gestational and placental pathology

Question 1

implantations

Answer 1

day 7-14

Question 2

eclampsia

Answer 2

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

Question 3

neutrophils in amnion

Answer 3

never normal
indicated infectious
if the neutrophils have infiltrated chorionic villi or if plasma cells are present indicates chronic infection

Question 4

first trimester chorionic villi

Answer 4

delicate mesh of central stroma surrounded by 2 discrete layers of epi
outer layer- synctiotrophoblasts
inner layer- cytotrophoblasts

Question 5

third trimester chorionic villi

Answer 5

stroma with dense network of dilated capillaries surrounded by thinned out synctiotrophoblasts and cytotrophoblasts

Question 6

metabolic transfer

Answer 6

mostly thru synctiotrophoblats both passive and active transport

Question 7

spontaneous abortion

Answer 7

pregnancy loss <20 weeks, but before 12

Question 8

1st trimester causes of abortion

Answer 8

chromosomal

Question 9

2nd trimester causes of abortion

Answer 9

mechanical

Question 10

3rd trimester causes

Answer 10

fetoplacental unti

Question 11

dichorionic

Answer 11

not identical

Question 12

monochrorionic

Answer 12

identical

Question 13

placenta previa

Answer 13

implantation on or near cervical os
blocks babys exit
presents as painless bleeding in 3rd trimester
Most common cause of antepartum hemorrhage
C-section

Question 14

abruptio placenta

Answer 14

dt premature separation of placenta -> clot
painful, may or may not bleed
emergency

Question 15

placenta accreta

Answer 15

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

Question 16

placental infection

Answer 16

ascending or from maternal

Question 17

acute chorioamnionitis

Answer 17

vaginal flora ascends -> loss of mucous plug -> travels thr membranes to umbilicus -> ascent to fetus

Question 18

preeclampsia/eclamsia

Answer 18

HTN >20weeks gestation
associated with proteinuria and edema
common in premigravida women >35

Question 19

pathophys of eclamsia

Answer 19

maternal endothelial dysfunction d/t underprofussion of placenta d/t abnormal adaptation of spiral aa to pregnancy

Question 20

HELLP

Answer 20

hemolysis
elevated liver enzymes
low platelets

Question 21

complete hydotidiform mole

Answer 21

arise from fertilization of empty ovum
no fetal parts
billous edema with diffuse trophoblastic proliferation
high risk of chrioCA

Question 22

partial hydrotidiform mole

Answer 22

2 sperm fertilizing single ovum

identifiable fetal parts

Question 23

when should you suspect gestational neoplasm

Answer 23

when uterus too large for date and no fetal heart beat/movement
HTN
thryrotoxicosis
painless bleeding

Question 24

choriocarcinoma

Answer 24

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