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

Question 1

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

Answer 1

placenta

Question 2

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

Answer 2

amnion

Question 3

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

Answer 3

chorion

Question 4

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

Answer 4

trophoblast

Question 5

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

Answer 5

decidua

Question 6

Syncytiotrophoblast is a syncytium of cells forming outer covering of _____

Answer 6

chorionic villi

Question 7

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

Answer 7

Syncytiotrophoblast to minimize diffusion barrier

Question 8

First trimester chorionic villi is covered by

Answer 8

inner cytotrophoblast and

Question 9

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

Answer 9

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

Question 10

most common pathogenesis of ectopic preg

Answer 10

scarring from previous infection of tube

*other: adhesions from appendicitis, endometriosis, surgery

Question 11

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

Answer 11

6 weeks

Question 12

ectopic preg presents with the same sigs as ____

Answer 12

peritonitis

Question 13

what is the def of a spontaneous abortion

Answer 13

preg loss before 20 weeks

Question 14

___% of clinically recognized preg end in spontaneous abortion

Answer 14

15

Question 15

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

Answer 15

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

Question 16

recurrent stillbirth (>3) is assc with

Answer 16

hyper-coagulable states

Question 17

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

Answer 17

immunologic (esp antiphospholipid syndrome)
anatomic
endocrinologic

**40% of sp ab have unknown etiology

Question 18

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

Answer 18

placenta previa

Question 19

complications of placenta previa

Answer 19

severe bleeding = placenta rupture and maternal death

Question 20

treatment for placenta previa

Answer 20

C/S

Question 21

defective decidua can lead to

Answer 21

placenta accreta > increta > percreta

Question 22

penetration of villous tissue into myometrium

Answer 22

placenta increta

Question 23

penetration of villous tissue through entire uterine wall

Answer 23

placent percreta

Question 24

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

Answer 24

placenta accreta

Question 25

cause of persistant postpartum bleeding

Answer 25

placenta accreta, increta, and percreta

Question 26

treatment for placenta accreta, increta, and percreta

Answer 26

hysterectomy, resection of uterus, or oversewing

Question 27

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

Answer 27

hydatidiform moles

Question 28

what age group tends to have hydatidiform moles

Answer 28

< 20 and > 40 yo

Question 29

complete vs partial hydatidiform moles

Answer 29

complete are diploid (empty ovum fertilized by 1 or 2 sperm) partial are triploid: regular ovum fert by 2 sperm

Question 30

hydatidiform moles are said to resemble ... due to ...

Answer 30

grapes due to cystic swelling of chorionic villi

Question 31

how are hydatidiform moles diagnosed

Answer 31

abnormal ultrasound showing diffuse villous enlargement abnormally elevated hCG

Question 32

treatment of hydatidiform moles

Answer 32

curretage -- scaping out | the uterine contents

Question 33

types of twin placenta

Answer 33

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)

Question 34

most common type of twin placentas

Answer 34

di di

Question 35

trophoblast hyperplasia

Answer 35

hydatidiform moles

Question 36

80% o twins with di di placentas are ___zygotic

Answer 36

dizygotic

Question 37

all twins that are monochorionic are ___ zygotic

Answer 37

monozygotic

Question 38

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

Answer 38

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

Question 39

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

Answer 39

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

Question 40

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

Answer 40

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

Question 41

bugs that cause acute chorioamnionitis

Answer 41

``` TORCH: Toxoplama gondii Other (syphillis, HIV) Rubella CMV HSV ```

Question 42

acute chorioamnionitis is a (descending, or ascending) infection

Answer 42

acending (from vagina or cervix)

Question 43

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

Answer 43

Rubella

Question 44

causes deafness, neurologic defects in neonates | **no cardiac malformations

Answer 44

CMV

Question 45

protozoan from cat feces

Answer 45

Toxoplama gondii

Question 46

neonate actually contracts intrapartum-ly

Answer 46

HSV

Question 47

most common transplacental infection

Answer 47

CMV

Question 48

causes microcephaly, fever, rash, seizures in neonates

Answer 48

Toxoplama gondii

Question 49

acute chorioamnionitis that is preventable with C section

Answer 49

HSV

Question 50

Stages/pathophys of acute chorioamnionitis

Answer 50

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

Question 51

Exudate and congestion of cord =

Answer 51

funistis | *assc with acute chorioamnionitis

Question 52

fetal complications of acute chorio

Answer 52

- fetal vasculitis, thrombosis → fetal demise if the thrombus occludes the umbilical cord - sepsis - cerebral palsy

Question 53

what can happen to the amniotic epithelium in acute chorio

Answer 53

it gets sloughed off (occlusion → necrosis)

Question 54

green discoloration of placenta

Answer 54

acute chorioamnionitis

Question 55

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

Answer 55

PROM and premature labor and delivery | fetal sepsis, cerebral palsy, endometritis

Question 56

what induces premature labor and delivery with acute chorio

Answer 56

inflam cytokines

Question 57

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

Answer 57

maternal

Question 58

presentation of acute chorio

Answer 58

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

Question 59

treatment of acute chorio

Answer 59

abx and delivery

Question 60

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

Answer 60

``` ruptured ectopic preg ovaria torsion appendicitis volvulus diverticulitis ```

Question 61

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

Answer 61

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

Question 62

(pregancy or labor) causes a physiologic leukocytosis

Answer 62

both preg up to 14k labor up to 30k

Question 63

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

Answer 63

diverticulitis

Question 64

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

Answer 64

volvus

Question 65

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

Answer 65

appendicitis

Question 66

Present with acute onset of moderate-severe | pelvic pain, often with nausea and vomiting + ovarian cyst

Answer 66

Corpus leutum rupture and hrmorrhage

Question 67

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

Answer 67

ovarian torsion

Question 68

difference between diverticulitis and volvulus

Answer 68

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

Question 69

what part of the intestine is involved in voluvulus?

Answer 69

cecal in pts between 25 and 35 | *sigmoid in elderly men

Question 70

due to overgrowth of normal flora trapped by occluding fecalith

Answer 70

appendicitis

Question 71

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

Answer 71

1st