Disorders of pregnancy Flashcards
Covers disorders of pregnancy
- Diagnosis?
vaginal bleeding, adnexal pain, adnexal mass
- List 2 complications
- Confirmatory test
- Ectopic pregnancy
- a. Hypovolemic shock, Hematosalpinx
- Vaginal USG
1. Gestational(Placental) /Non gestational(Ovarian) choriocarcinoma?
- Øunresponsive to chemotherapy
Øoften fatal
- Øexists in combination with other germ cell tumors
2. Marker for choriocarcinomas?
- Non gestational choriocarcinoma
- human chorionic gonadotropin (hCG)
irregular vaginal spotting of a bloody, brown fluid
rising titer of hCG after a molar pregnancy, abortion, or ectopic pregnancy.
Xray findings attached
What is the origin of these tumor cells?
trophoblastic cells
Diagnosis: Choriocarcinoma
Differences between a partial mole and a complete mole
Primipara
last trimester
new-onset hypertension (≥140 mm Hg systolic or ≥90 mm Hg diastolic) accompanied by proteinuria (>300 mg in 24-hr urine collection or 30 mg/dL [1+ dipstick])
Pre-eclampsia
- most common cause of ectopic pregnancy
- most common site of ectopic pregnancy in the fallopian tube?
- Scarring from previous PID
- broad ampullary portion below the fimbriae
most common mechanism of formation of a complete mole
The image shows a complete mole - most common mechanism is fertilization of an empty ovum by a single sperm that undergoes duplication of its chromosomes.
The image shows cross section of a fallopian tube in a woman who presented with bleeding per vagina and sudden onset abdominal pain.
Diagnosis?
Ectopic pregnancy
Right half shows chrorionic villi
Preeclampsia + generalized convulsions
Eclampsia
Initiating event in preeclampsia
Failure of vascular remodeling
3 factors involved in the pathogenesis of preeclampsia
- Abnormal placental vasculature (failed remodeling)
- Endothelial dysfunction
- Coagulation abnormalities
Components of HELLP syndrome
Hemolysis
Elevated liver enzymes
Low Platelets
Mechansim of HELLP syndrome
Microangiopathy and activation of intravascular coagulation
Hemolysis in HELLP is extravascular or intravascular?
Intravascular - thrombotic narrowing of the microcirculation
Lab features of hemolysis
- increased reticulocyte count
- increased unconjugated bilirubin
- elevated LDH
- decreased serum haptoglobin
- schistocytes on peripheral smear
Liver changes in preeclampsia
periportal hemorrhage and necrosis–>elevated AST, ALT.
Kidney changes in pre-eclampsia
- Decreased GFR–>increased creatinine, oliguria.
- fibrin thrombi seen in glomeruli
Placental morphology in preeclampsia
- infarct- coagulative necrosis
- fibrin thrombi
- increased syncytial knots
- retroplacental hematomas
Etiopathogenesis of acute fatty liver of pregnancy
Fetus with homozygous deficiency of LCHAD–>heterozygous mom accumulates fatty acid metabolism products–>toxic effect on liver
LCHAD= long chain 3 hydroxyacyl coA dehydrogenase
Morphology of acute fatty liver of pregnancy
diffuse microvesicular steatosis
Diagnosis?
* pregnant woman
* BP 120/80mmHg
* nausea, abdominal pain right upper quadrant
* jaundice
* leukocytosis
* encephalopathy
* elevated ammonia
* jaundice
Acute fatty liver of pregnancy
Partial mole or complete mole?
Complete mole
All villi dilated, extensive trophoblastic proliferation
Partial mole or complete mole?
Partial mole
Focal trophoblastic proliferation
Diagnosis
* persistent elevation of hCG after evacuation of a mole
* Microscopy- invasion of myomterium by chorionic villi+, proliferation of cytotrophoblasts and syncytiotrophoblasts
Invasive mole
Malignant neoplasm arising from extravillous (intermediate) trophoblasts
Placental site trophoblastic tumor (PSTT)
