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Reproductive > Common pathologies of pregnancy > Flashcards

Common pathologies of pregnancy Flashcards

1
Q

What hormone is first in hormonal cycle?

A

Estrogen

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2
Q

What happens if progesterone keeps rising in hormone cycle?

A

Egg fertilised

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3
Q

What does progesterone do to endometrium?

A

Thickens i/maintains it during second phase of cycle

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4
Q

What does progesterone turn endometrium into?

A

Decidua

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5
Q

What happens when endometrium turns into decidua?

A

Increases vascularity

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

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6
Q

What develops on the outer edge of the fertilised egg (chorion)?

A

Trophoblast cells

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7
Q

What hormone does trophoblast cells produce?

A

Beta-human chorionic gonadotrophin (B-hCG)

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8
Q

What is the target of B-hCG?

A

Corpus luteum in ovary

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9
Q

What is the function of B-hCG?

A

Stimulates corpus luteum to produce progestogen, which stops decidua from shedding

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10
Q

What is B-hCG used for clinically?

A

Basis of pregnancy tests

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11
Q

What do trophoblast cells do apart from produce B-hCG?

A

Stream off to invades mothers blood vessels and link these vessels up with those of the fetus

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12
Q

What is the forerunner of the placenta?

A

Chorionic villi covered by trophoblast cells

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13
Q

Case I: woman, 26yrs, missed period, pregnancy test positive, vaginal bleed after 7wks missed period, what is likely happened?

A

Miscarriage

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14
Q

Case I: woman, 26yrs, missed period, pregnancy test positive, vaginal bleed after 7wks missed period.
US: no fetus present but membranes and decidua lining uterus still there. What had happened?

A

Miscarriage

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15
Q

What can cause miscarriage?

A

Chromosomal abnormality
Infection
Maternal issues (ill-health, trauma, hormonal problems)

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16
Q

Case II: women, 32yrs, misses period, 8wks pregnant, small amount of bleeding PV, BhCG raised, US shows thickened lining of endometrial cavity, expanded fallopian tube on 1 side. What is likely diagnosis?

A

Ectopic pregnancy

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17
Q

Case II: women, 32yrs, misses period, 8wks pregnant, small amount of bleeding PV, BhCG raised, US shows thickened lining of endometrial cavity, expanded fallopian tube on 1 side. Ectopic pregnancy diagnosed. What are options?

A

Methotrexate

Removal of fallopian tube

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18
Q

Why is methotrexate used for ectopic pregnancy?

A

Trophoblast cells very sensitive to methotrexate and pregnancy would be expelled

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19
Q

Where is main place for ectopic pregnancy?

A

Fallopian tube

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20
Q

Case III: woman, 23yrs, sudden severe abdo pain, collapses, pulse fast, BP low, blood given and emergency laparotomy. Several litres of blood in abdomen, blood flowing from fallopian tube area, clamped, removed and sent to pathology. What is likely diagnosis?

A

Ruptured ectopic pregnancy

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21
Q

Why does low BP result in fast pulse?

A

Compensatory mechanism: low BP sensed by carotid bodies in neck, which sense partial pressure of O2 and tells heart to work harder

22
Q

What is an ectopic pregnancy?

A

Pregnancy in wrong anatomical site

23
Q

Why can ectopic pregnancy rupture?

A

Lack of proper decidual layer and small size of tube predispose to haemorrhage and rupture

24
Q

Case IV: woman, 32yrs, +be pregnancy test, 7 weeks pregnant, minor bleed, US of uterine cavity shows some placental tissue but no fetus. Fallopian tubes normal. B-hCG raised. What is likely diagnosis?

A

Miscarriage

25
Q

Case IV: woman, 32yrs, +be pregnancy test, 7 weeks pregnant, minor bleed, US of uterine cavity shows some placental tissue but no fetus. Fallopian tubes normal. B-hCG raised. On microscopy, enlarged chorionic villi with abundant trophoblasts. What is likely diagnosis?

A

Molar pregnancy

26
Q

What happens when parents methylate the genes in their ova/sperm?

A

Switches off different genes

27
Q

What is the result of the parents methylating different genes in their ova/sperm?

A

Mother: promotes early baby growth
Father: promotes early placenta growth via trophoblast proliferation

28
Q

What is the overall effect of methylation of genes in normal fertilisation?

A

Balanced growth of baby and placenta

29
Q

What causes a molar pregnancy?

A

Usually caused by 2 sperm fertilising 1 egg with NO chromosomes
Result is imbalance in methylated (switched off) genes

30
Q

What happens as a result of a molar pregnancy?

A

Trophoblast cells proliferate because they have too many of dad’s methylated genes
= overgrowth of placenta
= no or all but non-existent fetal growth

31
Q

If molar pregnancy persists what can it cause?

A

Malignant tumour called choriocarcinoma

32
Q

What is the treatment for a molar pregnancy?

A

If B-hCG returns to normal = no treatment

If B-hCG stays high = methotrexate

33
Q

What is nuchal thickening a sign of?

A

Trisomy 21 (Down syndrome)

34
Q

What does TOPFA stand for?

A

Termination of pregnancy for abnormality

35
Q

When there is no fetal heart movement what is this called?

A

Intrauterine death (IUD)

36
Q

How much does a normal baby at term weigh?

A

3.3kg

37
Q

What is likely if mother has poorly controlled diabetes and there is an IUD/stillbirth due to baby being too big?

A

Diabetic cherub

38
Q

Why does baby get so big in diabetic mother?

A

Glucose crosses placenta and baby cannot reduce glucose, insulin increases too, so baby has hyperinsulinemia and hyperglycaemia = massive growth of muscle/fat

39
Q

What are babies with long-term hyperinsulinemia and hyperglycaemia susceptible to?

A

Intrauterine death

40
Q

What are the problems of diabetes in pregnancy?

A

Malformations
Huge babies that obstruct labour
Intrauterine death
Neonatal hypoglycemia

41
Q

What is a fresh stillbirth?

A

Stillbirth in labour

42
Q

What is acute chorioamnionitis?

A

Acute inflammation from ascending infection from vagina and get into amniotic sac

43
Q

What is the presentation of ascending infection?

A

Mother ill: fever and raised neutrophils

Or mother well

44
Q

What is the presentation in baby if ascending infection?

A

IUD
Ill first days of life
Cerebral palsy later in life - hypoxia of labour

45
Q

Do opiates cross the placenta?

A

Yes

46
Q

Why would a IV heroin addict have her baby pre-booked in neonatal unit?

A

Baby can be treated for heroin withdrawal for first 5 days of life

47
Q

What is a common cause of IUD and neonatal illness?

A

Overtwisted cord

48
Q

What is the APGAR score?

A 
Score to quickly summarize health of newborn baby against infant mortality:
A: appearance
P: pulse
G: grimace - response to stimulation
A: activity - muscle tone
R: respiration
49
Q

What is placental abruption?

A

Separation of placenta from uterine wall

50
Q

What does placental abruption result in?

A

Hypoxia in baby

Sometimes antepartum haemorrhage in mother

51
Q

What is bleeding into the area where the placenta has come away from the uterine wall called?

A

Haematoma

52
Q

What are causes of placental abruption?

A

Hypertension
Trauma
Other: cocaine

Reproductive (20 decks)

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