gestational and placental pathology Flashcards
implantations
day 7-14
eclampsia
thought to be dt abnormal migration of cytotrophoblasts into spiral aa walls, therefore spiral aa do not expand properly -> HTN -> placenta releases factors into blood that causes maternal HTN
neutrophils in amnion
never normal
indicated infectious
if the neutrophils have infiltrated chorionic villi or if plasma cells are present indicates chronic infection
first trimester chorionic villi
delicate mesh of central stroma surrounded by 2 discrete layers of epi
outer layer- synctiotrophoblasts
inner layer- cytotrophoblasts
third trimester chorionic villi
stroma with dense network of dilated capillaries surrounded by thinned out synctiotrophoblasts and cytotrophoblasts
metabolic transfer
mostly thru synctiotrophoblats both passive and active transport
spontaneous abortion
pregnancy loss <20 weeks, but before 12
1st trimester causes of abortion
chromosomal
2nd trimester causes of abortion
mechanical
3rd trimester causes
fetoplacental unti
dichorionic
not identical
monochrorionic
identical
placenta previa
implantation on or near cervical os
blocks babys exit
presents as painless bleeding in 3rd trimester
Most common cause of antepartum hemorrhage
C-section
abruptio placenta
dt premature separation of placenta -> clot
painful, may or may not bleed
emergency
placenta accreta
attachment of placenta to myometrium loss of decidua basalis does not seperate after delivery hysterectomy requires uterine rupture in 15% accreta< increta< percreta c-section or other scarring major risk factors
placental infection
ascending or from maternal
acute chorioamnionitis
vaginal flora ascends -> loss of mucous plug -> travels thr membranes to umbilicus -> ascent to fetus
preeclampsia/eclamsia
HTN >20weeks gestation
associated with proteinuria and edema
common in premigravida women >35
pathophys of eclamsia
maternal endothelial dysfunction d/t underprofussion of placenta d/t abnormal adaptation of spiral aa to pregnancy
HELLP
hemolysis
elevated liver enzymes
low platelets
complete hydotidiform mole
arise from fertilization of empty ovum
no fetal parts
billous edema with diffuse trophoblastic proliferation
high risk of chrioCA
partial hydrotidiform mole
2 sperm fertilizing single ovum
identifiable fetal parts
when should you suspect gestational neoplasm
when uterus too large for date and no fetal heart beat/movement
HTN
thryrotoxicosis
painless bleeding
choriocarcinoma
arise from complete hydatidiform moles (50%), previous abortions (25%), normal pregnancies (22%) Beta-hCG MARKEDLY elevated lack villous strucutes mets to lungs, vagina, brain, liver chemo almost 1000% cure-rate methotrexate
