reproductive pathology 2

Question 1

pregnancy complications - types

Answer 1

1. placental abruption (abruptio placentae)
2. Placenta accreta/increta/percreta
3. Placental previa
4. Vasa previa
5. Postpartum hemorrhage
6. Ectopic pregnancy
7. hypertension

Question 2

placental abruption (abruptio placentae) - definition

Answer 2

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

Question 3

placental abruption (abruptio placentae) - risk factors

Answer 3

1. trauma (eg. motor vehicle accident)
2. smoking
3. cocaine abuse
4. hypertension
5. preeclampsia

Question 4

placental abruption (abruptio placentae) - presentation

Answer 4

1. abrupt, painful bleeding (concealed or apparent) in 3 third trimester
2. possible DIC
3. materna shock
4. fetal distress
5. Life threatening for mother and fetus

Question 5

Placenta accreta/increta/percreta general mechanism and results

Answer 5

defective decidual layer –> abnormal attachment and separation after delivery

Question 6

Placenta accreta/increta/percreta - types (distinguished by) and MC

Answer 6

distinguishable by depth of penetration:

1. Placenta accreta (MC)
2. Placent increta
3. Placenta percreta

Question 7

Placenta accreta?

Answer 7

placenta attaches to myometrium without penetrating it

Question 8

Placenta increta?

Answer 8

placenta panetrates INTO myometrium

Question 9

Placenta percreta?

Answer 9

placenta penetrates myometrium and into uterine serosa (invades entire uterine wall) –> can result in placental attachment to rectum or bladder

Question 10

Placenta accreta/increta/percreta - types, definition of every type and MC

Answer 10

1. Placenta accreta (MC) –> placenta attaches to myometrium without penetrating it
2. Placent increta –> placenta panetrates INTO myometrium
3. Placenta percreta –> placenta penetrates myometrium and into uterine serosa (invades entire uterine wall) –> can result in placental attachment to rectum or bladder

Question 11

Placenta accreta/increta/percreta - presentation

Answer 11

1. often detecten on US prior to delivery

2. no separation of placenta after delivery –> postpartum bleeding (can cause Sheehan syndrome)

Question 12

Placenta accreta/increta/percreta - risk factors

Answer 12

1. prior C section
2. inflammation
3. placenta previa

Question 13

Placenta previa?

Answer 13

attachment of placenta to lower uterine segment over (or less than 2 cm from) internal cervical os

Question 14

Placenta previa - risk factors

Answer 14

1. multiparity

2. prior C-secion

Question 15

Placenta previa can also cause

Answer 15

Placenta accreta/increta/percreta

Question 16

Placenta previa - types

Answer 16

compete –> covers all the os

partial –> covers not the entire os

Question 17

Vasa previa?

Answer 17

fetal vessels run over, or in close proximity to, cervical os

Question 18

Vasa previa - results in

Answer 18

1. vessel rupture
2. exsanguination (blood loss, to a degree sufficient to cause death)
3. fetal death

Question 19

Vasa previa - presentation

Answer 19

TRIAD

1. membrane rupture (rupture of the amniotic sac)
2. painless vaginal bleeding
3. fetal bradycardia (less than 110 beats/min)

Question 20

Vasa previa - management

Answer 20

emergency C-section

Question 21

Vasa previa is frequently associated with

Answer 21

velamentous umbilical insertion

Question 22

velamentous umbilical insertion?

Answer 22

cord inserts in chorioamniotic membrane rather than placenta –> fetal vessels travel to placenta unprotected by Wharton jelly

Question 23

Postapartum haemorrhage is due to (and MC)

Answer 23

mnemonic 4Ts
Tone uterine atony (MC)
Trauma - lacerations, incisions, uterine rupture 
Thrombin - coagulopathy 
Tissue - retaind products of conception

Question 24

uterine atony –> hemorrhage - mechanism

Answer 24

Normally, contraction of the uterine muscle compresses the vessels and reduces flow

Question 25

ectopic pregnancy - presentation

Answer 25

1. pain (clinically mistaken by appendicitis) | 2. bleeding (+/-)

Question 26

ectopic pregnancy - risk factors

Answer 26

1. prior ectopic pregnancy 2. history of infertility 3. salpingitis (PID) 4. Ruptured appendix 5. Prior tubal surgery

Question 27

ectopic pregnancy - confirm diagnosis with

Answer 27

US

Question 28

ectopic pregnancy - suspect it when

Answer 28

1. history of amenorrhea 2. lower tha excpected rise in hCG (based on dates) 3. sudden lower abdominal pain

Question 29

ectopic pregnancy - most often area

Answer 29

Ampulla of fallopian tube

Question 30

treatment of an ectopic pregnancy is necessary to

Answer 30

prevent serious , even life threatening complications

Question 31

Amniotic fluid abnormalities - types and defintion

Answer 31

1. Polyhydramnios: too much amniotic fluid | 2. Oligohydramnios: too little amniotic fluid

Question 32

causes of polyhydramnions

Answer 32

1. fetal malformations (eg. esophageal/duodenal atresia, anencephaly -->both inability to swallow amniotic fluid) 2. maternal diabetes 3. fetal anemia 4. multiple gestations

Question 33

causes of oligohydramnios

Answer 33

1. placental insuficiency 2. bilateral renal agenesis 3. posterior urethral valves (males) 4. ARPKD (inability to excrete urine)

Question 34

oligohydramnios - complications

Answer 34

POTTER sequence

Question 35

Potter sequence (syndrome) - presentation

Answer 35

1. limb deformites 2. facial anomalies (low set ears, retrognathia, flattened nose) 3. pulmonary hypoplasia