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Pathology 4 > Lecture 3 - Pregnancy Pathologies > Flashcards

Lecture 3 - Pregnancy Pathologies Flashcards

1
Q

what structure does the fertilization of the egg by the sperm result in?

A

zygote

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2
Q

how long does the fertilization process take?

A

~ 24 hours

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3
Q

how long is the sperms life span?

A

3-4 days

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4
Q

how long does it take the sperm to navigate the female reproductive track?

A

~ 10 hours

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5
Q

what is the route the sperm takes through the female reproductive track?

A

up vaginal canal, through cervix, into fallopian tubes - where fertilization begins

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6
Q

what happens during the acrosome reaction?

A

release of acrosome enzymes - hyaluronidase

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7
Q

what must occur before the sperm can fuse with the secondary oocyte?

A

the acrosome reaction that facilitates fertilization

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8
Q

what does the sperm come into contact with during fertilization?

A

corona radiata (ZP3) of oocyte

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9
Q

what aids in corona radiate penetration?

A

flagella action

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10
Q

what happens within 11 hours post fertilization?

A

oocyte has extruded a polar body with its excess chromonomes

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11
Q

what does the fusion of the oocyte and sperm nuclei mark?

A

creation of the zygote and end of fertilization

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12
Q

what step fallows creation of the zygote/ end of fertilization?

A

zygote begins to cleave

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13
Q

what occurs with each division (cleavage) of the zygote?

A

divides into 2 cells called blastomeres

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14
Q

how often does the zygotes cells divide again?

A

each division occurring about every 20 hours

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15
Q

what are 4 categories of causes of pregnancy pathologies/disorders?

A
  1. abnormal/pathologies of fertilization (ovum or sperm related)
  2. pathology of implantation
  3. pathology of placentation
  4. materono-fetal interaction
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16
Q

what are 4 factors relating to fertilization pathologies?

A
  1. ovum related
  2. sperm related
  3. genital organ related
  4. systemic related (DM, antibodies to spermatozoa or ova, psychological problems)
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17
Q

what are ovum related factors of fertilization pathologies?

A 
immature ovums (meiotic division is incomplete) or
inferior ovum quality (older women)
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18
Q

what % of normal ovum do not fertilize?

A

20%

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19
Q

what are sperm related factors of fertilization pathologies?

A

azoospermia (no living sperm), oligospemia (not enough sperm), or immotile spermatozoa

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20
Q

what are genital organ related factors of fertilization pathologies?

A

PID (fallopian tube pathology)

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21
Q

what % of infertility is caused by fallopian tube pathology?

A

30%

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22
Q

what is pelvic inflammatory disease?

A

fallopian tube is occluded or deformed by chronic inflammation or adhesion/scar tissue

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23
Q

what are 3 factors involved in implantation pathologies?

A
  1. uterus not hormonally primed with estrogen and progesterone so it cannot accept an embryo
  2. endometritis or uterine adhesions (Asherman’s syndrome)
  3. ectopic pregnancy
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24
Q

what is an ectopic/ extrauterine pregnancy?

A

implantation occurs outside the uterus

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25
Q

where is the most common location of a ectopic pregnancy?

A

fallopian tubes (often affected with PID) - 95% (ovary and abdominal cavity are also locations)

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26
Q

what are 4 risk factors of ectopic pregnancy?

A

PID
induced abortion
STI
IUD

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27
Q

what are 3 factors that ectopic pregnancies are related to?

A

delayed egg transport
decreased fallopian tube motility
distorted anatomy

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28
Q

what are 5 clinical manifestations of ectopic pregnancy?

A
  1. pelvic pain
  2. cramps
  3. irregular bleeding/spotting
  4. amenorrhea
  5. fainting
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29
Q

what is the definition of an abortion?

A

ending of pregnancy by the removal or forcing out of the fetus/embryo from the womb before it is viable

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30
Q

what are the two main types of abortions and the subtypes?

A
  1. induced/elective (medically indicated)

2. spontaneous: includes, complete, incomplete, missed and threatened

31
Q

what time frame are abortions the safest to perform?

A

within the first 6-10 weeks after the last menstrual period (13-24 have higher complication rate)

32
Q

what situation would permit an abortion to be performed after 24 weeks of pregnancy?

A

mothers life is in danger

33
Q

what are 3 methods of induced/elective abortions?

A 
vacuum aspiration (suction)
infusion of saline solution
surgical evacuation (scraping)
34
Q

what is the name of the pill used in a non surgical abortion?

A

RU 486

35
Q

what does the non surgical abortion pill do?

A

its an anti progestin drug that causes uterine lining to collaspse and embryo is lost - menstruation occurs

36
Q

what is the time frame that the non surgical abortion pill can be taken?

A

up to 5 weeks after conception

37
Q

what is the definition for placenta?

A

temporary organ that joins the mother and fetus - tranfers oxygen and nutrients from mother to fetus and permits release of cardbon dioxide and waste products from the fetus

38
Q

what are 4 categories of placental anomalies?

A

abnormalities in:

shape, size, placental cord (transfer), and amniotic fluid (inside)

39
Q

what is placenta accreta?

A

serious pregnancy condition that occurs when blood vessels and other parts of the placenta grow too deeply into the uterine wall (muscularis)

40
Q

with placenta accreta, what occurs with the placenta at time of delievery?

A

placenta does not shells out spontaneously from uterus and this may lead to extensive bleeding

41
Q

what is the treatment for placenta accreta?

A

manual extraction of the placenta to remove it from the uterus after delievery

42
Q

what is the definition of placenta previa?

A

implantation of the placenta over or near the cervix in the lower part of the uterus - the placenta may completely or partially cover the cervix

43
Q

what can make women more susceptible to placenta previa?

A

having had more than one pregnancy or structural abnormalities of the uterus - such as fibroids

44
Q

what can placenta previa cause in late pregnancy?

A

painless bleeding from the vagina that begins suddenly and may become profuse, endangering the life of women and the fetus - C section is almost always performed before labour begins

45
Q

what can ultrasonography help doctors identify?

A

placenta previa and distinguish it from a prematurely detached placenta

46
Q

define ‘abruptio placentae’

A

premature detachment of a normally positioned placenta from uterine wall

47
Q

what is a major risk factor of abruptio placentae?

A

eclampsia

48
Q

who is more likely to have a prematurely detached placenta?

A

women with high BP or cocaine users

49
Q

what do symptoms of abruptio placentae depend on?

A

degree of detachment and amount of blood lost (can be massive for some women - can die quickly from hypovolemic shock and infection)

50
Q

what is the treatment for abruptio placentae?

A

bed rest and c section

51
Q

when do symptoms of preeclampsia usually appear?

A

after 34th week of pregnancy

52
Q

what does the triad of preeclmapsia include?

A

hypertension (gestational HTN)
edema
proteinuria

53
Q

what clinical manifestations does eclampsia include?

A

all those from the preeclampsia triad (HTN, edema and proteinuria) plus seizures

54
Q

what is the prognosis of eclampsia if diagnosed early?

A

good - its a common pathology

55
Q

what is the rate of prevalence of preeclampsia and eclampsia, respectively?

A

3-4% : 6% of all pregnancies

56
Q

what pregnancy is preeclampsia and eclampsia most likely to occur?

A

first one

57
Q

how is preeclampsia and eclampsia treated?

A

HTN med, bed rest and c section

58
Q

what does the HELLP syndrome present with in regards to HTN complications, surrounding preeclampsia and eclampsia?

A

Hemolysis
Elevated Liver enzymes
Low platelets

59
Q

what does gestational diabetes cause?

A

high blood sugar that can affect pregnancy and baby’s health

60
Q

what condition does gestational diabetes put women at risk for?

A

type 2 diabetes

61
Q

for most women - what are the symptoms present of gestational diabetes?

A

for most it does not cause noticeable SSx

62
Q

what are 4 risk factors of gestational diabetes?

A

older than 25
family or personal health hx (ex. being pre-diabetic)
excess body weight
race (increased risk for black, hispanic, american indian or asian)

63
Q

what are 4 complications of gestational diabetes that may affect baby?

A

xs birth weight
premature birth/respiratory distress syndrome
hypoglycemia (could lead to seizures)
later development of type 2 diabetes

64
Q

what are 2 complications of gestational diabetes that may affect mother?

A

high BP and preeclampsia

future diabetes - during future pregnancy the risk of gestational diabetes goes up and type 2 later in life

65
Q

define ‘gestational trophoblastic disease’

A

abnormalities of placentation that lead to tumor like changes in placenta

66
Q

what is hydatidiform mole?

A

benign form of gestational trophoblastic disease

67
Q

what are 2 common forms of gestational trophoblastic disease (hydatidiform mole)?

A
  1. complete mole - fetus cannot be identified in amniotic sac due to chromosomal abnormality
  2. incomplete mole: placenta tumor usually attached to fetal parts and partially preserve normal placental tissue - due to oocyte fertilized with 2 spermatozoa
68
Q

what are 3 clinical signs of gestational trophoblastic disease?

A

enlarged uterus without any signs of fetal movement
high hCG levels
moles are aborted spontaneously (mid pregnancy - if diagnosed early an abortion is performed)

69
Q

what is the malignant form of gestational trophoblastic disease?

A

choriocarcinoma - malignant tumor composed of placental cells

70
Q

where are 3 source that choricocarcinoma develops from and the rate of occurrence from that source?

A

50% from hydatidiform mole
25% from placental cells after abortion
25% from normal placenta

71
Q

choriocarcinoma is highly invasive and secretes what hormone?

A

hCG

72
Q

how is choriocarcinoma highly invasive?

A

penetrates the wall of uterus, invading the veins which then metastasizes to the lung, liver and brain (tumor responds well to chemotherapy)

73
Q

what is the cure rate for choriocarcinoma if treated before brain metastasis?

A

80-100%

Pathology 4 (4 decks)

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