Patho: Disorders Of Pregnancy Flashcards
Disorders of early pregnancy:
Disorders of early pregnancy:
Spontaneous Abortion
Spontaneous Abortion
Spontaneous Abortion (aka miscarriage) Definition:
pregnancy loss before 20 weeks of gestation
When do most spontaneous abortions occur?
Most occur before 12 weeks
What is the Incidence of Spontaneous Abortion
10-15 % of clinically recognized pregnancies ( out of the pregnancies that have been + identified, this number is actually a lot higher due to the amount of females that abort never knowing they were pregnant
What are the possible Causes of Spontaneous Abortion?
Fetal : Genetic
Maternal
Unknown mechanisms
What are some Fetal causes of Spontaneous Abortion:
Chromosomal anomalies (50% in early Spontaneous Abortions)
Aneuploidy: abnormal number of chromosomes
Polyploidy: more than 2 paired (homologous) sets of chromonsmes (ie 4 rather than 2)
Translocations
Subtle genetic defects: no avb test
What are some maternal causes of spontaneous abortions? 1: 2: 3: 4: 5: 6:
Luteal-phase defect: Corpus leteum is not producing the progesterone or estrogen it is suppose to so there is not enough formation of the Decidual cells to support a good implantation
Poorly controlled diabetes: infections and poor circulation
Other uncorrected endocrine disorders: hypo or hyper thyroidism. Anything affecting the growth of the uterus
Physical defects of the uterus :
Systemic disorders affecting maternal vasculature
Infections
what are the Physical defects of the uterus that cause spontaneous abortions?
Submucosal leiomyoma (SM tumor) : tumors of the myometrium, affect implantation
Polyps: Interferer with good implantation
Malformation of the uterus : bicornate uterus
what are some of the Systemic disorders affecting maternal vasculature that cause abortions
Antiphopholipis antibody syndrome: an antibody that causes a hypercoagulable test, but if affects the PTT test (its long so it looks like they can not clot but really they are hypercoaguable) this is seen in lupus.
Coagulopathies: Factor 5 ligand
Hypertention: Rupturing of vessels in the placenta and interferes with ventilation
what are some of the infections that cause spontaneous abortions?
Bacterial :
•Toxoplasma
•Mycoplasma
•Listeria
Ascending infection
•Common in second-trimester
Viral infections
•Unknown mechanisms
when are ascending bacterial infections leading to spontaneous abortion most common?
in the second trimester
When do you do genetic testing after a spontaneous abortion?
When a female has 2 spontaneous abortions and the mother and father is relatively healthy.
Ectopic pregnancy
Ectopic pregnancy
Definition Ectopic Pregnancies:
Implantation of the fetus in any site other than a normal intrauterine location
Where are the most common sites for Ectopic pregnancy :
Fallopian tubes (∼90%) Ovary Abdominal cavity Intrauterine portion of the fallopian tube (called cornual pregnancy- where the tube attaches to the uterus)
How many pregnancies are Ectopic pregnancy ?
About 1 in every 150 pregnancies
What are the Predisposing conditions for tubal ectopic pregnancies?
Prior pelvic inflammatory disease resulting in fallopian tube scarring (chronic follicular salpingitis- inflammation of the tube) ( 30-50% of patients)
Why does Prior pelvic inflammatory disease resulting in fallopian tube scarring lead to an ectopic pregnancy?
Tube gets scared the fertilized egg doest have anywhere to go, so it tries to implant in the tube but since there is no Decidual cells implantation can no occur
What are some other causes for ectopic pregnancies? 1: 2: 3: 4:
Appendicitis- if at time of implantation the inflammation process interferes with the eggs movement
Endometriosis
Previous surgery
Intrauterine contraceptive devices: Increases the risk for Ectopic pregnancy by 2.5 fold.
( ?? some studies state that they have a higher number of total pregnancies that are Ectopic)
what is a Ovarian Pregnancy:
Fertilization and trapping of the ovum within the follicle just at the time of its rupture
What is a Abdominal pregnancies:
Fertilized ovum fails to enter or drop out of the fimbriated end of the tube
Morphology of Tubal Pregnancies:
Tubal pregnancies are the most common cause of what?
hematosalpinx (blood-filled fallopian tube)
When removed what will the tubal pregnancy look like?
Embryonal sac, surrounded by placental tissue composed of immature chorionic villi (trophoblsat don’t have anything to attach to and multiply)
Why can tubal pregnancies not implant into the tube wall?
Proper decidualization (Decidual cells ) is lacking in the fallopian tube
Sequelae: what can happen with a tubal pregnancy?
1:
2:
3:
Massive intraperitoneal hemorrhage: bleeding into the abd cavity, Growth of the gestational sac distends the fallopian tube causing thinning and rupture
Spontaneous regression and reabsorption of the fetus
Tubal Abortion: extruded into the abdominal cavity
Clinical Features of a tubal pregnancy :
Severe abdominal pain: Ask when the last menstrual period was, if it was about 6 weeks ago think about tubal pregnancy.
Hemorrhagic shock with signs of an acute abdomen
Diagnosis of a tubal pregnancy?
Chorionic gonadotropin assays, ultrasound studies, and laparoscopy
Twin Placentas:
Twin Placentas:
Where do twin placentas arise form?
Fertilaztion of two ova (dizygotic) (2 eggs and 2 sperm)
or
Division of one fertilized ovum (monozygotic)
It all depends on when the egg was fertilized when the two fetuses are developed
Early – 2 placenta- fertilization occurs and immediate multiplication of cells.
Late- 1 placenta
Three basic types of Twin Placentas:
Diamnionic dichorionic
Diamnionic monochorionic
Monoamnionic Monochorionic placentas
never really happened
Monoamnionic Dichorionic placenta
explain how you could get Diamnionic dichorionic
(may be fused chroion/placenta) (2 amnioinic sacs and 2 chornions/ placenta)
Fertilization occurs then you have cleavage of two fertilized masses with the same genetic material.
If duplication occurs between days 1-3= identical
This can happen if a monozygotic occurs within the first 1-3 days with one egg splitting into two, or it could have been two eggs getting fertilized by two sperm creating two embryos
explain how you could get Diamnionic monochorionic (60% monozygotic)
With monozygotic fertilization and cleavage that occurs around 4-8 days where you end up having 2 amnions and only 1 placenta with 2 cord
What is an issue with Diamnionic monochorionic?
Different fetal perfusion, one fetus may take a lot of the nutrients and the other gets the left over’s so you may see a disparity in size
explain how you could get Monoamnionic Monochorionic placentas:
1 placenta that feeds both
When a split occurs aroud day 8-13 youcan get one huge amnio and one huge placenta with 2 cords.
What is an issue with monoamnionic monochorionic ?
Different fetal perfusion, one fetus may take a lot of the nutrients and the other gets the left over’s so you may see a disparity in size.
What is the only placental/amnionic presentation can you state there is a monozygotic (identical) twins?
monoamnionic monochorionic
what is Monoamnionic Dichorionic placenta :
One amnion/2 chorions:
either monozygotic or dizygotic twins
this is an issue that occurs with conjoined twins, it rarely happeneds!
Division of monozygotic embryo at day
1-3 post fert: dichorion-diamnion
4-6 post fert: dichorion-monoamnion
7-9 post fert: monochrorion-monoamnion
what two do you really need to monitor fetal growth?
Diamnionic monochorionic
Monoamnionic Monochorionic placentas
