Common pathologies in pregnancy

Question 1

When does ovarian oestrogen production peak?

Answer 1

Around day 14

Question 2

When does ovarian progesterone production peak?

Answer 2

Around day 21?

Question 3

What does progesterone do to the endometrium?

Answer 3

Thickens lining
Increases vascularity
Between glands and vessels the stromal cells enlarge and become procoagulant stops bleeding, where monthly shedding occurs

Question 4

What kind of cell makes up the chorion (outer edge of egg)?

Answer 4

Trophoblast

Question 5

Where is B-hCG produced?

Answer 5

Trophoblast cells

Question 6

Where is the target site for B-hCG?

Answer 6

Corpus luteum in ovaries

Question 7

What does B-hCG do?

Answer 7

Stimulates corpus luteum to produce progestogen, which stops decidua from shedding

Question 8

How is B-hCG clinically significant?

Answer 8

Forms the basis of pregnancy tests

Question 9

What happens after the fertilised egg buries in the decidua?

Answer 9

Trophoblast cells stream off to invade mother’s blood vessels and (eventually) link these vessels up with those of the fetus

Question 10

What is a function of decidual cells during implantation?

Answer 10

Procoagulant

Help stop bleeding when trophoblast cells invade mother’s blood vessels

Question 11

What is the classic triad of symptoms for ectopic pregnancy?

Answer 11

Amenorrhoea
Pain (Abdominal, back, shoulder)
Vaginal bleeding

Question 12

What is a molar pregnancy?

Answer 12

Rare pregnancy complication

Large chorionic villi with overgrowth of trophoblast

Question 13

What causes molar pregnancy?

Answer 13

Normal prgnancy:
Different genes switched off in male and female gametes
Mum’s change promotes early baby growth
Dad’s change promotes early placental growth
Balanced
Molar:
usually result of 2 sperm fertilising an egg with no chromosomes
Imbalance in switched off genes

Question 14

How is molar pregnancy treated?

Answer 14

If BhCG returns to normal no treatment needed

If BhCG remains high then methotrexate

Question 15

What are some minor anomalies seen in Down’s syndrome?

Answer 15

Single palmar crease
Epicanthic folds
Protuberant tongue

Question 16

Which syndrome may cause duodenal atresia?

Answer 16

Down’s

Question 17

Why do diabetic mothers often birth bigger babies?

Answer 17

Too much glucose in mothers
Glucose crosses placenta and raises baby’s blood glucose
Baby’s insulin then increases and they cannot reduce it

Question 18

How are complications avoided for diabetic mothers and their babies?

Answer 18

Good glucose control before conception to prevent malformations and all the way through to prevent metabolic complications

Question 19

What may cause neutrophils to be present in membranes, cord and fetal plate of placenta?

Answer 19

Inflammation

Acute chorioamnionitis

Question 20

How does acute chorioamnionitis usually spread?

Answer 20

Bacteria are typically perineal or perianal flora (eg E.coli) which ascend vagina and get into the amniotic sac

Question 21

How can ascending infection affect baby’s brain?

Answer 21

Neutrophils produce cytokine ‘storm’. This activates some brain cells, which then get damaged by normal hypoxia of labour

Question 22

How can infection affect the baby later in life?

Answer 22

Cerebral palsy

Question 23

Do opiates cross the placenta?

Answer 23

Yes

Question 24

How might we assess for intrauterine death?

Answer 24

Scan for fetal heart movement

Question 25

What is an overtwisted cord?

Answer 25

Common cause of intrauterine death and neonatal illness

Probably caused by normal, active, baby moving and twisting round it’s own cord

Question 26

What is abruption?

Answer 26

Separation of placenta from uterine wall

Question 27

What may an abruption lead to?

Answer 27

Hypoxia in baby

Antepartum haemorrhage in mother

Question 28

What may cause abruption?

Answer 28

Hypertension
Trauma
Other possibilities include cocaine use