Common pathologies pregnancy Flashcards
once the egg is fertilized what happens to progesterone
progesterone levels continue to rise
continuing thickening the lining - turns endometrium into decidua - increasing vascularity
between glands and vessels the stromal cells enlarge and become procoagulant stopping the bleeding
what are the hormones produced in the hormonal cycle
progesterone
oestrogen
what hormone do trophoblast cells produce
B-hCG or Beta-human Chorionic Gonadotrophin
function is to stimulate corpus luteum to produce progestogen, which stops decidua from shedding
why is bhCG hormone important
Forms basis of pregnancy tests
Stimulates the ovary to produce progesterone throughout pregnancy, and stops decidua from shedding.
Woman, 26 yrs
Misses period
Pregnancy test positive
Vaginal bleeding 7 weeks after missed period
What has probably happened?
US scan: No fetus present but membranes and decidua lining uterus still there = miscarriage
Removal of remaining tissue by obstetrician to avoid bleeding and infection
Tissue sent to pathology:
why do miscarriages happen
Unknown in this case (it is very common for no cause to be obvious)
Causes include:
1. Fetal problem eg chromosomal abnormality,
2. Placenta/membranes/cord problem eg infection,
3. Uterus/cervix problem (eg cervical incompetence)
4. Maternal health issues (eg drug taking)
Woman, 32 years old
Misses period.
8 weeks pregnant 🡪 Small amount of bleeding per vagina
BhCG raised
Ultrasound: Thickened lining of endometrial cavity. Expanded fallopian tube on 1 side.
Diagnosis = ectopic pregnancy
Considered using methotrexate – but opted for operative removal of fallopian tube 🡪 tissue sent to pathology
Woman 23 years
Sudden severe abdominal pain. Collapses.
Admission to A&E 🡪 Pulse fast. BP low.
Blood given.
Emergency laparotomy:
At operation - several litres of blood in abdomen
Blood flowing from fallopian tube area - clamped, removed and sent to pathology
Pathology:
Microscopy = blood, fragments of fallopian tube and occasional chorionic villi (part of what will become the placenta and therefore tissue which confirms pregnancy)
Diagnosis = ruptured ectopic pregnancy
what is an ectopic pregnancy
= 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
A 26 year old female presents to the emergency department with right sided abdominal pain, vomiting and diarrhoea. Whilst analgesia and i.v. fluid resuscitation, antiemetics are given, further clinical history finds the pain has moved from the umbilicus to the RIF.
What is the most correct answer?
Ovarian torsion.
Ectopic pregnancy.
Acute appendicitis.
Fitz-Hugh-Curtis Syndrome.
Salpingitis Isthmica Nodosa.
acute appendicitis
What is the most common location for an ectopic pregnancy to implant?
Fallopian tube: Fimbrial end
Fallopian tube: Ampulla
Fallopian tube: Isthmus
Cornua/ Interstitium
Abdominal
ampulla
what is a molar pregnancy
A problem because in the testis dad has inactivated several genes by adding methyl groups to stretches of DNA
massive overgrowth of trophoblast cells and therefore overgrowth of placenta
no or all but non existent foetal growth
A form of precancer of trophoblast cells
If it persists can (rarely) give rise to a malignant tumour called choriocarcinoma
Molar pregnancy - treatment
If BhCG returns to normal – no further treatment.
If BhCG stays high (persistent disease) 🡪 cure by methotrexate
A 32 year old woman is 10 weeks pregnant, with nausea, hypermemesis and PV bleeding. USS demonstrates a typical ‘snowstorm appearance’ of the intrauterine tissues. What is the most correct diagnosis?
Confirmed intrauterine pregnancy.
Partial hydatidiform molar pregnancy.
Complete hydatidiform molar pregnancy.
Choriocarcinoma.
Missed misscarriage.
Complete hydatidiform molar pregnancy.
