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Pathology 2 Block 2 > Gestational and placental disorders > Flashcards

Gestational and placental disorders Flashcards

1
Q

what are the Abnormalities of placental attachment?

A
  • Placenta previa
  • Abruptio placetae
  • Placenta accreta
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2
Q

what is placenta previa?

A

Attachment of placenta to the lower uterine segment which is partially or completely covering the cervical os

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3
Q

what can be noticed about placenta previa with women in any trimester?

A

painless vaginal bleeding

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4
Q

will there be fetal distress in placenta previa?

A

no

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5
Q

how do you diagnose placenta previa?

A

transvaginal ultrasound

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6
Q

what is Abruptio placenta?

A

Premature separation of placenta due to formation of a retroplacental blood clot, which will separate the placenta from the implantation site

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7
Q

what increases the risk of abruptio placenta?

A
  • Hypertension**** - smoking - cocaine - DIC
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8
Q

in abruptio placenta, you will find what sign?

A

painful vaginal bleeding on 3rd trimester

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9
Q

is there fetal distress in abruptio placenta?

A

yes

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10
Q

what is placenta accreta?

A

attachment of the placenta directly to the myometrium without intervening decidua

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11
Q

how does placenta accreta manifest?

A

by impaired placental separation after delivery- sometimes with massive hemorrhage**

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12
Q

what will women require in placenta accreta?

A

a hysterectomy after delivery of baby

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13
Q

what increases the risk of placenta accreta?

A

previous C section

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14
Q

toxemia of pregnancy has this finding always present?

A

severe hypertension

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15
Q

when does toxemia of pregnancy occur?

A

on the third trimerster (24th, 25th week)

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16
Q

In which pregnancy is it most common to see toxemia of pregnancy?

A

1st pregnancy

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17
Q

what organs get afftected by toxemia of pregnancy?

A

kidney, liver and CNS

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18
Q

what are the 2 forms of toxemia of pregnancy?

A

1) pre-clampsia 2) eclampsia

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19
Q

what is pre-eclampsia?

A

mild form of toxemia with presence of hypertension, albuminuria, dependant edema

20
Q

in what trimester of pregnancy does pre-eclampsia occur?

A

3rd trimester

21
Q

in pre-eclampsia, what happens to the liver?

A

there will be liver cell necrosis around zone 1 (look for high ALT, AST)

22
Q

what is eclampsia?

what are the 4 signs?

A

severe toxemia with presence of: 1) Hypertension 2) Albuminuria 3) Dependent pitting edema and 4) Convulsions and DIC

23
Q

how is eclampsia reversed?

A

termination of pregnancy

24
Q

what are the 3 events that lead to eclampsia? these 3 events will cause what?

A

1) abnormal placentation 2) normal vasodilators are decreased 3) increased vasoconstrictors - placental hypoperfusion

25
Q

what pathologic findings will be present with eclampsia?

A
  • spiral arteries will have atherosclerosis, thrombus, fibrinoid necrosis
  • multiple placental infarcts
  • premature aging of placenta
26
Q

what are the clinical findings of eclampsia?

A

headache, blurred vision, hypertension, proteinuria, dependent pitting edema, generalized seizures, DIC

27
Q

how do you treat eclampsia?

A

delivery of fetus as soon as possible and Mg sulfate for seizures

28
Q

how do you treat pre-eclampsia?

A

anti-hypertensives and ant-platelets

29
Q

what is HEELP syndrome?

A

hemolysis, elevated liver enzymes, low platelets syndrome, considered a complication of severe pre-eclampsia

30
Q

what is the pathogenesis for HEELP syndrome?

A

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

31
Q

what are 2 trophoblastic neoplasms?

A

1) Hydatidiform mole (molar pregnancy) 2) Choriocarcinoma

32
Q

what is a hydatidiform mole?

A

A benign tumor of chorionic villus.

33
Q

what are the 2 types of hydatidiform mole?

A

1) Complete mole 2) Partial mole

34
Q

what is the most common hydatidiform mole?

A

complete mole

35
Q

what characterizes hydatidiform mole?

A
  • the entire placenta is neoplastic - dilated, swollen villi without fetal blood vessels - no embryo is present
36
Q

what is the karyotype of a complete hydatidiform mole?

A

46XX, with both x’s coming from male origin

37
Q

why does a complete hydatidiform mole happens?

A

an empty egg is fertilized by two haploid sperm, the empty embryo does not develop

38
Q

people with complete hydatidiform moles are at higher risk to develop what?

A

choreocarcinoma

39
Q

what are the clinical findings found in individuals with complete hydatidiform moles?

A

• 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

40
Q

what is a partial hydatidiform mole?

A

Not all villi are neoplastic or dilated and the embryo is present

41
Q

what is the karyotype of a partial hydatidiform mole?

A

triploid 69 XXY

42
Q

what is the risk of people with a partial hydatidiform mole?

A

low

43
Q

what is the treatment for molar pregnancy?

A

curettage and look for hCG levels

44
Q

what are the 2 types of choreocarcinoma?

A

1) gestational choreocarcinoma 2) non-gestational choriocarcinoma

45
Q

which type of choreocarcioma responds to chemotherapy?

A

gestational choreocarcinoma

46
Q

what makes up a choreocarcinoma?

A

syncytiotrophoblast, cytotrophoblast

Pathology 2 Block 2 (32 decks)

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