OB Path Part 1: Placentas, ectopic, abortions, chorioamnionitis Flashcards
temporary organ connecting fetus and mother providing the equivalent of respiratory (and renal) services
placenta
menbranous sac surrounding fetus-containsing serous fluid essential for fetal development
amnion
plate-shaped tissue under part
of amniotic sac containing fetal blood
vessels
chorion
outer layer of blastocyst
(from fertilized ovum) that implants in
uterus and forms placenta
trophoblast
outer layer of placenta that
normally peels off myometrium and
sheds with placenta
decidua
Syncytiotrophoblast is a syncytium of cells forming outer covering of _____
chorionic villi
thin out their cytoplasm and let their clumped nuclei hang off villi in “syncytial knots” to ….
Syncytiotrophoblast to minimize diffusion barrier
First trimester chorionic villi is covered by
inner cytotrophoblast and
how is the third trimester chorionic villi different than the first trimester one?
more efficient: more blood vessels, less interstitium, and thinnertrophoblast covering
most common pathogenesis of ectopic preg
scarring from previous infection of tube
*other: adhesions from appendicitis, endometriosis, surgery
how long after last menses will an ectopic present with acute adn pain, hemorrhage, and the whole 9 yards
6 weeks
ectopic preg presents with the same sigs as ____
peritonitis
what is the def of a spontaneous abortion
preg loss before 20 weeks
___% of clinically recognized preg end in spontaneous abortion
15
most common cause of preg loss in:
1st trimester
2nd
3rd
1: genetic (half with chromosomal abnormalities)
2: infection (acute chorioamnionitis
3: vascular (i.e. uteroplacental insuff 2’ to pre-eclampsia)
recurrent stillbirth (>3) is assc with
hyper-coagulable states
what are the 3 the most common type of known etiology for sp abortion
immunologic (esp antiphospholipid syndrome)
anatomic
endocrinologic
**40% of sp ab have unknown etiology
implantation in lower uterus or cervix, sometimes covering internal cervical os
placenta previa
complications of placenta previa
severe bleeding = placenta rupture and maternal death
treatment for placenta previa
C/S
defective decidua can lead to
placenta accreta > increta > percreta
penetration of villous tissue into myometrium
placenta increta
penetration of villous tissue through entire uterine wall
placent percreta
Absence of the fibrinoid layer between the villi and decidua (Nitabuch’s layer) –> adherence of villous tissue directly to myometrium
placenta accreta
cause of persistant postpartum bleeding
placenta accreta, increta, and percreta
treatment for placenta accreta, increta, and percreta
hysterectomy, resection of uterus, or oversewing
Abnormal gestations due
to two sperm fertilizing one egg, or one or two sperm fertilizing an “empty egg” with absent
or nonfunctional DNA``
hydatidiform moles
what age group tends to have hydatidiform moles
< 20 and > 40 yo
complete vs partial hydatidiform moles
complete are diploid (empty ovum fertilized by 1 or 2 sperm)
partial are triploid: regular ovum fert by 2 sperm
hydatidiform moles are said to resemble … due to …
grapes due to cystic swelling of chorionic villi
how are hydatidiform moles diagnosed
abnormal ultrasound showing diffuse villous enlargement
abnormally elevated hCG
treatment of hydatidiform moles
curretage – scaping out
the uterine contents
types of twin placenta
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)
most common type of twin placentas
di di
trophoblast hyperplasia
hydatidiform moles
80% o twins with di di placentas are ___zygotic
dizygotic
all twins that are monochorionic are ___ zygotic
monozygotic
what is twin-twin transfusion syndrome? in what type of placenta does it occur?
unbalanced anatomoses in monochorionic placenta can cause 1 twin to get too much blood and the other too little
how is the life of the mother threatened with twin-twin transfusion syndrome?
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
grossly how does a placenta look in win-twin transfusion syndrome?
one umbilical cord is engourged with blood and the other is thin and white
bugs that cause acute chorioamnionitis
TORCH: Toxoplama gondii Other (syphillis, HIV) Rubella CMV HSV
acute chorioamnionitis is a (descending, or ascending) infection
acending (from vagina or cervix)
causes deafness, neurologic defects, cardiac malformations, etc. in neonates
Rubella
causes deafness, neurologic defects in neonates
**no cardiac malformations
CMV
protozoan from cat feces
Toxoplama gondii
neonate actually contracts intrapartum-ly
HSV
most common transplacental infection
CMV
causes microcephaly, fever, rash, seizures in neonates
Toxoplama gondii
acute chorioamnionitis that is preventable with C section
HSV
Stages/pathophys of acute chorioamnionitis
maternal polys in intervillous space → chorion → amnion → Fetal polys in chorionic blood → fetal vasculitis → thrombus formation
Exudate and congestion of cord =
funistis
*assc with acute chorioamnionitis
fetal complications of acute chorio
- fetal vasculitis, thrombosis → fetal demise if the thrombus occludes the umbilical cord
- sepsis
- cerebral palsy
what can happen to the amniotic epithelium in acute chorio
it gets sloughed off (occlusion → necrosis)
green discoloration of placenta
acute chorioamnionitis
what can acute chorio cause … other than thrombosis and fetal demise
PROM and premature labor and delivery
fetal sepsis, cerebral palsy, endometritis
what induces premature labor and delivery with acute chorio
inflam cytokines
the inflam response in acute chorio is due mainly to (maternal or fetal) neutrophils
maternal
presentation of acute chorio
fever, tachycardia (maternal and fetal)
uterine tenderness
foul smelling amniotic fluid
leukocytosis
treatment of acute chorio
abx and delivery
Diff diagnosis of acute abdomen (pain?) is women of childbearing age
ruptured ectopic preg ovaria torsion appendicitis volvulus diverticulitis
5 most common causes of acute abdomen SURGICAL EMERGENCIES in women of child bearing age
- ruptured ectopic
- Corpus leutum rupture and hrmorrhage
- PID
- appendicitis
- ovaria torsion
(pregancy or labor) causes a physiologic leukocytosis
both
preg up to 14k
labor up to 30k
Present with abdominal pain, often for morethan a day, constipation or diarrhea, nausea + vomiting, diarrhea, with abdominal tenderness and leukocytosis
diverticulitis
Present with intermittent cramping lower
abdominal pain, progressive abdominal
distension, passing no stool or flatus, with
marked abdominal distension and tympany
volvus
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
appendicitis
Present with acute onset of moderate-severe
pelvic pain, often with nausea and vomiting + ovarian cyst
Corpus leutum rupture and hrmorrhage
Twisting on its ligamentous support, cutting off
venous outflow and then arterial inflow,
causing ischemia and then infarction
ovarian torsion
difference between diverticulitis and volvulus
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
what part of the intestine is involved in voluvulus?
cecal in pts between 25 and 35
*sigmoid in elderly men
due to overgrowth of normal flora trapped by occluding fecalith
appendicitis
in what trimester is an ovarian torsion most likely to present?
1st
