Common pathologies of pregnancy

Question 1

This graph shows 2 hormones produced by the ovaries and their relative amounts over the menstrual cycle

Identify the 2 hormones

Answer 1

Estrogen & progesterone

Question 2

Why would this occur?

Answer 2

Fertilisation of an egg

Question 3

What is the effect of progesterone on the endometrium?

Answer 3

Thickens lining

Changes cells

Turns the endometrium into decidua:

• increases vascularity
• Between glands and vessels the stromal cells enlarge and become procoagulant ==> stops bleeding

Question 4

Once an egg is fertilised - what cells appear on its edge?

What do these do?

Answer 4

Trophoblast cells - form at the outer edge of the chorion

These produce B-hCG (Beta-human chorionic gonadotrophin)

Question 5

For B-hCG:

• What is its target?
• What is its function?
• What is the hormone used for clinically?

Answer 5

Beta human chorionic gonadotrophin

Target?

• Corpus luteum in ovary

Function?

• stimulate Corpus Luteum to produce progestogen, which stops decidua from shedding

Clinical use?

• Pregnancy tests

Question 6

History:

• 32 y/o woman, misses period
• 8 weeks pregnant when small amount of bleeding out of vagina
• BhCG raised

Ultrasound:

• Thickened lining of endometrial cavity
• Expanded fallopian tube on 1 side

What is the diagnosis?

Answer 6

Ectopic pregnancy - implantation in the fallopian tube has caused it to expand

Question 7

What is a molar pregnancy?

Appearance on US?

Answer 7

Non-viable fertilised egg is implanted into uterus

This egg has no maternal material in it - and occurs when an empty ovum is fertilised by 2 sperm

It is characterised by a uterine mass with swollen chorionic villi. These villi grow in clusters that resemble grapes

Question 8

What is the link between molar pregnancies and cancer?

Answer 8

Molar pregnancy is a form of pre-cancer of trophoblast cells (huge overgrowth of these is the root of the problem)

If it persists can (rarely) give rise to a malignant tumour called choriocarcinoma

Question 9

What is the management of molar pregnancies?

Answer 9

Molar pregnancies will usually present as miscarriages

If BcHG returns to normal = no treatment needed

If BcHG stays high = methotrexate

Question 10

How can poorly controlled maternal diabetes cause Intra-uterine death?

Answer 10

1) In mother there is low insulin & high glucose in blood
2) High [glucose] means fetus receives lots of glucose
3) Fetus produces more insulin but this can not match constant supply of maternal glucose so:

• fetal [glucose] and [insulin] constantly high
  
  • baby grows huuge = diabetic cherub

4) This means increased likelihood of IUD

Question 11

Summarise the problems that diabetes can cause througout pregnancy

Answer 11

1st trimester - Malformations

3rd trimester - IUD (probably sudden metabolic or hypoxic problems)

Birth - Diabetic cherub can obstruct labour

Neonate - Hypoglycaemia

Question 12

History:

• 35 y/o woman
• Well throughout pregnancy
• Spontaneous labour at 36 weeks
• Labour progresses well but mum has fever
  
  • _​_raised neutrophils in blood
• Fetal heart beat lost minutes before delivery & can not be resuscitated = stillbirth

Pathology:

• Pathology sent samples of placental membranes and of umbillical cord
• Membranes & Cord show neutrophils

What is the diagnosis?

Answer 12

Chorioamnionitis

Bacterial infection of membranes, cord and fetal plate of placenta

Question 13

How does chorioamnionitis occur?

Answer 13

Ascending infection

Bacteria are typically perineal or perianal flora (eg E.coli) which ascend vagina and get into the amniotic sac

Question 14

How might chorioamnionitis present in a baby?

Answer 14

IUD

Ill in first days of life

Cerebral palsy later in life