Class: Gestational pathology Flashcards
maternal component of placenta
decidua basalis
fetal component of placenta
chorion
What connects chorion to decidua basalis
chorionic villi
What is the outermost layer of the chorion (facing the mother)
syntiotrophoblast
What 2 things does the trophoblast secrete and what do thewy do
hCG, placental lactogen –> they supprt the placenta
How many veins/arteries are in the umbilical cord
2veins, 1 artery
define vasa previa
fetal Vessels running over (or very near) to the cervical os
what other condition is Vasa Previa associated with and define it
Associated with velamentous cord: vessels don’t insert properly = increased risk of rupture
Classic triad of sx of Vasa Previa
painless vaginal beleding
fetal bradycardia
membrane rupture
Tx for Vasa Previa
Emergency C-section . Could lead to fetal death!
what does “previa” mean
obstruction (in childbirth)
Placenta previa most Often occurs when?
> 20 weeks
risk factor for placenta previa
PRIOR c-SCETION
define Abruptio Placentae
premature detachment of the placenta from the uterine wall
Cause of abruptio placentae
bleeding between decidua and placenta–> separation
findings in placental abruption (4)
abrupt, painful bleeding
DIC
maternal shock
fetal distress (heart monitor)
Risk factors for placental abruption (4)
Proir placental abruption, cocaine, abdominal trauma, HTN
Define placenta acreta
defective decidua–> abnormal attachment and separation of placenta after delivery
Risk factors for placenta acreta (3) - really only need forst for class- the other 2 are from FA
prior C-section, inflammation, placenta previa
What are the 3 types of abnormal decidua –> abnormal placental implantiation and how are they defined?
pLACENTA AccRETA- placenta attaches to myometrium
Increta- invades myometrium
percreta - perforates myometrium - can perforate entire uterine wall
How is placent accreta dx?
prenatal US shows hazy interface between placenta and decidua
complication of placenta accreta
Sheehan syndomre
defining finding in abruptio placentae (2)
fetal bradycardia, low maternal BP
what is MC fetal cause of spontaneous abortion
chromosomal abnormality (50%)
What are some common maternal risk factors for sponataneous abortion (5)
maternal age
weight extremes
DM, HTN
low folate
What is the only population in which we treat asymptomatic bacteriuria,
Pregnant women
Define Chorioamnionitis
infection of the chorion and amniotic fluid
two findings in Chorioamnionitis
green/pyuric placenta
neutrophil infiltrate of chorion and amniotic fluid
Presenting sx of Chorioamnionitis (1st one is the only important one)
maternal fever, uterine tenderness, maternal tachycardia, leukocytosis
What condition –> highest risk for Chorioamnionitis
pre-term deliveries
MC cause of Chorioamnionitis
Group B strep
3 other causes of Chorioamnionitis (other than GBS)
PROM, PPROM
congenital infx (TORCH)
procedures (amniocentesis)
How is Chorioamnionitis prevented (specifically)
swab for GBS at 37 weeks
If mom has a fever, placenta looks cloudy, or baby does anything weird at all what is tx
ABX right away. send to NICU
What can Chorioamnionitis cause in newborn
PNA, meningitis, sepsis
Define PIH (pregnancy induced HTN) (3 criteria)
> 140/90 and
20 weeks gestation
no proteinuria or end-organ dmage
5 drugs for HTN in pregnancy
alpha-methyl dopa clonidine labetalol Hydralazine CCBs
Define preeclampsia
widespread maternal endothelial dysfunciton–>new-onset HTN with either proteinuria or end-organ dysfunction > 20 weeks
What does HELLP stand for
Hemolysis, Elevated Liver enzymes, Low Platelets
what causes HELLP
preecclampsia endothelial dysfunction –> thrombosis–> microangiopathic hemolytic anemia, etc
presentation of eclampsia (2 for mother, 1 for baby)
Tonic-clonic seizure or coma accompanied by fetal bradycardia
tx for eclampsia (2)
IV magnesium Sulfate
immediate delivery
molar pregnancies are an abnormality of what process
fertilization
molar pregnancies are dt what cause?
excess paternal chromos
What is the pathological thing in molar pregnancies?
cystic swelling of chorionic villi and proliferation of the chorionic epithelium (trophoblast only)
3 associateions of Molar pregnancy
Hyperemesis gravidarum
Theca lutein cysts
Hyperthyroidism
How many sets of genes and fetal parts present or not and why?: complete mole
two sets of genes 46XX, 46XY
no fetal parts becuase all paternal genetic info
How many sets of genes and fetal parts present or not and why: partial mole
three sets of genes 69 XXY, 69 XYY, 69XXX
yes, fetal parts
which type of molar pregnancy shows SUPER elevated hCG
complete
which type of molar pregnancy shows snowstorm moles on US
complete
which type of molar pregnancy MC progresses to choriocarcinoma
complete
what causes Choriocarcinoma
persistent trophoblastic layer
what 2 anaplastic cell types are found in Choriocarcinoma and what 1 structure is not found
Anaplastic cytotrophoblasts and syncytiotrophoblasts with no chorionic vili
px for choriocarcinoma
highly treatbale
