deck_17322909 Flashcards
class 4 – reproductive pathologies
Prenatal Pathologies
Gestational Tumors
Breast Pathologies
placenta previa
“Previa” is a combination of two words: “pre” (or “prae”) meaning before, and “via” meaning way. “Previa” in medicine, usually refers to anything obstructing the passage in childbirth. Literally therefore, vasa previa means “vessels in the way, before the baby”.
placenta previa is
Implantation of the placenta over or near cervix, in lower part of the uterus.
Placenta may completely or partially cover the opening of the cervix.
placenta previa – how common?
who is more affected?
Occurs in 1 of 200 deliveries,
usually in women who have had more than one pregnancy
or who have structural abnormalities of the uterus, such as fibroids.
common risk factor – placenta previa
Scars in the uterus are a common risk factor
placenta previa — incidence increasing or lowering?
Incidence increasing
possibly increased smoking/alcohol
and increased proportion of women giving birth at later age
placenta previa — bleeding
Placenta previa can cause painless bleeding from the vagina that suddenly begins late in pregnancy.
The blood may be bright red.
can placenta previa be life-threatening?
Bleeding may become profuse, endangering the life of the woman and the fetus
how is placenta previa identified?
Ultrasonography helps doctors identify placenta previa and distinguish it from a placenta that has detached prematurely.
what happens if profuse bleeding during placenta previa?
When bleeding is profuse, women may be hospitalized until delivery, especially if the placenta is located over the cervix.
Women who bleed profusely may need repeated blood transfusions.
what happens if there is not significant bleeding during placenta previa
When bleeding is slight and delivery is not imminent, doctors typically advise bed rest in the hospital.
If the bleeding stops and does not recur, women are usually sent home, provided that they can return to the hospital easily.
is vaginal birth common for placenta previa?
A caesarean section is almost always performed before labour begins.
what can happen when women with placenta previa go into labour?
If women with placenta previa go into labour, the placenta tends to become detached very early, depriving the baby of its oxygen supply.
—> The lack of oxygen may result in brain damage or other problems.
ABRUPTIO PLACENTAE
Aka placental abruption
placental abruption is
Placental abruption is the premature detachment of a normally positioned placenta from the wall of the uterus. The placenta may detach incompletely (sometimes just 10 to 20%) or completely.
placental abruption, cause
The cause is usually unknown.
see risk factors
placental abruption, risk factors
Tobacco use
Mother is younger than 20 or older than 35
Fibroids
Previous c-section
high BP
(including preeclampsia)
cocaine-use
how commonly does placental detachment occur
Detachment of the placenta occurs in up to 1% of all deliveries.
preeclampsia
Etymology. The word “eclampsia” is from the Greek term for lightning.
“perhaps alluding to how suddenly and unexpectedly convulsions may arise.”
____
a condition in pregnancy characterized by high blood pressure, sometimes with fluid retention and proteinuria.
ABRUPTIO PLACENTAE – bleeding/hemorrhage
The uterus bleeds from the site where the placenta was attached.
The blood may pass through the cervix and out the vagina as an external hemorrhage,
or it may be trapped behind the placenta as a concealed hemorrhage.
placental abruption, SSx
Symptoms depend on the degree of detachment and the amount of blood lost (which may be massive).
Symptoms may include sudden continuous or crampy abdominal pain, tenderness when the abdomen is pressed, and shock.
complications of premature detachment (placental abruption)
can lead to widespread clotting inside the blood vessels (DIC),
kidney failure,
and bleeding into the walls of the uterus, esp. in women who also have preeclampsia.
kidney failure vs blood loss
“Heavy blood loss, an injury, or a bad infection called sepsis can reduce blood flow to the kidneys. Not enough fluid in the body (dehydration) also can harm the kidneys.”
what happens to fetus during placental abruption
When the placenta detaches, the supply of oxygen and nutrients to the fetus may be reduced.
how is placental abruption diagnosed
Doctors suspect premature detachment of the placenta on the basis of symptoms.
Ultrasonography can confirm the diagnosis.
how are women with placental abruption treated?
Women with premature detachment of placenta are hospitalized.
Treatment is bed rest.
If symptoms lessen, women may be discharged from the hospital.
what happens if bleeding worsens during placental disruption?
If bleeding continues or worsens or if the pregnancy is near term, an early delivery is often best for the woman and the baby.
placental abruption – vaginal birth?
If vaginal delivery is not possible, a c-section is performed.
HYDATIDIFORM mole
The first part of the name ‘hydatidiform’ comes from the Greek word ‘hydatid’ meaning droplet
These droplets appear to burrow into the wall of the uterus, hence the name mole.
In a complete molar pregnancy, the growth stops a fetus from developing.
HYDATIDIFORM MOLE aka
Aka molar pregnancy
hydatidiform mole is
growth of an abnormal fertilized egg
These growths are not viable
complete vs incomplete mole
Complete mole (46 XX or 46 XY)
Incomplete mole (69 XXY or 92 XXXY)
hydatidiform mole pathogenesis – vs normal
Normally, the fetus has 46 chromosomes, half of which have been inherited from the mother and the other half from the father
The cells of the complete mole (molar pregnancy) have a 46 XX or 46 XY KARYOTYPE;
—>
all of which have been inherited from the father.
—> 46 YY is not seen
karyotype define
“the number and visual appearance of the chromosomes in the cell nuclei of an organism or species.”
who passes on genetics for hydatidiform moles (COMPLETE MOLE)?
“all of which have been inherited from the father.”
(for complete moles)
what happens to maternal chromosomes during fertilization?
(in hydatidiform mole pathogenesis)
During fertilization the maternal chromosomes are lost and the paternal chromosomes (23X or 23Y) duplicate, bringing the number of chromosomes to 46
—> Thus, the hydatidiform mole has the correct number of chromosomes but the incorrect genetic makeup
pathogenesis of INCOMPLETE moles
involves mother and father
The incomplete moles (partial molar pregnancy) evolve from the oocytes fertilized with 1 or 2 spermatozoa;
—> the sperm duplicate; therefore, the cells have 69 or 92 chromosomes – one set from the mother and TWO sets from the father
hydatidiform moles – risk factors
The risk of hydatidiform moles is highest for women who become pregnant before age 17 or in their late 30s or later.
hydatidiform moles – rate
Hydatidiform moles occur in about 1 of 2,000 pregnancies in the United States and,
for unknown reasons, are nearly 10 times more common among Asian women
hydatidiform moles — clinical manifestations
what happens to abdomen?
Women who have a hydatidiform mole feel as if they are pregnant.
But because hydatidiform moles grow much faster than a fetus, the abdomen becomes larger much faster than it does in a normal pregnancy.
hydatidiform moles – SSx
Severe nausea and vomiting are common,
vaginal bleeding may occur.
—>
These symptoms indicate the need for prompt evaluation by a doctor.
hydatidiform moles – complications
infections,
bleeding,
and preeclampsia
or eclampsia
eclampsia
a condition in which one or more convulsions occur in a pregnant woman suffering from high blood pressure, often followed by coma and posing a threat to the health of mother and baby.
hydatidiform mole, Dx
Often, hydatidiform mole is diagnosed shortly after conception.
No fetal movement and heartbeat are detected.
what can happen as a result of mole decay?
where does the decayed tissue go?
what does it resemble?
As parts of the mole decay, small amounts of tissue that resemble a bunch of grapes may pass through the vagina.
—>
After examining this tissue under a microscope, a pathologist can confirm the diagnosis.
hydatidiform mole — other Dx techniques
blood test type?
Ultrasonography may be performed.
hCG blood test
—>
hCG level is higher if a hydatidiform mole is present
—>
(mole produces a large amount of this hormone.)
hydatidiform mole, Tx
surgery / D&C
D&C
dilation and curettage
hydatidiform moles vs INVASIVE moles
how commonly do hydatidiform moles become invasive?
About 15 to 20% of hydatidiform moles invade the surrounding tissue and tend to persist.
what is a complication of invasive moles?
Of these invasive moles, 2 to 3% become cancerous and spread throughout the body;
they are then called
choriocarcinomas.
choriocarcinoma
Choriocarcinoma is a fast-growing cancer that occurs in a woman’s uterus (womb).
The abnormal cells start in the tissue that would normally become the placenta.
choriocarcinoma – metastasis
Can spread quickly through
the lymphatic vessels or
bloodstream
choriocarcinoma
A malignant tumour composed of cytotrophoblastic and syncytiotrophoblastic cells
cytotrophoblast
“‘Cytotrophoblast’ is the name given to both the inner layer of the trophoblast (also called layer of Langhans) or the cells that live there. It is interior to the syncytiotrophoblast and external to the wall of the blastocyst in a developing embryo.”
“The syncytiotrophoblast (from the Greek ‘syn’- “together”; ‘cytio’- “of cells”; ‘tropho’- “nutrition”; ‘blast’- “bud”) is the epithelial covering of the highly vascular embryonic placental villi, which invades the wall of the uterus to establish nutrient circulation between the embryo and the mother. It is a multinucleate, terminally differentiated syncytium, extending to 13 cm.”
where does choriocarcinoma originate?
In 50% of cases, choriocarcinoma arises from preexisting complete moles
in 25% it arises from placental cells retained after miscarriage
25% arises from normal placenta after completion of a normal pregnancy
which mole type can give rise to choriocarcinoma (via invasive moles?)
COMPLETE MOLES
choriocarcinoma cells are highly ____ and secrete ____
Cells are highly invasive, secrete hCG
choriocarcinoma – what blood test is used to detect amount of tumour tissue?
hCG levels are used for estimating the amount of tumour tissue and for monitoring tumour tissue recurrence after chemotherapy
what can choriocarcinoma form in placental bed?
Choriocarcinoma forms bulky HEMORRHAGIC NODULES in the placental bed
where can choriocarcinoma implant?
It invades through the walls of the uterus and often implants in the vagina
where can choriocarcinoma metastasize?
invading the veins, it metastasizes to…
lung(s),
liver,
brain
where does choriocarcinoma most COMMONLY metastasize to?
brain
despite high rate of metastasis, does choriocarcinoma respond well to Treatment if detected early?
Yes.
Fortunately, this tumour responds well to combination of chemotherapy and medications
—> Cure rates of 80% to 100% have been achieved but only in those patients who do not have brain metastases
Mastitis
typically caused by ___
mastos = breast
Typically is caused by purulent bacteria, such as staphylococcus or streptococcus
how do microbes invade breasts?
The microbes invade the breast
through the dilated milk ducts
or through skin lacerations or
minor injuries acquired during suckling
mastitis usually affects women who are ____
Usually affects woman who are lactating (acute)
how common is mastitis
The most common inflammatory disease of the breast
under what circumstance can mastitis occur more commonly?
Stagnant milk in breast that has not been fully emptied by suckling provides a good growth medium for the bacteria
(plugged ducts)
can mastitis spread throughout a larger area of breasts?
Yes
Acute inflammation may spread through the entire breast
what can form as a complication of mastitis?
can cause a localized abscess to form
lesion develops quickly and causes localized or diffuse swelling of the breast
mastitis – how does the affected area feel?
The inflamed area appears red, is painful, and is sensitive to palpation
(point tenderness)
mastitis – what happens to fluid?
which cells invade area?
The entire area is edematous
is infiltrated with numerous acute inflammatory cells, mostly polymorphonuclear leukocytes (PMNs)
under what circumstances can abscesses form during mastitis?
The excretory ducts may contain pus, and if massive suppuration occurs in conjunction with destruction of tissue, an abscess will develop.
how can abscess formation be prevented
However, this does not usually happen if acute mastitis is recognized early and the lesion is properly treated
mastitis – Tx
Treatment - antibiotics and emptying the breast
Benign breast disease / Fibroadenoma
..
Common, benign breast irregularities
other names for benign breast disease
aka mammary dysplasia
(formerly fibrocystic breast disease)
benign breast disease / fibroadenoma
can be described as “____”
“Tissue nodularity”
clinical manifestations
Bilateral and cyclical swelling, discomfort, tenderness, pain
Mastalgia
Nodularity – regular, firm, mobile, rubbery
Nipple discharge
Infections and inflammation
Fluctuations in size
etiology
Idiopathic
Related to estrogen levels (pregnancy, lactation, menopause)
Dx
Examination
Palpation
Mammogram
Biopsy
Tx
Analgesics
Local heat/cold
Adequate support
fat necrosis
Sometimes the normal fat cells in the breast become round, firm lumps made up of damaged fatty tissue. This is called fat necrosis of the breast.
is fat necrosis in the breast painful?
The lumps may or may not be painful.
fat necrosis of breast — most common in which individuals?
This problem is most often seen in obese women who have very large breasts or after an injury to a breast.
fat necrosis can be caused by
Can be caused by an injury or blow to the breast.
skin around lump can look ____
Sometimes the skin around this lump looks red or bruised.
after what type of injury can fat necrosis of breasts occur?
Sometimes seen following a MVA in
which the seat belt has forcefully
squeezed the breast
fat necrosis of breasts – pathogenesis
The inadequate blood supply causes some cells to die and release particles of fat.
—> These drain to the surface. The remaining tissue may become hard or calcified.
is fat necrosis of breasts common?
Fat necrosis of the breast is uncommon.
breast cancer – mortality?
Second leading cause of cancer death among women
—> Lung cancer is 1st (?)
is mortality d/t breast cancer increasing or decreasing?
Mortality decreasing due to earlier diagnosis and better treatment
breast cancer – etiology / risk factors
Age
Gender
Personal or family history of breast cancer
Late first pregnancy, late menopause
Prolonged use of oral contraceptives or estrogen therapy
Ethnicity
Weight gain/obesity
Alcohol use
Breast cancer gene (BRCA 1 and 2)
Radiation exposure
BRCA mutation (?)
“BReast CAncer gene.”
“Every human has both the BRCA1 and BRCA2 genes.”
cancer d/t abnormal mutation (?)
breast cancer classification
Breast cancer is classified by the kind of tissue in which the cancer starts and by the extent of its spread.
ductal carcinoma
Breast cancer that starts in
the milk ducts is called
ductal carcinoma (80%)
lobular carcinoma
Breast cancer that starts in
the milk-producing glands
(lobules) is called lobular
carcinoma (20%)
types of ductal carcinoma
Ductal carcinoma in situ (DCIS)
Invasive ductal carcinoma (IDC)
Invasive lobular carcinoma
Medullary, tubular and mucinous carcinoma
Inflammatory breast cancer (IBC)
Paget’s disease of
the nipple
Ductal carcinoma in situ (DCIS)
most common type of in situ cancer; precancerous; highly treatable (30%)
Invasive ductal carcinoma (IDC)
&
Invasive lobular carcinoma
most common invasive breast cancer; begins
in a duct,
breaks through the
duct wall; invades fatty tissue
with further metastasis possible
through lymphatic vessels
____
ILC:
grows through the wall of the lobule and spreads via lymphatics or circulatory system (15%)
(Invasive lobular carcinoma)
grows through the wall of the lobule and spreads via lymphatics or circulatory system (15%)
Medullary, tubular and mucinous carcinoma
uncommon ductal carcinomas; invasive but better outcome than other types (<10%)
(other classification)
Inflammatory breast cancer (IBC)
rare, aggressive, invasive ductal cancer; presents similar to an infection with warmth, redness, lymphatic blockage
Paget’s disease of
the nipple
rare ductal
cancer arising near ducts
of nipple; symptoms
include itching, flaking,
bleeding nipple
breast cancer – clinical manifestations
Asymmetry
Lump
Puckering
Pain
Tender lymph nodes
Bruising
breast cancer, metastasis
Local extension may involve the chest wall, ribs, pleura, lungs, bronchi, vertebrae
Can spread via lymph nodes to lungs, liver, bone, adrenals, skin, brain
where does breast cancer commonly metastasize to?
Most commonly mets to bone – vertebrae, pelvis, hip, ribs, femur, humerus
breast cancer – early detection via
Self breast examinations (SBE)
Clinical breast exam (CBE)
Mammography
Genetic testing
breast cancer – Dx
Palpation
Mammography
Biopsy
X-ray
Breast cancer – Tx
Radiation
Chemotherapy
Medications
Surgery
breast cancer – prevention
Physical activity
Weight control
Alcohol restriction
Meds
Diet and supplements
Risk reduction mastectomy
CLASS 3
Female Reproductive and Perinatal Pathologies
Ovarian Cysts aka
functional cysts
aka unruptured follicles
ovarian cysts, benign or malignant ?
benign
ovarian cysts – etiology?
idiopathic
ovarian cysts, more commonly symptomatic or asymptomatic?
generally asymptomatic
under what circumstances do ovarian cysts resolve?
resolve spontaneously
when symptomatic, ovarian cyst SSx & clinical manifestations include …
pain
twisting of ovary
vomiting
bleeding
note
Ovarian follicles enlarge during the proliferative stage of the menstrual cycle and transform into graafian follicles.
Only one graafian follicle ruptures at ovulation
follicular cysts
Follicles that have not ruptured may remain filled with follicular fluid and may further enlarge into fluid-filled FOLLICULAR CYSTS
corpus luteum cysts
If the ovulated follicle transforms into a corpus luteum but does not involute and transform into a fibrotic corpus albicans, its cavity could fill with fluid forming a CORPUS LUTEUM CYST
polycystic ovarian syndrome – aka
Stein-Leventhal syndrome
polycystic ovarian syndrome =
Systemic metabolic endocrine disorder affecting pre-menopausal women
PCOS SSx/pathogenesis d/t …
Symptoms are due to excessive androgen levels
PCOS is the MOST COMMON ____ of ____ women
Most common endocrine ENDOCRINE DISORDER of young to middle-aged women
PCOS etiology
Unclear etiology
genetic and environmental factors seem to play a large role
PCOS occurs in ___% of women in ___
Common, occurring in 20% of women (US)
PCOS is one of the most common causes of ____
INFERTILITY
One of the most common causes of infertility
PCOS – clinical manifestations
Variable
Abdominal pressure
Pain
Abdominal bloating
Discomfort during urination, BM, or intercourse
PCOS, more clinical manifestations
Irregular menstruation
Infertility
Metabolic syndrome
Hirsutism
Acne
Male pattern baldness
cysts (not necessarily common)
PCOS – cysts??
often no cysts @ ovaries
despite its name – not commonly occurring with cysts
PCOS – Dx
History
Pelvic exam
Imaging
Lab tests
PCOS – what kind of lab tests?
Blood, endocrine
PCOS – Tx
Hormones
—>
Oral contraceptives
Surgery
Manage weight and/or diabetes
Ovarian cancers/neoplasms – classificaiton
Complex group of benign and malignant lesions
ovarian cancers – benign vs malignant – which is more common?
Benign tumours are more common than malignant
ovarian cancers – how does size of neoplasm correlate with whether malignant vs benign
Larger tumours tend to be benign
most common and second most common gynecologic cancer?
uterine cancer = most common
ovarian cancer = 2nd most common
gynecology – etymology
Etymology. The word gynaecology comes from the oblique stem (γυναικ-) of the Greek word γυνή (gyne) meaning ‘woman’, and -logia meaning ‘study’.
uterine cancer vs ovarian cancer (malignant)
—> Which has higher mortality?
ovarian cancer
Ranked 1st for death caused by gynecologic cancer
ovarian cancers – other method for classification
Classified according to…
HISTOLOGY and TYPE OF SECRETION
ovarian cancer – is diagnosis considered simple or challenging?
Diagnosis is difficult and often delayed
ovarian cancers – etiology and risk factors
Poorly understood
Hormonal, genetic, environmental factors
family history and ovarian cancer
which cancers in the family increase risk for ovarian cancer?
breast or ovarian cancer
Family history of breast or ovarian cancer
Even breast cancer in family hx can increase risk for ovarian cancer
ovulation vs ovarian cancer (risk factor)
The more times a woman ovulates, the higher the risk for ovarian cancer
ovarian neoplasms – clinical manifestations
Abdominal bloating
Abdominal discomfort/pain
Diarrhea
Bleeding
Ovarian torsion
Umbilical lump
Hirsutism
can ovarian cancer be asymptomatic – when is it typically asymptomatic?
Asymptomatic especially early
Mucinous Cystadenoma – benign or malignant?
benign, cystic tumor
are mucinous cystadenomas specific to ovaries?
No.
can occur in other locations:
ovaries, pancreas, appendix, fallopian tubes, lungs, urinary bladder, and liver
mucinous cystadenoma at ovaries – is it usually UNILATERAL or BILATERAL?
Usually unilateral
what is in the cavity of these tumors
filled with thick yellowish or white jellylike material
what happens if mucinous cystadenoma ruptures?
If these tumours rupture
the entire belly is filled
with mucus - colloquially referred to as “JELLY BELLY”
–> “belly” of ovary?
Serous Cystadenoma
They often consist of SEVERAL CYSTS lumped together within a COMMON OUTER CAPSULE
cavity of serous cystadenomas contain ____
serous fluid-like substance
—>
The cavity of these tumours is filled with clear fluid resembling serous fluid
serous cystadenoma – benign or malignant?
benign
serous cystadenoma – description
“Ovarian serous cystadenomas are a type of benign ovarian epithelial tumor at the benign end of the spectrum of ovarian serous tumors.”
benign teratoma
Germ cell tumour
recall “TERATOMA”
“a tumor composed of tissues not normally present at the site (the site being typically in the gonads).”
“A teratoma is a type of germ cell tumor — a tumor that starts in your reproductive cells like eggs and sperm.”
“Most teratomas are benign (noncancerous)”
benign teratoma – AKA
Often called DERMOID CYSTS
(benign) teratoma presents as…
Teratoma presents as a cyst lined on the inside with HAIRY SKIN
wall of benign teratoma tumour often contains ___
The wall of the tumour
contains other tissues,
most often TEETH AND CARTILAGE
Also
—> The skin appendages,
such as sebaceous and
sweat glands, secret
sebum and sweat into
the cavity
Benign Teratoma – what happens to these other types of tissues?
This remains there and decomposes into malodorous, mushy material
(When the tumour is resected and the cavity is opened , the contents stink, the same way our skin would stink if it were not washed for a few years)
are (benign) teratomas resected?
yes
why are teratomas resected?
can potentially in rare circumstances become malignant
—>
If they are left in place, the skin and other tissues on its wall may gradually undergo malignant transformation
under what circumstances can benign teratomas become malignant?
This usually occurs at an older age; although it is rare, and should not occur at all if the woman is under appropriate gynecologic supervision
Primary (malignant) tumours of ovaries
Serous cystadenocarcinoma
Mucinous cystadenocarcinoma
(Serous) papillary cystadenocarcinoma
Serous cystadenocarcinoma
filled with clear fluid
Mucinous cystadenocarcinoma
filled with mucous
Serous papillary cystadenocarcinoma
tumour elements are arranged as finger-like processes
most common malignant ovarian cancer?
Serous papillary cystadenocarcinoma accounts for 40% of all ovarian cancer
and most common malignant tumor
secondary tumours originating from ovaries
Metastasize from other malignancies
which cancers commonly metastasize to ovaries?
Metastases involving the ovaries originate most often from carcinomas of the ENDOMETRIUM and BREAST
breast cancer
uterine cancer
why do secondary ovarian cancers commonly originate from breasts/uterus?
These tumours often have estrogen receptors, which could explain their predilection for metastasizing to the ovaries
what other structure does ovarian cancer commonly metastasize from?
GI TRACT
Tumours of the GI tract also metastasize to ovaries
carcinoma of stomach vs ovaries
E.g. carcinoma of the stomach, which tends to produce bilateral enlargement of the ovaries
(Krukenberg tumours)
malignant ovarian tumours – Dx
Difficult and often delayed due to lack of symptoms or lack of specific symptoms
malignant tumours of ovaries – Tx
Surgery
Chemotherapy
HYPEREMESIS GRAVIDARUM
hyper vomiting + pregnant woman
“The word gravidarum is a Latin word that means ‘pregnant woman’”
hyperemesis gravidarum =
Severe nausea and uncontrollable vomiting during pregnancy
hyperemesis gravidarum results in ___
dehydration, starvation and ketosis
hyperemesis gravidarum – Dx
Diagnosis is clinical and by measurement of:
urine ketones,
serum electrolytes,
and renal function.
hyperemesis gravidarum – Tx
Treatment is with …
IV fluids,
antiemetics,
and temporary suspension of oral intake
hyperemesis gravidarum VS. morning sickness
Hyperemesis gravidarum is distinguished from morning sickness by weight loss
—> Morning sickness does not last as long
HG vs morning sickness
“Unlike regular pregnancy sickness, HG may not get better by 16 to 20 weeks. It may not clear up completely until the baby is born, although some symptoms may improve at around 20 weeks. See your GP or midwife if you have severe nausea and vomiting. Getting help early can help you avoid dehydration and weight loss.”
HG – etiology
Etiology - unknown
HG – what can dehydration lead to?
Dehydration can cause dangerous shifts in the electrolyte levels in the blood
what can happen to blood pH during HG
blood becomes too ACIDIC
HG and liver, brain, esophagus – (complications)
may cause serious
—> liver damage,
—> encephalopathy,
—> esophageal rupture
under what conditions does HG affect liver, brain, esophagus?
Hyperemesis gravidarum that persists past 18 wks
is uncommon
HG and eye – (complication)
Another serious complication is bleeding in the retina of the eye (HEMORRHAGIC RETINITIS)
what is a potential cause for HG —> hemorrhagic rinitis ?
can be caused by increased blood pressure
during vomiting
HG, Tx
IV rehydration and vitamin therapy
Termination of pregnancy if the mother’s life is in danger
TOXEMIA – two types
preeclampsia and eclampsia,
the latter is more severe
(LIGHTNING)
toxemia – etiology?
Etiology unknown
toxemia (preeclampsia / eclampsia) occurs as a result of …
Occurs as a result of an abnormally functioning PLACENTA
or abnormal maternoplacental interaction
pre-eclampsia =
pregnancy-induced HYPERTENSION and PROTEINURIA
ECLAMPSIA
unexplained generalized seizures in patients with preeclampsia
when can pre-eclampsia & eclampsia occur during pregnancy?
typically develop between 20 wk gestation and the end of the 1st wk postpartum
—> However, can occur as late as 4 weeks postpartum
what percentage of pregnant women does pre-eclampsia affect?
affects 3 to 7% of pregnant women
which groups are more commonly affected by pre-eclampsia?
usually primigravidas
and women with pre-existing hypertension or vascular disorders
(e.g., renal disorders, diabetic vasculopathy).
primigravida define
a woman who is pregnant for the first time.
other risk factors for pre-eclampsia / toxemia
maternal age < 20,
a family history of preeclampsia, eclampsia (?)
or poor outcome in previous pregnancies,
multifetal pregnancy,
obesity,
and thrombotic disorders (DIC)
toxemia – clinical manifestations
Edema
Weight gain
Petechiae
severe pre-eclampsia – clinical manifestations
may cause organ damage;
headache,
visual disturbances,
confusion,
abdominal pain,
nausea,
vomiting,
shortness of breath
pre-eclampsia / pregnancy toxemia — vs neuromuscular activity
Increased reflex reactivity, indicating neuromuscular irritability, can progress to seizures (ECLAMPSIA)
pregnancy toxemia – Dx
Clinical picture
Hypertension
Proteinuria
pregnancy toxemia – Tx
Delivery
Bed rest
Increased fluid intake
Decreased salt intake
what happens if eclampsia is not treated?
Untreated eclampsia can be fatal
EP
AKA “tubal pregnancy” (usually)
The fetus develops outside the uterus - in the fallopian tubes (m/c), the cervical canal, or the pelvic or abdominal wall
one of the most common primary causes of maternal death in the world
EP
EP – risk factors
Increasing maternal age
PID
Cigarette smoking
Endometriosis
STI (chlamydia trachomatis)
IUD
EP – incidence
Increasing incidence
—> perhaps due to higher average age of having children for women
EP – clinical manifestations
Variable
Pelvic pain
Cramps
Irregular bleeding (possibly leading to hypotension)
Amenorrhea
Fainting (if blood loss d/t fallopian tube rupture)
EP – clinical manifestations (continued)
Death (tubal rupture)
Fatigue
Nausea
Breast tenderness
Increased urinary frequency
EP – Dx
Pelvic mass
Clinical picture (physical exam)
Blood tests
US
EP – Tx
Surgery
(or methotrexate?)
MISCARRIAGE
Noninduced embryonic or fetal death
or passage of products of conception before the 20th week of pregnancy.
miscarriage – incidence?
10-15%
Incidence of spontaneous abortion is about 10 to 15% in confirmed pregnancies.
MISCARRIAGE – is incidence accurate?
Why?
Incidence is probably higher than accounted for,
because some very early abortions are mistaken for a late menstrual period
which viruses may be responsible for spontaneous abortion ?
CMV,
herpes,
rubella
what other pathologies may be responsible for spontaneous abortion?
autoimmune disease,
diabetes,
hypertension,
chromosomal abnormalities,
hormone deficiencies/excess,
etc
miscarriage – SSx
crampy pelvic pain,
bleeding,
expulsion of tissue
how can infection occur with miscarriage?
If products of conception remain in the uterus after spontaneous abortion infection may also develop, causing fever, pain, and sometimes sepsis.
stillbirth vs miscarriage
miscarriage = before 20th week
stillbirth = after 20th week
