glines trophoblast and abortion Flashcards Preview

REPRO 1 > glines trophoblast and abortion > Flashcards

Flashcards in glines trophoblast and abortion Deck (72):
1

The commonality of all gestational trophoblastic diseases is that they secrete ________

BETA -- HCG

2

Which 2 gestational trophoblastic diseases can metastasize?

choriocarcinoma and invasive moles (though not a cancer)

3

What is the gold standard for diagnosing ectopic pregnancy? How will the results of a mole be different?

Ultrasound and B-HCG (1200), in a mole the B-HCG will be much higher

4

How do you get a complete mole and what is the karyotype?

fertilization of empty ovum by haploid sperm; 46 XX RARELY is it 46 xy

5

What is the usual way by which you get a partial mole? Karyotype?

2 sperm fertilize a NON empty ovum; 69 XXY, XXX, or XYY

6

Because you know you've wondered this since embyro day #1, where does the term hydatidiform mole come from?

mole from latin mola, refers to false conception/millstone and hydatisia is greek for a drop of water (chorionic villi are fluid filled) and it looks very similar to hydatid cysts in echinococcus infections. Now you know.

7

Which type of mole is often present with a co-existing fetus?

partial or incomplete mole

8

Name 2 cancers that can cross placenta

melanoma and choriocarcinoma

9

What disease represents the majority of patients who have elevated B-HCG AFTER molar evacuation

invasive mole, not choriocarcinoma

10

What is the main route of metastasis for choriocarcinoma?

hematogenous

11

There will be no test question on this tumor

placental site trophoblastic tumor, not gonna worry about it then! But the major problem is that it is insensitive to chemo

12

The frequency of gestational trophoblastic disease is highest in this country

TAIWAN

13

Gestational trophoblastic disease tends to occur in areas with less of these 2 nutrients are consumed

beta carotene and folic acid

14

What should you do to the dose of folate in a pregant woman who has Hx of mole

increase the dose

15

What kind of age distribution occurs with moles?

bimodal (under 20, over 40)

16

Are moles benign or malignant?

benign (both are, complete and partial)

17

Complete moles have hyperplasia of this tissue

trophoblastic tissue

18

T/F: complete moles usually cause tremendous amounts of pain and mimic ectopic pregnancies

false, actually. They are surprisingly not associated with much pain

19

T/F: complete moles can mimic pre-ecclampsia

TRUE

20

Why would you hear wheezing/rhonchi in a patient with a mole?

they can spread to the lungs

21

What is the Tx for a complete mole?

suction evacuation followed by sharp curretage; IV pitocin with follow up B HCGS

22

If the B HCG levels don?t decline after molar evacuation which 2 drugs can you use?

methotrexate (also DOC for ectopic pregnancy) and actinomycin D

23

At what age is hysterectomy for Tx of molar pregnancy appropriate?

over 40

24

What is the most common gynecologic cancer?

endometrial

25

How awesome is Dr. Glines?

Pretty awesome

26

Which molar pregnancy is associated with a developing fetus?

partial mole

27

T/F: partial moles are defined as a snow-storm pattern on ultrasound

false, complete moles are snow-storm patterns because the fluid filled cysts are very large and look like a snow storm

28

Path tie-in, the snowstorm pattern on ultrasound translates to a ____________ pattern on histology

coast of norway, again both are caused by the fact that there are large cystic spaces

A image thumb
29

What is a common way for partial moles to present?

they may present as a spontaneous or missed abortion

30

T/F most patients with partial moles have very large uterus for gestational age

false, this is true of complete moles but partial mole pts are small for dates

31

When will a partial mole patient become pre-ecclamptic in comparison to a complete mole patient?

usually one month later

32

Which patient is more likely to have wheezes and rhonchi, one with a complete or partial mole?

complete mole as it is more likely than a partial mole to metastasize

33

What is the work up of choriocarcinoma and why would you suspect this?

You suspect this after molar evacuation when there is elevated B HCG that is persistent, then you also do a CT of pretty much the whole body, also a lumbar puncture

34

How do you Tx choriocarcinoma with a good prognosis

actinomycin D and methotrexate

35

If choriocarcinoma is metastatic what is used in conjunction with medications?

radiation

36

Can a woman who has had choriocarcinoma get pregnant again?

she can but she SHOULD NOT AS SHE CAN DIE!

37

Can a woman who has had a molar evacuation get pregnant again?

yes 1 year later

38

Miscarraige is a is a lay term for ______

abortion

39

A spontaneous abortion that occurs AFTER 20 weeks but before 37 is deemed ___________

Intrauterine fetal demise

40

A spontaneous abortion that occurs BEFORE 20 weeks is called

a missed abortion

41

What is the frequency of abortions?

50% of pregnancies, they think that many women do not know they are pregnant

42

At what maternal age is the risk of spontaenous abortion higher?

30 but even higher at 35 and 40

43

Name the 7 types of abortions

threatened, inevitable, incomplete, complete, missed, therapeutic/elective, septic (any of the others PLUS infection)

44

Define threatened abortion

vaginal bleeding before the 20th week with a CLOSED CERVICAL OS

45

Define inevitable abortion

bleeding that occurs with the cervical os OPEN

46

Define incomplete abortion

vaginal bleeding with the os open and passage of some fetal tissue

47

Define complete abortion

bleeding with the os closed (??) and passage of all products of conception

48

Define missed abortion

fetus dies before 20 weeks and is retained in uterus

49

Define septic abortion

any abortion that occurs with infection

50

This is the term to describe 3 or more successive abortions

recurrent abortion

51

What kind of abortion occurs when there is vaginal bleeding without the passage of fetal tissue with an open cervical os?

inevitable abortion

52

What kind of abortion occurs before 20 weeks and the fetus is retained in the uterus?

missed abortion

53

What term describes when the fetus dies after 20 weeks of gestation and is retained in the uterus?

Intrauterine fetal demise

54

What term describes when there is vaginal bleeding prior to the 20th week with a closed cervical os?

threatened abortion

55

What term describes when there is vaginal bleeding with an open cervical os and some passage of fetal tissue?

incomplete abortion

56

What term describes when a woman is 18 weeks pregnant, has a closed os and is bleeding and it is found that there is chorionitis due to ascending E. coli infection?

septic abortion (any abortion with an infection)

57

What is the most common cause of spontaneous abortion?

genetic anomaly

58

This bug can be harbored in the male prostate and causes spontaneous abortions

Listeria monocytogenes

59

What is Asherman's syndrome?

When the lining of the cervix adheres to itself i.e. left side adheres to right side so there is obliteration of the uterine cavity

60

What is a BIG cause of uterine abnormalities?

D/C and scrapings

61

Name 3 important immunologic causes of abortion i.e. Rh and 2 others

Kell and Duffy antigens (Kell kills, Duffy dies)

62

How do you manage a threatened abortion?

ultrasound and rest and reassurance (just because bleeding doesn?t mean baby died but still called threatened "abortion")

63

How do you manage an inevitable abortion?

Admit the patient, analgesia, D/C etc.

64

How do you manage an incomplete abortion?

Admit the patient, analgesia, D/C etc. --same as inevitable

65

How do you manage a missed abortion?

D/C , cytotec, prostaglandins, laminaria

66

How do you manage a complete abortion?

supportive measures if necessary

67

How do you manage a septic abortion?

IV antibiotics and evacuation

68

How do you manage recurrent abortions?

start doing cultures and labs for antibodies such as Rh, duffy, kell, etc.

69

If a patient has any abortion and is Rh negative what do you give them?

rhogam

70

What is Spalding's sign?

overlapping of fetal skull bones on X-ray due to liquefaction of the fetal brain

71

How do you ultimately Dx an abortion?

no fetal movement, no cardiac motion

72

How can you induce labor for someone with an abortion at 13-28 weeks? After 28 weeks? Why the difference?

13-28 weeks = prostaglandins; after 28 weeks = pitocin? The use of prostaglandins after 28 weeks is associated with a risk of uterine rupture