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Flashcards in PATH Deck (63):
1

This term describes the gross appearance of chorionic villi

cotyledons

2

How does maternal blood enter the intervillous space?

via the spiral arteries of the uterus

3

How does deoxygenated fetal blood enter the placenta?

via 2 umbilical arteries

4

Radial branching of the umbilical arteries form _______

chorionic arteries

5

What should you start thinking if you clamp the cord and there is only one umbilical artery?

other anomalies i.e. RENAL and HEART

6

What should you start thinking if you clamp the cord and there is only one umbilical vein?

Nice

7

Are there any ramifications to a cotyledon staying in the uterus after delivery?

yes they may lead to clotting and or hemorrhage

8

How are first trimester chorionic villi different than third trimester chorionic villi (microscopically)

first trimester ones are edematous in the center with trophoblastic proliferation on the margins? A third trimester villus will have thinner trophoblast and the center will contain more vessels!

9

What do syncytial knots tell you about the state of a 2nd trimester placenta? 1st trimester placenta?

These are normal in 2nd trimester as it is starting to mature but if in 1st trimester it is not good

10

Why would you see intervillous fibrin deposition in a 3rd trimester slice of placenta?

because blood fills the intervillous spaces thus, this is a normal finding

11

If you are looking at a slice of placenta and note an inflammatory infiltrate what is the likely Dx?

chorionitis (chorioamnionitis)

12

This is the correct term for inflammation of Wharton's Jelly?

Funisitis

13

Define spontaneous abortion

pregnancy loss before 20 weeks of gestation

14

What is the most likely fetal cause of spontaenous abortion (general)

chromosomal anomalies

15

What is a major maternal factor for spontaneous pregnancy loss?

UNCONTROLLED DIABETES, but there are many others

16

If you suspect a systemic disorder affecting maternal vasculature as the cause for a spontaneous abortion, what Ab should you test for?

anti-phospholipid antibodies, APA is assoc with SLE

17

This is the most common site of ectopic pregnancy

fallopian tubes (90%)

18

What is the most important predisposing factor to ectopic pregnancy?

Pelvic inflammatory Dz (C. trachomatis > N. gonorrhea)

19

What is the most common cause of a hematosalpinx?

Tubal pregnancy

20

If a woman is having problems late in pregnancy why are you no longer thinking of ectopic pregnancy (tubal)?

She would have had complications much earlier on from that, so a disorder late in pregnancy is not going to be in the fallopian tubes

21

What is a major problem that ascending chorioamnionitis may cause?

PROM and delivery

22

A calculation of fetal hyperactivity is directly proportional to the number of these

twists in the umbilical cord

23

A retroplacental hemorrhage is aka _________ _____________

abruptio placentae

24

What are the 3 types of twin placentas? Given that what combination is not possible?

diamnionicdichorionic, diamnionicmonochorionic, monoamnionicmonochorionic-------not possible to have 2 chorions and 1 amnion, which makes sense, really.

25

What is implied by a monochorionic placenta in twins?

identical twinning

26

What is implied by dichorionic placentation?

identical or fraternal twinning

27

What is a possible complication (for the twins) of monochorionic placentation?

twin-twin transfusion syndrome, this is when one twin steals more of the blood supply and grows bigger than the other twin, this may even kill the other twin

28

What is fetus papyrus?

a result of twin-twin transfusion syndrome where the dead twin regresses into the placenta

29

If the placenta is delivered and contains some of the uterine wall, what did disorder of placentation probably occurred?

placenta accreta because it invaded the myometrium

30

if the first thing to come out in deliver is the placenta, what disorder of placentation probably occurred?

placenta previa

31

In placenta previa, the blastocyst implants over the __________

cervical os

32

This disorder of placentation is a surgical emergency

abruptio placentae

33

Differentiate among the following: placenta accreta, placenta increta, placenta percreta

accreta goes into superficial myometrium, increta is deep into it and PERcreta is all the way out through the myometrium into the PERimetrium

34

These are the 2 pathways by which infection of fetus or extraembryonic membranes may occur

ascending or hematogenous/transplacental

35

What is the most common pathway of infection, what type of organism?

ascending via birth canal; bacterial

36

Describe what you would see on an amniocentesis sample if there was a bacterial chorioamnionitis?

it would be cloudy, just like a CSF sample from bacterial meningitis

37

Describe how you would differentiate whether an infection of the chorionic villi was from a typical bacterial infection via the ascending route or a TORCH infection from the hematogenous route.

Ascending infections are usually bacterial which cause acute inflammation so you would see congestion, edema and PMN's. TORCH infections are hematogenous and elicit a chronic response so you would expect lymphocytes

38

The triad of pre-eclampsia

edema, HTN, proteinuria

39

Pre-ecclampsia is from widespread dysfunction of ________

endothelium

40

Who is pre-ecclampsia the most common in?

primipara's

41

What should the father think if he has 3 kids and the mom is always pre-ecclamptic?

she's got some 'splainin to do

42

How is ecclampsia different from pre-ecclampsia?

They have seizures now

43

Why are there areas of coagulative necrosis of the placenta in pre-ecclampsia?

because placental infarcts ( = coagulative necrosis) are common

44

Given that there is an increase for risk of retroplacental hematomas in pre-ecclampsia one can deduce that there is likely an increased risk for this

abruptio placentae

45

Pre-ecclampsia may show this type of necrosis in decidual vessels

fibrinoid

46

Pre-ecclamptics may have deposition of this in their kidneys

FIBRIN

47

Hydatidiforms are associated with these 2 persistent trophoblastic diseases

invasive mole, choriocarcinoma

48

What is the bimodal age distribution for risk of hydatidiform moles?

at the tails of reproductive life i.e. teens and near-menopause

49

Differentiate the karyotypes of complete moles and partial moles

A complete mole will have 46 XX, a partial mole is TRIPLOID and is 69 XXY

50

T/F: complete moles are maternally derived

false, the karyotype arises from fertilization of an EMPTY OVUM with either a haploid sperm that duplicates (90%) or 2 sperm (dispermy, 10%)

51

What are the 3 possibilities for how a partial mole is formed?

2 sperm fertilize an ovum (NOT an empty ovum), a diploid ovum fertilized by 1 sperm, a diploid sperm fertilizes an ovum

52

T/F: a partial mole has an increased risk of choriocarcinoma

false

53

T/F: a mole that has a coast of Norway appearance on H/E has an increased risk of choriocarcinoma

True, coast of Norway describes the appearance of a complete mole which is associated with increased risk of choriocarcinoma

54

T/F: a partial mole has an increased risk of persistent molar disease

true but not choriocarcinoma

55

Which type of mole can be described as having a grape-like appearance?

a complete mole, much more so than a partial mole

56

THROWBACK: if a young girl came in with vaginal bleeding and you saw grape-like lesions in her vagina what would you diagnose her with?

Botryoides type rhabdomyosarcoma; botryo = "bunch of grapes"

57

What term describes a mole that penetrates or even perforates the uterine wall?

invasive mole

58

What are the malignant cells in a choriocarcinoma?

trophoblastic cells

59

T/F: a woman who has never been pregnant can develop choriocarcinoma

FALSE

60

Where do choriocarcinomas "love" to metastasize? Prognosis?

LUNGS (and brain) good prognosis with chemo

61

Do choriocarcinomas produce chorionic villi?

nope

62

What kind of trophoblastic tumor produces chorionic villi?

Placental site trophoblastic tumor

63

Are placental site trophoblastic tumors benign or malignant?

malignant