Common Pathologies in Pregnancy

Question 1

Which hormone turns the endometrium into decidua?

Answer 1

Progesterone

Question 2

What changes are involved with progesterone changing the endometrium into decidua?

Answer 2

It increases the vascularity and causes enlargement of the stromal cells between the glands and vessels, as well as these becoming procoagulant to stop bleeding.

Question 3

What cells produce beta-human chorionic gonadotrophin?

Answer 3

Trophoblasts

Question 4

What is the target of beta-HCG?

Answer 4

Stimulates the corpus luteum in the ovary to produce progestogen, which stops the decidua from shedding

Question 5

What are the most common causes of miscarriage?

Answer 5

• Chromosomal abnormality
• Infection
• Maternal issues (Ill-health, trauma, hormonal problems)

Question 6

What is the pathophysiology behind a molar pregnancy?

Answer 6

Most commonly two sperms fertilising an empty ova, resulting in an imbalance of switched off genes. This progresses to proliferation of trophoblasts and overgrowth of the placenta. There is no or all but non-existent fetal growth

Question 7

What complication can occur due to a molar pregnancy?

Answer 7

Molar pregnancies are a form of pre-cancer of the trophoblasts, which can give rise to a malignancy known as choriocarcinoma

Question 8

What is the management of a molar pregnancy?

Answer 8

Kept conservative if beta-HCG levels return to normal

If not then evacuation with methotrexate should be done

Question 9

What processes occur when there is poorly controlled maternal diabetes in pregnancy?

Answer 9

In pregnancies with poorly controlled maternal diabetes, glucose will cross the placenta and enter the baby’s circulation. This causes an increase of insulin in the baby but the baby cannot decrease the glucose as the mother continues to have glucose crossing the placenta. Long-term high insulin and high insulin causes massive growth, which makes the baby more susceptible to intrauterine death.

Question 10

What problems can diabetes in pregnancy cause?

Answer 10

• Malformations
• Huge babies that obstruct labour
• Intrauterine death (probable sudden metabolic and hypoxic problems)
• Neonatal hypoglycaemia

Question 11

What is chorioamnionitis?

Answer 11

Inflammation of the membranes, cord and fetal plate of the placenta.

Question 12

How does opiate use affect pregnancy?

Answer 12

• Pregnancy often proceeds well if mother eating properly
• Immediate withdrawal from heroin when baby is born
• Later withdrawal from methadone