Common pathologies of pregnancy

Question 1

What is the role of progesterone

Answer 1

• When egg is fertilized progesterone will continue to increase
• The role of the progesterone is to thicken the endometrium
• The progesterone does this by changing cells
• The endometrium becomes the DECIDUA

Question 2

What is the decidua and what are its main properties

Answer 2

thickened ENDOMETRIUM

• Increased vasculatity
• Stromal cells between the glands and vessels of the endometrium become BIGGER and PROCOAGULANT a.k.a STOP BLEEDING

Question 3

What makes up the fertilised egg?

Answer 3

-chorion surrounded by trophoblasts

Question 4

What do the trophoblast cells produce?

Answer 4

B-hcg

Question 5

What is the function of B-hCG?

Answer 5

stimulates the corpus luteum to produce progesterone which prevents the decider from shedding

Question 6

What happens to the egg once is buried in the decidua

Answer 6

1. -The egg (fertilized) burrows into the decidua
2. -Trophoblast cells invade mothers blood vessels and links them up with fetal blood vessels
3. -There are decidual cells in stroma
4. -Projections of the chorion (chorionic villi) covered in trophoblast cells move into the decidua
5. -The decidual cells are procoagulant and help stop bleeding when the trophobasts invade mother’s blood vessels
6. -Chorionic villi become covered in trophoblast cells in mothers blood make up most of placenta

Question 7

What is a molar pregnancy?

Answer 7

• A form of precancer of trophoblast cells

* If it persists can (rarely) give rise to a malignant tumour called choriocarcinoma

Question 8

What happens in normal fertilisation to the DNA of the mum and dad?

Answer 8

• Mum to be switches off certain genes in ova (eggs) by methylating them
• Dad to be switches off different genes in sperm by methylating them
• Mum and dad’s changes lead to different genes being swiched off
• Mum’s changes promote early baby growth
• Dad’s changes promote early placenta growth via trophoblast proliferation
• Overall effect is balanced growth of baby and placenta

Question 9

What happens to fertilisation in molar pregnancy?

Answer 9

ovum with no chromosomes because fertilised with 2 sperms with double the amount of methylated genes

Question 10

what is the treatment of molar pregnancy?

Answer 10

Removal and tissue and send to lab for biopsy.

• If BhCG should returns to normal within 6 weeks – no further treatment.
Give anti-D if rhesus negative

• If BhCG stays high (persistent disease)  cure by methotrexate