Female Genitral Tract 4 - Dobson Flashcards
What are the most common causes of late pregnancy (20 wks - 3rd trimester) loss?
Placental/vascular Cord Abruptio placenta disruption of fetal placental vessels uteroplacental malperfusion
Preeclampsia may lead to what?
HELLP syndrome
Hemolysis, elevated liver enzymes, low platelets
Rupture of ectopic pregnancy can lead to what?
Intraperitoneal hemorrhage which can be fatal
What kind of twins are involved in twin-twin Transfusion Syndrome?
What may be present?
Can cause what?
Monochorionic
AV shunt
Discordance in fetal size and amniotic fluid volume
What presents w/irregular vaginal bleeding of bloody, brown fluid (not related to mensturation) w/ enlarged uterus and a very high hCG?
Choriocarcinoma
How does a PST tumor present?
Prognosis?
Uterine mass w/bleeding or amenorrhea
Inc. hCG, Inc. hPL
Excellent if localized
What are the causes of spontaneous abortion?
Chromosomal abnormalities in fetus
Defects in uterus (leiomyoma)
Infections
When is hydatidiform mole diagnosed?
What age increased risk?
2x as common where?
Early in pregnancy (9 weeks) by sonogram
Teens and 40-50
Southeast Asia
Complete mole karyotype?
Increased what?
Risk of choriocarcinoma?
Rise of persistent mole?
Fetal tissue present?
46 XX
hCG
2.5%
15%
No
What is described by a complete absence of the decidua, villous tissue adheres directly to myometrium which leads to failure of placental separation at birth?
Placenta accreta
Morphology of hydatiform mole?
Edematous hydropic villi
Central cavities or cisterns
Extensive trophoblastic proliferation
Where does choriocarcinoma metastasize to most often?
Lung, vagina, brain
What is a rapidly invasive malignant neoplasm of trophoblastic cells derived from previous or abnormal pregnancy?
Choriocarcinoma
Placental site trophoblastic tumor produces what?
Human placental lactogen (hPL)
What are the TORCH infections that cause spontaneous abortion?
Toxoplasmosis Other (syphilis, VZV, Parvovirus B19, Listeria, HIV, Coxsackievirus) Rubella CMV Herpes virus
What anti-angiogenic factors are activated in preeclampsia?
sFlt1
Endoglin
Treatment for choriocarcinoma of gestational origin?
Nongestational choriocarcinoma treatment?
Chemo - 100%
Resistant to chemo
What is preeclampsia?
HTN
Edema
Proteinuria
How does an invasive mole present?
Treatment?
Vaginal bleeding and irregular uterine enlargement w/persistently elevated hCG
Chemo and hysterectomy
What is eclampsia?
Preeclampsia + seizure
Medical emergency
Choriocarcinomas arise from what setting?
50% complete mole
25% previous abortion
22% after normal pregnancy
What kind of necrosis does the placenta undergo?
Coagulative
Describe a hydatiform mole
Cystic swelling of chorionic villi, trophoblastic proliferation
Complete placenta previa covers internal cervical os and requires what?
C-section
How does ectopic pregnancy present?
6-8 weeks after last menstrual period
Mod-severe abdominal pain (may occur suddenly)
Vaginal bleeding
Partial mole karyotype?
Risk of choriocarcinoma?
Fetal tissue present?
69 XXY
None
YES
What increases the risk for ectopic pregnancy?
IUD
Smoking
Preclampsia occurs when usually?
More common in whom?
Last trimester after 34 weeks
Primiparas
What are the 3 main pathogenic factors of preeclampsia?
Abnormal placental vasculature
Endothelial dysfunction and imbalance of angiogenic and anti angiogenic factors
Coagulation abnormalities
What coagulation abnormalities occur w/preeclampsia?
Dec PGI2
DEC VEGF
Endoglin inhibits what?
Causes what?
TGF beta
Decreased NO
Scarring of fallopian tubes can be due to what?
Appendicitis
Endometriosis
What is described when a placenta implants in the lower uterine segment of the cervix leading to 3rd trimester bleeding?
Placenta previa
What is a major cause of severe, life-threatening postpartum bleeding?
RFs?
Placenta accreta
Previous pregnancy and C section
When do spontaneous abortions due to ascending infections occur?
Via what?
2nd trimester
Hematogenous dissemination
What is the #1 extrauterine site for ectopic pregnancy?
35-50% occur due to what?
fallopian tube
PID
