Path - Gestational

Question 1

what is the key risk factor for ectopic pregnancy?

Answer 1

PID resulting in chronic salpingitis and SCARRING of the tube

Question 2

classic presentation of ectopic pregnancy, early vs late Tx

Answer 2

lower quadrant abdominal pain a few weeks after missed period
rupture is medical emergency
early - methotrexate
late - surgery

Question 3

definition of spontaneous abortion and most common cause

Answer 3

miscarriage before 20 weeks
chromosomal anomolies (trisomy 16) and hypercoagulable states

Question 4

placenta acreta vs increta vs percreta

Answer 4

acreta - abnormal adherence of villous tissue to myometrium
increta - placental villin invade into myometrium
percreta - placental villi invade through myometrium

Question 5

what are the two major pathways of placental infection?

Answer 5

1. hematogenous - transplacental; TORCH group members

2. ascending through birth canal (most common) - always bacterial; acute infection = acute chorioamnionitis

Question 6

gross appearance of acute chorioamnionitis

Answer 6

green discoloration of surface membranes

cloudly amniotic fluid due to neutrophils

Question 7

what would histology show in listeria hematogenous infection of placenta?

Answer 7

acute necrotizing intervillositis

Question 8

characteristics and pathogenesis of pre-eclampsia

Answer 8

HTN, proteinuria, edema in 3rd trimester
abnormality of maternal-fetal vascular interface in the placenta (fibrinoid necrosis in vessels of placenta) –> resolves after delivery

Question 9

how do coagulation abnormalities arise from pre-eclampsia

Answer 9

decreased PGI2 (antithrombotic factor)

Question 10

HELLP syndrome

Answer 10

hemolysis, elevated liver enzymes, low platelets from pre-eclampsia

Question 11

timing of SIDS and risk factors

Answer 11

death of healthy infant 1 month to 1 year without obvious cause
sleeping on stomach, cig smoke, prematurity

Question 12

Hydatidiform mole characteristics, when its diagnosed

Answer 12

abnormal conception characterized by swollen and edmatous villi with proliferation of trophoblasts
diagnosed at 9 weeks via pelvic US

Question 13

how does a complete hydatidiform mole happen?

Answer 13

fertilization by two sperm of egg that has lost its chromosomes = all paternal chromosomes (90% are 46 XX)

Question 14

how does a partial mole happen?

Answer 14

normal ovum fertilized by two sperm = 69 chromosomes

Question 15

compare and contrast complete vs partial mole

Answer 15

complete: 46 chromosomes, absent fetal tissue, hydropic villi (full of water), diffuse trophoblastic proliferation (= increased BhCG), 2-3% risk of choriocarcinoma
partial: 69, present fetal tissue, some normal villi, focal trophoblastic proliferation, minimal risk for choriocarcinoma

Question 16

how does a molar pregnancy present?

Answer 16

uterus is much larger and B-hCG is much higher (trophoblastic proliferation)
2nd trimester - passage of GRAPE LIKE masses
on US - fetal heart sounds are absent, SNOWSTORM appearance

Question 17

Tx for hydatidiform mole

Answer 17

suction curettage

subsequent B-hCG monitoring to screen for development of choriocarcinoma (should go down)

Question 18

how does choriocarcinoma from the gestational pathway respond to chemo compared to that of ovarian origin?

Answer 18

well, ovarian does NOT respond to chemo

Question 19

how does choriocarcinoma present?

three main sites of choriocarcinoma metastasis?

Answer 19

vaginal spotting of brownish bloody fluid

lung liver brain