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ENRP II > female reproductive tract part 6 (last part) > Flashcards

female reproductive tract part 6 (last part) Flashcards

1
Q

what is an ectopic pregnancy

what is the most common site

what are the risk factors?

A

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

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2
Q

what are the clinical findings of an ectopic pregnancy

A

abdominal pain and bleeding 6-8 weeks after last period

(pain is due to dilation of the fallopian tube and hemorrhage)

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3
Q

how do you diangose an ectopic pregnancy

A

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)

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4
Q

rupture of an ectopic pregnancy is an emergency and can lead to?

A

severe abdominal pain and hemorrhagic shock (rupture into the peritoneal space)

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5
Q

pathologic findings of an ectopic pregnancy

A

enlarged swollen fallopian tubes with hemorrage or fetal parts

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6
Q

histological findings in ectopic pregnancy

A

fetal chorionic villi with hemorrahe

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7
Q

what is a spontaneous abortion?

A

this is pregnancy loss before 20 weeks

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8
Q

causes of a spontaneous abortion/miscarriage

A

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

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9
Q

diabetes can lead to a miscarriage due to poor _

A

vasculature

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10
Q

maternal side of the placenta contains

A

myometrium
decidua (specialized endometrium)
maternal arteries and veins (spiral arteries)

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11
Q

the fetal side of the placenta contains?

A

fetal chorionic villi which preform gas exchange

amnion

fetal vein and ateriy

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12
Q

amnion + chorion =

A

chorionic plate

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13
Q

twin pregnancies occur when two eggs are fertilized each by one sperm or when a previously fertilized egg splits in _

A

two

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14
Q

when two eggs are fertilized by two different sperm they are _

A

dizygotic/fraternal

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15
Q

dizygotic twinning results in?

A

dichorinoic

and diamniotic

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16
Q

if a previously fertilized egg splits in two they are _

A

monozygotic or identical tiwns

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17
Q

identical twins have the _ phenotypic characterisitcs

A

same

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18
Q

what are the different placental typese that monozygotic twins could have

A

di/di mono/di and mono/mono

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19
Q

twin chance is increased by many factors like?

A

fetility treatments and advanced maternal age, higher pregnancy number, and genetic factors

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20
Q

twin-twin tranfusion only occurs in _ twins

A

monochorionic (which are identical twins)

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21
Q

twin-twin tranfusion is caused by ?

A

ateriovenous anastomesis deep in the placenta between the fetal sides

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22
Q

what is the outcome of twin-twin transfusion syndrome

A

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

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23
Q

what is placent accreta

A

placenta attaches to the myometrium (superficially)

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24
Q

what is placenta increta

A

placents attaching within the myometrium

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25
Q

what is placenta percreta

A

the placents penetrates all the way through the myometrium into the uterine serosa

26
Q

failure of the placenta to seperate from the decidua can lead to

A

severe post partum hemorrhage

27
Q

risk factor for placenta accreta

A

previous C-section (disrupts the endometrial-myometrial junction

28
Q

what is placenta previa

A

placental implantation in the lower uterine segment or cervix

29
Q

plecenta previa results in ? and necessitates?

A

3rd trimester bleeding

c-section

30
Q

what is preeclampsia?

A

onset of new hypertension and proteinuria in pregnancy

loss of protein in the urine can cause edematous changes that swell the hands and feet

31
Q

symptoms of preeclampsia

A

headache, visual changes, increased LFTs, edema

32
Q

what is eclampsia

A

this is preeclampsia with grand mal seziures which are (loss of consciousness and violent muscle contractions)

33
Q

preeclampsia and ecclampsia typically occur after _ weeks of pregnancy. if they are in early pregnancy this can be associated with _ pregnancy or kidney disease

A

20

molar pregnancy

34
Q

describe the pathogenesis of preeclampsia and eclampsia

A

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

35
Q

how do the maternal blood vessels look in preeclampsia

A

small, contain fibrin thrombi, and show fibrinoid necrosis

36
Q

preeclampsia can cause fibrin thrombi in the mother in what organs

A

brain, liver, kidney (can cause necrosis)

37
Q

the placenta in preeclampsia will show ?

A

multiple infarcts

38
Q

what is HELLP syndrome

A

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.

39
Q

histology of HELLP syndrome

A

microangiopathic anemia with numerous schictocytes

schitocytes are fragmented red blood cells

40
Q

HELLP syndrome, preeclampsia, and ecclampsia all resolve after _

A

delivery

41
Q

what is a hydatiform mole

A

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

42
Q

molar pregnancies come to attention due to abnormally elevated _

A

HCG

43
Q

molar pregnancy is confirmed by _

A

ultrasound at 9 weeks gestation

pathologic evaluation is after evacutation of the uterus

44
Q

what are the two types of molar pregnancies

A

complete molar

partial molar

45
Q

what does a complete molar pregnancy look like?

are there fetal parts present

A

multicystic mass lesion with a snow storm ultrasound

no fetal parts or fetus is idenfified

46
Q

on histology what does a molar pregnancy look like?

A

enlarged villi that appears swollen/hydropic

marked trophoblastic proliferation

47
Q

complete molar pregnancies are a major risk for

A

choriocarcinoma

and an invasive mole

a malignant tumor of trophoblastic cells

48
Q

what is a partial molar pregnancy look like and are there fetal parts present?

A

enlarged abnormal villi and some normal villi

some fetal parts are present

mild trophoblastic proliferation

partially cystic

49
Q

partial molar prehnancy has a small risk for developing

A

an invasive mole

50
Q

a complete mole is _ derived

A

paternally derived

46XX
46XY

all genetic material from dad

51
Q

a partial mole is _ derived

A

derived from both parents resulting in triploidy

69XXX
69XXY
69XYY

1 egg fertilized by 2 sperm

52
Q

_ is marker than distinguhes between partial and complete molar pregnancies

A

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

53
Q

what is a gestational choriocarcinoma

what is a risk factor

A

malignant trophoblastic tumor

risk factor: complete mole

54
Q

gestational choriocarcinoma is intially diagnosed due to?

A

wide spread mestastasis , to the lungs, to the vagina, to the brain

coughing up blood, vaginal bleeding, neurological symtpoms

55
Q

in gestational choriocarcinoma _ is markedly elevated

A

HCG

56
Q

what does a gestational choriocarcinoma look like?

A

fleshy, hemorrhagic with areas of necrosis

57
Q

gestational choriocarcinoma is very malignant can chemotherapy help?

A

yes, nearly 100% remission and cure rate

this is different than ovarian choriocarcinoma which is not really amendable to treatment

58
Q

histology of gestational choriocarcinoma

A

atypical syncytiotrophoblasts with mononucelated cytotrophoblasts

59
Q

what is a placental site trophoblastic tumor

A

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

60
Q

clinical symptoms of a placental site trophoblastic tumor

A

uterine mass with abnormal uterine bleeding/ amneorrhea

usually confined to the uterus

61
Q

placental site trophoblastic tumors show an increased _

A

HCG

ENRP II (25 decks)

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