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35. Gestational Disorders
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35. Gestational Disorders

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Questions and Answers

Which microorganisms are most frequently found in the amniotic cavity during placental infections?

  • Clostridium perfringens, Listeria monocytogenes, and Bacteroides fragilis
  • Ureaplasma species, Gardnerella vaginalis, and Fusobacteria species (correct)
  • Haemophilus influenzae, Neisseria gonorrhoeae, and Chlamydia trachomatis
  • Streptococcus agalactiae, Escherichia coli, and Staphylococcus aureus

    • What is the hallmark of fetal inflammatory response syndrome (FIRS)?

  • Elevated maternal blood pressure and proteinuria
  • Increased amniotic fluid volume and fetal hydrops
  • Fetal leukocytosis and elevation in the fetal circulation of IL-6 (correct)
  • Decreased fetal heart rate and reduced fetal movement

    • What is the definition of chronic/preexisting hypertension in pregnancy?

  • Development of new arterial hypertension (i.e., blood pressure >130/80 mm Hg) in a pregnant woman after 20 weeks gestation
  • Blood pressure ≥130/80 mm Hg that predates pregnancy or presents before the 20th week of pregnancy or persists longer than 12 weeks postpartum (correct)
  • Elevated blood pressure in pregnancy without any prior history of hypertension or complications
  • Blood pressure ≥140/90 mm Hg after 20 weeks of gestation accompanied by proteinuria and/or end-organ dysfunction

    • What is the final diagnosis of gestational hypertension made?

    <p>Only postpartum</p> Signup and view all the answers

    What is the definition of proteinuria in the context of preeclampsia?

    <p>Urinary excretion of at least 300 mg of protein in a 24-hour specimen or 1+ dipstick reading</p> Signup and view all the answers

    What is the typical clinical presentation of failed pregnancies?

    <p>Vaginal bleeding and crampy pelvic pain</p> Signup and view all the answers

    What is the reported term for placental tissues in a pathological report?

    <p>Products of conception</p> Signup and view all the answers

    What does pelvic ultrasound typically reveal in failed pregnancies?

    <p>Absence of fetal cardiac activity</p> Signup and view all the answers

    How do serum levels of β-hCG change in failed pregnancies?

    <p>Decline earlier than 10-11 weeks</p> Signup and view all the answers

    Which chromosomal abnormality is most commonly associated with miscarriage?

    <p>Trisomy 16</p> Signup and view all the answers

    Which factor is not identified as a risk factor for ectopic pregnancy?

    <p>Younger age</p> Signup and view all the answers

    What are the typical signs and symptoms of an unruptured ectopic pregnancy?

    <p>Asymptomatic</p> Signup and view all the answers

    Which clinical triad is typically manifested by patients with ectopic pregnancy?

    <p>Pain, amenorrhea, and vaginal bleeding</p> Signup and view all the answers

    When do the symptoms of ectopic pregnancy typically appear?

    <p>6-8 weeks after the last menstrual period</p> Signup and view all the answers

    What is indicative of a ruptured ectopic pregnancy?

    <p>Severe abdominal pain, peritoneal signs, and hemorrhagic shock</p> Signup and view all the answers

    What is the 'gold standard' diagnostic test for ectopic pregnancy?

    <p>Diagnostic laparoscopy</p> Signup and view all the answers

    How do β-hCG levels typically change in intrauterine pregnancies?

    <p>They double every 48-72 hours</p> Signup and view all the answers

    What are the essential changes in the endometrium for the establishment of pregnancy?

    <p>Decidualization</p> Signup and view all the answers

    What can help differentiate between an intrauterine and ectopic pregnancy?

    <p>Endometrial curettage</p> Signup and view all the answers

    What is the diagnosis made if chorionic villi are not seen in endometrial curettage specimens?

    <p>Ectopic pregnancy</p> Signup and view all the answers

    What type of placenta previa involves the placenta lying within 2 to 3 cm of the cervical os but not covering it?

    <p>Marginal placenta previa</p> Signup and view all the answers

    What is the believed association between endometrial damage and subsequent placenta previa?

    <p>Suboptimally vascularized endometrium in the upper uterine cavity resulting from previous surgery or multiple pregnancies</p> Signup and view all the answers

    What is the typical presentation of patients with placenta previa?

    <p>Painless vaginal bleeding in the 2nd or 3rd trimester</p> Signup and view all the answers

    What is the most common theory regarding the pathogenesis of placenta accrete?

    <p>Defective decidualization</p> Signup and view all the answers

    Which form of placenta accreta occurs when the villi penetrate the full thickness of the myometrium and may invade neighboring organs?

    <p>Percreta</p> Signup and view all the answers

    What is the first clinical manifestation of placenta accreta?

    <p>Profuse, life-threatening hemorrhage</p> Signup and view all the answers

    What condition can result in the rupture of maternal vessels in placental abruption?

    <p>Preeclampsia</p> Signup and view all the answers

    What are the fetal consequences of placental abruption?

    <p>All of the above</p> Signup and view all the answers

    What is the cause of complete placental separations in placental abruption?

    <p>High pressure arterial hemorrhage in the central area of the placenta</p> Signup and view all the answers

    What are the potential maternal consequences of placental abruption?

    <p>All of the above</p> Signup and view all the answers

    What is the most common form of placenta accreta?

    <p>Accreta</p> Signup and view all the answers

    What is the prevalence of placental infections per 1000 live births?

    <p>9.7 cases</p> Signup and view all the answers

    Which structure is a location for fetal inflammatory response in placental infections?

    <p>Chorionic villi</p> Signup and view all the answers

    How do microorganisms most commonly reach the amniotic cavity?

    <p>Ascending from the lower genital tract</p> Signup and view all the answers

    What is the hallmark of fetal inflammatory response syndrome (FIRS)?

    <p>Fetal leukocytosis and elevation in the fetal circulation of IL-6</p> Signup and view all the answers

    What is the end-result of fetal invasion due to amnionitis?

    <p>Focal weakening of the fetal membranes at the internal cervical os, premature membrane rupture, and induction of pre-term contractions</p> Signup and view all the answers

    What are the typical clinical manifestations of chorioamnionitis?

    <p>Fever, uterine tenderness, abdominal pain, purulent foul-smelling fluid from the cervical os, maternal tachycardia, and fetal tachycardia</p> Signup and view all the answers

    What is one of the most common complications of preterm premature rupture of membranes (pPROM)?

    <p>Early delivery soon after membrane rupture</p> Signup and view all the answers

    What perinatal morbidity can be associated with preterm premature rupture of membranes (pPROM)?

    <p>Respiratory distress syndrome, neonatal sepsis, and fetal death</p> Signup and view all the answers

    What is the gross appearance of chorioamniotic membranes affected by chorioamnionitis?

    <p>Dull, opaque with yellow green discoloration and cloudy amniotic fluid, possibly with purulent exudate</p> Signup and view all the answers

    What histological finding is seen in chorioamnionitis?

    <p>Diffuse infiltration of neutrophils in the chorioamnionic membranes, decidua, placenta parenchyma, and fetal vessels</p> Signup and view all the answers

    At what gestational week does gestational hypertension typically develop?

    <p>After 20 weeks</p> Signup and view all the answers

    What is a risk factor for preeclampsia?

    <p>Age &lt;18 or &gt;40</p> Signup and view all the answers

    When do most cases of eclampsia present?

    <p>Third trimester</p> Signup and view all the answers

    What are the frequent signs/symptoms preceding a seizure in eclampsia?

    <p>Persistent headaches and visual disturbances</p> Signup and view all the answers

    What is the typical postictal phase following a generalized tonic-clonic seizure in eclampsia?

    <p>Confusion or agitation</p> Signup and view all the answers

    What is the blood pressure threshold for diagnosing preeclampsia?

    <p>≥140/90 mm Hg</p> Signup and view all the answers

    What is associated with proteinuria in the context of preeclampsia?

    <p>Peripheral edema</p> Signup and view all the answers

    Which mechanism may explain the development of seizures in eclampsia?

    <p>Cerebral vasospasm causing focal ischemia</p> Signup and view all the answers

    What is the hallmark of eclampsia?

    <p>Generalized tonic-clonic seizure</p> Signup and view all the answers

    What is the hallmark of HELLP syndrome?

    <p>Hemolysis, elevated liver enzymes, and low platelet count</p> Signup and view all the answers

    What is the main finding in hemolysis associated with HELLP syndrome?

    <p>Peripheral blood smear showing schistocytes</p> Signup and view all the answers

    Study Notes

    Gestational Disorders Overview

    • Case presentation of a 35-year-old primigravid woman with eclampsia at 7th month of pregnancy, leading to fetal distress and growth retardation
    • Spontaneous abortion is defined as pregnancy loss before 20 weeks, affecting 10-15% of recognized pregnancies, with common risk factors including maternal age, medical conditions, and teratogenic medications
    • Miscarriages are often attributed to chromosomal abnormalities (70%), with trisomies being the most common, and physical defects of the uterus can also contribute to implantation issues
    • Clinical symptoms of miscarriage include pelvic pain, vaginal bleeding, and absence of fetal cardiac activity on pelvic ultrasound
    • Ectopic pregnancy refers to implantation outside the uterine cavity, occurring in 1-2% of pregnancies, with the most common site being the fallopian tubes
    • Risk factors for ectopic pregnancy include pelvic inflammatory disease, previous pelvic surgery, increasing age, and smoking
    • Symptoms of unruptured ectopic pregnancy mimic normal pregnancy, while rupture leads to severe abdominal pain, peritoneal signs, and hemorrhagic shock
    • Diagnosis of ectopic pregnancy is challenging, with serum β-hCG levels and pelvic ultrasound being inconclusive
    • Placenta previa is when the placenta implants in the lower uterine segment or cervix, leading to serious third-trimester bleeding, and is associated with endometrial damage and uterine scarring
    • Placenta previa is diagnosed incidentally at mid-trimester transabdominal ultrasound, and cesarean delivery is indicated due to the risk of hemorrhage
    • Placenta accreta spectrum includes accreta, increta, and percreta, with defective decidualization in an area of scarring from previous uterine surgery being a common theory for its pathogenesis
    • Placenta accreta can lead to morbidly adherent placenta, with increta and percreta involving deeper invasion into the myometrium and potentially neighboring organs

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    Related Documents

    35. Gestational Disorders.pdf

    Description

    Explore various gestational disorders including eclampsia, spontaneous abortion, miscarriages, ectopic pregnancy, placenta previa, and placenta accreta spectrum. Learn about the clinical symptoms, risk factors, diagnosis, and management of these conditions.

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