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Endo/Repro > Gestational and Placental Disorders > Flashcards

Gestational and Placental Disorders Flashcards

1
Q

Why are diseases of pregnancy and pathologic conditions of the placenta important?

A
  • Due to causes of fetal intrauterine or perinatal death, congenital malformations, intrauterine growth restriction, maternal death, and morbidity for both the mother and child
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2
Q

How does blood enter the placenta?

A
  • Through the intervillous space through endometrial arteries and circulates around the villi to allow gas and nutrient exchange
  • Deoxygenated blood enters the placenta through two umbilical arteries that branch radially to form fetal chorionic arteries which branch until they form an extensive capillary system
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3
Q

What are some functions of the placenta?

A
  • Nutrient and waste diffusion
  • Hormone production –> hCG, progesterone, and hPL
  • Immunologic organ (down regulates antigen expression)
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4
Q

Does fetal and maternal blood mix?

A
  • No but sufficient free fetal DNA reaches the maternal circulation to permit prenatal genetic testing
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5
Q

What is prenatal cell free DNA screening used?

A
  • Method to screen for certain chromosomal abnormalities
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6
Q

What is spontaneous abortion defined as?

A
  • Pregnancy loss before 20 weeks gestation
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7
Q

What are some causes of spontaneous abortion?

A
  • Fetal chromosomal anomalies
  • Maternal endocrine factors
  • Physical defects of uterus
  • Systemic disorders affecting the maternal vasculature
  • Infections with protozoa, bacteria, or a number of viruses
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8
Q

What are some fetal chromosomal anomalies that cause spontaneous abortion?

A
  • Aneuploidy
  • Polyploidy
  • Translocations
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9
Q

What are some maternal endocrine factors that can cause spontaneous abortion?

A
  • Luteal phase defects
  • Poorly controlled diabetes
  • Other endocrine disorders
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10
Q

What are some physical defects of the uterus that can cause spontaneous abortion?

A
  • Submucosal leiomyomas
  • Uterine polyps
  • Uterine malformations that may prevent or disrupt implantation
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11
Q

What are some systemic disorders that affect maternal vasculature that can cause spontaneous abortion?

A
  • Antiphospholipid antibody syndrome
  • Coagulopathies
  • Hypertension
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12
Q

What are the most common microorganisms that cause preterm labor?

A
  • Ureaplasma urealyticum
  • Mycoplasma hominis
  • Gardnerella vaginalis
  • Trichomonas
  • Gonorrhea
  • Chlamydia
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13
Q

When do most spontaneous abortions occur?

A
  • Occur before end of first trimester

- Most are clinically not recognized as a pregnancy

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14
Q

What is an ectopic pregnancy?

A
  • Implantation of the fetus in a site other than the normal intrauterine locations
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15
Q

What is the most common location for an ectopic pregnancy?

A
  • Extrauterine fallopian tube
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16
Q

What are some other sites of ectopic pregancy?

A
  • Ovary
  • Abdominal cavity
  • Intrauterine portion of fallopian tube
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17
Q

What is the most common cause of hematosalpinx (blood filled fallopian tube?

A
  • Tubal pregnancy
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18
Q

What is a predisposing condition that leads to ectopic pregnancy?

A
  • Chronic salpingitis
  • Fallopian tube scarring/adhesions also can be due to appendicitis, endometriosis, or prior surgery
  • IUD increases ectopic pregnancy
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19
Q

What does an ectopic pregnancy look like?

A
  • Onset of moderate to severe abdominal pain and vaginal bleeding 6 to 8 weeks after the last menstrual period
  • Patient may rapidly develop hemorrhagic shock and signs of acute abdomen with tubal rupture
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20
Q

How is diagnosis made for ectopic pregnancy?

A
  • Determination of chorionic gonadotropin titers
  • Pelvic sonography
  • Endometrial biopsy
  • Laparoscopy
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21
Q

What is hCG?

A
  • Produced by trophoblasts and maintains the corpus luteum

- Levels double every 2 days during the first 4 weeks of pregnancy

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22
Q

What is a classic ultrasound sign of ectopic pregnancy?

A
  • Donut sign
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23
Q

When do disorders of late pregnancy show up?

A
  • During the third trimester and are related to the complex anatomy of the maturing placenta
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24
Q

What are the two pathways that infections use to cause premature rupture of amniotic membranes and delivery?

A
  1. Ascending infection (most common) and almost alway bacterial
  2. Hematogenous dissemination (viruses, Toxo, mycoplasma, listeria, chlamydia, ureaplasma)
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25
Q

What is the normal color of amniotic fluid?

A
  • Colorless or pale yellow
26
Q

What location of a retroplacental hemorrhage threatens both the mother and the fetus?

A
  • Interface of placenta and myometrium

- May have bleeding to warn there is something going on

27
Q

What is placental previa?

A
  • Condition where the placenta is attached close to or covering the cervix
  • Could be total, partial, or marginal coverage
28
Q

What is placenta accreta?

A
  • Partial or complete absence of the decidua, such that the placental villous tissue adheres directly to the myometrium leading to failure of placental separation at birth
  • Could be a cause of severe, life-threatening postpartum bleeding
29
Q

What causes uteroplacental vascular insufficiency?

A
  • Diabetes
  • Hypertension
  • Maternal conditions predisposing to blood clots
  • Smoking
  • Cocaine or other drugs
30
Q

What is twin-twin transfusion syndrome?

A
  • Occurs when women are pregnant with identical twins

- Blood begins to flow unevenly, with one fetal twin receiving too much blood and the other receiving too little

31
Q

What happens to the twin receiving too much blood in twin-twin transfusion syndrome?

A
  • May experience heart failure due to continual strain on its heart and blood vessels
32
Q

What happens to the twin receiving not enough blood in twin-twin transfusion syndrome?

A
  • May experience life-threatening anemia, insufficient nutrition and oxygen due to inadequate blood supply
33
Q

What is fetus papyraceus?

A
  • A mummified fetus associated with multiple gestations where one fetus dies and is flattened between the membranes of the living fetus and uterine wall
34
Q

What is preeclampsia?

A
  • Systemic syndrome characterized by widespread maternal endothelial dysfunction that present during pregnancy with a triad of symptoms
35
Q

What are the symptoms of preeclampsia?

A
  • Hypertension
  • Edema
  • Proteinuria
36
Q

What is eclampsia?

A
  • Preeclampsia symptoms along with seizures
37
Q

What do some women develop with severe preeclampsia?

A
  • Microangiopathic hemolytic anemia, elevated liver enzymes, and low platelets (HELLP syndrome)
38
Q

What plays a central role in preeclampsia?

A
  • The placenta

- Symptoms disappear rapidly after delivery of placenta

39
Q

What remodeling fails to occur in preeclampsia?

A
  • Extravillous trophoblast cells destroy the vascular smooth muscle and replace the maternal endothelial cells with fetal trophoblast cells
  • This converts the decidual spiral arteries from small caliber resistance vessels to large capacity uteroplacental vessels lacking a smooth muscle coat
  • Failure of this remodeling system leaves the placenta ill equipped to meet the increased circulatory needs of late gestation
40
Q

What does an ischemic placenta release?

A
  • Factors into the maternal circulation which antagonize the angiogenic effects of maternal VEGF and TGFB leading to systemic maternal endothelial dysfunction and the clinical symptoms of disease
41
Q

What is preeclampsia associated with?

A
  • A hypercoagulable state that may lead to formation of thrombi in arterioles and capillaries throughout the body (like liver, kidneys, brain, and pituitary)
42
Q

What is the hypercoagulability in preeclampsia related to?

A
  • Reduced endothelial production of PGI2 (potent antithrombotic factory, stimulated by VEGF) and increased release of procoagulant factors
43
Q

What are the periportal sinusoids that contain fibrin deposits associated with?

A
  • Hemorrhage into the space of Disse, leading to periportal hepatocellular coagulative necrosis
44
Q

What is the management of preeclampsia dependent on?

A
  • Gestational age and severity of disease
45
Q

What is the management of preeclampsia for term pregnancies?

A
  • Delivery is treatment of choice regardless of disease severity
46
Q

What is the management of mild preeclampsia for preterm pregnancies?

A
  • Managed expectantly by closely monitoring the mother and fetus
47
Q

What is the management of eclampsia, severe preeclampsia with maternal end organ dysfunction, fetal compromise, or the HELLP syndrome?

A
  • Delivery regardless of gestational age
48
Q

When does proteinuria regress?

A
  • Within 1 to 2 weeks following delivery
49
Q

What is at long term risk following preeclampsia?

A
  • Vascular disease of the heart and brain
50
Q

What are different types of gestational trophoblastic disease?

A
  • Hydatidiform mole
  • Invasive mole
  • Choriocarcinoma
  • Placental site trophoblastic tumor (PSTT)
51
Q

What is a hydatidiform mole?

A
  • Hydatid = a cyst containing watery fluid

- Associated with increased risk of persistent trophoblastic disease or choriocarcinoma

52
Q

How is a hydatidiform mole diagnosed?

A
  • Diagnosed early in pregnancy with sonogram
53
Q

What age is at an increased risk for hydatidiform mole?

A
  • Teens and 40-50s

- 2x as common in southeast asia

54
Q

What is the clinical presentation of molar pregnancies?

A
  • Spontaneous miscarriages or undergo curettage because of ultrasound findings (snowstorm) of abnormal villous enlargement
  • In a complete mole, hCG levels will greatly exceed those of a normal pregnancy of similar gestation (rate is also greater than that of a normal gestation)
55
Q

How does a complete hydatidiform mole form?

A
  • One sperm fertilizing an empty ovum OR two sperm fertilizing and empty ovum
  • No maternal DNA, no fetal tissue
56
Q

How does a partial hydatidiform mole form?

A
  • Two sperm fertilize a regular ovum
57
Q

What is an invasive mole?

A
  • An infiltrative lesion that penetrates or even perforates the uterine wall
  • Villi may invade parametrial tissue and blood vessels and may even embolize to distant sites (like lungs and brain) –> emboli do not grow
58
Q

What is gestational choriocarcinoma?

A
  • Rapidly invasive malignant neoplasm of syncyio and cytotrophoblasts derived from a previously normal or abnormal pregnancy that metastasizes widely
  • Very uncommon
59
Q

What is the clinical presentation of gestational choriocarcinoma?

A
  • Irregular vaginal bleeding of bloody, brown fluid
  • Enlarged uterus
  • May present with mets to lung, vagina, brain, liver, bone, kidney
  • hCG usually very high, unless tumor is necrotic
60
Q

What is the treatment for gestational choriocarcinoma?

A
  • Depends on stage of the tumor and usually consists of evacuation of the contents of the uterus and chemotherapy
61
Q

How effective is chemotherapy for gestational choriocarcinoma?

A
  • Spectacular and result in nearly 100% remission and a high rate of cures
62
Q

What is a placental site trophoblastic tumor?

A
  • Tumor of extravillous/intermediate trophoblasts
  • Produce human placental lactogen (hPL)
  • May follow a normal pregnancy, spontaneous abortion, or hydatidiform mole
  • Localized disease have an excellent prognosis

Endo/Repro (31 decks)

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