Gestational and placental disorders

Question 1

what are the Abnormalities of placental attachment?

Answer 1

• Placenta previa
• Abruptio placetae
• Placenta accreta

Question 2

what is placenta previa?

Answer 2

Attachment of placenta to the lower uterine segment which is partially or completely covering the cervical os

Question 3

what can be noticed about placenta previa with women in any trimester?

Answer 3

painless vaginal bleeding

Question 4

will there be fetal distress in placenta previa?

Answer 4

no

Question 5

how do you diagnose placenta previa?

Answer 5

transvaginal ultrasound

Question 6

what is Abruptio placenta?

Answer 6

Premature separation of placenta due to formation of a retroplacental blood clot, which will separate the placenta from the implantation site

Question 7

what increases the risk of abruptio placenta?

Answer 7

• Hypertension**** - smoking - cocaine - DIC

Question 8

in abruptio placenta, you will find what sign?

Answer 8

painful vaginal bleeding on 3rd trimester

Question 9

is there fetal distress in abruptio placenta?

Answer 9

yes

Question 10

what is placenta accreta?

Answer 10

attachment of the placenta directly to the myometrium without intervening decidua

Question 11

how does placenta accreta manifest?

Answer 11

by impaired placental separation after delivery- sometimes with massive hemorrhage**

Question 12

what will women require in placenta accreta?

Answer 12

a hysterectomy after delivery of baby

Question 13

what increases the risk of placenta accreta?

Answer 13

previous C section

Question 14

toxemia of pregnancy has this finding always present?

Answer 14

severe hypertension

Question 15

when does toxemia of pregnancy occur?

Answer 15

on the third trimerster (24th, 25th week)

Question 16

In which pregnancy is it most common to see toxemia of pregnancy?

Answer 16

1st pregnancy

Question 17

what organs get afftected by toxemia of pregnancy?

Answer 17

kidney, liver and CNS

Question 18

what are the 2 forms of toxemia of pregnancy?

Answer 18

1) pre-clampsia 2) eclampsia

Question 19

what is pre-eclampsia?

Answer 19

mild form of toxemia with presence of hypertension, albuminuria, dependant edema

Question 20

in what trimester of pregnancy does pre-eclampsia occur?

Answer 20

3rd trimester

Question 21

in pre-eclampsia, what happens to the liver?

Answer 21

there will be liver cell necrosis around zone 1 (look for high ALT, AST)

Question 22

what is eclampsia?

what are the 4 signs?

Answer 22

severe toxemia with presence of: 1) Hypertension 2) Albuminuria 3) Dependent pitting edema and 4) Convulsions and DIC

Question 23

how is eclampsia reversed?

Answer 23

termination of pregnancy

Question 24

what are the 3 events that lead to eclampsia? these 3 events will cause what?

Answer 24

1) abnormal placentation 2) normal vasodilators are decreased 3) increased vasoconstrictors - placental hypoperfusion

Question 25

what pathologic findings will be present with eclampsia?

Answer 25

* spiral arteries will have atherosclerosis, thrombus, fibrinoid necrosis * multiple placental infarcts * premature aging of placenta

Question 26

what are the clinical findings of eclampsia?

Answer 26

headache, blurred vision, hypertension, proteinuria, dependent pitting edema, generalized seizures, DIC

Question 27

how do you treat eclampsia?

Answer 27

delivery of fetus as soon as possible and Mg sulfate for seizures

Question 28

how do you treat pre-eclampsia?

Answer 28

anti-hypertensives and ant-platelets

Question 29

what is HEELP syndrome?

Answer 29

hemolysis, elevated liver enzymes, low platelets syndrome, considered a complication of severe pre-eclampsia

Question 30

what is the pathogenesis for HEELP syndrome?

Answer 30

1) Hemolysis due to microangiopathic hemolytic anemia 2) Elevated liver enzymes due to hemolytic process and possible liver involvement 3) decreased platelets due to consumption

Question 31

what are 2 trophoblastic neoplasms?

Answer 31

1) Hydatidiform mole (molar pregnancy) 2) Choriocarcinoma

Question 32

what is a hydatidiform mole?

Answer 32

A benign tumor of chorionic villus.

Question 33

what are the 2 types of hydatidiform mole?

Answer 33

1) Complete mole 2) Partial mole

Question 34

what is the most common hydatidiform mole?

Answer 34

complete mole

Question 35

what characterizes hydatidiform mole?

Answer 35

- the entire placenta is neoplastic - dilated, swollen villi without fetal blood vessels - no embryo is present

Question 36

what is the karyotype of a complete hydatidiform mole?

Answer 36

46XX, with both x's coming from male origin

Question 37

why does a complete hydatidiform mole happens?

Answer 37

an empty egg is fertilized by two haploid sperm, the empty embryo does not develop

Question 38

people with complete hydatidiform moles are at higher risk to develop what?

Answer 38

choreocarcinoma

Question 39

what are the clinical findings found in individuals with complete hydatidiform moles?

Answer 39

• Painless vaginal bleeding in 4th or 5th month of pregnancy • Passage of grape like structures through vagina Severe vomiting • Preeclampsia ( in 2% cases) • Uterus too large for gestational age • Size greater than dates • Increased hCG for gestational age • “Snowstrom” appearance with ultrasound Increased hCG for gestational age

Question 40

what is a partial hydatidiform mole?

Answer 40

Not all villi are neoplastic or dilated and the embryo is present

Question 41

what is the karyotype of a partial hydatidiform mole?

Answer 41

triploid 69 XXY

Question 42

what is the risk of people with a partial hydatidiform mole?

Answer 42

low

Question 43

what is the treatment for molar pregnancy?

Answer 43

curettage and look for hCG levels

Question 44

what are the 2 types of choreocarcinoma?

Answer 44

1) gestational choreocarcinoma 2) non-gestational choriocarcinoma

Question 45

which type of choreocarcioma responds to chemotherapy?

Answer 45

gestational choreocarcinoma

Question 46

what makes up a choreocarcinoma?

Answer 46

syncytiotrophoblast, cytotrophoblast