gestational pathology Flashcards
bening tumour of chorionic villi
cystic sweeling of chrionic villi and proiferation of chorionic epithelium involving only trophoblasts
hydatidiform mole
countrey with highest prevelance of hydatidiform moles
indonesia 1/200
what are complete moles in particular associated with
theca lutein cysts
hyperemesis gravidarum
hyperthyroidism - hCG
how do you treat hydatidiform moles
dilatio and cutterage and methotrexate
monitor with bhCG
what is a complete mole
all of the chorionic vili are neoplastic
what is a partial mole
normal villi amongst neoplastic villi
karyotype of complete vrs partial mole
complete - 46XX usually, can be 46XY
partial - 69 XXX, 69 XXY, 69 XYY
levels of hCG in complete vrs partial mole
> 100 000 in complete
< 100 000 in partial (still elevated)
which mole has increased uterine size for gestational age
complete
which mole has a risk of converting to a choriocarcinoma
complete not partial
which mole has fetal parts
partial
how does a complete mole come about
empty/enucleated ovum fertilized by single sperm that then duplicates
how does a partial mole come about
one proper egg and two sperm
risk of malignancy in complete vrs partial
15-20% malignant trophoblastic disease in complete
<5% in partial
apperance on u/s for complete vrs partial
complete - honeycombed uterus or clusters of grapes
snowstorm on u/s
partial - fetal parts
first trimester bleeding unlarged uterus hyperemisis pre-eclampsia hyperthyroidism
complete mole***
think about the symptoms each has
pre-eclampsia - hypertension and proteinuria
hyperthyroidism - hyper metabolism everywhere
vaginal bleeding abdominal pain increased hCG levels beyond normal for pregos no theca lutein cysts no hyperemesis
partial mole
define gestational hypertension/pregnancy-induced hypertension
BP > 140/90 mmHg AFTER 20th week of featstion
no pre-exisiting hypertension
no proteinuria
no end organ damage
how to treat gestational hypertension
alpha methyldopa
labetolol
hydralazine
nifedipine
ideal time to deliver in gestational hypertension
37 to 39 weeks of gestation
hypertension
proteinuria
dependent pitting oedema
pregnant women
pre-eclpamsia
what is hallmark for diagnosis of preeclampsia
new onset hypertnesion with either proteinuria or end organ dysfunction after 20th week fo gestation
new onset hypertension at < 20 weeks gestation
molar pregnancy suggestive
describe the pathogenesis of preeclampsia
abnormal placental spiral arteries – endothelial dysfunction – vasoconstrictors > vasodilatores – iscahemia
what are risk factors for preeclampsia
pre-exisiting hypertension
diabetes
bronic renal disease
autoimunne disorders
what are complications of preeclampsia
coagulopathy placental abruption uteroplacental insufficiency renal failure eclampsia
what is eclampsia
preeclampsia and maternal seizures
what are causes of fatalities in moms with eclampsia
stroke
intracranial hemorrhage
ARDS
stroke
intracranial hemorrhage
ARDS
causes fo fatalities in moms with eclampsia
how to treat preeclampsia
antihypertensives
IV MgSO4 to prevent seizures
only cure is to deliver fetus
how to treat eclampsia
IV MgSO4
antihypertensives
immediate delivery
what is HELLP syndrome
associated with eclampsia
H - hemolytic anaemia (will see schistocytes)
EL - elevated liver enzymes
LP - low platelets (from DIC)
what are teh consequences of HELLP syndrome
can lead to subcapsular hepatic hematoma – rupture – severe hypotension
what is treatment for HELLP syndrome
immediate delivery
presentation of preeclampsia/eclampsia/HELLP
hypertension proteinuria dependent pitting oedema weight gain of >4 /week renal disease liver disease - RUQ and hepatomegaly schistocytes pale and tired
what is the most common cause of late gestational bleeding
placental abruption
largest risk factor for placental abruption
hypertension
other risk factors for palcental abruption
trauam MVA smokin hypertension preeclampsia cocaine abuse
what is the pathos of placental abruption
premature separation (partial or complete) of placenta from uterine wall before delivery of munchkin
which placental complication is life threatenign for mom and baby
placental abruption
abrupt painful uterine bleeding in third trimester
forceful uterine contractions
evidence of fetal distress
placental abruption
possibel complications of placental abruption
DIC
maternal shock
featl distress
waht is placenta accreta/increta/percreta
defective decidual layer - abnormal attachment and espration afterdelivery
risk factors for placenta accreta/increta/percreta please
previous C section
inflammation
placenta previa
placenta attaches to myometrium without penetrating it
placenta accreta
placenta penetrates into myometrium
placenta iccreta
placenta perforates/penetrates through myometrium and into uterine serosa ie invades uterine wall
placenta percreta
which type of placenta xccreta is most common
accreta - attachment to myometrial wall
which placenta creta can result in placental attachment to rectum or bladdder
placenta percreta
what are potential consequences of placenta accreta/increta/percreta
no separation fo placenta after delivery - postpartum bleeding - SHEEHAN SYNDROME
what is placenta previa
attachment of placenta to lower uterine segment over (or < 2 cm from) internal cervical os
what is major rf for placenta previa
previosu c section
what are other rf for placenta previa
multiparity
prior C section
painless third trimester bleeding
soft and tender uterus
no fetal distress
placenta previa
describe vasa previa
fetal vessels run over or in close proximity to the cervical os
what are the consequences of vasa previa
vessel rupture
exsanguination
fetal death
membrane rupture
painless vaginal bleeding
fetal bradycardia < 110 bpm
vasa previa
cxpx of vasa previa please
membrane rupture
painless vaginal bleeding
fetal bradycardia < 110 bpm
treatment of vasa previa
emergency C section usually indicated
what is vasa previa commonly associated with
velamentous umbilical cord insertion - cord inserts in the chorioamniotic membranes rather than placenta - fetal vessels travel to placenta unprotected by wharton jelly
who cares about retained placental tissue
may cause postpartum hemorrhage
increases infection risk
where is the most common site of ectopic pregnancies
ampulla of the fallopian tube
amenorrhea lower than expected rise in bhCG based on dates sudden lower abdominal pain looks like appendicitis pain with or without bleeding
ectopic pregos
when to suscept ectopic pregos
amenorrhea
lower than expected rise in hCG based on dates
sudden lower abdominal pain
pain with or without bleeding
how to confirm ectopic pregnancy
u/s
what is main risk factor for ectopic pregnancy
previous PID
what are other risk factors for ectopic pregnancy
history of infertility salpingitis/PID ruptured appendix prior tubal surgery endometriosis progestion only meds
define polyhydramnios
> 1.5-2 L of AF
what causes polyhydramnios
inability to swallow - esophageal atresia/duodenal atresia, anencephaly
fetal aneima
multiple gestations
maternal diabetes - ftal hyperglycemsi - increase fetal urine output
what is oligohydraminos
< 0.5 L of AF
what causes oligohydramnios
placenta insufficiency bilateral renal agenesis posterior urethral valves in males - resultant inability to excrete urine juvenilie polycystic kidney disease PPROM fetal genitourinary obstruction
what can result from profound oligohyramnios
potter sequence
