Flashcards in Repro - Pathology (Pregnancy conditions) Deck (45)
What is a hydatidiform mole?
Cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast).
What is the karyotype in complete versus partial mole?
COMPLETE MOLE: 46,XX; 46,XY; PARTIAL MOLE: 69,XXX; 69,XXY; 69,XYY
What is the hCG level in complete versus partial mole?
COMPLETE MOLE: MARKEDLY increased (four arrows up); PARTIAL MOLE: increased (only one arrow up)
What is the uterine size in complete versus partial mole?
COMPLETE MOLE: Increased; PARTIAL MOLE: No Change
What is the likelihood of conversion to choriocarcinoma in complete versus partial mole?
COMPLETE MOLE: 2%; PARTIAL MOLE: Rare
Are there fetal parts in complete versus partial mole?
COMPLETE MOLE: No; PARTIAL MOLE: Yes (Think: "PARtial = fetal PARTs")
What are the components in complete versus partial mole?
COMPLETE MOLE: Enucleated egg + single sperm (subsequently duplicates paternal DNA); empty egg + 2 sperm is rare; PARTIAL MOLE: 2 sperm + 1 egg
What is the risk of complications in complete versus partial mole?
COMPLETE MOLE: 15-20% malignant trophoblastic disease; PARTIAL MOLE: Low risk of malignancy (< 5%)
What are the symptoms in complete versus partial mole?
COMPLETE MOLE: Vaginal bleeding, enlarged uterus, hyperemesis, preeclampsia, hyperthyroidism; PARTIAL MOLE: Vaginal bleeding, abdominal pain
What is seen in imaging for complete versus partial mole?
COMPLETE MOLE: Honeycombed uterus or "clusters of grapes", "snowstorm" on ultrasound; PARTIAL MOLE: Fetal parts
What is another name for gestational hypertension? How is it defined?
Pregnancy-induced hypertension; BP > 140/90 mmHg after the 20th week of gestation. No pre-existing hypertension. No proteinuria or end-organ damage.
What is the treatment for gestational hypertension?
Treatment: antihypertensive (alpha-methyldopa, labetalol, hydralazine, nifedipine), deliver at 39 weeks
How is preeclampsia defined? How is it distinguished from molar pregnancy?
Defined as hypertension (> 140/90 mmHg) and proteinuria (> 300 mg/24 hr) after 20th week of gestation to 6 weeks postpartum (< 20 weeks suggests molar pregnancy).
What are the severe features characteristic of preeclampsia?
Severe features include BP > 160/110 mmHg with or without end-organ damage, e.g., headache, scotoma, oliguria, increased AST/ALT, thrombocytopenia.
What causes preeclampsia? What are 3 possible consequences related to this?
Caused by abnormal placental spiral arteries, results in maternal endothelial dysfunction, vasoconstriction, or hyperreflexia.
In what patient populations is the risk for preeclampsia increased?
Incidence increases in patients with preexisting hypertension, diabetes, chronic renal disease, or autoimmune disorders.
What are complications associated with preeclampsia?
Complications: placental abruption, coagulopathy, renal failure, uteroplacental insufficiency, or eclampsia.
What is the treatment for preeclampsia?
Treatment: Antihypertensives, deliver at 34 weeks (severe) or 37 weeks (mild), IV magnesium sulfate to prevent seizure.
What is eclampsia? What is an important complication to consider?
Preeclampsia + maternal seizures; Maternal death due to stroke --> intracranial hemorrhage or ARDS
What is the treatment for eclampsia?
Treatment: Antihypertensives, IV magnesium sulfate, immediate delivery
What is a manifestation of severe preeclampsia that may occur without hypertension?
HELLP syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets. A manifestation of severe preeclampsia, although may occur without hypertension.
What is the treatment for severe preeclampsia (HELLP syndrome)?
Treatment: immediate delivery
What is placental abruption (abruptio placentae)?
Premature separation (partial or complete) of placenta from uterine wall before delivery of infant.
What are risk factors for placental abruption?
Risk factors: Trauma (e.g., motor vehicle accident), smoking, hypertension, preeclampsia, cocaine abuse.
What is the presentation of placental abruption? What are the more severe complications to consider?
Presentation: Abrupt, painful bleeding (concealed or apparent) in third trimester; possible DIC, maternal shock, fetal distress. Life threatening for mother and fetus.
What causes and defines placenta accreta/increta/percreta? What distinguishes these three? Which is most common?
Defective decidual layer --> abnormal attachment and separation after delivery; Three types distinguishable by the depth of penetration; Placenta accreta = most common type;
What are the risk factors for placenta accreta/increta/percreta?
Risk factors: prior C-section, inflammation, placenta previa.
What is placenta accreta?
Placenta attaches to myometrium without penetrating it; most common type; Think: "Accreta attaches"
What is placenta increta?
Placenta penetrates into myometrium; Think: "Increta into"