc
    • fluid in endomet.
    • give pt med. to dislodge tropo. cells D&C
  5. complete abortion
    • all product expelled
    • HCg falls rapidly
    • empty uterus
  6. Embryonic (fetal) demise
    • poc have not passed
    • no heartbeat
  7. Missed abortion
    • prolonged retention of poc during 1st trimester
    • no bleeding
    • no cardiac activity
    • person still thinks they are preg
  8. habitual abortion
    • serial abortions (3xs +)
    • chromosomal or uterine anomoly
    • incompetent cervix (cerclage to sew it)
  9. Subcorionic bleeding
    • worse concern in 1st tri
    • bleed from implantation btwn myo and gest sac
    • abrupto placenta-- 2nd tri
    • if hemmorage is big enough can be spl
    • avascular with color
  10. Spontaneous abortion
    • loss of fetus less than 500g or before 20 wks
    • 1st tri- chromosomal anomolies
    • 2nd tri- uterine anomolies (fibroid, bicorn.)
    • placenta still devloping. HCg increses but not as fast as it should
  11. Normal IUP HCg
    doubles every day
  12. frondosum
    embryonic side of placenta
  13. 3 differential diagnosis for + preg test
    • early iup >5weeks
    • nondeveloping preg
    • ectopic
  14. gest sac growth
    • seen at 4.5 weeks
    • grows 1mm/day
  15. yolk sac
    should be seen TV when gest sac 8mm
  16. should see embryo when gest sac is
    what week
    • 16mm
    • 7 wk- 46 mest days
    • embryo grows 1mm/day
  17. cardiac activity seen at what week
    what size embryo
    what size gest sac
    • 5.5-6.5 wk
    • 5mm embryo tv
    • mds 16mm
  18. retained products of conceptioon (rpoc)
    • thick end greated than 8mm
    • increased vascularity
    • visible embryonic parts
  19. gest sac with no embryo
    • normal early IUP less than 5 weeks
    • abnormal IUP
    • pseudogest sac with ectopic preg
    • must see embryo at 6.4wks
  20. abnormal gest sac
    • should be seen when 5mm (4-5weeks)
    • grow 1mm per day
    • must be seen by 5.2 weeks
  21. anembryonic preg (blighted ovum)
    • sac with no embryo
    • sac continues to grow .7mm/day (1.13normal)
    • HCg may rise but not as expected
  22. gest trop disease
    proliferation of trophoblast after abnormal conception

    • vag bleeding in 1st-2nd tri
    • dramatically elevated beta HCG
    • excessive vomiting and preeclamsia
    • low MSAFP1 in 1000 in america (under20 and over 40)

    • benign- hydatiform mole (partial complete or coexistant)
    • malignant- invasive mole and choriocarcinoma
  23. preeclamsia
    • high blood pressure
    • protienuria
    • edema
    • headache
    • weight gain


    eclamsia- convulsion state- coma- toxemia of preg
  24. hydatiform mole
    • partial- triploid. egg and two sperm
    • fetal parts develop, enlarged placenta
    • trisomies 13,18,21 (69 chrom)

    complete- diploid. egg with no nucleus and 1 sperm, no parts develop (23 chrom)

    • sonographic snowstorm- grape cluster
    • hydroptic chorionic villi

    bilateral ovarian THECA LUTIEN CYSTS

    D&C
  25. Invasive mole
    hydroptic villi of partial or complete mole invade myometrium and penetrate uterine wall
  26. persistent trop disesase
    trop cells in myo after d&c
  27. choriocarcinoma
    • malignant trop. disease 2-3%
    • fast growing and mets to lungs, liver, brain
    • susptible to chemotherapy
    • heavy bleeding, large uterus, increased hcg
  28. Cariac Acivity bpm
    • 90-170
    • over 170- can lead to heart failure, hydrops
  29. oligohydraminos
    • triploidy- chromosomal abnormalities
    • IUGR
  30. yolk sac max diameter
    • no greater than 7mm 5-10 weeks
    • squishes btwn amnion and chorion 9-10 weeks
  31. ectopic preg risk factors
    • PID
    • IUD
    • infertilty treatment
    • fallopian tube surgery
    • hx of ectopic
  32. ectopic preg symptopms/findings
    • pelvic pain 97%
    • vag bleeding w/ empty ut
    • adnexal mass
    • positive preg test
    • 25ml of blood in peritoneum
    • intraperitoneal fluid
  33. ectopic location
    • fallopian tube 95% (ampulla)
    • isthmus/cornu most dangerous
    • cervical
    • ovary
    • abdomen
  34. 1st and 2nd international standard
    which is more
    1st is 2xs second aka first is higher #
  35. discrim zone for finding ectopic
    • 1st standard- 1000-2000 iu/L
    • 2nd standard- 800-1000 iu/L

    doubles every 2 days with normal iup
  36. pseudogestational sac
    • 20% ectopic preg
    • intrauterine sac like structure
    • no living embryo or yolk sac
    • centrally located in ut, not burrowed
    • echos in sac
  37. ectopic may be mimmicked by
    hemorrhagic corpus lut cyst
  38. heterotrophic preg
    simuiltaneous intraunterine and extrauterine pregnancies
  39. interstitial pregnancy
    • cornual 2%
    • most life threatening
    • parauterine and myomet vasculature
    • eccentric gest sac location
  40. cervical preg
    • gest sac in cervix may look like spon. abortion
    • cervical preg will have color flow
    • abort is mishapen and no color
    • increased risk of hysterectomy from cervical vasculature
  41. ovarian preg
    • rare
    • less than 3%
    • adnexal mass
    • looks like hemmorahagic cyst
  42. nuchal translucency
    • 3mm max
    • resolve by 22 wks
    • 11-14 weeks
    • CRL 45-84mm
    • diagnose trisomy 21 or 18, 13
    • nasal bone
  43. cardiac anomalies
    relationship with cardiac defect and nuchal trans.
  44. should see 4ch heart by..
    outflow tracts..
    • 16wks must be by 20
    • 22-24wks
  45. 1st trimester cranium you see
    choriod plexus which fills lat ventricles and cranial vault

    cant have hydrocephalis in 1st tri
  46. hydraencephaly
    brain necrosis in first tri from occlusion of interal carotid arteries
  47. acrania
    • absense of the cranium- no skull bone
    • mickey mouse head
    • lack of echogenicity
    • predecessor of anenchphaly
    • ossification of cranium after 9wks
  48. Anencephaly
    • most common
    • CNS disorder
    • absence of the brain and cranial vault after eyes
  49. cephalocele
    midline cranial defect herniation of brain and meminges
  50. iniencephaly
    • rare and lethal
    • involves foramen magnum
    • extreme retroflexed spine
    • open spinal defect
  51. ventriculomegaly
    • dilated ventricular system with no enlargement of the cranium
    • 11wks ususally seen
    • compression or thinnning of choroid plexus
  52. holoprosencephaly
    failure of prosencephalon to differentiate into hemispheres and lateral ventricles btwn 4-8wks
  53. Dandy walker malformation
    • cystic dilitation of 4th vent
    • dysgenesis or agenesis of cerebellar vermis
    • frequent hydrocephaly
    • large posterior fossa cyst no cerebellum
    • dilated third and lat ventricles
  54. spina bifida
    • neural tube fails to close after 6wks
    • bulging post contour of fetal spine and mass from vertebral column
    • lemon sign
    • banana sign- cerebellum
    • 4th vent caudally displaced
    • best seen transverse
  55. midgut herniation
    normally 7-12 weeks
  56. gastroschisis
    • anterior wall defect usually to the right of umb cord. bowel and other organs protrude out of abdomen
    • no membrane- exposed to amn fluid
    • not assoc with other anomlies
    • elevated afp
  57. omphalocele
    • abd organs and bowerl into the base of umb cord
    • membrane covering
    • associated with other anomolies
    • cant be diag until after 12wks when normal herniation is done
  58. fetal bladder visable at
    14 weeks
  59. obstructive uropathy
    • large bladder
    • may extend into abdomen or out of body
  60. cystic hygroma
    • one of the most common anomomolies of 1st tri
    • high association with chrom anomolies
    • if present past 22wks will not survive
    • 2nd to 3rd tri- turners syndrome
  61. corpus luteum cyst
    • most common 1st tri ovarian mass
    • secrete progesterone to preserve embryo
    • less than 5 cm
    • may get large and have vascular ring
    • may look like ectopic but are intraovarian
    • regress and not seen at 16-18wks
  62. fibroids in 1st tri
    • identify in relation to cervix and placenta
    • may increase in size from estrogen and necrosis
    • may compress gest sac and abort

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