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Embryology (clinical Anatomy) > Practical 3: placentation and twinning > Flashcards

Practical 3: placentation and twinning Flashcards

1
Q

What is the difference in function of the syncitio and cytotrophoblast?

A

syncitio –> produces hormones + is invasive

cytotrophoblast –> proliferative

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2
Q

What does the maternal side of the placenta have and why are these present?

A

10-15 cotyledons due to decidual septa

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3
Q

what hormonal functions does the placenta have?

A

Progesterone
oestrogen/estriol
hCG (1st 2mths)
placental lactogen (somatomammotropin)

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4
Q

What is the function of somatomammotropin?

A

Gives the fetus priority of maternal glucose (mother diabetogenic) and stimulates breast lactiferous duct development

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5
Q

How does gas exchange occur across the placenta?

A

simple diffusion across the membrane between fetal and maternal vessels

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6
Q

Apart from O2, CO2 and hormones, what other substances cross the placenta?

A

FFAs, CHOs, AAs
vitamins
immunoglobululins (maternal antibodies)

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7
Q

How can you screen for rhesus sensitisation? How can it be prevented?

A

Blood test on 1st maternal visit. Rh -ve mothers can be given prophylactic anti-D antibodies at 28/40 and w/in 72 hrs of delivery

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8
Q

How does prophylactic Anti-D antibodies work?

A

Destroys fetal RBCs that have entered maternal circulation

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9
Q

When do the umbilical arteries and vein close?

A

Arteries: shortly after birth (functionally) but lumen closes after 2 mths

vein: shortly after umbilical arteries

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10
Q

when should the ductus arteriosus close

A

should close immediately after birth due to decrease of prostaglandins as ^ O2

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11
Q

Why are NSAIDs contraindicated after 30w pregnancy?

A

Ductus arteriosus premature closure (as PGs decreased)

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12
Q

How does gestational trophoblastic disease hydatidiform moles arise?

A

partial mole –> 69 chromosomes (2 sperms fertilising 1 egg)

complete mole –> 46 chromosomes (1 sperm duplicatiing or 2 sperm fertilisaing empty egg)

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13
Q

What are the risk factors for gestational trophoblastic disease?

A

Previous, age (<16 or >45), multiple pregnancy, women w/ hX OF AGE 12 MENARCHE/ocp USE/LIGHT MENSTRUATION, asian women

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14
Q

how can you detect gestational trophoblastic disease prenatally?

A

^^^ hCG
USS (snowstorm appearance)
biopsy (definitive)

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15
Q

what might hydatidiform moles progress to?

A

Invasive molar pregnancy (malignant)

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16
Q

What are the risk factors for placenta previa?

A

uterine surgery / c-section, previous, smoking, cocaine, ^ maternal age, uterine abnormalities (e.g. fibroids, congenital), large placenta (twins), multiparity

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17
Q

What are the possible consequences for placenta previa?

A

APH
Failure of head to engage –> c section
preterm delivery
…

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18
Q

What are the risk factors for placenta accreta?

A

smoking, multiparity, uterine surgery, advanced maternal age, asherman’s syndrome…

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19
Q

What are the 3 types of placenta accreta?

A

Accreta
increta
percreta

20
Q

What are the possible consequences placenta accreta?

A

PPH after delivery (blood loss, DIC, multiple organ failure, death…) [notice previa is assoc. w/ APH]

hysterectomy

21
Q

what is the problem with placenta abruption?

A

Shock w/out visible blood loss

22
Q

What are the risk factors for placental abruption?

A

pre-eclampsia, smoking, thrombophilias, prev c section, trauma (e.g. fall or car accident)

23
Q

what is placental abruption?

A

separation of the placenta from the uterine wall causing a build up of blood in the space

can be hidden or exposed

24
Q

How is placental abruption managed?

A

ABCD approach (manage blood loss)
emergency c section if fetal distress
monitor for PPH

25
Q

What are the implications of velamentous insertion of the umbilical cord if not picked up on USS?

A

if blood vessels overlie the cervix –> can rupture during ROM –> may cause fetal death

26
Q

What can velamentous cord insertion cause?

A

If the vessels overlie the cervix –> vasa previa (which can rupture –> blood loss + fetal demise)

27
Q

What is pre-eclampsia?

A

condition w/ HTN + proteinuria

28
Q

How common is pre-eclampsia?

A

affects 5% of pregnancies

29
Q

What are the risk factors for pre-eclampsia?

A

previous, multiple pregnancy, obesity, multipraity, FHx, DM, HTN, hydatidiform moles

30
Q

What are the symtpoms of pre-eclampsia?

A

headache, visual problems, convulsions, respiratory (chest pain, cough, dyspnoea), decreased urine output, RUQ pain

31
Q

what is HELLP syndrome?

A

A complication of pre-eclampsia (life-threatening)

Haemolysis (anaemia), elevated enzymes (LDH/AST/ALT), low platelet count

32
Q

Pre-eclampsia management?

A

Regular maternal and fetal monitoring (e.g. bloods, USS, dOPPLER USS, CTG)

HTN control: labetalol (or nefidipine)

If BP very high –> (prophylactic) anticonvulsants

plan delivery (+ stay for few days post-delivery)

33
Q

What is thought to be the major underlying cause of pre-eclampsia?

A

failed or incomplete differentiation of the cytotrophoblast cells (don’t undergo endothelial transformation)

invasion of maternal blood vessels is rudimentary

spiral arteries remain high resistant (small lumen)

34
Q

what is eclampsia?

A

1+ convulsion superimposed on pre-eclampsia

ABCDE (resusc)
magnesium sulfate (Rx seizure)
Rx HTN: IV labetalol
IV fluids/urine output
delivery only when mother stable (i.e. stable, seizures controlled, HTN controlled)
35
Q

What is cord prolapse? how is it managed until expert help arrives?

A

When UC herniates out of uterus w/ or before the presenting part of the fetus

is you see the cord push baby up to relieve pressure on cord to prevent hypoxia / brain damage

36
Q

define monozygotic twins?

A

Twins that arise from the splitting of 1 zygote

37
Q

Can you get monochorionic dizygotic twins?

A

Yes if the placentas fuse (but the amnions are always separate)

38
Q

how do dizygotic twins differ from monozygotic?

A

only share 50% of their genetic material (like normal brothers and sisters)

39
Q

which body regions are conjoined twins most commonly connected?

A

Thorax, abdomen and sacrum

40
Q

What is the function of oestrogen in pregnancy?

A

uterine growth

41
Q

give 2 risk factors for vasa previa?

A 
velamentous cord insertion (vessels not covered by umb. cord / amnion)
succenturiate lobe (accessory placental lobe)
42
Q

What is the incidence of placental abruption?

A

1/200

43
Q

What types of placental abruption are there?

A

Complete abruption (concealed haemorrhage)

Partial abruption (concealed or revealed haemorrhage)

44
Q

What process means women with placenta previa do not have it by 3rd trimester (resolves)?

A

trophotrophism

45
Q

What placental problem is associated w/ cocaine?

A

Placenta previa

Embryology (clinical Anatomy) (9 decks)

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