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Pathology/ICM-GYN Module > Gestational and trophoblastic diseases > Flashcards

Gestational and trophoblastic diseases Flashcards

1
Q

What is the placenta composed of?

A

chorionic villi

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2
Q

where does maternal blood enter the intervillous space?>

A

though endometrial arteries and circulates around the villi

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3
Q

What is the outer layer of the chorionic villi?

A

syncytiotrophoblast

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4
Q

what is the inner layer of the chorionic villi?

A

cytotrophoblast

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5
Q

what is spontaneous abortion classified as?

A

pregnancy loss before 20 weeks gestation

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6
Q

what are fetal causes of spontaneous abortion

A

aneuploidy
polyploidy
tranlocations

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7
Q

what are maternal causes of spontaneous abortion?

A 
luteal phase defect
diabetes (not controlled)
endocrine disorders
APLA
coagulapathies 
hypertension
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8
Q

what physical defects can cause spontaneous abortion

A

submucosal leiomyomas
uterine polyps
uterine malformations

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9
Q

what infections may cause spontaneous abortions?

A

toxoplasmosis
mycoplasma
listeria
viral infections

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10
Q

where do ectopic pregnancies usually occur

A

1fallopian tubes

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11
Q

what are risk factors for ectopic pregnancy?

A 
hx of PID 
hx of fallopian tube scarring (chronic follicular salpingitis)
appendicitis
endometriosis
prior surgery
IUD
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12
Q

Ectopic pregnancy signs and sx?

A

hemorrhagic shock

acute abdominal pain

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13
Q

how would you dx ectopic pregnancy

A

B-HCG
ultra sound
laparoscopy

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14
Q

If egg oops out of fimbriated end of tube what type of ectopic pregnancy is this?

A

abdominal etopic

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15
Q

what is hematosalpinx

A

blood in the fallopian tube most commonly caused by ectopic pregancy

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16
Q

What are copications of late pregnancy?

A

knots in umbilical cord-interruption of blood flow
ascending infections=chorioaminiotis can cause spent abortion
placental abruption

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17
Q

what is placenta previa?

A

plantation in lower uterine segment

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18
Q

how does placenta previa present?

A

third trimester bleeding

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19
Q

how must placenta previa be delivered?

A

though c-section

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20
Q

what is placenta abruption

A

separation of placenta from decide prior to delivery of fetus

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21
Q

how does placenta abrution present as

A

3rd trimester bleeding and fetal insufficiency

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22
Q

placent abruption is a common cause of _______

A

still birth

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23
Q

what is placenta accreta?

A

(superficial) improper implantation of placenta into myometrium with little or no intervening decidua

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24
Q

how does placenta accreta present?

A

with difficult delivery of placenta and post partum bleeding

requires hysterectomy

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25
Q

what are risk factors for placenta accreta

A

prior placent previa

and history of c-section

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26
Q

what is placenta increta

A

(deep) (superficial) improper implantation of placenta into myometrium with little or no intervening decidua

27
Q

what is placenta percreta

A

attachment of placenta through the myometrium

28
Q

most ascending infections are.___

A

bacterial

29
Q

what is chorioaminiotis

A

pin in membranes

30
Q

what is funisitis

A

infection of the umbilical cord

31
Q

what is acute villitis

A

bacteria in villi of the placenta

32
Q

what is the px of preeclampsia?

A

hypertension
edema
proteinuria
if ….headaches/visual disturbances…deliver

33
Q

when do you get preeclampsia?

A

last trimester

34
Q

how do you treat preeclampsia?

A

deliver

antihypertensives dont help

35
Q

what is the DD of preeclampsia and how would you tell apart?

A

gestational hypertension (no proteinuria)

36
Q

what is eclampsia

A

preeclampsia plus cns involment

convulsions->COMA

37
Q

WHAT do patients with severe preeclampsia develop?

A

HELLP

Hemolysis
Elevated
Liver enzymes
Low
Platlets
38
Q

What are the gestational trophoblastic diseases?

A 
COMPLETE MOLE
PARTIAL MOLE
INVASIVE MOLE
PALCENTAL SITE TROPHOBLASTIC TUMOR
CHORIOCARCINOMA
39
Q

what is a hydatidiform mole

A

Cystic swelling of chorionic villi

40
Q

moles increase risk of ______

A

persistent trophoblastic disease
choriocarcinoma
spontaneous pregnancy lost

41
Q

what is the clinical px of molar pregnancy?

A

spent pregnancy loss
some people might have D/cutterage
HCG will be high (faster then it should)

42
Q

what is a complete mole

A

completely dad empty ovum

no fetal parts

43
Q

how would a complete mole look histologically?

A

ALL villi enlarged and show edema

44
Q

what gene would u see in complete mole?

A

p57(-)

45
Q

what is a partial mole?

A

fertilization of one egg with 2 sperm
69,XXY or 92, XXXY\
fetal parts

46
Q

what would gene you see in partial mole?

A

p57 (+)

47
Q

how would a partial mole look histologically

A

not all villi enlarged

some show edema some don’t

48
Q

in which type of mole is there an increased risk of developing choriocarcinoma?

A

complete mole

49
Q

in which type of mole is P57KIP2 gene transcribed?

A

partial

50
Q

What is an invasive mole?

A

mole that penetrates or perforates the uterine wall

can lead to uterine rupture

51
Q

which type of mole can benign mets (not true because it cannot grow in these areas)

A

invasive moles

with their hydronic villi

52
Q

what is the clinical presentation of invasive mole?

A

vaginal bleeding
irreglar uterine enlargement
persistently high HCG

53
Q

How do you treat an invasive mole?

A

chemotherapy

54
Q

what is a choriocarincoma?

A

malignant neoplasm of trophoblastic cells

55
Q

how can you get a choriocarcinoma?

A

arises from moles (50%)
normal pregnancy (22%)
abortions (25%)
abnormal pregnancy/ectopic

56
Q

how do you get the non-gestational type choriocarcinoma?

A

arise from germ cells in ovary or mediastinum

57
Q

how invasive is choriocarcinoma?

A

rapidly invasive and mets all over

*usually mets to lung and bones at time of diagnosis)

58
Q

how do you treat gestational choriocarcinoma?

A

gestational is very chemo sensitive
100% remission with chemo
(vs. nongestational…worse prognosis)

59
Q

how does choriocarcinoma present?

A

irregular vaginal spotting

really really really high levels of HCG

60
Q

what is a placental site trophoblastic tumor

A

neoplastic proliferation of intermediate trophoblast

61
Q

how does placental site trophoblastic tumor px?

A

uterine mass with abnormal bleeding or amenorrhea

mildly elevated HCG

62
Q

where are intermediate trophoblast found?

A

implantation site
chorionic plate
placenta parenchyma
placenta membranes

63
Q

what is the prognosis for placental site trophoblastic tumor?

A

if localized =excellant prognosis

if advanced poor prognosis

Pathology/ICM-GYN Module (11 decks)

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