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Flashcards in Path of Placenta Deck (49)
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1

Discriminatory zone

maternal hCG level above gestational sac should be visible

~5-6 weeks Transvaginal US

~7 weeks
Transabdominal US

2

How often does ectopic pregnancy occur?

1/150 pregnancies
- implant anywhere but intrauterine

3

What usually precedes ectopic pregnancy?

PID

4

Complete mole

Partial mole

all dad (46, XX or XY)

Partially dad
(triploid, 69 chrom
2/3 from dad, 1/3 fr mom)

Need moms DNA to drive development
- without her, you have no fetus

5

Snowstorm appearance

Complete hydatidiform mole
- cystically dilated spaces w/o fetal parts

6

Triad of complete mole sx

1. hyperemesis
2. pre-eclampsia
3. hyperthyroidism

7

% of recurrence in complete mole

20% recurrent

1-2% dev into choriocarcinoma (monitor carefully after)

8

Follow up for molar preg

1. get serum hCG q1-2 weeks until 3 conseq. negative measurements
- give methotrexate if elevated

2. Contraception

9

Risk for post molar GTN

1. age >40
2. Uterine size
3. Theca lutein cysts >6 cm
4. hCG >100,000
5. medical complications
- ARDS, pre-eclampsia, hyperthyroidism

10

Choriocarcinoma

disease of trophoblast
-cyto (mononucleated) and syncitio (multinucleated)

can be widely metastatic

serum bHCG to detect

11

signs of choriocarcinoma

1. vaginal bleeding several mo after pregnancy
2. high serum hCG
3. Single/mult hemorrhagic well circumscribed nodules in uterus
4. biphasic pattern w. hemorrhage and necrosis
5. marked nuclear atypia and mitosis

12

Placental organ
- fxns

1. anchors gestation
2. disposable at birth
3. Fxns as:
kidney, lung, liver, intestines, and endocrine organ to fetus
4. Prod hormones
5. Immunologic organ
(physical barrier + protects fetal allograft from moms immune syst)

13

PLacental weight ratio (PWR)

reflects balance betwn fetal and placental growth
(surrogate indicator of utero fxning)
- decreases as gestational age increases

Predictive of:
1. perinatal morbidity/mortality
2. childhood growth & devel
3. Fetal origins of adult diseases

14

Does size matter for umbilical chords?

yes

Long = >75
- assoc w/ knots and fetal entanglement
- may correspond to later hyperactivity

Short =

15

umbilical artery carries _____ blood from fetus to placenta

deoxygenated

16

Which compartment (fetal or maternal) is found in intravillous and intervillous space?

Fetal compartment:
inTRAvillous

MaTERnal space:
inTERvillous

17

TPAL

Term delivery
Preterm delivery
Abortion
Living children

18

Acute chorioamnionitis
(maternal inflamm response in memb)

20-24% of live births

2ndary to bacterial intramniotic infxn
(Group B strep)

Neutrophils in fetal membranes

19

Fetal inflamm response

Vasculitis In:
1. babys vasculature (umbil cord)
2. chorionic plate

20

DIff between ascending vs trans-placental infection

Ascending
- maternal neutrophils in membrane

Trans-placental (hematogenous)
- histo: chronic villitis, intervillositis, lymphoplasmacytis deciduitis
(moms lymphocytes are killing villi)
- ToRCHeS infxn

21

ToRCHeS

Toxoplasma
Rubella
CMV
HIV
HSV
Syphilis

22

Rare problems of CMV placentitis

1. Intrauterine Fetal death
2. IU growth restriction
3. Deafness

*common infxn: primary and recurrent

23

Perivascular fibrous proliferation

syphilis

24

Granulomatous with cysts

toxoplasmosis

25

Multinucleated cells with inclusions

herpes
Tzank

26

Acute inflammation destroying villi

listeria

27

Meconium

baby poop
toxic

meaning:
baby's gut is mature
or
baby is stressed (esp if

28

Intervillous thrombi

feto-maternal hemorrhage
-see lines of zahn
(if extensive, get kleihauer - betke test)

risk factors:
1. multiple gestations
2. nuchal cord
3. low birth weight

29

kleihauer betke test

test for fetomaternal hemorrhage (FMH)

test if:
1. fetal demise
2. nonimmune hydrops
3. neonatal anemia

30

Placental infarct

acute cessation of maternal flow with live fetus
- central more sig than peripheral

- Evolves from red and firm to white and hard