Questions and Answers
What is failure to deliver the placenta within 30 minutes of birth called?
Placenta accreta
What are the risk factors of placental accreta spectrum?
History of c-section, history of uterine procedures, placental previa
What are the types of placenta accreta spectrum?
Placenta accreta, placenta increta, placenta percreta
What condition is characterized by secondary amenorrhea following a D&C?
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What are the causes of secondary amenorrhea?
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Match the disease with its corresponding histology:
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What is characterized by severe anemia in infants with symptoms such as webbed neck and macrocytic anemia?
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What is the treatment for Diamond-Blackfan anemia?
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What defect leads to Diamond-Blackfan anemia?
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List three causes of megaloblastic macrocytic anemias.
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List four causes of nonmegaloblastic macrocytic anemias.
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What is a common cause of normocytic anemia in young children?
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What condition is characterized by an autosomal recessive defect in DNA repair mechanisms?
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What results from a defect in uridine monophosphate synthase and causes megaloblastic macrocytic anemia?
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What causes megaloblastic macrocytic anemia with hypersegmented neutrophils?
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What are common causes of macrocytic anemia in young children?
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What conditions are associated with microcytic anemia in young children?
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What are some causes of normocytic anemia in young children?
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Study Notes
Placenta Accreta
- Defined as failure to deliver the placenta within 30 minutes of birth, leading to potential complications.
- Manual extraction can cause uncontrollable bleeding and retention of placental tissue.
- Emergent hysterectomy may be necessary due to severe hemorrhaging.
- The condition involves placental villi attaching to the myometrium surface.
Risk Factors for Placenta Accreta Spectrum
- History of cesarean section (c-section) increases risk.
- Previous uterine procedures, including dilation, curettage, myomectomy, and uterine ablation, are significant factors.
- Presence of placental previa also raises the likelihood of developing this spectrum.
Placenta Accreta Spectrum Components
- Placenta Accreta: Villi attach superficially to the myometrium.
- Placenta Increta: Villi penetrate deeper into the myometrium.
- Placenta Precreta: Villi invade through the myometrium to the uterine serosa or surrounding organs.
Asherman Syndrome
- Characterized by secondary amenorrhea after dilation and curettage (D&C).
- Results from trauma to the stratum basalis, leading to its absence in the endometrium.
Etiology of Secondary Amenorrhea
- Hypothalamic issues: Functional hypothalamic amenorrhea.
- Pituitary causes: Hyperprolactinemia, empty sella syndrome, and Sheehan syndrome.
- Ovarian disorders: Polycystic ovary syndrome and premature ovarian failure.
- Uterine condition: Asherman syndrome.
- Other contributing factors include congenital adrenal hyperplasia, hypothyroidism, and adrenal tumors.
Histology and Associated Diseases
- Absent stratum basalis: Asherman syndrome.
- Benign keratinocytes: Indicative of imperforate hymen.
- Enlarged ovaries: Found in polycystic ovary syndrome.
- Hyperplasia of lactotroph cells: Seen in prolactinoma.
- Corpora albicans and fibrotic cortex: Suggests atrophic ovary.
Diamond-Blackfan Anemia
- Diagnosed in infants with a male predominance.
- Most prevalent in Caucasian populations, presenting with symptoms of anemia like pallor and fatigue.
- Notable features include webbed neck, cleft palate, and triphalangeal thumbs.
- Associated with macrocytic anemia that is nonmegaloblastic, showing decreased reticulocyte count and normal leukocytes and platelets.
- Bone marrow biopsy demonstrates absence of erythroid precursors.
Treatment Options for Diamond-Blackfan Anemia
- Corticosteroids are standard treatment.
- Blood transfusions may be necessary.
- Hematopoietic stem cell transplant can be indicated.
Pure Red Cell Aplasia (PRCA)
- Associated with defects in erythropoiesis leading to Diamond-Blackfan anemia.
- Bone marrow erythroblasts undergo premature apoptosis due to mutations affecting ribosomal protein synthesis, resulting in TP53 activation.
Types of Macrocytic Anemia
- Megaloblastic: Includes B12 deficiency, folate deficiency, and orotic aciduria.
- Nonmegaloblastic: Includes Diamond-Blackfan anemia, alcohol use, liver disease, and thyroid disease.
Aplastic Anemia
- Characterized as normocytic anemia potentially due to viral infections, radiation, medications, or toxins.
- Presents with pancytopenia, including anemia, thrombocytopenia, and leukopenia.
Fanconi Anemia
- An autosomal recessive disorder involving DNA repair defects.
- Can present with either normocytic or macrocytic anemia and also causes pancytopenia.
Orotic Aciduria
- Another autosomal recessive condition with a defect in UMP synthase leading to elevated orotic acid and failure to thrive.
- Presents with delayed development and megaloblastic macrocytic anemia unresponsive to folate and B12 supplementation.
Vitamin B12 Deficiency Anemia
- Results in megaloblastic macrocytic anemia with the presence of hypersegmented neutrophils.
- Causes include a vegan diet, pernicious anemia, gastrectomy, gastric bypass, and ileal diseases such as Crohn's.
Anemia in Young Children
- Microcytic Anemias: Lead poisoning, sideroblastic anemia, thalassemias.
- Normocytic Anemias: Aplastic anemia, hereditary spherocytosis, leukemia, microangiopathic hemolytic anemia, pyruvate kinase deficiency, Rh incompatibility, sickle-cell anemia.
- Macrocytic Anemias: Orotic aciduria and Diamond-Blackfan anemia.
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Test your knowledge on placenta accreta and its related risk factors with this quiz designed for COMLEX Level 1 preparation. Understand the critical definitions and implications of failure to deliver the placenta. Prepare effectively for your medical exams!