Disorders of early pregnancy 12/19

Question 1

maternal influences in spontaneous abortions

Answer 1

inflammation and infection

uterine abnormalities

trauma (rare)

Question 2

chromosomal studies recommended in

Answer 2

habitual or recurrent abortions

malformed fetus

Question 3

placenta percreta

Answer 3

placenta grows through myometrium

Question 4

many cases of placenta previa-associated accreta occur in pt with

Answer 4

C-section scars

Question 5

twins

Answer 5

monozygotic: division of one fertilized ovum
dizygotic: fertilization of 2 ova

Question 6

types of twin placenta

Answer 6

Question 7

monochorionic placenta

Answer 7

implies monozygotic twins

time at which splitting occurs determines whether one or two amnions are present

Question 8

dichorionic gestation

Answer 8

may occur with mono or dizygotic twins

not specific

Question 9

twin-twin-transfusion

Answer 9

complication of monochorionic placenta

placental vascular anastomoses create abnormal sharing of fetal circulation through shunting

if imbalance in blood flow–>death of one or two fetuses

inspection sometimes reveal vanishing twin–> acardiac fetus or fetus papyraceous

Question 10

placental inflammation

Answer 10

placentitis or vilitis

fetal membranes (chorioamnionitis)

umbilical cord (funisitis)

Question 11

infection can reach placenta via 2 pathways

Answer 11

ascending infx: most common–> premature rupture of membranes. see cloudy amniotic fluid,chorioamnionitis

hematogenously: less common. think ToRCHES.See villitis

Question 12

chorioamnionitis

Answer 12

gross: opaque membranes and yellow.
micro. : neutrophils in amnion and chorion

Question 13

meconium staining

Answer 13

discoloration grossly

see vacuolation of amniotic epithelium,cell degeneration,epithelial necrosis,finely granular brown pigment in MQ of amnion,chorion and decidua

Question 14

squamous metaplasia

Answer 14

white bumps on fetal surface of placenta,cannot be scraped off,no particular association

Question 15

amnion nodosum

Answer 15

white bumps on fetal surface of placenta,can be scraped off,composed of anucleated squamous cells,associated with oligohydramnios

lack of amniotic fluid causes aggregation and sticking of squamous epithelium from fluid to fetal surface of placenta

Question 16

early rupture equence

(amniotic band sequence)

Answer 16

strips of membrane that have torn wrap around a developing extremity and impedes its development

example of disruption

Question 17

placental ischemia in preeclampsia due to

Answer 17

shallow implantation of trophoblast

this leads to decidual vasculopathy

uterine vasculature remodels resulting in reduced blood flow and ischemia

Question 18

placental changes in pre-eclampsia

Answer 18

pacental infarcts

retroplacental hematomas

increased villous ischemia

fibrinoid necrosis of uterine vessels and intramural lipid deposition

Question 19

placental infarcts

Answer 19

early: see congested hemorrhagic villi with villous crowding
late: coagulative necrosis with ghost villi

Question 20

complete mole

Answer 20

majority are 46XX.

androgenesis

Question 21

during evaluation of ectopic pregnancy, if no villi are seen:

Answer 21

pt already passed villi OR

villi still in uterus (unlikely with curettage) OR

pt has an ectopic