Gestational Pathology - Pathoma

Question 1

What is the most common site for ectopic pregnancy?

Answer 1

lumen of fallopian tube

Question 2

What is the key risk factor for ectopic pregnancy?

Answer 2

Scarring

Question 3

What is the classic presentation of ectopic pregnancy?

Answer 3

Lower quadrant abdominal pain weeks after missed period

Question 4

When does spontaneous miscarriage occur?

Answer 4

At 20 weeks or before

Question 5

How do spontaneous abortions present?

Answer 5

vaginal bleeding with crampy-like pain and passage of fetal tissue

Question 6

What is spontaneous abortion usually due to? Other causes?

Answer 6

Most often due to chromosomal anomalies

Other causes: hypercoaguable states, congenital infection, and exposure to teratogens

Question 7

What is Placenta Previa?

Answer 7

implantation of placenta in the lower uterine segment => placenta overlies cervical os (“preview of placenta”) => requires delivery by c-section

Question 8

What is the typical presentation of Placenta Previa?

Answer 8

Third-trimester bleeding

Question 9

What is Placental Abruption?

Answer 9

Separation of placenta from decidua prior to delivery of fetus => common cause of still birth

Question 10

What is the typical presentation of Placental Abruption?

Answer 10

Third trimester bleeding and fetal insufficiency

Question 11

What is Placenta Accreta?

Answer 11

Improper implantation of placenta into myometrium with little or no intervening decidua

Question 12

How does Placenta Accreta present?

Answer 12

Difficult delivery of the placenta and post-partum bleeding => often requires hysterectomy

Question 13

What condition is characterized by pregnancy-induced hypertension, proteinuria, and edema that typically arises in the third trimester?

Answer 13

Preeclampsia

Question 14

What is Preeclampsia due to?

Answer 14

Abnormality of maternal-fetal vascular interface in placenta

Question 15

What finding may be present in the placenta if Preeclampsia was present?

Answer 15

Fibrinoid necrosis of blood vessels

Question 16

What is Eclampsia?

Answer 16

Preeclampsia + Seizures => mandates delivery

Question 17

What is HELLP Syndrome?

Answer 17

Preeclampsia with thrombotic microangiopathy involving the liver

Question 18

What does HELLP stand for in HELLP Syndrome?

Answer 18

Hemolysis, Elevated Liver enzymes, Low Platelets

Question 19

What do you call an abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts resulting in the uterus expanding as if normal pregnancy is present?

Answer 19

Hydatidiform Mole

=> grow placental tissue (villi) instead of baby :(

Question 20

What are four clinical signs of a growing Hydatidiform Mole versus normal pregnancy?

Answer 20

1. Uterus will be larger than expected for gestational age
2. beta-hCG will be higher than expected for gestational age
3. Fetal heart sounds are absent
4. “Snow-storm” appearance on ultrasound

Question 21

What is the classic presentation of a Hydatidiform Mole (if no prenatal care)?

Answer 21

Passage of grape-like masses through vaginal canal in “2nd trimester”

Question 22

What classifies a Hydatidiform Mole as complete?

Answer 22

Genetics => Empty ovum fertilized by two sperm (46 chromosomes)

Fetal tissue => Absent

Villous edema => Most villi are hyrdopic

Trophoblastic proliferation => Diffuse, circumferential proliferation around hydropic villi

Risk of choriocarcinoma => YES (2-3%)

Question 23

What classifies a Hydatidiform Mole as partial?

Answer 23

Genetics => Normal ovum fertilized by two sperm (69 chromosomes)

Fetal tissue => Present

Villous edema => Some villi are hyrdopic, and some are normal

Trophoblastic proliferation => Focal proliferation around hydropic villi

Risk of choriocarcinoma => Minimal

Question 24

What is the treatment for Hydatidiform Mole?

Answer 24

Dilation and Curettage

beta-hCG monitored to ensure adequate mole removal and to screen for development of choriocarcinoma

Question 25

Which type of Choriocarcinoma responds well to chemotherapy? Germ cell pathway or Gestational pathway?

Answer 25

Choriocarcinoma that forms from the gestational pathway (i.e. hydatidiform mole)