Embryogenic Pathology

Question 1

What is “ectopic pregnancy” what is the most common site of this and the most common risk factor for this?

Answer 1

Ectopic pregnancy is the implantation of the fertilized egg at a site other than the uterus. The most common site is the lumen of Fallopian tube and the most common risk factor is scarring.

Question 2

What is the clinical manifestation of an ectopic pregnancy?

Answer 2

Lower quadrant abdominal pain of a woman who recently missed her period.

Question 3

What defines a “spontaneous abortion?”

Answer 3

Miscarriage of the fetus at or before 20 weeks of gestation.

Question 4

How do spontaneous abortions present?

Answer 4

Vaginal bleeding, cramp-like pain and passage of fetal tissues.

Question 5

What are the most common causes of spontaneous abortions?

Answer 5

Chromosomal abnormalities, hypercoagulable states (i.e. Lupus patients), congenital infections and exposure to teratogens.

Question 6

What is Placenta Previa?

Answer 6

Implantation of the placenta in the lower uterine segment instead of its normal place which is up high in the uterus. Placenta will overly the cervical os.

Question 7

How does Placenta previa present and what can be done about it?

Answer 7

It presents as 3rd trimester bleeding and the mother will require a C section because a vaginal delivery would impinge the placenta and cause fetal distress.

Question 8

What is “placental abruption?”

Answer 8

Seperation of the placenta from the decidua prior to delivery. Common cause of still birth.

Question 9

How does placental abruptions present?

Answer 9

3rd trimester bleeding and fetal insufficiency.

Question 10

What is “placenta accreta?”

Answer 10

Instead of the placenta attaching to the decidua (which is formed by endometrial thickening in response to estrogen) the decidua is either not present or minimal, thus the placenta attaches to the myometrium (which should be below the decidua) instead.

Question 11

What are the clinical features of placenta accreta?

Answer 11

Presents with difficulty delivering the placenta and post partum bleeding. Requires histerectomy.

Question 12

What is “pre-eclampsia?”

Answer 12

Pregnancy induced HTN, proteinura and edema in response to the loss of protein. Presents in 3rd trimester of preggo.

Question 13

What causes pre-eclampsia?

Answer 13

Something is wrong with the placenta and there is an abnormal maternal-fetal vascular interface in the placenta.

Question 14

What can be seen in the vessels of the placenta of patients with pre-eclampsia?

Answer 14

Fibrinoid necrosis in the vessels of placenta.

Question 15

How to tx pre-eclampsia?

Answer 15

Remove the placenta, the symptoms should resolve.

Question 16

How does pre-eclampsia relate to eclampsia?

Answer 16

Pre-eclampsia + seizures = eclampsia.

Question 17

How to tx eclampsia?

Answer 17

Baby has to be delivered and the placenta has to be removed asap.

Question 18

What is HELLP?

Answer 18

Pre-eclampsia with microangiopathy involving the liver (thrombus formation in the small vessels of the liver. H = hemolysis, EL = elevated liver enzymes, LP = low platelets.

Question 19

What is “sudden infant death syndrome?”

Answer 19

Death of a healthy baby from 1 month to 1 year, reason seems to be unknown. Patients die in their sleep.

Question 20

What are the risk factors for sudden infant death syndrome?

Answer 20

Sleeping on stomach. smoking in the household, and prematurity.

Question 21

What is a Hydatidiform mole?

Answer 21

Abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts. Uterus expands and woman thinks she has a normal preggo.

Question 22

How can you tell if a woman has a hydatidiform mole and not a baby?

Answer 22

Elevated beta HCG and increased size of the uterus out of proportation to the gestational age.

Question 23

What will be seen in the 2nd trimester of a woman with hydatidiform mole that received no pre-natal care?

Answer 23

She will pass “grape like masses” through her vagina. The masses are actually the edematous villi.

Question 24

With pre-natal care what would appear on an ultrasound of a hydatidiform mole?

Answer 24

No fetal heart sounds and a “snow storm” appearance on the ultrasound.

Question 25

What is the fear of a hydatidiform mole and which kind has this risk?

Answer 25

The complete mole has a 2-3% chance of a choriocarcinoma, whereas the partial mole does not have a risk.

Question 26

Describe a “complete hydatidiform mole?”

Answer 26

2 sperm fertilizes one empty egg, egg now hasa 46 chromosomes but no fetal tissue. Villi is completely edematous (they are hydropic – filled with water and edematous) with proliferation of the tropoblasts all around the villi. Increased beta HCG due to more synctiotrophoblasts which makes beta HCG.

Question 27

Describe a “partial hydatidiform mole?”

Answer 27

One egg with 23 maternal chromosomes gets fertilized by 2 sperm with a total of 46 chromosomes, so overall the egg now has 63 total chromosomes. Partial fetal tissue will be present, some of the villi will be edematous and there will be focal and partial proliferation of the trophoblasts. A complete mole in contrast would’ve been fully edematous, diffuse proliferation of the trophoblasts, etc. No chance of choriocarcinoma in partial.

Question 28

What is the tx of a hydatidiform mole?

Answer 28

Dilation of the cervix and curettage (cutting out, of the mole in this case), called D&C.

Question 29

What should be done in a patient with a hydatidiform mole after a D&C has been performed?

Answer 29

Monitering of the Beta HCG to make sure the mole is removed and to watch for choriocarcinoma.

Question 30

What are 2 ways a woman can develop choriocarcinoma?

Answer 30

From a random germ cell tumor, but half the case can be caused by a complication of gestation, i.e. a hydatidiform mole, a spontaneous abortion,etc.

Question 31

Chemotherapy and choriocarcinoma?

Answer 31

The choriocarcinoma from the germ cell variant does NOT respond to chemo, but from the gestational variant DOES respond.