Diseases of Pregnancy
Etiology of spontaneous abortion
fetal: genetic or acquired abnormality. maternal: infectious (toxo; myco; listeria); uterine abnormalities; trauma.
Micro of spontaneous abortion
decidual necrosis with neutrophilic infiltration; thrombi and hemorrhage within necrotic material
life threatening condition associated with postpartum bleeding. similarly life threatening condition associated with antepartum bleeding.
Placenta accreta-on myometrium. Placenta previa- through myometrium.
Three basic type of twin placenta
dichorionic diamnionic; monochorionic diamnionic; monochorionic monoamnionic
Potential complication of monochorionic pregnancies leading to abnormal sharing
infection of placenta; fetal membranes; and umbilical cord
placentitis/villitis; chorioamnionitis; funisitis
Gross and micro finding to chorioamnionitis
Gross: opaque/yellow/purulent membranes. Micro: see neutrophils.
Gross discoloration; vacuolation of amniotic epithelium. Brown granularly pigmented macrophages.
Pathogenesis of placental infection and consequences
Ascending-premature rupture of membranes (PROM). Hematogenous (transplacental) from TORCH.
White bumbs on fetal surfaces-pathogenesis and consequence
squamous metaplasia- cannot be scraped off. amnion nodosum-can be scraped off-associated w/ oligohydramnios.
amniotic band syndrome
earl yrupture sequence- amnion wrap around developing extremety. a disruption
hypertension; proteinuria and edema
preeclapsia plus convulsions. HELLP syndrome; hemolysis elevated liver enzymes and low platelets.
Pathogenesis of eclampsia
shallow implantation; remodling- reduced blood flow to placenta-vasoconstrictor release from placenta-endothelia damage-coagulation-DIC-lesions in liver; kidney; brain; pituitary; placenta.
Placental changes in pre-eclampsia
placental infarcts; retroplacental hematomas; syncytial knots; fibrinoid necrosis and atherosisi
Placental infarct gross:
early see red (hemmorhagic); later see white.
Placental abruption: definition; pathophys; risks; presentation.
Premature separation of placenta. Hemorrhage into decidual basalis. Risk: htn; trauma; cocaine; smoking; PROM; previous abruption. Vaginal bleeding and uterine tenderness.
hydatidiform mole; invasive mole; choriocarcinoma; placental site trophoblastic tumor (PSTT)
gross description hydatidaform mole.
cystic swelling of chorionic villi; trophoblastic proliferation
T/F Hydatidiform mole precede choriocarcinoma
Symptoms of hydatidiform mole
vaginal bleeding; larger than expected growth; elevated B-HCG
Pathogenisis and characteristics of complete mole
no embryonic develpment; no fetal parts. all villi are diordered and dilated. Paternal genetic material only. progresses to choriocarcinoma
Pathogenesis and characteristics of partial mole
fetal parts present. vilous hydrops only a portion of villi. triploid/tetraploidy from double amount of paternal dna
mole that penetrate/perforate uterine wall. SIgns similar to regular mole (vaginal bleeding and irregular uterine enlargement with elevated HCG). Response well to chemo.
choriocarcinoma etiology; groos and micro description. clincal course.
Trophoblastic cells are precursors. soft/fleshy/yellow tumor with area of necrosis. anaplastic cells; no villi. blood with B-HCG elevation.
Etiology of placental site trophoblastic tumor
trophoblasts at residual placental site following pregnancy. cought early good prognosis
common site of ectopic pregnancy
Risk factors for ectopic pregnancy
PID; chronic salphingitis; peritubal adhesions; endometriosis; leiomyomas; surgery
Diseases of Pregnancy