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REPRO 1 > glines trophoblast and abortion > Flashcards

glines trophoblast and abortion Flashcards

1
Q

The commonality of all gestational trophoblastic diseases is that they secrete ________

A

BETA – HCG

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2
Q

Which 2 gestational trophoblastic diseases can metastasize?

A

choriocarcinoma and invasive moles (though not a cancer)

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3
Q

What is the gold standard for diagnosing ectopic pregnancy? How will the results of a mole be different?

A

Ultrasound and B-HCG (1200), in a mole the B-HCG will be much higher

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4
Q

How do you get a complete mole and what is the karyotype?

A

fertilization of empty ovum by haploid sperm; 46 XX RARELY is it 46 xy

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5
Q

What is the usual way by which you get a partial mole? Karyotype?

A

2 sperm fertilize a NON empty ovum; 69 XXY, XXX, or XYY

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6
Q

Because you know you’ve wondered this since embyro day #1, where does the term hydatidiform mole come from?

A

mole from latin mola, refers to false conception/millstone and hydatisia is greek for a drop of water (chorionic villi are fluid filled) and it looks very similar to hydatid cysts in echinococcus infections. Now you know.

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7
Q

Which type of mole is often present with a co-existing fetus?

A

partial or incomplete mole

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8
Q

Name 2 cancers that can cross placenta

A

melanoma and choriocarcinoma

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9
Q

What disease represents the majority of patients who have elevated B-HCG AFTER molar evacuation

A

invasive mole, not choriocarcinoma

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10
Q

What is the main route of metastasis for choriocarcinoma?

A

hematogenous

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11
Q

There will be no test question on this tumor

A

placental site trophoblastic tumor, not gonna worry about it then! But the major problem is that it is insensitive to chemo

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12
Q

The frequency of gestational trophoblastic disease is highest in this country

A

TAIWAN

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13
Q

Gestational trophoblastic disease tends to occur in areas with less of these 2 nutrients are consumed

A

beta carotene and folic acid

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14
Q

What should you do to the dose of folate in a pregant woman who has Hx of mole

A

increase the dose

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15
Q

What kind of age distribution occurs with moles?

A

bimodal (under 20, over 40)

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16
Q

Are moles benign or malignant?

A

benign (both are, complete and partial)

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17
Q

Complete moles have hyperplasia of this tissue

A

trophoblastic tissue

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18
Q

T/F: complete moles usually cause tremendous amounts of pain and mimic ectopic pregnancies

A

false, actually. They are surprisingly not associated with much pain

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19
Q

T/F: complete moles can mimic pre-ecclampsia

A

TRUE

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20
Q

Why would you hear wheezing/rhonchi in a patient with a mole?

A

they can spread to the lungs

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21
Q

What is the Tx for a complete mole?

A

suction evacuation followed by sharp curretage; IV pitocin with follow up B HCGS

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22
Q

If the B HCG levels don?t decline after molar evacuation which 2 drugs can you use?

A

methotrexate (also DOC for ectopic pregnancy) and actinomycin D

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23
Q

At what age is hysterectomy for Tx of molar pregnancy appropriate?

A

over 40

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24
Q

What is the most common gynecologic cancer?

A

endometrial

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25
Q

How awesome is Dr. Glines?

A

Pretty awesome

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26
Q

Which molar pregnancy is associated with a developing fetus?

A

partial mole

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27
Q

T/F: partial moles are defined as a snow-storm pattern on ultrasound

A

false, complete moles are snow-storm patterns because the fluid filled cysts are very large and look like a snow storm

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28
Q

Path tie-in, the snowstorm pattern on ultrasound translates to a ____________ pattern on histology

A

coast of norway, again both are caused by the fact that there are large cystic spaces

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29
Q

What is a common way for partial moles to present?

A

they may present as a spontaneous or missed abortion

30
Q

T/F most patients with partial moles have very large uterus for gestational age

A

false, this is true of complete moles but partial mole pts are small for dates

31
Q

When will a partial mole patient become pre-ecclamptic in comparison to a complete mole patient?

A

usually one month later

32
Q

Which patient is more likely to have wheezes and rhonchi, one with a complete or partial mole?

A

complete mole as it is more likely than a partial mole to metastasize

33
Q

What is the work up of choriocarcinoma and why would you suspect this?

A

You suspect this after molar evacuation when there is elevated B HCG that is persistent, then you also do a CT of pretty much the whole body, also a lumbar puncture

34
Q

How do you Tx choriocarcinoma with a good prognosis

A

actinomycin D and methotrexate

35
Q

If choriocarcinoma is metastatic what is used in conjunction with medications?

A

radiation

36
Q

Can a woman who has had choriocarcinoma get pregnant again?

A

she can but she SHOULD NOT AS SHE CAN DIE!

37
Q

Can a woman who has had a molar evacuation get pregnant again?

A

yes 1 year later

38
Q

Miscarraige is a is a lay term for ______

A

abortion

39
Q

A spontaneous abortion that occurs AFTER 20 weeks but before 37 is deemed ___________

A

Intrauterine fetal demise

40
Q

A spontaneous abortion that occurs BEFORE 20 weeks is called

A

a missed abortion

41
Q

What is the frequency of abortions?

A

50% of pregnancies, they think that many women do not know they are pregnant

42
Q

At what maternal age is the risk of spontaenous abortion higher?

A

30 but even higher at 35 and 40

43
Q

Name the 7 types of abortions

A

threatened, inevitable, incomplete, complete, missed, therapeutic/elective, septic (any of the others PLUS infection)

44
Q

Define threatened abortion

A

vaginal bleeding before the 20th week with a CLOSED CERVICAL OS

45
Q

Define inevitable abortion

A

bleeding that occurs with the cervical os OPEN

46
Q

Define incomplete abortion

A

vaginal bleeding with the os open and passage of some fetal tissue

47
Q

Define complete abortion

A

bleeding with the os closed (??) and passage of all products of conception

48
Q

Define missed abortion

A

fetus dies before 20 weeks and is retained in uterus

49
Q

Define septic abortion

A

any abortion that occurs with infection

50
Q

This is the term to describe 3 or more successive abortions

A

recurrent abortion

51
Q

What kind of abortion occurs when there is vaginal bleeding without the passage of fetal tissue with an open cervical os?

A

inevitable abortion

52
Q

What kind of abortion occurs before 20 weeks and the fetus is retained in the uterus?

A

missed abortion

53
Q

What term describes when the fetus dies after 20 weeks of gestation and is retained in the uterus?

A

Intrauterine fetal demise

54
Q

What term describes when there is vaginal bleeding prior to the 20th week with a closed cervical os?

A

threatened abortion

55
Q

What term describes when there is vaginal bleeding with an open cervical os and some passage of fetal tissue?

A

incomplete abortion

56
Q

What term describes when a woman is 18 weeks pregnant, has a closed os and is bleeding and it is found that there is chorionitis due to ascending E. coli infection?

A

septic abortion (any abortion with an infection)

57
Q

What is the most common cause of spontaneous abortion?

A

genetic anomaly

58
Q

This bug can be harbored in the male prostate and causes spontaneous abortions

A

Listeria monocytogenes

59
Q

What is Asherman’s syndrome?

A

When the lining of the cervix adheres to itself i.e. left side adheres to right side so there is obliteration of the uterine cavity

60
Q

What is a BIG cause of uterine abnormalities?

A

D/C and scrapings

61
Q

Name 3 important immunologic causes of abortion i.e. Rh and 2 others

A

Kell and Duffy antigens (Kell kills, Duffy dies)

62
Q

How do you manage a threatened abortion?

A

ultrasound and rest and reassurance (just because bleeding doesn?t mean baby died but still called threatened “abortion”)

63
Q

How do you manage an inevitable abortion?

A

Admit the patient, analgesia, D/C etc.

64
Q

How do you manage an incomplete abortion?

A

Admit the patient, analgesia, D/C etc. –same as inevitable

65
Q

How do you manage a missed abortion?

A

D/C , cytotec, prostaglandins, laminaria

66
Q

How do you manage a complete abortion?

A

supportive measures if necessary

67
Q

How do you manage a septic abortion?

A

IV antibiotics and evacuation

68
Q

How do you manage recurrent abortions?

A

start doing cultures and labs for antibodies such as Rh, duffy, kell, etc.

69
Q

If a patient has any abortion and is Rh negative what do you give them?

A

rhogam

70
Q

What is Spalding’s sign?

A

overlapping of fetal skull bones on X-ray due to liquefaction of the fetal brain

71
Q

How do you ultimately Dx an abortion?

A

no fetal movement, no cardiac motion

72
Q

How can you induce labor for someone with an abortion at 13-28 weeks? After 28 weeks? Why the difference?

A

13-28 weeks = prostaglandins; after 28 weeks = pitocin? The use of prostaglandins after 28 weeks is associated with a risk of uterine rupture

REPRO 1 (10 decks)

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