Abnormal Early Pregnancy / Failed Pregnancy - Ob/GYN Class

Implantation of the fertilized ovum outside of the endometrial lining is known as an ectopic pregnancy. In a normal pregnancy, the fertilized egg implants in the endometrium of the uterus. However, in an ectopic pregnancy, the egg implants in other locations such as the fallopian tubes, ovaries, or abdominal cavity. Ectopic pregnancies are not viable and can be life-threatening if not detected and treated early.

Retention of parts of conception is referred to as an incomplete abortion. This term is used when some fetal or placental tissue remains in the uterus after a pregnancy has ended. It can occur spontaneously or as a result of a medical or surgical abortion. Incomplete abortion may cause symptoms such as heavy bleeding, cramping, and abdominal pain. It is important to seek medical attention if an incomplete abortion is suspected, as it can lead to complications if not treated appropriately.

In the case of a blighted ovum, the fertilized egg implants in the uterus but does not develop into an embryo. This means that there will be no identifiable embryo or yolk sac present. This condition is also known as anembryonic gestation and typically results in a miscarriage.

A spontaneous abortion, also known as a miscarriage, refers to the loss of a pregnancy before the 20th week. In such cases, there will be a rapid decline in HcG levels, which is the hormone produced during pregnancy. This decline occurs because the pregnancy is no longer viable. Additionally, vaginal bleeding with the presence of tissue/clots, cramping, and the disappearance of pregnancy symptoms are common signs of a spontaneous abortion.

The term "ring of fire" is used to describe an echogenic ring-like structure associated with ectopic pregnancy that displays color flow around it. This term is commonly used in medical literature to refer to this specific ultrasound finding.

In a spontaneous loss of pregnancy where all the products of conception evacuate, it is referred to as a complete abortion. This means that all the contents of the uterus, including the fetus and placenta, are expelled. The term "spontaneous" is used to indicate that the abortion occurred naturally, without any medical intervention. Therefore, the correct answer is "complete, spontaneous". The answer "spontaneous, complete" is incorrect because it reverses the order of the terms.

The correct answer is "empty" because in a spontaneous abortion, also known as a miscarriage, the uterus will be empty as the pregnancy has been lost. This means that there will be no gestational sac or fetus visible on the ultrasound.

A missed abortion is diagnosed when an embryo is identified lacking cardiac motion. This means that the pregnancy has stopped developing, but the body has not yet expelled the pregnancy tissue. The patient may or may not experience bleeding, but the embryo is still retained in the uterus.

The correct answer is "ampullary." An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, and the most common site for this to happen is in the ampullary portion of the fallopian tube. The ampulla is the widest and longest part of the fallopian tube, making it a favorable location for implantation.

The "second" most common site for ectopic implantation takes place in the isthmus region of the fallopian tube.

In a normal pregnancy, the levels of HcG (human chorionic gonadotropin) double every two days. HcG is a hormone produced by the placenta during pregnancy. Monitoring the levels of HcG can be used to confirm and track the progress of a pregnancy. The doubling of HcG levels every two days is considered a positive sign of a healthy pregnancy.

If a patient has 3 or more miscarriages or spontaneous abortions, it is considered a habitual abortion. This term is used to describe a pattern or tendency of recurrent miscarriages in a woman. It indicates that the patient has experienced multiple pregnancy losses, which can be distressing and may require further investigation and medical intervention to identify and address any underlying causes.

In a blighted ovum, the gestational sac may appear both too large and too small for the gestational age. This means that it may be larger or smaller than expected based on the duration of the pregnancy. Additionally, the shape of the gestational sac may be unusual, deviating from the typical round or oval shape.

An elective termination is referred to as a therapeutic abortion. This term is used to describe an abortion that is performed for medical reasons, such as to protect the physical or mental health of the mother or in cases where the fetus has severe abnormalities. Unlike other forms of abortion, which may be performed for personal or social reasons, a therapeutic abortion is considered necessary for the well-being of the mother.

Levels will increase "slowly" and decrease "slowly".

When a patient is suspected of having an ectopic pregnancy and presents with a small collection of fluid within the endometrium, it is referred to as a pseudogestational sac. This term is used to describe a fluid-filled structure that resembles a gestational sac, but is not actually indicative of a viable pregnancy. It may be seen in cases of ectopic pregnancy, where the fertilized egg implants outside of the uterus. The presence of a pseudogestational sac can help clinicians in diagnosing ectopic pregnancy and determining the appropriate course of treatment.

A blighted ovum, also known as an anembryonic pregnancy, occurs when a fertilized egg implants in the uterus, but the embryo does not develop. This results in an empty gestational sac without a viable fetus.

Inevitable abortion, also known as pending abortion, is characterized by the rupture of membranes in the presence of cervical dilation. This means that the abortion is unavoidable and will happen soon, as indicated by the rupture of the membranes and the opening of the cervix.

Oligohydramnios and cervical funneling may be seen sonographically with both inevitable and pending abortion. Inevitable abortion refers to a situation where the termination of pregnancy is imminent and cannot be prevented. On the other hand, pending abortion refers to a situation where the termination of pregnancy is likely to occur but has not yet happened. Both conditions can cause changes in the amniotic fluid levels and the cervix, which can be visualized through ultrasound.

The classic triad of presenting symptoms of ectopic pregnancy includes adnexal mass, bleeding, and pain. These symptoms are commonly seen in cases of ectopic pregnancy, where the fertilized egg implants outside of the uterus, typically in the fallopian tube. The presence of an adnexal mass, which refers to an abnormal growth near the ovaries or fallopian tubes, along with bleeding and pain, can indicate the possibility of an ectopic pregnancy. It is important to recognize these symptoms early on as ectopic pregnancies can be life-threatening if not treated promptly.

If no yolk sac is visualized with a mean sac diameter (MSD) of 10mm on transvaginal ultrasound, it is suggestive of a blighted ovum. To confirm this, the pregnancy should be rescanned within 3 to 7 days. This is because the absence of a yolk sac at this stage could indicate an abnormal pregnancy, and rescanning after a few days allows for further evaluation and confirmation of the diagnosis.

The fimbria is the part of the fallopian tube that is closest to the ovary. Ectopic implantation refers to the implantation of a fertilized egg outside of the uterus, which can result in a potentially life-threatening condition. The fimbria is not a common site for ectopic implantation, making it "very rare" for this to occur in this region of the fallopian tube.

In this scenario, the correct answer is "threatened." When a pregnant patient presents with bloody vaginal discharge, bleeding, and cramping at less than 20 weeks gestation, it is indicative of a threatened abortion. A threatened abortion refers to vaginal bleeding during pregnancy that may or may not lead to the loss of the fetus. It is important for healthcare providers to closely monitor the patient and provide appropriate care to prevent further complications.

Ectopic pregnancy should be considered if there is no evidence of normal intrauterine pregnancy in the presence of BhCG level of 800-1000 mlU/ml (2nd IS) or 1000-2000 mlU/ml (IRP). This means that if there is no indication of a pregnancy inside the uterus and the levels of the hormone BhCG are within the specified range, it is likely that the pregnancy is ectopic, meaning it has implanted outside of the uterus.

In a case of blighted ovum, the levels of serum progesterone may fall or be lower than normal. Additionally, the levels of HcG (human chorionic gonadotropin) may rise slowly instead of at the proper rate. Eventually, the HcG levels may begin to taper off. This suggests that the pregnancy is not progressing as it should and may result in a miscarriage.

Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, typically in the fallopian tube. Previous tube surgery can cause scarring or damage to the fallopian tube, increasing the risk of ectopic pregnancy. Pelvic inflammatory disease (PID) can also lead to scarring and blockage of the fallopian tubes, making it more likely for the egg to implant in the wrong place. Endometriosis, a condition where the tissue lining the uterus grows outside of it, can affect the fallopian tubes and increase the risk of ectopic pregnancy. IUD usage, particularly if it fails to prevent pregnancy, can also increase the chances of ectopic pregnancy. Developmental abnormalities of the tube can create an environment where the egg cannot properly travel to the uterus, leading to ectopic pregnancy. Obesity and diabetes mellitus do not directly cause ectopic pregnancy.

When a patient has an ectopic pregnancy, it means that the fertilized egg implants outside of the uterus, usually in the fallopian tubes. In this case, the question is asking about the location of fluid collection in the cul-de-sac, which is a space in the pelvic cavity. The correct answer is "posterior," indicating that the fluid would accumulate in the posterior cul-de-sac. If the ectopic pregnancy ruptures, the fluid would also be present in Morrison's pouch, which is another term for the space between the liver and the right kidney.

The correct answer includes four sites for ectopic implantation, which are abdominal, cervical, cornual, and ovary. These sites refer to the locations where fertilized eggs can implant and develop outside of the uterus.