Gestational and Placental - Dobson Flashcards by Andrew Herrmann

Hormonal and immunologic functions of placenta

Produces hCG and hPL

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

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Problems with pregnancy before 20 weeks (early)

Spontaneous abortion

- Ectopic pregnancy

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Most spontaneous abortions occur when?

Before 12 weeks

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

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

Antiphospholipid antibody syndrome

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

Ascending (chlamydia, etc.)

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A woman has repetitive miscarriages. Potential cause?

Antiphospholipid antibody syndrome

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Most common site of ectopic pregnancy

Fallopian tube ampulla (90%)

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Ectopic pregnancy often occurs because ___ is damaged

Causes?

Fallopian tube (scarring/adhesions)

PID, appendicitis, endometriosis, surgery

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Non-pathology increased risk factors for ectopic pregnancy

IUD, smoking

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Most serious consequence of ectopic pregnancy

Hematosalpinx –> tubal rupture –> intraperitoneal hemorrhage

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

Ectopic pregnancy

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How to confirm an ectopic pregnancy?

Ultrasound, laparoscopy

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Function of hCG

Maintain corpus luteum, thus maintaining progesterone

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Ultrasound finding for ectopic pregnancy

Donut sign (round object w/ dark center)

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Treating ectopic pregnancy

Methotrexate, surgery

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

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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)

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

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

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?

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Placental infection (chorioamnionitis)

Ascending bacterial infection

Hematogenous spread of TORCH infection to the embryo

Fetal response to placental infection?

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Vasculitis of cord (funisitis)

TORCH infections spread to placenta how?

Cause what?

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Hematogenous

Chronic inflammation in chorionic villi (lymphocytic)

Congenital syphilis - classic symptoms (6)

Other symptoms (4)

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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

Twin-twin transfusion syndrome

Requires what type of twinning?

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

Monochorionic (vascular anastamoses btwn the 2 circulations

Placenta previa vs. Placenta accreta

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Previa - placenta blocking cervical os

Accreta - placenta directly attached to myometrium (no decidua)

Placenta previa - symptom Placental accreta - symptom

3rd trimester bleeding Postpartum bleeding/hemorrhaging

Pregnant woman (34+ weeks) w/ HTN, edema, and proteinuria Most important complication? More common in who?

Preeclampsia Seizures (--> eclampsia) Primiparas (delivering for 1st time)

What is preeclampsia? Cause?

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

Molecular mechanisms of preeclampsia (3)

- 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

HELLP syndrome

10-20% of preeclampsia also develops: | - hemolytic anemia, elevated liver enzymes, low platelets

Hypercoaguable state in preeclampsia can lead to what else?

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

After preeclampsia...

Risk of HTN and microalbuminuria w/in 7 years | 2x risk of vascular diseases of heart and brain

Gestational trophoblastic diseases - what are they? Examples

Proliferation of placental tissue (villous or trophoblastic) Molar pregnancy, invasive mole, choriocarcinoma, PSST

Woman comes in with very high hCG level. An ultrasound shows abnormal villous enlargement. No fetal tissues are found. Chromosomal finding? How for each?

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

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?

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

Partial mole - chromosomal findings (why?) Fetal tissue?

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

Complete vs. partial mole: - hCG - Risk of choriocarcinoma

Complete - higher hCG, risk of choriocarcinoma Partial - not as high hCG, no risk of choriocarcinoma

Invasive mole - what is it?

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

Invasive mole - presentation

Vaginal bleeding, irregular uterine enlargement, persistently high hCG

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

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

Gestational choriocarcinoma - most commonly following what?

Complete mole

Patient presents w/ uterine mass, maybe bleeding, moderately elevated hCG, and increased hPL Often follows what? (3)

Placental site trophoblastic tumor (PSTT) Normal pregnancy, spontaneous abortion, or molar pregnancy

Gestational and Placental - Dobson Flashcards

(41 cards)