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Obstretic Pathology 1 Flashcards

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1
Q

_____ is a temporary organ connecting
fetus and mother providing
the equivalent of respiratory
(and renal) services.

A

Placenta

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2
Q

_____ is a membranous sac surrounding
fetus containing serous fluid essential
for fetal development

A

Amnion

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3
Q

_____ is a plate-shaped tissue under part
of amniotic sac containing fetal blood
vessels that branch into villi projecting
into space filled with maternal blood

A

chorion

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4
Q

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

A

trophoblast

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5
Q

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

A

Decidua

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6
Q 
\_\_\_\_\_\_ are syncytium of
 cells forming outer covering of 
 chorionic villi, which thin out their
 cytoplasm and let their clumped
 nuclei hang off villi in “syncytial
 knots” to minimize diffusion barrier
A

syncytiotrophoblast

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7
Q

In the first trimester, what is the chorionic villi covered by?

A

Double layer of inner and outer cytotrophoblast

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8
Q

In the 3rd trimester, what happens to the covering of chorionic villi?

A

more blood vessels, less interstitium, thinner trophoblast covering

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9
Q

How often to ectopic pregnancies occur and where?

A

1 in ever 150; 90% within fallopian tube

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10
Q

Pathogenesis of ectopic pregnancy

A

up to 50% from scarring from previous infection of tube. Other causes are adhesion from appendicitis, endometriosis, or surgery

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11
Q

What is the most common presentation of ectopic pregnancy?

A

acute severe abdominal pain due to fallopian
tube rupture and pelvic hemorrhage,
about 6 weeks after last menses
Can lead to hemorrhagic shock, death

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12
Q

How is a diagnosis of ectopic pregnancy made?

A

history, physical (signs of peritonitis), ultrasound, pregnancy test

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13
Q

What is the treatment and prognosis of ectopic pregnancy?

A

Surgery- good with prompt treatment

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14
Q

Define spontaneous abortion.

A

pregnancy loss before 20 weeks

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15
Q

How often do spontaneous abortions occur?

A 
up to 15% of clinically
 recognized pregnancies, but sensitive
 gonadotropin assays show that 22%
 more of pregnancies abort
 spontaneously, most in first trimester
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16
Q

How does rate of spontaneous abortion occur with aging?

A

Rate increases from
11% in pregnancies of 20-24 year-olds
to 51% in 40-44 year-olds

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17
Q

What is the most common cause of pregnancy loss in first trimester?

A

Genetic: half with chromosomal abnormalities

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18
Q

What is the most common cause of pregnancy loss in second trimester?

A

infectious: acute chorioamnionitis

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19
Q

What is the most common cause of pregnancy loss in third trimester?

A

Vascular- uteroplacental insufficiency, commonly associated with pre-eclampsia

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20
Q

6 causes of recurrent spontaneous abortion?

A

Immunologic (especially APLS) 25%, Anatomic 22%;Endocrinologic 20%;Microbiologic 6%; Genetic 3%;Unknown 40%

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21
Q

Recurrent stillbirth is associated with ______ states.

A

Hypercoagulable

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22
Q

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

A

Placenta previa

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23
Q

What does placenta previa result in?

A

severe bleeding, may result in placental rupture, massive bleeding and maternal death

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24
Q

How do you treat and diagnose placenta previa?

A

ultrasound; c-section

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25
What is placenta accreta?
defective decidua, with adherence of villous tissue to myometrium
26
What is placenta increta?
defective decidua, with penetration of villous tissue into myometrium
27
What is placenta percreta?
defective decidua, with penetration of villous tissue through entire uterine wall
28
Which is more common and least common - p accreta, increta, percreta? What can they cause and how are they treated?
80%;15%;5% | Persistent postpartum bleeding, hysterectomy, or resection or oversewing
29
What is a hydatidiform mole?
Abnormal gestations due to two sperm fertilizing one egg, or one or two sperm fertilizing an “empty egg” with absent or nonfunctional DNA
30
How common are hydatidiform moles?
``` Rare in US (1 in 1,000 pregnancies) Less rare in east [esp. southeast] Asia (1 in 100 pregnancies in Indonesia) Tend to occur in women <20 years old or over 40 years old ```
31
Complete moles are _____. Partial moles are ____.
diploid; triploid
32
Morphology of hydatidiform moles
cystic swelling of chorionic villia makes them resemble grapes. Trophoblast hyperplasia more prominent in complete moles- usually all the way around villi.
33
How and When are hydatidiform moles diagnosed? How are they treated?
``` Diagnosed at average of 8.5 weeks due to abnormal ultrasound showing diffuse villous enlargement and/or abnormally rapid and high elevation of beta human chorionic gonado- tropin (beta-HCG) Treated with curretage (scaping out the uterine contents) and monitoring beta-HCG to make sure it is all out ```
34
What are the 4 different types of twin placentas?
``` Dichronic diamnionic (two separate everything) Dichronic diamnionic fused (shared placenta) Monochorionic diamnionic (shared chorion and placenta) Monochorionic monoamnionic (shared placenta, amnion, chorion) ```
35
69% of twins are _____. 80% of these placentas are _____.
dichronic diamnionic; dizygotic
36
30% of twins are _____. All twins with this placenta are _____.
Monochorionic diamnionic. monozygotic
37
What is twin-twin transfusion syndrome?
unbalanced vascular anastomoses in monochorionic placentas can cause one twin to get too much blood and the other too little (mono mono)
38
In twin-twin fusion syndrome, what can death of deprived donor twin cause?
necrotic procoagulant material into the anastomoses threatening the life of the other twin and then the mother.
39
What are the hematogenous placental infections?
``` T for Toxoplasma gondii O for Other (syphilis, HIV, etc.) R for Rubella (German measles) C for Cytomegalovirus H for Herpes simplex virus ```
40
What placental infection ascends from vagina?
acute chorioamnionitis
41
Where does T. gondii come from and what does it cause?
protozoan from cat feces, causes microcephaly, fever, rash, seizures in neonates
42
What can rubella cause?
causes deafness, neurologic defects, | cardiac malformations, etc. in neonates
43
Describe cytomegalovirus infection of placenta.
most common transplacental infection in US, causes deafness, neurologic defects in neonates
44
Describe transplacental herpes infection
actually gotten intrapartum from maternal genital lesions, causes skin infection & worse in neonates, preventable with C section
45
How common is acute chorioamnionitis?
Common: 41% of women with premature rupture of membranes at <27 weeks and 15% at 28-36 weeks
46
What are stages of acute chorioamnionitis? Describe the inflammation
``` maternal polys in intervillous space, then in chorion, then in amnion, then fetal polys in chorionic blood vessels (fetal vasculitis) where inflammation may lead to thrombosis because Inflammation is procoagulant ```
47
What is funisitis?
exudate and congestion of cord
48
What can be histologically with acute chorioamnionitis?
Polys infiltrating the chorion. Subchronic fibrin with entrapped villi.
49
What happens histologically in acute chorioamionitis when infection has eaten through the basement membrane of the amnion?
A plug of granulation repair tissue is visible
50
T or F. Acute chorioamnionitis can be complicated by fetal vasculitis, and thrombosis that can result in fetal demis if occluding the umbilical cord vessels.
T
51
Histologically, what is seen with intra-amniotic infections?
Sloughing of the amniotic epithelium, thrombi
52
Describe acute chorioamnionitis. (origin, type, inflammation)
``` Infection ascends from vagina and cervix Inflammatory response = mainly maternal neutrophils (so starts in intervillous space) Infection is usually polymicrobial, with multiple vaginal flora bacteria ```
53
What is acute chorioamnionitis syndrome?
fever, tachycardia (fetal and maternal), uterine tenderness, foul smelling amniotic fluid and leukocytosis
54
Diagnosis, treatment, and prognosis of acute chorioamnionitis
Diagnosis: clinical Treatment: antibiotics and delivery Prognosis: usually good, but can cause fetal sepsis, cerebral palsy, endometritis
55
What comlications can arise from acute chorioamnionitis?
Causes premature rupture of membranes (acronym “PROM” [not a dance]) and premature labor and delivery (due to inflammatory cytokines)
56
What 5 things should be included in acute abdomen in women of child bearing age
Ruptured Ectopic Pregnancy Ovarian Torsion Appendicitis Volvulus Diverticulitis
57
5 most common causes acute abdomen surgical emergency
1. ruptured ectopic pregnancy 2. corpus luteum rupture & hemorrhage 3. pelvic inflammatory disease 4. appendicitis 5. ovarian torsion
58
What causes ovarian torsion?
Twisting on ligamentous support, cutting off venous outflow and then arterial inflow, causing ischemia and then infarction
59
When is ovarian torsion most common?
Most common in women of childbearing age with ovarian mass or pregnancy (more likely in first trimester
60
How does ovarian torsion present? treatment?
Present with acute onset of moderate-severe pelvic pain, often with nausea and vomiting Treatment: surgery
61
What is appendicitis?
Inflammation of appendix due to overgrowth of | normal flora trapped by occluding fecalith
62
How common is appendicitis with pregnancy?
Occurs in up to 1 in 800 pregnancies (more | likely in second trimester
63
How does appendicitis present?
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
64
What is volvulus
Twisting of colonic segment on its mesentery | causing obstruction, dilatation, ischemia
65
Epidemiology of volvulus
90% sigmoid in elderly men, but cecal volvulus | is most common in patients between 25 & 35
66
How does volvulus present and what is the treatment?
Present with intermittent cramping lower abdominal pain, progressive abdominal distension, passing no stool or flatus, with marked abdominal distension and tympany Treatment: untwisting by inserting tube
67
What is diverticulitis? When is it common? How does it present? What is the treatment?
Inflammation of a transmural outpouching of colonic mucosa due to perforation +/- abscess Common, primarily in elderly patients Present with abdominal pain, often for more than a day, (left lower quadrant in 70% of whites, right side in 75% of Asians), constipation (50%), nausea + vomiting (?50%), diarrhea (30%), with abdominal tenderness and leukocytosis Treatment: surgery or non-surgical therapy
68
Pregnancy causes leukocytosis up to ____ and labor causes leukocytosis up to _____ but neither causes bandemia.
14,000; 30,000

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