Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RDS Test 1 > B8.013 Histology/ Immunology of Pregnancy > Flashcards

B8.013 Histology/ Immunology of Pregnancy Flashcards

1
Q

earliest stages of pregnancy

A 
day 0 - fertilization
fertilized egg
day 1 - first cleavage
day 2 - 2 cell stage
4 cell stage
day 3-4 - 8 cell uncompacted morula
day 4 - 8 cell compacted morula
day 5 - early blastocyst
day 6-7 - last stage blastocyst (hatching)
day 8-9 - implantation of the blastocyst
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

uterine proliferative phase

A

days leading up to ovulation (ovarian follicular phase)
estradiol:
-stimulates proliferation of uterine glands
-stimulates proliferation of stroma
-glands lengthen, straight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

uterine secretory phase

A

days following ovulation (ovarian luteal phase)
progesterone and to a lesser extent, estradiol:
-stimulate development of uterine glands (tortuous, curved)
-stimulate endometrium to become thick, vascular, spongey
-glands secrete glycogen, mucin
prepared to support implantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what happens after the uterine secretory phase if implantation does NOT occur

A

spiral arteries in the basalis spasm, cutting off the blood supply
hypoxia leads to sloughing off of the wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what does the uterus do to create the receptive window

A

expression of several cytokines and growth factors including LIF, integrins, osteopontin
correlates with window of implantation and the development of pinopods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are pinopods

A

balloon like protrusions on the endometrium

embryo will sit on them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

when and for how long does the receptive window occur

A

short

begins 6-10 days after the LH surge and is believed to last less than 48 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what happens when the receptive window closes

A

morphological differentiation of endometrial fibroblasts into secretory epithelioid decidual cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

syncytiotrophoblast

A

epithelial covering of embryo that interacts with maternal blood (outermost layer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

cytotrophoblast

A

embryonic cell layer under the syncytiotrophoblast
buds to form villi surrounding the embryo
invade maternal vasculature and form lacunae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

embryonic villi

A

villi initially cover the entire embryo
with further growth, there is partial regression of the villi
remaining villi form the future placenta (smooth portion is the chorion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

where does the embryo implant

A

endometrium

completely penetrates and becomes surrounded by maternal vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

function of progesterone during implantation

A

released from ovary to regulate prostaglandin production and facilitation of immune tolerance in the endometrium
regulates how far the embryo can move into the maternal wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

anchoring villi

A

cytotrophoblastic cell projections that connect the fetus to the maternal decidua

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how does fetal vasculature form?

A

eventually forms from cytotrophoblastic villi

more complex network grows over time in the intervilous space amongst the lacunar circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

why is the fetus in such close contact w maternal blood flow

A

nutrient exchange to developing fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is a hydatidiform mole

A

benign form of gestational trophoblast disease
nonviable fertilized ovum implants and develops a placenta derived tumor
fills the uterine cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what cell types make up a mole

A

atypical trophoblast proliferation (cytotrophoblast and syncytiotrophoblast)
villi with stromal edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

partial mole

A

maternal and paternal genetic material
some fetal tissue
focal slight to moderate trophoblast production
variable edematous villi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

complete mole

A

paternal genetic material only
no fetal tissue
diffuse trophoblast proliferation, villous edema
often large uterus for gestational age
elevated bhCG levels
15-20% become deep, develop into choriocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

symptoms of a mole

A 
vaginal bleeding
severe nausea and vomiting
pelvic pain
anemia
hyperthyroidism
high blood pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

risk factors for a mole

A

age: <20 or 36-40
prior mole
1-2/1000 deliveries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

appearance of mole on histo

A

acellular stroma
abnormal trophoblast proliferation
grape like structure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

genetic information about moles

A

usually results from duplication of the haploid genome of a single sperm or fertilization by 2 sperm occurring in an ovum that has lost its maternal chromosomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

monospermic mole

A 
more common (80%) loss of maternal chromosomes before or immediately after fertilization by 1 sperm followed by duplication of paternal chromosomes
46, XX or 46, YY
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

dispermic mole

A 
less common (20%)
loss of maternal chromosomes before or immediately after fertilization by 2 sperm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

placenta previa

A

potentially serious complication of pregnancy where the placenta implants into the lower segment of the uterus
edge of placenta covers the internal os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

normal placenta

A

edge is 2 cm from internal os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

low lying placenta

A

edge of placenta less than 2 cm from internal os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

risk factors for placenta previa

A

prior endometrial damage

uterine scarring from curettage, surgical insult, prior placenta previa, multiple prior pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

symptoms of placenta previa

A

painless bleeding most common
premature contractions
baby is breech or in transverse
uterus larger than it should be for gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

result of low lying placentas

A

90% identified ultimately resolve by 3rd trimester
if does not resolve, complications include:
bleeding
preterm birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

risk factors for placenta previa

A 
previous placenta previa
previous c section
previous suction curettage for abortion
age >35
multiparity
asian
smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

first immunologic phase of pregnancy

A 
embryo penetrates epithelium
-invades decidua
-vascular remodeling
consists of cellular invasion, tissue remodeling, tissue repair
*pro-inflammatory state
leads to morning sickness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

second immunologic phase of pregnancy

A

rapid fetal growth and development

general anti-inflammatory state

36
Q

third immunologic phase of pregnancy

A

delivery!
inflammatory
influx of immune cells into the myometrium
proinflammatory setting promotes decidual activation, cervical changes, uterine contraction, rejection of the placenta

37
Q

immune cells present at the placental uterine interface

A 
uNK
macrophages
t cells
dendritic cells
mast cells
b cells
38
Q

uterine natural killer cells

A

recognize virally infected or malignant cells without being previously sensitized
CD56 and CD 16+

39
Q

function of uNK cells during pregnancy

A

poor cytotoxic function in healthy pregnancy
low levels during proliferative phase, peaks during secretory phase of menstrual cycle (reflects a role in implantation)
levels remain high until the 2nd trimester, then begin to drop
70% of decidual leukocytes are uNK cells during the 1st trimester

40
Q

interaction between uNK and trophoblast cells

A

provides for trophoblast invasion, while also limiting it

secrete both pro and anti inflammatory cytokines

41
Q

HLA G on trophoblast

A

increased expression associated with suppressed implantation

42
Q

TLR 3 on uNK cell

A

increased expression associated with increased miscarriage

43
Q

number of uNK cells

A

increased number associated with miscarriage, implantation failure

44
Q

NKG2A on uNK cells

A

recognizes self, inhibitory to cytotoxicity

low levels of NKG2A associated with recurrent pregnancy loss

45
Q

CD161 on uNK cells

A

increased expression associated with increased miscarriage

46
Q

relationship between uNK cells and angiogenesis

A

high uNK density or activity associated with excessive angiogenesis and increased blood flow increases oxidative stress
can lead to pregnancy loss

47
Q

how do uNK cells influence angiogenesis

A

secrete VEGF, PIGF, and angiopoietin

48
Q

deficient remodeling of spiral arteries

A

associated with poor trophoblast invasion, reduced number of invasive trophoblasts

49
Q

preeclampsia

A 
high BP in women who havent had it before
high protein in urine
swelling in feet, legs, hands
rapid weight gain
severe headaches
vomiting, nausea
appears late in pregnancy
50
Q

“cure” for preeclampsia

A

delivery

51
Q

pathophys of preeclampsia

A

deficient remodeling of the spiral arteries, reduced placental blood flow

52
Q

action of prednisolone in pregnancy

A

reduced numbers of uNK cells and suppresses uNK cell cytotoxicity
given preconception can improve pregnancy rates\not effective if anti phospholipid Abs present

53
Q

IVIg therapy in pregnancy

A

immunosuppressive

reduces uNK cell cytotoxicity

54
Q

macrophages at the maternal placental interface

A

primary APC in decidua
20% of decidual leukocytes
numbers constant throughout pregnancy

55
Q

role of macrophages in pregnancy

A 
generally M2 phenotype
-tissue repair
-inhibition of inflammation
role in trophoblast invasion, placental growth, fetal development, parturition
removal of dying trophoblasts
56
Q

why is removal of dead trophoblasts by macrophages important

A

prevent release of paternal antigens, thus limit maternal immune response

57
Q

function of T reg cells in pregnancy

A

maintenance of immunologic self tolerance
significant expansion in the decidua and systemically during pregnancy
specific to paternal antigens
persist after delivery, rapidly accumulate with subsequent pregnancy

58
Q

FOXP3

A

regulates Treg cells
reduced expression in endometrium associated with infertility
spontaneous abortion associated with lower systemic Treg levels

59
Q

Th17 cells in pregnancy

A 
IL-17 producing CD4+
numbers expand in uterus during pregnancy
inflammatory
thought to protect from microbes
thought to be regulsted by Tregs
60
Q

altered Th17:Treg ratio

A

associated with spontaneous abortion, preeclampsia, preterm birth

61
Q

function of dendritic cells in pregnancy

A

initiate and coordinate innate and adaptive immune responses
accumulate before implantation, remain throughout gestation
play a role in decidualization, exhibit low levels of antigen presentation

62
Q

mast cells in pregnancy

A

numbers expand in the uterus with pregnancy

promote anti-inflammatory state; function unknown

63
Q

B cells in pregnancy

A

IL-10 producing B cells expand peripherally
present in decidua
importance unknown

64
Q

immune role of decidual cells in pregnancy

A

recent evidence suggests decidual cells play a role in regulating differentiation, migration, and function of uterine immune cells
express chemoattractant, inhibit recruitment of T cells into uterus

65
Q

complications of bacterial infection in pregnancy

A

cause of 40% of preterm labor
cause of 80% of preterm birth before 30 weeks
preeclampsia

66
Q

complications of viral infection in pregnancy

A 
fetal developmental complications
preterm birth
spontaneous abortion
stillbirth
preeclampsia
67
Q

routes of infectivity of decidua, placenta, fetal membranes

A

ascend into uterus from lower tract
descend into uterus from peritoneal cavity
maternal circulation

68
Q

preterm birth

A

when a baby is born too early, before 37 weeks

affects 1 in 10 infants

69
Q

risk factors for premature birth

A

previous premature birth
pregnancy with multiples
problems with the uterus, cervix, or placenta
smoking cigs or doing drugs
infections of amniotic fluid and lower genital tract

70
Q

difference between trophoblast response to infection in 1st and 2nd trimesters vs the 3rd

A 
1st and 2nd:
milder response to gram (-) compared to gram (+)
TLR8 active
TLR6 active
3rd:
gram (+) and gram(-) responses similar
TLR2 active in decidual cells
71
Q

NOD receptor activation

A

pathogen enters intracellular space

infection/response via NOD1/2 has been associated with preterm birth

72
Q

what inflamm cytokines are released in response to infection at placenta

A

TNFa
IFNg
IL-12
IL-8

73
Q

result of placental infection

A

may result in a fetal inflammatory response, and may lead to morphological and developmental abnormalities
fetus has a mature immune system!!!

74
Q

what is RPL

A

recurrent pregnancy loss
3 or more consecutive, spontaneous pregnancy losses under 20 wks
affects 5% of repro aged women

75
Q

risk factors for miscarriage

A 
advanced maternal age
smoking
alcohol consumption
use of illicit drugs like cocaine
use of NSAIDs
high caffeine consumption
extremes of maternal weight
76
Q

common causes of RPR

A 
50% unexplained
autoimmune (15-20%)
endocrine (15-20%)
anatomic (10-15%)
genetic (2-5%)
infection (0.5-5%)
77
Q

what is antiphospholipid Ab syndrome

A

most common hypercoagulable disorder
heterogenous autoantibody binds to phospholipid protein complex
includes: lupus anticoagulant syndrome and anticardiolipin antibody syndrome

78
Q

symptoms of antiphospholipid Ab syndrome

A

venous and arterial thrombosis
recurrent spontaneous abortion
stroke
TIA

79
Q

treatment for antiphospholipid Ab syndrome

A

anticoagulation
lovinox
low dose aspirin

80
Q

invasive placenta

A

placenta attaches too strongly or invades too deeply into the wall of the uterus

81
Q

placenta accreta

A

placenta attaches too strongly to myometrium, but does not invade into it

82
Q

placenta increta

A

placenta invades into the myometrium

83
Q

placenta percreta

A

placenta invades through the full thickness of the uterine wall
can attach to adjacent organs in the abdomen, usually the bladder

84
Q

risk factors for invasive placenta

A

previous c-section is biggest
previous gynsurgeries
intra-uterine surgery
embolization treatment for a fibroid

85
Q

complications of placenta accreta

A

heavy bleeding, can lead to DIC during delivery as well as lung failure and kidney failure
premature birth

86
Q

management of invasive placenta

A

antenatal evaluation using US and MRI
planned c-section in a specialized unit
planned hysterectomy in severe cases

87
Q

symptoms of placenta accreta

A

no signs of symptoms during pregnancy

vaginal bleeding during 3rd trimester might occur

RDS Test 1 (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions