1
Q
Gestational age begins with this
A
1st day of LMP (last menstrual period)
begins with implantation
2
Q
Pregnancy diagnosis is made with this
A
beta-hCG
3
Q
Beta-hCG is an analog of this
A
LH
(stimulates progesterone release from CL in early pregnancy)
4
Q
Beta-hCG is secreted by these cells
A
Syncytiotrophoblast cells
5
Q
Beta-hCG is detectable at this time
A
At implantation
6-9 days after conception
6
Q
Beta-hCG levels peak at this time
A
8-10 weeks
7
Q
Beta-hCG levels decline to plateau at this time
A
20 weeks
8
Q
Fetal chromosomal disorders cause low or high beta-hCG levels?
A
Low
(*except Down syndrome = high)
9
Q
Molar pregnancy causes low or high beta-hCG levels?
A
High
10
Q
Down syndrome causes low or high beta-hCG levels?
A
High
11
Q
Ectopic pregnancy causes low or high beta-hCG levels?
A
Low
12
Q
This molecule decreases vascular tone in pregnancy
A
Progesterone
13
Q
Vascular tone is decreased or increased in pregnancy?
A
Decreased
(d/t progesterone)
14
Q
Pregnancy can produce this murmur
A
Systolic flow murmur; S3 gallop
15
Q
Pregnancy can cause this acid/base imbalance
A
Respiratory alkalosis
(due to tachypnea)
16
Q
Pregnancy causes respiratory alkalosis due to this
A
Tachypnea
(progesterone effect on CNS)
17
Q
Pregnancy causes respiratory alkalosis due to tachypnea, which is the result of this
A
Progesterone effect on CNS
18
Q
Does pregnancy cause decreased or increased smooth muscle tone?
A
Decreased
19
Q
Pregnancy causes this effect on the ureters
A
Hydroureter
(due to smooth muscle hypotonia)
20
Q
Why does pregnancy cause hydroureter?
A
Smooth muscle hypotonia
21
Q
How can pregnancy cause gallstones?
A
Decreased smooth muscle tone
22
Q
How can pregnancy cause pruritus?
A
Decreased smooth muscle tone = cholestasis
23
Q
Pregnancy increases these 3 coag factors
A
Fibrinogen
Factor V
Factor VIII
24
Q
Pregnancy results in less or more coagulable state?
A
Hypercoagulable
esp venous
25
Pregnancy decreases this coag factor
Factor S
26
This accounts for half of miscarriages before 20 weeks GA
Chromosomal anomalies
27
Asherman syndrome is due to this
Intrauterine scar tissue
usually due to infection or surgery
28
Asherman syndrome causes this
Recurrent miscarriage
29
Cervical incompetence is usually due to this
Cervical surgery/trauma
30
Cervical incompetence causes miscarriage at this time
2nd trimester
31
Submucosal leiomyomas and endometrial polyps cause miscarriage at this time
Early
before 20 weeks GA
32
These two vascular/coag disorders cause earlier miscarriage before 20 weeks GA
Anti-phospholipid
Factor V Leiden
33
Multiple gestation cause pregnancy loss at this time
Late
third trimester; >20 weeks GA
34
Premature rupture of membranes causes pregnancy loss at this time
Late
third trimester; >20 weeks GA
35
Placental disorders cause pregnancy loss at this time
Late
third trimester; >20 weeks GA
36
Chorioamnionitis causes pregnancy loss at this time
Late
third trimester; >20 weeks GA
37
This is the outer layer immediately in contact with amniotic fluid
Amnion
38
This is the layer beneath amnion
Chorion
39
Only identical twins have this form of placenta
Monochorionic
40
Dizygotic twins result in placenta that is always this form
Diamniotic dichorionic
41
Twin gestation produces these 2 main risks
Risk of cord accidents
Risk of twin-twin transfusion
42
With twin-twin transfusion, is the smaller or larger twin usually with more morbidity and mortality after birth?
Larger twin
43
This describes vascular anastomses between fetal circulations
Twin-twin transfusion
44
Twin-twin transfusion results in this main effect
Growth discordance
45
This is placenta implantation over or near cervical os
Placental previa
46
Placental previa frequently occurs at this time
Early in pregnancy
(most will migrate superiorly by term)
47
Placental previa has a risk of this
Intrapartum hemorrhage
(maternal and fetal)
48
Placental previa produces this clinical symptom
Painless vaginal bleeding, abrupt onset
(typically recurrent; may be episodic and self-limited or massive)
49
This is used to confirm the diagnosis of Placental previa
Ultrasound
50
This is premature detachment of placenta
Abruptio placenta
51
What is Placenta previa?
Placenta implantation over or near cervical os
52
What is Abruptio placenta?
Premature detachment of placenta
53
These are 3 main risk factors for Abruptio placenta
Vascular disease
Spontaneous/idiopathic
Maternal trauma
54
These are 3 complications of Abruptio placenta
Fetal growth restriction
Premature birth
Fetal mortality
55
This condition produces maternal pain, vaginal bleeding
May induce uterine contractions
Less fetal movements, growth
Often hidden (found at delivery or on ultrasound)
Abruptio placenta
56
How can Abruptio placenta be "hidden"?
If retroplacental or at superior margin
57
This is a risk for Intrauterine ascending infection
Prolonged/premature rupture of membranes
58
This is the sequence of Intrauterine ascending infection
Membranes --> amniotic fluid --> cord
59
This is acute inflammation in membranes
Chorioamnionitis
60
This is acute inflammation in cord
Funisitis
61
Chorioamnionitis is acute inflammation in this
Membranes
62
Funisitis is acute inflammation in this
Cord
63
Cloudy amniotic fluid that is foul-smelling, membranes cloudy and purulent appearing, can be due to this
Intrauterine ascending infection
64
Does hematogenous maternal infection affecting fetus typically produce villitis or chorioamnionitis?
Villitis
65
This infection is usually lymphoplasmacytic infiltrate
Often with vascular narrowing and fibrosis
Chronic villitis
66
This is a separate, smaller placental lobe
Placental succenturiate lobe
67
Placental succenturiate lobe is separated from main disk by this
Chorionic membranes
68
Placental succenturiate lobe has risk of this if vessels traverse os
Vasa Previa
69
Placental succenturiate lobe has risk of this
Vascular compression or rupture
70
With this condition, vasculature travels through membranes
Risk of Vasa Previa, risk of vascular compression or rupture
Placental succenturiate lobe
71
This is AKA Battledore placenta
Marginal cord insertion
72
Marginal cord insertion is inserted at this
At or near edge of placenta
73
Marginal cord insertion has increased risk of this
Decreased perfusion
also risk of detaching cord during delivery of placenta
74
In this, vessels travel through membranes before joining disk
Velamentous insertion
75
Velamentous insertion has these 3 risks
Low perfusion
Vasa Previa
Vascular accident during delivery
76
This is pregnancy induced hypertension >140/90
Pre-eclampsia spectrum
77
Pre-eclampsia spectrum is more common in this type of patient
Primigravid women, younger women
78
Pre-eclampsia is defined by this BP
>140/90
79
This is a more severe form of the Pre-eclampsia spectrum
HELLP syndrome
80
This is the most severe form of Pre-eclampsia spectrum
Eclampsia
results in convulsions
81
In normal placentation, this invades uterine wall and replaces spiral artery smooth muscle
Result is converts high pressure resistance artery = low pressure, high flow artery
Trophoblast
82
In the pathogenesis of pre-eclampsia, failure of this leads to persistence of smooth muscle
Trophoblast
83
In the pathogenesis of pre-eclampsia, trophoblast failure leads to this
Persistence of smooth muscle
(placenta hypoxia as placenta grows)
84
What leads to decreased placental blood flow in the pathogenesis of pre-eclampsia?
Maternal hypertension
85
What leads to protein loss and edema in the pathogenesis of pre-eclampsia?
Maternal renal dysfunction
86
What leads to microangiopathic hemolysis, platelet destruction, and placental infarction in the pathogenesis of pre-eclampsia?
Maternal hypercoagulability
87
What leads to intrauterine growth restriction, placental infarcts and abruption in the pathogenesis of pre-eclampsia?
Placental hypoperfusion
88
Pre-eclampsia becomes clinically apparent at this time
3rd trimester
(earlier with Molar and multiple gestation)
89
This condition can produce edema, proteinuria, HTN
Signs of endothelial damage
Becomes clinically apparent in 3rd trimester
Pre-eclampsia spetrum
90
Pre-eclampsia spectrum with CNS involvement / convulsions is this
Eclampsia
91
In this condition, fetus can have acute atherosis, decidual vasculopathy, and thrombotic vasculopathy
Pre-eclampsia spectrum
92
Morphology of this condition shows:
Maternal kidney with endothelial swelling and bloodless glomeruli
Pre-eclampsia
93
Morphology of this condition shows:
Maternal microangiopathic hemolysis
Maternal liver parenchymal/subcapsular hemorrhages, microthrombi
Pre-eclampsia spectrum
94
This is the only cure for Pre-eclampsia spectrum
Delivery of placenta
95
These are 3 indications for delivery in Pre-eclampsia
Maternal organ dysfunction
Fetal compromise
HELLP or Eclampsia
96
Placental infarct occurs almost always in this
Term placentas
97
Placental infarct is not significant unless it is this amount of volume
>10-20%
98
Placental infarct of a large amount causes this
Uteroplacental insufficiency
(= fetal growth restriction, stillbirth)
99
These are 4 types of conditions that cause post-partum bleeding
Uterine atony
Tissue retained
Thrombin (coag disorders)
Trauma
100
This is an example of a coag disorder that can cause post-partum bleeding
Amniotic fluid embolism
101
This is failure of myometrial contraction
Uterine atony
102
Uterine atony is failure of this
Myometrial contraction
103
This is the most common cause of post-delivery obstetric hemorrhage
Uterine atony
104
Uterine stretch can cause this condition of post-partum bleeding
(e.g. twins, macrosomia, polyhydramnios)
Uterine atony
105
How can prolonged labor or oxytocin admin cause Uterine atony?
Uterine exhaustion
106
These are 2 types of meds that can cause Uterine atony
MgSO2
Anesthesia
107
This can cause a boggy soft uterus and profuse vaginal bleeding post-partum
Uterine atony
108
These are 3 types of management for Uterine atony
Oxytocin
Uterine massage
Hysterectomy
109
This is when the placenta adheres directly to endometrium
No intervening decidual layer
Placenta accreta
110
What is Placenta accreta?
Placenta adheres directly to endometrium
111
These are 2 main risk factors for Placenta accreta
Placenta previa (esp with c-section scar)
Implantation on scar, leiomyoma, abnormal surface
112
In Placenta accreta, retained placenta carries this risk
Infection
(also of prolonged hemorrhage; malignant degeneration)
113
Placenta accreta results in difficulty of this during delivery
Separating placenta
114
These are 3 complications of Placenta accreta
Maternal-fetal bleeding
Retained placenta
Myometrial invasion
115
This is when placenta invades into myometrium
Placenta increta
116
This is when placenta invades through wall into serosa or adjacent structures
Placenta percreta
117
Placenta increta is when it invades into this
Myometrium
118
Placenta percreta is when it invades into this
Through wall
into serosa or adjacent structures
119
This is consumption coagulopathy due to amniotic fluid in maternal circulation
Amniotic fluid embolism
120
This is the classic triad of Amniotic fluid embolism
(at late labor or immediately after delivery)
Abrupt hemodynamic compromise
Abrupt respiratory compromise
Consumptive coagulopathy
121
This condition causes abrupt hemodynamic compromise, respiratory compromise, and consumptive coagulopathy
Amniotic fluid embolism
122
This is a risk factor for Amniotic fluid embolism
Uterine atony
123
This is a common outcome of Amniotic fluid embolism
Maternal/infant death
(often from neuro impairment)
124
The pathogenesis of this condition involves fetal tissue entering maternal circulation, leading to an anaphylactic reaction
Amniotic fluid embolism
125
How does Amniotic fluid embolism cause R then L heart failure?
Pulmonary vasoconstriction
126
How does Amniotic fluid embolism cause profound hypoxia?
PUlmonary vasoconstriction
127
This is abnormal proliferative placental tissue
Gestational trophoblastic disease
128
Complete and partial hydatidiform moles, invasive mole, and choriocarcinoma are this type of condition
Gestational trophoblastic disease
129
This is gestational tissue completely derived from paternal chromosomes with an empty ovum
Complete mole
130
Complete hydatidiform mole is gestational tissue completely derived from this
Paternal chromosomes with an empty ovum
131
Complete hydatidiform mole is most often due to this
Duplication of one sperm
--> 46 XX
132
Complete hydatidiform mole can develop into this
Choriocarcinoma
133
Complete hydatidiform mole can persist or form this
Invasive mole
134
Complete hydatidiform mole causes a rapid increase in these levels
hCG
135
This condition causes rapid uterine enlargement, vaginal bleeding, rapid increase in hCG levels, with no fetal tissue on ultrasound
Complete hydatidiform mole
136
Complete hydatidiform mole shows this on ultrasound
No fetal tissue
137
In Complete hydatidiform mole, rapid increase in hCG levels often causes this
Hyperemesis gravidarum
138
Morphology of this condition shows large villi and trophoblastic proliferation
Complete hydatidiform mole
139
This is gestational tissue derived from intact ovum and two sperm
Partial hydatidiform mole
140
Partial hydatidiform mole is gestational tissue derived from this
Intact ovum and two sperm
141
Is a complete or Partial hydatidiform mole from an empty ovum?
Complete
(partial = intact ovum)
142
Partial hydatidiform mole causes this genetics
Always triploid
143
Does Complete or Partial hydatidiform mole have an increase risk of choriocarcinoma?
Complete
144
Is fetal tissue present in Complete or Partial hydatidiform mole?
Partial
(no fetal tissue in complete)
145
This type of mole is always triploid
Causes miscarriage and high hCG
Partial hydatidiform mole
146
This is molar tissue invading into uterine wall
Invasive mole
147
Invasive mole is molar tissue invading into this
Uterine wall
148
Invasive mole invading through full thickness causes this
Perforation
149
How can Invasive mole "metastasize" to distant sites?
(but will regress)
Uterine vessels
150
This may invade uterine vessels and "metastasize" to distant sites but will regress
Invasive mole
151
This is malignant trophoblastic tissue
Choriocarcinoma
152
Choriocarcinoma is this malignant tissue
Trophoblastic
153
This condition arises from molar pregnancy, ectopic pregnancy, or retained placental tissue
Aggressive tumor but 100% cure with chemo
Choriocarcinoma
154
This causes vaginal bleeding
May occur weeks/months after molar or normal pregnancy
hCG very high
Highly sensitive to chemotherapy
Choriocarcinoma
155
Is gestational or non-gestation Choriocarcinoma chemo-resistant?
Non-gestation
(gestational Choriocarcinoma is highly sensitive to chemo)
156
This is a hemorrhagic tumor with two cell components
Frequent metastasis to lung/brain = "cannonballs"
Choriocarcinoma
157
Umbilical cord knot has higher risk in these 3 conditions
Polyhyramnios
Diabetes
Monoamniotic twins
158
What is a false umbilical cord knot?
Vascular redundancy
no significance
159
Single umbilical artery causes a higher rate of fetal anomalies, especially these 2 types
Genitourinary and Cardiac
Endocrine Weeks 4 5 6
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