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Reproduction > Some Common Pathologies of Pregnancy > Flashcards

Some Common Pathologies of Pregnancy Flashcards

1
Q

When during the hormonal cycle does Oestrogen peak

A

Day 14

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2
Q

When during the hormonal cycle does Progesterone peak

A

Day 21

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3
Q

If progesterone continues to rise after the 21st day what has occurred

A

Egg has been fertilised

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4
Q

Progesterone’s effect on Endometrium

A
  • Thickens lining
  • Changes cells
  • Increases vascularity
  • Stromal cells enlarge and become procoagulant => stops bleeding
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5
Q

Egg AKA?

A

Chorion

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6
Q

What type of cell is the outer edge of chorion composed of

A

Trophoblast cells

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7
Q

What hormone is released by Trophoblasts

A

Beta-human Chorionic Gonadotropin (B-hCG)

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8
Q

What is the target of Beta-human Chorionic Gonadotropin (B-hCG)

A

Corpus luteum in ovary

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9
Q

What is the function of B-hCG

A

-Stimulates corpus luteum to produce progesterone, which stops decidua from shedding

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10
Q

What is B-hCG used for clinically

A

Forms basis of pregnancy test

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11
Q

When does B-hCG start to get produced

A

~6days after pregnancy

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12
Q

Where are Decidual Stromal cells located

A

Between vessels

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13
Q

What do trophoblast do

A
  • Stream off to invade Mother’s blood vessels

- Eventually link those vessels with the foetus’

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14
Q

What are projections of chorion called

A

Chorionic villi

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15
Q

What is the function of chorionic villi

A
  • Chorionic villi, covered in trophoblasts, invade into the decidua
  • Eventually the chorionic villi, covered in trophoblasts, are bathed in the mother’s blood and form the forerunner of the placenta
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16
Q

What stops the invasion of trophoblasts causing severe bleeding

A

The procoagulant properties of the decidual cells

17
Q

Case 1

  • Woman, 26yrs
  • Misses period
  • Pregnancy test positive
  • Vaginal bleeding 7 weeks after missed period

What has probably happened

A

Miscarriage

18
Q

Case 1

US scan shows no foetus but membranes and decidua lining uterus still there

What does this confirm and what is the next step in management

A
  • Miscarriage

- Removal of remaining tissue by obstetrician

19
Q

Case 1

Causes of miscarriage

A

-Unknown in this case (which is very common)
- Chromosomal abnormality
-Infection
-Maternal issues;
Ill-health
Trauma
Hormonal problems

20
Q

Case 2

  • Woman, 32 yrs
  • Misses period
  • 8 weeks pregnant
  • Small amount of bleeding per vagina
  • BhCG raised
  • US = Thickened endometrium + expanded fallopian tube on 1 side

Diagnosis? Next step in management ?

A
  • Ectopic Pregnancy

- Considered using methotrexate but opted for surgical removal of fallopian tube

21
Q

Case 2

What is checked at follow up

A

B-hCG

22
Q

Case 3

  • Woman, 23 yrs
  • Sudden, severe, abdo pain
  • Collapses
  • A&E admission => Tachycardic + Hypotensive

Immediate treatment, next step in management and suspected diagnosis

A
  • Give blood
  • Emergency laparotomy
  • Ruptured ectopic pregnancy + ?Appendicitis?
23
Q

Case 3

Emergency laparotomy shows

  • Several litres of blood in abdomen
  • Blood flowing from fallopian tube area
  • Clamped and sent to path
  • Results = Blood, fragments of fallopian tube and occasional chorionic villi

Diagnosis

A

Ruptured Ectopic Pregnancy

24
Q

Case 3

What is checked at follow up

A
  • B-hCG

- Is raised post-op but returns to normal, woman is well 3 weeks later

25
Q

Symptoms of an Ectopic Pregnancy

A
  • Vaginal bleeding (often starts and stops, may bewatery and dark brown in colour)
  • Abdo pain (typically low down onone side. It can develop suddenly or gradually, and may be persistent or come and go)
  • Shoulder tip pain (usually a sign the ectopic is causing internal bleeding)
  • Discomfort during urination and/or defecation, may also have diarrhoea
26
Q

Symptoms of a ruptured ectopic

A
  • Sharp, sudden and intense abdo pain
  • Feeling verydizzy orfainting
  • Nausea
  • Looking very pale
  • Tachycardia
  • Hypotension

Reproduction (22 decks)

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