Gestational and placental disorders Flashcards
what are the Abnormalities of placental attachment?
- Placenta previa
- Abruptio placetae
- Placenta accreta
what is placenta previa?
Attachment of placenta to the lower uterine segment which is partially or completely covering the cervical os
what can be noticed about placenta previa with women in any trimester?
painless vaginal bleeding
will there be fetal distress in placenta previa?
no
how do you diagnose placenta previa?
transvaginal ultrasound
what is Abruptio placenta?
Premature separation of placenta due to formation of a retroplacental blood clot, which will separate the placenta from the implantation site
what increases the risk of abruptio placenta?
- Hypertension**** - smoking - cocaine - DIC
in abruptio placenta, you will find what sign?
painful vaginal bleeding on 3rd trimester
is there fetal distress in abruptio placenta?
yes
what is placenta accreta?
attachment of the placenta directly to the myometrium without intervening decidua
how does placenta accreta manifest?
by impaired placental separation after delivery- sometimes with massive hemorrhage**
what will women require in placenta accreta?
a hysterectomy after delivery of baby
what increases the risk of placenta accreta?
previous C section
toxemia of pregnancy has this finding always present?
severe hypertension
when does toxemia of pregnancy occur?
on the third trimerster (24th, 25th week)
In which pregnancy is it most common to see toxemia of pregnancy?
1st pregnancy
what organs get afftected by toxemia of pregnancy?
kidney, liver and CNS
what are the 2 forms of toxemia of pregnancy?
1) pre-clampsia 2) eclampsia
what is pre-eclampsia?
mild form of toxemia with presence of hypertension, albuminuria, dependant edema
in what trimester of pregnancy does pre-eclampsia occur?
3rd trimester
in pre-eclampsia, what happens to the liver?
there will be liver cell necrosis around zone 1 (look for high ALT, AST)
what is eclampsia?
what are the 4 signs?
severe toxemia with presence of: 1) Hypertension 2) Albuminuria 3) Dependent pitting edema and 4) Convulsions and DIC
how is eclampsia reversed?
termination of pregnancy
what are the 3 events that lead to eclampsia? these 3 events will cause what?
1) abnormal placentation 2) normal vasodilators are decreased 3) increased vasoconstrictors - placental hypoperfusion
what pathologic findings will be present with eclampsia?
- spiral arteries will have atherosclerosis, thrombus, fibrinoid necrosis
- multiple placental infarcts
- premature aging of placenta
what are the clinical findings of eclampsia?
headache, blurred vision, hypertension, proteinuria, dependent pitting edema, generalized seizures, DIC
how do you treat eclampsia?
delivery of fetus as soon as possible and Mg sulfate for seizures
how do you treat pre-eclampsia?
anti-hypertensives and ant-platelets
what is HEELP syndrome?
hemolysis, elevated liver enzymes, low platelets syndrome, considered a complication of severe pre-eclampsia
what is the pathogenesis for HEELP syndrome?
1) Hemolysis due to microangiopathic hemolytic anemia 2) Elevated liver enzymes due to hemolytic process and possible liver involvement 3) decreased platelets due to consumption
what are 2 trophoblastic neoplasms?
1) Hydatidiform mole (molar pregnancy) 2) Choriocarcinoma
what is a hydatidiform mole?
A benign tumor of chorionic villus.
what are the 2 types of hydatidiform mole?
1) Complete mole 2) Partial mole
what is the most common hydatidiform mole?
complete mole
what characterizes hydatidiform mole?
- the entire placenta is neoplastic - dilated, swollen villi without fetal blood vessels - no embryo is present
what is the karyotype of a complete hydatidiform mole?
46XX, with both x’s coming from male origin
why does a complete hydatidiform mole happens?
an empty egg is fertilized by two haploid sperm, the empty embryo does not develop
people with complete hydatidiform moles are at higher risk to develop what?
choreocarcinoma
what are the clinical findings found in individuals with complete hydatidiform moles?
• Painless vaginal bleeding in 4th or 5th month of pregnancy • Passage of grape like structures through vagina Severe vomiting • Preeclampsia ( in 2% cases) • Uterus too large for gestational age • Size greater than dates • Increased hCG for gestational age • “Snowstrom” appearance with ultrasound Increased hCG for gestational age
what is a partial hydatidiform mole?
Not all villi are neoplastic or dilated and the embryo is present
what is the karyotype of a partial hydatidiform mole?
triploid 69 XXY
what is the risk of people with a partial hydatidiform mole?
low
what is the treatment for molar pregnancy?
curettage and look for hCG levels
what are the 2 types of choreocarcinoma?
1) gestational choreocarcinoma 2) non-gestational choriocarcinoma
which type of choreocarcioma responds to chemotherapy?
gestational choreocarcinoma
what makes up a choreocarcinoma?
syncytiotrophoblast, cytotrophoblast
