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OSD_Repro > Gestational Pathology > Flashcards

Gestational Pathology Flashcards

1
Q 
2 layers of the fetal membrane:
The \_\_\_(A)\_\_\_ is a layer of \_\_\_(B)\_\_\_ epithelial cells affixed to a basement membrane that lines the inside of the amniotic sac, bathing in the amniotic fluid generated by the embryo or fetus.

The ___(C)___ is a variably thick connective tissue layer which abuts the decidualized endometrium of the uterus.

The umbilical cord normally contains two arteries and one vein embedded in a gelatinous yet firm matrix known as ___(D)___.

The umbilical vein carries oxygen and nutrients from the villi to the baby, then the deoxygenated blood from the baby goes back through the umbilical arteries to the ___(E)____.

A

a) amnion
b) cuboidal
c) chorion
d) Wharton’s jelly (WJ)
e) chorionic villi

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2
Q

Amniotic Fluid Infection -
What are the 2 ways this can cause a maternal inflammatory response?
What are the pathogens ass’d w/ each?

A
  1. Ascending infection (more common; bacterial)
    - Group B streptococci
    - Listeria monocytogenes
    - (or multimicrobial)
  2. Hematogenous spread (rare now; TORCH)
    - Toxoplasmosis
    - Others (Syphilis, Listeria, TB)
    - Rubella
    - Cytomegalovirus
    - Herpes Simplex
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3
Q

What is Pre-eclampsia? Eclampsia?

A

Pre-eclampsia = Insidious onset of hypertension & edema, followed by proteinuria

Eclampsia = Seizures as a complication of pre-eclampsia

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4
Q

Maternal Hypertension occurs in 3-5% of pregnant women.

a) When during pregnancy does it typically occur?
b) It is more common in women w/ what characteristics? (4)

A

a) 3rd trimester

b) Primigravidas, women w/ molar pregnancy, hypertension, or pre-existing kidney disease

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5
Q

What are some complications of maternal hypertension?

A

Maternal:

  • Seizures (eclampsia)
  • Visual disturbances
  • HELLP (Hemolysis, Elevated Liver enzymes, & Low Platelet count)
  • ARF

Fetal:

  • Pre-term labor
  • IUGR
  • IUFD
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6
Q

Maternal Hypertension - Tx/management?

A

Delivery ASAP

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7
Q

Estradiol is a mitogen for granulosa cells. What does this mean (“mitogen”)?

A

It means that it triggers granulosa cells to undergo mitosis & divide

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8
Q

3 pathologic features of Uteroplacental Insufficiency (placental ischemia)?

A

1- Small placenta
2- Placental infarcts
3- Decidual vasculopathy

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9
Q

Placenta Previa:
Where does the placenta implant?
What complication is ass’d w/ this?

A

Placenta implants on the lower uterine segment (LUS) or cervix.

Complication: Antepartum bleeding may lead to placenta accrete

(Further exp: The dilation of the cervix disrupts the placenta leading to antepartum bleeding. The bleeding may be mild, moderate or may be massive and life threatening hemorrhage)

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10
Q

What is a Placenta Accreta?

What complication is ass’d w/ this?

A

Placenta in direct contact to the myometrium
(i.e. no decidua in between)

Complication: Postpartum bleeding

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11
Q

Placenta Previa - how is Dx made?

A

Ultrasound

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12
Q

Where does the placenta normally implant?

A

Lateral wall of the uterine fundus

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13
Q

What is “Placenta Increta”?

A

When the chorionic villi penetrate through the myometrium

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14
Q

What is “Placenta Percreta”?

A

When the placental villi have perforated through the myometrium to or through the uterine serosa

(most severe abnormal placentation)

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15
Q

Placenta Accreta - Tx?

A

Hysterectomy

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16
Q

Complete molar pregnancy - Cause & Pathology? Risk of choriocarcinoma?
Some or all of the villi affected?

A

An egg that is missing its nucleus is fertilized and may or may not contain fetal tissue.

  • Diploid (46 chromosomes – completely paternal)
  • 90% is 46 XX “Daddy’s girl”
  • No fetal parts on US
  • Increased risk of choriocarcinoma
  • All of the villi are affected
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17
Q

Partial molar pregnancy - Cause & Pathology? Risk of choriocarcinoma?
Some or all of the villi affected?

A

Cause - An egg that is missing its nucleus is fertilized by 2 sperm or by 1 sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid) or 92,XXXY (tetraploid)

  • Triploid (69 chromosomes – mixed paternal & maternal)
  • 90% is 46 XX “Daddy’s girl”
  • Fetal parts seen on US
  • No increased risk of choriocarcinoma
  • Some of the villi are affected?
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18
Q

How does a molar pregnancy typically present?

A
  • Typically presents in the first or early second trimesters as abortion or with bleeding
  • Very high hCG levels (»» normal pregnancy)
  • Uterus bigger than a pregnancy of same gestational age
  • Ultrasound shows “snowstorm”
    appearance of uterus.
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19
Q

Gross & histologic appearance of molar pregnancy?

A

Gross appearance: “bunch of grapes” represents swollen chorionic villi

Histologic appearance: Swollen (edematous) villi, with circumferential trophoblastic proliferation
and nuclear atypia

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20
Q

The fetus gains 95% of its weight in the __?__ half of pregnancy.

A

2nd

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21
Q

Pregnancy Cardiac Ouput:
Half of increase occurs by __a__ weeks
Maximum cardiac output achieved by __b__ weeks.

A

a) 8
b) 20

**Changes anticipate increased demands not initiated by demands

22
Q

T or F?

Heart rate increases 15-20 bpm during pregnancy.

A

True

23
Q

Does Stroke volume change during pregnancy?

A

Yes, stroke volume increases 30%

24
Q

What changes are seen during contractions of labor & then, immediately postpartum?

A

Cardiac output increases further during labor.

Immediately postpartum sudden increase in cardiac output.

25
Q

What changes in the cardiac outline (as seen on x-ray) occur during pregnancy?

A
  • Diaphragm elevated nearly 4 cm
  • Apex of the heart pushed anteriorly and superiorly to the left
  • Appears like cardiomegaly on chest x-ray
26
Q

What changes are seen on the cardiac exam during pregnancy?

A
  • Wide splitting of S1 is often present
  • Splitting of S2
  • Systolic ejection murmur
  • Presence of 3rd heart sound
27
Q

What changes that can be seen on echocardiogram occur during pregnancy?

A
  • All four chambers and valvular annular diameters are increased.
  • Mild pulmonic and tricuspid regurgitation present in 90%
  • Mitral regurgitation in 30%
28
Q

What EKG changes may occur during pregnancy?

A
  • Ventricular extrasystoles are common
  • Transient ST segment and T wave changes
  • Presence of Q wave and inverted T waves in lead III
  • Attenuated Q wave in lead AVF
  • Inverted T waves in leads V1,V2,V3
29
Q

Blood pressure changes during pregnancy?

A
  • Decreased blood pressure mean 105/60
  • Systolic decreased by 10 mm Hg
  • Diastolic decreased by 15 mm Hg
  • Returns to prepregnant levels at term
30
Q

SVR changes during pregnancy?

A

SVR decreases during pregnancy

  • High flow, low resistance of uteroplacental vascular bed and
  • Systemic vasodilation
  • Pregnant women refractory to angiotension II
31
Q

Changes in antecubital and femoral venous blood pressure throughout normal pregnancy and early puerperium?

A
  • Venous pressure in lower extremities is increased

- Along with decreased osmolality causes edema

32
Q

Blood volume changes during pregnancy?

A
  • Blood volume increases by 45%
  • Protects against hemodynamic effects of blood loss
  • Rise in plasma volume exceeds the increase in RBC mass
  • Causes dilutional anemia hemoglobin 12g/dl
  • Fetal requirement 6-7mg/day in 2nd half of pregnancy
33
Q

Coagulation changes during pregnancy?

A
  • Prothrombin and partial thromboplastin times decreased by 20%
  • Resistance to activated protein C increases
  • Protein S decreases
  • Fibrinogen increases
  • Hypercoagulable state
34
Q

Immunological changes during pregnancy?

A

WBC increased –mostly neutrophils

35
Q

Changes in lung volumes & respiratory rate during pregnancy?

A

Tidal volume increases 30-40%

  • Mostly due to decrease in functional residual volume of 20%- residual volume decreases due to elevation of diaphragm
  • Respiratory rate unchanged
36
Q

Changes in ventilation & oxygen consumption during pregnancy?

A
  • Minute ventilation rises by 50%

- Oxygen consumption increases by 20%

37
Q

Changes in acid-base balance during pregnancy?

A
  • Slight respiratory alkalosis with metabolic compensation

- Slight rise in Pa o2

38
Q

Changes in urinary system during pregnancy?

A
  • Renal hypertrophy increase in size by 1 cm
  • Dilation of renal pelvis/calyces
    (more on RIGHT than LEFT during 3rd trimester due to dextrorotation of the uterus)
  • Dilation of ureters to 2 cm
  • Mechanical compression at the pelvic brim
  • Progesterone-induced smooth muscle relaxation
39
Q

Changes in renal blood flow & GFR during pregnancy?

A

Renal blood flow increases 50%

GFR increases 50%

40
Q

Changes in serum BUN & Creatinine during pregnancy?
Glucosuria?
Proteinuria?

A
  • Serum Creatinine and BUN levels decrease
  • Glycosuria occurs due to exceeding of maximum tubular reabsorptive capacity
  • No increase in proteinuria
41
Q

Changes in Na & plasma osmolarity during pregnancy?

A

Na retention increases 900 mEq but serum Na decreases

- thus, ↓ plasma osmolality

42
Q

Changes in glycemic control during pregnancy?

A

Large fluctuations occur

  • Fasting glucose levels are lower—accelerated starvation
  • Greater insulin secretion but higher glucose level in response to a meal
43
Q

What causes the transient insulin resistance during pregnancy?

A

Insulin resistance due to placental hormones-human chorionic somatomammotropin, progesterone

  • Also cortisol, prolactin and glucagon
44
Q

Gestational Diabetes - etiology? Risk of T2 diabetes later on?

A

Gestational diabetes occurs when a woman’s pancreatic function not sufficient to overcome insulin resistance of pregnancy.

Half of women with GDM will develop Type 2 DM later in life.

45
Q

Liver changes seen during pregnancy?

A
  • Size and histology are unchanged
  • Spider angiomas and palmar erythema due to high levels of estrogen
  • Serum albumin and total protein decrease–dilutional
  • Serum alkaline phosphatase is higher due to placental production
  • Other LFT’s are unchanged
46
Q

Gall Bladder changes seen during pregnancy?

A
  • Decreased rate of emptying due to progesterone

- Cholesterol saturation is increased while chenodeoxycholic acid is decreased in bile favoring stone formation

47
Q

GI changes seen during pregnancy?

A

Small bowel
- Motility is reduced due to progesterone allowing for more efficient absorption

Large bowel

  • Decreased transit times allows for both water and sodium absorption
  • Increased portal hypertension leading to dilation wherever there are portosystemic venous anastomoses
48
Q

Skeletal changes seen during pregnancy?

A
  • Lordosis of pregnancy~ progressive increase in anterior convexity of the lumbar spine Preserves center of gravity
  • Ligaments of the symphysis and sacroiliac joints loosen during pregnancy due to relaxin
49
Q

During pregnancy, increased _____ stimulates intestinal absorption

A

calcitriol

50
Q

Skin changes seen during pregnancy?

A
  • Hyperpigmentation
  • 90% of pregnancies
  • Localized to areas of increased melanocytes
  • Infraumbilical skin darkens forming “linea nigra”
  • Melasma or chloasma - mask of pregnancy

OSD_Repro (15 decks)

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