Placental-fetal-maternal physiology

what differentiates the primary, secondary, and tertiary villi?

primary: cytotrophoblasts

secondary: mesenchyme

tertiary: fetal vascular structures

What is this?

abnormal placental attachment to the myometrium

placental accreta (A for attachment and A for accreta)

where does the placenta normally attach?

to the endometrium (inner layer of uterus)

what is this?

placenta penetrates into the myometrium

placenta increta

what is this?

placenta perforates through the myometrium into the uterine serosa

placenta percreta

what is this?

placenta covers and obstructs the cervix → needs cesarean

placenta previa

what is this?

premature separation of placenta from uterine wall before delivery of infant

abruptio placentae

what is this?

risk factor: trauma, smoking, HTN, preeclampsia, cocaine abuse

abruptio placentae

what is this?

presentation: abrupt, painful bleeding in the 3rd trimester

abruptio placentae

explain early maternal-fetal circulation

first 8 weeks: nutrients from decidual cells not maternal contribution, placenta grows more than embryo, hypoxic environment → increased VEGF

starting 9-10 weeks: maternal blood begins to flow, increased O2, increased glucose and decreased VEGF, fetal growth more than placenta

what makes fetal circulation closed so that maternal immune cells can’t get in?

syncytium

What is this?

may present with edema, new onset HTN, proteinuria and/or end organ damage

pre-eclampsia

what is this?

pathophysiology: incomplete remodeling of maternal spiral arteries

pre-eclampsia

what is this?

onset of seizures in women with pre-eclampsia

eclampsia

what is this?

headaches (frontal/occipital/thunderclap), visual disturbances, abdominal pain, and confusion

eclampsia

what is this?

tonic/clonic seizures, may be associated with placental hypoperfusion

eclampsia

What is this?

vagianal bleeding, pelvic pain, and shoulder pain

ectopic pregnancy

what is this?

not enough amniotic fluid

oligohydramnios

what is this?

too much amniotic fluid, risk of premature birth, prolapsed umbilical cord

polyhydramnios

what is this?

the placenta is close to the cervix but does not cover it

placental marginatum

what is this?

consequences can include: poor growth, preterm birth, and stillbirth

placental insufficiency

what breaks when your “water breaks”?

amniotic sac (prior to 37 weeks can indicate preterm labor; can increase infection if labor does not start within a certain time post-rupture)

Describe the placenta’s main functions

3 organs in one: lungs, kidneys, and liver

respiration, nutrient transfer, and waste excretion

what levels can we use to assess feta well-being?

estradiol (ca be produced from the fetus, so low levels may indicate fetal distress)

If teh fetus is considered a foreign antigen, how is the fetus protected from maternal immune cells?

the placenta is an immunologic barrier and there is no MCH class 1 representation on syncytiotrophoblasts

Explain Rh hemolytic disease of the newborn

Mom Rh- and baby Rh+

1st pregnancy usually not affected but mother makes abs → then 2nd pregnancy is Rh+ → hemolytic anemia

How can we prevent fetal hemolytic anemia?

rosette test and rhogam

What can these cause?

esophageal or duodenal atresia or anencephaly

polyhydramnios (fetus can’t swallow the amniotic fluid)

What can these cause?

bilateral renal agenesis

oligohydramnios (fetus kidneys not making any amniotic fluid)

What are the TORCHES infections?

T: toxoplasma gondii

O: other

R: Rubella

C: CMV

H: HIV and HSV

S: syphilis

(no “E”)

With intruterine gorwth restirction, just becase a baby is in the 10th percentile for weight doesn’t mean a problem, so what else do we look at?

symetric vs asymmetric: head circumference, abdominal circumference, and femur length

what is the difference in A1GDM vs A2GDM?

1: managed with diet changes

2: responsive only to medication

explain how pregnancy is a diabetogenic state with respect to gestational diabetes

increased insulin resistance and excess fetal glucose