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LC 02 > Path of Placenta > Flashcards

Path of Placenta Flashcards

1
Q

Discriminatory zone

A

maternal hCG level above gestational sac should be visible

~5-6 weeks Transvaginal US

~7 weeks
Transabdominal US

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2
Q

How often does ectopic pregnancy occur?

A

1/150 pregnancies

- implant anywhere but intrauterine

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3
Q

What usually precedes ectopic pregnancy?

A

PID

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4
Q

Complete mole

Partial mole

A

all dad (46, XX or XY)

Partially dad
(triploid, 69 chrom
2/3 from dad, 1/3 fr mom)

Need moms DNA to drive development
- without her, you have no fetus

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5
Q

Snowstorm appearance

A

Complete hydatidiform mole

- cystically dilated spaces w/o fetal parts

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6
Q

Triad of complete mole sx

A
  1. hyperemesis
  2. pre-eclampsia
  3. hyperthyroidism
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7
Q

% of recurrence in complete mole

A

20% recurrent

1-2% dev into choriocarcinoma (monitor carefully after)

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8
Q

Follow up for molar preg

A
  1. get serum hCG q1-2 weeks until 3 conseq. negative measurements
    - give methotrexate if elevated
  2. Contraception
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9
Q

Risk for post molar GTN

A
  1. age >40
  2. Uterine size
  3. Theca lutein cysts >6 cm
  4. hCG >100,000
  5. medical complications
    - ARDS, pre-eclampsia, hyperthyroidism
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10
Q

Choriocarcinoma

A

disease of trophoblast
-cyto (mononucleated) and syncitio (multinucleated)

can be widely metastatic

serum bHCG to detect

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11
Q

signs of choriocarcinoma

A
  1. vaginal bleeding several mo after pregnancy
  2. high serum hCG
  3. Single/mult hemorrhagic well circumscribed nodules in uterus
  4. biphasic pattern w. hemorrhage and necrosis
  5. marked nuclear atypia and mitosis
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12
Q

Placental organ

- fxns

A
  1. anchors gestation
  2. disposable at birth
  3. Fxns as:
    kidney, lung, liver, intestines, and endocrine organ to fetus
  4. Prod hormones
  5. Immunologic organ
    (physical barrier + protects fetal allograft from moms immune syst)
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13
Q

PLacental weight ratio (PWR)

A

reflects balance betwn fetal and placental growth
(surrogate indicator of utero fxning)
- decreases as gestational age increases

Predictive of:

  1. perinatal morbidity/mortality
  2. childhood growth & devel
  3. Fetal origins of adult diseases
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14
Q

Does size matter for umbilical chords?

A

yes

Long = >75

  • assoc w/ knots and fetal entanglement
  • may correspond to later hyperactivity

Short =

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15
Q

umbilical artery carries _____ blood from fetus to placenta

A

deoxygenated

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16
Q

Which compartment (fetal or maternal) is found in intravillous and intervillous space?

A

Fetal compartment:
inTRAvillous

MaTERnal space:
inTERvillous

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17
Q

TPAL

A

Term delivery
Preterm delivery
Abortion
Living children

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18
Q

Acute chorioamnionitis

maternal inflamm response in memb

A

20-24% of live births

2ndary to bacterial intramniotic infxn
(Group B strep)

Neutrophils in fetal membranes

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19
Q

Fetal inflamm response

A

Vasculitis In:

  1. babys vasculature (umbil cord)
  2. chorionic plate
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20
Q

DIff between ascending vs trans-placental infection

A

Ascending
- maternal neutrophils in membrane

Trans-placental (hematogenous)
- histo: chronic villitis, intervillositis, lymphoplasmacytis deciduitis
(moms lymphocytes are killing villi)
- ToRCHeS infxn

21
Q

ToRCHeS

A 
Toxoplasma
Rubella
CMV
HIV
HSV
Syphilis
22
Q

Rare problems of CMV placentitis

A
  1. Intrauterine Fetal death
  2. IU growth restriction
  3. Deafness

*common infxn: primary and recurrent

23
Q

Perivascular fibrous proliferation

A

syphilis

24
Q

Granulomatous with cysts

A

toxoplasmosis

25
Q

Multinucleated cells with inclusions

A

herpes

Tzank

26
Q

Acute inflammation destroying villi

A

listeria

27
Q

Meconium

A

baby poop
toxic

meaning:
baby’s gut is mature
or
baby is stressed (esp if

28
Q

Intervillous thrombi

A

feto-maternal hemorrhage
-see lines of zahn
(if extensive, get kleihauer - betke test)

risk factors:

  1. multiple gestations
  2. nuchal cord
  3. low birth weight
29
Q

kleihauer betke test

A

test for fetomaternal hemorrhage (FMH)

test if:

  1. fetal demise
  2. nonimmune hydrops
  3. neonatal anemia
30
Q

Placental infarct

A

acute cessation of maternal flow with live fetus
- central more sig than peripheral

  • Evolves from red and firm to white and hard
31
Q

PLacenta accreta

A

failure of decidual formation

  • trophoblast invade abnormally deeply
  • chorionic villi adhere to myometrium
32
Q

Predisposing factors for placental accreta

A
  1. Prior C-section
  2. Endometrial ablation
  3. Multiple D&C
    (anything that disrupts endometrial lining)

*PA: defective decidual layer

33
Q

Chorionic villi touching myometrial cells

A

placenta accreta

34
Q

Pre-eclampsia

A

Hypertension + proteinuria after 20 weeks gestational age

  • trophoblast dont invade enough
  • maintain high pressure flow
35
Q

Most imp risk factor for pre-eclampsia

A
  1. Prior preeclampsia in prior pregnancy
  2. Fam hx
  3. Preexisting disease
36
Q

treatment of preeclampsia

A

delivery

37
Q

women who do cocaine predisposes her to?

A

PLacental abruption

38
Q

PLacental abruption risk factors

A
  1. trauma
  2. smoking
  3. HTN
  4. preeclampsia
  5. cocain abuse
39
Q

uterine atony

A

lack of effective myometrial contraction following delivery

–> post partum hemorrhage

40
Q

Risk factors for uterin atony

A
  1. overdistention (from mult gestation)
  2. Uterine fatigue
  3. uterin infxn
  4. retained placental tissue
41
Q

DIC

A

massive activation of the clotting cascade –> widespread thrombosis

Secondary depletion of platelets and coagulation factors leads to bleeding, ischemia, and shock

42
Q

Spontaneous abortion (SAB) eitiology by trimester
First trimester
Second trimester
Third trimester

A

First trimester:
- chromosomal

Second trimester
- structural defects, placental, infectious

Third trimester
- placental*, structural defects

43
Q

Internal abnormalities of down syndrome

A
  1. heart (ASD) and GI anomalies

2. Pancreastic, bone marrow fibrosis

44
Q

Polydactyly and facial defects.

Single fused eye

A

Patau’s syndrome

47, XX + 13

45
Q

Rocker bottom feet,
Omphalocele (guts thru umbil),
Hand deformities (not polydactyly)

A

edwards syndrome

47 xx +18

46
Q

Syndactyly (fusion of digits

A

triploidy
69, XXX or XXY

incompatible with life

47
Q

Causes of fetal hydrops

A

80%: Non immune
- infxn, cardiac anomalies, neoplasms, metabolic disorders

20% Immune:
maternal ab against fetal RBC cross placenta (RH+ baby)

48
Q

Neural tube defects are determined when?

A 
1st month of pregnancy
(1st 4 weeks)
- Use folate!
- Avoid alcohol
- Elevated AFP
49
Q

Most common neoplasm of newborn

A

sacrococcygeal teratoma

- yolk sac most freq malignancy

LC 02 (15 decks)

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