Gestational Pathology - Pathoma Flashcards
What is the most common site for ectopic pregnancy?
lumen of fallopian tube
What is the key risk factor for ectopic pregnancy?
Scarring
What is the classic presentation of ectopic pregnancy?
Lower quadrant abdominal pain weeks after missed period
When does spontaneous miscarriage occur?
At 20 weeks or before
How do spontaneous abortions present?
vaginal bleeding with crampy-like pain and passage of fetal tissue
What is spontaneous abortion usually due to? Other causes?
Most often due to chromosomal anomalies
Other causes: hypercoaguable states, congenital infection, and exposure to teratogens
What is Placenta Previa?
implantation of placenta in the lower uterine segment => placenta overlies cervical os (“preview of placenta”) => requires delivery by c-section
What is the typical presentation of Placenta Previa?
Third-trimester bleeding
What is Placental Abruption?
Separation of placenta from decidua prior to delivery of fetus => common cause of still birth
What is the typical presentation of Placental Abruption?
Third trimester bleeding and fetal insufficiency
What is Placenta Accreta?
Improper implantation of placenta into myometrium with little or no intervening decidua
How does Placenta Accreta present?
Difficult delivery of the placenta and post-partum bleeding => often requires hysterectomy
What condition is characterized by pregnancy-induced hypertension, proteinuria, and edema that typically arises in the third trimester?
Preeclampsia
What is Preeclampsia due to?
Abnormality of maternal-fetal vascular interface in placenta
What finding may be present in the placenta if Preeclampsia was present?
Fibrinoid necrosis of blood vessels
What is Eclampsia?
Preeclampsia + Seizures => mandates delivery
What is HELLP Syndrome?
Preeclampsia with thrombotic microangiopathy involving the liver
What does HELLP stand for in HELLP Syndrome?
Hemolysis, Elevated Liver enzymes, Low Platelets
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?
Hydatidiform Mole
=> grow placental tissue (villi) instead of baby :(
What are four clinical signs of a growing Hydatidiform Mole versus normal pregnancy?
- Uterus will be larger than expected for gestational age
- beta-hCG will be higher than expected for gestational age
- Fetal heart sounds are absent
- “Snow-storm” appearance on ultrasound
What is the classic presentation of a Hydatidiform Mole (if no prenatal care)?
Passage of grape-like masses through vaginal canal in “2nd trimester”
What classifies a Hydatidiform Mole as complete?
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%)
What classifies a Hydatidiform Mole as partial?
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
What is the treatment for Hydatidiform Mole?
Dilation and Curettage
beta-hCG monitored to ensure adequate mole removal and to screen for development of choriocarcinoma
Which type of Choriocarcinoma responds well to chemotherapy? Germ cell pathway or Gestational pathway?
Choriocarcinoma that forms from the gestational pathway (i.e. hydatidiform mole)
