multiple gestations

Question 1

dizygotic?

Answer 1

fraternal, due to fertilization of 2 ova by 2 diff sperm cells

Question 2

monozygotic

Answer 2

identical, formed from the fertilization of 1 ovume: increased risk of fetal transfusion syndrome and discordant fetal growh

Question 3

is this considered high risk?

Answer 3

heck yes

Question 4

what are some maternal complications of multiple gestations?

Answer 4

preterm labor, spontaneous abortion, anemia

Question 5

what are fetal complciations of multiple gestations?

Answer 5

IUGR, placental abnormalities, breech, umbili al cord prolapse, preeclampsia

Question 6

what is gestational trophoblastic dz?

Answer 6

wide array of disorcders associated with abnormal placental trophoblastic tissue

Question 7

what are the 4 types of gestational trophoblastic dz?

Answer 7

molar prego
invasive mole
choriocarcinoma
placental site throphoblastic tumor

Question 8

what is a hydatidiform mole?

Answer 8

neoplasm du to abnormal placental development w/ trophoblastic tissue proliferation arisitn from gestational tissue__> not maternal in origin, MC type, benign

Question 9

what is a complete molar pregnancy?

Answer 9

egg with no DNA fertilized by 1 or 2 sperm–> 46 XX –> all paternal chromosomes–> associated with higher risk of malignant development into choriocarcinoma

Question 10

what is a partial molar pregnancy?

Answer 10

when an egg is fertilized by 2 sperm or 1 sperm that duplicates its chromosomes, there may be development of a fetus, but it is always malformed and never viable

Question 11

what is the PP of molar prego?

Answer 11

abnormal prego in which a nonviable ferilzied egg implants in the uterus w/ a non viable prego which will fail to come to term = abnormal placental development

Question 12

what are s/sx of a molar prego?

Answer 12

• painless vag bleeding
• uterine size/date discrepancies (larger than expected)
• preeclampsia before 20 wsk
• hyperemesis gravidarum (occurs earlier than usual)
• choriocarcinoma

Question 13

where does choriocarcinoma mets too?

Answer 13

lungs! (MC)

lower genital tract (purple black nodules), pelvic mass

Question 14

what are the 2 most common rf for a molar prego?

Answer 14

prior molar prego, extremes of maternal age (<20, > 35, asain

Question 15

how is molar prego dx?

Answer 15

BHCB > 1,000,000

very low maternal AFP

Question 16

what will an US show in a molar prego?

Answer 16

snowstorm or cluster of grapes appearance, absence of fetal parts and heart sounds (complete)

may see gestational sac in partial

Question 17

what are the cluster of grapes?

Answer 17

enlarged cystic chorionic villi

Question 18

how is a molar prego mananged?

Answer 18

surgery: suction curettage! asap to avoid risk of choriocarcinoma development

• pts followed weekly until bhcg levels fall to an undetectable level
• hysterectomy is also an option

Question 19

what should be avoid after a molar prego?

Answer 19

pregnancy for 1 yr

Question 20

how to you treat choriocarciinoma?

Answer 20

chemo, methotrexate

Question 21

when do you suspect choriocarcinoma?

Answer 21

if B hcg rises or plateaus after tx, continued hemorrhage after tx, or vaginal tumor/ pelvic mass