Implantation, pregnancy, diseases of pregnancy

Question 1

What is decidualization?

Answer 1

trophectoderm (embryo) contacts maternal epi => increased vascular permeability in embryo, edema in ICM, swelling of stromal cells w/ glycogen granules, capillary sprouting/ingrowth

Question 2

What is the purpose for decidualization?

Answer 2

IMPLANTATION => complete embed the embryo into the decidua 12 days after fertilization

Question 3

8-12 days after fertilization, what does the blastocyst produce? what is it similar to?

Answer 3

hCG => structurally similar to LH

Question 4

What is the action of hCG?

Answer 4

acts of ovary to stimulate luteal growth and suppress luteolysis

Question 5

What is the purpose of the placenta?

Answer 5

exchange of nutrients and waste products between maternal and fetal circulations

Question 6

When does the placenta begin its action?

Answer 6

5 weeks post-fertilization is developed and functional => not fully mature

Question 7

what makes up the placenta?

Answer 7

villi from cell columns from chorionic syncytiotrophoblast containing fetal blood vessels

Question 8

Villi branching and penetrating maternal stroma leads to what?

Answer 8

forming a mass of terminal villi separated from fetal capillaries by thin layer of villi

Question 9

During pregnancy, what is the purpose for high estrogen and progesterone?

Answer 9

stimulate development of mammary glands for lactation;

prevent milk production

Question 10

after birth, what happens to estrogen and progesterone levels?

Answer 10

decline to allow for milk production

Question 11

What is necessary for milk production?

Answer 11

prolactin secretion by anterior pituitary

Question 12

What inhibits prolactin secretion? how is this altered?

Answer 12

hypothalamic dopamine release inhibits but suckling decreases dopamine release

Question 13

What hormone is responsible for the ejection of milk?

Answer 13

oxytocin secreted by posterior pituitary

Question 14

When is oxytocin released?

Answer 14

stretch of myometrial cells; suckling; baby crying

Question 15

2 diseases of pregnancy induced HTN?

Answer 15

pre-eclampsia;

eclampsia

Question 16

What is the definition of pre-eclampsia?

Answer 16

HTN; proteinuria; edema

Question 17

Definition of eclampsia

Answer 17

HTN; proteinuria; edema; SEIZURES

Question 18

Which pregnancy induced HTN disease is most common and why?

Answer 18

pre-eclampsia most common;

eclampsia is rare due to aggressive management of pre-eclampsia

Question 19

What are Sx of pre-eclampsia?

Answer 19

headache; blurred vision; mental changes;
facial and extremity edema;
abdominal pain

Question 20

At what time frame does pre-eclampsia become more common?

Answer 20

after 20 weeks gestation

Question 21

What are distinguishing lab features of pre-eclampsia and eclampsia?

Answer 21

hemolysis;
elevated LFTs;
low platelets (HELLP syndrome)

Question 22

What is the best Tx for pregnancy induced HTN?

Answer 22

delivery of fetus if possible

Question 23

If delivery is not proper Tx for pregnancy induced HTN, what is the next Tx?

Answer 23

manage w/ bed rest, salt restriction, IV MgSO4, anti-hypertensives, diazepam

Question 24

Define abruptio placentae

Answer 24

placenta detaches prematurely from endometrium

Question 25

What is the risk in abruptio placentae?

Answer 25

death for fetus;

DIC in mother

Question 26

Define placenta previa

Answer 26

placenta overlies cervical os

Question 27

What must be done if placenta previa is Dx?

Answer 27

C-section delivery => prevents hemorrhage from mother/fetus due to tearing of placenta during delivery

Question 28

Define placenta accreta

Answer 28

placenta implants directly in myometrium rather than endometrium

Question 29

What must be done if placenta accreta is Dx?

Answer 29

after delivery => hysterectomy to ensure all of placenta was removed

Question 30

Differentiate polyhydramnios from oligohydramnios

Answer 30

poly=> very large amount of amniotic fluid

oligo=> very small amount of amniotic fluid

Question 31

What may lead to polyhydramnios?

Answer 31

anencephaly;
esophageal atresia;
duodenal atresia

Question 32

What may lead to oligohydramnios?

Answer 32

bilateral renal agenesis;
posterior urethral valves (males)

Both prevent urination

Question 33

What is the most common site for ectopic pregnancy? why?

Answer 33

fallopian tube => pathology prevents egg from reaching uterine cavity

Question 34

What is the risk of ectopic pregnancy?

Answer 34

potentially fatal hemorrhage to mother

Question 35

What are common infectious agents that cross the placenta?

Answer 35

TORCHH
Toxoplasma;
Other (Syphilis, Listeria, B19, Coxsackie B, Polio)
Rubella
CMV
Herpes
HIV