Gyne III

Question 1

How many weeks is late pregnancy

Answer 1

20 wks

Question 2

Early Pregnancy Disorders [2]

causes and locations

Answer 2

Spontaneous Abortion

Ectopic Pregnancy

• caused by infection, inflammation leading to adhesion, kinking, blocking
• leiomyoma, cysts
• IUCD

Locations - fallopian tube; abdominal; ovarian

Question 3

Presentations of ectopic pregnancy

Cx and Dx

Answer 3

Presentations

• Amenorrhea (cos pregnant)
• Abdominal Pain (cos pregnant wrong place)
• Bleeding - shock

Cx

• Rupture
• Bleeding
• Abortion

Dx
hCG (cos pregnant), Pelvic Ultrasound (cos pregnant wrong place), Endometrium Biopsy

Question 4

Late Pregnancy: infections of embryonal stuff [3]

Causes
Cx (recall is normal implantation already)

Answer 4

Chorioamnionitis
Villitis (placenta)
Funisitis (umbilical cord)

Literally any cause
Toxoplasmosis
Others (Hep B)
Rubella (worse at the start)
CMV
HPV

Intrauterine Growth Retardation, Low Birth weight, premature delivery
Congenital abnormalities - Death

Question 5

Toxemia of Pregnancy
(late pregnancy presentation)

Pathophysiology and effects, Complications!

Answer 5

Obstruction of spiral arterioles

• Placenta ischemia as decreased uteroplacental perfusion
• Cytokines released - leading to endothelial dysfunction

Diffuse endothelial dysfunction, vasoconstriction, vascular permeability increases
- DIC, Proteinuria

-TXA2 increases, Renin increases
Hypertension - Preeclampsia
Hemorrhage Brain, Liver, Kidney

Eclampsia - Seizures

Question 6

Placenta problems [3]

Answer 6

Placenta Previa

• impant of placenta near internal OS
• hence placenta is delivered before the fetus leading to Antepartum Hemorrhage APH
• Caesarean

Abruptio Placenta; Placenta Abruption

• separated before giving birth
• concealed bleeding, shock, bleeding, APH

Placenta Accreta

• Normally placenta attach to Myometrium in between has decidual layer of modified endometrium;
• now is gone
• failure to separate even at 3rd stage of labor
• Maternal vessels maintain to be dilated if placenta still there - bleeding PPH

Question 7

What are trophoblasts

Answer 7

Tissues that lines chorionic villi

Question 8

Describe Hydatiform moles, Describe molar pregnancy

Answer 8

Non-viable fertilized egg impants; Placenta has vesicles which arise by distention of the chorionic villi by fluid; hyperplasia of chorionic villi

A molar pregnancy is a gestational trophoblastic disease which grows into a mass in the uterus that has swollen chorionic villi.

– Chorionic villi are villi that sprout from the chorion to provide maximal contact area with maternal blood.

Question 9

Complete mole vs Partial mole

Genetic marker to differentiate?

Answer 9

Egg 0 maternal DNA

• w 2 Sperms or 1 Sperm which duplicated
• – In the first case, the sperm then reduplicates, forming a “complete” 46 chromosome set.

Egg 1 maternal DNA
- w 2 Sperms or 1 Sperm which duplicated

Diploid vs Triploid;
Dilated swelled, VASCICULAR villi, trophoblast proliferation, w no development
vs
VASCIULAR and NORMAL villi + some development
(cos 69 XXYX)

p57

Question 10

Invasive Mole

Answer 10

Any mole which invades into myometrium and mets through blood

Question 11

Choriocarcinoma - gestational trophoblastic disease
- what cells origin

also a GCT and can arise in testes/ovary

Answer 11

Consists of syncytio-cyto- trophoblast