Please enable JavaScript.
Coggle requires JavaScript to display documents.
1st Trimester Complications, image, image, image, image - Coggle Diagram
1st Trimester Complications
EPF
Early pregnancy failure
Viability
IUP (Intra uterine pregnancy)
+FHR
CRL >=5-7 mm
FHR
(CRL 1-7mm) >> follow up
Is this pregnancy VIABLE?
Confirm IUP(Pregnancy) (CRL +FHR)
Confirm IUD(Demise) (CRM -FHR)
Causes
Blighted Ovum
Anembryonic pregnancy
pregnancy starts but stops growing early
Clinically
“don’t feel pregnant any more”
Fatigue, nausea, breast tenderness subsides
±bleeding
US
Empty sac / No embryo or YS
+- irregular sac
Could be pseudosac (more irregular)
“Poor” trophoblastic ring
Adverse outcomes if:
MSD **
≥25
mm
(>7wks)** without EMBRYO
DDX (Ectopic)
Spontaneous abortion (Miscarriage)
Complete
All products of conception (POC) have passed
Endometrium (
Thick
>> Thin)
Careful
!!! -Was an IUP previously identified? >> Check for previous scan (may be there is an ectopic somewhere)
Incomplete
RPOC
Retained Products of Conception
prolonged bleeding Post SA, TA, NVD or C/S
Presence of
chorionic villi
, which indicates persistent placental or trophoblastic tissue
US
EV scan with color Doppler required
Thickened Endometrial Echo Complex (
EEC
)
Material within uterine cavity
+
blood flow
in endometrium/cavity
+
Doppler
enhances diagnostic confidence
? ↑myometrialflow
RPOC or clot
US
Variable
appearance
Irregular GS/ Thickened Endometrium
Hyperechoic tissue within uterus
Offer EV
Threatened
Ectopic pregnancy
What?
Implantation
outside
the endometrium
Implantation with
< 5mm
myometrial
mantle
Clinically
Asymptomatic
Pain, Bleeding, Adnexal Mass
Rt Shoulder Pain/↓blood pressure
Ix
bhCG
–slower rate of rise (20%)
US
Where
?
Most commonly
Ampulla
of fallopian tube (same side as the
corpus luteum
)
Could be
anywhere
!
Interstitial (tubal)
Myometrial mantle <5mm
Late presentation (rupture)
Surrounded by myometrium (Unlike other tubal ectopic)
Findings
Uterus
Thick lining/
decidual
rxn.
+
pseudosac
Secretory Fluid in Endo
Irregular shape (NOT round/oval)
Absent Double Ring Sign
Adnexa
+
mass
++ variable appearance
Identify both ovaries/CL !!!
Posterior cul-de-sac
+- free fluid with echoes
if + >>>> check morrison's pouch
Beware of the
corpus luteum
/
similar
signs with ectopic
Correlate
the clinical picture i.e LMP, + preg test
If pregnancy test + and no IUP TA >> Offer an
EV
Risk factors
Previous Ectopic
Tubal Surgery, Adhesions
Endometriosis, PID
ART (assisted
GTD
Gestational Trophoblastic Disease
Types
Partial/Incomplete Mole
Abnormal Embryo and Placenta
Complete Mole
Abnormal, cystic ++proliferating placenta
Choriocarcinoma
Persistent GTD
Coexisting Mole and Fetus
Rare
Overview
Bleeding
+Pain
Spontaneous Abortion
Ectopic
SCH
GTD
Size / Dates Discrepancy
SFD/SGA/Low SFH
Long
Cycles
EPF (demise)
Partial/
lncomplete
Molar Pregnancy
Ectopic
Wrong Dates
LFD/LGA/High SFH
Short
Cycles
Multiples
Bicornuate
Fibroids/Ov
Mass
Complete
Molar Pregnancy
Wrong Dates
Maternal
obesity
can make uterine palpation/size
estimation challenging
Clinical History +++ Important
HCG / Dates Discrepancy
Too Low
Anembryonic Pregnancy
Ectopic
EPF (demise)
Long Cycles
Wrong dates
hCG
Rises until 10 weeks then plateaus
Produced by the trophoblast/chorion
Too High
Short Cycles
Multiples
Molar Pregnancy
Wrong dates
CRL not seen
GS + YS
(IUP confirmed)
Too early
EPF
IU GS
ONLY / No IUP
Too Early
EPF
Pseudosac (ectopic)
No IUP = PUL (Pregnancy of unknown location)
On initial early OB scans (NO PREVIOUS)
Never
assume the “known LMP” is accurate
Always
Give patient the
benefit of the doubt
Follow –up
(Bloodwork / Ultrasound)
Check for
previous scans
Take a thorough
history
