Common pathologies of pregnancy

Question 1

what is the chorion?

Answer 1

fertilised egg

Question 2

bHCG is produced where?

Answer 2

by trophoblast cells on the edge of the chorion

Question 3

what is bHCGs target?

Answer 3

the corpus luteum in the ovary

Question 4

what is bHCGs Function?

Answer 4

to stimulate the corpus luteum to produce progestogen throughout pregnancy and stop the decidua from shedding

Question 5

CASE 1

Woman, 26 years old
misses period - pregnancy test is positive
vaginal bleeding 7 weeks after her missed period
What has happened?

Answer 5

Miscarriage

Question 6

if an US scan shows no feotus present but the membrane decidua lining in the uterus is there what has happened?

Answer 6

miscarriage

Question 7

causes of miscarriage:

Answer 7

chromosomal abnormality

infection

maternal ill health

trauma

maternal hormonal problems

Question 8

CASE 2

woman, 32 years old
misses her period
8 weeks pregnant - small amount of bleeding per vagina
bHCG is raised
USS shows thickened lining of the endometrial cavity and expanded fallopian tube

Answer 8

ectopic pregnancy

Question 9

what can be used in ectopic pregnancy to expel feotus?

Answer 9

methotrexate

Question 10

CASE 3

woman 23 years old
sudden severe abdominal pain
she collapses
admitted to A and E - her pulse is fast and her BP is low
emergency laparotomy shows several litres of blood in her abdomen

what is a possible diagnosis?

Answer 10

ruptured ectopic pregnancy

fallopian tube should get clamped, removed and sent to pathology

Question 11

ectopic pregnancy is most commonly in:

Answer 11

fallopian tube

Question 12

ectopic pregnancy will predispose woman to what?

Answer 12

haemorrhage and rupture

Question 13

what does progesterone do?

Answer 13

thickens the lining of the endometrium

turns endometrium into decidua

Question 14

patient miscarried - abnormal chorionic villi with abundant trophoblasts on pathology shows the pregnancy to be:

Answer 14

molar pregnancy

Question 15

molar pregnancy

Answer 15

2 lots of ‘dads genes’

massive overgrowth of trophoblast cells and therefore overgrowth of placenta (a form of pre-cancer of trophoblast cells)

none or all but no existent fetal growth

Question 16

how do you treat a molar pregnancy?

Answer 16

if bHCG returns to normal - then don’t treat

if bHCG is high - give methotrexate

Question 17

what does nuchal thickening on a scan show?

Answer 17

down syndrome

Question 18

duodenal atresia is a common abnormality where?

Answer 18

down syndrome babies

Question 19

what is chromioamnioitis?

Answer 19

intra-amniotic
ascending infection

inflammation of fetal membranes (amnion and chorion) due to a bacterial infection

Question 20

do opiates cross the placenta?

Answer 20

yes

Question 21

what is placenta abruption?

Answer 21

haemorrhage
resulting from separation of the placenta form the uterine wall

causes a lack of oxygen for the baby

(a collection of blood (haematoma) forms behind the placenta)

Question 22

3 types of placental abruption

Answer 22

revealed (major haemorrhage extent is apparent externally as blood escapes from cervical os)

concealed (haemorrhage occurs between the placenta and the uterine wall)

mixed (both concealed and revealed)

Question 23

common complication of placenta abruption

Answer 23

antepartum haemorrhage in the mother

Question 24

common causes of placental abruption

Answer 24

hypertension

trauma

cocaine

pre-eclampsia

smoking

parity

increased age

Question 25

what is an APGARS test? what does it stand for?

Answer 25

test given to new borns straight after birth

appearance 
pulse
grimace
activity
respiration