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Reproductive - step > gestational pathology > Flashcards

gestational pathology Flashcards

1
Q

bening tumour of chorionic villi

cystic sweeling of chrionic villi and proiferation of chorionic epithelium involving only trophoblasts

A

hydatidiform mole

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2
Q

countrey with highest prevelance of hydatidiform moles

A

indonesia 1/200

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3
Q

what are complete moles in particular associated with

A

theca lutein cysts
hyperemesis gravidarum
hyperthyroidism - hCG

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4
Q

how do you treat hydatidiform moles

A

dilatio and cutterage and methotrexate

monitor with bhCG

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5
Q

what is a complete mole

A

all of the chorionic vili are neoplastic

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6
Q

what is a partial mole

A

normal villi amongst neoplastic villi

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7
Q

karyotype of complete vrs partial mole

A

complete - 46XX usually, can be 46XY

partial - 69 XXX, 69 XXY, 69 XYY

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8
Q

levels of hCG in complete vrs partial mole

A

> 100 000 in complete

< 100 000 in partial (still elevated)

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9
Q

which mole has increased uterine size for gestational age

A

complete

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10
Q

which mole has a risk of converting to a choriocarcinoma

A

complete not partial

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11
Q

which mole has fetal parts

A

partial

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12
Q

how does a complete mole come about

A

empty/enucleated ovum fertilized by single sperm that then duplicates

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13
Q

how does a partial mole come about

A

one proper egg and two sperm

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14
Q

risk of malignancy in complete vrs partial

A

15-20% malignant trophoblastic disease in complete

<5% in partial

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15
Q

apperance on u/s for complete vrs partial

A

complete - honeycombed uterus or clusters of grapes
snowstorm on u/s
partial - fetal parts

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16
Q 
first trimester bleeding
unlarged uterus
hyperemisis
pre-eclampsia
hyperthyroidism
A

complete mole***

think about the symptoms each has
pre-eclampsia - hypertension and proteinuria
hyperthyroidism - hyper metabolism everywhere

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17
Q 
vaginal bleeding 
abdominal pain
increased hCG levels beyond normal for pregos
no theca lutein cysts
no hyperemesis
A

partial mole

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18
Q

define gestational hypertension/pregnancy-induced hypertension

A

BP > 140/90 mmHg AFTER 20th week of featstion
no pre-exisiting hypertension
no proteinuria
no end organ damage

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19
Q

how to treat gestational hypertension

A

alpha methyldopa
labetolol
hydralazine
nifedipine

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20
Q

ideal time to deliver in gestational hypertension

A

37 to 39 weeks of gestation

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21
Q

hypertension
proteinuria
dependent pitting oedema
pregnant women

A

pre-eclpamsia

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22
Q

what is hallmark for diagnosis of preeclampsia

A

new onset hypertnesion with either proteinuria or end organ dysfunction after 20th week fo gestation

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23
Q

new onset hypertension at < 20 weeks gestation

A

molar pregnancy suggestive

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24
Q

describe the pathogenesis of preeclampsia

A

abnormal placental spiral arteries – endothelial dysfunction – vasoconstrictors > vasodilatores – iscahemia

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25
Q

what are risk factors for preeclampsia

A

pre-exisiting hypertension
diabetes
bronic renal disease
autoimunne disorders

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26
Q

what are complications of preeclampsia

A 
coagulopathy
placental abruption
uteroplacental insufficiency
renal failure
eclampsia
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27
Q

what is eclampsia

A

preeclampsia and maternal seizures

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28
Q

what are causes of fatalities in moms with eclampsia

A

stroke
intracranial hemorrhage
ARDS

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29
Q

stroke
intracranial hemorrhage
ARDS

A

causes fo fatalities in moms with eclampsia

30
Q

how to treat preeclampsia

A

antihypertensives
IV MgSO4 to prevent seizures
only cure is to deliver fetus

31
Q

how to treat eclampsia

A

IV MgSO4
antihypertensives
immediate delivery

32
Q

what is HELLP syndrome

A

associated with eclampsia
H - hemolytic anaemia (will see schistocytes)
EL - elevated liver enzymes
LP - low platelets (from DIC)

33
Q

what are teh consequences of HELLP syndrome

A

can lead to subcapsular hepatic hematoma – rupture – severe hypotension

34
Q

what is treatment for HELLP syndrome

A

immediate delivery

35
Q

presentation of preeclampsia/eclampsia/HELLP

A 
hypertension
proteinuria
dependent pitting oedema
weight gain of >4 /week
renal disease
liver disease - RUQ and hepatomegaly
schistocytes
pale and tired
36
Q

what is the most common cause of late gestational bleeding

A

placental abruption

37
Q

largest risk factor for placental abruption

A

hypertension

38
Q

other risk factors for palcental abruption

A 
trauam  MVA
smokin
hypertension
preeclampsia
cocaine abuse
39
Q

what is the pathos of placental abruption

A

premature separation (partial or complete) of placenta from uterine wall before delivery of munchkin

40
Q

which placental complication is life threatenign for mom and baby

A

placental abruption

41
Q

abrupt painful uterine bleeding in third trimester
forceful uterine contractions
evidence of fetal distress

A

placental abruption

42
Q

possibel complications of placental abruption

A

DIC
maternal shock
featl distress

43
Q

waht is placenta accreta/increta/percreta

A

defective decidual layer - abnormal attachment and espration afterdelivery

44
Q

risk factors for placenta accreta/increta/percreta please

A

previous C section
inflammation
placenta previa

45
Q

placenta attaches to myometrium without penetrating it

A

placenta accreta

46
Q

placenta penetrates into myometrium

A

placenta iccreta

47
Q

placenta perforates/penetrates through myometrium and into uterine serosa ie invades uterine wall

A

placenta percreta

48
Q

which type of placenta xccreta is most common

A

accreta - attachment to myometrial wall

49
Q

which placenta creta can result in placental attachment to rectum or bladdder

A

placenta percreta

50
Q

what are potential consequences of placenta accreta/increta/percreta

A

no separation fo placenta after delivery - postpartum bleeding - SHEEHAN SYNDROME

51
Q

what is placenta previa

A

attachment of placenta to lower uterine segment over (or < 2 cm from) internal cervical os

52
Q

what is major rf for placenta previa

A

previosu c section

53
Q

what are other rf for placenta previa

A

multiparity

prior C section

54
Q

painless third trimester bleeding
soft and tender uterus
no fetal distress

A

placenta previa

55
Q

describe vasa previa

A

fetal vessels run over or in close proximity to the cervical os

56
Q

what are the consequences of vasa previa

A

vessel rupture
exsanguination
fetal death

57
Q

membrane rupture
painless vaginal bleeding
fetal bradycardia < 110 bpm

A

vasa previa

58
Q

cxpx of vasa previa please

A

membrane rupture
painless vaginal bleeding
fetal bradycardia < 110 bpm

59
Q

treatment of vasa previa

A

emergency C section usually indicated

60
Q

what is vasa previa commonly associated with

A

velamentous umbilical cord insertion - cord inserts in the chorioamniotic membranes rather than placenta - fetal vessels travel to placenta unprotected by wharton jelly

61
Q

who cares about retained placental tissue

A

may cause postpartum hemorrhage

increases infection risk

62
Q

where is the most common site of ectopic pregnancies

A

ampulla of the fallopian tube

63
Q 
amenorrhea
lower than expected rise in bhCG based on dates
sudden lower abdominal pain
looks like appendicitis
pain with or without bleeding
A

ectopic pregos

64
Q

when to suscept ectopic pregos

A

amenorrhea
lower than expected rise in hCG based on dates
sudden lower abdominal pain
pain with or without bleeding

65
Q

how to confirm ectopic pregnancy

A

u/s

66
Q

what is main risk factor for ectopic pregnancy

A

previous PID

67
Q

what are other risk factors for ectopic pregnancy

A 
history of infertility
salpingitis/PID
ruptured appendix
prior tubal surgery
endometriosis
progestion only meds
68
Q

define polyhydramnios

A

> 1.5-2 L of AF

69
Q

what causes polyhydramnios

A

inability to swallow - esophageal atresia/duodenal atresia, anencephaly
fetal aneima
multiple gestations
maternal diabetes - ftal hyperglycemsi - increase fetal urine output

70
Q

what is oligohydraminos

A

< 0.5 L of AF

71
Q

what causes oligohydramnios

A 
placenta insufficiency
bilateral renal agenesis
posterior urethral valves in males - resultant inability to excrete urine
juvenilie polycystic kidney disease
PPROM
fetal genitourinary obstruction
72
Q

what can result from profound oligohyramnios

A

potter sequence

Reproductive - step (11 decks)

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