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Repro 2 > Gestational and Placental - Dobson > Flashcards

Gestational and Placental - Dobson Flashcards

1
Q

Hormonal and immunologic functions of placenta

A
  • Produces hCG and hPL

- Down-regulates antigen expression from baby (prevent maternal Ab attack)

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2
Q

Problems with pregnancy before 20 weeks (early)

A
  • Spontaneous abortion

- Ectopic pregnancy

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3
Q

Most spontaneous abortions occur when?

A

Before 12 weeks

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4
Q

Known causes of spontaneous abortion (5 groups - w/ causes w/in each group)

A
  • Chromosomal abnormalities (50+%)
  • Uterus defects (submucosal leiomyoma, uterine polyps, uterine septum/didelphys)
  • Infections (Toxo, Mycoplasma, Listeria, CMV, HSV2, Parvo, Rubella, Chlamydia, Ureaplasma)
  • Endocrine (luteal-phase defect, maternal DM, thyroid)
  • Systemic vascular disorders (APS, coagulopathies, HTN)
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5
Q

A woman cannot get pregnant, and blood tests show a false positive syphilis test. Dx?

A

Antiphospholipid antibody syndrome

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6
Q

A woman has a second-trimester spontaneous abortion. Most likely infection?

A

Ascending (chlamydia, etc.)

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7
Q

A woman has repetitive miscarriages. Potential cause?

A

Antiphospholipid antibody syndrome

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8
Q

Most common site of ectopic pregnancy

A

Fallopian tube ampulla (90%)

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9
Q

Ectopic pregnancy often occurs because ___ is damaged

Causes?

A

Fallopian tube (scarring/adhesions)

PID, appendicitis, endometriosis, surgery

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10
Q

Non-pathology increased risk factors for ectopic pregnancy

A

IUD, smoking

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11
Q

Most serious consequence of ectopic pregnancy

A

Hematosalpinx –> tubal rupture –> intraperitoneal hemorrhage

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12
Q

Severe abdominal pain, vaginal bleeding 6-8 weeks after last menstrual period, hypotension, shock

A

Ectopic pregnancy

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13
Q

How to confirm an ectopic pregnancy?

A

Ultrasound, laparoscopy

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14
Q

Function of hCG

A

Maintain corpus luteum, thus maintaining progesterone

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15
Q

Ultrasound finding for ectopic pregnancy

A

Donut sign (round object w/ dark center)

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16
Q

Treating ectopic pregnancy

A

Methotrexate, surgery

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17
Q

Problems w/ pregnancy after 20 weeks (3rd trimester) (5)

A
  • Cord problem (knot, nuchal, prolapse)
  • Abruptio placenta
  • Disruption of placental fetal vessels
  • Uteroplacental malperfusion (abnormal placement or development, maternal vascular disease)
  • Ascending infections (bacterial usually)
18
Q

Causes of uteroplacental malperfusion, which can lead to late pregnancy issues

A

Uteroplacental vascular insufficiency (UPVI)
DM, HTN, coagulation, smoking, cocaine/drugs
Misplaced uterus (previa, accreta)

19
Q

Baby is born prematurely. Amniotic fluid is cloudy with purulent exudate, w/ infiltrate of neutrophils, edema, and congested vessels

Cause?

What if it was chronic inflammatory cell infiltrate in chorionic villi?

A

Placental infection (chorioamnionitis)

Ascending bacterial infection

Hematogenous spread of TORCH infection to the embryo

20
Q

Fetal response to placental infection?

A

Vasculitis of cord (funisitis)

21
Q

TORCH infections spread to placenta how?

Cause what?

A

Hematogenous

Chronic inflammation in chorionic villi (lymphocytic)

22
Q

Congenital syphilis - classic symptoms (6)

Other symptoms (4)

A 
Rash of palms and soles
Saber shins (ant. bowing of tibia)
Saddle-shaped nose
Hutchison teeth (notched incisors)
Mulberry molars (enamel outgrowths)
Deafness

Hepatomegaly, pulmonary interstitial fibrosis, rhinitis, rash

23
Q

Twin-twin transfusion syndrome

Requires what type of twinning?

A

Uneven shunting of blood to one vs. the other –> flushed, edematous child + pale, shrunken child

Monochorionic (vascular anastamoses btwn the 2 circulations

24
Q

Placenta previa vs. Placenta accreta

A

Previa - placenta blocking cervical os

Accreta - placenta directly attached to myometrium (no decidua)

25
Q

Placenta previa - symptom

Placental accreta - symptom

A

3rd trimester bleeding

Postpartum bleeding/hemorrhaging

26
Q

Pregnant woman (34+ weeks) w/ HTN, edema, and proteinuria

Most important complication?

More common in who?

A

Preeclampsia

Seizures (–> eclampsia)

Primiparas (delivering for 1st time)

27
Q

What is preeclampsia? Cause?

A

SYSTEMIC endothelial dysfunction in the mother during pregnancy, caused by placenta-derived factors that alter the mother’s endothelium

28
Q

Molecular mechanisms of preeclampsia (3)

A
  • Extravillous trophoblastic cells DON’T destroy vascular SM of maternal decidual vessels, causing increased resistance and low blood flow (ischemia)
  • Ischemic placenta releases ***sFltl –> antagonizes VEGF–> low PGI2 –> low anticoagulation –> hypercoaguability
  • Ischemic placenta releases ***endoglin –> antagonizes TFG-beta –> low N.O. –> hypertension and hypoperfusion
29
Q

HELLP syndrome

A

10-20% of preeclampsia also develops:

- hemolytic anemia, elevated liver enzymes, low platelets

30
Q

Hypercoaguable state in preeclampsia can lead to what else?

A

Thrombi in liver (hematoma), kidneys (diffuse cortical necrosis), brain, and pituitary (hypopituitarism)

31
Q

After preeclampsia…

A

Risk of HTN and microalbuminuria w/in 7 years

2x risk of vascular diseases of heart and brain

32
Q

Gestational trophoblastic diseases - what are they?

Examples

A

Proliferation of placental tissue (villous or trophoblastic)

Molar pregnancy, invasive mole, choriocarcinoma, PSST

33
Q

Woman comes in with very high hCG level. An ultrasound shows abnormal villous enlargement. No fetal tissues are found.

Chromosomal finding? How for each?

A

Complete hydatidiform mole

46 XX - empty egg + 1 sperm that duplicates its DNA
46 XY - empty egg + 2 sperm (could also by 46 XX)

34
Q

Translucent, cystic, grape-like structures w/in uterus. Path shows swollen villous tissue covered completely by extensive trophoblastic cells

How to tell this from the other kind?

A

Complete mole

Partial mole = only SOME enlarged villi w/ less trophoblastic hyperplasia

35
Q

Partial mole - chromosomal findings (why?)

Fetal tissue?

A

69 XXY - normal egg + 2 sperm
92 XXXY - ???

Some

36
Q

Complete vs. partial mole:

  • hCG
  • Risk of choriocarcinoma
A

Complete - higher hCG, risk of choriocarcinoma

Partial - not as high hCG, no risk of choriocarcinoma

37
Q

Invasive mole - what is it?

A

Molar pregnancy –> penetrates/perforates uterine wall w/ proliferation of cytotrophoblasts AND syncytiotrophoblasts

38
Q

Invasive mole - presentation

A

Vaginal bleeding, irregular uterine enlargement, persistently high hCG

39
Q

Woman w/ irregular vaginal bleeding, bloody/brown fluid, enlarged uterus, hCG VERY high; masses in lung

What is it?

A

Gestational choriocarcinoma

Invasive malignant neoplasm of trophoblastic cells after a normal OR abnormal pregnancy

40
Q

Gestational choriocarcinoma - most commonly following what?

A

Complete mole

41
Q

Patient presents w/ uterine mass, maybe bleeding, moderately elevated hCG, and increased hPL

Often follows what? (3)

A

Placental site trophoblastic tumor (PSTT)

Normal pregnancy, spontaneous abortion, or molar pregnancy

Repro 2 (28 decks)

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