repro 5 Flashcards
ectopic pregnancy
implantation at any site outside of the endometrium
increased risk PID, adhesions, IUD, endometriosis
pain, shock, vaginal bleeding, death
ruptured ectopic
is an emergency
early pregnancy
spontaneous abortion and miscarriage is common
common
foetal chromosomal abnormalities, maternal endocrine factors, physical uterus problems, maternal vasculature problems
infection
late pregnancy
foetal death less common
interruption of blood flow - knots or compression of cord
implantation problems - previa (implants low over the os) , accrete , increta (invading into muscle wall) and percreta (implants through full thickness of the wall)
abruption which can be hidden or visible (where placenta pulls away from the implantation into the endometrium)
malperfusion - preeclampsia, smoking, infarcts
twin pregnancy
monochorionic twin placentas have vascular anastomoses connecting twins circulations, there may include one or more arteriovenous shunts
if the shunts preferentially increase blood flow to one twin at the expense of the other, one twin is under-refused and the other is fluid overloaded
if severe, death of one or both foetuses
dichorionic diamnionic
different amniotic sac and chorions
monochorionic diamnionic
identical twins
monochorionic mono amniotic twins
both babies are in the same sac
at risk of vascular anastomoses - where one twin may get more blood supply
placenta infections
develop either by ascending through the birth canal, or by haematogenous spread
ascending infections
predominantly bacterial, ascend through the os
localised infection in membranes
premature rupture and preterm delivery
haematogenous infections
TORCH group
toxoplasmosis, Others (syphilis, listeria), Rubella, CMV, Herpes simplex
preeclampsia and eclampsia
a systemic syndrome characterised by widespread maternal endothelial dysfunction in pregnancy with HTN, oedema and proteinuria
more common in first time others
eclampsia
seizures/convulsions
HELLP syndrome
variant of preeclampsia
microangiopathic haemolytic anaemia, raised LLFT, low platelets
harder to diagnose and has higher mortality rate
cure for preeclampsia and HELLP
delivery
gestational trophoblastic disease
tumour/tumour like condition with proliferation of placental tissue, either villous or trophoblastic
complete/partial hydatidiform moles, invasive mole, choriocarcinoma and placental site trophoblastic tumour
hydatidiform moles have increased risk of invasive mole (aka persistent trophoblastic disease)
formation of molar pregnancies
complete mole - sperm fertilises empty egg, lead to large grape like structures. risk of developing into choriocarcinoma or persistent trophoblastic disease
partial mole - forms when two perm fertilise an egg with genetic information, light risk of persistent trophoblastic disease but not of choriocarcinoma
invasive mole - penetrates uterus wall and can embolism to lungs and other sites, responds when too cheomo
gestational choriocarcinoma
formation of molar pregnancies
complete mole - sperm fertilises empty egg, lead to large grape like structures. risk of developing into choriocarcinoma or persistent trophoblastic disease
partial mole - forms when two perm fertilise an egg with genetic information, light risk of persistent trophoblastic disease but not of choriocarcinoma
invasive mole - penetrates uterus wall and can embolism to lungs and other sites, responds when too cheomo
gestational choriocarcinoma
can occur after mole, miscarriage or pregnancy
haematogenous spread, lungs, vagina
response well to chemo - unlike non gestational choriocarcinoma
