Common pathologies of pregnancy

Question 1

How does progesterone affect the endometrium?

Answer 1

Thickens it.
Turns it into decidua (modified mucosal lining of uterus).
Increases vascularity.
Between glands and vessels the stroll cells enlarge and become procoagulant - stops bleeding.

Question 2

What is present on the outer edge of chorion (egg)?

Answer 2

Trophoblast cells are on outside of fertilised egg.

Question 3

What hormone do trophoblast cells produce?

Answer 3

B-hCG (Beta-human Chorionic Gonadotrophin).

Question 4

What is the target for B-hCG?

Answer 4

Corpus luteum in the ovary.

Question 5

What is the function of B-hCG?

Answer 5

Stimulate corpus lute to produce progesterone, which stops decidua from shedding.

Question 6

What happens to trophoblast cells when the fertilised egg implants in the desidua?

Answer 6

Trophoblast cells stream off to invade mother’s blood vessels and link these up to the foetus’s.
Projections of chorion (chorionic villi) covered in throphblast cells start to move into desidua.
Eventually the chorionic villi covered by trophoblast cells, are bathed in the mother’s blood, forming the forerunner of the placenta.

Question 7

What is miscarriage?

Answer 7

Natural death of a foetus or embryo before it is able to survive independently.

Question 8

What are some signs and symptoms of miscarriage?

Answer 8

Vaginal bleeding
Cramping and pain in lower abdomen. 
Discharge/ fluid from vagina
Discharge of tissue from your vagina. 
No longer experiencing symptoms of pregnancy e.g nausea, breast tenderness.

Question 9

What are some causes of miscarriage?

Answer 9

Idiopathic
Chromosomal abnormality
Infection
Maternal issues - ill health, trauma, hormonal problems.

Question 10

What is an ectopic pregnancy?

Answer 10

A fertilised egg implants itself out with the uterus, usually within a Fallopian tube.

Question 11

What are some signs and symptoms of an Ectopic pregnancy?

Answer 11

Missed period
Abdominal pain usually down 1 side.
Vaginal bleeding or brown watery discharge.
Pain in the tip of your shoulder.
Discomfort when urinating or passing bowels.
Raised B-hCG.

Question 12

What are some investigations carried out to determine an ectopic pregnancy?

Answer 12

Pelvic ultrasound - may show thickening of endometrium or an expanded Fallopian tube.
Bloods - B-hCG. May be carried out twice over 48hrs to see how it changes.

Question 13

What is the treatment for an ectopic pregnancy?

Answer 13

Expectant management - sees if treatment is necessary.

Medication - methotrexate stops baby growing.

Surgical - to remove pregnancy and often Fallopian tube that it occurred in.

Question 14

What are some side effects of methotrexate?

Answer 14

Diarrhoea
Abdominal pain
Nausea
Liver damage if drink alcohol soon after.
Dizziness
Teratogenic - need contraception 3months after.

Question 15

What is a ruptured ectopic pregnancy?

Answer 15

A fertilised egg that has implanted out with the uterus grows and begins to tear the structure it is within, causing severe internal haemorrhage.

Question 16

What are some symptoms of a ruptured ectopic pregnancy?

Answer 16

Severe abdominal pain
Dizziness
Tachycardia
Fainting
Hypotension
Blood within abdomen.

Question 17

What is a molar pregnancy?

Answer 17

A non viable fertilised egg becomes implanted in the uterus and fails to come to term. It is a trophoblastic disease that results in a mass forming in the uterus with swollen chorionic villi.

Question 18

How do males and females switch off different genes within their gametes?

Answer 18

Methylating them.

Question 19

What do Mum’s changes in gamete genes promote?

Answer 19

Early baby growth

Question 20

What do Dad’s changes in gamete genes promote?

Answer 20

Early placenta growth

Question 21

What are some causes of molar pregnancy?

Answer 21

2 sperm fertilising one egg with no chromosomes.
The amount of genetic material present within the fertilised egg is wrong.
Idiopathic
Age, previous molar pregnancy and ethnicity (more common in asian women) are all risk factors.

Question 22

What can occur if molar pregnancy persists?

Answer 22

May give rise to malignant tumour called Choriocarcinoma.

Question 23

What is the treatment for molar pregnancy?

Answer 23

If B-hCG returns to normal then no further treatment required.
If B-hCG stays high then use methotrexate.