Gynae and obs: gestational, placental disorders Flashcards
disorders of early pregnancy (2)
- Spontaneous abortion
- Ectopic pregnancy
Disorders of late pregnancy (3)
- Placental abnormalities
- Placental inflammations
- Toxemias of pregnancy
trophoblastic diseases (3)
- hydatidiform moles (partial/complete)
- Invasive mole
- Choriocarcinoma
spontaneous abortion
- which part of pregnancy does it usually happen
before 12 weeks
spontaneous abortion causes
- Uterine defects: fibroids, polyps
- Endocrine factors
- Systemic disorders: HTN, Diabetes
- Fetal chromosomal anomalies
- Infections: TORCH (congenital):
toxoplasmosis, rubella, cytomegalovirus, herpes simplex
ectopic pregnancy definition
Implantation of the fetus in any site other than a normal uterine location
risk factors for ectopic pregnancy (6)
- Chronic salpingitis (gonococcal infection)
- Peritubal adhesions (appendicitis)
- Leiomyomas
- Previous surgery
- Benign cysts and tumours of tube
- IUCD (intra uterine contraceptive device)
ectopic pregnancy clinical features (4)
- Amenorrhoea (6-8 weeks)
- Abdominal pain
- Vaginal bleeding
- Hemorrhagic shock
ectopic pregnancy complications (4)
- rupture
- haemorrhage
- > Haematosalpinx (bleeding in FT)
- > Haemoperitoneum (bleeding into peritoneal cavity)
- spontaneous regression of pregnancy
- tubal abortion
ectopic pregnancy diagnostic methods (3)
- hCG titres: indicate pregnancy
- pelvic ultrasound: dilation of FT
- endometrial biopsy: pregnancy like changes but no placenta
placental inflammation
- possible sites (3)
- how infection get to the placenta
- placenta: villitis
- membranes: chorioamnionitis
- umbilical cord: funisitis
- ascend through birth canal
- hematogenous
organisms causing placental infections (4 groups + special pneumonic!*)
- STD: syphilis, chlamydia
- bacteria: strep, listeriosis
- viral: rubella, CMV, HSV*
- protozoa: toxoplasmosis*
TORCH**
consequences of antenatal (before birth) infections
- IUGR (Intrauterine growth restriction)
- low birth weight
- premature birth
- congenital anormalies
- deafness
complications of toxemia of pregnancy (blood poisoning by toxins)
- Preeclampsia: Hypertension, proteinuria, edema
- eclampsia: (severe)
Convulsion (sudden involuntary contraction of muscles)
DIC (disseminated intravascular coagulation: causes blood clots to form throughout the body)
toxemia of pregnancy
- which part of pregnancy does it usually happen
- who does it affect more
last trimester
primiparas (pts giving birth for the 1st time)
pathogenesis of preeclampsia
- Diffuse endothelial dysfunction and vasoconstriction -> hypertension
- Increased vascular permeability -> proteinuria and edema
toxemia effects on liver
irregular, focal, subcapsular, and intraparenchymal hemorrhages
toxemia effects on kidney
marked swelling of endothelial cells and fibrin thombi of glomeruli
toxemia effects on brain
hemorrhage and small-vessel thromboses
placenta abnormalities (3)
- Placenta Previa
- Abruptio Placentae
- Placenta Accreta
placenta previa
- definition
Implantation of placenta over or near the internal os, necessitating delivery of placenta before foetus
(instead of the placenta being at the top: baby delivered -> deliver placenta, placenta is at the bottom covering the cervix: need to remove placenta first before can access the baby)
placenta previa
- complications
- treatment
- Antepartum hemorrhage
- Cesarean section usually performed
Abruptio Placentae
- definition
Premature incomplete or complete separation of normally positioned placenta from uterine wall during pregnancy or before delivery
Abruptio Placentae
- complications
- bleeding (concealed/revealed)
shock/ DIC (blood clots)
severe fetal distress -> death
Placenta Accreta definition
Adhesion of normal
placental villi to uterine wall due to absence of decidual
plate between villi and myometrium
(sticks entirely to the uterine wall)
cause of failure of placenta to separate in 3rd stage of labor
Normal > accreta > increta > percreta
accreta: infiltrate endometrium - adhere to myometrium
increta: infiltrate myometrium
percreta: infiltrate serosa layer
Placenta Accreta complications + treatment
- severe PPH (post-partum hemorrhage) -> shock
- Hysterectomy (removal of the uterus)
trophoblastic diseases (3)
- hydatidiform mole – partial & complete
- Invasive mole
- Choriocarcinoma
caused by abnormal proliferation of trophoblastic cells (the outermost layer of cells of the blastocyst that attaches the fertilized ovum to the uterine wall and serves as a nutritive pathway for the embryo)
trophoblastic diseases
- who has higher risk (geography, age, history)
- Asia, Africa and Latin America
- Extremes of reproductive age: Malignant sequelae frequent in older patients
- history of previous mole increases risk
previous success pregnancies gives protection = lower risk
complete vs partial hydatidiform mole
mole = clump of growing tissue
complete: fertilization of an egg in which the nucleus is lost or inactivated (no maternal chromosomes, XY both paternal)
fetus is absent
partial: 69 chromosomes (instead of usual 46) - triploid
fetus can be present
hydatidiform mole
diagnostic test + clinical symptoms
clinical symptoms:
- vaginal bleeding
- Hyperemesis, pulmonary embolization and hyperthyroidism
diagnostic test: - serology: raised hCG levels - PET scan - see tissue growth - genome testing (p57 - maternal genome) if p57 negative = complete mole
hydatidiform mole complications
- Uterine hemorrhage
- Coagulopathy
- Infection
- Continued trophoblastic activity (progress into invasive mole/ choriocarcinoma)
Invasive mole
- definition
- metastasis
- complication
hydropic villi invade the myometrium or blood vessels, or are transported to extrauterine sites
- low metastatic risk, but still probable (to lungs/ vulva/ broad ligament)
- locally aggressive
- uterine perforation
- intraperitoneal bleeding
leads to death
gestational choriocarcinoma
- malignancy & aggressiveness
- pathogenesis
malignant epithelial tumour arising from trophoblast of any gestational event (hydatidiform mole/ abortion/ pregnancy)
It consists mainly of biphasic proliferation of syncytio-cytotrophoblast
- aggressive and malignant
- mostly progression from complete mole
gestational choriocarcinoma
- gross and micro appearance
- metastasis
- gross: hemorrhagic friable mass in uterine cavity
- micro: Hemorrhage and necrosis, anaplastic trophoblast, vascular invasion
- metastasis: widespread metastasis via blood
affects lungs/ vagina/ brain/ liver
gestational choriocarcinoma
- clinical symptoms
- survival
- prognostic factors
- Abnormal uterine bleeding
- hemorrhagic events distally caused by distant metastases
high HCG levels
high survival with chemotherapy
prognosis depends on:
distant metastases, success of Chemotherapy, choriocarcinoma following term pregnancy
staging of gestational choriocarcinoma
I - confined to the uterus
II - metastases or direct extension to other GENITAL structures (vagina, ovaries, broad ligament or fallopian tubes)
III- Metastases to the lungs
IV - distant metastases further than lung
