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48 Cards in this Set
- Front
- Back
whats the chorion |
its part of the baby that gets into decidua of placenta
if twins with one chroion its always monozygotic the chorion surrounds the amnion and the amnion surrounds the baby |
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define abortion
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fetal death <20 weeks
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what causes spontaneous abortion
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MUST BE BEFORE 12 weeks
super common Mom SLE, DM, HTN, uterine abnormality, hormone imbalance, infections FETAL: (more common than maternal) chromosomal abnormalities, |
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what are hte types of abortion
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fetal expulsion <20 weeks
1. spontaneous- "miscarriage" BEFORE 12 weeks 2. threatened- sx of abortion, closed cervix 3. habitual- 3 or more losses at same time in preggo 4. Complete- decidual cast, gestational sac in fetus 5. Incomplete- sac remains, bleeding will stop when POC are removed 6. inevitable- POC in cervix 7. missed- retained POC |
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what does this mean
1. gravid 2. para 3. POG1 P1G3A1 multigensational |
gravid: # times pregnant
para: # babies delivered P0G1- preg w/first kid. no previous abortion P1G3A1: has one kid, one abortion and currently preggo Multigestational: had twins, NOT the same as multiparosu |
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does endometriosis and PCOD lead to infertility
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yep, PID too
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what is teh msot common site of ectopic preggo
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fallopian tube
salpingocyesis **fertilization SHOULD happen in tube but NOT implantation |
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what are risk factors for ectopic
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PID
endometriosis Adhesions IUD |
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a woman w/an ectopic will present how
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1. placental seperation-
2. MASSIVE HEMORRHAGE if rupture BLEEDING, ABD pain, usually occurs 6 weeks from LMP |
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what is salpingocyesis
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tubal preggo
most common site of ectopic |
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• AC is a 38 y/o gravida 5 para 2 female is seen in
her doctor’s office for vaginal bleeding, abdominal cramps and back pain on Feb. 16. Her pregnancy test is positive. • Her LMP was Dec. 20. She started spotting intermittently on Feb.1 and began heavy bleeding one week later. History: 2 living children, one spontaneous abortion and a salpingectomy 2 years earlier for ectopic pregnancy of the left fallopian tube. • She had gonorrhea 20 years earlier. Ultrasound reveals an ectopic pregnancy of the right adnexa and a left ovarian cyst. • At emergency surgery, a 4 cm gestational sac of the ruptured right fallopian tube hold a fetus consistent with 5‐6 wks. gestational size. There i is a corpus luteum of the left ovary. • The left adnexa is encased in adhesions Salpingectomy is performed how is salpingocyesis dx |
HCG
US NO CHRORIONIC VILLI |
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what are the risk factors for pre-eclampsia
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first time preg w/a guy
multiple gestation molar preg HTN DM Obses AI **the placenta is ischemic |
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what is the clinical of pre-eclampsia
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edema
HTN proteinuria **its a big deal bc when it progresses to eclampsia it --> seizures **its when maternal blood to placenta is decreased and there is placental ischemia AFTER 34 WEEKS |
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what are some complications of pre-eclampsia
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placenta- small, decidual arthrosis, infarct
fetus- IUGR, SGA, hypoxic, increased morbidity/mortality Maternal: DIC, HELLP, Eclampsia, renal, hepatic, cerebral disease AFTER 34 WEEKS |
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in pre eclampsia what do these things look like
1. decidual arteries 2. placenta 3. maternal glomeruli and liver |
1, decidua: arthrosis, spiral arteries from mom shot down bc baby isnt keeping them open with invasion
2. placenta: infarct, small 3. Liver and glomeruli have fibrin in the sinusoids. renal cortical necrosis AFTER 34 weeks |
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ok so you are preg for the first time and had a mole beofre and have HTN. what are you at increase risk for
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pre-eclampsia
other risks: first preg HTN DM Obese Molar preg AI dusease OLD, young Multigestation |
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placental ischemia in pre eclampsia leads to what
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HTN, Glomerular injusry, decreased GFR, HELLP, DIC
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when in preg is there fibrin in the sinusoids of glomeruli and liver
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pre eclampsia
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when is there decidual arthrosis
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pre eclampsia
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at what time in preggo can you say a person has pre eclampsia
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AFTER 34 weeks
Proteinuria, HTN, EDEMA |
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a 36 weeker comes in with HTN and swollen hands, she complains of HA and weight gain. you take UA expecting...
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protein
**sounds like preeclampsia **bad bc placenta infarcts and causes IUGR in baby |
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27 y/o female admitted during first pregnancy
at 38 weeks gestation with blood pressure 160/100mmHg. She had ankle edema and proteinuria. Oligura led to immediate cesarean section. Patient c/o blurred vision. Symptoms resolved and vision returned to normal about 1 week after delivery |
pre eclampsia
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whats the deal with a mole and partial mole
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**WHEN 2 sperm get into one egg. causes + hCG but no baby, can lead to choriocarcinoma complete mole: NO egg nucleus. this is a "gestational trophoblastic disease"
Complete: 46XX or 46XY. no fetus, risk of persistent trophoblast, risk for chroiocarcinoma, chorionic villi are grapelike partial mole: egg nucleus |
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what si a hydatidiform mole
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disease of trophoblast, cystic swelling of chroionic villi, grape like cluster
Complete: 2sperm + 1egg NO maternal DNA Incomplete: 2 sperm + 1 egg maternal DNA |
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if a mole is 46XX and has risk of chroiocarcinoma is it complete or incomplete mole
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complete
2 sperm and no maternal DNA |
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whats the clinical presentation for a complete mole
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4-5 month vaginal bleeding
grape like mass in blood HUGE uterus, early preecliampsia HCG is also higher than normal |
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your pt comes in preggo and they have a really high HCG nad the uterus is LGA, do you think they have DM or a mole
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complete mole
46XX or 46 XY **the pt will have early pre eclampsia and 4/5 month uterine bleeding |
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This 34 y/o gravida 5, para 4 female presented
to the ER c/o vaginal spotting. She gave a history consistent with 15 weeks pregnancy with no prenatal care. She stated that she had never felt this baby move. • She had vomited daily for over 1 month, more than with her previous pregnancies. • Her blood pressure was repeatedly ~168/88. • The uterine fundus was 2 fingers below the umbilicus consistent with 18‐20 wk gestation There were no fetal heart tones auscultated. • A pelvic ultrasound disclosed and enlarged uterus with mixed densities, a “snow storm” appearance and no fetal parts. • She was taken to surgery for dilation and suction evacuation of the uterus. 230 gm of grape‐like tissues were removed. • Diagnosis? • What are the pathogenesis? • Risks? Morphology? |
uterine growth was advanved
Dx hyditiform mole Pathogenesis Risk: early preeclampsia, no baby, choriocarcinoma Morph: grape like cluster |
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whats the chromosome for a partial mole
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sperm + sperm + maternal DNA
23+ 23+ 23= 69 |
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whats a major difference in a partail and complete mole other than the chomosome number
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partial might have a baby but they are lost at 10 weeks
low risk of choriocarcinoma with partial complete is NO baby and higher risk for chrosiocarcinoma for 1 year. DONT GET PREG |
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a 10 week baby that was a partial mole wont make it. what do they look like
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syndactyly
big head |
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partial or complete mole
1. 46 2. 69 3. baby present 4. NO baby 5. risk for chorio 6. presents like missed abortion 7. HCG super high 8. HCG mild elevation 9. hydropic villi present in all 10. hydropic villi only in some 11. trophoblast proliforation is FOCAL 12. trophoblast is diffuse 13. atypia diffuse 14. atypis minimal 15 p57+ 16. p57 - 17. BV in villi |
1. 46: complete
2. 69: partial 3. baby present: partial 4. NO baby; complete 5. risk for chorio: complete 6. presents like missed abortion: partial 7. HCG super high: complete 8. HCG mild elevation: partial 9. hydropic villi present in all: complete 10. hydropic villi only in some: partial 11. trophoblast proliforation is FOCAL: partial 12. trophoblast is diffuse: complete 13. atypia diffuse:complete 14. atypis minimal: partial 15 p57+ partial 16. p57 - complete 17. BV in villi: partial 18: vaginal bleed: complete |
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complete mole
1. karyotype 2. bleeding 3. uterus 4. HCG 5. edema of hydropic villi 6. trophoblast proliforation 7. atypia 8. p57 9. embryo 10. chorio risk |
1. karyotype: 46. 2 sperm NO mom
2. bleeding: LOTS 3. uterus: BIG 4. HCG: HIGH 5. edema of hydropic villi: ALL 6. trophoblast proliforation: DIFFUSE 7. atypia:DIFFUSE 8. p57: - 9. embryo; NEVER 10. chorio risk: HIGHER |
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which precursor has the highest risk for transformation into gestational chroiocarcinoma
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moles** about 1/2
previous abortion totally normal preggo ectopic preg |
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what teh clinical, dx and prognosis of gestational choriocarcinoma
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its caused most often by moles
**can have bloody/brown discharge, foul smelling HCG is high LOTS OF METS 100% cure with chemo and take out uterus |
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what is the bloody brown tumor that invades myometrium it gives a + preg test and is widelt mets
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gestational chroiocarcinoma
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in gestational choriocarcinoma we know often it is presnt when there has been a molar preggo. there is brown/blood smelly discharge and its common to have mets. whats the tx
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chemo and hysterectomy- almost 100%
cure **invation of myometrium by bloody brown tumor- HCG is + mets early and widespread- lung, spleen, liver, kidney |
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what are the placentas that are risk for fetus
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1. marginal: insertion of umbilical cord. risk of cord compression
2. Velamentous: BC branch before then enter the placenta. risk for tear and hemorrhage |
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what is:
1. abruptio placenta 2 placenta previa 3. placenta accretia |
1. abruptio: premature seperation of placenta; causes DIC in mom
2. privia: placenta near os, need c section 3. accretia: placenta grows into myometrium. SUPER big risk of bleeding. no deciduia |
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what type of placental abnormlaity leads to...
1. risk of umbilical cord compression 2. risk of tearing vessels |
1. marginal insertion of cord into plavents
2. velamentous insertion- bifircation of vessels before insertion |
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whats vasa privia
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velamentous vessels in front of presenting fetus
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placenta accreta is on the exam. what is it
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when the placenta is directly attached to myometrium w/o decidua
SEVERE post partum hemrrhage |
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whats the dif btwn dizygotic and monozygotic twins
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Di- 2 ova, most common. Di Di only. but di di can sometimes be monozygotic
Mono- one ova. monochorian is always mono |
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when determining twins based on chorion and amnion recall what is what
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chorion- the bigger bag! if there is just one it timplies mono twins
Amnion- the little bag that surrounds baby, its within the chirion |
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ok so mom has twins and they are...
1. monochorion 2. dichorion what is it likely they are fraternal or identical |
1. mono- imply monozygotic twins
2. dichortion diamnion- can be either |
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what are some complication unique to twin preggos
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1. increased pre eclampsia
2. premies 3. incresed velamentous cord insertion (bifurcation of vessels w/i membranes. risk of 4. increased congenital anomalies |
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what is twin twin transfusion, when is it seen
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seen in monozygotic twins who are MONOCHORTIONIC- they share vascular supply unequally and one twins steals more blood. the one large twin and one small.
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ok so with monochorionic monozygotic twins there can be twin twin transfisions, whats teh complications assosicated iwth monoamniootic twins
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cord entranglement
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