Developmental Pathology 2 Flashcards
Define hydrops fetalis.
severe diffuse edema of of tissues and multiple effusion in body cavities
What are the major causes of immune and non-immune (3) hydrops?
immune: classically associated with Rh factor incompatibility (erythroblastosis fetalis/ HDON)
non-immune: cardiovascular defects, chromosomal anomalies (Turners 45X) and non-immune fetal anemia (parvo B19, hemoglobinopathy)
What is cystic hygroma?
‘posterior cervical hygroma’
fluid accumulation in the neck
associated with multiple causes, essentially a focal form of fetal hydrops, U/S dx may indicate underlying lethal condition
Contrast omphalocele and castroschesis.
omphalocele is a large *umbilical cord defect through which intestines protrude, covered in a membranous sac
gastrocschesis is a paraumbilical *abdominal wall defect with extruded free loops of bowel, not covered by a sac
How is volume of amniotic fluid regulated?
fetus largely regulates amniotic fluid: amniotic fluid is produced by fetal urine and removed by fetal swallowing
Give examples of what cases oligohydramnios and polyhydramnios.
oligohydramnios: urethral obstruction (prune belly), renal anomalies (potter sequence)
polyhydramnios: esophageal obstruction (atresia)
Describe the association of symptoms that occur with Prune Belly Syndrome (sequence).
resulting from urethral obstruction occurring mainly in males
prune-like belly with wrinkled skin, thin or absent abdominal musculature, dilated bladder, hydroureters, hydronephrosis, renal dysplasia
cryptorchidism (lack of descent), hypo plastic prostate
What is intrauterine growth restriction?
fetus is small for gestational age based on ultrasound measurements (less than 10th percentile weight for gestational age)
Contrast the causes of symmetric (proportional) and asymmetric FRG/ IUGR.
symmetric: fetal head and body equally small due to fetal factors ie. chromosomal defect/infections- a global insult
asymmetric: head size is normal but body and other organs are small often due to placental or maternal factors (ie. uteroplacental insufficiency, abnormal cord, placenta prevue or abruption)
What are the structures of a normal umbilical cord?
two arteries and a single vein (if only a single artery can signal CV troubles)
What are the detrimental effects of an ascending infection? What is typically the etiology?
ascending infections are often bacterial, they cause chroioamnionitis and premature birth, not IUGR
Define chronic villititis and what is usually suggests.
chronic inflammatory cells of the placental villi suggest chronic transplacental infection (TORCHES) or villitits of unknown etiology (VUE) or autoimmune process
What is the syndrome associated with transplacental parvovirus B19 infection?
has a predilection for RBC, causing anemia, hydrops and extramedulary hematopoeisis
What do PPROM and PROM stand for?
PPROM: preterm premature rupture of membranes
PROM: premature rupture of membranes refers to rupture of membranes prior to labor but after 37 weeks
What are causes/associations with premature delivery?
prior preterm labor or premature birth multiple gestation structural abnormalities of uterus, cervix or placenta smoking, drugs, alcohol poor maternal nutrition chronic maternal disease pre-pregnancy weight outside the normal range prior history of spontaneous abortions trauma/ injury during pregnancy **ascending infections
______ infections may cause premature rupture of membranes due to inflammation and premature rupture of membranes increases the risk of ______ infections.
transcervical can cause PROM
ascending infection risk increased with PROM
Contrast chroiomaniotis and fetal vasculitis/ funisitis.
chroioamniotis is acute inflammation of fetal membranes due to *maternal immune response (maternal PMN), can cause PPROM and complications of prematurity
fetal vasculitis/funistis is the fetal inflammatory response causing acute inflammation of the umbilical cord, indicates neonatal infection
Organisms including gram negatives and Group B strep can cause fetal/ neonatal infection in the form of _____, ______ and ______.
pneumonia, meningitis and sepsis
Which bugs cause early onset vs. late onset perinatal infection?
early (first week of life): E. coli, Group B strep
late (later than 1 week after birth): Listeria, Candida
What are the 3 most common causes of neonatal meninigitis?
EGL:
E. coli
Group B strep
Listeria
Describe the problems seen in the following organ systems if an infant is born prematurely.
brain: hemorrhages (germinal matrix, intraventricular)
GI tract: necrotizing enterocolitis
Heart: PDA
Liver: physiologic jaundice (risk of kernicterus)
Lungs: hyaline membrane disease
What should be administered to mothers if preterm delivery is expected, to better prepare neonatal lungs for breathing?
glucocorticoids (steroids) will induce surfactant synthesis, alveoli do not develop until 26-32 weeks and there is usually a deficiency in surfactant
Describe the events that occur with neonatal respiratory distress syndrome.
atelectasis of small alveoli
hypoxemia, CO2, and acidosis
poor pulmonary perfusion and cellular damage
leakage of plasma and fibrin
deposition of fibrin membranes (fibrin, fibrinogen and cell debris)
(develops only after birth)
What are the possible complications of neonatal Respiratory distress syndrome (hyaline membrane disease) and how is it treated?
treated with assisted ventilation and high oxygen levels and prophylactic exogenous surfactant
complications include chronic lung disease, retinopathy and bronchopulmonary dysplasia (epithelial hyperplasia, interstitial fibrosis and alveolar wall thickening) due to oxygen toxicity and/or barotrauma from respiratory