reproductive pathology 2 Flashcards
pregnancy complications - types
- placental abruption (abruptio placentae)
- Placenta accreta/increta/percreta
- Placental previa
- Vasa previa
- Postpartum hemorrhage
- Ectopic pregnancy
- hypertension
placental abruption (abruptio placentae) - definition
premature separation (partial or complete) of placenta from uterine wall before delivery of infant
placental abruption (abruptio placentae) - risk factors
- trauma (eg. motor vehicle accident)
- smoking
- cocaine abuse
- hypertension
- preeclampsia
placental abruption (abruptio placentae) - presentation
- abrupt, painful bleeding (concealed or apparent) in 3 third trimester
- possible DIC
- materna shock
- fetal distress
- Life threatening for mother and fetus
Placenta accreta/increta/percreta general mechanism and results
defective decidual layer –> abnormal attachment and separation after delivery
Placenta accreta/increta/percreta - types (distinguished by) and MC
distinguishable by depth of penetration:
- Placenta accreta (MC)
- Placent increta
- Placenta percreta
Placenta accreta?
placenta attaches to myometrium without penetrating it
Placenta increta?
placenta panetrates INTO myometrium
Placenta percreta?
placenta penetrates myometrium and into uterine serosa (invades entire uterine wall) –> can result in placental attachment to rectum or bladder
Placenta accreta/increta/percreta - types, definition of every type and MC
- Placenta accreta (MC) –> placenta attaches to myometrium without penetrating it
- Placent increta –> placenta panetrates INTO myometrium
- Placenta percreta –> placenta penetrates myometrium and into uterine serosa (invades entire uterine wall) –> can result in placental attachment to rectum or bladder
Placenta accreta/increta/percreta - presentation
- often detecten on US prior to delivery
2. no separation of placenta after delivery –> postpartum bleeding (can cause Sheehan syndrome)
Placenta accreta/increta/percreta - risk factors
- prior C section
- inflammation
- placenta previa
Placenta previa?
attachment of placenta to lower uterine segment over (or less than 2 cm from) internal cervical os
Placenta previa - risk factors
- multiparity
2. prior C-secion
Placenta previa can also cause
Placenta accreta/increta/percreta
Placenta previa - types
compete –> covers all the os
partial –> covers not the entire os
Vasa previa?
fetal vessels run over, or in close proximity to, cervical os
Vasa previa - results in
- vessel rupture
- exsanguination (blood loss, to a degree sufficient to cause death)
- fetal death
Vasa previa - presentation
TRIAD
- membrane rupture (rupture of the amniotic sac)
- painless vaginal bleeding
- fetal bradycardia (less than 110 beats/min)
Vasa previa - management
emergency C-section
Vasa previa is frequently associated with
velamentous umbilical insertion
velamentous umbilical insertion?
cord inserts in chorioamniotic membrane rather than placenta –> fetal vessels travel to placenta unprotected by Wharton jelly
Postapartum haemorrhage is due to (and MC)
mnemonic 4Ts Tone uterine atony (MC) Trauma - lacerations, incisions, uterine rupture Thrombin - coagulopathy Tissue - retaind products of conception
uterine atony –> hemorrhage - mechanism
Normally, contraction of the uterine muscle compresses the vessels and reduces flow
ectopic pregnancy - presentation
- pain (clinically mistaken by appendicitis)
2. bleeding (+/-)
ectopic pregnancy - risk factors
- prior ectopic pregnancy
- history of infertility
- salpingitis (PID)
- Ruptured appendix
- Prior tubal surgery
ectopic pregnancy - confirm diagnosis with
US
ectopic pregnancy - suspect it when
- history of amenorrhea
- lower tha excpected rise in hCG (based on dates)
- sudden lower abdominal pain
ectopic pregnancy - most often area
Ampulla of fallopian tube
treatment of an ectopic pregnancy is necessary to
prevent serious , even life threatening complications
Amniotic fluid abnormalities - types and defintion
- Polyhydramnios: too much amniotic fluid
2. Oligohydramnios: too little amniotic fluid
causes of polyhydramnions
- fetal malformations (eg. esophageal/duodenal atresia, anencephaly –>both inability to swallow amniotic fluid)
- maternal diabetes
- fetal anemia
- multiple gestations
causes of oligohydramnios
- placental insuficiency
- bilateral renal agenesis
- posterior urethral valves (males)
- ARPKD
(inability to excrete urine)
oligohydramnios - complications
POTTER sequence
Potter sequence (syndrome) - presentation
- limb deformites
- facial anomalies (low set ears, retrognathia, flattened nose)
- pulmonary hypoplasia