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Repro > Obstretic Pathology 1 > Flashcards

Obstretic Pathology 1 Flashcards

1
Q

_____ is a temporary organ connecting
fetus and mother providing
the equivalent of respiratory
(and renal) services.

A

Placenta

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2
Q

_____ is a membranous sac surrounding
fetus containing serous fluid essential
for fetal development

A

Amnion

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3
Q

_____ is a plate-shaped tissue under part
of amniotic sac containing fetal blood
vessels that branch into villi projecting
into space filled with maternal blood

A

chorion

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4
Q

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

A

trophoblast

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5
Q

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

A

Decidua

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6
Q 
\_\_\_\_\_\_ are syncytium of
 cells forming outer covering of 
 chorionic villi, which thin out their
 cytoplasm and let their clumped
 nuclei hang off villi in “syncytial
 knots” to minimize diffusion barrier
A

syncytiotrophoblast

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7
Q

In the first trimester, what is the chorionic villi covered by?

A

Double layer of inner and outer cytotrophoblast

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8
Q

In the 3rd trimester, what happens to the covering of chorionic villi?

A

more blood vessels, less interstitium, thinner trophoblast covering

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9
Q

How often to ectopic pregnancies occur and where?

A

1 in ever 150; 90% within fallopian tube

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10
Q

Pathogenesis of ectopic pregnancy

A

up to 50% from scarring from previous infection of tube. Other causes are adhesion from appendicitis, endometriosis, or surgery

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11
Q

What is the most common presentation of ectopic pregnancy?

A

acute severe abdominal pain due to fallopian
tube rupture and pelvic hemorrhage,
about 6 weeks after last menses
Can lead to hemorrhagic shock, death

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12
Q

How is a diagnosis of ectopic pregnancy made?

A

history, physical (signs of peritonitis), ultrasound, pregnancy test

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13
Q

What is the treatment and prognosis of ectopic pregnancy?

A

Surgery- good with prompt treatment

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14
Q

Define spontaneous abortion.

A

pregnancy loss before 20 weeks

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15
Q

How often do spontaneous abortions occur?

A 
up to 15% of clinically
 recognized pregnancies, but sensitive
 gonadotropin assays show that 22%
 more of pregnancies abort
 spontaneously, most in first trimester
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16
Q

How does rate of spontaneous abortion occur with aging?

A

Rate increases from
11% in pregnancies of 20-24 year-olds
to 51% in 40-44 year-olds

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17
Q

What is the most common cause of pregnancy loss in first trimester?

A

Genetic: half with chromosomal abnormalities

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18
Q

What is the most common cause of pregnancy loss in second trimester?

A

infectious: acute chorioamnionitis

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19
Q

What is the most common cause of pregnancy loss in third trimester?

A

Vascular- uteroplacental insufficiency, commonly associated with pre-eclampsia

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20
Q

6 causes of recurrent spontaneous abortion?

A

Immunologic (especially APLS) 25%, Anatomic 22%;Endocrinologic 20%;Microbiologic 6%; Genetic 3%;Unknown 40%

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21
Q

Recurrent stillbirth is associated with ______ states.

A

Hypercoagulable

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22
Q

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

A

Placenta previa

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23
Q

What does placenta previa result in?

A

severe bleeding, may result in placental rupture, massive bleeding and maternal death

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24
Q

How do you treat and diagnose placenta previa?

A

ultrasound; c-section

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25
Q

What is placenta accreta?

A

defective decidua, with adherence of villous tissue to myometrium

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26
Q

What is placenta increta?

A

defective decidua, with penetration of villous tissue into myometrium

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27
Q

What is placenta percreta?

A

defective decidua, with penetration of villous tissue through entire uterine wall

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28
Q

Which is more common and least common - p accreta, increta, percreta? What can they cause and how are they treated?

A

80%;15%;5%

Persistent postpartum bleeding, hysterectomy, or resection or oversewing

29
Q

What is a hydatidiform mole?

A

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

30
Q

How common are hydatidiform moles?

A 
Rare in US (1 in 1,000 pregnancies)
Less rare in east [esp. southeast] Asia
 (1 in 100 pregnancies in Indonesia)
Tend to occur in women <20 years old
 or over 40 years old
31
Q

Complete moles are _____. Partial moles are ____.

A

diploid; triploid

32
Q

Morphology of hydatidiform moles

A

cystic swelling of chorionic villia makes them resemble grapes. Trophoblast hyperplasia more prominent in complete moles- usually all the way around villi.

33
Q

How and When are hydatidiform moles diagnosed? How are they treated?

A 
Diagnosed at average of 8.5 weeks
 due to abnormal ultrasound showing
 diffuse villous enlargement and/or
 abnormally rapid and high elevation
 of beta human chorionic gonado-
 tropin (beta-HCG)
Treated with curretage (scaping out
 the uterine contents) and monitoring
 beta-HCG to make sure it is all out
34
Q

What are the 4 different types of twin placentas?

A 
Dichronic diamnionic (two separate everything)
Dichronic diamnionic fused (shared placenta)
Monochorionic diamnionic (shared chorion and placenta)
Monochorionic monoamnionic (shared placenta, amnion, chorion)
35
Q

69% of twins are _____. 80% of these placentas are _____.

A

dichronic diamnionic; dizygotic

36
Q

30% of twins are _____. All twins with this placenta are _____.

A

Monochorionic diamnionic. monozygotic

37
Q

What is twin-twin transfusion syndrome?

A

unbalanced vascular anastomoses in monochorionic placentas can cause one
twin to get too much blood and the other too little (mono mono)

38
Q

In twin-twin fusion syndrome, what can death of deprived donor twin cause?

A

necrotic procoagulant material into the
anastomoses threatening the life of the
other twin and then the mother.

39
Q

What are the hematogenous placental infections?

A 
T for Toxoplasma gondii
O for Other (syphilis, HIV, etc.)
R for Rubella (German measles)
C for Cytomegalovirus
H for Herpes simplex virus
40
Q

What placental infection ascends from vagina?

A

acute chorioamnionitis

41
Q

Where does T. gondii come from and what does it cause?

A

protozoan from cat feces, causes
microcephaly, fever, rash, seizures
in neonates

42
Q

What can rubella cause?

A

causes deafness, neurologic defects,

cardiac malformations, etc. in neonates

43
Q

Describe cytomegalovirus infection of placenta.

A

most common transplacental infection
in US, causes deafness, neurologic
defects in neonates

44
Q

Describe transplacental herpes infection

A

actually gotten intrapartum from maternal genital lesions, causes skin infection & worse
in neonates, preventable with C section

45
Q

How common is acute chorioamnionitis?

A

Common: 41% of women with premature
rupture of membranes at <27 weeks and
15% at 28-36 weeks

46
Q

What are stages of acute chorioamnionitis? Describe the inflammation

A 
maternal polys in intervillous
 space, then in chorion, then in amnion,
 then fetal polys in chorionic blood
 vessels (fetal vasculitis) where
 inflammation may lead to thrombosis
 because
		Inflammation is procoagulant
47
Q

What is funisitis?

A

exudate and congestion of cord

48
Q

What can be histologically with acute chorioamnionitis?

A

Polys infiltrating the chorion. Subchronic fibrin with entrapped villi.

49
Q

What happens histologically in acute chorioamionitis when infection has eaten through the basement membrane of the amnion?

A

A plug of granulation repair tissue is visible

50
Q

T or F. Acute chorioamnionitis can be complicated by fetal vasculitis, and thrombosis that can result in fetal demis if occluding the umbilical cord vessels.

A

T

51
Q

Histologically, what is seen with intra-amniotic infections?

A

Sloughing of the amniotic epithelium, thrombi

52
Q

Describe acute chorioamnionitis. (origin, type, inflammation)

A 
Infection ascends from vagina and cervix
Inflammatory response = mainly maternal
 neutrophils (so starts in intervillous space)
Infection is usually polymicrobial, with
 multiple vaginal flora bacteria
53
Q

What is acute chorioamnionitis syndrome?

A

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

54
Q

Diagnosis, treatment, and prognosis of acute chorioamnionitis

A

Diagnosis: clinical
Treatment: antibiotics and delivery
Prognosis: usually good, but can cause
fetal sepsis, cerebral palsy, endometritis

55
Q

What comlications can arise from acute chorioamnionitis?

A

Causes premature rupture of membranes
(acronym “PROM” [not a dance]) and

premature labor and delivery
(due to inflammatory cytokines)

56
Q

What 5 things should be included in acute abdomen in women of child bearing age

A

Ruptured Ectopic Pregnancy

Ovarian Torsion

Appendicitis

Volvulus

Diverticulitis

57
Q

5 most common causes acute abdomen surgical emergency

A
  1. ruptured ectopic pregnancy
  2. corpus luteum rupture & hemorrhage
  3. pelvic inflammatory disease
  4. appendicitis
  5. ovarian torsion
58
Q

What causes ovarian torsion?

A

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

59
Q

When is ovarian torsion most common?

A

Most common in women of childbearing age
with ovarian mass or pregnancy (more likely
in first trimester

60
Q

How does ovarian torsion present? treatment?

A

Present with acute onset of moderate-severe
pelvic pain, often with nausea and vomiting
Treatment: surgery

61
Q

What is appendicitis?

A

Inflammation of appendix due to overgrowth of

normal flora trapped by occluding fecalith

62
Q

How common is appendicitis with pregnancy?

A

Occurs in up to 1 in 800 pregnancies (more

likely in second trimester

63
Q

How does appendicitis present?

A

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

64
Q

What is volvulus

A

Twisting of colonic segment on its mesentery

causing obstruction, dilatation, ischemia

65
Q

Epidemiology of volvulus

A

90% sigmoid in elderly men, but cecal volvulus

is most common in patients between 25 & 35

66
Q

How does volvulus present and what is the treatment?

A

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

Treatment: untwisting by inserting tube

67
Q

What is diverticulitis? When is it common? How does it present? What is the treatment?

A

Inflammation of a transmural outpouching of
colonic mucosa due to perforation +/- abscess

Common, primarily in elderly patients

Present with abdominal pain, often for more
than a day, (left lower quadrant in 70% of whites, right side in 75% of Asians), constipation (50%), nausea + vomiting (?50%), diarrhea (30%), with abdominal tenderness and leukocytosis

Treatment: surgery or non-surgical therapy

68
Q

Pregnancy causes leukocytosis up to ____ and labor causes leukocytosis up to _____ but neither causes bandemia.

A

14,000; 30,000

Repro (5 decks)

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