Pathology - Gestational

Question 1

What is spontaneous abortion?

Answer 1

Miscarriage of fetus (20 weeks before gestation)

- Vaginal bleeding, cramp like pain and passage of fetal tissues

Question 2

How common is spontaneous abortion?

Answer 2

Up to 1/4 pregnancies

Question 3

What can spontaneous abortions be due to?

Answer 3

• Chromosomal anomalies
• Hypercoagulable states (SLE)
• Congenital infection
• Exposure to teratogens

Question 4

What is placenta previa?

Answer 4

• Implantation of placenta in lower uterine segment

- Overlies cervical os

Question 5

What does placenta previa present with?

Answer 5

• 3rd trimester bleeding

Question 6

What does placenta previa require (what intervention needed)?

Answer 6

C-section

Question 7

How can placenta previa cause fetal distress?

Answer 7

As the baby is being delivered it can compress the placenta - blood source compromised

Question 8

What is abruptio placentae?

Answer 8

• Seperation of placenta from decidua prior to delivery

Question 9

What does abruptio placentae present with?

Answer 9

• 3rd trimester bleeding and fetal insufficiency

- Still birth possibility

Question 10

What can be seen on the placenta after delivery in abruptio placentae?

Answer 10

Blood and clots on the surface of the placenta

Question 11

What is placenta accreta?

Answer 11

• Improper implantation of placenta into myometrium with little or no intervening decidua

Question 12

What are the layers of the endometrium?

Answer 12

• Functional layer

- Basal layer

Question 13

How does placenta accreta present?

Answer 13

Difficulty delivering placenta and post-partum bleeding

Question 14

What is required often in placenta accreta?

Answer 14

Hysterectomy

Question 15

What is preeclampsia due to?

Answer 15

Abnormality of maternal-fetal interface in placenta

Question 16

What does preeclampsia involve?

Answer 16

• Hypertension after 20 weeks

- Proteinuria or end-organ dysfunction

Question 17

What is eclampsia?

Answer 17

Preeclampsia + seizures

Question 18

What hypertension drugs are recommended in pregnancy?

Answer 18

• Hydralazine
• alpha-methyldopa
• Labetalol
• Nifedipine
  Hypertensive moms love Nifedipine

Question 19

How is gestational hypertension defined?

Answer 19

> 140/90 mmHg after 20 weeks

Question 20

What medications may be used in Preeclampsia?

Answer 20

Antihypertensives
- Hydralazine, alpha-methyldopa, labetalol, nifedipine

• IV magnesium sulfate (seizures)

Question 21

When should babies be delivered in gestational diabetes?

Answer 21

37-39 weeks

Question 22

What is the definitive treatment for preeclampsia, eclampsia and HELLP syndrome?

Answer 22

Delivery

Question 23

How is HELLP syndrome defined?

Answer 23

• Preeclampsia with thrombotic microangiopathy of the liver

- Hemolysis, Elevated liver enzymes, Low platelets

Question 24

What will a blood smear reveal in a patient with HELLP syndrome?

Answer 24

Schistocytes

Question 25

What are the 2 major complications of HELLP syndrome?

Answer 25

- Hepatic subscapular hematomas (rupture - severe hypertension) - DIC (due to release of TF)

Question 26

What is placenta increta?

Answer 26

When the placenta penetrates into the myometrium

Question 27

What is placenta percreta?

Answer 27

Placenta perforates through myometrium and into uterine serosa (invades entire uterine wall) - Placenta may attach to rectum or bladder (hematuria)

Question 28

How does placenta percreta present?

Answer 28

- Detected on US prior to delivery | - No separation of placenta after delivery -> PPH

Question 29

What can PPH cause as a complication?

Answer 29

Sheehan syndrome (hypopituitarism -> O2 cannot reach the gland)

Question 30

What is a hydatidiform mole?

Answer 30

- Abnormal conception characterised by swollen and edematous villi with proliferation of trophoblasts - Uterus expands as if normal pregnancy is present

Question 31

What are the hCG levels like in a hydatidiform mole?

Answer 31

Higher than usual for the time

Question 32

What is associated with hydatidiform mole?

Answer 32

- Early preeclampsia (<20 wks) - Theca-lutein cysts - Hyperemesis gravidarum - Hyperthyroidism

Question 33

What is the classical presentation of a hydatidiform mole?

Answer 33

- Passage of grape-like masses through vaginal canal in 2nd trimester (edematous villi) - US in 1st trimester would reveal absent heart sounds and snow storm appearance

Question 34

What appearance would hydatidiform moles give on US?

Answer 34

Snow-storm

Question 35

What type of mole involves an enucleated egg?

Answer 35

Complete mole (single sperm which duplicates)

Question 36

Which type of mole has diffuse trophoblastic proliferation?

Answer 36

Complete mole

Question 37

Which type of mole has fetal parts?

Answer 37

Partial

Question 38

Which type of mole is P57 positive?

Answer 38

Partial

Question 39

Which type of mole cuases an increased uterine size?

Answer 39

complete

Question 40

Which type of mole causes a larger increase in hCG complete or partial?

Answer 40

Complete

Question 41

Which type of mole has an increased eisk of invasiveness?

Answer 41

Complete (15-20%) | Partial (<5%)

Question 42

Which type of mole has a larger risk of choriocarcinoma?

Answer 42

Complete (2% risk)

Question 43

What is a choriocarcinoma a malignancy of?

Answer 43

trophoblastic (cyto and syncyto) tissue (no chorionic villi present)

Question 44

What can choriocarcinoma increase the chances of?

Answer 44

Theca-lutein cysts

Question 45

What does choriocarcinoma present with?

Answer 45

- Abnormal increased hCG - SOB - Hemoptysis - Cannonball metastases on lungs on X-ray

Question 46

What is choriocarcinoma treated with?

Answer 46

Methotrexate

Question 47

How is molar pregnancy treated?

Answer 47

Dilation and curettage

Question 48

What is vasa previa?

Answer 48

Fetal vessels run over or in close proximity to cervical os | - Triad of membrane rupture, painless vaginal bleeding and fetal bradycardia

Question 49

How is vasa previa treated?

Answer 49

C-section

Question 50

What is vasa previa associated with?

Answer 50

- Velamentous umbilical cord insertion (inserts in chorioamniotic membrane rather than placenta) - Vessels then travel unprotected by whartons jelly

Question 51

What can postpartum hemorrhage be due to?

Answer 51

4Ts - Tone (uterine atony -> soft boggy uterus) - Trauma (lacerations, incisions, uterine rupture) - Thrombin (coagulaopathy) - Tissue (retained products of conception)

Question 52

What is the treatment of PPH?

Answer 52

- Uterine massage - Oxytocin - Surgery

Question 53

What vessels may be ligated in surgery of PPH?

Answer 53

Uterine or internal iliac artery (will preserve fertility since ovarian arteries provide collateral circulation)

Question 54

What is supine hypotensive syndrome (aortocaval compression syndrome)?

Answer 54

- Seen at > 20 weeks gestation - Supine compression of patients abdominal aorta and IVC by gravid uterus -> decreased placental perfusion and decreased venous return (hypotension)

Question 55

What gynae cancers are more common?

Answer 55

Endometrial most then ovarian then cervical (US) | - Cervical is more common worldwide

Question 56

What type of gynae cancers have the best vs worst prognosis?

Answer 56

- Cervical (best) (<45 yrs) - Endometrial (~55 yrs) - Ovarian (worst) (>65 yrs) CEOs often go best to worst as they get older