Pathology - Gestational Flashcards
What is spontaneous abortion?
Miscarriage of fetus (20 weeks before gestation)
- Vaginal bleeding, cramp like pain and passage of fetal tissues
How common is spontaneous abortion?
Up to 1/4 pregnancies
What can spontaneous abortions be due to?
- Chromosomal anomalies
- Hypercoagulable states (SLE)
- Congenital infection
- Exposure to teratogens
What is placenta previa?
- Implantation of placenta in lower uterine segment
- Overlies cervical os
What does placenta previa present with?
- 3rd trimester bleeding
What does placenta previa require (what intervention needed)?
C-section
How can placenta previa cause fetal distress?
As the baby is being delivered it can compress the placenta - blood source compromised
What is abruptio placentae?
- Seperation of placenta from decidua prior to delivery
What does abruptio placentae present with?
- 3rd trimester bleeding and fetal insufficiency
- Still birth possibility
What can be seen on the placenta after delivery in abruptio placentae?
Blood and clots on the surface of the placenta
What is placenta accreta?
- Improper implantation of placenta into myometrium with little or no intervening decidua
What are the layers of the endometrium?
- Functional layer
- Basal layer
How does placenta accreta present?
Difficulty delivering placenta and post-partum bleeding
What is required often in placenta accreta?
Hysterectomy
What is preeclampsia due to?
Abnormality of maternal-fetal interface in placenta
What does preeclampsia involve?
- Hypertension after 20 weeks
- Proteinuria or end-organ dysfunction
What is eclampsia?
Preeclampsia + seizures
What hypertension drugs are recommended in pregnancy?
- Hydralazine
- alpha-methyldopa
- Labetalol
- Nifedipine
Hypertensive moms love Nifedipine
How is gestational hypertension defined?
> 140/90 mmHg after 20 weeks
What medications may be used in Preeclampsia?
Antihypertensives
- Hydralazine, alpha-methyldopa, labetalol, nifedipine
- IV magnesium sulfate (seizures)
When should babies be delivered in gestational diabetes?
37-39 weeks
What is the definitive treatment for preeclampsia, eclampsia and HELLP syndrome?
Delivery
How is HELLP syndrome defined?
- Preeclampsia with thrombotic microangiopathy of the liver
- Hemolysis, Elevated liver enzymes, Low platelets
What will a blood smear reveal in a patient with HELLP syndrome?
Schistocytes
What are the 2 major complications of HELLP syndrome?
- Hepatic subscapular hematomas (rupture - severe hypertension)
- DIC (due to release of TF)
What is placenta increta?
When the placenta penetrates into the myometrium
What is placenta percreta?
Placenta perforates through myometrium and into uterine serosa (invades entire uterine wall)
- Placenta may attach to rectum or bladder (hematuria)
How does placenta percreta present?
- Detected on US prior to delivery
- No separation of placenta after delivery -> PPH
What can PPH cause as a complication?
Sheehan syndrome (hypopituitarism -> O2 cannot reach the gland)
What is a hydatidiform mole?
- Abnormal conception characterised by swollen and edematous villi with proliferation of trophoblasts
- Uterus expands as if normal pregnancy is present
What are the hCG levels like in a hydatidiform mole?
Higher than usual for the time
What is associated with hydatidiform mole?
- Early preeclampsia (<20 wks)
- Theca-lutein cysts
- Hyperemesis gravidarum
- Hyperthyroidism
What is the classical presentation of a hydatidiform mole?
- Passage of grape-like masses through vaginal canal in 2nd trimester
(edematous villi) - US in 1st trimester would reveal absent heart sounds and snow storm appearance
What appearance would hydatidiform moles give on US?
Snow-storm
What type of mole involves an enucleated egg?
Complete mole (single sperm which duplicates)
Which type of mole has diffuse trophoblastic proliferation?
Complete mole
Which type of mole has fetal parts?
Partial
Which type of mole is P57 positive?
Partial
Which type of mole cuases an increased uterine size?
complete
Which type of mole causes a larger increase in hCG complete or partial?
Complete
Which type of mole has an increased eisk of invasiveness?
Complete (15-20%)
Partial (<5%)
Which type of mole has a larger risk of choriocarcinoma?
Complete (2% risk)
What is a choriocarcinoma a malignancy of?
trophoblastic (cyto and syncyto) tissue (no chorionic villi present)
What can choriocarcinoma increase the chances of?
Theca-lutein cysts
What does choriocarcinoma present with?
- Abnormal increased hCG
- SOB
- Hemoptysis
- Cannonball metastases on lungs on X-ray
What is choriocarcinoma treated with?
Methotrexate
How is molar pregnancy treated?
Dilation and curettage
What is vasa previa?
Fetal vessels run over or in close proximity to cervical os
- Triad of membrane rupture, painless vaginal bleeding and fetal bradycardia
How is vasa previa treated?
C-section
What is vasa previa associated with?
- Velamentous umbilical cord insertion (inserts in chorioamniotic membrane rather than placenta)
- Vessels then travel unprotected by whartons jelly
What can postpartum hemorrhage be due to?
4Ts
- Tone (uterine atony -> soft boggy uterus)
- Trauma (lacerations, incisions, uterine rupture)
- Thrombin (coagulaopathy)
- Tissue (retained products of conception)
What is the treatment of PPH?
- Uterine massage
- Oxytocin
- Surgery
What vessels may be ligated in surgery of PPH?
Uterine or internal iliac artery (will preserve fertility since ovarian arteries provide collateral circulation)
What is supine hypotensive syndrome (aortocaval compression syndrome)?
- Seen at > 20 weeks gestation
- Supine compression of patients abdominal aorta and IVC by gravid uterus -> decreased placental perfusion and decreased venous return (hypotension)
What gynae cancers are more common?
Endometrial most then ovarian then cervical (US)
- Cervical is more common worldwide
What type of gynae cancers have the best vs worst prognosis?
- Cervical (best) (<45 yrs)
- Endometrial (~55 yrs)
- Ovarian (worst) (>65 yrs)
CEOs often go best to worst as they get older
