Some Common Pathologies of Pregnancy Flashcards
When during the hormonal cycle does Oestrogen peak
Day 14
When during the hormonal cycle does Progesterone peak
Day 21
If progesterone continues to rise after the 21st day what has occurred
Egg has been fertilised
Progesterone’s effect on Endometrium
- Thickens lining
- Changes cells
- Increases vascularity
- Stromal cells enlarge and become procoagulant => stops bleeding
Egg AKA?
Chorion
What type of cell is the outer edge of chorion composed of
Trophoblast cells
What hormone is released by Trophoblasts
Beta-human Chorionic Gonadotropin (B-hCG)
What is the target of Beta-human Chorionic Gonadotropin (B-hCG)
Corpus luteum in ovary
What is the function of B-hCG
-Stimulates corpus luteum to produce progesterone, which stops decidua from shedding
What is B-hCG used for clinically
Forms basis of pregnancy test
When does B-hCG start to get produced
~6days after pregnancy
Where are Decidual Stromal cells located
Between vessels
What do trophoblast do
- Stream off to invade Mother’s blood vessels
- Eventually link those vessels with the foetus’
What are projections of chorion called
Chorionic villi
What is the function of chorionic villi
- 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
What stops the invasion of trophoblasts causing severe bleeding
The procoagulant properties of the decidual cells
Case 1
- Woman, 26yrs
- Misses period
- Pregnancy test positive
- Vaginal bleeding 7 weeks after missed period
What has probably happened
Miscarriage
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
- Miscarriage
- Removal of remaining tissue by obstetrician
Case 1
Causes of miscarriage
-Unknown in this case (which is very common)
- Chromosomal abnormality
-Infection
-Maternal issues;
Ill-health
Trauma
Hormonal problems
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 ?
- Ectopic Pregnancy
- Considered using methotrexate but opted for surgical removal of fallopian tube
Case 2
What is checked at follow up
B-hCG
Case 3
- Woman, 23 yrs
- Sudden, severe, abdo pain
- Collapses
- A&E admission => Tachycardic + Hypotensive
Immediate treatment, next step in management and suspected diagnosis
- Give blood
- Emergency laparotomy
- Ruptured ectopic pregnancy + ?Appendicitis?
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
Ruptured Ectopic Pregnancy
Case 3
What is checked at follow up
- B-hCG
- Is raised post-op but returns to normal, woman is well 3 weeks later
Symptoms of an Ectopic Pregnancy
- 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
Symptoms of a ruptured ectopic
- Sharp, sudden and intense abdo pain
- Feeling verydizzy orfainting
- Nausea
- Looking very pale
- Tachycardia
- Hypotension
