OB Path Part 1: Placentas, ectopic, abortions, chorioamnionitis Flashcards Preview

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Flashcards in OB Path Part 1: Placentas, ectopic, abortions, chorioamnionitis Deck (71):
1

temporary organ connecting fetus and mother providing the equivalent of respiratory (and renal) services

placenta

2

menbranous sac surrounding fetus-containsing serous fluid essential for fetal development

amnion

3

plate-shaped tissue under part
of amniotic sac containing fetal blood
vessels

chorion

4

outer layer of blastocyst
(from fertilized ovum) that implants in
uterus and forms placenta

trophoblast

5

outer layer of placenta that
normally peels off myometrium and
sheds with placenta

decidua

6

Syncytiotrophoblast is a syncytium of cells forming outer covering of _____

chorionic villi

7

thin out their cytoplasm and let their clumped nuclei hang off villi in “syncytial knots” to ....

Syncytiotrophoblast to minimize diffusion barrier

8

First trimester chorionic villi is covered by

inner cytotrophoblast and

9

how is the third trimester chorionic villi different than the first trimester one?

more efficient: more blood vessels, less interstitium, and thinnertrophoblast covering

10

most common pathogenesis of ectopic preg

scarring from previous infection of tube
*other: adhesions from appendicitis, endometriosis, surgery

11

how long after last menses will an ectopic present with acute adn pain, hemorrhage, and the whole 9 yards

6 weeks

12

ectopic preg presents with the same sigs as ____

peritonitis

13

what is the def of a spontaneous abortion

preg loss before 20 weeks

14

___% of clinically recognized preg end in spontaneous abortion

15

15

most common cause of preg loss in:
1st trimester
2nd
3rd

1: genetic (half with chromosomal abnormalities)
2: infection (acute chorioamnionitis
3: vascular (i.e. uteroplacental insuff 2' to pre-eclampsia)

16

recurrent stillbirth (>3) is assc with

hyper-coagulable states

17

what are the 3 the most common type of known etiology for sp abortion

immunologic (esp antiphospholipid syndrome)
anatomic
endocrinologic

**40% of sp ab have unknown etiology

18

implantation in lower uterus or cervix, sometimes covering internal cervical os

placenta previa

19

complications of placenta previa

severe bleeding = placenta rupture and maternal death

20

treatment for placenta previa

C/S

21

defective decidua can lead to

placenta accreta > increta > percreta

22

penetration of villous tissue into myometrium

placenta increta

23

penetration of villous tissue through entire uterine wall

placent percreta

24

Absence of the fibrinoid layer between the villi and decidua (Nitabuch’s layer) --> adherence of villous tissue directly to myometrium

placenta accreta

25

cause of persistant postpartum bleeding

placenta accreta, increta, and percreta

26

treatment for placenta accreta, increta, and percreta

hysterectomy, resection of uterus, or oversewing

27

Abnormal gestations due
to two sperm fertilizing one egg, or one or two sperm fertilizing an “empty egg” with absent
or nonfunctional DNA``

hydatidiform moles

28

what age group tends to have hydatidiform moles

< 20 and > 40 yo

29

complete vs partial hydatidiform moles

complete are diploid (empty ovum fertilized by 1 or 2 sperm)

partial are triploid: regular ovum fert by 2 sperm

30

hydatidiform moles are said to resemble ... due to ...

grapes due to cystic swelling of chorionic villi

31

how are hydatidiform moles diagnosed

abnormal ultrasound showing diffuse villous enlargement

abnormally elevated hCG

32

treatment of hydatidiform moles

curretage -- scaping out
the uterine contents

33

types of twin placenta

di di = 2 chorions and 2 amnions (placenta may or may not be fused)

mono di = 1 chorion 2 amions (1 placenta)

mono mono = 1 chorion 1 amion (1 placenta)

34

most common type of twin placentas

di di

35

trophoblast hyperplasia

hydatidiform moles

36

80% o twins with di di placentas are ___zygotic

dizygotic

37

all twins that are monochorionic are ___ zygotic

monozygotic

38

what is twin-twin transfusion syndrome? in what type of placenta does it occur?

unbalanced anatomoses in monochorionic placenta can cause 1 twin to get too much blood and the other too little

39

how is the life of the mother threatened with twin-twin transfusion syndrome?

when the deprived twin dies it can send necrotic and pro-coagulant material into the blood stream/anastomoses
**Also THREATENS the life of the OTHER TWIN

40

grossly how does a placenta look in win-twin transfusion syndrome?

one umbilical cord is engourged with blood and the other is thin and white

41

bugs that cause acute chorioamnionitis

TORCH:
Toxoplama gondii
Other (syphillis, HIV)
Rubella
CMV
HSV

42

acute chorioamnionitis is a (descending, or ascending) infection

acending (from vagina or cervix)

43

causes deafness, neurologic defects, cardiac malformations, etc. in neonates

Rubella

44

causes deafness, neurologic defects in neonates
**no cardiac malformations

CMV

45

protozoan from cat feces

Toxoplama gondii

46

neonate actually contracts intrapartum-ly

HSV

47

most common transplacental infection

CMV

48

causes microcephaly, fever, rash, seizures in neonates

Toxoplama gondii

49

acute chorioamnionitis that is preventable with C section

HSV

50

Stages/pathophys of acute chorioamnionitis

maternal polys in intervillous space → chorion → amnion → Fetal polys in chorionic blood → fetal vasculitis → thrombus formation

51

Exudate and congestion of cord =

funistis
*assc with acute chorioamnionitis

52

fetal complications of acute chorio

-fetal vasculitis, thrombosis → fetal demise if the thrombus occludes the umbilical cord
-sepsis
-cerebral palsy

53

what can happen to the amniotic epithelium in acute chorio

it gets sloughed off (occlusion → necrosis)

54

green discoloration of placenta

acute chorioamnionitis

55

what can acute chorio cause ... other than thrombosis and fetal demise

PROM and premature labor and delivery
fetal sepsis, cerebral palsy, endometritis

56

what induces premature labor and delivery with acute chorio

inflam cytokines

57

the inflam response in acute chorio is due mainly to (maternal or fetal) neutrophils

maternal

58

presentation of acute chorio

fever, tachycardia (maternal and fetal)
uterine tenderness
foul smelling amniotic fluid
leukocytosis

59

treatment of acute chorio

abx and delivery

60

Diff diagnosis of acute abdomen (pain?) is women of childbearing age

ruptured ectopic preg
ovaria torsion
appendicitis
volvulus
diverticulitis

61

5 most common causes of acute abdomen SURGICAL EMERGENCIES in women of child bearing age

1. ruptured ectopic
2. Corpus leutum rupture and hrmorrhage
3. PID
4. appendicitis
5. ovaria torsion

62

(pregancy or labor) causes a physiologic leukocytosis

both
preg up to 14k
labor up to 30k

63

Present with abdominal pain, often for morethan a day, constipation or diarrhea, nausea + vomiting, diarrhea, with abdominal tenderness and leukocytosis

diverticulitis

64

Present with intermittent cramping lower
abdominal pain, progressive abdominal
distension, passing no stool or flatus, with
marked abdominal distension and tympany

volvus

65

Present with periumbilical abdominal pain that
migrates to right lower quadrant, anorexia,
nausea, vomiting, followed by fever, with
tenderness at McBurney’s point halfway
between umbilicus and anterior superior
iliac spine, rebound tenderness if perforated

appendicitis

66

Present with acute onset of moderate-severe
pelvic pain, often with nausea and vomiting + ovarian cyst

Corpus leutum rupture and hrmorrhage

67

Twisting on its ligamentous support, cutting off
venous outflow and then arterial inflow,
causing ischemia and then infarction

ovarian torsion

68

difference between diverticulitis and volvulus

voluvulus is the twisting of colonic segemtn on its mesentery (causes obst, dilation, ischemia).

diverticulitis is the inflam of transmural out pouching of colonic mucosa due to perforation +/- abscess

69

what part of the intestine is involved in voluvulus?

cecal in pts between 25 and 35
*sigmoid in elderly men

70

due to overgrowth of normal flora trapped by occluding fecalith

appendicitis

71

in what trimester is an ovarian torsion most likely to present?

1st