female reproductive tract part 6 (last part) Flashcards
what is an ectopic pregnancy
what is the most common site
what are the risk factors?
implantation of the fetus OUTSIDE of the uterus
fallopian tube
Pelvic inflammatory disease from an ascneding infection like chlamydia and gonorrhea
any thing that would cause peritubal scarring
what are the clinical findings of an ectopic pregnancy
abdominal pain and bleeding 6-8 weeks after last period
(pain is due to dilation of the fallopian tube and hemorrhage)
how do you diangose an ectopic pregnancy
HCG pregnancy test and transvaginal ultrasound which will fail to show a gestational sac (seen at 5 weeks) in the uterus (can show a fallopian complex mass)
rupture of an ectopic pregnancy is an emergency and can lead to?
severe abdominal pain and hemorrhagic shock (rupture into the peritoneal space)
pathologic findings of an ectopic pregnancy
enlarged swollen fallopian tubes with hemorrage or fetal parts
histological findings in ectopic pregnancy
fetal chorionic villi with hemorrahe
what is a spontaneous abortion?
this is pregnancy loss before 20 weeks
causes of a spontaneous abortion/miscarriage
fetal chromosomal abnormalities (50% of all miscarriages)
endocrine factors (thyroid, diabetes), uterine abnormalieis (polyp) TORCH infections, insuffiecent maternal vasculature , thrombosis (antiphopholipid syndrome)
trauma, drugs
a lot of things
diabetes can lead to a miscarriage due to poor _
vasculature
maternal side of the placenta contains
myometrium
decidua (specialized endometrium)
maternal arteries and veins (spiral arteries)
the fetal side of the placenta contains?
fetal chorionic villi which preform gas exchange
amnion
fetal vein and ateriy
amnion + chorion =
chorionic plate
twin pregnancies occur when two eggs are fertilized each by one sperm or when a previously fertilized egg splits in _
two
when two eggs are fertilized by two different sperm they are _
dizygotic/fraternal
dizygotic twinning results in?
dichorinoic
and diamniotic
if a previously fertilized egg splits in two they are _
monozygotic or identical tiwns
identical twins have the _ phenotypic characterisitcs
same
what are the different placental typese that monozygotic twins could have
di/di mono/di and mono/mono
twin chance is increased by many factors like?
fetility treatments and advanced maternal age, higher pregnancy number, and genetic factors
twin-twin tranfusion only occurs in _ twins
monochorionic (which are identical twins)
twin-twin tranfusion is caused by ?
ateriovenous anastomesis deep in the placenta between the fetal sides
what is the outcome of twin-twin transfusion syndrome
one twin who is under perfused (anemia, hypotensive, oliguria) while one twin is fluid overloaded (polycythemia, HTN, polyuria)
both can lead to fetal demise if there is too much of an imbalance
what is placent accreta
placenta attaches to the myometrium (superficially)
what is placenta increta
placents attaching within the myometrium
what is placenta percreta
the placents penetrates all the way through the myometrium into the uterine serosa
failure of the placenta to seperate from the decidua can lead to
severe post partum hemorrhage
risk factor for placenta accreta
previous C-section (disrupts the endometrial-myometrial junction
what is placenta previa
placental implantation in the lower uterine segment or cervix
plecenta previa results in ? and necessitates?
3rd trimester bleeding
c-section
what is preeclampsia?
onset of new hypertension and proteinuria in pregnancy
loss of protein in the urine can cause edematous changes that swell the hands and feet
symptoms of preeclampsia
headache, visual changes, increased LFTs, edema
what is eclampsia
this is preeclampsia with grand mal seziures which are (loss of consciousness and violent muscle contractions)
preeclampsia and ecclampsia typically occur after _ weeks of pregnancy. if they are in early pregnancy this can be associated with _ pregnancy or kidney disease
20
molar pregnancy
describe the pathogenesis of preeclampsia and eclampsia
this starts very early in pregnancy
lack of trophoblastic implantation causes a lack of enlargment of the maternal vessels to the placenta which causes placental ischemia which results in factors being released that cause hypertension and fibrin thrombi to form more easily
how do the maternal blood vessels look in preeclampsia
small, contain fibrin thrombi, and show fibrinoid necrosis
preeclampsia can cause fibrin thrombi in the mother in what organs
brain, liver, kidney (can cause necrosis)
the placenta in preeclampsia will show ?
multiple infarcts
what is HELLP syndrome
a severe form of preeclampsia with hemolysis (microangiopathic anemia: schistocytes)
elevated liver enzymes
low platelets
can have features of preeclampsia (HTN, proteinuria)
microvascualr thrombi are deposited within small vessels (thrombi fragment RBC and cause liver damage elevating the liver enzymes and consume platelets.
histology of HELLP syndrome
microangiopathic anemia with numerous schictocytes
schitocytes are fragmented red blood cells
HELLP syndrome, preeclampsia, and ecclampsia all resolve after _
delivery
what is a hydatiform mole
a molar pregnancy which is an abnormal pregnancy with cystic swelling of chorionic villi
a mass of cystic and swollen chorionic villi surrounded by trophoblastic proliferation
molar pregnancies come to attention due to abnormally elevated _
HCG
molar pregnancy is confirmed by _
ultrasound at 9 weeks gestation
pathologic evaluation is after evacutation of the uterus
what are the two types of molar pregnancies
complete molar
partial molar
what does a complete molar pregnancy look like?
are there fetal parts present
multicystic mass lesion with a snow storm ultrasound
no fetal parts or fetus is idenfified
on histology what does a molar pregnancy look like?
enlarged villi that appears swollen/hydropic
marked trophoblastic proliferation
complete molar pregnancies are a major risk for
choriocarcinoma
and an invasive mole
a malignant tumor of trophoblastic cells
what is a partial molar pregnancy look like and are there fetal parts present?
enlarged abnormal villi and some normal villi
some fetal parts are present
mild trophoblastic proliferation
partially cystic
partial molar prehnancy has a small risk for developing
an invasive mole
a complete mole is _ derived
paternally derived
46XX
46XY
all genetic material from dad
a partial mole is _ derived
derived from both parents resulting in triploidy
69XXX
69XXY
69XYY
1 egg fertilized by 2 sperm
_ is marker than distinguhes between partial and complete molar pregnancies
P57
this is a maternally expressed protein product
so it will stain brown in a partial molar pregnancy
it will NOT stain brown in a complete molar pregnancy
what is a gestational choriocarcinoma
what is a risk factor
malignant trophoblastic tumor
risk factor: complete mole
gestational choriocarcinoma is intially diagnosed due to?
wide spread mestastasis , to the lungs, to the vagina, to the brain
coughing up blood, vaginal bleeding, neurological symtpoms
in gestational choriocarcinoma _ is markedly elevated
HCG
what does a gestational choriocarcinoma look like?
fleshy, hemorrhagic with areas of necrosis
gestational choriocarcinoma is very malignant can chemotherapy help?
yes, nearly 100% remission and cure rate
this is different than ovarian choriocarcinoma which is not really amendable to treatment
histology of gestational choriocarcinoma
atypical syncytiotrophoblasts with mononucelated cytotrophoblasts
what is a placental site trophoblastic tumor
this is a rare malignant tumor of the intermediate trophoblasts that commnly follows a normal pregnancy or spontenous abortion
can present many years after pregnancy/ miscarriage
clinical symptoms of a placental site trophoblastic tumor
uterine mass with abnormal uterine bleeding/ amneorrhea
usually confined to the uterus
placental site trophoblastic tumors show an increased _
HCG
