Gestational and Placental Pathology (Gianani) - SRS

Question 1

What are the two main disorders of early pregnancy?

Answer 1

1. Spontaneous abortion/miscarriage
2. Ectopic pregnancy

Question 2

What is the definition of spontaneous abortion?

Answer 2

Lost pregnancy before 20 weeks

Question 3

Spontaneous abortion, or “miscarriage,” is defined as pregnancy loss before 20 weeks of gestation. Most of these occur before 12 weeks. Ten to fifteen percent of clinically recognized pregnancies terminate in spontaneous abortion. However, using sensitive chorionic gonadotropin assays, it has been determined that an additional 20% of early pregnancies in otherwise healthy women terminate spontaneously, many without notice. In most individual instances, the mechanisms leading to early loss of pregnancy are unknown. However, multiple fetal and maternal causes of spontaneous abortion have been identified. What are five of these?

Answer 3

1. Fetal chromosomal anomalies
2. Maternal endocrine factors
3. Physical defects of uterus
4. Systemic disorders affecting the maternal vasculature
5. Infections with protozoa, bacteria, or viruses

Question 4

What are some physical uterine defects that can cause spontaneous abortion?

Answer 4

1. Submucosal leiomyomas
2. Uterine polyps
3. Didelphys uterus

Question 5

What are some maternal endocrine factors that can lead to spontaneous abortion?

Answer 5

luteal-phase defect

poorly controlled DM

Question 6

Ectopic pregnancy refers to implantation of the fetus in a site other than the normal intrauterine location; the most common site is?

Answer 6

the extrauterine fallopian tube (approximately 90% of cases).

Question 7

The clinical course of ectopic tubal pregnancy is characterized by the onset of moderate to severe abdominal pain and vaginal bleeding 6 to 8 weeks after last menstrual period, correlating with distention and then rupture of the fallopian tube. Early diagnosis is critical. Why?

Answer 7

PAtient may rapidly develop hemorrhagic shock with acute abdomen.

Question 8

What is the dx of a ruptured tubal pregnancy based on?

Answer 8

1. HcG titers
2. pelvic sonography
3. endometrial biopsy
4. laparoscopy

Question 9

What are four disorders of late pregnancy?

Answer 9

1. •Complications arising from twin placenta.
2. •Abnormalities of placental implantation.
3. •Placental infection.
4. •Preeclampsia and eclampsia.

Question 10

One complication of monochorionic twin pregnancy is twin twin transfusion syndrome. How does this happen?

Answer 10

Monochorionic twin placentas have vascular anastomoses that connect the circulations of the twins, and in some cases these connections include one or more arteriovenous shunts. If these shunts preferentially increase blood flow to one twin at the expense of the second, one twin will be underperfused, while the second will be fluid overloaded.

Question 11

What is placenta previa?

Answer 11

Placenta implants in the lower uterine segment or cervix, leading to third trimester bleeding. May require C section since the cervical OS may be completely obstructed.

Question 12

What is placenta accreta?

Answer 12

Partial or complete abscence of the decidua, such that placental villous tissue adheres directly to the myometrium leading to a failure of placental separation at birth.

Cause of severe possibly life threatening post partum bleeding.

Question 13

What are the two pathways in which placental infections occur?

Answer 13

1. ascending through the birth canal
2. Hematogenous (transplacental) infections

Question 14

Which route of placental infection is more common?

What type of organism?

Consequence?

Answer 14

Ascending infections are by far the most common and are virtually always bacterial; in many such instances, localized infection of the membranes produces premature rupture of membranes and preterm delivery.

Question 15

Preeclampsia is a systemic syndrome characterized by widespread maternal endothelial dysfunction that presents during pregnancy with what three symptoms?

Answer 15

1. HTN
2. Edema
3. Proteinuria

Question 16

If a 34 weeks pregnant patient reports headaches and visual disturbances, what are these indicative of?

Answer 16

Severe preeclampsia

Question 17

Eclampsia is heralded by CNS involvement including?

Answer 17

Convulsions and eventual coma

Question 18

What are three types of gestation trophoblastic disease?

Answer 18

1. •Hydatiform mole.
2. •Choriocarcinoma.
3. •Placental site trophoblastic tumor (PSTT)

Question 19

What are the two types of choriocarcinoma?

Answer 19

1. gestational d/t normal pregnancy
2. complete mole

Question 20

Will the levels of HCG be high in choriocarcinoma?

Answer 20

Maybe. Can either be high or low. Can’t count on this.

Question 21

What are the two types of hydatiform moles?

Answer 21

Complete

Partial

Question 22

Both complete and partial moles can become invasive. If this continues unchecked what are some consequences?

Answer 22

1. Can perforate the uterus
2. Give rise to emboli

Question 23

How is a complete mole formed?

Answer 23

Sperm fertilizes an empty ovum

Question 24

Characterize the ploidy of the complete mole.

Answer 24

Diploid

Question 25

What is the ploidy of a partial mole?

Answer 25

Triploid

Question 26

A partial mole may have what in it that is absent in a complete hydaditiform mole?

Answer 26

Partial embryo