Diseases of Pregnancy

Normal

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 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

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

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 3 rd 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