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LC 02 > Path of Placenta > Flashcards

Path of Placenta Flashcards

1
Q

Discriminatory zone

A

maternal hCG level above gestational sac should be visible

~5-6 weeks Transvaginal US

~7 weeks
Transabdominal US

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2
Q

How often does ectopic pregnancy occur?

A

1/150 pregnancies

- implant anywhere but intrauterine

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3
Q

What usually precedes ectopic pregnancy?

A

PID

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4
Q

Complete mole

Partial mole

A

all dad (46, XX or XY)

Partially dad
(triploid, 69 chrom
2/3 from dad, 1/3 fr mom)

Need moms DNA to drive development
- without her, you have no fetus

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5
Q

Snowstorm appearance

A

Complete hydatidiform mole

- cystically dilated spaces w/o fetal parts

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6
Q

Triad of complete mole sx

A
  1. hyperemesis
  2. pre-eclampsia
  3. hyperthyroidism
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7
Q

% of recurrence in complete mole

A

20% recurrent

1-2% dev into choriocarcinoma (monitor carefully after)

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8
Q

Follow up for molar preg

A
  1. get serum hCG q1-2 weeks until 3 conseq. negative measurements
    - give methotrexate if elevated
  2. Contraception
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9
Q

Risk for post molar GTN

A
  1. age >40
  2. Uterine size
  3. Theca lutein cysts >6 cm
  4. hCG >100,000
  5. medical complications
    - ARDS, pre-eclampsia, hyperthyroidism
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10
Q

Choriocarcinoma

A

disease of trophoblast
-cyto (mononucleated) and syncitio (multinucleated)

can be widely metastatic

serum bHCG to detect

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11
Q

signs of choriocarcinoma

A
  1. vaginal bleeding several mo after pregnancy
  2. high serum hCG
  3. Single/mult hemorrhagic well circumscribed nodules in uterus
  4. biphasic pattern w. hemorrhage and necrosis
  5. marked nuclear atypia and mitosis
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12
Q

Placental organ

- fxns

A
  1. anchors gestation
  2. disposable at birth
  3. Fxns as:
    kidney, lung, liver, intestines, and endocrine organ to fetus
  4. Prod hormones
  5. Immunologic organ
    (physical barrier + protects fetal allograft from moms immune syst)
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13
Q

PLacental weight ratio (PWR)

A

reflects balance betwn fetal and placental growth
(surrogate indicator of utero fxning)
- decreases as gestational age increases

Predictive of:

  1. perinatal morbidity/mortality
  2. childhood growth & devel
  3. Fetal origins of adult diseases
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14
Q

Does size matter for umbilical chords?

A

yes

Long = >75

  • assoc w/ knots and fetal entanglement
  • may correspond to later hyperactivity

Short =

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15
Q

umbilical artery carries _____ blood from fetus to placenta

A

deoxygenated

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16
Q

Which compartment (fetal or maternal) is found in intravillous and intervillous space?

A

Fetal compartment:
inTRAvillous

MaTERnal space:
inTERvillous

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17
Q

TPAL

A

Term delivery
Preterm delivery
Abortion
Living children

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18
Q

Acute chorioamnionitis

maternal inflamm response in memb

A

20-24% of live births

2ndary to bacterial intramniotic infxn
(Group B strep)

Neutrophils in fetal membranes

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19
Q

Fetal inflamm response

A

Vasculitis In:

  1. babys vasculature (umbil cord)
  2. chorionic plate
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20
Q

DIff between ascending vs trans-placental infection

A

Ascending
- maternal neutrophils in membrane

Trans-placental (hematogenous)
- histo: chronic villitis, intervillositis, lymphoplasmacytis deciduitis
(moms lymphocytes are killing villi)
- ToRCHeS infxn

21
Q

ToRCHeS

A 
Toxoplasma
Rubella
CMV
HIV
HSV
Syphilis
22
Q

Rare problems of CMV placentitis

A
  1. Intrauterine Fetal death
  2. IU growth restriction
  3. Deafness

*common infxn: primary and recurrent

23
Q

Perivascular fibrous proliferation

24
Q

Granulomatous with cysts

A

toxoplasmosis

25
Multinucleated cells with inclusions
herpes | Tzank
26
Acute inflammation destroying villi
listeria
27
Meconium
baby poop toxic meaning: baby's gut is mature or baby is stressed (esp if
28
Intervillous thrombi
feto-maternal hemorrhage -see lines of zahn (if extensive, get kleihauer - betke test) risk factors: 1. multiple gestations 2. nuchal cord 3. low birth weight
29
kleihauer betke test
test for fetomaternal hemorrhage (FMH) test if: 1. fetal demise 2. nonimmune hydrops 3. neonatal anemia
30
Placental infarct
acute cessation of maternal flow with live fetus - central more sig than peripheral - Evolves from red and firm to white and hard
31
PLacenta accreta
failure of decidual formation - trophoblast invade abnormally deeply - chorionic villi adhere to myometrium
32
Predisposing factors for placental accreta
1. Prior C-section 2. Endometrial ablation 3. Multiple D&C (anything that disrupts endometrial lining) *PA: defective decidual layer
33
Chorionic villi touching myometrial cells
placenta accreta
34
Pre-eclampsia
Hypertension + proteinuria after 20 weeks gestational age * trophoblast dont invade enough - maintain high pressure flow
35
Most imp risk factor for pre-eclampsia
1. Prior preeclampsia in prior pregnancy 2. Fam hx 3. Preexisting disease
36
treatment of preeclampsia
delivery
37
women who do cocaine predisposes her to?
PLacental abruption
38
PLacental abruption risk factors
1. trauma 2. smoking 3. HTN 4. preeclampsia 5. cocain abuse
39
uterine atony
lack of effective myometrial contraction following delivery | --> post partum hemorrhage
40
Risk factors for uterin atony
1. overdistention (from mult gestation) 2. Uterine fatigue 3. uterin infxn 4. retained placental tissue
41
DIC
massive activation of the clotting cascade --> widespread thrombosis Secondary depletion of platelets and coagulation factors leads to bleeding, ischemia, and shock
42
Spontaneous abortion (SAB) eitiology by trimester First trimester Second trimester Third trimester
First trimester: - chromosomal Second trimester - structural defects, placental, infectious Third trimester - placental*, structural defects
43
Internal abnormalities of down syndrome
1. heart (ASD) and GI anomalies | 2. Pancreastic, bone marrow fibrosis
44
Polydactyly and facial defects. | Single fused eye
Patau's syndrome 47, XX + 13
45
Rocker bottom feet, Omphalocele (guts thru umbil), Hand deformities (not polydactyly)
edwards syndrome | 47 xx +18
46
Syndactyly (fusion of digits
triploidy 69, XXX or XXY incompatible with life
47
Causes of fetal hydrops
80%: Non immune - infxn, cardiac anomalies, neoplasms, metabolic disorders 20% Immune: maternal ab against fetal RBC cross placenta (RH+ baby)
48
Neural tube defects are determined when?
``` 1st month of pregnancy (1st 4 weeks) - Use folate! - Avoid alcohol - Elevated AFP ```
49
Most common neoplasm of newborn
sacrococcygeal teratoma | - yolk sac most freq malignancy

LC 02 (15 decks)

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