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Pathology of prematurity Flashcards

1
Q

What age counts as prematurity

A

<37 weeks

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2
Q

4 common ‘causes’ of prematurity

A

Chorioamniotitis
Preeclampsia
Chronic villitis
MPVFD

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3
Q

What happens in normal pregnancy implantation to spiral arteries

A

Trophoblast invades the wall of the spiral arteries in myometrium
Opens up the spiral arteries so they can’t respond to changes in blood pressure

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4
Q

What happens in preeclampsia in terms of the spiral arteries

A

Failure of invasion

Spiral arteries respond to changes in blood pressure

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5
Q

What is seen in superficial implantation

A

Trophoblast cells seen in the decidua

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6
Q

What is the decidua

A

The uterine lining during pregnancy

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7
Q

What histological changes are seen in pre eclampsia

A

Muscularised arteries
Atherosis (fat) in endothelial wall
Necrosis of the wall

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8
Q

What are the consequences for baby if there is acute chorioamnionitis

A

Baby born prematurely but not necessary IUGR

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9
Q

What is acute chorioamniotic

A

Inflammation of foetal membrane

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10
Q

How do placentas appear in MPVFD

A

Placentas very hard with marbled appearance

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11
Q

What is the histological evidence for MPVFD

A

Chorionic villi are enclosed in fibrin

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12
Q

What can the cause be for chronic villitis

A

Viral invasion

Autoimmune

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13
Q

What is chronic villitis

A

Invasion of villi by lymphocytes

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14
Q

What may babies present with in the short term if born premature

A

RDS
Lung haemorrhage
Pneumonia
Apnoea of prematurity

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15
Q

What is the foetal response to chorioamniotis

A

Pneumonia

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16
Q

What is the long term problem from prematurity

A

Chronic lung disease of infancy

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17
Q

What causes RDS

A

Lack of surfactant due to biochemical immaturity

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18
Q

How do RDS babies present

A

Signs of respiratory distress (tachypnoea, expiratory grunting, recession)

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19
Q

What is the onset of RDS

A

4 hoursa

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20
Q

How do lungs appear in scan of RSD

A

Lungs appear ground glass shadowing

Spot on black- air bronchogram because air is in bronchus but not in the lung tissue

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21
Q

What % of babies less than 28 weeks have RDS

A

60

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22
Q

Describe classic presentation of lung morphology

A

Purple lungs
Liver like consistency
PDA

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23
Q

At what week are first blood vessels seen in lungs

24
Q

When can babies breathe

25
What is hilum membrane disease
Manifestation of acute lung injury Damaged vascular integrity allows fluid to leak into the air spaces Partial reabsorption leavs proteinaceous material
26
How does alveolus appear in HMD
Covered in pink proteinaceous material- forms a membrane covering the alveolus therefore causing a barrier to oxygenation
27
When do macrophages appear to scavenge the hilum membranes
2-3 days
28
What are the acute complications of HMD
Air leaks due to increased pressure which can lead to pneumothorax
29
What is pulmonary interstitial emphysema
Air in the interstitium | Increased resp distress due to compression on parenchyma
30
What is a chronic complication of HMD
Bronchopulmonary dysplasia
31
What are the 3 stages of lung development
Canalicular stage Saccular stage Alveolar stage
32
What are the features of 'new' BPD
- Fewer, larger alveoli and septa - Arrest in pulmonary alveolar and vascular development - Abnormalities in VEGF - Thickened muscular layer of pulmonary arterioles
33
How do you prevent RDS
Antenatal steroids Avoidance of intrauterine hypoxia Prophylactic surfactant treatment Keep warm, avoid acidosis
34
When is pulmonary haemorrhage common
In babies with hypoxia
35
How does pulmonary haemorrhage look histologically
Lumens full of black/ red blood
36
What is necrotising enterocolitis
Acute bacterial invasion/ inflammation/ necrosis of bowel with gas formation in bowel wall
37
Risk factors of necrotising entercolitis
Prematurity Hypoxia Infection Enteral feeding
38
What is first treatment for necrotising enterocolitis
Stop feeds Antibiotics Surgery if necessary
39
Clinical presentation of necrotising enterocolitis
Abdominal distension, tenderness, discolouration Blood in stool Generalised collapse
40
Complications of necrotising enterocolitis
``` Death Short gut (after surgery) Strictures and late obstruction ```
41
What pathological morphology is characteristic of nectrosing enterocolitis
``` Perforations of ileocecal region Deeply congested mucosa Patchy or diffuse ulceration Dilation of involved segments Dusky serosal surface ```
42
Describe the histological signs of NEC
Pneumatosis Epithelial regrowth and granulation tissue Fibrosis of muscularisis propria
43
What are the risk factors for periventricular haemorrhage
``` Prematurity RDS Pneumothorax Hypercapnia Acidosis Hypotension Instability and handling ```
44
What are the complications of intracerebral bleeding
Collapse and death Loss of brain parenchymal tissue with cyst development Blockage of CSF circulation leading to hydrocephalus
45
What is intraventricular haemorrhage often secondary to
Bleeding in germinal matrix
46
What happens with ventricles that are over distended
Blood dissects into parenchyma
47
What are the risk factors for IVH
``` Prematurity Conditions that disturb cerebral blood flow HMD with hypoxia Hypothermia Hypercapnia and acidosis BP instability ```
48
What is stage 1 of IVH
Haemorrhage in the matrix
49
What is stage 2 of IVH
IVH without ventricular dilation
50
What is stage 3 of IVH
IVH with enlarged ventricles
51
What is stage 4 of IVH
IVH with parenchymal haemorrhage
52
What is periventricular leucomalacia
Necrosis of the white matter
53
What is damaged by periventricular leucomalacia in term babies
The cortex
54
What are the features of hypoxic ischaemic encephalopathy in full term infants
``` Bilateral damage to cortical grey matter Shrinkage and gliosis after several weeks Cellular necrosis and apoptosis Capillary proliferation Multifocal ischaemic necrosis ```
55
What causes placental abruptions
Interuption of venous return with backward increase in venous pressure and intracranial and intrathoracic haemorrhages

HD 2 (26 decks)

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