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Endocrine- MHD > Placenta > Flashcards

Placenta Flashcards

1
Q

Which hormone is secreted by the placenta?

A

hCG (+ many others)

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2
Q

What is the decidua?

A

Endometrium of pregnancy

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3
Q

Are the chorion/amnion derived from maternal or fetal tissue?

A

Fetal tissue

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4
Q

What is the function of the chorionic villi?

A

Chorionic villi sprout from the chorion to provide a large contact area between fetal and maternal circulations

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5
Q

What is the two layered epithelium of the chorion called?

A

Trophoblast

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6
Q

Do the fetal and maternal blood sources mix?

A

NO- not under normal circumstances

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7
Q

Does the umbilical vein bring oxygenated or deoxygenated blood to the fetus?

A

oxygenated

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8
Q

How does fetal blood become oxygenated?

A

The placenta is like the lungs for the fetal blood- the oxygenated maternal blood enters in spiral/endometrial arteries and bathes the fetal blood supply- oxygen is extracted

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9
Q

Spontaneous abortions (miscarriages) occur when?

A

Anytime before 20 weeks

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10
Q

What is the primary cause of a spontaneous abortion?

A

More than half are due to chromosomal abnormalities

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11
Q

Where do ectopic pregnancies usually occur?

A

90% occur in the fallopian tubes

10% occur in the ovary or abdominal cavity

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12
Q

Name 2 predisposing factors to ectopic pregnancies

A

Previous inflammation that led to scarring

IUDs

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13
Q

How will an ectopic pregnancy present?

A

Abdominal pain, acute abdomen

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14
Q

Will a monochorionic placenta produce fraternal or identical twins?

A

Identical

Monochorionic placentas imply monozygotic twins

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15
Q

What is the cause of twin-twin transfusion syndrome?

A

Intertwin vascular connections within the placenta

Leads to polyhydramnios in one amniotic sac, and oligohydramnios in the other amniotic sac

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16
Q

What is it called when the placenta attaches to the lower uterine segment or cervix?

A

Placenta previa

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17
Q

What are the consequences of placenta previa?

A

Serious 3rd trimester bleeding

Dilation of the cervix disrupts the placenta

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18
Q

What is it called when there is partial or complete absence of the decidua with adherence of placental villous tissue directly to the myometrium?

A

Placenta accreta

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19
Q

What are the consequences of placenta accreta?

A

Failure of placental separation –> incomplete/non-delivery of the placenta following birth.

Causes postpartum bleeding

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20
Q

Name 2 predisposing factors to placenta accreta

A 
Placenta previa (60%)
Previous cesarean section
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21
Q

What is it called when there is a premature separation of the placenta and formation of a retroplacental blood clot?

A

Abruptio placentae

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22
Q

What are the consequences of abruptio placentae?

A

Painful maternal bleeding

Potential fetal death due to inadequate blood supply to the fetus

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23
Q

What are consequences of retained placental tissue?

A

Postpartum hemorrhage

Infection

24
Q

What is Preeclampsia-eclampsia?

A

Systemic syndrome characterized by widespread maternal endothelial dysfunction presenting clinically with hypertension, edema and proteinuria during pregnancy

25
Q

Is preeclampsia more common with the first pregnancy or subsequent pregnancies?

A

First preganancy

26
Q

What causes preeclampsia-eclampsia?

A

Not sure, but delivery of the placenta rapidly reverses the symptoms

(Coagulation abnormalities? Endothelial dysfunction and imbalance? Abnormal placental vasculature?)

27
Q

How is the liver affected by preeclampsia?

A

Fibrin thrombi, hemorrhage, necrosis

28
Q

How are the kidneys affected by preeclampsia?

A

Fibrin in glomeruli and capillaries

Renal cortical necrosis

29
Q

How is the brain affected by preeclampsia?

A

hemorrhage and thrombosis

30
Q

What is the triad at defines preeclampsia?

A

HTN, edema, proteinuria

31
Q

What defines severe preeclampsia?

A

Preeclampsia + headaches and vision changes

32
Q

What defines eclampsia?

A

Preeclampsia + convulsions

33
Q

What is HELLP syndrome

A

Severe preeclampsia + hemolysis, elevated liver enzymes, and low platelets

34
Q

What are some long term maternal sequelae of preeclampsia?

A

20% develop HTN and microalbuminuria within 7 years

2x increased heart and brain vascular disease

35
Q

What is the most common route of a placental infection?

A

Ascending- usually bacterial, through the birth canal

Less commonly, TORCH infection through hematogenous spread

36
Q

List the TORCH infections

A 
T- Toxoplasma Gondii
O-Others (Parvovirus B 19), Syphilis, TB, listeria
R- Rubella
C- CMV
H- Herpes simplex virus, HIV
37
Q

What are the symptoms of a TORCH infection?

A

fever, encephalitis, chorioretinitis, hepatosplenomegaly, pneumonitis, myocarditis, hemolytic anemia and vesicular or hemorrhagic skin lesions

38
Q

Generally speaking, what are hydatidiform moles?

A

A noncancerous tumor that develops in the uterus as a result of a nonviable pregnancy

Leads to cystic swelling of the chorionic villi with trophoblastic proliferation

39
Q

What is the general presentation of a hydatidiform mole?

A

Most women present with miscarriage, and undergo D&C based on the US/hCG findings

40
Q

In complete hydatidiform moles, how many chromosomes are present? What is their origin?

A

46 chromosomes are present, BOTH sets are from the male origin.

41
Q

What are the two ways a complete hydatidiform mole can arise?

A

Empty ovum penetrated by two sperm –> 46 chromosomes

Empty ovum penetrated by one sperm which duplicates such that there are now 46 chromosomes

42
Q

What is the origin of the chromosomes of a partial hydatidiform mole?

A

Two sperms enter an ovum with 23 chromosomes already –> 69 chromosomes

43
Q

What is the karyotype of partial vs complete hydatidiform moles?

A

Complete: 46, XX or 46, XY
Partial: Triploid

44
Q

Describe the presence of villous edema in partial vs complete moles

A

Complete: all villi are edematous
Partial: some villi are edematous

45
Q

Describe the trophoblast proliferation of partial vs complete moles

A

Complete: Diffuse, circumferential
Partial: Focal, slight

46
Q

Describe the histologic atypia of complete vs partial moles

A

Complete; often present

Partial: absent

47
Q

Describe the serum hCG levels in complete vs partial moles

A

Complete: Elevated
Partial: less elevated

48
Q

Is fetal tissue present in complete moles? Partial moles?

A

Complete; Fetal tissue is absent

Partial: Fetal tissue is present

49
Q

Describe the malignant potential of complete vs partial moles

A

Complete; 2.5% progress to choriocarcinomas (often fatal)

Partial: almost zero malignant potential

50
Q

What defines an invasive mole?

A

A mole that penetrates the uterine wall- villi invade the myometrium

51
Q

How are invasive hydatidiform moles treated?

A

Chemotherapy

52
Q

Are gestational choriocarcinomas malignant or benign?

A

Malignant- they are rapidly invasive and widely metastatic

53
Q

Gestational choriocarcinomas are neoplasms arising from which cell type?

A

Trophoblast derived cells

54
Q

What is the treatment for choriorcarcinoma?

A

Surgery and chemotherapy- chemo is extremely effective

55
Q

What does the chorion attach to?

A

The decidua

56
Q

Do ovarian choriocarcinomas require fertilization?

A

No- they are non-gestational, and a result of extra-embryonic differentiation in malignant germ cells

57
Q

What is the prognosis for ovarian choriocarcinomas?

A

Poor response to chemotherapy, poor prognosis

Endocrine- MHD (17 decks)

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