ch. 48 1st Tri. Complications

Vaginal bleeding (25% of patients)

• under 20 weeks
• viable embryo with heart beat and vag. bleeding
• cervix closed
• 50% will abort

• immenent pregnancy loss
• bleeding, clots, cramps, dilated cervix
• HCg plateau and decline
• distorted gest sac, low location of sac, cervical funneling
• rupture of membranes

• 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

• all product expelled
• HCg falls rapidly
• empty uterus

• poc have not passed
• no heartbeat

• prolonged retention of poc during 1st trimester
• no bleeding
• no cardiac activity
• person still thinks they are preg

• serial abortions (3xs +)
• chromosomal or uterine anomoly
• incompetent cervix (cerclage to sew it)

• 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

• 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

doubles every day

embryonic side of placenta

• early iup >5weeks
• nondeveloping preg
• ectopic

• seen at 4.5 weeks
• grows 1mm/day

should be seen TV when gest sac 8mm

• 16mm
• 7 wk- 46 mest days
• embryo grows 1mm/day

• 5.5-6.5 wk
• 5mm embryo tv
• mds 16mm

• thick end greated than 8mm
• increased vascularity
• visible embryonic parts

• normal early IUP less than 5 weeks
• abnormal IUP
• pseudogest sac with ectopic preg
• must see embryo at 6.4wks

• should be seen when 5mm (4-5weeks)
• grow 1mm per day
• must be seen by 5.2 weeks

• sac with no embryo
• sac continues to grow .7mm/day (1.13normal)
• HCg may rise but not as expected

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

• high blood pressure
• protienuria
• edema
• headache
• weight gain

eclamsia- convulsion state- coma- toxemia of preg

• 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

hydroptic villi of partial or complete mole invade myometrium and penetrate uterine wall

trop cells in myo after d&c

• malignant trop. disease 2-3%
• fast growing and mets to lungs, liver, brain
• susptible to chemotherapy
• heavy bleeding, large uterus, increased hcg

• 90-170
• over 170- can lead to heart failure, hydrops

• triploidy- chromosomal abnormalities
• IUGR

• no greater than 7mm 5-10 weeks
• squishes btwn amnion and chorion 9-10 weeks

• PID
• IUD
• infertilty treatment
• fallopian tube surgery
• hx of ectopic

• pelvic pain 97%
• vag bleeding w/ empty ut
• adnexal mass
• positive preg test
• 25ml of blood in peritoneum
• intraperitoneal fluid

• fallopian tube 95% (ampulla)
• isthmus/cornu most dangerous
• cervical
• ovary
• abdomen

1st is 2xs second aka first is higher #

• 1st standard- 1000-2000 iu/L
• 2nd standard- 800-1000 iu/L

doubles every 2 days with normal iup

• 20% ectopic preg
• intrauterine sac like structure
• no living embryo or yolk sac
• centrally located in ut, not burrowed
• echos in sac

hemorrhagic corpus lut cyst

simuiltaneous intraunterine and extrauterine pregnancies

• cornual 2%
• most life threatening
• parauterine and myomet vasculature
• eccentric gest sac location

• 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

• rare
• less than 3%
• adnexal mass
• looks like hemmorahagic cyst

• 3mm max
• resolve by 22 wks
• 11-14 weeks
• CRL 45-84mm
• diagnose trisomy 21 or 18, 13
• nasal bone

relationship with cardiac defect and nuchal trans.

• 16wks must be by 20
• 22-24wks

choriod plexus which fills lat ventricles and cranial vault

cant have hydrocephalis in 1st tri

brain necrosis in first tri from occlusion of interal carotid arteries

• absense of the cranium- no skull bone
• mickey mouse head
• lack of echogenicity
• predecessor of anenchphaly
• ossification of cranium after 9wks

• most common
• CNS disorder
• absence of the brain and cranial vault after eyes

midline cranial defect herniation of brain and meminges

• rare and lethal
• involves foramen magnum
• extreme retroflexed spine
• open spinal defect

• dilated ventricular system with no enlargement of the cranium
• 11wks ususally seen
• compression or thinnning of choroid plexus

failure of prosencephalon to differentiate into hemispheres and lateral ventricles btwn 4-8wks

• cystic dilitation of 4th vent
• dysgenesis or agenesis of cerebellar vermis
• frequent hydrocephaly
• large posterior fossa cyst no cerebellum
• dilated third and lat ventricles

• 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

normally 7-12 weeks

• 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

• 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

14 weeks

• large bladder
• may extend into abdomen or out of body

• 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

• 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

• identify in relation to cervix and placenta
• may increase in size from estrogen and necrosis
• may compress gest sac and abort