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Reproductive System Brian > Common Pathologies of Pregnancy > Flashcards

Common Pathologies of Pregnancy Flashcards

1
Q

What is hormone A and B?

A
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2
Q

If the egg is fertalised, does progesterone rise of fall?

A

Continues to rise instead of falling as it usually would

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3
Q

What does progesterone do to the endometrium?

A
  • Turns it into decidua
    • Thickening of lining
    • Changes cells
    • Increases vascularity
  • Monthly shedding occurs at the end
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4
Q

What does the egg become when it is fertalised by sperm?

A

When the egg is fertilised by sperm it becomes a chorion:

  • Trophoblast cells on outside of fertilised egg, which produce beta-human chorionic gonadotrophin (B-hCG)
    • Target is corpus luteum in ovary, stimulating it to produce progestogen which stops decidua from shedding
    • Used clinically in pregnancy tests
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5
Q

What cells are found on the outside of a fertilised egg?

A
  • Trophoblast cells on outside of fertilised egg, which produce beta-human chorionic gonadotrophin (B-hCG)
    • Target is corpus luteum in ovary, stimulating it to produce progestogen which stops decidua from shedding
    • Used clinically in pregnancy tests
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6
Q

What hormone is produced by trophoblast cells?

A
  • Produces beta-human chorionic gonadotrophin (B-hCG)
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7
Q

What is the target and effect of B-hCG?

A
  • Target is corpus luteum in ovary, stimulating it to produce progestogen which stops decidua from shedding
  • Used clinically in pregnancy tests
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8
Q

What hormone is looked at in pregnancy tests?

A

Beta-human chorionic gonadotrophin (B-hCG)

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9
Q

What does the fertilised egg burrow into?

A

Decidua

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10
Q

What happens once the fertilised egg burrows into the decidua?

A
  • Trophoblast cells steam off to invade mothers blood vessels, linking those vessels with foetus eventually
  • Decidual stromal cells are between vessels
  • Projections of chorion (chorionic villi) covered in trophoblast cells start to move into decidua
  • Decidual cells are procoagulant to help stop bleeding when trophoblast cells invade
  • Eventually, chorionic villi are bathed in mothers blood, forming forerunner of the placenta
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11
Q

What is the aetiology of miscarriage?

A
  • Foetal problem such as chromosomal abnormality
  • Placental/membranes/cord problem such as from infection
  • Uterus/cervix problem such as cervical incompetence
  • Maternal health issues such as drug taking
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12
Q

What is the presentation of a miscarriage?

A
  • Misses period, positive pregnancy test, but then starts bleeding again spontaneously
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13
Q

What investigation is done for miscarriage?

A
  • USS
    • No foetus present but membranes and decidua lining uterus still there
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14
Q

What is the management of miscarriage?

A
  • Removal of remaining tissue by obstetrician to avoid bleeding and infection
    • Tissue sent to lab
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15
Q

What is an ectopic pregnancy?

A

Fertilised egg implants itself outside of womb, usually in one of fallopian tubes

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16
Q

In an ectopic pregnancy, where does the egg usually implant?

A

One of the fallopian tubes

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17
Q

What is the presentation of ectopic pregnancy?

A
  • Misses period, then many weeks later small amount of bleeding
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18
Q

What investigations are done for ectopic pregnancy?

A
  • BhCG raised
  • USS
    • Thickened lining of endometrial cavity, expanded fallopian tube on one side
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19
Q

What is the management of ectopic pregnancy?

A
  • Methotrexate
    • Chemotherapy agent, used for medical abortions
  • Or removal of fallopian tube
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20
Q

Is an ectopic pregnancy feasible?

A

No, the baby must be aborted

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21
Q

What are risk factors for ruptured ectopic pregnancy?

A
  • Lack of proper decidua layer
  • Small size of tube
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22
Q

What is the presentation of ruptured ectopic pregnancy?

A
  • Severe abdominal pain, collapse
  • Tachycardia, hypotension
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23
Q

What investigations are done for ruptured ectopic pregnancy?

A
  • Microscopy after emergency laparotomy
    • Presence of fragmented fallopian tube with placental sac
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24
Q

What is the mangement of ruptured ectopic pregnancy?

A
  • Give blood
  • Emergency laparotomy
    • Blood flowing from fallopian tube area, which is clamped and sent to pathology
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25
Q

What is a molar pregnancy?

A

Problem with egg so foetus and placenta does not develop the way they should after conception

26
Q

What is the aetiology of a molar pregnancy?

A
  • Normally
    • Mum switches off certain genes in ova by methylating them, dad switches of different genes in sperm by methylating them
    • Mums changes promote early baby growth, dads promotes early placental growth via trophoblast proliferation
    • Overall effect is balanced growth of baby and placenta
  • Molar pregnancy
    • Various causes, most common caused by 2 sperm fertilising one ova with no chromosomes
    • Resulting in imbalance in methylated (switched off) genes, fast proliferation of trophoblast cells causing overgrowth of placenta
27
Q

How are genes switched off in the ova and sperm before they meet?

A

Methylated

28
Q

Mums and dads genes promote what growth early on?

A

Mum - baby growth

Dad - placental growth

29
Q

What is the presentation of molar pregnancy?

A
  • Positive pregnancy test, and then minor bleeding
30
Q

What investigations are done for molar pregnancy?

A
  • USS
    • Uterine cavity shows some placental tissue but no foetus
  • B-hCG raised
  • Microscopy
    • Enlarged abnormal chorionic villi with abundant trophoblast
31
Q

What is a possible complication of molar pregnancy?

A
  • If persists, can rarely give rise to malignant tumour called choriocarcinoma
32
Q

What is the management of molar pregnancy?

A
  • If BhCG returns to normal
    • No further treatment
  • If BhCG stays high
    • Cure by methotrexate
33
Q

What is the presentation of trisomy 21 in the foetus?

A
  • Nuchal thickening on scan
34
Q

What investigations are done when nuchal thickening is seen on the baby scan?

A
  • Amniocentesis
    • Trisomy 21 (down syndrome)
35
Q

What is the management of trisomy 21 in the foetus?

A
  • Abortion act allows for termination
    • Termination of Pregnancy for Abnormality (TOPFA) before 24 weeks, only after 24 weeks if substantial risk child would be seriously handicapped
    • Parents’ choice
36
Q

What is seen in a postmortum for a foetus with trisomy 21?

A
  • External features of down syndrome
    • Single palmar crease
    • Epicanthic folds
    • Protuberant tongue
  • Duodenal atresia – interrupted duodenum
37
Q

What is a major risk factor for stillbirth?

A
  • Poorly controlled diabetes mellitus
38
Q

What is the presentation of stillbirth?

A
  • Pregnancy doing well, then in late weeks (such as week 36) baby stops kicking
39
Q

What investigation should be done for stillbirth?

A
  • USS
    • No foetal heart movement – intrauterine death (IUD)
40
Q

What is the management of stillbirth?

A
  • Trial of labour or caesarean section
41
Q

What can happen to the foetus due to poorly controlled diabetes?

A
  • Still birth, postmortum shows:
  • Huge baby with broad shoulders (called diabetic cherub)
    • Happens due to the effects of too much glucose in mother
    • Which crosses placenta into baby, increasing insulin in baby which cannot reduce it to normal as mum keeps sending more across the placenta
42
Q

What are some problems diabetes can cause in pregnancy during the 1st trimester, 3rd trimester, labour and neonatal period?

A
  • 1st trimester
    • Malformations
  • 3rd trimester
    • Intrauterine death (sudden metabolic and hypoxic problems)
  • Labour
    • Huge babies that obstruct labour
  • Neonatal period
    • Hypoglycaemia
43
Q

What is an example of an ascending infection?

A

Acute chorioamnionitis

44
Q

What is acute chorioamnionitis?

A

Acute inflammation of membrane and chorion of the placenta

45
Q

What is the aetiology of acute chorioamnionitis?

A
  • Polymicrobial bacterial infection in the setting of membrane rupture
    • Ascending infection, bacteria typically present in perineal or perianal flora ascend vagina and get into amniotic sac
46
Q

What is the presentation of acute chorioamnionitis?

A
  • Mother
    • Ill, has fever and raised neutrophils in blood
    • But can be well
  • Baby
    • Intrauterine death
    • Ill in first day of life, put to neonatal unit, cerebral palsy later on in life
      • Cerebral palsy because neutrophils produce cytokine storm which activates some brain cells which get damaged by normal hypoxia of labour
47
Q

What investigations are done for acute chorioamnionitis?

A
  • Examine placenta, microscopy of membranes
    • Microscopy contains neutrophils in cord, membranes and placenta
48
Q

What is the aetiology for drug withdrawal in the new born?

A
  • Mother taking drugs during pregnancy, such as opiates which cross the placenta
49
Q

What is a risk factor for drug withdrawal in a newborn?

A
  • Drug addict mother
50
Q

What is the management of drug withdrawal in a newborn?

A
  • Admit baby to neonatal unit and treat for drug withdrawal
51
Q

What is the aetiology of an overtwisted cord?

A
  • Normal, active, baby moving and twisting round its own cord
52
Q

What is the presentation of overtwisted cord?

A
  • Normal pregnancy to term, then decreased movement late on such as week 40
53
Q

What investigation is done for overtwisted cord?

A
  • USS
    • No heart movement
54
Q

What are possible complications of overtwisted cord?

A
  • Causes intrauterine death
    • Twisted cord results in poor blood flow to and from baby (ischaemia)
  • Neonatal illness
55
Q

What is abruption?

A

Separation of placenta from uterine wall, causing hypoxia in baby and antepartum haemorrhage in mother

56
Q

What is the aetiology of abruption?

A
  • Hypertension
  • Trauma
  • Other such as cocaine use
57
Q

What is the presentation of abruption?

A
  • Vaginal bleeding late on, such as week 35
58
Q

What investigations are done for abruption?

A
  • USS
    • Separation of part of placenta from uterus with collection of blood (haematoma)
  • Microscopy of placenta
59
Q

What is the treatment of abruption?

A
  • Emergency caesarean section
60
Q

What is APGARS?

A
  • Appearance, pulse, grimace, activity and respiration – test used to check babys health
61
Q

What is the prognosis of abruption?

A
  • Baby has low APGARS
    • Appearance, pulse, grimace, activity and respiration – test used to check babys health
    • Each scored from 0-2, with 2 being best score
  • Unwell in neonatal unit for few days then much better

Reproductive System Brian (34 decks)

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