Diseases of Pregnancy. Normal Ectopic Pregnancy.

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Diseases of Pregnancy
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Transcript of Diseases of Pregnancy. Normal Ectopic Pregnancy.

Diseases of Pregnancy

Normal

Ectopic Pregnancy

Ectopic Pregnancy

• 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

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

Gestational Trophoblastic Diseases

• Hydatidiform mole– Complete– Partial

• Invasive mole

• Choriocarcinoma

• High level of hCG

Hydatidiform Mole

• Grape like, cystically dilated villi

• Common <20, >40 year

• Uterus filled with cystic structures (grape like)

Hydatidiform mole

• Complete– No fetus

– Diploid 46xx

– Empty egg+ 2 sperms

– 1/2000 pregnancy

• Partial– Fetus present

– Triploid 69xxy

– Egg+ 2 sperms

Complete mole

• Complete mole

• Micro– Hydropic swelling of villi– Proliferation of trophoblasts

• 10% progress to invasive mole

• 2% develop choriocarcinoma

Partial Mole

Invasive Mole

Invasive mole

• Progression of complete mole

• Extension/invasion to the myometrium

• Sometimes involve the vagina and the surrounding structures

• No metastasis

Choriocarcinoma

Choriocarcinoma

• 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

Inflammation of Placenta

• 1. Ascending

• 2. Hematogenous

• Premature birth

• Premature rupture of membranes

• Mycoplasma, Candida, bacteria

• Syphilis, TB, Toxo…

Inflammation of Placenta

• Acute inflammation:– 1. Amnion/Chroion- Chorioamnionitis– 2. Umbilical cord- Funisitis– 3. Villi- villitis

Chorioamnionitis

Funisitis

Villitis

Preeclampsia/Eclampsia

• Hypertension, proteinuria, edema in the 3rd trimester

• Commonly in first pregnancy of >35year

• Eclampsia: seizures

• DIC, ischemic organ injury

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

Preeclampsia/Eclampsia

• Placenta– Infarcts– Retroplacental hemorrhage– Villous edema, hypovascularity– Acute atherosis (fibrinoid necrosis)– Microvascular thrombi in all organs: kidney,

Brain, Heart…

Infarct