Repro 12 - Pregnancy Part 2

Question 1

What is a hydatidiform mole?

Answer 1

Abnormal fertilization that leads to proliferation of trophoblastic cells. Tumor arises from gestational tissue. Histologically: edematous chorionic villus. Most common precursor of choriocarcinoma. It can be complete or partial hydatidiform moles.

Question 2

What is the most common precursor of choriocarcinoma?

Answer 2

Hydatidiform mole.

Question 3

What is a Complete Hydatidiform Mole?

Answer 3

There is 2 sets of paternal chromosomes; 46XX or 46XY. 85% of cases are from 1 haploid sperm fertilizing ovum and then duplicating its chromosomes (maternal chromosomes absent or inactivated). The rest of the cases are due to fertilization by two sperm.

Question 4

What are the symptoms of Complete Hydatidiform Mole?

Answer 4

Markedly elevated Beta-hCG. Large uterus from what is expected at the time: can lead to early uterine rupture. No fetal parts. 2% choriocarcinoma. 15-20% are malignant trophoblastic disease; they invade other tissues but they don’t penetrate the base membrane like true cancer.

Question 5

What is a partial hydatidiform mole?

Answer 5

Caused by 2 sperm fertilizing 1 egg. This causes 69XXY/XXX/XYY.

Question 6

What are the symptoms of Partial hydatidiform mole?

Answer 6

Elevated beta-hCG (but not as high as in complete hydatidiform mole). Normal uterine size. Some fetal parts. Choriocarcinoma is rare and there is low risk of malignant trophoblastic disease. Can cause vaginal bleeding but not early uterine rupture as seen in complete hydatidiform mole.

Question 7

What do we see in ultrasound in both complete and imcomplete hydatidiform mole?

Answer 7

Honeycomb, or Snowstorm appearance.

Question 8

What is the treatment for hydatidiform mole?

Answer 8

Dilation and curettage (D&C). Serial measurements of beta-hCG after D&C to make sure that they go down to zero. If they do not go down to zero, give methotrexate and/or other chemotherapy to kill the rest of the tissue. No pregnancy 6 to 12 months.

Question 9

What are the different types of placenta previa?

Answer 9

Complete. Partial. Marginal. Low-lying.

Question 10

What is the symptoms of Placenta previa? How do we diagnose it?

Answer 10

Painless vaginal bleeding at the third trimester. We diagnose it with ultrasound.

Question 11

What is a vasa previa?

Answer 11

Fetal blood vessels cover the cervix; risk of fetal hemorrhage and death.

Question 12

What is Placenta accreta? What is the only treatment?

Answer 12

A defective decidua basalis causes the placenta to attach directly to myometrium and cannot detach after delivery. Only treatment is hysterectomy.

Question 13

What is placenta increta?

Answer 13

A type of placenta accreta, the placenta grows into wall of uterus.

Question 14

What is placenta percreta?

Answer 14

A type of placenta accreta, the placenta perforates thru the uterus.

Question 15

What is abruptio placentae?

Answer 15

A premature detachment of the placenta, the bleeding happens inside the uterus, irritating it, causing lots of contraction, pain and a rapid labor; painful vaginal bleeding at the third trimester. Can lead to DIC or fetal death.

Question 16

What are risk factors for placenta abruptio? What is the test to diagnose for this?

Answer 16

Trauma, abuse. Stims (smoking, cocaine). HTN. The test to diagnose this is Kleihauer-Betke test.

Question 17

What does the Kleihauer-Betke test tests for?

Answer 17

For placental abruption by looking for fetal RBCs in the mother’s blood.

Question 18

What is polyhydramnios? Oligohydramnios?

Answer 18

Polyhydramnios: too much amniotic fluid (1.5-2 liters). Oligohydramnios: too little amniotic fluid (less than 0.5 liters).

Question 19

What would be the cause of polyhydramnios?

Answer 19

Esophageal or duodenal atresia. Anencephaly. Maternal diabetes. Genetic disorders.

Question 20

What would be the cause of oligohydramnios?

Answer 20

Placental insufficiency. Bilateral renal agenesis. Posterior urethral valves.

Question 21

What is the triad of Potter syndrome?

Answer 21

Oligohydramnios. Limb and facial deformities. Pulmonary hypoplasia.

Question 22

What is the difference b/w chronic HTN vs Gestational HTN?

Answer 22

Chronic HTN is BP equal to or more than 140/90 before 20 weeks. Gestation is BP 140/90 AFTER 20 weeks.

Question 23

What is the difference b/w preeclampsia and eclampsia?

Answer 23

Preeclampsia: BP equal or over 140/90, Proteinuria of 300 mg/24, and Edema (though no longer on the official list). It becomes Eclampsia when the mother presents w/ seizures. Both are after 20 weeks.

Question 24

What other diseases is preeclampsia/eclampsia associated w/?

Answer 24

HTN. Diabetes. Chronic renal disease. Autoimmune disorder (Lupus, Antiphospholipid antibody syndrome).

Question 25

What is the triad of HELLP syndrome? What are the symptoms?

Answer 25

Hemolysis. Elevated Liver enzymes. Low Platelets; the hemolysis causes anemia, the elevated liver enzymes causes RUQ pain and maybe jaundice, the low platelets cause easy bruising and bleeding.

Question 26

What is the treatment for seizures in eclampsia?

Answer 26

IV magnesium.

Question 27

What are the signs of IV magnesium toxicity?

Answer 27

Decreased or absent Deep tendon reflexes. Pulmonary edema. AMS (altered mental state). Cardiac conduction defects.

Question 28

What are the differences seen in the fetus in someone w/ gestational diabetes versus Type I and II diabetes?

Answer 28

In gestational diabetes, it causes macrosomia. In type I and II can cause miscarriage and fetal anomalies (congenital heart defects, neural tube defects, Caudal regression syndrome): high glucose is toxic and teratogenic in the first 10 weeks of life (cannot get this in gestational diabetes).

Question 29

What is the most common cause of bleeding after delivery?

Answer 29

Uterine atony.

Question 30

What are the causes of bleeding after delivery?

Answer 30

Uterine atony. Retained placenta. Genital lacerations.

Question 31

What is Sheehan syndrome?

Answer 31

Massive bleeding and hypotension during labor causing infarction of pituitary. This causes Hypopituitarism: no lactation, amenorrhea, cold intolerance.

Question 32

What is the most common place of ectopic pregnancy?

Answer 32

99% happens somewhere in the tube (interstitial, isthmic tubal, ampulla).

Question 33

What are the risk factors of ectopic pregnancy?

Answer 33

Infertility. Salpingitis. PID. Ruptured appendix. Endometriosis. Prior tubal surgery. Current IUD.

Question 34

What is the pharmacological treatment for ectopic pregnancy?

Answer 34

Methotrexate.

Question 35

What are six common causes of recurrent Miscarriage?

Answer 35

Low progesterone. Chromosomal abnormalities. Uterine abnormalities. Infections. Poor maternal health. Autoimmune/clotting disorders.

Question 36

What is Asherman syndrome?

Answer 36

The formation of a scar tissue in the uterine cavity due to uterine surgery. This leads to recurrent miscarriage.

Question 37

A pregnant woman at 16 weeks of gestation presents w/ an atypically large abdomen and hypertension. What abnormality might be seen on blood test, and what is the disorder?

Answer 37

A complete hydatidiform mole. Causes very high levels of beta-hCG.

Question 38

What is the difference b/w placenta previa, abruptio, and accreta?

Answer 38

Placenta previa: placenta overlies the cervical os and painless vaginal bleeding and requires C-section. Placenta abruptio: painful vaginal bleeding from premature placental separation, associated w/ stim use and trauma. Placenta accreta: placenta does not separate after birth due to abnormal attachment to myometrium.

Question 39

A pregnant woman w/ previous c-section is at increased risk for which placental abnormalities?

Answer 39

Placenta previa. Placenta accreta. The scar in the endometrium and is a common place where the placenta would grab on and grow abnormally.

Question 40

A 15-y.o female patient of yours who normally comes w/ her parents presents alone this time. She states that she is sexually active but that she knows she is not pregnant because she has never menstruated. What would be the appropriate next step in managing this patient?

Answer 40

Evaluate for delayed puberty. Education. Pregnancy test. Contraception.