OB Path Part 2: other shit that was already supposed to be covered Flashcards
Pre-eclampsia = a complication of pregnancy, a systemic syndrome of maternal endothelial dysfunction causing ...
HTN, proteinuria, edema
when does pre-eclampsia typically presnet
3rd trimester of pregnancy
Pre-eclamptic trophoblast fail to … , resulting in …
convert spiral arteries resulting in placental ischemia
what does ischemic placenta release (due to pre-eclmapsia)
ANTI-ANGIOGENIC FACTORS:
sFlt-1 (truncated VEGF)
endoglin (TGF-B receptor decoy)
PRO-INFLAM cytokines: TNFa
PRO-COAG: dec prostacylin (PGI2) production
pathophys of pre-eclampsia
uteroplacental malperfucion → placental ischemia → release of sFlt-1 and endoglin block VEFG and TGF mediated production of NO and prostacyclin → endothelial cell injury → ↓ renal blood flow, ↑TPR, ↑MAP, enhanced pressor response → HTN, proteinuria, edema
effect of pre-eclampsia on the fetus
IUGR → SGA
hypoxia
effect of pre-eclampsia on the mother
DIC
HELLP syndrome
eclampsia
renal, hepatic, cerebral dz
Pre-eclampsia and eclampsia are associated with visible changes in placental arteries very similar to …
atherosclerosis
HELLP syndrome =
Hemolysis, Elevated Liver enzymes and Low Platelets
histo changes of acute artherosis of uterine blood vessel in eclampsia
fibrinoid necrosis and subendothelial macrophages
The initial effect of ischemia on the development of chorionic villi is … , but when ischemia becomes more severe, it results in …
accelerated maturation that makes them more efficient at gas exchange, nutrient import and waste export
villous hypoplasia.
what can form in the intervillous space in pre-eclmapsia
fibrin clot → necrosis of villi
defn of pre-eclampsia
new onset HNT and proteinura after 20 weeks gestation
pathogensis of HELLP syndrome
activation of platelets and clotting factors, creating fibrin stings in capillaries that causes hemolysis, platelet aggregation, lowering the count, and thrombi in liver sinusoids that injure hepatocytes, who release their enzymes
severe complications of HELLP syndrome
liver rupture
hepato-renal failiure
pulm edema → ARDS
causes of placental ischemia and infarction
pre-eclampsia > hyper-coagulable states, autoimmune vasculitis, and smoking
the fetus can tolerate infarction of ___% of the placenta
50%
The findings suggest that children with heavy alcohol exposure have decreased …
brain plasticity
edematous grape-like chorionic villi
Hydatidiform Mole
Spreads hematogenously
(like a sarcoma), so to lungs first
Most common first symptom:
uterine bleeding
Treatment: hysterectomy and
chemotherapy
Prognosis: 70% survival if mets
choriocarcinoma
common sites of metastatic choriocarcinoma
lung, liver, spleen, kidney, brain
Deficiency of amniotic fluid
oligiohydramnios
consequences of oligiohydramnios to the fetus
pulmonary hypoplasia
**also due to detal renal disease (inability to make fetal “urine”/amniotic fluid
malformations seen in fetus with oligiohydramnios
strictures of hands and feet (more severe = clubfeet), potter facies (flattened face, nose, and ears)
mechanical fibrotic lesions causing limb strictures or amputations
amniotic bands
cause fetal demise, especially in the second trimester when fetal movement can pull on it
umbilical cord true knots
bleeding at the decidual-placental interface causing placental detachment before delivery of the fetus
placental abruption
the immediate cause of placental abruption is …
rupture of decidual blood vessels
when in pregnancy is pulmonary thromboembolism greater? why?
during and after delivery (due to release of IVC compression)
Life-threatening obstetric emergency due to acute cardio- pulmonary failure from pulmonary vasospasm, hypertension and right heart failure triggering pulmonary diffuse alveolar damage, sometimes with a second phase of DIC and
hemorrhage
amniotic fluid embolism
results in a retroplacental hematoma
placental abruption
pathogenesis of amniotic fluid embolism
detal amniotic elements entering maternal veins as decidual detached → embolizes to lungs → vasospasm → DAD/RT heart failure
Peripartum Cardiomyopathy defn
myocarditis that leads to dilated cardiomyopathy (without another identifiable cause) 3 mos before or after delivery
Magnesium sulfate toxicity (used to treat eclampsia) presnets as
acute onset dyspnea