Pathology - Pregnancy Complications

Question 1

What is Placental abruption (abruptio placentae)

Answer 1

Premature separation (partial or complete) of placenta from uterine wall before delivery of infant.

Question 2

What are the risk factors for placental abruption? (5)

Answer 2

trauma (eg, motor vehicle accident)
smoking, 
hypertension
preeclampsia
cocaine abuse

Question 3

What presents with sudden-onset, painful bleeding (concealed or apparent) in third trimester; possible DIC, maternal shock, fetal distress. Life threatening for mother and fetus.

Answer 3

Placental Abruption - abruptio placentae

Question 4

What is Placenta accreta?

Answer 4

placenta attaches to myometrium without penetrating it; most common type.

Question 5

What is Placenta increta?

Answer 5

placenta penetrates into myometrium.

Question 6

What is Placenta percreta?

Answer 6

placenta penetrates (“perforates”) through myometrium and into uterine serosa (invades entire uterine wall)

Question 7

What causes Placenta accreta/increta/precreta?

Answer 7

Defective decidual layer -> abnormal attachment and separation after delivery.

Question 8

What are the risk factors for Placenta accreta/increta/precreta? (3)

Answer 8

prior C-section, inflammation, placenta previa.

Question 9

What placental issue can result in placental attachment to rectum or bladder.

Answer 9

Placenta Percreta

Question 10

What placental issue is most common type?

Answer 10

Placenta Accreta

Question 11

What presents with: often detected on ultrasound prior to delivery. No separation of placenta after delivery postpartum bleeding

Answer 11

Placenta Accreta/increta/accreta

Question 12

What can Placenta Accreta/increta/accreta cause?

Answer 12

Sheehan Syndrome

Question 13

What is Placenta previa

Answer 13

Attachment of placenta to lower uterine segment over (or

Question 14

What are risk factors for Placenta previa? (2)

Answer 14

multiparity, prior C-section.

Question 15

How does Placenta Previa present?

Answer 15

painless third-trimester bleeding

Question 16

What is Vasa Previa?

Answer 16

Fetal vessels run over, or in close proximity

to, cervical os.

Question 17

What may result in vessel rupture, exsanguination -> fetal death.

Answer 17

Vasa Previa

Question 18

What is the Vasa Previa Triad?

Answer 18

Presents with triad of membrane rupture
painless vaginal bleeding
fetal bradycardia

Question 19

Treatment for Vasa Previa?

Answer 19

Emergency C-Section

Question 20

What is a velamentous umbilical cord insertion

Answer 20

Cord inserts in chorioamniotic membrane rather than placenta fetal vessels travel to placenta unprotected by Wharton jelly

Question 21

What is associated with a velamentous umbilical cord insertion?

Answer 21

Vasa Previa

Question 22

What are the 4 Ts of postpartum hemorrhage?

Answer 22

Tone (uterine atony; most common)
Trauma (lacerations, incisions, uterine rupture)
Thrombin (coagulopathy)
Tissue (retained products of conception).

Question 23

Most common location for an ectopic pregnancy?

Answer 23

Most often in ampulla of fallopian tube

Question 24

Ectopic pregnancy can frequently be misdiagnosed as what?

Answer 24

acute appendicitis

Question 25

what imaging is used to confirm ectopic pregnancy?

Answer 25

ultrasound

Question 26

When should you suspect ectopic pregnancy?

Answer 26

Suspect with history of amenorrhea, lower-than-expected rise in hCG based on dates, and sudden lower abdominal pain

Question 27

Key risk factor for ectopic pregnancy?

Answer 27

Scarring secondary to pelvic inflammatory disease

Question 28

Risk factors for ectopic pregnancy? (5)

Answer 28

``` Prior ectopic pregnancy History of infertility ƒSalpingitis (PID) ƒRuptured appendix ƒPrior tubal surgery ```

Question 29

Fetal malformations that cause polyhydramnios?

Answer 29

esophageal/duodenal atresia, anencephaly; both result in inability to swallow amniotic fluid

Question 30

What other risk factors are there for polyhydramnios (3)

Answer 30

maternal diabetes, fetal anemia, multiple gestations.

Question 31

What are the causes of oligohydramnios? (3)

Answer 31

placental insufficiency, bilateral renal agenesis, posterior urethral valves (in males)

Question 32

What can occur with oligohydramnios?

Answer 32

Potter Sequence