1. Diseases of Pregnancy

2. Normal

6. Ectopic Pregnancy

7. 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

8. 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

9. Gestational Trophoblastic Diseases Hydatidiform mole –Complete –Partial Invasive mole Choriocarcinoma High level of hCG

10. Hydatidiform Mole Grape like, cystically dilated villi Common 40 year Uterus filled with cystic structures (grape like)

11. Hydatidiform mole Complete –No fetus –Diploid 46xx –Empty egg+ 2 sperms –1/2000 pregnancy Partial –Fetus present –Triploid 69xxy –Egg+ 2 sperms

12. Complete mole

15. Micro –Hydropic swelling of villi –Proliferation of trophoblasts 10% progress to invasive mole 2% develop choriocarcinoma

16. Partial Mole

19. Invasive Mole

20. Invasive mole Progression of complete mole Extension/invasion to the myometrium Sometimes involve the vagina and the surrounding structures No metastasis

23. Choriocarcinoma

24. 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

28. Inflammation of Placenta 1. Ascending 2. Hematogenous Premature birth Premature rupture of membranes Mycoplasma, Candida, bacteria Syphilis, TB, Toxo…

29. Inflammation of Placenta Acute inflammation: –1. Amnion/Chroion- Chorioamnionitis –2. Umbilical cord- Funisitis –3. Villi- villitis

30. Chorioamnionitis

32. Funisitis

34. Villitis

36. Preeclampsia/Eclampsia Hypertension, proteinuria, edema in the 3 rd trimester Commonly in first pregnancy of >35year Eclampsia: seizures DIC, ischemic organ injury

37. 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

38. Preeclampsia/Eclampsia Placenta –Infarcts –Retroplacental hemorrhage –Villous edema, hypovascularity –Acute atherosis (fibrinoid necrosis) –Microvascular thrombi in all organs: kidney, Brain, Heart…

39. Infarct