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MS2 - Life Cycle > Pathology of the Placenta and Gestational Trophoblastic Disease > Flashcards

Pathology of the Placenta and Gestational Trophoblastic Disease Flashcards

1
Q

How does ectopic pregnancy change hCG levels?

A

It delays/lowers the rise of hCG.

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2
Q

Trophoblastic disease presents with __________ hCG levels.

A

Initially delayed but then excessive hCG rise (that is, above 10,000 mIU/mL)

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3
Q

What is the discriminatory zone?

A

The DZ is the hCG range above which a uterine pregnancy should be visible on ultrasound.

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4
Q

What is gestational trophoblastic disease?

A

A group of rare tumors that involve abnormal growth of cells… starting in the cells that would normally develop into the placenta

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5
Q

___________ DNA stimulates placental development.

A

Paternal

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6
Q

What is the difference between complete and partial moles?

A
  • Complete: diandric diploid (46, XY or XX), meaning the sperm contributed all of the genetic material
  • Partial: diandric triploid (69, XXY), meaning two sperms fertilized one egg or one sperm fertilized one egg and then divided intra-egg
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7
Q

How will partial and complete moles appear on ultrasound?

A

Partial moles can have fetal parts and complete moles do not have parts and have a “snowstorm” appearance.

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8
Q

On gross exam, complete molar pregnancies have a ___________ appearance.

A

grape-like

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9
Q

20% of complete moles will develop into ______________.

A

gestational trophoblastic disease

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10
Q

Why do providers ask women who’ve recently had a complete molar pregnancy to take birth control?

A

Follow-up is done by monitoring hCG levels, so if a woman gets pregnant then the hCG levels will not be reliable.

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11
Q

How are complete molar pregnancies treated?

A

Curettage and (if hCG remains elevated) methotrexate

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12
Q

The key histologic finding in choriocarcinoma is _____________.

A

a biphasic tumor: mononuclear trophoblasts and multinuclear syncytiotrophoblasts

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13
Q

The most common site of choriocarcinoma metastasis is _____________.

A

the lungs

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14
Q

The placenta is divided into two sides, terminologically: ________________.

A

the fetal surface is where the cord attaches

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15
Q

What does IUFD stand for?

A

Intra-uterine fetal demise

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16
Q

Fetal vasculature enters the placenta in the _____________ spaces.

A

villous

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17
Q

The maternal blood enters the ___________ spaces.

A

intervillous (maTERnal = inTERvillous)

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18
Q

What can the attachment point of the umbilical cord tell you about the baby?

A

Most of the time, the umbilical cord attaches to the center of the placenta. In some cases, the cord can attach to the periphery. If it’s somewhat loosely/distantly attach –called velamentous –then there’s a greater chance that the child had hypoxic episodes due to repeated pressure occlusions.

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19
Q

There are two umbilical _________ but only one umbilical ____________.

A

arteries; vein

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20
Q

Increased _____________ increases risk of entanglement.

A

umbilical cord length

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21
Q

What is fetus papyraceus?

A

If a twin dies in a di/di, then the fetus that survives grows and presses onto the remnant sac of the other and can leave a fibrous impression.

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22
Q

Yellow blotches on a placenta can indicate _____________.

A

Listeria infection

23
Q

Explain the extensive GP nomenclature system.

A 
G = pregancies
P = outcomes, denoted TPAL (term, preterm, abortion, living)

Example: G5P2032 is five pregnancies, two of which were term, zero were preterm, three were aborted, and two are living

24
Q

What most commonly causes acute chorioamnionitis?

A

Group B Strep

25
Q

Listeria leads to ___________ inflammation, whereas most other placental infections lead to ___________ inflammation.

A

acute; chronic

26
Q

At 39 weeks’ gestation, about 15% of fetuses ___________.

A

have passed meconium

27
Q

C-sections raise risk of ______________.

A

placenta accreta

28
Q

Histologically, what two layers will be touching in placenta accreta?

A

The villi will abut the myometrium.

29
Q

Hypertension and proteinuria after 20 weeks’ gestation indicate ___________.

A

pre-eclampsia

30
Q

How common is pre-eclampsia?

A

It occurs in about 5% of U.S. pregnancies.

31
Q

What are the sequelae of pre-eclampsia?

A
  • 35% risk of stillbirth
  • Preterm delivery
  • Fetal hypoxia, neurologic injury
  • Maternal DIC, stroke, HTN, and pulmonary edema
32
Q

The only treatment for pre-eclampsia is ______________.

A

delivery

33
Q

What is placental detachment called?

A

Placental abruption

34
Q

What does the obstetric acronym SAB stand for?

A

Spontaneous Abortion

35
Q

What’s the difference between symmetric and asymmetric intrauterine growth restriction?

A
  • Symmetric: genetic etiology

* Asymmetric: non-genetic, physical malformation (such as oligohydramnios)

36
Q

If a first trimester SAB has a cystic hygroma, what is the likely karyotype?

A

45, XO

37
Q

Which trisomy increases the risk of omphalocele?

A

Edward’s and Patau’s

38
Q

Neural tube defects can be detected by elevated levels of _____________.

A

AFP

39
Q

What is the incidence of ectopic pregnancies?

A

1:150

40
Q

In addition to hydropic villi, partial hydatidiform moles will have ______________.

A

fibrotic villi

41
Q

Most complete moles arise from _____________.

A

one sperm that divides in an empty ovum

42
Q

What is the incidence of complete hydatidiform moles?

A

1:1,500 pregnancies

43
Q

Explain the utility of p57 staining.

A

p57 is maternally expressed, so it will be absent in complete moles.

44
Q

There can be remnant _____________ in the umbilical cord.

A

GI epithelium (from when the GI tract bulged out into the cord)

45
Q

The spiral arteries empty into the intervillous space after passing through the decidua _______________.

A

parietalis

46
Q

What are signs of congenital HSV2 infection?

A

Same as in adults: temporal encephalitis, herpetic lesions

47
Q

Compare and contrast the two types of villitis.

A 
Infectious villitis: 
•Maternal and fetal illness
• Early pregnancy 
•Less chance of recurrence 
•Very rare
Villitis of unknown etiology: 
•Less likely to have maternal and fetal illness
• Late pregnancy
•Greater chance of recurrence 
•More common
48
Q

Placenta accreta is thought to form due to _____________.

A

failed decidual development

49
Q

___________ is when the placenta invades the myometrium.

A

Placenta increta

50
Q

Pre-eclampsia results from ________________.

A

impaired flow of blood from the spiral arteries to the intervillous space

51
Q

What are symptoms of abruptio placentae?

A
  • Rapid uterine contractions
  • Vaginal bleeding
  • Back pain
52
Q

What causes acute abruption?

A

Rupture of villi due to ischemic injury

53
Q

What is the incidence of Down syndrome?

A

1:700

MS2 - Life Cycle (61 decks)

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