High-risk pregnancies — Flashcards

Flashcard 21: Define placenta accreta.

Answer: placenta invades beyond decidua and attaches to myometrium

Extra: Massive maternal bleeding at delivery. Risk factors: prior C-section, prior placenta previa.

Flashcard 22: HELLP syndrome

Answer: variant/complication of preeclampsia/eclampsia

Extra: hemolysis increased: liver enzymes decreased: platelets 

Flashcard 23: What is the primary pathophysiology of preeclampsia/eclampsia?

Answer: Placental ischemia secondary to impaired remodeling of spiral arteries and high maternal vascular resistance.

Extra: Signs/Symptoms: Headache, blurred vision, RUQ pain, edema, altered mental status, hyperreflexia, +/- seizures (eclampsia). Labs: - Increased: Hyperuricemia - Decreased: Platelets (Thrombocytopenia) Management: 1. Definitive treatment: Delivery. 2. Supportive: Bed rest, antihypertensives (e.g., Labetalol, Hydralazine). 3. Seizure prophylaxis/treatment: IV Magnesium sulfate. Risk Factors: Prior history, HTN, DM, renal disease, autoimmune disorders (e.g., APS), nulliparity. Complications: HELLP syndrome, placental abruption, stroke.

Flashcard 24: Pathogenesis of a partial hydatidiform mole

Answer: Triploidy (typically 2 sperm + 1 normal egg)

Extra: Karyotype: 69,XXX; 69,XXY; or 69,XYY. Key features of Partial Mole: - Fetal parts often present. - Slightly elevated β-hCG (not as high as Complete Mole). - Low risk of progression to Choriocarcinoma (<5%). - Histology: Some hydropic villi, focal trophoblastic proliferation.

Flashcard 25: Genetic pathogenesis of a complete hydatidiform mole?

Answer: 1 sperm (doubled) or 2 sperm + 1 empty egg::Genotype

Extra: Genetic makeup: Usually 46,XX (90%) or 46,XY. Most commonly caused by a single sperm fertilizing an empty egg and duplicating its chromosomes (androgenesis). Clinical features: • Cystic swelling of chorionic villi and proliferation of trophoblastic tissue • Presentation: Abnormal vaginal bleeding, uterine size > dates • Labs: Markedly increased β-hCG (>100,000 mIU/mL) • Ultrasound: Snowstorm appearance (hydropic villi) • Risk: Highest risk of progression to Choriocarcinoma (2-3%) • Treatment: Suction D&C, follow β-hCG levels to zero.

Flashcard 26: What is the mechanism of a congenital hydrocele?

Answer: incomplete fusion of processus vaginalis leads to fluid build-up in testicle

Extra: Congenital hydrocele is often associated with an indirect inguinal hernia due to the same patent processus vaginalis. Diagnosis is usually clinical with transillumination.

Flashcard 27: Cryptorchidism: What are the characteristic hormonal changes and complications?

Answer: Hormonal profile: Increased FSH and LH; Decreased Inhibin. Testosterone is usually normal (unless bilateral).

Extra: Pathophysiology: Impaired spermatogenesis and increased risk of germ cell tumors. Risk factor: Prematurity. Note: Orchiopexy reduces the risk of infertility and allows for easier monitoring of tumors, but the inherent risk of malignancy remains higher than the general population.

Flashcard 28: Main pathophysiology of gynecomastia?

Answer: hyperestrogenism from any source

Extra: Female-like breast tissue in a male. Commonly seen in states of hyperestrogenism or androgen deficiency.

Flashcard 29: Clinical features of fibrocystic disease of the breast?

Answer: Premenstrual bilateral breast pain and multiple lumps that fluctuate in size with the menstrual cycle.

Extra: Fibrocystic change is the most common cause of breast lumps in women of reproductive age. It is a benign condition and often improves after menopause. Diagnosis is usually clinical, sometimes supported by ultrasound (showing cysts).

Flashcard 30: GYN tumor prognosis: _____ > _____ > _____

Answer: endometrial