Some common pathologies of pregnancy Flashcards
1
Q
What has occurred when progestogen has kept rising
A
- Egg has been fertilised by sperm
- Trophoblast on exterior of fertilised egg produces b-hCG (beta human gonadotropic hormone)
- b-hCG signals corpus luteum to continue producing progestogen
- Overall prevents endometrium from shedding
2
Q
b-hCG
A
- Produced by trophoblast cells lining the chorion
- Trophic hormone that targets the corpus luteum
- Stimulates corpus luteum to produce progestogen → prevents decide from shedding
- Provides basis for the pregnancy test → targets b-hCG
3
Q
Chorionic villi
A
- Finger-like projections of the chorion covered in trophoblast cells
- Moves into the decidua and forms basis of early placenta
4
Q
- Woman, 26 years old
- Missed period
- Positive pregnancy test
- Vaginal bleeding for 7 weeks after missing period
A
- Miscarriage
- No foetus present in ultrasound but membranes and decidua lining of the uterus present
- Remaining tissue sent to pathology
- No further complications, b-hCG returns to normal (zero
5
Q
Causes of miscarriages
A
- Unknown
- Chromosomal abnormality
- Infection
- Maternal issues (trauma, ill-health, hormonal irregularities)
6
Q
- Woman, 32 years old
- Missed period
- 8 weeks pregnancy → small amount of vaginal bleeding
A
- Ectopic pregnancy
- Raised b-hCG
- Ultrasound: thickened endometrial lining of cavity, expanded Fallopian tube on one side
- Consider methotrexate or operative Fallopian tube removal
7
Q
- Woman 23 years old
- Sudden severe abdominal pain and collapses
- Admitted to A & E
- Fast pulse, low BP → shock (susceptive hypovolemic)
A
- Treatment
- Blood transfusion
- Emergency laparotomy
- Pathology
- Several litres of blood in abdominal
- Blood flowing from Fallopian tube → clamped and removed
- Microscopy: Fragments fallopian tube with placenta and sac
- Diagnosis: ruptured ectopic pregnancy
- Follow-up: raised b-hCG after operation, returns to normal and well within 3 weeks
8
Q
Ectopic pregnancy
A
- Pregnancy in wrong abdominal site (fallopian tube, peritoneal cavity, uterine cavity)
- Lack of proper decidual layer
- Risk: small size of tubes
- Asymptomatic early → unknown that she is pregnant
9
Q
- 32 year old woman
- Positive pregnancy test
- 7 weeks pregnancy with minor bleeding
- Ultrasound: placental tissue in uterine cavity, no fetus, normal fallopian times
- Raised b-hCG
A
- Diagnosis: miscarriage
- Removal of endometrial tissue
- Pathology: large chorionic villi macroscopically visible as vesicles (small grapes)
- Cause: molar pregnancy
10
Q
Molar pregnancy
A
- Non-viable pregnancy with an overgrowth of trophoblast cells and large chorionic villi
- A form of pre-cancer of trophoblast cells
- Persistent form leads to choriocarcinoma
11
Q
What causes molar pregnancy
A
- 2 sperm fertilising egg with no chromosomes
- Leads to imbalance in methylated (switched off genes)
- Too much of male methylated genes leads to placental overgrowth → massive trophoblast cell proliferation
12
Q
Treatment of molar pregnancy
A
- If b-hCG returns to normal → no further treatmetn
- If b-hCG stays high (persistent disease → methotrexate
13
Q
- 40 year old woman
- 10 weeks pregnancy
- Scan: nuchal thickening
A
- Amniocentesis: trisomy 21 (Down syndrome)
- Termination of pregnancy for abnormality (TOPFA) at 20 weeks
- Post mortem
- Single palmar crease
- Duodenal atresia
- Epicanthic folds
- Protuberant tongue
14
Q
Decision for a TOPFA for pregnancy pathologies
A
- Up to the parents
- Must weigh up quality of life with continuing pregnancy
15
Q
Poorly controlled diabetes
A
- 28 year old mother poorly controlled diabetes mellitus
- Pregnancy sign well until 36 weeks → baby stops kicking
- Scan: No foetal heart movement = Intrauterine death (IUD)
- Trial of labour attempted baby too big → Caesarean section
- Post-mortem: large baby with broad shoulders → diabetic cherub
