Female Genital tract - B/87

Question 1

Placental inflammation and infections

Answer 1

Acending infections: Mycoplasma, candida, vaginal flora. They can potentially cause chorioamionitis. It if extends beyond the membranes it can cause Acute vasculitis of the umibilcal cord. Can lead to premature birth or rupture of the embryonic membranes.

Hematogenous spread: syphilis, listeriosis, toxoplasmosis, viruses - Can give rise to TORCH complex.

Question 2

Ectopic pregnancy

Answer 2

Pregnany occurring anywhere else, but the mucosal covering of the uterus. Can occur in the Fallopian tubes (90%), the ovaries or the abdominal cavity. Can be due to endometriosis, inflammation or tumor obstruction.
Normally normal embryonic development, can eventually lead to massive intraperitoneal hemorrhage and intratubal hematoma. Rupture and hemorrhage can led to shock.

Question 3

Gestational trophoblastic disease

Answer 3

Hyatidiform mole - can be complete and partial
Complete: an empty egg is fertilized by two spermatozoa - does not permit embryogenesis. Thus all the chorionic villi are abnormal, without vessels and edematous.
Partial mole: Normal egg is fertilized by two spermatozoa - some normal chorionic villi can be seen. Fetal parts may be detected.

Chroriocarcinoma - aggressive malignant tumor which arises from wither gestational chorionic epithelium or less frequently from totipotent cells within the gonads or elsewhere. Brown bloody discharge along with elevation in hCG and an absence of uterine enlargement (as in the case of the moles). Necrotic mass, no chorionic villi - only anaplastic cyto- and syncytiotrophoblasts. Tumor has usually already metastasized by the time of discovery - responds well to chemotherapy, unless it arises from the gonads.

Placental site trophoblastic tumor - derived from the placental site or from intermediate trophoblastic cells. Produces hCG. Can be confined to endomyometrium, or it can spread to outside the uterus.

Question 4

Preeclampsia and eclampsia

Answer 4

Preeclampsia - development of hypertension, proteinuria and edema.

Eclampsia - symptoms of preeclampsia along with convulsive seizures. The renal function is impaired, blood pressure increase and potentially DIC.

Musculoskeletal wall of the spiral arteries is replaced with fibrinous material which allows dilation. In preeclampsia and eclampsia this does not occur. Can lead to placental hypo perfusion and placental infarction, hypertension due to decreased amounts of vasodilators release from trophoblasts. An ischemic placenta can release thromboplastic substances which can lead to DIC.