female reproductive tract part 6 (last part)

Question 1

what is an ectopic pregnancy

what is the most common site

what are the risk factors?

Answer 1

implantation of the fetus OUTSIDE of the uterus

fallopian tube

Pelvic inflammatory disease from an ascneding infection like chlamydia and gonorrhea

any thing that would cause peritubal scarring

Question 2

what are the clinical findings of an ectopic pregnancy

Answer 2

abdominal pain and bleeding 6-8 weeks after last period

(pain is due to dilation of the fallopian tube and hemorrhage)

Question 3

how do you diangose an ectopic pregnancy

Answer 3

HCG pregnancy test and transvaginal ultrasound which will fail to show a gestational sac (seen at 5 weeks) in the uterus (can show a fallopian complex mass)

Question 4

rupture of an ectopic pregnancy is an emergency and can lead to?

Answer 4

severe abdominal pain and hemorrhagic shock (rupture into the peritoneal space)

Question 5

pathologic findings of an ectopic pregnancy

Answer 5

enlarged swollen fallopian tubes with hemorrage or fetal parts

Question 6

histological findings in ectopic pregnancy

Answer 6

fetal chorionic villi with hemorrahe

Question 7

what is a spontaneous abortion?

Answer 7

this is pregnancy loss before 20 weeks

Question 8

causes of a spontaneous abortion/miscarriage

Answer 8

fetal chromosomal abnormalities (50% of all miscarriages)

endocrine factors (thyroid, diabetes), uterine abnormalieis (polyp) TORCH infections, insuffiecent maternal vasculature , thrombosis (antiphopholipid syndrome)

trauma, drugs

a lot of things

Question 9

diabetes can lead to a miscarriage due to poor _

Answer 9

vasculature

Question 10

maternal side of the placenta contains

Answer 10

myometrium
decidua (specialized endometrium)
maternal arteries and veins (spiral arteries)

Question 11

the fetal side of the placenta contains?

Answer 11

fetal chorionic villi which preform gas exchange

amnion

fetal vein and ateriy

Question 12

amnion + chorion =

Answer 12

chorionic plate

Question 13

twin pregnancies occur when two eggs are fertilized each by one sperm or when a previously fertilized egg splits in _

Answer 13

two

Question 14

when two eggs are fertilized by two different sperm they are _

Answer 14

dizygotic/fraternal

Question 15

dizygotic twinning results in?

Answer 15

dichorinoic

and diamniotic

Question 16

if a previously fertilized egg splits in two they are _

Answer 16

monozygotic or identical tiwns

Question 17

identical twins have the _ phenotypic characterisitcs

Answer 17

same

Question 18

what are the different placental typese that monozygotic twins could have

Answer 18

di/di mono/di and mono/mono

Question 19

twin chance is increased by many factors like?

Answer 19

fetility treatments and advanced maternal age, higher pregnancy number, and genetic factors

Question 20

twin-twin tranfusion only occurs in _ twins

Answer 20

monochorionic (which are identical twins)

Question 21

twin-twin tranfusion is caused by ?

Answer 21

ateriovenous anastomesis deep in the placenta between the fetal sides

Question 22

what is the outcome of twin-twin transfusion syndrome

Answer 22

one twin who is under perfused (anemia, hypotensive, oliguria) while one twin is fluid overloaded (polycythemia, HTN, polyuria)

both can lead to fetal demise if there is too much of an imbalance

Question 23

what is placent accreta

Answer 23

placenta attaches to the myometrium (superficially)

Question 24

what is placenta increta

Answer 24

placents attaching within the myometrium

Question 25

what is placenta percreta

Answer 25

the placents penetrates all the way through the myometrium into the uterine serosa

Question 26

failure of the placenta to seperate from the decidua can lead to

Answer 26

severe post partum hemorrhage

Question 27

risk factor for placenta accreta

Answer 27

previous C-section (disrupts the endometrial-myometrial junction

Question 28

what is placenta previa

Answer 28

placental implantation in the lower uterine segment or cervix

Question 29

plecenta previa results in ? and necessitates?

Answer 29

3rd trimester bleeding c-section

Question 30

what is preeclampsia?

Answer 30

onset of new hypertension and proteinuria in pregnancy loss of protein in the urine can cause edematous changes that swell the hands and feet

Question 31

symptoms of preeclampsia

Answer 31

headache, visual changes, increased LFTs, edema

Question 32

what is eclampsia

Answer 32

this is preeclampsia with grand mal seziures which are (loss of consciousness and violent muscle contractions)

Question 33

preeclampsia and ecclampsia typically occur after _ weeks of pregnancy. if they are in early pregnancy this can be associated with _ pregnancy or kidney disease

Answer 33

20 molar pregnancy

Question 34

describe the pathogenesis of preeclampsia and eclampsia

Answer 34

this starts very early in pregnancy lack of trophoblastic implantation causes a lack of enlargment of the maternal vessels to the placenta which causes placental ischemia which results in factors being released that cause hypertension and fibrin thrombi to form more easily

Question 35

how do the maternal blood vessels look in preeclampsia

Answer 35

small, contain fibrin thrombi, and show fibrinoid necrosis

Question 36

preeclampsia can cause fibrin thrombi in the mother in what organs

Answer 36

brain, liver, kidney (can cause necrosis)

Question 37

the placenta in preeclampsia will show ?

Answer 37

multiple infarcts

Question 38

what is HELLP syndrome

Answer 38

a severe form of preeclampsia with hemolysis (microangiopathic anemia: schistocytes) elevated liver enzymes low platelets can have features of preeclampsia (HTN, proteinuria) microvascualr thrombi are deposited within small vessels (thrombi fragment RBC and cause liver damage elevating the liver enzymes and consume platelets.

Question 39

histology of HELLP syndrome

Answer 39

microangiopathic anemia with numerous schictocytes ## Footnote schitocytes are fragmented red blood cells

Question 40

HELLP syndrome, preeclampsia, and ecclampsia all resolve after _

Answer 40

delivery

Question 41

what is a hydatiform mole

Answer 41

a molar pregnancy which is an abnormal pregnancy with cystic swelling of chorionic villi a mass of cystic and swollen chorionic villi surrounded by trophoblastic proliferation

Question 42

molar pregnancies come to attention due to abnormally elevated _

Answer 42

HCG

Question 43

molar pregnancy is confirmed by _

Answer 43

ultrasound at 9 weeks gestation ## Footnote pathologic evaluation is after evacutation of the uterus

Question 44

what are the two types of molar pregnancies

Answer 44

complete molar partial molar

Question 45

what does a complete molar pregnancy look like? are there fetal parts present

Answer 45

multicystic mass lesion with a snow storm ultrasound no fetal parts or fetus is idenfified

Question 46

on histology what does a molar pregnancy look like?

Answer 46

enlarged villi that appears swollen/hydropic marked trophoblastic proliferation

Question 47

complete molar pregnancies are a major risk for

Answer 47

choriocarcinoma and an invasive mole ## Footnote a malignant tumor of trophoblastic cells

Question 48

what is a partial molar pregnancy look like and are there fetal parts present?

Answer 48

enlarged abnormal villi and some normal villi some fetal parts are present mild trophoblastic proliferation partially cystic

Question 49

partial molar prehnancy has a small risk for developing

Answer 49

an invasive mole

Question 50

a complete mole is _ derived

Answer 50

paternally derived 46XX 46XY all genetic material from dad

Question 51

a partial mole is _ derived

Answer 51

derived from both parents resulting in triploidy 69XXX 69XXY 69XYY 1 egg fertilized by 2 sperm

Question 52

_ is marker than distinguhes between partial and complete molar pregnancies

Answer 52

P57 this is a maternally expressed protein product so it will stain brown in a partial molar pregnancy it will NOT stain brown in a complete molar pregnancy

Question 53

what is a gestational choriocarcinoma what is a risk factor

Answer 53

malignant trophoblastic tumor risk factor: complete mole

Question 54

gestational choriocarcinoma is intially diagnosed due to?

Answer 54

wide spread mestastasis , to the lungs, to the vagina, to the brain coughing up blood, vaginal bleeding, neurological symtpoms

Question 55

in gestational choriocarcinoma _ is markedly elevated

Answer 55

HCG

Question 56

what does a gestational choriocarcinoma look like?

Answer 56

fleshy, hemorrhagic with areas of necrosis

Question 57

gestational choriocarcinoma is very malignant can chemotherapy help?

Answer 57

yes, nearly 100% remission and cure rate this is different than ovarian choriocarcinoma which is not really amendable to treatment

Question 58

histology of gestational choriocarcinoma

Answer 58

atypical syncytiotrophoblasts with mononucelated cytotrophoblasts

Question 59

what is a placental site trophoblastic tumor

Answer 59

this is a rare malignant tumor of the intermediate trophoblasts that commnly follows a normal pregnancy or spontenous abortion can present many years after pregnancy/ miscarriage

Question 60

clinical symptoms of a placental site trophoblastic tumor

Answer 60

uterine mass with abnormal uterine bleeding/ amneorrhea usually confined to the uterus

Question 61

placental site trophoblastic tumors show an increased _

Answer 61

HCG