13.7 Gestational Path Flashcards
What is the most common site for an ectopic pregnancy?
Lumen of the fallopian tube
What is the key risk factor for ectopic pregnancy?
Scarring of the uterus (e.g. asherman syndrome, PID, endometriosis)
What is the classic presentation of an ectopic pregnancy?
Lower quadrant abdominal pain weeks after a missed period
What is the treatment for an ectopic pregnancy?
Surgical emergency
What is the definition of a spontaneous abortion?
Miscarriage of the fetus, before 20 weeks gestation
What is the classic presentation of spontaneous abortions?
Vaginal bleeding, cramp-like pain, and passage of fetal tissue
What is the most common cause of spontaneous abortions?
Chromosomal anomalies
What is the classic hypercoagulable state that can produce recurrent miscarriages?
SLE–lupus anticoagulant
Exposure to a teratogen within the first 2 weeks of gestation usually leads to what?
spontaneous abortion
Exposure to a teratogen between 3-8 weeks gestation usually leads to what?
malformations
Exposure to a teratogen between 3-9 months usually leads to what?
Organ hypoplasia
What is placenta previa?
Implantation of the placenta in the lower uterine segment, overlying the os
How does placenta previa usually present?
Third trimester bleeding
What is the treatment for placenta previa?
C-section
What is placental abruption?
Separation of the placenta from the decidua, prior to delivery of the fetus
Placental abruption usually leads to what?
Still birth
What is the usual presentation of placental abruption?
Third trimester bleeding and fetal insufficiency
What are the gross characteristics of placental abruption?
Large blood clots between placenta and uterine wall
What is placenta accreta?
Improper implantation of the placenta into the myometrium with little or no intervening decidua
What is the usual presentation of placental accreta?
Difficult delivery of the placenta and postpartum bleeding
What is the treatment for placenta accreta?
Hysterectomy
What is preeclampsia? What causes it?
Pregnancy-induced HTN, proteinuria, and edema in the 3rd trimester, d/t abnormality of maternal-fetal vascular interface in placenta
What is seen in the vessels of the placenta with preeclampsia?
Fibrinoid necrosis
What is eclampsia?
seizure induced by HTN from baby
What is HELLP syndrome?
Preeclampsia with thrombotic microangiopathy involving the liver
What are the labs that are elevated with HELLP syndrome? (3)
Hemolysis
Elevated LFTs
Low platelets
What causes the hemolysis with HELLP?
Platelet deposition in the blood vessels leading to schistocyte formation
What is SIDS? What is the age range that this occurs in?
Death of a healthy infant between 1 month to 1 year
What type of sleeping is a risk factor for the development of SIDS?
Sleeping on the stomach
What are the environmental risk factors for SIDS?
Smoking in house
Prematurity
What are hydatidiform moles?
Abnormal conception characterized by swollen and edematous villi, with proliferation of the trophoblasts
What are the classic s/sx of hydatidiform moles? (2)
- Uterus bigger than expected for dates of gestation
- beta-HCG higher than expected
What are the gross characteristics of hydatidiform moles?
Swollen and edematous villi
What are the presenting s/sx of a hydatidiform mole w/o prenatal care?
Passage of grape-like masses through the vaginal canal in the 2ns trimester
What are the grape-like masses that are passed with hydatidiform moles composed of?
Large, edematous villi
What are the classic US findings of hydatidiform moles?
Snow-storm appearance
What is the presentation of hydatidiform moles WITH prenatal care?
US with snowstorm appearance and without fetal heart sounds
What is the difference in partial and complete moles in terms of: genetics?
Partial = normal ovum fertilized by 2 sperm (69 chromosomes)
Complete = a-genetic ovum, fertilized by 2 sperm (46 chromosomes)
What is the difference in partial and complete moles in terms of: presence of fetal tissue
Present with partial moles
Absent with complete
What is the difference in partial and complete moles in terms of: villi appearance?
Partial = some normal, some edematous
Complete= all villi are hydropic
What is the difference in partial and complete moles in terms of: trophoblastic proliferation?
Partial = focal proliferation present around hydropic villi
Complete = diffuse, circumferential proliferation around hydropic villi
What is the difference in partial and complete moles in terms of: risk for choriocarcinoma?
Partial = minimal Complete = 2-3%
What is the difference in partial and complete moles in terms of: beta-HCG levels? Why?
Complete = super high Partial = high, but not as high
Trophoblasts secrete HCG, and there are more aberrant trophoblasts in complete moles
What is the treatment for a mole?
D and C, following beta-HCG to ensure all tissue is expelled, and ensure no choriocarcinoma
What are the villi like in choriocarcinoma?
There are none–proliferation of syncytiotrophoblasts and cytotrophoblasts
What are the two ways to get choriocarcinomas?
complication of a mole, or arise primarily from germ cell tumor
How do you differentiate between choriocarcinomas 2/2 moles vs primary?
ones from moles respond well to chemo, whereas primary do NOT
What is the effect of EtOH on the developing fetus?
MR
Long philtrum
What is the effect of cocaine on the developing fetus?
IUGR, and placental abruption
What is the effect of thalidomide on the developing fetus?
Limb defects
What is the effect of cigarette smoke on the developing fetus?
IUGR
What is the effect of isotretinoin on the developing fetus?
Spontaneous abortion
Hearing loss
Visual impairments
What is the effect of tetracyclines on the developing fetus?
Discolored teeth
What is the effect of Warfarin on the developing fetus?
Fetal bleeding
What is the effect of phenytoin on the developing fetus?
Digit hypoplasia
cleft lip/palate
