Pregnancy Pathology

Question 1

the most common site of an ectopic pregnancy is ________

Answer 1

ampulla of the fallopian tube

Question 2

what is a the placental abnormality in which the placenta attaches to the lower uterine wall (over the internal os)

Answer 2

placenta previa; do a C-section

get a “preview” of the placenta when you look through the cervix because of its abnormal position in the uterus

Question 3

what is the abnormality in placenta accrete?

Answer 3

• this occurs when the placenta is directly attached to the myometrium without penetrating it due to a defect in the formation of the decidual layer causing severe post partum hemorrhage

Question 4

_________ is a condition that occurs when the placenta prematurely separates (partial or complete) from the endometrial implantation site in the uterine wallpriorto delivery.

Answer 4

abruptio placenta

Question 5

painless bleeding in the third trimester is associated with what placental abnormality?

Answer 5

placenta previa

Question 6

SEVERE post partum hemorrhage is seen in what placental abnormality

Answer 6

placenta accreta

Question 7

what are the symptoms of HELLP syndrome and what condition is it associated with

Answer 7

HELLP: hemolysis, elevated liver enzyme levels, and low platelet levels; pre eclampsia with thrombotic microangiopathy involving the liver vessels

10% of pre eclampsia can develop into HELLP syndrome

Question 8

what are some predisposing factors for pre-eclampsia

Answer 8

• first birth at over 35 years old
• multiple pregnancies
• hydramnios
• pre existing HTN
• hydatidiform mole

Question 9

what is said to be the most likely cause of pre-eclampsia?

Answer 9

• placental ischemia which leads to an imbalance in circulating angiogenic and anti angiogenic factors. this ischemia occurs when the trophoblasts FAIL to invade the tunica media smooth muscle of the maternal spiral arteries and the muscular layer still remains → ischemia of the placenta

Question 10

failure of ___________ is said to be the most likely cause of pre eclampsia

Answer 10

the trophoblastic cells to invade and remove the smooth muscle layer of the spiral arteries → placental ischemia

the spiral arteries fail to dilate and thin out like in normal pregnancy due to lack of smooth muscle coat (lack of SM = dilate)

Question 11

DIC is seen in pre eclampsia / eclampsia

Answer 11

eclampsia

Question 12

what would you expect to see on histology of the placenta in a patient with eclampsia?

Answer 12

• acute atherosis: foamy macrophages in necrotic vessel wall and later get macrophages and lymphocytes
• hyaline deposition in the endothelium

Question 13

_____ necrosis is seen in the placenta in eclampsia

Answer 13

fibrinoid

Question 14

chorionic villi has a inner _______ tissue and outer ________ tissue

Answer 14

inner cytotrophoblast and outer synctitiotrophoblast

Question 15

what are 4 gestational trophoblastic diseases?

Answer 15

• hydatidiform mole (molar pregnancy)
• invasive mole
• gestational choriocarcinoma
• placental stie trophoblastic tumor

Question 16

all of the trophoblastic diseases will have ↑ βHCG except _______

Answer 16

placental site trophoblastic tumor

Question 17

hydatidiform mole is due to an abnormal proliferation of _____

Answer 17

chorionic vili (trophoblasts) which are large edematous avascular villi

Question 18

_______ mole is fertilized by two sperms (ovum has lost all of its chromosomes so it it is an empty ovum)

Answer 18

complete mole; (46 XX or rarely 46 XY)
no fetal parts are seen and the uterus will be enlarged and filled with grape like vesicles

complete mole = compete father

Question 19

______ mole has an ovum that is fertilized by 2 different sperms (X and Y) → 69 XXY

Answer 19

partial mole; fetal parts may be seen

partial: part mother part father

Question 20

which one has higher βHCG levels: complete or partial mole

Answer 20

complete because it has a complete circumferential proliferation of the trophoblastic cells

Question 21

_________ is the tissue that develops into carcinoma in gestational choriocarcinoma

Answer 21

fetal trophoblastic tissue where half of the time it comes from molar pregnancies

Question 22

gestational choriocarcinoma can/ cannot be treated with chemotherapy

Answer 22

CAN be treated with chemotherapy.

NON gestational choriocarcinoma in the ovary CANNOT be treated with chemotherapy

Question 23

can you see chorionic villi in gestational choriocarcinoma?

Answer 23

NO

Question 24

________ (gestational trophoblastic disease) is due to the proliferation of intermediate trophoblasts and cytotrophoblasts in the uterus

Answer 24

placental site trophoblastic tumor

Question 25

↑/ ↓/ normal β HCG levels in placental site trophoblastic tumor

Answer 25

↓ ↓

Question 26

which of the gestational trophoblastic diseases have no chorionic villi?

Answer 26

placental site trophoblastic tumor and gestational choriocarcinoma

Question 27

the most common cause of spontaneous abortion is _______

Answer 27

chromosomal abnormalities in the fetus

Question 28

which placental abnormality presents with 3rd trimester bleeding?

Answer 28

placenta previa and placenta abruptia

Question 29

patients with pre eclampsia will see fibroid necrosis in ______

Answer 29

vessels of the placenta

Question 30

a pregnant patient goes in for a routine ultrasound in her first trimester and the physical observes a snow storm appearance on US; diagnosis?

Answer 30

hydatidiform mole

Question 31

complete/partial mole will have NO fetal tissue

Answer 31

complete mole; completely a mole (completely father)

Question 32

complete/partial mole has a higher risk for choriocarcinoma

Answer 32

complete

Question 33

69 chromosomes is seen in complete/partial mole

Answer 33

partial

Question 34

_______ pathway of choriocarcinoma responds well to chemotherapy

Answer 34

gestational (such as if it arises as a complication of molar pregnancy); the germ cell pathway does not