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