Flashcards in Embryogenic Pathology Deck (31)
What is "ectopic pregnancy" what is the most common site of this and the most common risk factor for this?
Ectopic pregnancy is the implantation of the fertilized egg at a site other than the uterus. The most common site is the lumen of Fallopian tube and the most common risk factor is scarring.
What is the clinical manifestation of an ectopic pregnancy?
Lower quadrant abdominal pain of a woman who recently missed her period.
What defines a "spontaneous abortion?"
Miscarriage of the fetus at or before 20 weeks of gestation.
How do spontaneous abortions present?
Vaginal bleeding, cramp-like pain and passage of fetal tissues.
What are the most common causes of spontaneous abortions?
Chromosomal abnormalities, hypercoagulable states (i.e. Lupus patients), congenital infections and exposure to teratogens.
What is Placenta Previa?
Implantation of the placenta in the lower uterine segment instead of its normal place which is up high in the uterus. Placenta will overly the cervical os.
How does Placenta previa present and what can be done about it?
It presents as 3rd trimester bleeding and the mother will require a C section because a vaginal delivery would impinge the placenta and cause fetal distress.
What is "placental abruption?"
Seperation of the placenta from the decidua prior to delivery. Common cause of still birth.
How does placental abruptions present?
3rd trimester bleeding and fetal insufficiency.
What is "placenta accreta?"
Instead of the placenta attaching to the decidua (which is formed by endometrial thickening in response to estrogen) the decidua is either not present or minimal, thus the placenta attaches to the myometrium (which should be below the decidua) instead.
What are the clinical features of placenta accreta?
Presents with difficulty delivering the placenta and post partum bleeding. Requires histerectomy.
What is "pre-eclampsia?"
Pregnancy induced HTN, proteinura and edema in response to the loss of protein. Presents in 3rd trimester of preggo.
What causes pre-eclampsia?
Something is wrong with the placenta and there is an abnormal maternal-fetal vascular interface in the placenta.
What can be seen in the vessels of the placenta of patients with pre-eclampsia?
Fibrinoid necrosis in the vessels of placenta.
How to tx pre-eclampsia?
Remove the placenta, the symptoms should resolve.
How does pre-eclampsia relate to eclampsia?
Pre-eclampsia + seizures = eclampsia.
How to tx eclampsia?
Baby has to be delivered and the placenta has to be removed asap.
What is HELLP?
Pre-eclampsia with microangiopathy involving the liver (thrombus formation in the small vessels of the liver. H = hemolysis, EL = elevated liver enzymes, LP = low platelets.
What is "sudden infant death syndrome?"
Death of a healthy baby from 1 month to 1 year, reason seems to be unknown. Patients die in their sleep.
What are the risk factors for sudden infant death syndrome?
Sleeping on stomach. smoking in the household, and prematurity.
What is a Hydatidiform mole?
Abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts. Uterus expands and woman thinks she has a normal preggo.
How can you tell if a woman has a hydatidiform mole and not a baby?
Elevated beta HCG and increased size of the uterus out of proportation to the gestational age.
What will be seen in the 2nd trimester of a woman with hydatidiform mole that received no pre-natal care?
She will pass "grape like masses" through her vagina. The masses are actually the edematous villi.
With pre-natal care what would appear on an ultrasound of a hydatidiform mole?
No fetal heart sounds and a "snow storm" appearance on the ultrasound.
What is the fear of a hydatidiform mole and which kind has this risk?
The complete mole has a 2-3% chance of a choriocarcinoma, whereas the partial mole does not have a risk.
Describe a "complete hydatidiform mole?"
2 sperm fertilizes one empty egg, egg now hasa 46 chromosomes but no fetal tissue. Villi is completely edematous (they are hydropic -- filled with water and edematous) with proliferation of the tropoblasts all around the villi. Increased beta HCG due to more synctiotrophoblasts which makes beta HCG.
Describe a "partial hydatidiform mole?"
One egg with 23 maternal chromosomes gets fertilized by 2 sperm with a total of 46 chromosomes, so overall the egg now has 63 total chromosomes. Partial fetal tissue will be present, some of the villi will be edematous and there will be focal and partial proliferation of the trophoblasts. A complete mole in contrast would've been fully edematous, diffuse proliferation of the trophoblasts, etc. No chance of choriocarcinoma in partial.
What is the tx of a hydatidiform mole?
Dilation of the cervix and curettage (cutting out, of the mole in this case), called D&C.
What should be done in a patient with a hydatidiform mole after a D&C has been performed?
Monitering of the Beta HCG to make sure the mole is removed and to watch for choriocarcinoma.
What are 2 ways a woman can develop choriocarcinoma?
From a random germ cell tumor, but half the case can be caused by a complication of gestation, i.e. a hydatidiform mole, a spontaneous abortion,etc.