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Repro > OB Path Part 1: Placentas, ectopic, abortions, chorioamnionitis > Flashcards

OB Path Part 1: Placentas, ectopic, abortions, chorioamnionitis Flashcards

1
Q

temporary organ connecting fetus and mother providing the equivalent of respiratory (and renal) services

A

placenta

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2
Q

menbranous sac surrounding fetus-containsing serous fluid essential for fetal development

A

amnion

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3
Q

plate-shaped tissue under part
of amniotic sac containing fetal blood
vessels

A

chorion

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4
Q

outer layer of blastocyst
(from fertilized ovum) that implants in
uterus and forms placenta

A

trophoblast

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5
Q

outer layer of placenta that
normally peels off myometrium and
sheds with placenta

A

decidua

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6
Q

Syncytiotrophoblast is a syncytium of cells forming outer covering of _____

A

chorionic villi

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7
Q

thin out their cytoplasm and let their clumped nuclei hang off villi in “syncytial knots” to ….

A

Syncytiotrophoblast to minimize diffusion barrier

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8
Q

First trimester chorionic villi is covered by

A

inner cytotrophoblast and

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9
Q

how is the third trimester chorionic villi different than the first trimester one?

A

more efficient: more blood vessels, less interstitium, and thinnertrophoblast covering

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10
Q

most common pathogenesis of ectopic preg

A

scarring from previous infection of tube

*other: adhesions from appendicitis, endometriosis, surgery

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11
Q

how long after last menses will an ectopic present with acute adn pain, hemorrhage, and the whole 9 yards

A

6 weeks

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12
Q

ectopic preg presents with the same sigs as ____

A

peritonitis

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13
Q

what is the def of a spontaneous abortion

A

preg loss before 20 weeks

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14
Q

___% of clinically recognized preg end in spontaneous abortion

A

15

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15
Q

most common cause of preg loss in:
1st trimester
2nd
3rd

A

1: genetic (half with chromosomal abnormalities)
2: infection (acute chorioamnionitis
3: vascular (i.e. uteroplacental insuff 2’ to pre-eclampsia)

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16
Q

recurrent stillbirth (>3) is assc with

A

hyper-coagulable states

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17
Q

what are the 3 the most common type of known etiology for sp abortion

A

immunologic (esp antiphospholipid syndrome)
anatomic
endocrinologic

**40% of sp ab have unknown etiology

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18
Q

implantation in lower uterus or cervix, sometimes covering internal cervical os

A

placenta previa

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19
Q

complications of placenta previa

A

severe bleeding = placenta rupture and maternal death

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20
Q

treatment for placenta previa

A

C/S

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21
Q

defective decidua can lead to

A

placenta accreta > increta > percreta

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22
Q

penetration of villous tissue into myometrium

A

placenta increta

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23
Q

penetration of villous tissue through entire uterine wall

A

placent percreta

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24
Q

Absence of the fibrinoid layer between the villi and decidua (Nitabuch’s layer) –> adherence of villous tissue directly to myometrium

A

placenta accreta

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25
Q

cause of persistant postpartum bleeding

A

placenta accreta, increta, and percreta

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26
Q

treatment for placenta accreta, increta, and percreta

A

hysterectomy, resection of uterus, or oversewing

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27
Q

Abnormal gestations due
to two sperm fertilizing one egg, or one or two sperm fertilizing an “empty egg” with absent
or nonfunctional DNA``

A

hydatidiform moles

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28
Q

what age group tends to have hydatidiform moles

A

< 20 and > 40 yo

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29
Q

complete vs partial hydatidiform moles

A

complete are diploid (empty ovum fertilized by 1 or 2 sperm)

partial are triploid: regular ovum fert by 2 sperm

30
Q

hydatidiform moles are said to resemble … due to …

A

grapes due to cystic swelling of chorionic villi

31
Q

how are hydatidiform moles diagnosed

A

abnormal ultrasound showing diffuse villous enlargement

abnormally elevated hCG

32
Q

treatment of hydatidiform moles

A

curretage – scaping out

the uterine contents

33
Q

types of twin placenta

A

di di = 2 chorions and 2 amnions (placenta may or may not be fused)

mono di = 1 chorion 2 amions (1 placenta)

mono mono = 1 chorion 1 amion (1 placenta)

34
Q

most common type of twin placentas

A

di di

35
Q

trophoblast hyperplasia

A

hydatidiform moles

36
Q

80% o twins with di di placentas are ___zygotic

A

dizygotic

37
Q

all twins that are monochorionic are ___ zygotic

A

monozygotic

38
Q

what is twin-twin transfusion syndrome? in what type of placenta does it occur?

A

unbalanced anatomoses in monochorionic placenta can cause 1 twin to get too much blood and the other too little

39
Q

how is the life of the mother threatened with twin-twin transfusion syndrome?

A

when the deprived twin dies it can send necrotic and pro-coagulant material into the blood stream/anastomoses
**Also THREATENS the life of the OTHER TWIN

40
Q

grossly how does a placenta look in win-twin transfusion syndrome?

A

one umbilical cord is engourged with blood and the other is thin and white

41
Q

bugs that cause acute chorioamnionitis

A 
TORCH:
Toxoplama gondii
Other (syphillis, HIV)
Rubella
CMV
HSV
42
Q

acute chorioamnionitis is a (descending, or ascending) infection

A

acending (from vagina or cervix)

43
Q

causes deafness, neurologic defects, cardiac malformations, etc. in neonates

A

Rubella

44
Q

causes deafness, neurologic defects in neonates

**no cardiac malformations

A

CMV

45
Q

protozoan from cat feces

A

Toxoplama gondii

46
Q

neonate actually contracts intrapartum-ly

A

HSV

47
Q

most common transplacental infection

A

CMV

48
Q

causes microcephaly, fever, rash, seizures in neonates

A

Toxoplama gondii

49
Q

acute chorioamnionitis that is preventable with C section

A

HSV

50
Q

Stages/pathophys of acute chorioamnionitis

A

maternal polys in intervillous space → chorion → amnion → Fetal polys in chorionic blood → fetal vasculitis → thrombus formation

51
Q

Exudate and congestion of cord =

A

funistis

*assc with acute chorioamnionitis

52
Q

fetal complications of acute chorio

A
  • fetal vasculitis, thrombosis → fetal demise if the thrombus occludes the umbilical cord
  • sepsis
  • cerebral palsy
53
Q

what can happen to the amniotic epithelium in acute chorio

A

it gets sloughed off (occlusion → necrosis)

54
Q

green discoloration of placenta

A

acute chorioamnionitis

55
Q

what can acute chorio cause … other than thrombosis and fetal demise

A

PROM and premature labor and delivery

fetal sepsis, cerebral palsy, endometritis

56
Q

what induces premature labor and delivery with acute chorio

A

inflam cytokines

57
Q

the inflam response in acute chorio is due mainly to (maternal or fetal) neutrophils

A

maternal

58
Q

presentation of acute chorio

A

fever, tachycardia (maternal and fetal)
uterine tenderness
foul smelling amniotic fluid
leukocytosis

59
Q

treatment of acute chorio

A

abx and delivery

60
Q

Diff diagnosis of acute abdomen (pain?) is women of childbearing age

A 
ruptured ectopic preg
ovaria torsion
appendicitis 
volvulus
diverticulitis
61
Q

5 most common causes of acute abdomen SURGICAL EMERGENCIES in women of child bearing age

A
  1. ruptured ectopic
  2. Corpus leutum rupture and hrmorrhage
  3. PID
  4. appendicitis
  5. ovaria torsion
62
Q

(pregancy or labor) causes a physiologic leukocytosis

A

both
preg up to 14k
labor up to 30k

63
Q

Present with abdominal pain, often for morethan a day, constipation or diarrhea, nausea + vomiting, diarrhea, with abdominal tenderness and leukocytosis

A

diverticulitis

64
Q

Present with intermittent cramping lower
abdominal pain, progressive abdominal
distension, passing no stool or flatus, with
marked abdominal distension and tympany

A

volvus

65
Q

Present with periumbilical abdominal pain that
migrates to right lower quadrant, anorexia,
nausea, vomiting, followed by fever, with
tenderness at McBurney’s point halfway
between umbilicus and anterior superior
iliac spine, rebound tenderness if perforated

A

appendicitis

66
Q

Present with acute onset of moderate-severe

pelvic pain, often with nausea and vomiting + ovarian cyst

A

Corpus leutum rupture and hrmorrhage

67
Q

Twisting on its ligamentous support, cutting off
venous outflow and then arterial inflow,
causing ischemia and then infarction

A

ovarian torsion

68
Q

difference between diverticulitis and volvulus

A

voluvulus is the twisting of colonic segemtn on its mesentery (causes obst, dilation, ischemia).

diverticulitis is the inflam of transmural out pouching of colonic mucosa due to perforation +/- abscess

69
Q

what part of the intestine is involved in voluvulus?

A

cecal in pts between 25 and 35

*sigmoid in elderly men

70
Q

due to overgrowth of normal flora trapped by occluding fecalith

A

appendicitis

71
Q

in what trimester is an ovarian torsion most likely to present?

A

1st

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