Common Pathologies of Pregnancy Flashcards
What is hormone A and B?
If the egg is fertalised, does progesterone rise of fall?
Continues to rise instead of falling as it usually would
What does progesterone do to the endometrium?
- Turns it into decidua
- Thickening of lining
- Changes cells
- Increases vascularity
- Monthly shedding occurs at the end
What does the egg become when it is fertalised by sperm?
When the egg is fertilised by sperm it becomes a chorion:
- Trophoblast cells on outside of fertilised egg, which produce beta-human chorionic gonadotrophin (B-hCG)
- Target is corpus luteum in ovary, stimulating it to produce progestogen which stops decidua from shedding
- Used clinically in pregnancy tests
What cells are found on the outside of a fertilised egg?
- Trophoblast cells on outside of fertilised egg, which produce beta-human chorionic gonadotrophin (B-hCG)
- Target is corpus luteum in ovary, stimulating it to produce progestogen which stops decidua from shedding
- Used clinically in pregnancy tests
What hormone is produced by trophoblast cells?
- Produces beta-human chorionic gonadotrophin (B-hCG)
What is the target and effect of B-hCG?
- Target is corpus luteum in ovary, stimulating it to produce progestogen which stops decidua from shedding
- Used clinically in pregnancy tests
What hormone is looked at in pregnancy tests?
Beta-human chorionic gonadotrophin (B-hCG)
What does the fertilised egg burrow into?
Decidua
What happens once the fertilised egg burrows into the decidua?
- Trophoblast cells steam off to invade mothers blood vessels, linking those vessels with foetus eventually
- Decidual stromal cells are between vessels
- Projections of chorion (chorionic villi) covered in trophoblast cells start to move into decidua
- Decidual cells are procoagulant to help stop bleeding when trophoblast cells invade
- Eventually, chorionic villi are bathed in mothers blood, forming forerunner of the placenta
What is the aetiology of miscarriage?
- Foetal problem such as chromosomal abnormality
- Placental/membranes/cord problem such as from infection
- Uterus/cervix problem such as cervical incompetence
- Maternal health issues such as drug taking
What is the presentation of a miscarriage?
- Misses period, positive pregnancy test, but then starts bleeding again spontaneously
What investigation is done for miscarriage?
- USS
- No foetus present but membranes and decidua lining uterus still there
What is the management of miscarriage?
- Removal of remaining tissue by obstetrician to avoid bleeding and infection
- Tissue sent to lab
What is an ectopic pregnancy?
Fertilised egg implants itself outside of womb, usually in one of fallopian tubes
In an ectopic pregnancy, where does the egg usually implant?
One of the fallopian tubes
What is the presentation of ectopic pregnancy?
- Misses period, then many weeks later small amount of bleeding
What investigations are done for ectopic pregnancy?
- BhCG raised
- USS
- Thickened lining of endometrial cavity, expanded fallopian tube on one side
What is the management of ectopic pregnancy?
- Methotrexate
- Chemotherapy agent, used for medical abortions
- Or removal of fallopian tube
Is an ectopic pregnancy feasible?
No, the baby must be aborted
What are risk factors for ruptured ectopic pregnancy?
- Lack of proper decidua layer
- Small size of tube
What is the presentation of ruptured ectopic pregnancy?
- Severe abdominal pain, collapse
- Tachycardia, hypotension
What investigations are done for ruptured ectopic pregnancy?
- Microscopy after emergency laparotomy
- Presence of fragmented fallopian tube with placental sac
What is the mangement of ruptured ectopic pregnancy?
- Give blood
- Emergency laparotomy
- Blood flowing from fallopian tube area, which is clamped and sent to pathology