Placental and Gestational Pathology Flashcards
What is spontaneous abortion?
spontaneous termination of pregnancy before 20th week gestation
60% of spontaneous abortions are due to what?
chromosomal abnormalities, i.e., autosomal trisomies
40% of spontaneous abortions are due to what?(2-3 points)
Infections, i.e., TORCH, listeria mycoplasma, toxoplasma, CMV, rubella, herpes and endocrine abnormalities( low progesterone) and uterine abnormalities
What uterine abnormality can cause a spontaneous abortion?
submucosal leiomyoma
Type of abortion: uterine bleeding without cervical dilatation; fifty percent will abort
threatened abortion
Type of abortion: uterine bleeding with cervical dilatation
inevitable abortion
Type of abortion: some products of conception are still in the uterine cavity after expulsion of part of conceptus
incomplete abortion
Type of abortion: intrauterine fetal death without onset of labor
missed abortion
How do you treat incomplete abortion?
evacuation of uterus by curettage
How do you treat miss abortion?
uterine curettage
How do you treat threatened abortion?
bed rest
How do you treat inevitable abortion?
evacuation of uterus by curettage
Type of abortion: a condition in which the woman has had three or more consecutive spontaneous abortion
habitual abortions
Type of abortion: infection of products of conception along with infection of upper genital tract
septic abortion
How do you treat septic abortion?
curettage and antibiotics
What is ectopic pregnancy?
Pregnancy occurring outside of the uterine cavity
Where do ectopic pregnancies usually take place?
most commonly in the ampulla of the fallopian tube
What type of abdominal pain is experienced by patients with missed abortions?
none
What are risk factors for ectopic pregnancy?(3-5 points)
history of PID, previous ectopic pregnancy, peritubal adhesions resulting from endometriosis, previous pelvic or abdominal surgery, IUD use, in vitro fertilization or other assisted production
What are the clinical features related to ectopic pregnancy?(3 points)
Classic Triad: pelvic/ lower abdominal pain, vaginal bleeding and tender adnexal mass, following 2-6 weeks of amenorrhea
What symptoms are indicative of tubal rupture at the site of implantation during ectopic pregnancy?
Onset of excrutiating abdominal pain with rapid progression to shock
What can you do for a definite diagnosis of ectopic pregnancy?
laproscopy
How do you diagnose ectopic pregnancy?(2-4 points)
measure βHCG; pelvic ultrasound; laparascopy; culdocentesis; blood in the pouch of douglas
How do you treat a patient with ectopic pregnancy?(2 ponts)
stabilization of the patient and removal of pregnancy
Is it possible for tubal pregnancies to go to term?
no
Is it possible for abdominal pregnancies outside of the uterine cavity to go to term?
Yes
ectopic pregnancy
ectopic pregnancy
What is the probelm with velamentous placenta?
You’re worried about blood flow getting to the fetus
What is the condition: the umbilical cord is inserted into the membranes rather than into the central part of the placental tissue
velamentous placenta
What is the name of the disorder: seperate placental lobes connected to the main placenta by membranes?
succenturiate lobes
What are you worried about as a physician with a patient suffering grom succenturiate lobes?
parturition; you believe you have all of the placenta but you don’t
Velamentous Placenta
Succenturiate Placenta
What is placenta previa?
It is abnormal implantation of the placenta over the cervical os
What are the types of placenta previa? What is the different with each of them?(3-6 points)
complete(placenta completely covering the internal os, partial(placnta covering a portion of internal os) and marginal (edge of the placenta reaching margin of the internal os)
What are risk factors for placenta previa?(1-3 points)
granda multipara, maternal age and prior cesarean delivery
What are the clinical features of placenta previa?**(2 points) **This occurs with what type of women? What week in gestation?
Painless vaginal bleeding without any warning sign, occuring in women with uneventful prenatal course, after 28th week of gestation-most typical presentation; initial bleeding is not profuse
What are the complications of placenta previa?(2-4 points)
pre-term delivery, premature rupture of membrane, intrauterine fetal growth retardation, placenta acreta(abnormal placental attachment to the myometrium) which casues third trimester bleeding as well as postpatum hemorrhage
Placenta Accreta
What is abruptio plaentae?
Premature separtion of normally implanted placenta from the uterine
What is premature separation of normally implanted placenta? What are the risk factors?(3-6 points)
Abruptio Placentae; hypertension, prior placental abruption, increasing maternal age, mulitparty, cocacine addiction, cigarette smoking, trauma
What are the clinical features of Abruptio Placentae: 80% of the cases; 65% of the cases? What happens in severe cases?**(1-2 points) **When do these features usually occur during pregnancy?
painful vagina bleeding occurs in 80% of the cases; uterine tenderness occurs in 65% of the cases; in severe cases you see shock and DIC; these features usually take place after 30th week of gestation
What is the most common morphology you see in Abruptio Placenta when you consider the pathology of the disease? How is this related to the timeframe for this lesion?
retroplacenta hematoma is the most common morphology; the most recent hematomas can be easily detached from the maternal surface; older hematomas are usually adherent to the placenta
Abruptio Placentae
A large central circular depression on the fetal surface of the placenta surrounded by an elevated ridge. Associated with low birth weight and premature labor. What is the disorder?
circumvallate placenta with extra chorial part
Placenta comprises almost two equal parts?
Bipartite placenta
Circumvallate placenta is associated with what pregnancy abnormalities?(1-2 points)
low birth weight and premature labor
Circumvallate Placenta
What is a major cause of maternal death, perinatal death and perinatal morbidity when considering all of the gestional and placental pathologies?
antepartum hemorrhage
About 50% of antepartum hemorrhage are due to what placental abnormalities? What about 30%? When do these occur?
Placenta Previa; Placenta abruption; they occur during the third semester
What is the volume of blood loss during postpartal hemorrhage? What time frame?
500 mL of blood during the first 24 hours of delivery
What is the most common cause of pospartal hemorrhage when you’re considering the gestional and placental pathologies? What are other common causes?(1-2 points)
uterine atony; retained products of conception and genital trauma related to delivery
During twin pregnancies, monozygotic or dizygotic, what type of placenta?
twin placentas
What type of twins: reuslts from division of one fertilized ovum into two separate ova
monozygotic
What type of twins: results when two ova (produced during ovulation) are fertilized?
dizygotic twins
2/3rds of twin pregnancies are dizygotic or monozygotic?
they’re dizygotic; the other third is monozygotic
What are the types of twin placentas? Which one is rare?
dichorionic diamniotic; monochorionic diamniotic; monochorionic and monoamniotic; the last one mentiond in the aforementioned list
Twin Placenta
Dizygotic Twin
Monozygotic Twins
Twin-Twin Transfusion; the one on the left dies while the one on the right survives
What are complications of twin placenta?(4-7 points)
anemia, preterm labor and delivery; intrauterine growth retardation; toxemia; polyhydramnious; fetal malformations and placenta previa
Infection of fetal membranes - amion and chorin? It is usually due to what type of infection? From what location?(2 points) What type of bacteria?(1-3 points)
What are predisposing factors?(1-2 points)
chorioaminonitis; ascending infections from the vagina or the cervix; E. Coli, Neisseria gonorrhea and group B streptococcus; sexual intercourse and premature rupture of membrane
What is the description of the amniotic fluid for a patient suffering from choriamniotis? What is the description of the membrane?(1-2 points)
It’s cloudy; opaque and yellow
What is the histology of the membranes for a patient with chorioaminotis? What are complications?(3-5 points)
neutrophilic infiltrate; pre-term labor, pneumonia, skin infection, eye infection of the neonate and fetal hypoxia
Acute Chorioamnionitis
Acute Chorioamnionitis
Acute Chorioamnionitis
The amnion is the top layer
The fetus is above the amnion in the clear space
Acute Finusitis
You should worry about infection of the infant
This is infection of the umbilical cord
Infection of chorionic villi: usually due to hematogenous spread of bacteria, fungi, and viruses
Villitis
Villitis
The presence of hypertension, edema and proteinuria in pregnant women?
preeclampsia
What is preeclampsia?
The presence of hypertension, edema and proteinuria in pregnant women
Preeclampsia usually occur with what type of women?
nulliparous women or women who never had a pregnancy
When does preeclampsia usually happen?
It happens during the third trimester
What presentation is common in severe preeclampsia?(2-3 points) Recently(2015), a special severe form of preeclampsia has been described. What is the acronym used to remember the presentations of the patients?
headaches, dizziness and visual disturbances; HELLP Syndrome: Hemolytic anemia, Elevated liver enzymes, Low Platelets
What is eclampsia? What is an in invariable hemolytic issue seen in patients suffering with eclampsia?
gradual seizures occur in preeclampsia patients; DIC
How do doctors usually control the Gran Mal seizures associated with eclampsia?
intravenous MgSO4
What is the main probelm with preeclampsia? How does this affect the placenta? What biochemical affect does this have on the placenta? How does this affect the vasculature of the placenta? What vessels specificially?
hypertension; you get decreased blood flow to the placenta; there would be decrease prostaglandin synthesis; there will be vasoconstriction of the vessels of the placenta; there will be acute atherosis of the spiroarterioles
Placental Infarct
This is a white infarct due to the arteries being involved
Placental Infarct
this is a white infarct due to the fact that the arteries are invovled
Acute Atherosis
What is gestational trophoblastic disease?
It comprimises a spectrum of abnormal proliferative(benign or malignant) trophoblastic disorders
What is a hydatidiform mole?
A benign gestational trophoblastic disease
Gestational tropholastic disease: What is an invasive mole? How severe is this mole?
An invaisve mole is an trophoblastic gestional disease that that marked local destruction and hemorrhage with rate potential to spread to distant organs?
Gestational Trophoblastic Disease: what is a choriocarcinoma? What is the severity?
A choriocarcinoma is a widely metastazing and markedly hemorrhagic and necrotic, malignant tumor
Are hydatidiform moles more common in the far east or in the United States? What age groups are usually affected?**(two infinite ranges) **Are there any disparities in the United States population that are affected with the diseae?
It’s more common in the fat east; children under 15 and adults over 40; yes, there seems to be a connection with low socioeconomic status
Completely hyratidiform mole: how likely is the incidence of choriocarcinoma? How is the uterus affected?(2 points) What is a common name for the lesion seen in the uterus? What is the karyotype?(2 points) Is it maternal, paternal or both? What is the condition of the egg?
rare, 2%; the uterus is filled with edematous villi; imparting the appearance of a bunch of grapes; the karyotyes is 46 XX or 46 XY; paternal; the egg is empty
Complete hydatidiform mole: what is the presentation of the patient?(1-3 points) How can it be diagnosed based on what the physican finds in the blood sample? When is it discovered? What may you see in the ultrasound?
rapid uterine enlargement, uterine bleeding and passage of tissue per vaginum; It can be diagnosed by measuring a threshold rise in β-HCG; 4th or 5th month of pregnancy; a snowstorm pattern
What is the gross description of the complete hydatidiform mole?(1-3 points) What is the microscopic description?(3-5 points)
markedly edematous villi mimicking a bunch of grapes; markedly edematous avascular villi and trophoblastic proliferation of both synctio-and cytotrophoblastics with consideriable atypia
