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OB GYN > M1: Immunology of Pregnancy > Flashcards

M1: Immunology of Pregnancy Flashcards

0
Q

Maternal blood spurts from __________ into the placental _________ and bathes the outer _________. Allow exchange of gases, nutrients and other substances with fetal capillary blood within the villous core.

A

Uteroplacental vessels. Intervillous space. Syncitiotrophoblast.

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1
Q

Fetus is dependent on the ________ for pulmonary, hepatic and renal functions. Accomplished through unique anatomical relationship of the placenta and its uterine interface.

A

Placenta

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2
Q

Fetal & maternal blood are not mixed in the

A

Hemochorial placenta

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3
Q

There is a ______ system that links mother and fetus.

A

Paracrine

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4
Q

________ of the maternal decidua parietalis and the extraembryonic chorion laeve.

A

Juxtaposition

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5
Q

Plays a critical part at the maternal-fetal interface. Invasiveness for implantation, nutritional for conceptus & endocrine function for maternal physiological adaptations & pregnancy maintenance.

A

Trophoblast

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6
Q

Trophoblast: human placental formation begins with this which gives rise to a trophoblast cell layer encircling the blastocyst.

A

Trophectoderm

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7
Q

Trophoblast: trophectoderm appear at the _______ stage.

A

Morula

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8
Q

Trophoblast differentiation occurs when

A

8th day postfertilization

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9
Q

Trophoblast Differentiation: inner, mononucleated. Germinal cells from syncytium. Well demarcated cell border, single nucleus, undergoes DNA synthesis and mitosis.

A

Cytotrophoblast

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10
Q

Trophoblast Differentiation: outer, multinucleated. Has amorphous cytoplasm without cell borders, nuclei that are multiple and diverse in size & shape, and a continuous syncytial lining.

A

Syncitiotrophoblast

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11
Q

Trophoblast Differentiation: After implantation is complete, trophoblast further differentiate into two main pathways.

A

Extravillous & Villous trophoblasts

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12
Q

Trophoblast Differentiation: transports O2, nutrients and other compounds between the fetus and the mother.

A

Chorionic villi

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13
Q

Trophoblast Differentiation: gives rise to chorionic villi

A

Villous trophoblast

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14
Q

Trophoblast Differentiation: migrates into decidua and myometrium. Penetrates maternal vasculature, thus coming into contact with various maternal cell types. Further classified as ________ & _________.

A

Extravillous Trophoblast. Interstitial T. & Endovascular T.

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15
Q

Trophoblast Differentiation: Penetrates spiral artery lumen. Creates low resistance blood flow.

A

Endovascular trophoblast

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16
Q

Trophoblast Differentiation: invade the decidua and eventually penetrate the myometrium to form placental bed giant cells. Surrounds spiral arteries (do not invade)

A

Interstitial trophoblast

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17
Q

Early Trophoblast Invasion: Day wherein blastocyst become totally encased within the endometrium.

A

Day 10

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18
Q

Early Trophoblast Invasion: At ____ of development, the blastocyst wall facing the uterine lumen is a single layer of flattened cells. The opposite, thicker wall with two zones. _________ & the embryo-forming _________.

A

9 days. Trophoblast. Inner cell mass.

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19
Q

Early Trophoblast Invasion: As early as _______ postfertilization, the inner cell mass or _______ is differentiated into a thick plate of ________ and an underlying ________.

A

7 1/2 days. Embryonic disc. Primitive ectoderm. Endoderm.

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20
Q

Early Trophoblast Invasion: ________ appear between the embryonic disc and trophoblast and enclose a space that will become the _________.

A

Small cells. Amniotic cavity.

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21
Q

Early Trophoblast Invasion: _________ first appears as isolated cells within the blastocyst cavity.

A

Embryonic mesenchyme

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22
Q

Early Trophoblast Invasion: When the blastocyst cavity is completely lined with mesoderm, it is called _________. And its membrane is called _________ which is composed of mesenchyme & trophoblast.

A

Chorionic vesicle. Chorion.

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23
Q

Early Trophoblast Invasion: Some mesenchymal cells will condense to form the ________ which joins the embryo to the nutrient chorion and later develops into the _________.

A

Body stalk. Umbilical cord.

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24
Q

Early Trophoblast Invasion: ____ day. The syncitiotrophoblast is invaded by a system of intercommunicating channels called ________ which becomes filled with maternal blood.

A

12th day. Trophoblastic Lacunae.

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25
Q

Chorionic Villi: ______ 12th days postfertilization, extravillous cytotrophoblasts gives rise to __________ composed of cytotrophoblast core covered by __________.

A

Before. Solid primary villi. Syncitiotrophoblast.

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26
Q

Chorionic Villi: As the lacunae join, a complicated _______ is formed that is partitioned by solid cytotrophoblastic columns.

A

Labyrinth

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27
Q

Chorionic Villi: The trophoblast lined labyrinthine channels form the _________ and the solid cellular columns form the _________.

A

Intervillous space. Primary villous stalks.

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28
Q

Chorionic Villi: 12th day postfertilization, _______ is formed, invasion of _______ derived from extraembryonic mesoderm into the solid trophoblast column.

A

Secondary villi. Mesenchymal cords.

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29
Q

Chorionic Villi: ________ begins on the mesenchymal cords. ______ are formed.

A

Angiogenesis. Tertiary villi.

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30
Q

Chorionic Villi: Day wherein maternal arterial blood enter the intervillous space.

A

15th day

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31
Q

Chorionic Villi: Day wherein fetal blood vessels are functional.,placental circulation is established.

A

17th day

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32
Q

Chorionic Villi:Fetal placental circulation is completed when the __________ of the embryo connected with _________.

A

Blood vessels. Chorionic vessels.

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33
Q

Chorionic Villi: In some villi, angiogenesis fails from __________. It can be seen normally but exaggeration of the process is seen with __________.

A

Lack of circulation. Hydatidiform mole.

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34
Q

Chorionic Villi: Villi are covered by outer layer of _______ and inner layer of ______, which are also known as ________.

A

Syncytium. Cytotrophoblast. Langhans cells.

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35
Q

Chorionic Villi: Cytotrophoblast proliferation at the villous tips produces the trophoblastic cell columns that form _________ not invaded by fetal mesenchyme, anchored to the decidua at the basal plate.

A

Anchoring villi

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36
Q

Chorionic Villi: ________ consists of two layers of trophoblasts externally and fibrous mesoderm internally.

A

Chorionic plate

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37
Q

Chorionic Villi: The __________ is formed by 8-10 weeks as the amnionic and the primary chorionic plate mesenchyme fuse together.

A

Definitive chorionic plate

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38
Q

Chorionic Villi: _______ is formed by the fusion of connective stalk @ allantois.

A

Umbilical cord

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39
Q

Hemochrial placenta: _______ act to increase surface area in direct contact with maternal blood. Associated pinocytic vacuoles and vesicles are r/t absorptive and secretory placental functions.

A

Microvilli

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40
Q

Hemochrial placenta: more prominent during the first trimester of pregnancy; consists of inner layer of cytotrophoblastsn and associated basal lamina covered by syncytiotrophoblast.

A

Hemodichorial

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41
Q

Hemochrial placenta: later in pregnancy; inner layer of cytotrophoblasts are no longer continuous, only scattered cells are present; aids in nutrient and oxygen transport of the fetus.

A

Hemomonochorial

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42
Q

Chorion & Decidua Devt: chorionic villi in contact with the decidua basalis; fetal component of the placenta.

A

Chorion frondosum (leafy chorion)

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43
Q

Chorion & Decidua Devt: avascular fetal membrane; abuts the decidua parietalis. Until the near end of the third month, this is separated from the amnion by the exocoelomic cavity to form an avascular ________.

A

Chorion laeve (smooth chorion)

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44
Q

Chorion & Decidua Devt: is more translucent that amnion and rearely exceeds 1mm thickness. Both are important sites of molecular transfer and metabolic activity.

A

Chorion laevae

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45
Q

Maternal Regulation of TI & VG: During the first half of pregnancy, ___________ accumulate in the decidua and are found in direct contact with trophoblast.

A

Decidual Natural Killer Cells (dNK)

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46
Q

Maternal Regulation of TI & VG: dNK cells lack ___________ and are able to dampen inflammatory ______ cells.

A

Cytotoxic functions. T(H)17.

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47
Q

Maternal Regulation of TI & VG: Together with _________, prevent NK cells from recognizing and destroying fetal cells as foreign.

A

Decidual macrophages

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48
Q

Maternal Regulation of TI & VG: also have the ability to attract and promote trophoblast invasion into the decidua (IL-8 & interferon-inducible protein 10) and promote vascular growth (proangiogenic factors such as VEGF & PIGF)

A

dNK cells

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49
Q

Trophoblast invasion of the Endometrium: _________ of the first trimester of pregnancy are highly invasive & extends from the endometrium to the inner third of the myometrium. This process occurs under _________ conditions.

A

Extravillous trophoblast. Low oxygen.

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50
Q

Trophoblast invasion of the Endometrium: Invasive trophoblasts secrete _________ that digests ECM and activate ________ already present in the endometrium.

A

Proteolytic enzymes. Proteinases.

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51
Q

Trophoblast invasion of the Endometrium: Trophoblast also secrete ___________ which converts plasminogen to plasmin which degrades matrix proteins and activates matrix metalloproteases.

A

Urokinase Type Plasminogen Activator

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52
Q

Trophoblast invasion of the Endometrium: critical for human trophoblast invasion

A

MMP-9

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53
Q

Trophoblast invasion of the Endometrium: the degree of trophoblast invasion is controlled by ______________ and by factors that cause trophoblast migration.

A

Matrix degradation regulation

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54
Q

Trophoblast invasion of the Endometrium: Trophoblast secrete _______ which acts in an autocrine manner, promotes invasion into endometrium.

A

IGF 2

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55
Q

Trophoblast invasion of the Endometrium: secreten insulin like growth factor binding protein type 4 which blocks autocrine loop.

A

Decidual cells

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56
Q

Trophoblast invasion of the Endometrium: Low ______ levels are critical for trophoblast invasion and remodeling of the spiral arteries.

A

Estradiol

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57
Q

Trophoblast invasion of the Endometrium: As the pregnancy advances, increasing estradiol levels repress & control the extent of uterine vessel transformation via _______ & ________ expression.

A

VEGF. Integrin Receptor.

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58
Q

Invasion of Spiral Arteries: extensive modification of vasculature by

A

Trophoblast

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59
Q

Occur in the first half of pregnancy, important in uteroplacental blood flow. Also integral in some pathological conditions such as preeclampsia,fetal growth restriction & preterm birth.

A

Invasion of Spiral Arteries

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60
Q

Invasion of Spiral Arteries: two extravillous trophoblasts

A

Imterstitial & Endovascular

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61
Q

Invasion of Spiral Arteries: Uteroplacental vessel devt proceeds in ____ waves or stages.

A

Two

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62
Q

Invasion of Spiral Arteries: 1. Occurs _________ postfertilization. Invasion & modification of spiral arteries up to the border between the decidua & myometrium.

A

Before 12 weeks

63
Q

Invasion of Spiral Arteries: 2. Between ___________. Invasion of the intramyometrial segments of spiral arteries.

A

12 & 16 weeks

64
Q

Invasion of Spiral Arteries: narrow lumen, muscular spiral arteries, dilated, low resistance uteroplacental vessels.

A

Remodelling

65
Q

Invasion of Spiral Arteries: In ________, trophoblast invasion is incomplete resulting to narrower and less distensible blood vessels.

A

Preeclampsia

66
Q

Approximately ________ after conception, maternal blood enters the intervillous space in fountain-like bursts from the spiral arteries.

A

One month

67
Q

Placental Growth: PG is more rapid than that of the fetus

A

First trimester

68
Q

Placental Growth: _____ postmenstrual weeks. Placental & fetal weights are approximately equal.

A

17

69
Q

Placental Growth: Term. Placental weight is approximately _____ of fetal weight.

A

1/6

70
Q

Placental Growth: Lobes, slightly elevated convex areas; c

Varies fro 10-38, incompletely separated by grooves that overlie the __________.

A

Placental septa

71
Q

Placental Growth: functional units of the placenta

A

Lobule or Cotyledons

72
Q

Placental Maturation: As the villi continue to branch and the terminal ramifications become more numerous and smaller, the volume and prominence of cytotrophoblasts _____.

A

Decrease

73
Q

Placental Maturation: As the _________ thins, the fetal vessels become more prominent and lie closer to the surface.

A

Syncytium

74
Q

Placental Maturation: In early pregnancy, the branching connective-tissue cells are separated by an abundant loose intercellular matrix. Later the _________ becomes denser and the cells are more spindly @ more closely packed.

A

Villous stroma

75
Q

Placental Maturation: Stromal infiltration of ________ (fetal macrophages) phagocytic, immunosuppressive, cytokine production, paracrine regulation of trophoblast functions.

A

Hofbauer cells

76
Q

Fetal Circulation: Deoxygenated venous-like fetal blood flows to the placenta through ___________.

A

Two umbilical arteries

77
Q

Fetal Circulation: Blood with significantly higher oxygen content returns from the placenta via a single _________ to the fetus. AVA.

A

Umbilical vein

78
Q

Fetal Circulation: branches of umbilical vessels that traverse along the fetal surface of the placenta in the chorionic plate, responsive to vasoactive substances.

A

Placental surface or chorionic vessels

79
Q

Fetal Circulation: chorionic arteries always _________ chorionic veins.

A

Cross over

80
Q

Fetal Circulation: ____% of the placenta. Chorionic arteries form a fine network of supplying the ________.

A
  1. Cotyledons.
81
Q

Fetal Circulation: ____% of the placenta. The arteries radiate to the edge without narrowing.

A

35

82
Q

Fetal Circulation: perforating branches of surface arteries that pass through the chorionic plate.

A

Truncal arteries

83
Q

Fetal Circulation: Each trunchal artery supplies one main stem ______ & thus one ______.

A

Villus. Cotyledon.

84
Q

Maternal Circulation: Maternal blood enters through the _______ and is driven high up toward the ________ by arterial pressure before laterally dispersing.

A

Basal plate. Chorionic plate.

85
Q

Maternal Circulation: After bathing the external microvillous surface of the chorionic villi, maternal blood drains back through the venous orifices in the basal plate and enters the __________.

A

Uterine veins

86
Q

Maternal Circulation: Maternal blood traverses the placenta randomnly without _________.

A

Preformed channels

87
Q

Maternal Circulation: Spiral arteries are ______ to but veins are ______ to the uterine wall. Aids in closure of veins during uterine contraction and prevents exit of maternal blood from the intervillous space.

A

Perpendicular. Parallel.

88
Q

Maternal Circulation: There are about _____ spiral arterial entries into the intervillous space at term.

A

120

89
Q

Maternal Circulation: After the _____ week, a prominent venous plexus separates the ________ from the myometrium and thus participates in providing a cleavage plane for placental separation.

A

30th. Decidua basalis

90
Q

Immunological consideration: are the only fetal-derived cells in direct contact with maternal tissues.

A

Trophoblasts

91
Q

Immunological consideration: act to control the invasion of trophoblast, which have adapted to survive immunologically hostile environment.

A

Maternal Natural Killer Cells

92
Q

Immunological consideration: Model of trophoblast invasion & maternal vascular remodeling. Decidual NK cells work in concert with _________. They mediate angiogenesis through production of proangiogenic factors such as ______ and control trophoblast chemoattractiom toward spiral arteries by production of IL-8 & Interferon inducible protein 10.

A

Stromal cells. VEGF.

93
Q

Immunogenecity of Trophoblast: is considered immunologically inert and therefore unable to create maternal immune response.

A

Placenta

94
Q

Immunogenecity of Trophoblast: are absent from villous trophoblast, which appear to be immunologically inert at all gestational ages.

A

MHC Class I & II Antigens

95
Q

Immunogenecity of Trophoblast: do express MHC Class I molecules.

A

Invasive Extravillous Trophoblasts

96
Q

Immunogenecity of Trophoblast: Normal implantation depends on controlled ________ of the maternal EM-decidia and spiral arteries.

A

Trophoblastic invasion

97
Q

Immunogenecity of Trophoblast: permit then limit trophoblast invasion

A

dNK cells + HLA class 1 genes

98
Q

Are the products of multiple genetic loci of MHC located within the short arm of chromosome 6

A

HLA genes

99
Q

Encode the major class I (class Ia) transplantation antigen.

A

HLA-A, HLA-B & HLA-C (classical genes)

100
Q

Encode class Ib HLA antigens

A

HLA-E & HLA-G

101
Q

Combine with unique expression of 3 specific HLA Class I genes im extravillous cytotrophoblast act in concert to permit and subsequently limit trophoblast invasion.

A

Uterine dNK cells

102
Q

Originate in the bone marrow and belong to the natural killer cell lineage. Predominant population of leukocyte present in mid-luteal phase endometrium at the expected time of implementation. Has distinct phenotype characterized by a high surface density of ______ or neural cell adhesion molecule.

A

Uterine Natural Killer Cells. CD56.

103
Q

uNKC: Filtration is increased by ________ and by stromal cells production of ______ and decidual _______.

A

Progesterone. IL-15. Prolactin.

104
Q

uNKC: nuclei of the uNK cell begin to disintegrate near the end of ________ of nonfertile ovulatory cycles.

A

Luteal phase

105
Q

uNKC: If implantation proceeds. It persists in large numbers in ________ during early pregnancy.

A

Decidua

106
Q

uNKC: 1st trimester Decidua, many uNK cells in close proximity to __________ where they serve regulate trophoblast invasion.

A

Extravillous trophoblasts

107
Q

uNKC: At term, ____ uNK cells in the deciduas.

A

Few

108
Q

uNKC: uNK cells secrete large amounts of ____________ activated state. May function primarily to forestall trophoblast apoptosis and not to promote trophoblast replication.m

A

Granulocyte-Macrophage-Colony-Stimulating factor (GM-CSF)

109
Q

uNKC: suggest a role in decidual vascular remodeling

A

Expression of angiogenic factors by uNK cells

110
Q

uNKC: primary responsible for decidual immuno surveillance

A

uNK cells

111
Q

Expressed only in humans specifically in cytotrophoblast. Has a high restricted tissue distribution. Identified only in extravillous cytotrophoblast in the decidua basalis and in the chorion laeve. During pregnancy, a soluble major isoform ________ is increased.

A

HLA-G expression in Trophoblasts. HLA-G2.

112
Q

HLA-G: embryos used for in vitro fertilization do not implant if they do not express _________.

A

HLA-G Isoform

113
Q

HLA-G: causes an abnormality in HLA-G expression

A

Pre eclampsia

114
Q

At term it is a tough and tenacious but pliable membrane. It is an innermost avascular fetal membrane filled with amniotic fluid. Provides almost all tensile strength of the fetal membranes. It’s reliance to rupture.

A

Amnion

115
Q

Is the relatively acellular zona spongiosa (contiguous with the second fetal membrane, chorion leave)

A

Outermost amnion layer

116
Q

Lacks smooth muscle cells, nerves, lymphatics and importantly blood vessels.

A

Human amnion

117
Q

Precursors of amnionic epithelium that line the inner surface of trophoblasts

A

Amniogenic cells

118
Q

The amnion is first identifiable _______ day of embryo development. It is initially a minute vesicle.

A

7th or 8th

119
Q

Becomes in contact with interior surface of the chorion leave.

A

Amniotic sac distention

120
Q

_______ of chorion laeve and amnion cause an obliteration of extraembryonic coelem.

A

Apposition

121
Q

Covers the placental surface

A

Placental amnion

122
Q

Covers the umbilical cord

A

Umbilical amnion

123
Q

Derivation fibroblast like mesenchymal cell layer

A

Embryonic mesoderm

124
Q

Interstitial collagens are deposited between two cell layers (epithelial & mesenchymal cells) which marks the formation of ___________ which separates the two layers of amnion cells.

A

Amnion Compact Layer

125
Q

At ________ amniotic sac expands to line the placenta and chorion frondosum, result to reduction and sparse distribution of mesenchymal cells.

A

10-14 weeks

126
Q

Early in pregnancy, __________ replicates at a rate appreciably faster than mesenchymal cells.

A

Amniotic epithelium

127
Q

At term, _________ are widely dispersed with the appearance of long slender fibrils.

A

Mesenchymal cells

128
Q

The apical surface of replete with highly developed microvilli. Function as a major site of transfer between amnionic fluid and amnion.

A

Amnion Epithelial cells

129
Q

Produce in the epithelia but functions in mesenchymal cells. It promotes synthesis of MMPs.

A

Fibronectin

130
Q

Breaks down the strength-bearing collagens and increases PG synthesis to prompt uterine contractions and cervical ripening.

A

MMPs

131
Q

Regulates the amnion tensile strength

A

Collagen 7

132
Q

Major interstitial collagen in tissues characterized by great tensile strength

A

Collagen I

133
Q

Contribute to tissue integrity and provides both tissue extensibility and tensile strength

A

Collagen III

134
Q

Provide amnion extensibility

A

Elastin microfibrils

135
Q

Regulates amnion tensile strength. Promote tissue strength.

A

Decorin

136
Q

At term average amniotic fluid volume is

A

1000mL

137
Q

What week does the amniotic fluid become a clear fluid that collects within the amniotic cavity increases as pregnancy progresses them decreases.

A

34 weeks

138
Q

Umbilical cord develops in the

A

Yolk sac & umbilical vessels

139
Q

Month in which the expanding amnion obliterates the exocoelom, fuses with the chorion laeve, and covers the bulging placental disc and the lateral surface of the body stalk, umbilical cord or funis.

A

Middle third of the month

140
Q

Disappears early during fetal development leaving only the original left vein

A

Righ umbilical

141
Q

Umbilical vesicle lined by a single layer of

A

Flattened or cuboidal epithelium

142
Q

It is a glycoprotein with biological activity similar to LH.

A

HCG

143
Q

In what week does hCG expressed in both syncytiotrophoblast & cytotrophoblast

A

Before 5 weeks

144
Q

Complete hCG secretion (maximum)

A

8-10weeks

145
Q

Plasma levels decline at what weeks

A

10-12 weeks

146
Q

Both GnRH and its receptor are expressed by

A

Cyto & Syncytio

147
Q

Elevates circulating hCG levels

A

GnRH administration

148
Q

Inhibits GnRH & hCG production

A

Inhibin

149
Q

Stimulates GnRH & hCG production

A

Activin

150
Q

Promote uterine vascular dilatation and myometrial smooth-muscle relaxation

A

hCG

151
Q

Ectopic pregnancy & early pregnancy wastage

A

Low HCG

152
Q

Multifetal pregnancy, erythroblastosis fetalis, gestational trophoblastic dse & levels of this are seen in midtrimester with fetus with down syndrome

A

High HCG

153
Q

Has a potent lactogenic growth hormone like bioactivity and immunochemical resemblance to human growth hormone. Concentrated in syncytiotrophoblast. Detected in the 2nd or 3rd week after fertilization.

A

HPL

154
Q

Promotes maternal lipolysis with increased circulating free fatty acid levels. Inhibits leptin secretion, favors protein synthesis and provides a readily available AA source of the fetus.

A

HPL

OB GYN (5 decks)

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