Gestational and trophoblastic diseases Flashcards
What is the placenta composed of?
chorionic villi
where does maternal blood enter the intervillous space?>
though endometrial arteries and circulates around the villi
What is the outer layer of the chorionic villi?
syncytiotrophoblast
what is the inner layer of the chorionic villi?
cytotrophoblast
what is spontaneous abortion classified as?
pregnancy loss before 20 weeks gestation
what are fetal causes of spontaneous abortion
aneuploidy
polyploidy
tranlocations
what are maternal causes of spontaneous abortion?
luteal phase defect diabetes (not controlled) endocrine disorders APLA coagulapathies hypertension
what physical defects can cause spontaneous abortion
submucosal leiomyomas
uterine polyps
uterine malformations
what infections may cause spontaneous abortions?
toxoplasmosis
mycoplasma
listeria
viral infections
where do ectopic pregnancies usually occur
1fallopian tubes
what are risk factors for ectopic pregnancy?
hx of PID hx of fallopian tube scarring (chronic follicular salpingitis) appendicitis endometriosis prior surgery IUD
Ectopic pregnancy signs and sx?
hemorrhagic shock
acute abdominal pain
how would you dx ectopic pregnancy
B-HCG
ultra sound
laparoscopy
If egg oops out of fimbriated end of tube what type of ectopic pregnancy is this?
abdominal etopic
what is hematosalpinx
blood in the fallopian tube most commonly caused by ectopic pregancy
What are copications of late pregnancy?
knots in umbilical cord-interruption of blood flow
ascending infections=chorioaminiotis can cause spent abortion
placental abruption
what is placenta previa?
plantation in lower uterine segment
how does placenta previa present?
third trimester bleeding
how must placenta previa be delivered?
though c-section
what is placenta abruption
separation of placenta from decide prior to delivery of fetus
how does placenta abrution present as
3rd trimester bleeding and fetal insufficiency
placent abruption is a common cause of _______
still birth
what is placenta accreta?
(superficial) improper implantation of placenta into myometrium with little or no intervening decidua
how does placenta accreta present?
with difficult delivery of placenta and post partum bleeding
requires hysterectomy
what are risk factors for placenta accreta
prior placent previa
and history of c-section
what is placenta increta
(deep) (superficial) improper implantation of placenta into myometrium with little or no intervening decidua
what is placenta percreta
attachment of placenta through the myometrium
most ascending infections are.___
bacterial
what is chorioaminiotis
pin in membranes
what is funisitis
infection of the umbilical cord
what is acute villitis
bacteria in villi of the placenta
what is the px of preeclampsia?
hypertension
edema
proteinuria
if ….headaches/visual disturbances…deliver
when do you get preeclampsia?
last trimester
how do you treat preeclampsia?
deliver
antihypertensives dont help
what is the DD of preeclampsia and how would you tell apart?
gestational hypertension (no proteinuria)
what is eclampsia
preeclampsia plus cns involment
convulsions->COMA
WHAT do patients with severe preeclampsia develop?
HELLP
Hemolysis Elevated Liver enzymes Low Platlets
What are the gestational trophoblastic diseases?
COMPLETE MOLE PARTIAL MOLE INVASIVE MOLE PALCENTAL SITE TROPHOBLASTIC TUMOR CHORIOCARCINOMA
what is a hydatidiform mole
Cystic swelling of chorionic villi
moles increase risk of ______
persistent trophoblastic disease
choriocarcinoma
spontaneous pregnancy lost
what is the clinical px of molar pregnancy?
spent pregnancy loss
some people might have D/cutterage
HCG will be high (faster then it should)
what is a complete mole
completely dad empty ovum
no fetal parts
how would a complete mole look histologically?
ALL villi enlarged and show edema
what gene would u see in complete mole?
p57(-)
what is a partial mole?
fertilization of one egg with 2 sperm
69,XXY or 92, XXXY\
fetal parts
what would gene you see in partial mole?
p57 (+)
how would a partial mole look histologically
not all villi enlarged
some show edema some don’t
in which type of mole is there an increased risk of developing choriocarcinoma?
complete mole
in which type of mole is P57KIP2 gene transcribed?
partial
What is an invasive mole?
mole that penetrates or perforates the uterine wall
can lead to uterine rupture
which type of mole can benign mets (not true because it cannot grow in these areas)
invasive moles
with their hydronic villi
what is the clinical presentation of invasive mole?
vaginal bleeding
irreglar uterine enlargement
persistently high HCG
How do you treat an invasive mole?
chemotherapy
what is a choriocarincoma?
malignant neoplasm of trophoblastic cells
how can you get a choriocarcinoma?
arises from moles (50%)
normal pregnancy (22%)
abortions (25%)
abnormal pregnancy/ectopic
how do you get the non-gestational type choriocarcinoma?
arise from germ cells in ovary or mediastinum
how invasive is choriocarcinoma?
rapidly invasive and mets all over
*usually mets to lung and bones at time of diagnosis)
how do you treat gestational choriocarcinoma?
gestational is very chemo sensitive
100% remission with chemo
(vs. nongestational…worse prognosis)
how does choriocarcinoma present?
irregular vaginal spotting
really really really high levels of HCG
what is a placental site trophoblastic tumor
neoplastic proliferation of intermediate trophoblast
how does placental site trophoblastic tumor px?
uterine mass with abnormal bleeding or amenorrhea
mildly elevated HCG
where are intermediate trophoblast found?
implantation site
chorionic plate
placenta parenchyma
placenta membranes
what is the prognosis for placental site trophoblastic tumor?
if localized =excellant prognosis
if advanced poor prognosis
