Repro - Pathology (Pregnancy conditions) Flashcards
Pg. 576-579 in First Aid 2014 Pg. 525-527 in First Aid 2013 Sections include: -Hydatidiform mole -Hypertension in pregnancy -Pregnancy complications -Amniotic fluid abnormalities
What is a hydatidiform mole?
Cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast).
What is the karyotype in complete versus partial mole?
COMPLETE MOLE: 46,XX; 46,XY; PARTIAL MOLE: 69,XXX; 69,XXY; 69,XYY
What is the hCG level in complete versus partial mole?
COMPLETE MOLE: MARKEDLY increased (four arrows up); PARTIAL MOLE: increased (only one arrow up)
What is the uterine size in complete versus partial mole?
COMPLETE MOLE: Increased; PARTIAL MOLE: No Change
What is the likelihood of conversion to choriocarcinoma in complete versus partial mole?
COMPLETE MOLE: 2%; PARTIAL MOLE: Rare
Are there fetal parts in complete versus partial mole?
COMPLETE MOLE: No; PARTIAL MOLE: Yes (Think: “PARtial = fetal PARTs”)
What are the components in complete versus partial mole?
COMPLETE MOLE: Enucleated egg + single sperm (subsequently duplicates paternal DNA); empty egg + 2 sperm is rare; PARTIAL MOLE: 2 sperm + 1 egg
What is the risk of complications in complete versus partial mole?
COMPLETE MOLE: 15-20% malignant trophoblastic disease; PARTIAL MOLE: Low risk of malignancy (< 5%)
What are the symptoms in complete versus partial mole?
COMPLETE MOLE: Vaginal bleeding, enlarged uterus, hyperemesis, preeclampsia, hyperthyroidism; PARTIAL MOLE: Vaginal bleeding, abdominal pain
What is seen in imaging for complete versus partial mole?
COMPLETE MOLE: Honeycombed uterus or “clusters of grapes”, “snowstorm” on ultrasound; PARTIAL MOLE: Fetal parts
What is another name for gestational hypertension? How is it defined?
Pregnancy-induced hypertension; BP > 140/90 mmHg after the 20th week of gestation. No pre-existing hypertension. No proteinuria or end-organ damage.
What is the treatment for gestational hypertension?
Treatment: antihypertensive (alpha-methyldopa, labetalol, hydralazine, nifedipine), deliver at 39 weeks
How is preeclampsia defined? How is it distinguished from molar pregnancy?
Defined as hypertension (> 140/90 mmHg) and proteinuria (> 300 mg/24 hr) after 20th week of gestation to 6 weeks postpartum (< 20 weeks suggests molar pregnancy).
What are the severe features characteristic of preeclampsia?
Severe features include BP > 160/110 mmHg with or without end-organ damage, e.g., headache, scotoma, oliguria, increased AST/ALT, thrombocytopenia.
What causes preeclampsia? What are 3 possible consequences related to this?
Caused by abnormal placental spiral arteries, results in maternal endothelial dysfunction, vasoconstriction, or hyperreflexia.
In what patient populations is the risk for preeclampsia increased?
Incidence increases in patients with preexisting hypertension, diabetes, chronic renal disease, or autoimmune disorders.
What are complications associated with preeclampsia?
Complications: placental abruption, coagulopathy, renal failure, uteroplacental insufficiency, or eclampsia.
What is the treatment for preeclampsia?
Treatment: Antihypertensives, deliver at 34 weeks (severe) or 37 weeks (mild), IV magnesium sulfate to prevent seizure.
What is eclampsia? What is an important complication to consider?
Preeclampsia + maternal seizures; Maternal death due to stroke –> intracranial hemorrhage or ARDS
What is the treatment for eclampsia?
Treatment: Antihypertensives, IV magnesium sulfate, immediate delivery
What is a manifestation of severe preeclampsia that may occur without hypertension?
HELLP syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets. A manifestation of severe preeclampsia, although may occur without hypertension.
What is the treatment for severe preeclampsia (HELLP syndrome)?
Treatment: immediate delivery
What is placental abruption (abruptio placentae)?
Premature separation (partial or complete) of placenta from uterine wall before delivery of infant.
What are risk factors for placental abruption?
Risk factors: Trauma (e.g., motor vehicle accident), smoking, hypertension, preeclampsia, cocaine abuse.
What is the presentation of placental abruption? What are the more severe complications to consider?
Presentation: Abrupt, painful bleeding (concealed or apparent) in third trimester; possible DIC, maternal shock, fetal distress. Life threatening for mother and fetus.
What causes and defines placenta accreta/increta/percreta? What distinguishes these three? Which is most common?
Defective decidual layer –> abnormal attachment and separation after delivery; Three types distinguishable by the depth of penetration; Placenta accreta = most common type;
What are the risk factors for placenta accreta/increta/percreta?
Risk factors: prior C-section, inflammation, placenta previa.
What is placenta accreta?
Placenta attaches to myometrium without penetrating it; most common type; Think: “Accreta attaches”
What is placenta increta?
Placenta penetrates into myometrium; Think: “Increta into”
What is placenta percreta? What can result in this case?
Placenta penetrates (“perforates”) through the myometrium and into uterine serosa (invades entire uterine wall); can result in placental attachment to rectum or bladder; Think: “Percreta perforates”
What is the presentation of placenta accreta/increta/percreta? What is its severity?
No separation of placenta after delivery –> massive bleeding; Life threatening for mother
What is placenta previa, and where is it located?
Attachment of placenta to lower uterine segment; Lies near (marginal, not shown), partially covers (partial), or completely covers internal os.
What are the risk factors for placenta previa?
Risk factors: multiparity, prior C-section
What complications can result from retained placental tissue?
May cause postpartum hemorrhage, increase risk of infection
Where does ectopic pregnancy most often occur?
Most often in ampulla of fallopian tube
With what history should ectopic pregnancy be expected? What is used to confirm an ectopic pregnancy?
Suspect with history of amenorrhea, lower-than-expected rise in hCG based on dates, and sudden lower abdominal pain; Confirm with ultrasound.
For what is ectopic pregnancy often clinically mistaken?
Often clinically mistaken for appendicitis.
What symptom(s) is/are associated with ectopic pregnancy?
Pain with or without bleeding.
What are the risk factors associated with ectopic pregnancy?
Risk factors: history of infertility, salpingitis (PID), ruptured appendix, prior tubal surgery
What is the definition of polyhydramnios?
> 1.5-2 L of amniotic fluid
What is the definition of oligohydramnios?
< 0.5 L of amniotic fluid
What conditions are associated with polyhydramnios?
Associated with fetal malformations (e.g., esophageal/duodenal atresia, anencephaly; both result in inability to swallow amniotic fluid), maternal diabetes, fetal anemia, multiple gestations.
What conditions are associated with oligohydramnios?
Associated with placental insufficiency, bilateral renal agenesis, or posterior urethral valves (in males) and resultant inability to excrete urine.
What condition can any profound oligohydramnios cause?
Any profound oligohydramnios can cause Potter sequence.
What is the treatment for hydatidiform mole?
Dilation and curettage and methotrexate. Monitor Beta-hCG.
