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RDS Test 1 > B8.013 Histology/ Immunology of Pregnancy > Flashcards

B8.013 Histology/ Immunology of Pregnancy Flashcards

(87 cards)

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1
Q

earliest stages of pregnancy

A 
day 0 - fertilization
fertilized egg
day 1 - first cleavage
day 2 - 2 cell stage
4 cell stage
day 3-4 - 8 cell uncompacted morula
day 4 - 8 cell compacted morula
day 5 - early blastocyst
day 6-7 - last stage blastocyst (hatching)
day 8-9 - implantation of the blastocyst
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2
Q

uterine proliferative phase

A

days leading up to ovulation (ovarian follicular phase)
estradiol:
-stimulates proliferation of uterine glands
-stimulates proliferation of stroma
-glands lengthen, straight

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3
Q

uterine secretory phase

A

days following ovulation (ovarian luteal phase)
progesterone and to a lesser extent, estradiol:
-stimulate development of uterine glands (tortuous, curved)
-stimulate endometrium to become thick, vascular, spongey
-glands secrete glycogen, mucin
prepared to support implantation

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4
Q

what happens after the uterine secretory phase if implantation does NOT occur

A

spiral arteries in the basalis spasm, cutting off the blood supply
hypoxia leads to sloughing off of the wall

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5
Q

what does the uterus do to create the receptive window

A

expression of several cytokines and growth factors including LIF, integrins, osteopontin
correlates with window of implantation and the development of pinopods

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6
Q

what are pinopods

A

balloon like protrusions on the endometrium

embryo will sit on them

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7
Q

when and for how long does the receptive window occur

A

short

begins 6-10 days after the LH surge and is believed to last less than 48 hrs

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8
Q

what happens when the receptive window closes

A

morphological differentiation of endometrial fibroblasts into secretory epithelioid decidual cells

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9
Q

syncytiotrophoblast

A

epithelial covering of embryo that interacts with maternal blood (outermost layer)

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10
Q

cytotrophoblast

A

embryonic cell layer under the syncytiotrophoblast
buds to form villi surrounding the embryo
invade maternal vasculature and form lacunae

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11
Q

embryonic villi

A

villi initially cover the entire embryo
with further growth, there is partial regression of the villi
remaining villi form the future placenta (smooth portion is the chorion)

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12
Q

where does the embryo implant

A

endometrium

completely penetrates and becomes surrounded by maternal vessels

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13
Q

function of progesterone during implantation

A

released from ovary to regulate prostaglandin production and facilitation of immune tolerance in the endometrium
regulates how far the embryo can move into the maternal wall

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14
Q

anchoring villi

A

cytotrophoblastic cell projections that connect the fetus to the maternal decidua

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15
Q

how does fetal vasculature form?

A

eventually forms from cytotrophoblastic villi

more complex network grows over time in the intervilous space amongst the lacunar circulation

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16
Q

why is the fetus in such close contact w maternal blood flow

A

nutrient exchange to developing fetus

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17
Q

what is a hydatidiform mole

A

benign form of gestational trophoblast disease
nonviable fertilized ovum implants and develops a placenta derived tumor
fills the uterine cavity

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18
Q

what cell types make up a mole

A

atypical trophoblast proliferation (cytotrophoblast and syncytiotrophoblast)
villi with stromal edema

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19
Q

partial mole

A

maternal and paternal genetic material
some fetal tissue
focal slight to moderate trophoblast production
variable edematous villi

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20
Q

complete mole

A

paternal genetic material only
no fetal tissue
diffuse trophoblast proliferation, villous edema
often large uterus for gestational age
elevated bhCG levels
15-20% become deep, develop into choriocarcinoma

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21
Q

symptoms of a mole

A 
vaginal bleeding
severe nausea and vomiting
pelvic pain
anemia
hyperthyroidism
high blood pressure
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22
Q

risk factors for a mole

A

age: <20 or 36-40
prior mole
1-2/1000 deliveries

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23
Q

appearance of mole on histo

A

acellular stroma
abnormal trophoblast proliferation
grape like structure

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24
Q

genetic information about moles

A

usually results from duplication of the haploid genome of a single sperm or fertilization by 2 sperm occurring in an ovum that has lost its maternal chromosomes

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25
monospermic mole
``` more common (80%) loss of maternal chromosomes before or immediately after fertilization by 1 sperm followed by duplication of paternal chromosomes 46, XX or 46, YY ```
26
dispermic mole
``` less common (20%) loss of maternal chromosomes before or immediately after fertilization by 2 sperm ```
27
placenta previa
potentially serious complication of pregnancy where the placenta implants into the lower segment of the uterus edge of placenta covers the internal os
28
normal placenta
edge is 2 cm from internal os
29
low lying placenta
edge of placenta less than 2 cm from internal os
30
risk factors for placenta previa
prior endometrial damage | uterine scarring from curettage, surgical insult, prior placenta previa, multiple prior pregnancies
31
symptoms of placenta previa
painless bleeding most common premature contractions baby is breech or in transverse uterus larger than it should be for gestational age
32
result of low lying placentas
90% identified ultimately resolve by 3rd trimester if does not resolve, complications include: bleeding preterm birth
33
risk factors for placenta previa
``` previous placenta previa previous c section previous suction curettage for abortion age >35 multiparity asian smoking ```
34
first immunologic phase of pregnancy
``` embryo penetrates epithelium -invades decidua -vascular remodeling consists of cellular invasion, tissue remodeling, tissue repair *pro-inflammatory state leads to morning sickness ```
35
second immunologic phase of pregnancy
rapid fetal growth and development | general anti-inflammatory state
36
third immunologic phase of pregnancy
delivery! inflammatory influx of immune cells into the myometrium proinflammatory setting promotes decidual activation, cervical changes, uterine contraction, rejection of the placenta
37
immune cells present at the placental uterine interface
``` uNK macrophages t cells dendritic cells mast cells b cells ```
38
uterine natural killer cells
recognize virally infected or malignant cells without being previously sensitized CD56 and CD 16+
39
function of uNK cells during pregnancy
poor cytotoxic function in healthy pregnancy low levels during proliferative phase, peaks during secretory phase of menstrual cycle (reflects a role in implantation) levels remain high until the 2nd trimester, then begin to drop 70% of decidual leukocytes are uNK cells during the 1st trimester
40
interaction between uNK and trophoblast cells
provides for trophoblast invasion, while also limiting it | secrete both pro and anti inflammatory cytokines
41
HLA G on trophoblast
increased expression associated with suppressed implantation
42
TLR 3 on uNK cell
increased expression associated with increased miscarriage
43
number of uNK cells
increased number associated with miscarriage, implantation failure
44
NKG2A on uNK cells
recognizes self, inhibitory to cytotoxicity | low levels of NKG2A associated with recurrent pregnancy loss
45
CD161 on uNK cells
increased expression associated with increased miscarriage
46
relationship between uNK cells and angiogenesis
high uNK density or activity associated with excessive angiogenesis and increased blood flow increases oxidative stress can lead to pregnancy loss
47
how do uNK cells influence angiogenesis
secrete VEGF, PIGF, and angiopoietin
48
deficient remodeling of spiral arteries
associated with poor trophoblast invasion, reduced number of invasive trophoblasts
49
preeclampsia
``` high BP in women who havent had it before high protein in urine swelling in feet, legs, hands rapid weight gain severe headaches vomiting, nausea appears late in pregnancy ```
50
"cure" for preeclampsia
delivery
51
pathophys of preeclampsia
deficient remodeling of the spiral arteries, reduced placental blood flow
52
action of prednisolone in pregnancy
reduced numbers of uNK cells and suppresses uNK cell cytotoxicity given preconception can improve pregnancy rates\not effective if anti phospholipid Abs present
53
IVIg therapy in pregnancy
immunosuppressive | reduces uNK cell cytotoxicity
54
macrophages at the maternal placental interface
primary APC in decidua 20% of decidual leukocytes numbers constant throughout pregnancy
55
role of macrophages in pregnancy
``` generally M2 phenotype -tissue repair -inhibition of inflammation role in trophoblast invasion, placental growth, fetal development, parturition removal of dying trophoblasts ```
56
why is removal of dead trophoblasts by macrophages important
prevent release of paternal antigens, thus limit maternal immune response
57
function of T reg cells in pregnancy
maintenance of immunologic self tolerance significant expansion in the decidua and systemically during pregnancy specific to paternal antigens persist after delivery, rapidly accumulate with subsequent pregnancy
58
FOXP3
regulates Treg cells reduced expression in endometrium associated with infertility spontaneous abortion associated with lower systemic Treg levels
59
Th17 cells in pregnancy
``` IL-17 producing CD4+ numbers expand in uterus during pregnancy inflammatory thought to protect from microbes thought to be regulsted by Tregs ```
60
altered Th17:Treg ratio
associated with spontaneous abortion, preeclampsia, preterm birth
61
function of dendritic cells in pregnancy
initiate and coordinate innate and adaptive immune responses accumulate before implantation, remain throughout gestation play a role in decidualization, exhibit low levels of antigen presentation
62
mast cells in pregnancy
numbers expand in the uterus with pregnancy | promote anti-inflammatory state; function unknown
63
B cells in pregnancy
IL-10 producing B cells expand peripherally present in decidua importance unknown
64
immune role of decidual cells in pregnancy
recent evidence suggests decidual cells play a role in regulating differentiation, migration, and function of uterine immune cells express chemoattractant, inhibit recruitment of T cells into uterus
65
complications of bacterial infection in pregnancy
cause of 40% of preterm labor cause of 80% of preterm birth before 30 weeks preeclampsia
66
complications of viral infection in pregnancy
``` fetal developmental complications preterm birth spontaneous abortion stillbirth preeclampsia ```
67
routes of infectivity of decidua, placenta, fetal membranes
ascend into uterus from lower tract descend into uterus from peritoneal cavity maternal circulation
68
preterm birth
when a baby is born too early, before 37 weeks | affects 1 in 10 infants
69
risk factors for premature birth
previous premature birth pregnancy with multiples problems with the uterus, cervix, or placenta smoking cigs or doing drugs infections of amniotic fluid and lower genital tract
70
difference between trophoblast response to infection in 1st and 2nd trimesters vs the 3rd
``` 1st and 2nd: milder response to gram (-) compared to gram (+) TLR8 active TLR6 active 3rd: gram (+) and gram(-) responses similar TLR2 active in decidual cells ```
71
NOD receptor activation
pathogen enters intracellular space | infection/response via NOD1/2 has been associated with preterm birth
72
what inflamm cytokines are released in response to infection at placenta
TNFa IFNg IL-12 IL-8
73
result of placental infection
may result in a fetal inflammatory response, and may lead to morphological and developmental abnormalities fetus has a mature immune system!!!
74
what is RPL
recurrent pregnancy loss 3 or more consecutive, spontaneous pregnancy losses under 20 wks affects 5% of repro aged women
75
risk factors for miscarriage
``` advanced maternal age smoking alcohol consumption use of illicit drugs like cocaine use of NSAIDs high caffeine consumption extremes of maternal weight ```
76
common causes of RPR
``` 50% unexplained autoimmune (15-20%) endocrine (15-20%) anatomic (10-15%) genetic (2-5%) infection (0.5-5%) ```
77
what is antiphospholipid Ab syndrome
most common hypercoagulable disorder heterogenous autoantibody binds to phospholipid protein complex includes: lupus anticoagulant syndrome and anticardiolipin antibody syndrome
78
symptoms of antiphospholipid Ab syndrome
venous and arterial thrombosis recurrent spontaneous abortion stroke TIA
79
treatment for antiphospholipid Ab syndrome
anticoagulation lovinox low dose aspirin
80
invasive placenta
placenta attaches too strongly or invades too deeply into the wall of the uterus
81
placenta accreta
placenta attaches too strongly to myometrium, but does not invade into it
82
placenta increta
placenta invades into the myometrium
83
placenta percreta
placenta invades through the full thickness of the uterine wall can attach to adjacent organs in the abdomen, usually the bladder
84
risk factors for invasive placenta
previous c-section is biggest previous gynsurgeries intra-uterine surgery embolization treatment for a fibroid
85
complications of placenta accreta
heavy bleeding, can lead to DIC during delivery as well as lung failure and kidney failure premature birth
86
management of invasive placenta
antenatal evaluation using US and MRI planned c-section in a specialized unit planned hysterectomy in severe cases
87
symptoms of placenta accreta
no signs of symptoms during pregnancy | vaginal bleeding during 3rd trimester might occur

RDS Test 1 (22 decks)

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