Twenty Three Flashcards
(15 cards)
What is ectopic pregnancy? Where does it normally occur? What is the major risk factor? What is the classic presentation?
I. E C T O P I C PREGNANC Y
A, Implantation of fertilized ovum at a site other than the uterine wall; most c o m m o n
site is the lumen of the fallopian tub e (Fig. 13.17).
B. Key risk factor is scarring (e.g., secondary to pelvic inflammatory disease or
endometriosis).
C. Classic presentation is lower quadrant abdominal pain a few weeks after a missed
period.
1 . Surgical emergency; majo r complications are bleeding into laliopian tube
(hematosalpinx) and rupture.
What is spontaneous abortion? When does it occur? How common is it/ How does it present? What are the most common causes? How does the timetable of teratogens effect the fetal results?
H, S P O N T A N E O U S A B O R T I O N
A. Miscarriage of fetus occurring before 20 weeks gestation (usually during first
trimester)
i. Common; occurs in up to 1/4 of recognizable pregnancies
B. Presents as vaginal bleeding, cramp-like pain, and passage of fetal tissues
C. Most often due to chromosomal anomalies (especially trisomy 16); other causes
include hypercoagulablc stales (e.g., antiphospholipid syndrome) , congenital
infection, and exposure to teratogens (especially during the first 2 weeks of embryogenesis).
t. Effect of teratogens generally depends on the dose, agent, and time of exposure
(Table 12.1).
i. First two weeks of gestation—spontaneous abortion
ii. Weeks 3-8—ris k of organ malformatio n
iii. Months 3-9—ris k of organ hypoplasia
What is placenta previa? How does it present? Treatment?
III. PLACENT A PREVI A
A. Implantation of the placenta in the lower ulerine segment; placenta overlies cervical
os (opening).
B. Presents as third-trimester bleeding
C. Often requires delivery of fetus by caesarian section
What is placental abruption? How does it present? Outcome? What is it associated with?
IV. PLACENTA L A B R U P T I O N
A. Separation of placenta from the decidua prior to delivery of the fetus (Fig. 13.18}
B. C o m m o n cause of still birth
C. Presents with third-trimester bleeding and fetal insufficiency
Abruption is associated with maternal smoking, advanced maternal age, chorioamnionitis, cocaine use, preeclampsia and eclampsia
What is placenta accreta? How does it present? Treatment? What are some risk factors?
V. PLACENT A ACCRET A
A. Improper implantation of placenta into the myometrium with little or no
intervening decidua
B . Presents with difficult delivery of the placenta and postpartum bleeding
C. Often requires hysterectomy
Can occur with previa or if placenta
implants on old C-section scar
What is preeclampsia? Pathophys? What is eclampsia? What is HELLP? What is the treatment for eclampsia and HELLP?
VI. P R E E C L A M P S I A
A. Pregnancy-induced hypertension, proteinuria, and edema, usually arising in the
third trimester; seen in approximately 5% of pregnancies
I. Hypertensio n may be severe, leading to headaches and visual abnormalities.
B. Due to abnormality of the maternal-fetal vascular interface in the placenta; resolves with delivery
C. Eclampsia is preeclampsia with seizures.
D. HELLP is preeclampsia with thrombotic microangiopathy involving the liver; characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets
E. Both eclampsia and HELLP usually warrant immediate delivery.
What is a hydatiform mole? Compare and contrast it with normal pregnancy. How does it present w/o prenatal care? With prenatal care? What is the treatment? How is the treatment monitored? What are the two types of choriocarcinoma? How are they clinically different?
A. Abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts
B Uterus expands as if a normal pregnancy is present, but the uterus is much larger and p-hCG much higher than expected for date of gestation.
C. Classically presents in the second trimester as passage of grape-like masses through the vaginal canal (Fig. 13.19A).
i. With prenatal care, moles are diagnosed by routine ultrasound in the early first trimester. Fetal heart sounds are absent, and a ‘snowstorm’ appearance is classically seen on ultrasound.
D. Classified as complete or partial (Table 12.2}
E. Treatment is dilatation and curettage.
1 . Subsequent (3-hCG monitoring is important to ensure adequate mole removal and to screen for the development of choriocarcinoma.
i. Choriocarcinoma may arise as a complication of gestation (spontaneous abortion, normal pregnancy, or hydatidiform mole} or as a spontaneous germ
cell tumor.
ii. Choriocarcinomas that arise from the gestational pathway respond well to chemotherapy; those that arise from the germ cell pathway do not.
Constrast partial moles and complete moles.
PARTIAL MOLE
Genetics: Normal ovum fertilized by two sperm (or one sperm that duplicates chromosomes): 69 chromosomes
Fetal tissue: Present
Villous edema:Some villi are hydropic, an d some
are normal.
Trophoblasti c proliferation: Focal proliferation preseot around hydropic villi
Ris k for choriocarcinoma: Minima l
COMPLETE MOLE
Empty ovum fertilized by two sperm (or one sperm that duplicates chromosomes); 46 chromosomes
Absent
Most vill i are hydropic (Fig. 13.19B).
Diffuse, circumferential proliferation around hydropic villi
2-3 %
What is a fetus papyraceus?
If fetus is not delivered may be resorbed or
remain as fetus papyraceus .
What are some things that can go wrong with the umbilical cords? What is marginal insertion? Velamentous insertion? What is a short cord associated with? Too long? Excessive twisting? What occurs with a single umbilical artery?
c) Abnormal umbilical cords
i) Knots and entanglement
ii) Abnormal insertion
(1) Marginal: at the edge of placenta
(2) Velamentous (Membranous): cord inserts on fetal membranes.
iii) Too long, too short, too twisted
(1) Too short: (72 cm) knots, entanglement, still birth, neonatal death can occur, can be associated with entanglement, still birth, neonatal death
(3) Excessive twisting can cause thrombi, occlusion, hypoperfusion, stricture, fetal death. On average 11 coils in a normal umbilical cord.
iv) Single umbilical artery. 1% of all placentas, increased risk of visceral anomaly (particularly renal and cardiovascular but any system abnormality can occur), intrauterine growth retardation.
What is a limb body wall anomaly?
Thoracoschisis
Abdominoschisis
Limb defects
Exencephaly
And short cord
What are 3 different types of twins? Some general rules?
Diamnionic Dichorionic
Diamnionic Monochorionic
Monoamnionic Monochorionic
The Rules:
All fraternals are DiDi,
All Monochorionic are identical
What is twin twin transfusion syndrome? When does it most often occur?
Placental vascular anatomosis allow sharing of fetal circulations thru shunting. Imbalance in blood flow can cause fetal demise
Most often in Diamnionic
Monochorionic twins
What is the most common type of fetal infection? What does it lead to? What usually causes it? What is it associated with?
Most common type of infection
Leads to acute
chorioamnionitis, funisitis
Usually bacterial
Associated with PROM,
prematurity
What organisms lead to fetal infection through hematogenous spread? What do they lead to?
TORCH agents, virus, occasional
bacteria (Syphilis, Listeria) in
mothers blood
Villitis
