Pathology - S2B1 - Female GU 5
Terms
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copy deck
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What is this showing? - Fetal surface of a normal Placenta
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What is this showing? - Maternal surface of a normal Placenta
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What are the predisposing factors to Placental Inflammation and Infection?
Which is most common? -
1. Premature rupture of membranes ****
2. Induced abortion
3. Hematogenous spread
4. Sex in the 3rd trimester - What microbes are responsible for Ascending infection of the Placenta?
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1. Group B Streptococci
2. Anaerobic Strep
3. Staph
4. Coliforms and Bacteroides
5. Clostridium Welchii - What microbes are responsible for hematogenous spread causing Placental infection?
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1. Treponema Pallidum
2. Listeria Monocytogenes
3. Candida
4. Toxoplasma
5. CMV -
-Inflammation of the placental villi = 1
-Inflammation of fetal membranes = 2
-Inflammation of the umbilical cord = 3 -
1. Placentitis
2. Chorioamnionitis
3. Funisitis -
What is this showing? - Chorioamnionitis = inflammation of the fetal membranes = amnion, chorion, allantois, and yolk sac
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Term for accessory lobes of the placenta along the margin
- risk for hemorrhage if the accessory lobes are detached - Placenta Succenturiata
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What are these showing? - Accessory lobe = Succenturiate
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What is this showing?
What is the risk? -
Succenturiate lobe
If it ruptures there can be massive bleeding - Marginal (peripheral)insertion of the umbilical cord
- Battledore placenta
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What are these showing? - Battledore placenta = marginal placement of the placenta
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What is this showing? - Placenta circumvallata = membranes double back for a short distance over the fetal surface when the chorionic plate is too small
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What is this picture showing? -
Diamnionic + Dichorionic
- could be monozygotic or dizygotic -
What is this picture showing? -
Diamnionic + Monochorionic = Monozygotic -
Is this Di- or Monozygotic? - Could be either, but most likely Dizygotic
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What is the name for this syndrome?
What causes it? -
Stealing Syndrome
One placenta with 2 babies, one baby is stealing blood from the other - What is "Velamentous insertion of the Umbilical Cord"?
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When the major umbilical vessels separate in the fetal membranes before reaching the placental disk
-is of no major consequence in utero
-could lead to greater chances for cord trauma with bleeding during delivery - Abnormal penetration of the placenta into the uterine wall in which the Villi reach the Myometrium but do not invade it
- Placenta Accreta
- Abnormal penetration of the placenta into the uterine wall in which the Villi invade beyond the Endometrium into the Myometrium
- Placenta Increta
- Abnormal penetration of the placenta into the uterine wall in which the Villi penetrate through the entire Myometrium and may reach the serosal surface
- Placenta Percreta
- What is the pathophysiology of Placenta Accreta, Increta, Percreta?
- Defective decidual layer
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What is shown here? - Placenta accreta, percreta
- What is the clinical manifestation of Placental Accreta?
- Massive hemorrhage after delivery -> requires hysterctomy
- What predisposes to Placenta Accreta?
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1. Endometrial inflammation
2. prior C-section scars - What is Placenta Praevia?
- Attachment of the placenta over the Cervical Os
- What is Placenta Praevia associated with?
- Placenta Accreta
- How may Placenta Previa present clinically?
- repeated bouts of bleeding during the entire pregnancy
- What are Spontaneous abortions associated with in 50% of the cases?
- Chromosomal abnormalities -> Trisomy 16
- Implantation of the conceptus at some other site than the Endometrial lining of the uterus
- Ectopic pregnancy
- How common is Ectopic Pregnancy?
- 1 in 100 pregnancies
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What are 4 causes of Ectopic pregnancy?
Which is most common? -
1. Chronic Salpingitis (PID) ***
2. Congenital abnormalities of the Salpinx
3. Extrinsic compression of Salpinx (tumors, adhesions)
4. Transmigration of the ovum - What is the most common cause of Hematosalpinx?
- Ectopic pregnancy
- What are the most common sites of Ectopic pregnancy?
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What are these showing? - Ectopic Tubal pregnancy
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What is this showing? - Late Ectopic Tubal pregnancy
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A woman with previous history of Pelvic Inflammatory Disease presents with sudden onset of lower abdominal pain and is in hypovolemic shock. Her last menstruation was 6 weeks ago and she has elevated hCG but not as high as normal pregnancies.
- Ruptured Fallopian Tube Ectopic pregnancy
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What are these showing? -
Ectopic tubal pregnancy
- hemorrhage
-decidua
-chorionic villi - What is the triad of Toxemia of Pregnancy?
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1. Hypertension
2. Proteinuria
3. Edema - When does Toxemia of Pregnancy usually occur?
- 3rd trimester of a woman's first pregnancy
- What are the 2 forms of Toxemia of Pregnancy?
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1. Preeclampsia
2. Eclampsia - What differentiates Preeclampsia from Eclampsia?
- Eclampsia includes seizures
- Describe the pathogenesis of Toxemia of Pregnancy
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1. Abnormal placentation -> obstruction of Spiral arteris
2. Normal vasodilator are decreased
3. Vasoconstrictors are increased
4. Net effect = Placental hypoperfusion -
What is this showing? -
Toxemia of Pregnancy
-placenta with infarcts = lighter parts -
What has happened here? -
Toxemia of Pregnancy
- chorionic villi with coagulative necrosis and infarction of the placenta - What are the 3 sequelae of Toxemia of Pregnancy?
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1. Complete recovery
2. Persistent HTN
3. Persistent Renal Damage - What is the treatment for Eclampsia?
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Magnesium sulfate
Diazepam - What are the 4 Gestational Trophoblastic Diseases?
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1. Hydatidiform mole
2. Chorioadenoma destruens
3. Choriocarcinoma
4. Placental site trophoblastic tumor - Cystic, hydropic swelling of the Chorionic Villi with variable hyperplastic and anaplastic changes in the chorionic epithelium
- Hydatidiform mole
- Where is Hydatidiform Mole somewhat common?
- Asian countries = Taiwan, Phillipines, India
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What is this? - Complete Molar Pregnancy
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What is this? -
Hydatidiform mole
-no blood vessels within Villi
-proliferation of trophoblast with some atypia -
An 18 year old woman in hter 16 week of pregnancy presents with excessive vomiting (10/day for 3 days) and vaginal bleeding. Labs show beta-hCG. Ultrasound shows "snow-storm" appearance
What is the diagnosis? - Hydatidiform Mole
- What is the most common cause of Choriocarcinoma?
- Complete Mole
- What is the genotype of complete mole?
- 46 XX with both sets of chromosomes coming from the father
- What is the genotype of Partial Mole?
- 69 XXY usually due to fertilization of egg by 2 sperm
- Edematous changes of Villi with the presence of Fetal Parts
- Partial Mole
- What is Chorioadenoma Destruens?
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Invasive mole
-vaginal bleeding
-elevated hCG in serum and urine
-rupture of uterus with hemorrhage, sepsis, and death -
What are these showing? - Invasive Mole = Chorioadenoma Destruens
- What are the 3 most common causes of Choriocarcinoma?
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1. Complete Hydatidiform mole
2. Previous abortion = originates from residual chorionic villi
3. Normal pregnancies - This is proliferation of Malignant Syncytial and Cytotrophoblastic cells...chorionic villi are not present
- Choriocarcinoma
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What is this? - Choriocarcinoma
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An Asian woman with a previous history of Hydatidiform Mole and abortion presents with excessive vaginal bleeding. Lab results confirm elevated hCG in serum and urine. She has also been coughing up blood.
1. What is the diagnosis?
2. Why -
1. Gestational Choriocarcinoma
2. Syncytiotrophoblasts secrete hCG
3. Metastasis to the lungs - What are common sites of Metastasis of Gestational Choriocarcinoma?
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Lungs
Brain
Liver