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Repro/GU > 208, 209, 210 Pregnancy > Flashcards

208, 209, 210 Pregnancy Flashcards

1
Q

What changes occur in the uterus during pregnancy?

A

massively increases in size and volume

hypertrophy from estrogen (and maybe progesterone)

increased blood flow

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2
Q

What changes occur in the cervix during pregnancy?

A

softening, cyanosis (early pregnancy)

hypertrophy and hyperplasia with eversion of columnar endocervical glands

production of mucus rich in immunoglobulins (protects from vaginal bacteria)

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3
Q

What changes occur in the vagina during pregnancy?

A

increased vascularity (Chadwick sign)

increased mucosal thickness

loosened connective tissue

hypertrophy of smooth muscles

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4
Q

How long is the corpus luteum present and functional during pregnancy?

A

until 7 weeks gestation

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5
Q

What are the symptoms of a luteoma?

A

maternal virilization

no effect on fetus

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6
Q

What cardiac changes are normal in pregnancy?

A

heart displaces up and to the left (looks in larged on CXR)

increased blood volume (50%)

increased resting heart rate (15%)

both of which lead to increased cardiac output

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7
Q

What vascular changes are normal in pregnancy?

A

blood pressure decreases in second trimester and returns to normal levels in third trimester

impaired venous return with an increase in SVR

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8
Q

What respiratory changes are normal in pregnancy?

A

elevated diaphragm and increased subcostal angle

increased tidal volume, decreased residual volume

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9
Q

What GI changes are normal in pregnancy?

A

displacement of stomach and intestines by uterus

increased hepatic blood flow (can have “abnormal” alk phos and albumin)

reduced gallbladder contractility

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10
Q

What renal/urinary changes are normal in pregnancy?

A

increased kidney size and GFR (may need to serum creatinine decrease)

uterine displacment of ureters

increased bladder pressure

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11
Q

What hematologic changes are normal in pregnancy?

A

hypervolemia

increased erythrocyte volume (slight increase in Hb and Hct)

increased iron requirement

can have slight leukocytosis (increased CD8, decreased CD4)

increased clotting factors

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12
Q

What factors regulate placental transfer of nutrients?

A

maternal blood flow and surface area of exchange

concentration of nutrients and mode of transport

rate of fetal blood flow and surface area of exchange

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13
Q

What changes to fetal circulation occur at birth?

A

foramen ovale closes

ductus venosus and umbilical vessels collapse

closure of ductus arteriosus (due to marked decrease in pulmonary vascular resistance because of loss of fluid)

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14
Q

What makes most of the amniotic fluid volume?

A

fetal kidneys secreting urine (after 16 weeks of gestation)

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15
Q

What is the difference in O2 saturation between fetal and adult hemoglobin?

A

fetal hemoglobin has increased oxygen affinity relative to adult hemoglobin

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16
Q

What is the role of CRH in labor and delivery?

A

stimulates maternal adrenals to produce DHES –> increases placental estrogen synthesis –> stimulates myometrial contractility

also accelerates maturation of fetal lungs

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17
Q

What factors mediate myometrial contractility for labor and delivery?

A

prostaglandin F2alpha and oxytocin bind to cells and promote calcium channel opening –> depolarizes cells and leads to contraction of myocytes

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18
Q

Frequency of contractions is controlled by ____________; force of contractions is controlled by ____________.

A

Frequency of contractions is controlled by frequency of action potentials; force of contractions is controlled by numer of fibers activated.

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19
Q

What are the milestones of stage 1 of labor?

A

interval between onset of labor and full cervical dilation

oncet of painful contractions with variable duration

rapid survical change

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20
Q

What are the milestones of stage 2 of labor?

A

interval between full cervical dilation and delivery of fetus

can last up to 4 hours (nulliparas) or 3 hours in multiparas

epidural analgesia decreases duration

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21
Q

What are the milestones of stage 3 of labor?

A

interval between delivery of neonate and delivery of placenta

usually occurs 10-30 mins after delivery

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22
Q

A 33 yo G3P2 at 28 weeks presents to her internist for her flu shot. She appears well but her resting heart rate is 100 bpm and her BP is 90/60. Her internist orders a CXR, which demonstrates a mildly enlarged cardiac silhouette. A d-dimer is elevated. An ABG is done that demonstrates mild respiratory alkylosis. What is her most likely diagnosis?

a) pulmonary embolus
b) acute influenza
c) cardiomyopathy
d) normal pregnancy

A

d) normal pregnancy

all of these changes (increased HR, decreased BP, enlarged CXR cardiac silhouette, elevated coagulation factors, mild respiratory alkylosis) are normal in pregnancy

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23
Q

A 38 yo G2P1 @ 7 weeks of pregnancy is taken to the operating room for suspected ovarian torsion. Laparoscopy confirms this diagnosis and the left ovary is removed. Pathology confirms the presence of a corpus luteum cyst on the removed ovary. What should be given to maintain her pregnancy?

a) nothing
b) estrogen
c) progesterone
d) hCG

A

c) progesterone

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24
Q

Oxygenated blood is delivered to the fetus from the:

a) umbilical arteries
b) umbilical vein
c) fetal lungs

A

b) umbilical vein

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25
Q

What treatments should be offered during preterm labor?

A

antenatal corticosteroids (fetal lung development)

antibiotics for GBS infection

diagnosis and treatment of underlying causes

26
Q

What strategies may be used to prevent preterm birth?

A

17-hydroxyprogesterone caproate

vaginal progesterone

cerclage in short cervix (a stitch) if prior preterm labor

screen/treat bacteriuria

treat symptomatic bacterial vaginosis

smoking cessation

longer intervals between pregnancies

27
Q

What is the definition of cervical insufficiency?

A

painless cervical dilation in absence of contractions, usually mid-trimester

may result in membrane prolapse, preterm premature rupture of membranes (PPROM) and preterm labor

28
Q

What is the difference between PROM and PPROM?

A

PROM = rupture of membranes prior to onset of labor

PPROM = rupture of membranes prior to onset of labor and before 37 weeks gestation

29
Q

How is premature membrane rupture diagnosed?

A

sterile speculum exam with vaginal pooling of basic fluid and microscopic “ferning” patterns

30
Q

How is PROM/PPROM managed?

A

hospitalize for duration of pregnancy with expectant management + steroids/antibiotics (if < 34 weeks)

31
Q

What is placenta previa?

A

implantation of placenta in location where it covers cervical os

characterized by painless bright red vaginal bleeding

32
Q

What are the risk factors for placenta previa?

A

prior cesarean delivery, multiparity, advanced maternal age, prior placenta previa, smoking

33
Q

What are the treatments for placenta previa?

A

monitor with pelvic rest

planned C-section at 37 weeks

expectant management if appropriate

monitor for progression to placenta accreta

34
Q

What is vasa previa? How is it diagnosed?

A

vaginal bleeding from fetal vessels

can theoretically diagnose with an Apt test (fetal blood cells won’t lyse in alkaline solution), but usually does not happen becuase this is an indication for rapid delivery (only takes minutes for a fetus to bleed out)

35
Q

What is placental abruption?

A

premature separation of placenta from the uterine wall and most typically characterized by vaginal bleeding in the presence of uterine contractions

vaginal bleeding may not always be evident (can be concealed bhind placenta)

36
Q

What are the risk factors for placental abruption?

A

hypertension, prior abruption, abdominal trauma, smoking, cocaine, uterine anomalies or submucosal fibroids, PPROM

37
Q

What is the definition of fetal growth restriction? What are common causes?

A

fetus less than 10th percentile for a given gestational age

fetal: aneuploidy, fetal anomalies, infection, multiple gestation
uteroplacental: chronic hypertension, preeclampsia, chronic abruption
maternal: malnutrition, drug use, smoking, chronic medical conditions

38
Q

What is the definition of preeclampsia?

A

new-onset hypertension and proteinuria

can have severe features (BP >160/110, maternal symptoms like headache/RUQ pain, hepatic injury/failure, renal injury/failure, pulmonary edema, coagulopathy, HELLP syndrome)

39
Q

What is the definition of Rh alloimmunization?

A

exposure of Rh negative mother to Rh positive fetal blood leads to antibody production that can result in hemolytic disease of fetus/newborn in subsequent pregnancies

prevent by giving Rh Ig to all pregnant women who are Rh negative

40
Q

What are the common etiologies of spontaneous abortion/miscarriage?

A

definition: pregnancy loss before week 20 of gestation

chromosomal abnormalities (most common), congenital anomalies, infection, uterine anomaly, maternal medical condition

41
Q

What are the common etiologies of intrauterine fetal demise/stillbirth?

A

definition: pregnancy loss after 20th week gestation

chromosomal abnormalities, congenital anomalies, maternal medical conditions, hypertensive disorders of pregnancy, infection, multiple gestations

42
Q

What is the mechanism of disease leading to Rh alloimmunization of the fetus? What is the earliest gestational age at which this can occur?

A

maternal IgG antibodies can cross placenta and directly hemolyze fetal RBCs that are Rh positive

treat starting at 28 weeks gestation

43
Q

How do fetal growth restriction and preeclampsia result in preterm delivery?

A

both are iatrogenic indicators –> balance of risk of harm to mother/fetus is higher with continued pregnancy than with delivery

44
Q

What is the difference between cervical insufficiency and preterm labor?

A

CI presents from weeks 16-24 with painless cervical dilation

preterm labor occurs later with painful uterine contractions and cervical changes

45
Q

What are the contents of the umbilical cord?

A

2 umbilical arteries (deoxygenated)

1 umbilical vein (oxygenated)

stroma (Wharton’s jelly)

covered by amnion

46
Q
A
47
Q

What structures of the placental disc come from the mother vs. fetus?

A

maternal: intervillous blood, decidua of disc and membranes
fetal: cord, chorionic plate, villous tree, chorion + amnion of membranes, trophoblasts in decidua

48
Q

What is uteroplacental insufficiency?

A

problems with getting maternal blood from circulation into the placenta, associated with hypertension and preeclampsia

caused by failure of fetal trophoblasts to remodel maternal vessels –> hypertension secondary renal arterial stenosis

49
Q

What are the placental manifestations of uteroplacental insufficiency?

A

abnormal maternal vessels (thick walled), global underperfusion problems (ex. growth restriction), focal/regional underperfusion (infarct, placental abruption)

50
Q

What is fetal vascular malperfusion?

A

problems getting fetal blood into the placenta and back

associated with cord accident and problems with fetal circulation (ex. heart disease, abnormal umbilical cord, thrombosis)

51
Q

What are causes of acute placental inflammation?

A

neutrophil-predominant inflammation in the placenta

caused by vaginal/GI microbes or hematogenous spread

52
Q

What are the maternal and fetal responses to acute placental inflammation?

A

maternal response: subchorionitis, chorionitis, amnion necrosis

fetal response: phlebitis, umbilical arteritis, necrotizing funisitis

53
Q

What is chronic placental inflammation?

A

lymphocyte or macrophage inflammation of the placenta

caused by infection or maternal anti-fetal rejection

54
Q

What are the complications of placenta previa?

A

requires c-section

if delivery attempted, can lead to severe hemorrhage with maternal and/or fetal demise

55
Q

What are the types of abnormally adherent placenta?

A

accreta = placental tissue on myometrium

increta = invasion of fetal placental tissues into myometrium

percreta = invasion of fetal placental tissues through uterine serosa and onto adjacent structures

56
Q

What are the different placental manifestations of twins?

A

dichorionic, diamniotic (thick dividing membrane)

monochorionic, diamniotic (thin dividing membrane)

monochorionic, monoamniotic (no membrane)

57
Q

What gametes make up a partial mole? What is the hCG level? What are the findings?

A

gametes: 1 egg + 2 sperm (69 chromosomes)

elevated hCG

fetal parts present, some hydropic placental villi

58
Q

What gametes make up a complete mole? What is the hCG level? What are the findings?

A

gametes: empty ovum + 2 sperm (46 chromosomes)

very elevated hCG

no fetal tissue, many hydropic villi (“grapes” and snowstorm on ultrasound)

59
Q

Which type of molar pregnancy has a higher risk of choriocarcinoma?

A

complete moles

60
Q

What are the components of the fetoplacental interface? Is there normally mixing of maternal and fetal blood in the placenta?

A

fetoplacental interface = barrier between fetal and maternal vasculature

chorionic villous is where it resides

formed in midtrimester out of cytotrophoblasts and syncytiotrophoblasts

barrier allows for exchange of gasses and nutrients WITHOUT mixing of the two circulations

61
Q

When there is amniotic fluid infection, acute inflammatory cells emanate from both fetal and maternal circulations in response to chemotactic stimuli and can be seen in placental tissues. In which anatomic components of the placenta are you most likely to see maternal inflammatory cells? fetal inflammatory cells?

A

maternal acute inflammatory cells (neutrophils) can be seen in the membranes of the placenta where they originate from the blood vessels in the parietal decidua; also in the subchorionic space

fetal acute inflammatory cells can also be seen in the chorionic plate, emanating from the large fetal vessels; also seen exiting the umbilical vessels in the umbilical cord

62
Q

A woman undergoes a spontaneous 1st trimester abortion. Examination of the passed tissue shows a fetus and an abnormal appearing placenta. Genetic testing by karyotype shows the conceptus is triploid, 69 XXY. Is this a complete mole? Partial mole? Is more testing needed?

A

this is likely a partial mole (complete mole would be diploid)

need additional testing to be sure

Repro/GU (30 decks)

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