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Pathology > Weibliche Geschlechtsorgane - Diseases Of Pregnancy > Flashcards

Weibliche Geschlechtsorgane - Diseases Of Pregnancy Flashcards

0
Q

Placental inflammations and infections

How do the most infection reach the placenta?

With what are these olacental infections often associated?

A

Ascensing infections are by far the more common!!

In the most cases, these infections are bacterial and are associated with premature reputure of the fetal membranes!

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1
Q

Placental inflammations and infections

Name the two pathos how infections may reach the placenta?

A
  1. ascension (Aufstieg) through the birth canal

2. hematogenous spread

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2
Q

Placental inflammations and infections - ascending infections

  1. How does the inflammated placenta looks microscopically?
  2. What happens with the extension beyond the membranes?
  3. What are the pathogens of the ascending infections?
A

1.

  • the chorioamnion shows neutrophilic infiltration
  • associated with edema

2.

  • the infection may involve the umbilical cord and placental villi
  • > acute vasculitis of the cord (Nabel) = funisitis

3.

  • Mycoplasma
  • Candida
  • numerous bacteria of vaginal flora
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3
Q

Placental inflammations and infections - hematogenous spread

  1. What part of placenta is most frequently affected by a
    hematogenous infection?
  2. What are the pathogen of the hematogenous infection?
  3. What can hematogenous pathogen do, too?
A
  1. placental villi -> villitis

2.

  • syphilis
  • tuberculosis
  • listeriosis
  • tocoplasmosis
  • various viruses -> cytomegalovirus, rubella, HSV

3.
Transplacental infection can affect the fetus and give rise to the TORCH (toxoplasmosis, other infections, rubella,
cytomegalovirus infections, herpes)

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4
Q

Ectopic pregnancy

Ectopic pregnancy is defined an implantation of a fertilized ovum
In any other side than the uterus

  1. How often is a ectopic pregnancy?
  2. Where does the implantation occus?
A
  1. 1% of pregnancies
    • 90% occurs in the oviducts (tubal pregnancy)
    • ovaries
    • abdominal cavity
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5
Q

Ectopic pregnancy

What increases the chance of ectopic pregnancy?

What is the reason for 50% of all ectopic pregnancies?
Name other reasons!

A

Any factor that retards passage of the ovum through the oviducts
predisposes to ectopic pregnancy

In about half of the cases, slowed passage is attributable to chronic inflammation and scarring in the oviduct

Note that intrauterine tumors and endometriosis may also hamper passage of the ovum
-> In the other 50% of tubal prgnancies, no anatomic cause is
evident

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6
Q

Ectopic pregnancy

Name the probable reason for ovarian pregnancies!

A

Probably, ovarian pregnancies result from rare instances in which
the ovum is fertilized just as the follicle ruptures

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7
Q

Ectopic pregnancy

Gestation (Schwangerschaft) within the abdominal cavity occurs when?

A

When the fertilized egg drops out of the fimbriated end of the oviduct (Eileiter) and implants of the peritoneum

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8
Q

Ectopic pregnancy

Describe the morphology of the tubal pregnancy!

A

There is formation of placental tissue

The invading placenta ecentually burrows (graben) through the
wall of the oviduct, causing:
- intratubal hematoma (hematosalpinx)
- intraperitoneal hemorrhage

  • maybe you can see histological placental villi or, rarely, the
    embryo
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9
Q

Ectopic pregnancy

What does rupture of an ectopic pregnancy may cause?

A

Rupture of an ectopic pregnancy is a medical emergency that, if
left untreated, may result in exsanguination(Verblutung)
and death

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10
Q

Gestational trophoblastic disease

  1. Name the three morphologic categories of gestational
    trophoblastic disease?
  2. What do they have all in common?
A

1.

  • hydatidform mole (Blasen oder Traubenmole)
  • invasive mole
  • choriocarcinoma
  1. high hCG (human chorionic gonadotropin)
    With higher concentration in blood and urine than in normal
    pregnant women
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11
Q

Gestational trophoblastic disease - hydatidiform mole

  1. What are hydatidiform moles?
  2. Tell something about their gen!
A

1.
- a voluminous mass of swollen, sometimes cystically dilated,
chorionic villi (Zotten)
- these swollen villi are covered by varying amounts of normal
to highly atypical chorionic epithelium

  1. there are to kinds of hydatidform moles: complete and partial
    - complete: never contain fetal parts; chorionic epithelial cells are
    diploid 46,XX (rarely 46,XY)
    - partial: may contain fetal parts; triploid e.g. 69,XXY

–> both types result from abnormal fertilization

Blasenmole: hydropisch-ödematöse Degeneration der Chorionzotten der Plazenta mit Ausbildung von flüssigkeitsgefüllten Blasen, die traubenförmig angeordnet sind.
Proliferation der Zyto- und Synzytiotrophoblasten
-> absterben der Embryonalanlage

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12
Q

Gestational trophoblastic disease - invasive hydatidiform mole

What is a invasive mole?

A

Invasive hydatidiform mole, also known as invasive mole and chorioadenoma destruens is a type of cancer that grows into the muscular wall of the uterus. It is formed after conception (fertilization of an egg by a sperm). It may spread to other parts of the body, such as the vagina, vulva, and lung.

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13
Q

Gestational trophoblastic disease - gestational choriocarcinoma

  1. Where is the choriocarcinoma from?
A

1.

  • from gestational chronic epithelium
  • less frequently from totipotential cells = (Als omnipotent bezeichnet man Stammzellen, die die Fähigkeit haben, sich in alle Zelltypen eines Organismus differenzieren zu können, bzw. sich zu einem kompletten, lebensfähigen Organismus zu entwickeln. Ein Beispiel für omnipotente Stammzellen sind befruchtete Eizellen.)
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14
Q

Gestational trophoblastic disease - gestational choriocarcinoma

  1. Wie heißt choriocarcinoma in deutsch?
  2. How ofter are choriocarcinoma?
  3. What is the precursor of this disease?
  4. What parameter is high when a women has a choriocarcinoma?
A
  1. Chorionepitheliom oder chorionkarzinom
  2. In the west: 1 per 30000 pregnancies
    In Asia and Africa 1 per 2000 pregnancies
  3. 50% the choriocarcinoma arises from complete hydatidifrom
    moles; about 25% arise after abortion
  4. Beta-hCG in blood and urine
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15
Q

Gestational trophoblastic disease - gestational choriocarcinoma

  1. How does a choriocarcinoma appears in the uterus?
  2. How does a choriocarcinoma spread?
A
  1. It apears as hemorrhagic, necrotic uterine mass
    - –> sometimes the necrosis is so extensive that little tumor remains or only metastases tell the story
2. very earlx, the tumor insinuates itself into (einschleichen) the
    myometrium and into vessels
Metastasis:
- Lung 50%
- Vagina 30-40%
- brain
- liver
- kidney
- uncommon: lymphatic invasion
16
Q

Gestational trophoblastic disease - gestational choriocarcinoma

  1. How do you therapy?
  2. What is the prognosis?
A
  1. chemotherapy

2.
- the tumor and the metastases are very sensitiv to chemotherapy
-> nearly 100% of affected patients are cured, even those with
metasases at distant sites as the lungs

[If the choriocarcinoma arises in the gonads like ovary or testis, it responses poorly to chemotherapy. -> probabely because of the parental antigens on placental choriocarcinoma]

17
Q

Preeclampsia

  1. What is the trias of the preclampsia symptoms?
  2. What are the secondary symptoms?
A
    • Hypertension
    • Proteinuria
    • Edema
  2. vertigo (dizziness), Headache, visual defects, nausea, puke
18
Q

Preeclampsia

  1. What parameters are increased?
  2. How frequently does preclampsia occur?
  3. What are the risks of preclampsia?
A
  1. Liver-parameter (in 20% of the cases):
    • bilirubin
    • Transaminasen
    • AP (Alkaline phosphatase)
  2. 5-10%

3.

  • Women over 35 years of age
  • primipara (Erstgebärende)
  • multiples (Mehrlinge)
  • obesity or diabetes
19
Q

Preeclampsia

  1. Therapy: Don’t does!
  2. Emergency therapy!
A

1.
- RR not under 140/90
- no salt-diet (deterioration/Verschlechterung of the mother’s and
child’s condition)

  1. Aortion or Caesarean -> premature birth
20
Q

Preeclampsia

  1. What may happen in the placenta?
  2. What does Preclampsia may cause?
A
  1. They are abnormalies in maternal and placental blood flow.
    This may result placental ischemia and infarction and
    abnormalities in production of vasodilatorThe decreases uteroplacental blood-flow result in placental
    hypoxia, placental dysfunction, and a shift to a systemic
    antiangiogenic state(Antiangiogenese)
    -> increase of sFlt1, sEng
    -> reduction of VEGF

2.

  • > eclampsia
  • > HELLP-Syndrom
21
Q

Eclampsia

  1. What symptom are there?
A
  1. in addition to the preeclampsia, eclampsia causes:
    • seizures
    • End-organ failure -> kidney and liver // may be fatal

Pathology (12 decks)

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