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Urogenital Y2 > L20 - Early pregnancy problems > Flashcards

L20 - Early pregnancy problems Flashcards

1. Briefly overview normal embryo transport and implantation within the uterus 2. Define the types of miscarriage 3. Define recurrent miscarriage and discuss the known genetic, immune and biochemical causes 4. Describe the normal anatomy of the Fallopian tubes and the common sites of implantation of ectopic pregnancies and clinical risk factors for this condition.

1
Q

Recap the events that occur in the 2nd week of pregnancy? (4)

A
  1. Embryoblast, 2 layers: epiblast & hypoblast
  2. Trophoblast, 2 layers: cytotrophoblast & syncytiotrophoblast
  3. Yolk sac, 2: primary & secondary
  4. Cavities, 2: amniotic & chorionic
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2
Q

Describe when and how the blastocycst adheres to the uterine wall?

A

end of 1st week.

  • Contact with uterine endometrium induces trophoblast at embryonic pole to proliferate.
  • Some of these proliferating cells lose their cell membrane, coalesce to form the syncytium.
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3
Q

What is the synctiotrophoblast?

A

Mass of cytoplasm containing number of dispersed nuclei.

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4
Q

Describe the cytotrophoblast?

A

Cell of trophoblast that line the wall of the blastocyst retain their cell membrane.

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5
Q

What occurs between day 6-9 of pregnancy?

A
  • Embryo fully implanted in endometrium.
  • cytotrophoblast —secretes—> proteolytic enzymes
  • to break down the ECM between endometrial cells.
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6
Q

How is the yolk sac formed?

A

Formed from the proliferation of hypoblast cell.

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7
Q

What layers must maternal and foetal blood flow through? (4)

A
  1. Endothelium of villus capillaries
  2. Loose connective tissue in core of the villus (extraembryonic mesoderm)
  3. Layer of cytotrophoblast
  4. Layer of synctiotrophoblast
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8
Q

Describe a hydatidiform mole?

signs / symptoms

A
  • Pregnancy without embryo.
  • Causes excessive nausea and vomitting
  • due to excessively high levels of hCG.
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9
Q

Describe partial hydatidiform mole?

A
  • Presence of typical nucleated embryonic erthryoblasts in molar villi
  • presence of fetal BV indicate embryo was once present.
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10
Q

Define spontaneous miscarriage?

A
  • Fetus dies or delivers dead

- before 24 completed weeks of pregnancy.

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11
Q

State the different types of miscarriage?

A 
Threatened 
Inevitable 
Incomplete 
Complete 
Septic 
Missed
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12
Q

Threatened miscarraige

A

Bleeding, fetus still alive, os closed

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13
Q

Inevitable miscarriage

A

Heavier bleeding, fetus may be alive, os open, miscarriage about to occur.

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14
Q

Incomplete miscarriage

A

Some fetal part have been passed.

os usually open.

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15
Q

Complete miscarriage

A

All foetal tissue passed, bleeding has dimished, uterus no longer enlarged.
Cervical os is closed.

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16
Q

Septic miscarriage

A

Endometritis
Tender uterus
Infection

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17
Q

Missed miscarriage

A

Fetus not developed / died in utero, but not recognised until bleeding occurs.

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18
Q

Recurrent miscarriage

A

3 or more in succession.

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19
Q

Ectopic pregnancy

A

Embryo implants outside uterine cavity.

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20
Q

A patient with an ectopic pregnancy may present with…

A
  • Lower abdominal pain.

- Dark vaginal bleeding.

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21
Q

What may be the medical management for an ectopic pregnancy?

A
  • Ectopic unruptured, no cardiac activity: single does of methotrextate.
  • Subsequent monitoring of hCG levels are important
22
Q

Hyperemesis Gavidarum

A

Nausea, vomiting in early pregnancy.
Very severe.
Cause severe dehydration, weight loss of electrolyte imbalance.

23
Q

What is gestational trophoblastic disease?

where does GTD begin?

A
  1. Normal development: trophoblastic cells form villi which grow into lining of uterus. This layer will develop into placenta.
    - GTD begins in this layer of cells.
    - HCG produced in excess
24
Q

Briefly describe hydatidiform moles?

A 
Complete 
- PATERNAL!
- when one sperm fertilise an empty oocyte 
- diploid 
- no fetal tissue
Partial 
- triploid usually 
- derived from two sperm entering one oocyte.
25
Q

State different types of haemorrhage during pregnancy

A
  1. Threatened
  2. Antepartum
  3. Intrapartum
  4. Post-Partum
26
Q

Threatened haemorrhage

A

Can occur up to 24 weeks gestation

27
Q

Antepartum haemorrhage occurs…

A

24 weeks until onset of labor

28
Q

Intrapartum haemorrhage occurs…

A

From onset of labour until end of second stage.

29
Q

Post-partum haemorrhage occurs…

A

3rd stage of labour until end of puerperium.

- 6 weeks after child birth.

30
Q

Placenta Praevia

A

Placenta encroachs upon lower segment of uterus.
Extending 5cm from internal os.
May occur during labour.
Often painless bleeding.

31
Q

When might a women be advised not to deliver vaginally?

A

When their placental edge is not 2cm away from the internal os.

32
Q

Placental abruption

A

When placenta separates from uterus before childbirth.

Retroplacental haemorrhage, bleeding between placenta and uterus.

33
Q

What may placental abruption result in?

A

Retroplacental haemorrhage.

Reduced area for gas exchange between foetal and maternal circulation
- leading to foetal hypoxia and acidosis

34
Q

Vasa Praevia

A

Umbilical cord vessels run in fetal membrane and cross internal os of cervis.
Vessels may spontaneously rupture in early labour.

35
Q

Describe two types of post-partum haemorrhage?

A

PRIMARY (within 24hr)
1. Minor: Blood loss of <500mls, no hypovolemic shock
2. Major: >1000mls lost and hypovolemic shock
SECONDARY
1. (24hr to 12weeks post birth)
2. Infection? endometritis

36
Q

What may be some causes of post-partum haemorrhage?

A

Trauma - perineal tear
Thrombin - coagulopathy
Tissue

37
Q

What is the name given to the cartilaginous joint between the pubic joint?

A

Symphysis pubis.

38
Q

Describe the broad ligament?

A

Fold in peritoneum.
Mesovarium - between uterus and ovary
Mesosalphinx - covers fallopian tube

39
Q

What are the 3 parts of the fallopian tube?

A 
Isthmus 
- closest to uterus 
Ampulla
- commonest site of fertilization 
Infundibulum 
- fimbriae
40
Q

What are the 3 layers of the fallopian tube and descirbe them ?

A

Mucosa
- simple columnar epithelium, ciliated and secretory
Muscularis
- inner circular and outer longitudinal fold
Serosa
- simple squamous epithlium

41
Q

Blood supply to fallopian tubes

A

Branche sof ovarian and uterine arteries

42
Q

Where is the fallopian tube situated and describe it?

A

10cm length, 1cm diameter.

Found in mesosalpinx (fold in broad ligament)

43
Q

What symptoms may a patient with an ectopic pregnancy present wiht?

A

Usually asymptomatic until point of rupture.

  • abdo pain
  • abnormal vaginal bleeding
  • shoulder tip pain (reffered pain)
  • diarrhoea
44
Q

State potential causes of recurrent miscarriage

A 
Maternal age 
Genetic factors 
Structural uterine abnormalities 
Antiphospholipid syndrome 
Thrombophillia 
Cervical weakness 
endocrine causes 
Unexplained
45
Q

How may maternal age contribute to mischarraige?

A

Aging oocyte smore likely to be abnormal
35-39 y/o : 25% risk
40-44 y/o : 51% risk

46
Q

Give examples of structural uterine abnormalities that may lead to miscarriage

A

Septate / subseptate nucleus
Fibroids
Adhesions in uterine cavity

47
Q

Fibroids

A

Benign growths in muscle layer of uterus.

48
Q

Asherman’s syndrome

A

Acquired uterine condition when scar tissue forms inside the uterus and/ or the cervix.
- can cause infertility

49
Q

What is antiphospholipid syndrome?

A

Maternal antibodies directed against phospholipid binding plasma proteins.
Causes increased risk of blood clots.

50
Q

What is HbA1c?

A

Average blood glucose levels for the past 2/3 months.

High HbA1c In first trimester can cause increased risk of miscarriage and malformations.

Urogenital Y2 (16 decks)

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