Complications during pregnancy: Pathology review
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Complications during pregnancy: Pathology review
Pathology
Female reproductive system disorders
Amenorrhea
Breast cancer
Fibrocystic breast changes
Intraductal papilloma
Mastitis
Paget disease of the breast
Phyllodes tumor
Intrauterine growth restriction
Oligohydramnios
Polyhydramnios
Potter sequence
Postpartum hemorrhage
Preterm labor
Pelvic inflammatory disease
Urethritis
Ectopic pregnancy
Gestational trophoblastic disease
Miscarriage
Germ cell ovarian tumor
Krukenberg tumor
Ovarian cyst
Ovarian torsion
Polycystic ovary syndrome
Premature ovarian failure
Sex cord-gonadal stromal tumor
Surface epithelial-stromal tumor
Chorioamnionitis
Congenital cytomegalovirus (NORD)
Congenital rubella syndrome
Congenital syphilis
Congenital toxoplasmosis
Neonatal conjunctivitis
Neonatal herpes simplex
Neonatal meningitis
Neonatal sepsis
Cervical incompetence
Gestational diabetes
Gestational hypertension
Hyperemesis gravidarum
Placenta accreta
Placenta previa
Placental abruption
Preeclampsia & eclampsia
Female sexual interest and arousal disorder
Genito-pelvic pain and penetration disorder
Orgasmic dysfunction
Fetal alcohol syndrome
Fetal hydantoin syndrome
Cervical cancer
Choriocarcinoma
Endometrial cancer
Endometrial hyperplasia
Endometriosis
Endometritis
Uterine fibroid
Male and female reproductive system disorders
Delayed puberty
Precocious puberty
5-alpha-reductase deficiency
Androgen insensitivity syndrome
Kallmann syndrome
Klinefelter syndrome
Turner syndrome
Male reproductive system disorders
Bladder exstrophy
Hypospadias and epispadias
Penile cancer
Priapism
Benign prostatic hyperplasia
Prostate cancer
Prostatitis
Erectile dysfunction
Male hypoactive sexual desire disorder
Cryptorchidism
Epididymitis
Inguinal hernia
Orchitis
Testicular cancer
Testicular torsion
Varicocele
Reproductive system pathology review
Benign breast conditions: Pathology review
Breast cancer: Pathology review
Cervical cancer: Pathology review
Complications during pregnancy: Pathology review
Congenital TORCH infections: Pathology review
Disorders of sex chromosomes: Pathology review
Disorders of sexual development and sex hormones: Pathology review
HIV and AIDS: Pathology review
Ovarian cysts and tumors: Pathology review
Penile conditions: Pathology review
Prostate disorders and cancer: Pathology review
Sexually transmitted infections: Vaginitis and cervicitis: Pathology review
Sexually transmitted infections: Warts and ulcers: Pathology review
Testicular and scrotal conditions: Pathology review
Testicular tumors: Pathology review
Uterine disorders: Pathology review
Vaginal and vulvar disorders: Pathology review
Assessments
Complications during pregnancy: Pathology review
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Transcript
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26 year-old Effie is brought to the emergency department with severe lower abdominal pain and bloody vaginal discharge that began a few hours ago. Her last menstrual period was 7 weeks ago. She has been sexually active with multiple partners and uses condoms on occasion. Her past medical history is significant for pelvic inflammatory disease. On examination, her blood pressure is 80/40 mmHg and her pulse is 130 beats per minute. She is pale and her extremities are cold and clammy. Next to her, there’s also 37-year-old Kate who came in noting an abrupt onset of abdominal pain and continuous vaginal bleeding. She is going through week 28 of her fourth pregnancy and was involved in a car crash a couple of hours ago, but did not immediately seek medical care. On presentation, fetal heart rate and movement are significantly diminished. Laboratory studies reveal low platelets, prolonged PT and PTT and elevated d-dimers. Peripheral blood smear shows schistocytes.
Based on their initial presentation, both Effie and Kate have a form of pregnancy complication.
Now, the most common medical complication of pregnancy is hypertensive disorders of pregnancy. These are diseases that cause high blood pressure during pregnancy, either a systolic blood pressure higher than 140 mmHg, or a diastolic blood pressure higher than 90 mmHg, or both. So, when hypertension is diagnosed before 20 weeks gestation, it’s usually chronic hypertension, meaning that it’s not due to pregnancy.
After 20 weeks gestation, new onset hypertension without proteinuria or damage to other organs is gestational hypertension. Now if hypertension gets severe, meaning systolic blood pressure of 160 mmHg or greater and/or diastolic blood pressure of 110 mmHg or greater, it can often lead to organ damage. One key thing to look out for is the presence of proteinuria, or excessive amounts of protein in the urine, which is a marker of kidney damage. Other affected organs include the brain and liver.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "Greenspan's Basic and Clinical Endocrinology, Tenth Edition" McGraw-Hill Education / Medical (2017)
- "Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location" Human Reproduction Update (2013)
- "Methotrexate for ectopic pregnancy: when and how" Archives of Gynecology and Obstetrics (2014)
- "Tubal ectopic pregnancy: diagnosis and management" Archives of Gynecology and Obstetrics (2008)
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