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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
define abortion
fetal death <20 weeks
what causes spontaneous abortion
MUST BE BEFORE 12 weeks
super common

Mom
SLE, DM, HTN, uterine abnormality, hormone imbalance, infections

FETAL: (more common than maternal)
chromosomal abnormalities,
what are hte types of abortion
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
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
does endometriosis and PCOD lead to infertility
yep, PID too
what is teh msot common site of ectopic preggo
fallopian tube

salpingocyesis

**fertilization SHOULD happen in tube but NOT implantation
what are risk factors for ectopic
PID
endometriosis
Adhesions
IUD
a woman w/an ectopic will present how
1. placental seperation-
2. MASSIVE HEMORRHAGE if rupture

BLEEDING, ABD pain, usually occurs 6 weeks from LMP
what is salpingocyesis
tubal preggo

most common site of ectopic
• 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
what are the risk factors for pre-eclampsia
first time preg w/a guy
multiple gestation
molar preg
HTN
DM
Obses
AI

**the placenta is ischemic
what is the clinical of pre-eclampsia
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
what are some complications of pre-eclampsia
placenta- small, decidual arthrosis, infarct

fetus- IUGR, SGA, hypoxic, increased morbidity/mortality

Maternal: DIC, HELLP, Eclampsia, renal, hepatic, cerebral disease

AFTER 34 WEEKS
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
ok so you are preg for the first time and had a mole beofre and have HTN. what are you at increase risk for
pre-eclampsia

other risks:
first preg
HTN
DM
Obese
Molar preg
AI dusease
OLD, young
Multigestation
placental ischemia in pre eclampsia leads to what
HTN, Glomerular injusry, decreased GFR, HELLP, DIC
when in preg is there fibrin in the sinusoids of glomeruli and liver
pre eclampsia
when is there decidual arthrosis
pre eclampsia
at what time in preggo can you say a person has pre eclampsia
AFTER 34 weeks

Proteinuria, HTN, EDEMA
a 36 weeker comes in with HTN and swollen hands, she complains of HA and weight gain. you take UA expecting...
protein

**sounds like preeclampsia

**bad bc placenta infarcts and causes IUGR in baby
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
whats the deal with a mole and partial mole
**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
what si a hydatidiform mole
disease of trophoblast, cystic swelling of chroionic villi, grape like cluster

Complete: 2sperm + 1egg NO maternal DNA
Incomplete: 2 sperm + 1 egg maternal DNA
if a mole is 46XX and has risk of chroiocarcinoma is it complete or incomplete mole
complete

2 sperm and no maternal DNA
whats the clinical presentation for a complete mole
4-5 month vaginal bleeding
grape like mass in blood
HUGE uterus, early preecliampsia
HCG is also higher than normal
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
complete mole

46XX or 46 XY

**the pt will have early pre eclampsia and 4/5 month uterine bleeding
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
whats the chromosome for a partial mole
sperm + sperm + maternal DNA
23+ 23+ 23= 69
whats a major difference in a partail and complete mole other than the chomosome number
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
a 10 week baby that was a partial mole wont make it. what do they look like
syndactyly
big head
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
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
which precursor has the highest risk for transformation into gestational chroiocarcinoma
moles** about 1/2
previous abortion
totally normal preggo
ectopic preg
what teh clinical, dx and prognosis of gestational choriocarcinoma
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
what is the bloody brown tumor that invades myometrium it gives a + preg test and is widelt mets
gestational chroiocarcinoma
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
chemo and hysterectomy- almost 100%
cure

**invation of myometrium by bloody brown tumor-
HCG is +
mets early and widespread- lung, spleen, liver, kidney
what are the placentas that are risk for fetus
1. marginal: insertion of umbilical cord. risk of cord compression

2. Velamentous: BC branch before then enter the placenta. risk for tear and hemorrhage
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
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
whats vasa privia
velamentous vessels in front of presenting fetus
placenta accreta is on the exam. what is it
when the placenta is directly attached to myometrium w/o decidua

SEVERE post partum hemrrhage
whats the dif btwn dizygotic and monozygotic twins
Di- 2 ova, most common. Di Di only. but di di can sometimes be monozygotic

Mono- one ova. monochorian is always mono
when determining twins based on chorion and amnion recall what is what
chorion- the bigger bag! if there is just one it timplies mono twins

Amnion- the little bag that surrounds baby, its within the chirion
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
what are some complication unique to twin preggos
1. increased pre eclampsia
2. premies
3. incresed velamentous cord insertion (bifurcation of vessels w/i membranes. risk of
4. increased congenital anomalies
what is twin twin transfusion, when is it seen
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.
ok so with monochorionic monozygotic twins there can be twin twin transfisions, whats teh complications assosicated iwth monoamniootic twins
cord entranglement