Common pathologies in pregnancy Flashcards
When does ovarian oestrogen production peak?
Around day 14
When does ovarian progesterone production peak?
Around day 21?
What does progesterone do to the endometrium?
Thickens lining
Increases vascularity
Between glands and vessels the stromal cells enlarge and become procoagulant stops bleeding, where monthly shedding occurs
What kind of cell makes up the chorion (outer edge of egg)?
Trophoblast
Where is B-hCG produced?
Trophoblast cells
Where is the target site for B-hCG?
Corpus luteum in ovaries
What does B-hCG do?
Stimulates corpus luteum to produce progestogen, which stops decidua from shedding
How is B-hCG clinically significant?
Forms the basis of pregnancy tests
What happens after the fertilised egg buries in the decidua?
Trophoblast cells stream off to invade mother’s blood vessels and (eventually) link these vessels up with those of the fetus
What is a function of decidual cells during implantation?
Procoagulant
Help stop bleeding when trophoblast cells invade mother’s blood vessels
What is the classic triad of symptoms for ectopic pregnancy?
Amenorrhoea
Pain (Abdominal, back, shoulder)
Vaginal bleeding
What is a molar pregnancy?
Rare pregnancy complication
Large chorionic villi with overgrowth of trophoblast
What causes molar pregnancy?
Normal prgnancy:
Different genes switched off in male and female gametes
Mum’s change promotes early baby growth
Dad’s change promotes early placental growth
Balanced
Molar:
usually result of 2 sperm fertilising an egg with no chromosomes
Imbalance in switched off genes
How is molar pregnancy treated?
If BhCG returns to normal no treatment needed
If BhCG remains high then methotrexate
What are some minor anomalies seen in Down’s syndrome?
Single palmar crease
Epicanthic folds
Protuberant tongue
Which syndrome may cause duodenal atresia?
Down’s
Why do diabetic mothers often birth bigger babies?
Too much glucose in mothers
Glucose crosses placenta and raises baby’s blood glucose
Baby’s insulin then increases and they cannot reduce it
How are complications avoided for diabetic mothers and their babies?
Good glucose control before conception to prevent malformations and all the way through to prevent metabolic complications
What may cause neutrophils to be present in membranes, cord and fetal plate of placenta?
Inflammation
Acute chorioamnionitis
How does acute chorioamnionitis usually spread?
Bacteria are typically perineal or perianal flora (eg E.coli) which ascend vagina and get into the amniotic sac
How can ascending infection affect baby’s brain?
Neutrophils produce cytokine ‘storm’. This activates some brain cells, which then get damaged by normal hypoxia of labour
How can infection affect the baby later in life?
Cerebral palsy
Do opiates cross the placenta?
Yes
How might we assess for intrauterine death?
Scan for fetal heart movement
What is an overtwisted cord?
Common cause of intrauterine death and neonatal illness
Probably caused by normal, active, baby moving and twisting round it’s own cord
What is abruption?
Separation of placenta from uterine wall
What may an abruption lead to?
Hypoxia in baby
Antepartum haemorrhage in mother
What may cause abruption?
Hypertension
Trauma
Other possibilities include cocaine use
