Thursday, February 19, 2015

Study group discussion: Embryology and gestational trophoblastic disease

I have a few questions on embryology!

At which stage does the embryo implant?

Isn't confabulations when you lie and believe it to be the truth

Blastocyst? 18-20 cell stage?

Yes!

When does the urine pregnancy test become positive? And why?

14 days?

Why 14 days?

HCG is secreted.. I don't know. The placenta starts forming?

The trophoblast invades the sinuses at day 12 so that's when beta HCG from the syncitiotrophoblast gets into the mother's blood in high amounts.

Okay! I didn't know this :D

*We had a confusion about when it gets in the blood vs when it comes in urine, so we Googled*

A urine home pregnancy test HPT usually becomes positive within a week or so after implantation, or around the time of your expected menstrual period. It becomes positive about 12-14 days days after ovulation and fertilization.

Implantation occurs at which day?

6 day!

So 6+7=13

That's when you'll get urine test positive!

Speaking of placenta, which Placental hormone is the cause of gestational diabetes?

HPL. Human placental lactogen.

Yes, HPL it is!

Which placental hormone correlates best with growth of placenta?

Human placental somatomammotropin.

If a patient is pregnant through IVF. Till when do you give progesterone and why?

8 weeks.

Cause it takes 8-12 wks for the placenta to completely take over the function of hormone production from ovaries.

Yes, placenta takes over progesterone production around 10 weeks!

Also serum HCG doubles up every 48 hours!

Yes, hCG doubles every 2 days

Clinical significance?

In Ectopic pregnancy, it fails to double.

Downs syndrome!

What if it's more?

In GTD, it increases.

Yep.

Snow storm apperance! It's seen in gestational trophoblastic disease on USG.

Yes, snow storm is in hydatidiform mole.

In my viva, I was asked how will you suspect GTD in a normal pregnancy, clinically?

Thyroid symptoms.
Excess vomiting.

Patient has no symptoms. She came in for a normal check up. Clinically, no tests.

Increased hCG.

You won't do hCG for everyone who comes in, right?

You will see grape like vesicles per vaginum. Excess vaginal bleeding.

No grapes visible. She is at 7 month gestation. Completely normal.

Think more basic, guys!

You are asking just signs, right?

I was asked how will you suspect hydatidiform mole CLINICALLY in a asymptomatic patient.

The uterus height does increase.
That's symphysio fundal height (SFH)

Correct!

And if you are lucky enough.. There is this boggy feeling to the uterus.

No palpable finding.. No fetal parts.
Yes!

Then you won't be able to asculate for a heart sound. That's what my examiner wanted to hear!

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