Common pathologies of pregnancy

Question 1

What hormone is first in hormonal cycle?

Answer 1

Estrogen

Question 2

What happens if progesterone keeps rising in hormone cycle?

Answer 2

Egg fertilised

Question 3

What does progesterone do to endometrium?

Answer 3

Thickens i/maintains it during second phase of cycle

Question 4

What does progesterone turn endometrium into?

Answer 4

Decidua

Question 5

What happens when endometrium turns into decidua?

Answer 5

Increases vascularity

Between glands and vessels the stromal cells enlarge and become procoagulant -> stops bleeding

Question 6

What develops on the outer edge of the fertilised egg (chorion)?

Answer 6

Trophoblast cells

Question 7

What hormone does trophoblast cells produce?

Answer 7

Beta-human chorionic gonadotrophin (B-hCG)

Question 8

What is the target of B-hCG?

Answer 8

Corpus luteum in ovary

Question 9

What is the function of B-hCG?

Answer 9

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

Question 10

What is B-hCG used for clinically?

Answer 10

Basis of pregnancy tests

Question 11

What do trophoblast cells do apart from produce B-hCG?

Answer 11

Stream off to invades mothers blood vessels and link these vessels up with those of the fetus

Question 12

What is the forerunner of the placenta?

Answer 12

Chorionic villi covered by trophoblast cells

Question 13

Case I: woman, 26yrs, missed period, pregnancy test positive, vaginal bleed after 7wks missed period, what is likely happened?

Answer 13

Miscarriage

Question 14

Case I: woman, 26yrs, missed period, pregnancy test positive, vaginal bleed after 7wks missed period.
US: no fetus present but membranes and decidua lining uterus still there. What had happened?

Answer 14

Miscarriage

Question 15

What can cause miscarriage?

Answer 15

Chromosomal abnormality
Infection
Maternal issues (ill-health, trauma, hormonal problems)

Question 16

Case II: women, 32yrs, misses period, 8wks pregnant, small amount of bleeding PV, BhCG raised, US shows thickened lining of endometrial cavity, expanded fallopian tube on 1 side. What is likely diagnosis?

Answer 16

Ectopic pregnancy

Question 17

Case II: women, 32yrs, misses period, 8wks pregnant, small amount of bleeding PV, BhCG raised, US shows thickened lining of endometrial cavity, expanded fallopian tube on 1 side. Ectopic pregnancy diagnosed. What are options?

Answer 17

Methotrexate

Removal of fallopian tube

Question 18

Why is methotrexate used for ectopic pregnancy?

Answer 18

Trophoblast cells very sensitive to methotrexate and pregnancy would be expelled

Question 19

Where is main place for ectopic pregnancy?

Answer 19

Fallopian tube

Question 20

Case III: woman, 23yrs, sudden severe abdo pain, collapses, pulse fast, BP low, blood given and emergency laparotomy. Several litres of blood in abdomen, blood flowing from fallopian tube area, clamped, removed and sent to pathology. What is likely diagnosis?

Answer 20

Ruptured ectopic pregnancy

Question 21

Why does low BP result in fast pulse?

Answer 21

Compensatory mechanism: low BP sensed by carotid bodies in neck, which sense partial pressure of O2 and tells heart to work harder

Question 22

What is an ectopic pregnancy?

Answer 22

Pregnancy in wrong anatomical site

Question 23

Why can ectopic pregnancy rupture?

Answer 23

Lack of proper decidual layer and small size of tube predispose to haemorrhage and rupture

Question 24

Case IV: woman, 32yrs, +be pregnancy test, 7 weeks pregnant, minor bleed, US of uterine cavity shows some placental tissue but no fetus. Fallopian tubes normal. B-hCG raised. What is likely diagnosis?

Answer 24

Miscarriage

Question 25

Case IV: woman, 32yrs, +be pregnancy test, 7 weeks pregnant, minor bleed, US of uterine cavity shows some placental tissue but no fetus. Fallopian tubes normal. B-hCG raised. On microscopy, enlarged chorionic villi with abundant trophoblasts. What is likely diagnosis?

Answer 25

Molar pregnancy

Question 26

What happens when parents methylate the genes in their ova/sperm?

Answer 26

Switches off different genes

Question 27

What is the result of the parents methylating different genes in their ova/sperm?

Answer 27

Mother: promotes early baby growth Father: promotes early placenta growth via trophoblast proliferation

Question 28

What is the overall effect of methylation of genes in normal fertilisation?

Answer 28

Balanced growth of baby and placenta

Question 29

What causes a molar pregnancy?

Answer 29

Usually caused by 2 sperm fertilising 1 egg with NO chromosomes Result is imbalance in methylated (switched off) genes

Question 30

What happens as a result of a molar pregnancy?

Answer 30

Trophoblast cells proliferate because they have too many of dad's methylated genes = overgrowth of placenta = no or all but non-existent fetal growth

Question 31

If molar pregnancy persists what can it cause?

Answer 31

Malignant tumour called choriocarcinoma

Question 32

What is the treatment for a molar pregnancy?

Answer 32

If B-hCG returns to normal = no treatment | If B-hCG stays high = methotrexate

Question 33

What is nuchal thickening a sign of?

Answer 33

Trisomy 21 (Down syndrome)

Question 34

What does TOPFA stand for?

Answer 34

Termination of pregnancy for abnormality

Question 35

When there is no fetal heart movement what is this called?

Answer 35

Intrauterine death (IUD)

Question 36

How much does a normal baby at term weigh?

Answer 36

3.3kg

Question 37

What is likely if mother has poorly controlled diabetes and there is an IUD/stillbirth due to baby being too big?

Answer 37

Diabetic cherub

Question 38

Why does baby get so big in diabetic mother?

Answer 38

Glucose crosses placenta and baby cannot reduce glucose, insulin increases too, so baby has hyperinsulinemia and hyperglycaemia = massive growth of muscle/fat

Question 39

What are babies with long-term hyperinsulinemia and hyperglycaemia susceptible to?

Answer 39

Intrauterine death

Question 40

What are the problems of diabetes in pregnancy?

Answer 40

Malformations Huge babies that obstruct labour Intrauterine death Neonatal hypoglycemia

Question 41

What is a fresh stillbirth?

Answer 41

Stillbirth in labour

Question 42

What is acute chorioamnionitis?

Answer 42

Acute inflammation from ascending infection from vagina and get into amniotic sac

Question 43

What is the presentation of ascending infection?

Answer 43

Mother ill: fever and raised neutrophils | Or mother well

Question 44

What is the presentation in baby if ascending infection?

Answer 44

IUD Ill first days of life Cerebral palsy later in life - hypoxia of labour

Question 45

Do opiates cross the placenta?

Answer 45

Yes

Question 46

Why would a IV heroin addict have her baby pre-booked in neonatal unit?

Answer 46

Baby can be treated for heroin withdrawal for first 5 days of life

Question 47

What is a common cause of IUD and neonatal illness?

Answer 47

Overtwisted cord

Question 48

What is the APGAR score?

Answer 48

``` Score to quickly summarize health of newborn baby against infant mortality: A: appearance P: pulse G: grimace - response to stimulation A: activity - muscle tone R: respiration ```

Question 49

What is placental abruption?

Answer 49

Separation of placenta from uterine wall

Question 50

What does placental abruption result in?

Answer 50

Hypoxia in baby | Sometimes antepartum haemorrhage in mother

Question 51

What is bleeding into the area where the placenta has come away from the uterine wall called?

Answer 51

Haematoma

Question 52

What are causes of placental abruption?

Answer 52

Hypertension Trauma Other: cocaine