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Gynae > gynae 3 > Flashcards

gynae 3 Flashcards

1
Q

Disorders of early pregnancy are?

A

Spontaneous Abortion
Ectopic Pregnancy

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2
Q

Define spontaneous abortion?

A

Loss of pregnancy before 20 weeks without outside intervention

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3
Q

Causes of spontaneous abortion?

A
  1. Uterine Defects: Fiboids, Polyps
  2. Endocrine Factors
  3. Systemic Disorders: HTN, Diabetes
  4. Fetal Chromosomal Anomalies
  5. Infection - TORCH
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4
Q

When can chromosomal analysis be done for a patient?

A
  1. Habitual or recurrent abortions - loss of 3 or more pre-viable pregnancies
  2. Malformed fetus
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5
Q

Predisposing factors for ectopic pregnancy?

A
  1. Chronic salpingitis (gonococcal)
  2. Peritubal adhesions (appendicitis)
  3. Leiomyomas
  4. Previous Surgery
  5. Benign cysts and tumours of tube
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6
Q

Can fallopian tubes look normal and still give ectopic pregnancy?

A

yes

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7
Q

Complications of ectopic pregnancy?

A
  1. Rupture
  2. Hemorhhage
    - hematosalpinx
    - hemoperitoneum
  3. Spontaneous regression of pregnancy
  4. Tubal Abortion
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8
Q

Clinical features of ectopic pregnancy?

A
  • amenorrhea 6-8w
  • abdominal pain
  • vaginal bleeding
  • hemorrhagic shock
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9
Q

Histological features of ectopic pregnancy?

A

Walls of fallopian tube have placenta-like tissue with chorionic villi

sometimes can see the primitive embryo

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10
Q

3 disorders of late pregnancy?

A
  1. Placental inflammation
  2. Toxemias of pregnancy
  3. Placental Abnormalities
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11
Q

What types of placental inflammations can one get?

A
  1. Placenta - villitis
  2. Membranes - chorioamionitis
  3. Umbilical cord - funisitis
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12
Q

How can placental inflammation be acquired?

A
  1. Ascending infections through birth canal
  2. Hematogenous - TORCH
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13
Q

Types of placental infections?

A

Syphilis
Chlamydia
Strep
Listeriosis
Rubella
CMV
Toxoplasmosis

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14
Q

Consequences of antenatal infections?

A

IUGR, low birth weight, premature delivery
Congenital anomalies
deafness

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15
Q

Symptoms of preeclampsia?

A

HTN
Proteinuria
Edema

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16
Q

Symptoms of Eclampsia?

A

Convulsion
DIC

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17
Q

What is the pathogenesis of eclampsia?

A

Unknown cause causing altered placentation and then organic or functional obstruction of spiral arterioles

endothelial dysfunction, vasoconstriction, increased vascular permeability

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18
Q

How does toxemia of pregnancy present in
a) liver
b) kidney
c) brain
d) placenta

A

a) subcapsular, intraparenchymal hemorrhages
b) glomeruli shows marked swelling of endothelial cells and fibrin thrombi
c) gross or microscopic foci of hemorrhage along with small-vessel thromboses
d) Infarcts, hematomas, fibrinoid necrosis of vessels

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19
Q

3 placental abnormalities?

A

placenta previa - abnormal localisation of placenta implantation site
abruptio placentae - premature incomplete of normally positioned placenta fro, uterine wall during pregnancy or before delivery
placenta accreta - abnormal adhesion of normally placed placental villi to uterine wall due to absence of decidual plate between villi and myometrium

20
Q

Consequence of placenta previa? Complication?

A

implantation of placenta over or near the internal os, necessitating delivery of placenta before fetus via C-sect

Antepartum hemorrhage

21
Q

Consequences of abruptio placentae

A

Bleeding can be concealed or revealed

Severe bleeding - shock, DIV
Severe fetal distress - death

22
Q

consequence and complication of placenta accreta. treatment?

A

failure of placenta to separate in 3rd stage of labour

severe post partum hemorrhage - shock

hysterectomy

23
Q

what are gestational trophoblastic diseases?

A

to describe closely related condiotions characterised by active abnormal proliferation of trophoblastic cells

  • hydatiform mole - partial & complete
  • invasive mole
  • choriocarcinoma
24
Q

what is the function of the trophoblast?

A

outermost layer of cells of the blastocyst that attaches the fertilised ovum to the iterine wall, serving as a nutritive pathway for the embryo

25
Q

epide of trophoblastic diseases

A

geographical: asia, africa, latin america
age: increased risk - extremes of reproductive age, malignant sequalae frequent in older pt
obstetric history: term pregnancy and live births have a protective effect; history of previous mole confers increased risk; half of choriocarcinoma’s follow molar pregnancy

26
Q

define complete and partial hydatiform mole

A

complete: abnormal conceptus without emrbyo-fetus and with gross hydropic swelling of villi

partial: intimate admixture of both normal and abnormal villi . fetal dvt may be present.

27
Q

Clinical features of hydatidiform mole?

A
  1. Vaginal bleeding
  2. Uterus larger than dates
  3. Preeclampsia toxemia in 25%
  4. Passage pf molar vesicles
  5. Hyperemesis, pulmonary embolism, hyperthyroidism

Serology: Raised HCG levels

28
Q

Complications/risks of hydatidiform mole

A

uterine hemorrhage
coagulopathy
infection
continued trophoblastic activity

29
Q

Pathogenesis of a complete mole?

A

From the fertilisation of an egg in which the nucleus is lost or activated

Most are 46XX where both X chromosomes are of paternal origin, but a few are 46XY, again also of paternal origin

30
Q

compare normal trophoblastic villi to a complete hydatiform mole?

A

Normal:
- smaller in size
- immature
- contain fetal vessels
- trophoblastic layer in outer aspect

Complete:
- Villi dilated
- Hydropic Degeneration – edematous
- lining epithelium of trophoblast shows proliferation - instead of single layer, shows sheet-like proliferation

31
Q

Compare normal trophoblastic villi to partial hydatiform mole?

A

Normal:
- smaller in size
- immature
- contain fetal vessels
- trophoblastic layer in outer aspect

Partial:
- mixture of normal looking chorionic villi & abnormal villi (hydropic degeneration)

32
Q

pathogenesis of partial hydatiform mole?

A

egg fertilised by 2 sperms of a diploid sperm = triploid

33
Q

compare complete and partial moles?

A
34
Q

p57 is a surrogate marker fo the maternal genome

A
35
Q

define invasive mole:

A

hydatiform mole in which hydropic villi invades the myometrium or blood vessels or are transported to extrauterine sites

36
Q

define choriocarcinoma

A

malignant epithelial tumour arising from trophoblast of any gestational event, commonly from hydatiform mole, consisting of biphasic proliferation of syncytio-cytotrophoblast

37
Q

are invasive moles metastatic?

A

locally aggressive, low metastatic risk
- mostly confined to uterus
- can distant mets to lungs vulva broad ligament

38
Q

what causes death in invasive moles

A

uterine perforation or intraperitoneal bleeding

39
Q

gross appearance of gestational choriocarcinoma?

A

hemorrhagic friable mass in uterine cavity

40
Q

histological features of gestational choriocarcinoma?

A

hemorrhage and necrosis, anaplastic trophoblast, vascular invasion

41
Q

epide of what precedes choriocarcinoma?

A

50% complete mole
25% abortion
25% normal pregnancy
3% ectopic

42
Q

how does choriocarcinoma spread?

A

blood, lymphatics (uncommon)
- lungs (50%)
- vagina
- brain, liver, marrow

43
Q

clinical features of choriocarcinoma?

A

abnormal uterine bleeding
distant mets - hemorrhagic events
serological - HCG levels

44
Q

staging of gestational trophoblastic disease based on spread

A

1 - confiend to uterus
2 - extends by mets or direct extension to other genital structures
3 - mets to lungs
4 - other distant mets w or w/o lung involvement

45
Q

Causes of acquired infertility in females?

A
46
Q

Infertility investigations

A
  1. Hormonal Assays
  2. Endometrial Sampling
  3. Laproscopy
  4. Hysteroscopy - scope into endometrial cavity to look at endothelial surface (polyps)
  5. Hsterosalpingography
  6. Microbiologic studies

Gynae (3 decks)

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