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FA - Reproductive > Repro - Pathology (Pregnancy conditions) > Flashcards

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

1
Q

What is a hydatidiform mole?

A

Cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast).

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2
Q

What is the karyotype in complete versus partial mole?

A

COMPLETE MOLE: 46,XX; 46,XY; PARTIAL MOLE: 69,XXX; 69,XXY; 69,XYY

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3
Q

What is the hCG level in complete versus partial mole?

A

COMPLETE MOLE: MARKEDLY increased (four arrows up); PARTIAL MOLE: increased (only one arrow up)

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4
Q

What is the uterine size in complete versus partial mole?

A

COMPLETE MOLE: Increased; PARTIAL MOLE: No Change

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5
Q

What is the likelihood of conversion to choriocarcinoma in complete versus partial mole?

A

COMPLETE MOLE: 2%; PARTIAL MOLE: Rare

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6
Q

Are there fetal parts in complete versus partial mole?

A

COMPLETE MOLE: No; PARTIAL MOLE: Yes (Think: “PARtial = fetal PARTs”)

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7
Q

What are the components in complete versus partial mole?

A

COMPLETE MOLE: Enucleated egg + single sperm (subsequently duplicates paternal DNA); empty egg + 2 sperm is rare; PARTIAL MOLE: 2 sperm + 1 egg

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8
Q

What is the risk of complications in complete versus partial mole?

A

COMPLETE MOLE: 15-20% malignant trophoblastic disease; PARTIAL MOLE: Low risk of malignancy (< 5%)

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9
Q

What are the symptoms in complete versus partial mole?

A

COMPLETE MOLE: Vaginal bleeding, enlarged uterus, hyperemesis, preeclampsia, hyperthyroidism; PARTIAL MOLE: Vaginal bleeding, abdominal pain

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10
Q

What is seen in imaging for complete versus partial mole?

A

COMPLETE MOLE: Honeycombed uterus or “clusters of grapes”, “snowstorm” on ultrasound; PARTIAL MOLE: Fetal parts

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11
Q

What is another name for gestational hypertension? How is it defined?

A

Pregnancy-induced hypertension; BP > 140/90 mmHg after the 20th week of gestation. No pre-existing hypertension. No proteinuria or end-organ damage.

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12
Q

What is the treatment for gestational hypertension?

A

Treatment: antihypertensive (alpha-methyldopa, labetalol, hydralazine, nifedipine), deliver at 39 weeks

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13
Q

How is preeclampsia defined? How is it distinguished from molar pregnancy?

A

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).

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14
Q

What are the severe features characteristic of preeclampsia?

A

Severe features include BP > 160/110 mmHg with or without end-organ damage, e.g., headache, scotoma, oliguria, increased AST/ALT, thrombocytopenia.

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15
Q

What causes preeclampsia? What are 3 possible consequences related to this?

A

Caused by abnormal placental spiral arteries, results in maternal endothelial dysfunction, vasoconstriction, or hyperreflexia.

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16
Q

In what patient populations is the risk for preeclampsia increased?

A

Incidence increases in patients with preexisting hypertension, diabetes, chronic renal disease, or autoimmune disorders.

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17
Q

What are complications associated with preeclampsia?

A

Complications: placental abruption, coagulopathy, renal failure, uteroplacental insufficiency, or eclampsia.

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18
Q

What is the treatment for preeclampsia?

A

Treatment: Antihypertensives, deliver at 34 weeks (severe) or 37 weeks (mild), IV magnesium sulfate to prevent seizure.

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19
Q

What is eclampsia? What is an important complication to consider?

A

Preeclampsia + maternal seizures; Maternal death due to stroke –> intracranial hemorrhage or ARDS

20
Q

What is the treatment for eclampsia?

A

Treatment: Antihypertensives, IV magnesium sulfate, immediate delivery

21
Q

What is a manifestation of severe preeclampsia that may occur without hypertension?

A

HELLP syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets. A manifestation of severe preeclampsia, although may occur without hypertension.

22
Q

What is the treatment for severe preeclampsia (HELLP syndrome)?

A

Treatment: immediate delivery

23
Q

What is placental abruption (abruptio placentae)?

A

Premature separation (partial or complete) of placenta from uterine wall before delivery of infant.

24
Q

What are risk factors for placental abruption?

A

Risk factors: Trauma (e.g., motor vehicle accident), smoking, hypertension, preeclampsia, cocaine abuse.

25
Q

What is the presentation of placental abruption? What are the more severe complications to consider?

A

Presentation: Abrupt, painful bleeding (concealed or apparent) in third trimester; possible DIC, maternal shock, fetal distress. Life threatening for mother and fetus.

26
Q

What causes and defines placenta accreta/increta/percreta? What distinguishes these three? Which is most common?

A

Defective decidual layer –> abnormal attachment and separation after delivery; Three types distinguishable by the depth of penetration; Placenta accreta = most common type;

27
Q

What are the risk factors for placenta accreta/increta/percreta?

A

Risk factors: prior C-section, inflammation, placenta previa.

28
Q

What is placenta accreta?

A

Placenta attaches to myometrium without penetrating it; most common type; Think: “Accreta attaches”

29
Q

What is placenta increta?

A

Placenta penetrates into myometrium; Think: “Increta into”

30
Q

What is placenta percreta? What can result in this case?

A

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”

31
Q

What is the presentation of placenta accreta/increta/percreta? What is its severity?

A

No separation of placenta after delivery –> massive bleeding; Life threatening for mother

32
Q

What is placenta previa, and where is it located?

A

Attachment of placenta to lower uterine segment; Lies near (marginal, not shown), partially covers (partial), or completely covers internal os.

33
Q

What are the risk factors for placenta previa?

A

Risk factors: multiparity, prior C-section

34
Q

What complications can result from retained placental tissue?

A

May cause postpartum hemorrhage, increase risk of infection

35
Q

Where does ectopic pregnancy most often occur?

A

Most often in ampulla of fallopian tube

36
Q

With what history should ectopic pregnancy be expected? What is used to confirm an ectopic pregnancy?

A

Suspect with history of amenorrhea, lower-than-expected rise in hCG based on dates, and sudden lower abdominal pain; Confirm with ultrasound.

37
Q

For what is ectopic pregnancy often clinically mistaken?

A

Often clinically mistaken for appendicitis.

38
Q

What symptom(s) is/are associated with ectopic pregnancy?

A

Pain with or without bleeding.

39
Q

What are the risk factors associated with ectopic pregnancy?

A

Risk factors: history of infertility, salpingitis (PID), ruptured appendix, prior tubal surgery

40
Q

What is the definition of polyhydramnios?

A

> 1.5-2 L of amniotic fluid

41
Q

What is the definition of oligohydramnios?

A

< 0.5 L of amniotic fluid

42
Q

What conditions are associated with polyhydramnios?

A

Associated with fetal malformations (e.g., esophageal/duodenal atresia, anencephaly; both result in inability to swallow amniotic fluid), maternal diabetes, fetal anemia, multiple gestations.

43
Q

What conditions are associated with oligohydramnios?

A

Associated with placental insufficiency, bilateral renal agenesis, or posterior urethral valves (in males) and resultant inability to excrete urine.

44
Q

What condition can any profound oligohydramnios cause?

A

Any profound oligohydramnios can cause Potter sequence.

45
Q

What is the treatment for hydatidiform mole?

A

Dilation and curettage and methotrexate. Monitor Beta-hCG.

FA - Reproductive (18 decks)

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