Nichols OB 2 Flashcards
Pre-eclampsia is
a complication of pregnancy involving a systemic syndrome of maternal endothelial dysfunction causing:
- HTN
- Proteinuria
- Edema
What are some risk factors for pre-eclampsia
First pregnancy Obesity Age less than 20 or over 40 DM Multiple pregnancies HTN long intervals between pregnancy
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.
Pre-eclamptic trophoblasts fail to convert spiral arteries
How does pre-eclampsia form?
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
Ischemic placenta also releases pro-inflammatory cytokines like tumor necrosis factor.
ok
What is the truncated VEGF receptor?
sFlt-1….acts as a decoy so VEGF binds it and doesn’t work
What is the truncated form of TGF-beta receptor?
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
Blockage of prostacyclin production makes Pre-eclampsia what kind of state?
Pro-coagulant
Pre-eclampsia leads to what in the fetus?
IUGR
Pre-eclampsia leads to what in the mother
Hypertension, DIC (disseminated intravascular coagulation (due to low prostacyclin levels), HELLP, and eclampsia
What is HELLP
Hemolysis, liver enzymes high, low platelets
HeLLp
Visible changes in placental arteries during pre-eclampsia resemble what non-pregnancy related condition
atherosclerosis
Dx of pre-eclampsia is warranted when?
New onset of HTN and proteinuria after 20 weeks gestation…KNOW
What question do you ask first when managing pre-eclampsia
Need to know how severe it is
If it is mild, tx includes
administration of corticosteroids to accelerate fetal lung development
If severe?
DELIVER THE KID
HeLLp
Hemolysis, Liver enzymes high, Low platelets
What the fuck is HeLLp
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
Most common causes of Placental ischemia and necrosis?
1) Pre-eclampsia is the overwhelming favorite
2) Hypercoagulable states
3) Autoimmune vasculitis
4) Smoking
Fetus can tolerate what level of placental infarction?
50%
Heavy drinking during pregnancy disrupts proper brain development in children and adolescents
Children with heavy alcohol exposure have reduced brain plasticity
Hydatidiform mole on pathology?
edematous grape-like chorionic villi
Choriocarcinoma spreads how
hematogenously
If choriocarcinoma spreads hematogenously, where does it go first?
LUNGS
First symptoms of choriocarcinoma?
Uterine bleeding
Treatment of choriocarcinoma
hysterectomy and chemo
What the hell does oligohydraminoas mean?
deficiency of amniotic fluid
What happens when there is too little amniotic fluid?
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
Potter facies
flat face due to oligohydraminos
clubfeet and contractures of hands and feet due to
oligohydramnios
umbillical cord knots occur in what percent of pregnancies?
1%
What is placental abruption?
Bleeding at the decidual-placental interface which causes detachment before delivery of the fetus
Risk of Pulmonary thromboembolism is increased up to 50 fold during pregnancy
Risk is greatest during delivery and after
Amniotic fluid embolism
life threatening obstetric emergency due to acute cardiopulmonary failure from pulmonary vasospasm, hypertension, and right heart failure triggering pulmonary diffuse alvolar damage
What causes amniotic fluid embolism
Thought to be due to fetal and amniotic elements entering maternal veins as decidua detaches. Embolizes to the lungs where they react with vasospasm
Five leading causes of maternal death
thromboembolism, hemorrhage, pre-eclampsia, infection, cardiomyopathy
