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This Concept Map, created with IHMC CmapTools, has information related to: Pregnancy, Pregnancy Late TWIN PLACENTAS Fertilize 2 ova (dizygotic) Fertilize 1 ovum (monozygotic) DICHORIONIC DIAMNIOTIC-best Px MONOCHORIONIC DIAMNIONIC MONOCHORIONIC MONOAMNIONIC Monochorionic-identical, monozygotic Complication-twin-twin transfusion ->death of one or both, Pregnancy Late PLACENTAL ABNORMALITIES PLACENTA ACCRETA-absence of decidua -adhere directly to myometrium -post-partum bleeding (can't separate) -60%-w/ placenta previa (lower in uterus) -preterm labor, antepartum bleeding -predisposed by scars, inflam PLACENTA PREVIA - implant in lower uterus -can occlude os -can bleed ABRUPTIO PLACENTAE-premature separation -ass'd w/ DIC, Pregnancy Gestational Trophoblastic Dz HYDATIDIFORM MOLE - MID-GESTATION 4th-5th month -in teens and 40+yos 1:2000, more in FAR EAST, AFRICA -cystic swelling of chor villi -UTERUS LARGER THAN EXPECTED -precede chorioCA in 50% of CCA -monitor HCG levels CLINICAL-abnl uterine bleeding, passage of tissue, grapelike masses -big uterus (esp by US) Tx-remove mole by curettage, hysterectomy Px-80-90% stay benign 10%->invasive mole 2.5%->chorioCA, Pregnancy Early Pregnancy ECTOPIC PREGNANCY -90% to tubes -most common cause of tubal hematoma -can rupture -1:150 pregnancies -30-50% w/ PID, salpingitis -IUDs, adhesions, endo'osis increase risk -50% in NL tubes! Everything forms correctly! CLINICAL-severe abd pain 6wks after missed period-ruptured tube ->shocklike state -MEDICAL EMERGENCY, Pregnancy Gestational Trophoblastic Dz PLACENTAL SITE TROPHOBLASTIC TUMOR -prolif trophoblastic tumor invades myomet -intermediate trophoblast mostly -mononuclear (not syncytio->HCG) -reactive for HPL -invasive, but self-limited -malignant-high mitoses, hyperplastic, wide mets Px-cure w/ curettage, Pregnancy Late PRE-ECLAMPSIA/ECLAMPSIA-after 32nd wk Toxemia of pregnancy HTN, PROTEINURIA, EDEMA -HA, visual disturbances +CONVULSIONS, coma = eclampsia -primiparus ->DIC all over Placental Ischemia-initial event -shallow implantation -decreased uteroplacental perfusion ->vasoconstrictors, inhibit dilators ->HTN, DIC DIC-endoth dmg, clotting factor imbalance -AT-III reduced HTN-most preggers resistant to angiotensin; toxemia->lose resistance MORPH-lesions all over LIVER-hemorrhages-ABNL LFTs KIDNEY-fibrin, dense deposits in glom -decreased GFR BRAIN-hemorrhage PLACENTA-ischemic change UTERUS-acute atherosis of vessels Tx-must induce delivery - rapid recovery, Pregnancy Early Pregnancy SPONTANEOUS ABORTION 10-15% of pregnancies Major origins: Fetus defective implantation genetic abnormality MOM-inflam, uterine abnlities, trauma, toxo, mycoplasma, listeria, viruses, HYDATIDIFORM MOLE - MID-GESTATION 4th-5th month -in teens and 40+yos 1:2000, more in FAR EAST, AFRICA -cystic swelling of chor villi -UTERUS LARGER THAN EXPECTED -precede chorioCA in 50% of CCA -monitor HCG levels CLINICAL-abnl uterine bleeding, passage of tissue, grapelike masses -big uterus (esp by US) Tx-remove mole by curettage, hysterectomy Px-80-90% stay benign 10%->invasive mole 2.5%->chorioCA 2 Benign Types COMPLETE - 46 XX -all/most villi edematous -swollen, cystic dilation -trophoblast hyperplasia -androgenesis-two sperm into one empty egg -no emb development-no parts -more frequently->chorioCA, Pregnancy Gestational Trophoblastic Dz INVASIVE MOLE -penetrate or perforate uterine wall -invade myometrium by hydropic chorionic villi -tumor can invade vessels, etc. -can embolize elsewhere CLINICAL-vaginal bleeding, irreg uterine enlargement -persistently elevated HCG -rupture of uterus->hemorrhage Tx-CTX, Pregnancy Peripartum SHEEHAN SYNDROME Postpartum ant. pit. necrosis -due to severe hypotension -from blood loss -insidious onset of hypofcn, PRE-ECLAMPSIA/ECLAMPSIA-after 32nd wk Toxemia of pregnancy HTN, PROTEINURIA, EDEMA -HA, visual disturbances +CONVULSIONS, coma = eclampsia -primiparus ->DIC all over Placental Ischemia-initial event -shallow implantation -decreased uteroplacental perfusion ->vasoconstrictors, inhibit dilators ->HTN, DIC DIC-endoth dmg, clotting factor imbalance -AT-III reduced HTN-most preggers resistant to angiotensin; toxemia->lose resistance MORPH-lesions all over LIVER-hemorrhages-ABNL LFTs KIDNEY-fibrin, dense deposits in glom -decreased GFR BRAIN-hemorrhage PLACENTA-ischemic change UTERUS-acute atherosis of vessels Tx-must induce delivery - rapid recovery Variant HELLP Hemolysis Elevated Liver enzymes Low Platelets, Pregnancy Peripartum AMNIOTIC FLUID EMBOLISM -sudden resp difficulty, shock, DIC, death, Pregnancy Late PLACENTAL INFLAM/INFX Mostly ASCENDING -intercourse enhances -can->CHORIOAMNIONITIS hematogenous -TORCH could be involved, Pregnancy Gestational Trophoblastic Dz CHORIOCARCINOMA-more freq than ov CCA -epith malignant neoplasm -trophoblastic cells from any prev NL or ABNL pregnancy -mostly arises in uterus -also ectopic -rapidly invasive, wide mets! MORPH-soft white-yellow, some ischemic necrosis -ABNL prolif of cyto- and syncytio- -doesn't produce chor villi -sometimes anaplasia, abnl mitoses -in fatal cases, mets to lungs, brain, marrow, liver, other -sometimes primary totally necrotic ->primary disappears, only mets left CLINICAL-no large, bulky mass -irreg spotting of foul, brown, bloody fluid -after miscarriage, during NL preg, after curettage Px- good w/ CTX - up to 100% cure (much better than non-gestational), Pregnancy Late INTRAUTERINE GROWTH RESTRICTION -important cause of infant M&M -birth weight th percentile -causes: chrom abnlities and malformations (20%) maternal vascular dz-toxemia (30%) thrombolytic disorders, maternal and fetal infx autoimmune disorders (chronic villitis), fetal vascular disorders (fetal thrombosis) other metabolic disorders ɭ/3 placenta is small for date - poor perfusion Px-careful monitoring of development Tx-rapid delivery if blood flow looks bad, HYDATIDIFORM MOLE - MID-GESTATION 4th-5th month -in teens and 40+yos 1:2000, more in FAR EAST, AFRICA -cystic swelling of chor villi -UTERUS LARGER THAN EXPECTED -precede chorioCA in 50% of CCA -monitor HCG levels CLINICAL-abnl uterine bleeding, passage of tissue, grapelike masses -big uterus (esp by US) Tx-remove mole by curettage, hysterectomy Px-80-90% stay benign 10%->invasive mole 2.5%->chorioCA 2 Benign Types PARTIAL - 69XXY or more -some villi edematous -focal trophoblast prolif -egg fertilized by 1-2 sperm -viable for wks-fetal parts -less frequent to CA