Nichols OB 2

Question 1

Pre-eclampsia is

Answer 1

a complication of pregnancy involving a systemic syndrome of maternal endothelial dysfunction causing:

• HTN
• Proteinuria
• Edema

Question 2

What are some risk factors for pre-eclampsia

Answer 2

First pregnancy
Obesity
Age less than 20 or over 40
DM
Multiple pregnancies
HTN
long intervals between pregnancy

Question 3

BOOM…SO, normally, spiral artery remodelling occurs when the Extra-villous trophoblast cells invade the myometrial spiral arteries going to the placenta and destroy the smooth muscle in their walls thus changing them from small caliber low flow arteries to Low resistance high flow arteries.

Answer 3

Pre-eclamptic trophoblasts fail to convert spiral arteries

Question 4

How does pre-eclampsia form?

Answer 4

The ischemic placenta releases anti-angiogenic substances:

1) sFlt-1, a truncated form of VEGF receptor that acts as a decoy
2) soluble endoglin, a for of TGF-beta receptor that acts as a decoy

This blocks TGF and VEGF mediated production of nitric oxide and prostacyclin, causing maternal hypertension, proteinuria, and edema

Question 5

Ischemic placenta also releases pro-inflammatory cytokines like tumor necrosis factor.

Answer 5

ok

Question 6

What is the truncated VEGF receptor?

Answer 6

sFlt-1….acts as a decoy so VEGF binds it and doesn’t work

Question 7

What is the truncated form of TGF-beta receptor?

Answer 7

endoglin…acts as a decoy so that TGF-Beta doesnt bind

BOTH OF these decoys block the VEGF and TGF mediated production of prostacyclin and nitric oxide which would normally result in vasodilation. Instead you get hypertension, proteinuria and edema due to the HTN

Question 8

Blockage of prostacyclin production makes Pre-eclampsia what kind of state?

Answer 8

Pro-coagulant

Question 9

Pre-eclampsia leads to what in the fetus?

Answer 9

IUGR

Question 10

Pre-eclampsia leads to what in the mother

Answer 10

Hypertension, DIC (disseminated intravascular coagulation (due to low prostacyclin levels), HELLP, and eclampsia

Question 11

What is HELLP

Answer 11

Hemolysis, liver enzymes high, low platelets

HeLLp

Question 12

Visible changes in placental arteries during pre-eclampsia resemble what non-pregnancy related condition

Answer 12

atherosclerosis

Question 13

Dx of pre-eclampsia is warranted when?

Answer 13

New onset of HTN and proteinuria after 20 weeks gestation…KNOW

Question 14

What question do you ask first when managing pre-eclampsia

Answer 14

Need to know how severe it is

Question 15

If it is mild, tx includes

Answer 15

administration of corticosteroids to accelerate fetal lung development

Question 16

If severe?

Answer 16

DELIVER THE KID

Question 17

HeLLp

Answer 17

Hemolysis, Liver enzymes high, Low platelets

Question 18

What the fuck is HeLLp

Answer 18

Well, we know that pre-eclampsia is a pro-coagulant state… In this state, clotting factors and plateletts are activated into fibrin clots which shred red cells causing hemolysis. The widespread clotting causes low platelett count, and thrombi in the liver injure hepatocytes (liver cells) which then release their enzymes

Question 19

Most common causes of Placental ischemia and necrosis?

Answer 19

1) Pre-eclampsia is the overwhelming favorite
2) Hypercoagulable states
3) Autoimmune vasculitis
4) Smoking

Question 20

Fetus can tolerate what level of placental infarction?

Answer 20

50%

Question 21

Heavy drinking during pregnancy disrupts proper brain development in children and adolescents

Answer 21

Children with heavy alcohol exposure have reduced brain plasticity

Question 22

Hydatidiform mole on pathology?

Answer 22

edematous grape-like chorionic villi

Question 23

Choriocarcinoma spreads how

Answer 23

hematogenously

Question 24

If choriocarcinoma spreads hematogenously, where does it go first?

Answer 24

LUNGS

Question 25

First symptoms of choriocarcinoma?

Answer 25

Uterine bleeding

Question 26

Treatment of choriocarcinoma

Answer 26

hysterectomy and chemo

Question 27

What the hell does oligohydraminoas mean?

Answer 27

deficiency of amniotic fluid

Question 28

What happens when there is too little amniotic fluid?

Answer 28

Basically there is no padding between the fetus and pressure coming from outside the placenta. Causes compressive injuries to the fetus BUT also causes pulmonary hypoplasia because the fetus needs to “breathe” for fetal lung development and absence of fetal urine in amniotic fluid due to fetal renal disease causes lack of lung development

Question 29

Potter facies

Answer 29

flat face due to oligohydraminos

Question 30

clubfeet and contractures of hands and feet due to

Answer 30

oligohydramnios

Question 31

umbillical cord knots occur in what percent of pregnancies?

Answer 31

1%

Question 32

What is placental abruption?

Answer 32

Bleeding at the decidual-placental interface which causes detachment before delivery of the fetus

Question 33

Risk of Pulmonary thromboembolism is increased up to 50 fold during pregnancy

Answer 33

Risk is greatest during delivery and after

Question 34

Amniotic fluid embolism

Answer 34

life threatening obstetric emergency due to acute cardiopulmonary failure from pulmonary vasospasm, hypertension, and right heart failure triggering pulmonary diffuse alvolar damage

Question 35

What causes amniotic fluid embolism

Answer 35

Thought to be due to fetal and amniotic elements entering maternal veins as decidua detaches. Embolizes to the lungs where they react with vasospasm

Question 36

Five leading causes of maternal death

Answer 36

thromboembolism, hemorrhage, pre-eclampsia, infection, cardiomyopathy