diseases of pregnancy. normal ectopic pregnancy

Download Diseases of Pregnancy. Normal Ectopic Pregnancy

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  • Slide 1
  • Diseases of Pregnancy
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  • Normal
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  • Ectopic Pregnancy
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  • Implantation outside the uterus 1% of all pregnancies Common site of implantation: tube, ovary, abdominal cavity The cause Obstruction of the tube by Inflammation Endometriosis Tumors 50% no obvious cause
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  • Ectopic Pregnancy Implantation outside the uterus The pregnancy starts nomal Tubal pregnancy- rupture, hemorrhage, acute abdomen, shock, can be fatal Abdominal pregnancy may rarely continue Rarely: spontaneous resorption
  • Slide 9
  • Gestational Trophoblastic Diseases Hydatidiform mole Complete Partial Invasive mole Choriocarcinoma High level of hCG
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  • Hydatidiform Mole Grape like, cystically dilated villi Common 40 year Uterus filled with cystic structures (grape like)
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  • Hydatidiform mole Complete No fetus Diploid 46xx Empty egg+ 2 sperms 1/2000 pregnancy Partial Fetus present Triploid 69xxy Egg+ 2 sperms
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  • Complete mole
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  • Micro Hydropic swelling of villi Proliferation of trophoblasts 10% progress to invasive mole 2% develop choriocarcinoma
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  • Partial Mole
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  • Invasive Mole
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  • Invasive mole Progression of complete mole Extension/invasion to the myometrium Sometimes involve the vagina and the surrounding structures No metastasis
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  • Choriocarcinoma
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  • Highly aggressive tumor Asia>US 50% of cases follow complete mole High hCG Hemorrhagic necrotic tumor No villi, consists of cyto and syncytiotrophoblast Metastasize early in the course of disease Respond to chemotherapy- cure
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  • Inflammation of Placenta 1. Ascending 2. Hematogenous Premature birth Premature rupture of membranes Mycoplasma, Candida, bacteria Syphilis, TB, Toxo
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  • Inflammation of Placenta Acute inflammation: 1. Amnion/Chroion- Chorioamnionitis 2. Umbilical cord- Funisitis 3. Villi- villitis
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  • Chorioamnionitis
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  • Funisitis
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  • Villitis
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  • Preeclampsia/Eclampsia Hypertension, proteinuria, edema in the 3 rd trimester Commonly in first pregnancy of >35year Eclampsia: seizures DIC, ischemic organ injury
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  • Preeclampsia/Eclampsia Pathogenesis Abnormal development of spiral arteries of uteroplacental bed Normally- formation of vascular sinudoides Preeclampsia- formation of narrow channels Consequences: Placental hypoperfusion- infarct Low level of vasodilator PGE2, nitric oxide High level of thromboxane
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  • Preeclampsia/Eclampsia Placenta Infarcts Retroplacental hemorrhage Villous edema, hypovascularity Acute atherosis (fibrinoid necrosis) Microvascular thrombi in all organs: kidney, Brain, Heart
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  • Infarct
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