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Flashcards in Fetal Pathology Deck (33)
1

What week gestation does the fetal period start?

9 wks and lasts until birth

2

What is the perinatal period?

3-5mo before birth and first week post birth

3

What is the neonatal period?

Birth-4wks

4

What is considered preterm?

<37wks

5

Genetic defects count for how many % early preg loss

(early preg loss=<20wks gestation) answer: 50%, monosomy X is the most common

6

What is 45X syndrome?

Turner's syndrome
-Most common chromosomal aberration in early preg loss
-Small stature, gonadal dysgenesis, adolescent presentation due to delayed menarche
-Comes with horseshoe kidney, bicuspid aortic valve and coarctation of aorta
-Detect prenatally with cystic hygroma +/- hydrops (fetal edema)

7

What arel TORCH infections?

TORCH infections early in pregnancy can cause mortality and morbidity including restricted growth, mental retardation, cataracts, cardiac anomalies, and bone defects

8

Name the congenital TORCH infections

Toxoplasmosis
Other (syphilis, parvovirus B19)
Rubella
Cytomegalovirus
Herpes

9

What increases your risk of contracting toxoplasmosis?

Cat feces exposure

10

What is the triad of rubella?

Cataracts, hearing loss, heart murmur

11

What is the highest risk gestation weeks for rubella?

3-11, most moms are vaccinated tho so this si rare

12

What is the triad of cytomegalovirus

Chorioretinitis, cerebral calcifications, microcephaly

13

What is an echogenic bowel?

Ultrasound finding that is a marker for aneuploidic abnormalities and TORCH pathologies

14

What are some risk factors for preterm birth?

-Preterm premature rupture of placental membranes
-Intrauterine infection
-Uterine, cervical, placental structural abnormalities
-Multiple gestation

15

What is considered low birth weight?

<2500 grams

16

What are some complications of prematurity?

-Hyaline membrane disease and chronic neonatal lung disease (functional and structural immaturity of lungs)
-Necrotizing enterocolitis (ischemic damage to gut)
-Intraventricular hemorrhage
-Sepsis
-Long term complications including dev delay

17

Describe hyaline membrane disease

-Most common cause of resp distress in newborns
-Presentation: inc difficulty breathing beginning 30 min after birth, progressing to cyanosis within hours
-Routine chest radiograph shows granular densities described as "ground glass" appearance

18

What is the micro path of hyaline membrane disease?

Thick membranes, dilated alveoli, decreased surface area

19

What is the pathogenesis of hyaline membrane disease?

The lungs need 37 weeks to fully develop.

Structural: not enough surface area
Functional: not enough surfactant

Details: premature lungs have decreased structural surface area for gas exchange and increased surface tension from a functional deficit of surfactant, both of which lead to respiratory distress.

20

What is chronic neonatal lung disease (gross path and micro path)?

-Result of hyaline membrane disease
-Gross path: lung has nodular, irregular, firm surface with extra fissures
-Micro path: weird architecture with simplified and enlarged alveolar spaces (less surface area) and proliferation of smooth muscle

21

What is necrotizing enterocolitis?

-Immaturity of the intestinal tract including motility, digestion, circulatory regulation and barrier fxn

-Has high mortality (50%) and increasing incidence

22

What is the gross path of necrotizing enterocolitis?

-Gross path: distended bowel with thin walls, congestion, hemorrhagic infarction, and possibly perforation, strictures, and adhesions

23

What is the micropath of necrotizing enterocolitis?

-Micro path: loss of cellular details, transmural necrosis, hemorrhage

24

What is the pathogenesis of necrotizing enterocolitis?

-Pathogenesis: multifactorial—intestinal immaturity, immune immaturity, ischemia, hypoxia, genetics, feeding practices

25

What are the complications of necrotizing enterocolitis?

-Complications: surgery (20-40%), neurodevelopmental delay, growth delay, bowel strictures, short gut syndrome, abdominal adhesion with risk of obstruction

26

What are the symptoms of necrotizing enterocolitis?

-Non-specific
-Apnea, bradycardia, temp instability, lethargy, mottling, inc need for ventilatory support

27

What is intraventricular hemorrhage?

-Disease of immaturity
-The germinal matrix gives rise to neurons in infants and is very vascular. It recedes from 16-34 weeks gestation but if it is still present at birth, it can bleed and cause hemorrhage, leading to impairment or death.
-Bleeding occurs in germinal matrix and then spills into the lateral ventricles
-Bleeding occurs within hours of birth, but can be delayed

28

What is a congenital hemangioma?

-Benign tumor of vascular origin
-Most common tumor of infancy
-Can occur in nearly any location and cause localized morbidity (ex. Airway obstruction in the lung, platelet trapping from being large)

29

What is a congenital teratoma?

-A tumor with all 3 germ cell layers
-Occur anywhere on midline of the body
-Benign (mature teratoma) or malignant (immature teratoma)
-Grow very rapidly—this can cause hemorrhage and fetal demise

30

Where do congenital teratomas most commonly occur?

Sacrococcygeal

31

List some other common malignant neoplasms of infancy/childhood:

leukemia, lymphoma, hepatoblastoma, mesoblastic nephroma, fibrosarcoma, Wilms tumor

32

What is Wilms tumor ?

Tumor of the kidney (also called nephroblastoma)

Note that most congenital and pediatric tumors recapitulate developmental programs and may mimic the histologic appearance of fetal tissue, in contrast to adult tumors with multiple somatic mutations.

33

What are the mechanisms of disease in the fetus and neonate?

-Anomalous development

-Infection

-Neoplasia

-Unique complications of prematurity
--Hyaline membrane disease and chronic neonatal lung disease (functional and structural immaturity of lungs)
--Necrotizing enterocolitis (ischemic damage to gut)
--Intraventricular hemorrhage
-Sepsis
--Long term complications including dev delay