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Systems: Reproduction AB > Common Pathologies of Pregnancy > Flashcards

Common Pathologies of Pregnancy Flashcards

1
Q

Describe the hormone levels in a normal ovarian cycle.

A
  • Oestrogen peaks about day 14

- Progesterone rapidly increases from day 14 and decreases again by day 28 if pregnancy is not achieved

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2
Q

What happens to progesterone when a woman becomes pregnant?

A

Continues to increase beyond day 28

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3
Q

What does progesterone do once an egg has been fertilised?

A

Acts on the endometrium

  • Thickens the lining
  • Converts the endometrium to decidua
  • Increases the vascularity of the endometrium
  • Stromal cells enlarge between glands and vessels and become procoagulant which stops bleeding and leads to cessation of menstrual periods
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4
Q

What cells are found on the outer edge of the chorion?

A

Trophoblast cells

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5
Q

What do trophoblast cells produce?

A

Beta- human chorionic gonadotrophin

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6
Q

What is the target for B-hCG?

A

The corpus luteum of the ovary

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7
Q

What is the function of B-hCG?

A

To stimulate corpus luteum to produce progesterone, which stops decidua from shedding

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8
Q

What hormone forms the basis of pregnancy tests?

A

B-hCG

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9
Q

Describe the process of implantation.

A
  • Chorion burrows into decidua
  • Trophoblast cells stream off to invade mother’s blood vessels and link them up with the foetus
  • Chorionic villi covered in trophoblasts move into the decidua
  • Deceidual cells are procoagulant and help stop bleeding
  • Eventually the chorionic villi are bathed in mother’s blood forming the forerunner of the placenta
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10
Q

What is an ectopic pregnancy?

A

Pregnancy which occurs in the wrong anatomical site

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11
Q

What is the most common site of ectopic pregnancy?

A

Fallopian tube

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12
Q

What predisposes to rupture in ectopic pregnancy?

A

Lack of proper decidual layer and small size of fallopian tube

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13
Q

What happens in normal pregnancy to promote growth of the baby and the placenta?

A
  • Mum switches off certain genes in her eggs by methylating them
  • Dad switches off certain genes in his sperm by methylating them
  • Mum and dad’s changes lead to different genes being switched off
  • Mum’s changes promote early baby growth
  • Dad’s changes promote early placenta growth via trophoblast prooliferation
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14
Q

What is the pathogenesis behind a molar pregnancy?

A
  • It is often caused by 2 sperm fertilising 1 egg with no chromosomes
  • Results in imbalance of methylated genes causing trophoblast overgrowth
  • Leads to no or all but non-existent foetal growth
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15
Q

What can happen if a molar pregnancy persists?

A
  • Form of pre-cancer of trophoblast cells

- Can give rise to a malignant tumour called a choriocarcinoma

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16
Q

How is a molar pregnancy treated?

A

Removal of pregnancy

  • If BhCG returns to normal then no further treatment is required
  • If BhCG stays high (persistent disease) then cure with methotrexate
17
Q

What are the associated problems of diabetes in pregnancy?

A
  • Malformations
  • Huge babies that obstruct labour
  • IUD (probable sudden metabolic and hypoxic problems)
  • Neonatal hypoglycaemia
18
Q

What should those with diabetes do before becoming pregnant?

A

Obtain good glucose control before conception (to prevent malformations) and then all the way through pregnancy (to prevent metabolic complications)

19
Q

Why do women with diabetes tend to have macrosomic babies?

A
  • Effects of too much glucose in the mother
  • Glucose crosses the placenta and raises babies blood glucose
  • Insulin goes up in the baby
  • Baby cannot reduce glucose as mum keeps sending more across the placenta
  • Long-term high insulin and high glucose leads to massive growth
20
Q

What can ascending infection in the mother cause ?

A

Ascending infection in mother such as acute chorioamnionitis can affect baby’s brain leading to conditions such as cerebral palsy in later life or even IUD

21
Q

How does chorioamnionitis lead to neurological damage in the foetus?

A
  • Mum’s neutrophils produce a cytokine storm.

- This activates some brain cells which then get damaged by normal hypoxia of labour

22
Q

Do opiates cross the placenta?

A

Yes and baby can get addicted to them

23
Q

How do opiate addicted babies usually do?

A

Pregnancy often goes well if mother is eating properly

24
Q

How is an heroin addicted baby treated once it is born?

A
  • Immediate withdrawal from heroin when the baby is born

- Later withdrawal from methadone

25
Q

What is a placental abruption?

A

Separation of the placenta from the uterine wall

26
Q

What effect does placental abruption have on the baby?

A

-Decreases baby’s supply of oxygen and results in hypoxia

27
Q

What can placental abruption often cause in the mother?

A

Antepartum haemorrhage

28
Q

How can varying degrees of bleeding occur as a result of placental abruption?

A

Placenta may separate in different places which can result in different degrees of bleeding

  • Vaginal bleeding
  • Formation of localised haematoma
29
Q

What can cause placental abruption?

A
  • Hypertension
  • Trauma (including abuse)
  • Other including cocaine use
30
Q

Give some causes of miscarriage.

A
  • Chromosomal abnormality
  • Infection
  • Maternal issues such as ill-health, trauma or hormonal problems
31
Q

How can chorioamnionitis present in the mother?

A
  • Mother can be ill with fever and raised neutrophils in the blood
  • Mother be well
32
Q

How can chorioaminionitis present in the baby?

A
  • IUD
  • Illness in the 1st days of life leading to NICU stay
  • Cerebral palsy later in life
33
Q

What are the typical organisms involved in chorioamnionitis?

A

Perineal or perianal flora including E.coli

34
Q

What is over twisted cord a common cause of?

A

IUD and neonatal illness

Systems: Reproduction AB (35 decks)

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