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
What is a molar pregnancy?
Problem with egg so foetus and placenta does not develop the way they should after conception
What is the aetiology of a molar pregnancy?
- Normally
- Mum switches off certain genes in ova by methylating them, dad switches of different genes in sperm by methylating them
- Mums changes promote early baby growth, dads promotes early placental growth via trophoblast proliferation
- Overall effect is balanced growth of baby and placenta
- Molar pregnancy
- Various causes, most common caused by 2 sperm fertilising one ova with no chromosomes
- Resulting in imbalance in methylated (switched off) genes, fast proliferation of trophoblast cells causing overgrowth of placenta
How are genes switched off in the ova and sperm before they meet?
Methylated
Mums and dads genes promote what growth early on?
Mum - baby growth
Dad - placental growth
What is the presentation of molar pregnancy?
- Positive pregnancy test, and then minor bleeding
What investigations are done for molar pregnancy?
- USS
- Uterine cavity shows some placental tissue but no foetus
- B-hCG raised
- Microscopy
- Enlarged abnormal chorionic villi with abundant trophoblast
What is a possible complication of molar pregnancy?
- If persists, can rarely give rise to malignant tumour called choriocarcinoma
What is the management of molar pregnancy?
- If BhCG returns to normal
- No further treatment
- If BhCG stays high
- Cure by methotrexate
What is the presentation of trisomy 21 in the foetus?
- Nuchal thickening on scan
What investigations are done when nuchal thickening is seen on the baby scan?
- Amniocentesis
- Trisomy 21 (down syndrome)
What is the management of trisomy 21 in the foetus?
- Abortion act allows for termination
- Termination of Pregnancy for Abnormality (TOPFA) before 24 weeks, only after 24 weeks if substantial risk child would be seriously handicapped
- Parents’ choice
What is seen in a postmortum for a foetus with trisomy 21?
- External features of down syndrome
- Single palmar crease
- Epicanthic folds
- Protuberant tongue
- Duodenal atresia – interrupted duodenum
What is a major risk factor for stillbirth?
- Poorly controlled diabetes mellitus
What is the presentation of stillbirth?
- Pregnancy doing well, then in late weeks (such as week 36) baby stops kicking
What investigation should be done for stillbirth?
- USS
- No foetal heart movement – intrauterine death (IUD)
What is the management of stillbirth?
- Trial of labour or caesarean section
What can happen to the foetus due to poorly controlled diabetes?
- Still birth, postmortum shows:
- Huge baby with broad shoulders (called diabetic cherub)
- Happens due to the effects of too much glucose in mother
- Which crosses placenta into baby, increasing insulin in baby which cannot reduce it to normal as mum keeps sending more across the placenta
What are some problems diabetes can cause in pregnancy during the 1st trimester, 3rd trimester, labour and neonatal period?
- 1st trimester
- Malformations
- 3rd trimester
- Intrauterine death (sudden metabolic and hypoxic problems)
- Labour
- Huge babies that obstruct labour
- Neonatal period
- Hypoglycaemia
What is an example of an ascending infection?
Acute chorioamnionitis
What is acute chorioamnionitis?
Acute inflammation of membrane and chorion of the placenta
What is the aetiology of acute chorioamnionitis?
- Polymicrobial bacterial infection in the setting of membrane rupture
- Ascending infection, bacteria typically present in perineal or perianal flora ascend vagina and get into amniotic sac
What is the presentation of acute chorioamnionitis?
- Mother
- Ill, has fever and raised neutrophils in blood
- But can be well
- Baby
- Intrauterine death
- Ill in first day of life, put to neonatal unit, cerebral palsy later on in life
- Cerebral palsy because neutrophils produce cytokine storm which activates some brain cells which get damaged by normal hypoxia of labour
What investigations are done for acute chorioamnionitis?
- Examine placenta, microscopy of membranes
- Microscopy contains neutrophils in cord, membranes and placenta
What is the aetiology for drug withdrawal in the new born?
- Mother taking drugs during pregnancy, such as opiates which cross the placenta
What is a risk factor for drug withdrawal in a newborn?
- Drug addict mother
What is the management of drug withdrawal in a newborn?
- Admit baby to neonatal unit and treat for drug withdrawal
What is the aetiology of an overtwisted cord?
- Normal, active, baby moving and twisting round its own cord
What is the presentation of overtwisted cord?
- Normal pregnancy to term, then decreased movement late on such as week 40
What investigation is done for overtwisted cord?
- USS
- No heart movement
What are possible complications of overtwisted cord?
- Causes intrauterine death
- Twisted cord results in poor blood flow to and from baby (ischaemia)
- Neonatal illness
What is abruption?
Separation of placenta from uterine wall, causing hypoxia in baby and antepartum haemorrhage in mother
What is the aetiology of abruption?
- Hypertension
- Trauma
- Other such as cocaine use
What is the presentation of abruption?
- Vaginal bleeding late on, such as week 35
What investigations are done for abruption?
- USS
- Separation of part of placenta from uterus with collection of blood (haematoma)
- Microscopy of placenta
What is the treatment of abruption?
- Emergency caesarean section
What is APGARS?
- Appearance, pulse, grimace, activity and respiration – test used to check babys health
What is the prognosis of abruption?
- Baby has low APGARS
- Appearance, pulse, grimace, activity and respiration – test used to check babys health
- Each scored from 0-2, with 2 being best score
- Unwell in neonatal unit for few days then much better
