B8-013 Histology/Immunology of Pregnancy Flashcards
a benign form of gestational trophoblast disease
nonviable fertilized ovum implants and develops a placenta-derived tumor
hydatidiform mole
“snowstorm” on ultrasound
“clusters of grapes”
hydatidiform mole
is a complete or partial hydatidiform mole more likely to progress to cancer?
complete
usually results from duplication of the haploid genome of a single sperm
or
fertilization by 2 sperm occurring in an ovum that has lost maternal chromosomes
complete hydatidiform mole
most commonly enucleated egg + single sperm that duplicates its DNA
complete hydatidiform mole
usually results from fertilization of an apparently normal ovum by 2 sperm
partial hydatidiform mole
is a complete or partial hydatidiform mole associated with a uterus larger than normal for gestational age?
complete
is a complete or partial hydatidiform mole associated with extremely elevated hCG?
complete
[complete or partial mole]
46 XX or 46 XY
complete
[complete or partial mole]
69XXX, 69 XXY, 69 XYY
partial
[complete or partial mole]
2 sperm + 1 normal egg
partial
attachment of placenta over internal cervical os
placenta previa
presents with painless vaginal bleeding in third trimester
placenta previa
risk factors for abnormal positioning of the placenta [2]
prior endometrial damage
uterine scarring
edge of placenta is less than 2 cm from internal os
low lying placenta
edge of placenta is more than 2 cm from the internal os
normal
can a patient have a vaginal delivery with a placenta previa?
no
can a patient have a vaginal delivery with a low lying placenta?
yes typically
placenta attaches too strongly or invades too deeply into the wall of the uterus
invasive placenta
placenta attaches too strongly to the muscular layer of the uterine wall, but does not invade
placenta acreta
placenta invades into myometrium
placenta increta
placenta invades through the full thickness of the uterine wall and can attach to adjacent organs in the abdomen
placenta percreta
presents with difficulty separating placenta from uterus after fetal delivery
severe postpartum hemorrhage on attempted removal
invasive placenta spectrum
first immunologic phase is a […] state
pro-inflammatory
(vascular remodeling, cellular invasion, tissue repair: contributes to morning sickness)
second immunologic phase is a […] state
anti-inflammatory
(rapid fetal growth and development)
third immunologic phase is a […] state
inflammatory
(immune cells move into myometrium, uterine contractions, delivery)
[…] cells are characterized with poor cytotoxic function in a healthy pregnancy
uterine NKs
tamps down immune response to “non-self” tissue
markers of uNKs
CD56
CD16
characterized by deficient remodeling of the spiral arteries
preeclampsia
cells that remove dying trophoblast
play a key role in preventing release of paternal antigens, limiting maternal immune response
macrophages
[…] cells maintain self tolerance
T-regulatory cells
pro-inflammatory T cells that protect from microbes
Th 17
infection can impact the balance of proinflammatory and anti-inflammatory cell types causing […] in the first trimester, or […] in the third trimester
infection can impact the balance of proinflammatory and anti-inflammatory cell types causing [miscarriage] in the first trimester, or [preterm labor] in the third trimester
recurrent pregnancy loss is […] or more consecutive, spontaneous pregnancy losses
3
treatment for anti-phospholipid syndrome
lovenox
low dose aspirin
laboratory findings of lupus anticoagulant, anticardiolipin, anti-B2 glycoprotein 1
anti-phospholipid syndrome
patients with pre-existing […] tend to have worse symptoms during pregnancy and are at a high risk of preeclampsia
lupus
previous […] is a risk factor for placenta previa
cesarean delivery
(and AMA)
painless vaginal bleeding in the third trimester
placenta previa
antiphospholipid syndrome is associated with repeat
miscarriages
vaginal bleeding, back pain, contractions
placental abruption
maintains luteal progesterone production until placental progesterone production is initiated
hCG
elevated bp in late pregnancy
proteinuria
headache
preeclampsia
excessive […] cell invasion causes placenta accreta
trophoblast
usually asymptomatic
if not found early in pregnancy via US, it is found at delivery
placenta accreta
elevated hCG
no fetal tissue
vaginal bleeding
molar pregnancy
placenta with grape-like cystic structures
molar pregnancy
excessive trophoblast invasion through the uterine wall
placenta percreta
in IVF, the blastocyst must be transplanted back to the uterus during a receptive window of the […] phase
secretory
spiral arteries are remodeled by […] after implantation
trophoblasts
implantation occurs during the […] phase
secretory
peak estradiol secretion occurs during the […] phase
proliferative
