Gestational Pathology

Question 1

Ectopic Pregnancy

Answer 1

Implants at other site, ie fallopian tube

RLQ/LLQ pain weeks after missed period
Get a pregnancy test!
Risk of rupture - Surgical emergency

Question 2

Spontaneous Abortion

Answer 2

Miscarriage of fetus, usually <20 weeks

Vaginal bleeding, crampy pain, passage of fetal tissue

Due to chromosomal anomalies, hyper-coagulable states, congenital infection, teratogens

Question 3

Placenta Previa

Answer 3

Placenta plants in lower uterus, overlies cervical os

Third trimester bleeding
Delivery by C-section

Question 4

Placenta Abruption

Answer 4

Placenta separates from decidua PRIOR to delivery

Third trimester bleeding
Fetal insufficiency (blood supply is cut off)
Stillbirth

Blood & clots on “maternal surface” of placenta

Question 5

Placenta Accreta

Answer 5

Placenta plants directly into myometrium

Difficult delivery of placenta + post-partum bleeding

Requires hysterectomy

Question 6

Preeclampsia

Answer 6

Pregnancy-HTN + Proteinuria + Edema
Seen in third trimester

Due to abnormal “vascular interface” of placenta with fibrinoid necrosis in vessels

Eclampsia = Pre-eclampsia + Seizures
Mandates delivery of placenta (& baby)

Question 7

HELLP

Answer 7

Pre-eclampsia + Thrombotic microangiopathy in liver

***Platelet thrombi in small blood vessels causes passing RBCs to shear into shistocytes
-Hemolysis
-Elevated liver enzymes because liver infarct
-Low platelets because used up in clots

Question 8

Sudden Infant Death Syndrome

Answer 8

Death of healthy infant (1 mo to 1 yr) without cause, during sleep usually

Risk: Sleeping on stomach, smoking, prematurity

Question 9

Hydatidiform Mole

Answer 9

Abnormal conception
-No fetus, just placental tissue
-Edematous villi with trophoblasts

More rapid uterus expansion
HIGH hCG

WithOUT Prenatal Care
-Passage of grape-like masses via vagina (2ND trimester)

WITH Prenatal Care
-Dx early first trimester by US
-“Snow storm” appearance
-Absent fetal heart sounds

D&C
Monitor hCG to ensure adequate removal & screen for choriocarcinoma

Question 10

Complete & Partial Mole

Answer 10

Complete
-Empty ovum with two sperm, “Completely Dad”
-No fetal tissue, “Completely a mole”
-All villi are hydropic, “Completely edematous”
-Trophoblasts all along the villi, “Completely covered”
-HIGH hCG
-Greater risk of choriocarcinoma

Partial
-Normal ovum with two sperm
-Some fetal tissue
-Some villi are hydropic
-Some villi covered by trophoblasts
-Not as high hCG
-Lower risk of choriocarcinoma

Question 11

Choriocarcinoma

Answer 11

Complication of gestation ~ Responds to CTX
Spontaneous germ cell tumor ~ Does not