Common Pathologies of Pregnancy

Question 1

What does it mean when progesterone levels continue to rise rather than fall after the peak?

Answer 1

Egg has been fertilised

Question 2

What does progesterone do to the lining of the endometrium?

Answer 2

Turns endometrium into decidua

Question 3

What is decidua?

Answer 3

The thick layer of modified mucous membrane which lines the uterus during pregnancy and is shed with the afterbirth

Question 4

What is the effect of turning endometrium into decidua?

Answer 4

Increases vascularity

Between glands and vessels, the stromal cells enlarge and become procoagulant => stops bleeding

Question 5

What is a fertilised egg?

Answer 5

Chorion

Question 6

What surrounds the outer edge of the chorion?

Answer 6

Trophoblast cells

Question 7

Which hormone is produced by trophoblast cells?

Answer 7

Beta-human Chorionic Gonadotrophin (B-hCG)

Question 8

What is the target for B-hCG?

Answer 8

Corpus luteum in the ovary

Question 9

What is the function of B-hCG?

Answer 9

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

Question 10

What is B-hCG used for clincially?

Answer 10

Forms basis of pregnancy tests

Question 11

What is an ectopic pregnancy?

Answer 11

Pregnancy in the wrong anatomical site
Most common in fallopian tube
Lack of proper decidual layer and small size of tube predispose to haemorrhage and rupture
If it presents early woman may not even know she is pregnant

Question 12

What is molar pregnancy?

Answer 12

A form of precancer of trophoblast cells

Question 13

What is a common cause of molar pregnancy?

Answer 13

2 sperm fertilising one egg with no chromosomes

Question 14

What is a choriocarcinoma?

Answer 14

Molar pregnaces can be a form of precancer of trophoblast cells which can give rise to a malignant tumour

Question 15

How is a molar pregnancy treated if BhCG returns to normal?

Answer 15

No further treatment

Question 16

How is a molar pregnancy treated if BhCG does not return to normal?

Answer 16

Cure by methotrexate

Question 17

What is the effect of the mother’s methylation of the genes in the ovary?

Answer 17

Promotion of early baby growth

Question 18

What is the effect of the father’s methylation of the genes in the testis?

Answer 18

Promotion of placenta growth via trophoblast proliferation

Question 19

What happens when 2 sperm fertilise one egg with no chromosomes?

Answer 19

Molar pregnancy due to imbalance in methylated genes - trophoblast cells proliferate because they have too many of the father’s methylated genes => overgrowth of placenta/no foetal growth

Question 20

How does diabetes in the pregnant mother affect the foetus?

Answer 20

Larger baby due to longterm hyperinsulinaemia and hyperglycaemia

Question 21

Problems associated with diabetes in pregnancy

Answer 21

Malformations
Huge babies that obstruct labour
Intrauterine death
Neonatal hypoglycaemia

Question 22

What is chorioamnionitis?

Answer 22

Neutrophils present in membranes

Question 23

Do opiates cross the placenta?

Answer 23

Yes

Question 24

Why would a woman with an IV heroin addiction be prebooked into a large maternity unit beside the neonatal unit?

Answer 24

So that baby can be admitted to neonatal unit and treated for heroin withdrawal

Question 25

Why would the baby of a woman with an IV heroin addiction ‘overfeed’ with constant mouthing movements at 3 weeks?

Answer 25

Methodone withdrawal (takes longer to get out of the system)

Question 26

What is a common cause of intrauterine death and neonatal illness?

Answer 26

Overtwisted cord

Question 27

What is abruption?

Answer 27

Separation of placenta from uterine wall
Results in hypoxia in baby
Often causes antepartum haemorrhage in mother

Question 28

Causes of abruption

Answer 28

Hypertension
Trauma
Other (eg cocaine)