Systems Path II Exam 2 - Pregnancy related

those with ascending placental infections (MC) are at risk for what?

chorioamnionitis

with chorioamnionitis (ascending placental infection), membranes become inflamed and may trigger preterm contractions which could cause water to break early. what is this called?

preterm premature rupture of the membranes (PPROM)

signs/symptoms of ascending placental infection

neutrophils, edema, change in discharge, pain

MC cause of ascending placental infection

bacterial (STI or normal flora)

what type of placental infection is associated with placental villitis?

transplacental

what is placental villitis?

chorionic villi (structures covering the surface of placenta to ensure baby receives enough nutrients/gases from mom)

causes of transplacental infections

toxoplasmosis, other, rubella, CMV, HSV (TORCH)

non-uterine implantation resulting in a not viable pregnancy

ectopic pregnancy

90% of ectopic pregnancies are

tubal

Causes of ectopic pregnancy (risk factors)

previous ectopic pregnancy, inflammation/infection of fallopian tube, fertility treatment, tubal surgery, birth control

what is a big concern regarding ectopic pregnancies?

rupture during 1st trimester -> hemorrhage and shock, acute abdominal pain, future infertility

what is the leading cause of pregnancy-related maternal mortality in the 1st trimester and accounts for 4% of pregnancy-related deaths?

hemorrhage from ectopic pregnancy

signs/symptoms of ectopic pregnancy

missed cycle (hCG+), abdominal pain, abnormal vaginal bleeding

abnormal development of benign tumors due to abnormal fertilization

gestational trophoblastic disease

what creates the other layer of a blastocyst and normally develops into the placenta?

trophoblast

signs/symptoms of gestational trophoblastic disease

mimic early pregnancy (high hCG, no fetal heart sound)

Types of gestational trophoblastic disease

hydatidform mole, invasive mole & choriocarcinoma

benign tumor, cystic "grape-like" mass ; when an egg is fertilized, but the placenta develops into a mass of cysts instead of a fetus

hydatidiform mole/molar pregnancy

what type of hydatidiform mole develops from 1 or 2 sperm and 1 egg (no maternal DNA), and contains no fetal parts (risk for invasive mole)

complete

what type of hydatidiform mole develops from 1 egg + 1 or 2 sperm -> triploid and contains early fetal parts?

partial

when trophoblast cells form an abnormal mass that grows into the muscle layer of the uterus which is benign but locally invasive, forms complete moles and has a potential for life-threatening hemorrhage

invasive mole

cancerous tumor which forms inside a pregnant woman's uterus which usually occurs when growths from molar pregnancies turn cancerous

choriocarcinoma

remnants of choriocarcinoma

complete mole (50%), pregnancy (25%), abortion (25%)

signs/symptoms of a choriocarcinoma

severe uterine bleeding, extreme increased hCG

treatment for low risk choriocarcinoma

chemo (100% cure)

treatment for high risk choriocarcinoma

surgery, chemo, radiation

where does a choriocarcinoma MC metastasize?

lungs : cannonball metastasis

what other cancers may produce a cannonball metastasis appearance?

testicular choriocarcinoma, renal cell carcinoma, prostatic adenocarcinoma

extremely rare, slow-growing tumor which develops where the placenta attaches to the uterine wall

placenta-site trophoblastic tumor

toxemia of pregnancy

preeclampsia

MAIN signs of preeclampsia

HTN, proteinuria, edema in face or periphery

Causes of preeclampsia

idiopathic (effective spiral artery remodeling), endothelial dysfunction

When does preeclampsia usually occur?

>20-weeks gestation, 3rd trimester

risk for preeclampsia

1st pregnancy (primigravida), >35 years-old

other signs/symptoms of preeclampsia

placental hypoxia (fetus), end-organ damage (liver and kidney, maternal), pitting edema, proteinuria, pulmonary edema, RBC damage, thrombosis, low platelets

total number of times a woman has been pregnant

Gravidity

number of pregnancies that reached >20 weeks or fetus >500g

parity

advanced preeclampsia

eclampsia

signs/symptoms of eclampsia

seizures, worsening HTN, headache, diplopia, epigastric pain, worsening organ damage (kidneys, liver, CNS)

10% of eclampsia cases develop what?

HELLP syndrome

What is HELLP syndrome?

hemolysis, elevated liver enzymes, low platelets

treatment for eclampsia

delivery/induction (>37 weeks), Mg sulfate, anti-hypertensive meds