Flashcards in pathology 2 Deck (29):
Name four preexisting medical conditions that are associated with an increased risk of developing preeclampsia.
Hypertension, chronic renal disease, diabetes, and autoimmune disorders
A pregnant woman at 25 weeks' gestation has a blood pressure of 140/90 mm Hg and protein in her urine. What is the diagnosis and treatment?
Preeclampsia—antihypertensives, IV magnesium sulfate will prevent seizures, definitive treatment is delivery of fetus
A pregnant woman in the ED has high BP, a platelet count of 90, and elevated liver function tests and indirect bilirubin. Diagnosis?
This is likely HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelet count) (treatment is immediate delivery)
A pregnant woman is diagnosed with preeclampsia. What is thought to be the etiology of preeclampsia?
Abnormal placental spiral arteries leading to maternal endothelial dysfunction, vasoconstriction, and ischemia
A pregnant woman being monitored for preeclampsia suddenly seizes. What is this condition called? What are the treatment options?
Eclampsia; IV magnesium sulfate, antihypertensives, immediate delivery
A woman with no preexisting hypertension, proteinuria, or end-organ damage has a BP of 140/90 mmHg at week 25 of pregnancy. Diagnosis?
Gestational hypertension (pregnancy-induced hypertension)
What are the treatment options for gestational hypertension?
Antihypertensives (labetalol, hydralazine, nifedipine, and α-methyldopa), and delivery at 37–39 weeks
Pregnancy-induced hypertension is defined as BP ≥140/90 after week 20 of gestation. Hypertension before this time suggests ____.
A woman has eclampsia. Maternal death associated with this may occur due to what three conditions?
Stroke, intracranial hemorrhage, and adult respiratory distress syndrome
A pregnant woman is diagnosed with preeclampsia. What are some complications that could result from preeclampsia?
Placental abruption, renal failure, uteroplacental insufficiency, coagulopathy, eclampsia
At 15 weeks, a pregnant woman has new-onset proteinuria and hypertension. What is the diagnosis?
Consider a molar pregnancy, as preeclampsia usually does not arise until at least 20 weeks of gestation
A pregnant woman has hypertension, proteinuria, and schistocytes are seen on blood smear. She then develops severe hypotension. Why?
She has preeclampsia and HELLP syndrome, so she likely ruptured a hepatic subcapsular hematoma, leading to severe hypotension
At 15 weeks, a pregnant woman has new-onset hypertension without proteinuria. Diagnosis?
Undiagnosed chronic hypertension, which can only be gestational hypertension if it develops after the 20th week of gestation
After delivery, a woman has massive bleeding and fails to complete the third stage (delivery of the placenta). What is the likely diagnosis?
Placenta accreta, increta, or percreta
A 25-year-old woman has not had her period for 8 weeks, and presents with severe LLQ pain without vaginal bleeding. Diagnosis?
Ectopic pregnancy, which does not always need to have vaginal bleeding—key is pain with or without bleeding and amenorrhea
Name three risk factors for placenta accreta, increta, or percreta. Name five risk factors for abruptio placentae.
Accreta/increta/percreta = prior C-section, inflammation, placenta previa—abruptio = smoking, hypertension, cocaine, trauma, preeclampsia
A woman has sudden lower abdominal pain, a history of amenorrhea, and a lower-than-expected rise in hCG levels. What diagnosis is likely?
Ectopic pregnancy (confirm with ultrasound [note that ectopic pregnancy often is mistaken clinically for appendicitis])
A patient is diagnosed with placenta previa. What are two risk factors for this condition?
Multiparity and prior C-sections
A 35-year-old woman presents on 7 days postpartum with massive painless vaginal bleeding. What is the most likely diagnosis?
Retained placental tissue (causing postpartum hemorrhage and increased risk of infection)
You suspect abruptio placentae in a pregnant woman with abrupt, painful bleeding in third trimester. What other symptoms could be present?
Possible disseminated intravascular coagulation, maternal shock, fetal distress
A woman is diagnosed with an ectopic pregnancy. Name four risk factors that might have predisposed her.
Pelvic inflammatory disease (PID, salpingitis), prior tubal surgery, ruptured appendix, and history of infertility
Placenta accreta/increta/percreta is caused by a defective ____ layer, leading to abnormal placental attachment/separation after delivery
A patient presents with membrane rupture, painless vaginal bleeding, and fetal heart rate
Emergency C-section (this is the classic triad of vasa previa)
If placenta accreta/increta/percreta is undetected before delivery, massive postpartum bleeding may ensue. Potential complications?
Sheehan syndrome, which is placental accreta/increta/percreta (usually is detected on ultrasound before delivery)
A woman with painless third-trimester bleeding has a placenta seen
Likely yes—this is placenta previa for which prior C-section is a risk factor
A pregnant woman was told that she has oligohydramnios after her last ultrasound. What process is causing this condition?
Oligohydramnios is caused by an inability of the fetus to excrete urine
Name three congenital conditions that are associated with oligohydramnios (less than 0.5 L of amniotic fluid).
Placental insufficiency, bilateral renal agenesis, and posterior urethral valves (in male subjects)
What fetal syndrome is associated with severe oligohydramnios?
Potter sequence (lack of amniotic fluid leads to pulmonary hypoplasia, characteristic facies, and other abnormalities)