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Reproductive - step > gestational pathology > Flashcards

gestational pathology Flashcards

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1
Q

bening tumour of chorionic villi

cystic sweeling of chrionic villi and proiferation of chorionic epithelium involving only trophoblasts

A

hydatidiform mole

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2
Q

countrey with highest prevelance of hydatidiform moles

A

indonesia 1/200

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3
Q

what are complete moles in particular associated with

A

theca lutein cysts
hyperemesis gravidarum
hyperthyroidism - hCG

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4
Q

how do you treat hydatidiform moles

A

dilatio and cutterage and methotrexate

monitor with bhCG

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5
Q

what is a complete mole

A

all of the chorionic vili are neoplastic

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6
Q

what is a partial mole

A

normal villi amongst neoplastic villi

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7
Q

karyotype of complete vrs partial mole

A

complete - 46XX usually, can be 46XY

partial - 69 XXX, 69 XXY, 69 XYY

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8
Q

levels of hCG in complete vrs partial mole

A

> 100 000 in complete

< 100 000 in partial (still elevated)

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9
Q

which mole has increased uterine size for gestational age

A

complete

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10
Q

which mole has a risk of converting to a choriocarcinoma

A

complete not partial

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11
Q

which mole has fetal parts

A

partial

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12
Q

how does a complete mole come about

A

empty/enucleated ovum fertilized by single sperm that then duplicates

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13
Q

how does a partial mole come about

A

one proper egg and two sperm

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14
Q

risk of malignancy in complete vrs partial

A

15-20% malignant trophoblastic disease in complete

<5% in partial

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15
Q

apperance on u/s for complete vrs partial

A

complete - honeycombed uterus or clusters of grapes
snowstorm on u/s
partial - fetal parts

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16
Q 
first trimester bleeding
unlarged uterus
hyperemisis
pre-eclampsia
hyperthyroidism
A

complete mole***

think about the symptoms each has
pre-eclampsia - hypertension and proteinuria
hyperthyroidism - hyper metabolism everywhere

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17
Q 
vaginal bleeding 
abdominal pain
increased hCG levels beyond normal for pregos
no theca lutein cysts
no hyperemesis
A

partial mole

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18
Q

define gestational hypertension/pregnancy-induced hypertension

A

BP > 140/90 mmHg AFTER 20th week of featstion
no pre-exisiting hypertension
no proteinuria
no end organ damage

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19
Q

how to treat gestational hypertension

A

alpha methyldopa
labetolol
hydralazine
nifedipine

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20
Q

ideal time to deliver in gestational hypertension

A

37 to 39 weeks of gestation

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21
Q

hypertension
proteinuria
dependent pitting oedema
pregnant women

A

pre-eclpamsia

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22
Q

what is hallmark for diagnosis of preeclampsia

A

new onset hypertnesion with either proteinuria or end organ dysfunction after 20th week fo gestation

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23
Q

new onset hypertension at < 20 weeks gestation

A

molar pregnancy suggestive

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24
Q

describe the pathogenesis of preeclampsia

A

abnormal placental spiral arteries – endothelial dysfunction – vasoconstrictors > vasodilatores – iscahemia

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25
what are risk factors for preeclampsia
pre-exisiting hypertension diabetes bronic renal disease autoimunne disorders
26
what are complications of preeclampsia
``` coagulopathy placental abruption uteroplacental insufficiency renal failure eclampsia ```
27
what is eclampsia
preeclampsia and maternal seizures
28
what are causes of fatalities in moms with eclampsia
stroke intracranial hemorrhage ARDS
29
stroke intracranial hemorrhage ARDS
causes fo fatalities in moms with eclampsia
30
how to treat preeclampsia
antihypertensives IV MgSO4 to prevent seizures only cure is to deliver fetus
31
how to treat eclampsia
IV MgSO4 antihypertensives immediate delivery
32
what is HELLP syndrome
associated with eclampsia H - hemolytic anaemia (will see schistocytes) EL - elevated liver enzymes LP - low platelets (from DIC)
33
what are teh consequences of HELLP syndrome
can lead to subcapsular hepatic hematoma -- rupture -- severe hypotension
34
what is treatment for HELLP syndrome
immediate delivery
35
presentation of preeclampsia/eclampsia/HELLP
``` hypertension proteinuria dependent pitting oedema weight gain of >4 /week renal disease liver disease - RUQ and hepatomegaly schistocytes pale and tired ```
36
what is the most common cause of late gestational bleeding
placental abruption
37
largest risk factor for placental abruption
hypertension
38
other risk factors for palcental abruption
``` trauam MVA smokin hypertension preeclampsia cocaine abuse ```
39
what is the pathos of placental abruption
premature separation (partial or complete) of placenta from uterine wall before delivery of munchkin
40
which placental complication is life threatenign for mom and baby
placental abruption
41
abrupt painful uterine bleeding in third trimester forceful uterine contractions evidence of fetal distress
placental abruption
42
possibel complications of placental abruption
DIC maternal shock featl distress
43
waht is placenta accreta/increta/percreta
defective decidual layer - abnormal attachment and espration afterdelivery
44
risk factors for placenta accreta/increta/percreta please
previous C section inflammation placenta previa
45
placenta attaches to myometrium without penetrating it
placenta accreta
46
placenta penetrates into myometrium
placenta iccreta
47
placenta perforates/penetrates through myometrium and into uterine serosa ie invades uterine wall
placenta percreta
48
which type of placenta xccreta is most common
accreta - attachment to myometrial wall
49
which placenta creta can result in placental attachment to rectum or bladdder
placenta percreta
50
what are potential consequences of placenta accreta/increta/percreta
no separation fo placenta after delivery - postpartum bleeding - SHEEHAN SYNDROME
51
what is placenta previa
attachment of placenta to lower uterine segment over (or < 2 cm from) internal cervical os
52
what is major rf for placenta previa
previosu c section
53
what are other rf for placenta previa
multiparity | prior C section
54
painless third trimester bleeding soft and tender uterus no fetal distress
placenta previa
55
describe vasa previa
fetal vessels run over or in close proximity to the cervical os
56
what are the consequences of vasa previa
vessel rupture exsanguination fetal death
57
membrane rupture painless vaginal bleeding fetal bradycardia < 110 bpm
vasa previa
58
cxpx of vasa previa please
membrane rupture painless vaginal bleeding fetal bradycardia < 110 bpm
59
treatment of vasa previa
emergency C section usually indicated
60
what is vasa previa commonly associated with
velamentous umbilical cord insertion - cord inserts in the chorioamniotic membranes rather than placenta - fetal vessels travel to placenta unprotected by wharton jelly
61
who cares about retained placental tissue
may cause postpartum hemorrhage | increases infection risk
62
where is the most common site of ectopic pregnancies
ampulla of the fallopian tube
63
``` amenorrhea lower than expected rise in bhCG based on dates sudden lower abdominal pain looks like appendicitis pain with or without bleeding ```
ectopic pregos
64
when to suscept ectopic pregos
amenorrhea lower than expected rise in hCG based on dates sudden lower abdominal pain pain with or without bleeding
65
how to confirm ectopic pregnancy
u/s
66
what is main risk factor for ectopic pregnancy
previous PID
67
what are other risk factors for ectopic pregnancy
``` history of infertility salpingitis/PID ruptured appendix prior tubal surgery endometriosis progestion only meds ```
68
define polyhydramnios
> 1.5-2 L of AF
69
what causes polyhydramnios
inability to swallow - esophageal atresia/duodenal atresia, anencephaly fetal aneima multiple gestations maternal diabetes - ftal hyperglycemsi - increase fetal urine output
70
what is oligohydraminos
< 0.5 L of AF
71
what causes oligohydramnios
``` placenta insufficiency bilateral renal agenesis posterior urethral valves in males - resultant inability to excrete urine juvenilie polycystic kidney disease PPROM fetal genitourinary obstruction ```
72
what can result from profound oligohyramnios
potter sequence

Reproductive - step (11 decks)

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