OB Path Part 2: other shit that was already supposed to be covered

Question 1

Pre-eclampsia = a complication of
 pregnancy, a systemic syndrome of
 maternal endothelial dysfunction
 causing
...

Answer 1

HTN, proteinuria, edema

Question 2

when does pre-eclampsia typically presnet

Answer 2

3rd trimester of pregnancy

Question 3

Pre-eclamptic trophoblast fail to … , resulting in …

Answer 3

convert spiral arteries resulting in placental ischemia

Question 4

what does ischemic placenta release (due to pre-eclmapsia)

Answer 4

ANTI-ANGIOGENIC FACTORS:
sFlt-1 (truncated VEGF)
endoglin (TGF-B receptor decoy)

PRO-INFLAM cytokines: TNFa

PRO-COAG: dec prostacylin (PGI2) production

Question 5

pathophys of pre-eclampsia

Answer 5

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

Question 6

effect of pre-eclampsia on the fetus

Answer 6

IUGR → SGA

hypoxia

Question 7

effect of pre-eclampsia on the mother

Answer 7

DIC
HELLP syndrome
eclampsia
renal, hepatic, cerebral dz

Question 8

Pre-eclampsia and eclampsia are associated with visible changes in placental arteries very similar to …

Answer 8

atherosclerosis

Question 9

HELLP syndrome =

Answer 9

Hemolysis, Elevated Liver enzymes and Low Platelets

Question 10

histo changes of acute artherosis of uterine blood vessel in eclampsia

Answer 10

fibrinoid necrosis and subendothelial macrophages

Question 11

The initial effect of ischemia on the development of chorionic villi is … , but when ischemia becomes more severe, it results in …

Answer 11

accelerated maturation that makes them more efficient at gas exchange, nutrient import and waste export

villous hypoplasia.

Question 12

what can form in the intervillous space in pre-eclmapsia

Answer 12

fibrin clot → necrosis of villi

Question 13

defn of pre-eclampsia

Answer 13

new onset HNT and proteinura after 20 weeks gestation

Question 14

pathogensis of HELLP syndrome

Answer 14

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

Question 15

severe complications of HELLP syndrome

Answer 15

liver rupture
hepato-renal failiure
pulm edema → ARDS

Question 16

causes of placental ischemia and infarction

Answer 16

pre-eclampsia > hyper-coagulable states, autoimmune vasculitis, and smoking

Question 17

the fetus can tolerate infarction of ___% of the placenta

Answer 17

50%

Question 18

The findings suggest that children with heavy alcohol exposure have decreased …

Answer 18

brain plasticity

Question 19

edematous grape-like chorionic villi

Answer 19

Hydatidiform Mole

Question 20

Spreads hematogenously
(like a sarcoma), so to lungs first

Most common first symptom:
uterine bleeding

Treatment: hysterectomy and
chemotherapy

Prognosis: 70% survival if mets

Answer 20

choriocarcinoma

Question 21

common sites of metastatic choriocarcinoma

Answer 21

lung, liver, spleen, kidney, brain

Question 22

Deficiency of amniotic fluid

Answer 22

oligiohydramnios

Question 23

consequences of oligiohydramnios to the fetus

Answer 23

pulmonary hypoplasia

**also due to detal renal disease (inability to make fetal “urine”/amniotic fluid

Question 24

malformations seen in fetus with oligiohydramnios

Answer 24

strictures of hands and feet (more severe = clubfeet), potter facies (flattened face, nose, and ears)

Question 25

mechanical fibrotic lesions causing limb strictures or amputations

Answer 25

amniotic bands

Question 26

cause fetal demise, especially in the second trimester when fetal movement can pull on it

Answer 26

umbilical cord true knots

Question 27

bleeding at the decidual-placental interface causing placental detachment before delivery of the fetus

Answer 27

placental abruption

Question 28

the immediate cause of placental abruption is ...

Answer 28

rupture of decidual blood vessels

Question 29

when in pregnancy is pulmonary thromboembolism greater? why?

Answer 29

during and after delivery (due to release of IVC compression)

Question 30

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

Answer 30

amniotic fluid embolism

Question 31

results in a retroplacental hematoma

Answer 31

placental abruption

Question 32

pathogenesis of amniotic fluid embolism

Answer 32

detal amniotic elements entering maternal veins as decidual detached → embolizes to lungs → vasospasm → DAD/RT heart failure

Question 33

Peripartum Cardiomyopathy defn

Answer 33

myocarditis that leads to dilated cardiomyopathy (without another identifiable cause) 3 mos before or after delivery

Question 34

Magnesium sulfate toxicity (used to treat eclampsia) presnets as

Answer 34

acute onset dyspnea