CASES FOR PLACENTAL HORMONES AND FETAL MEMBRANES

LECTURE FOR JANUARY 14, 2019 – DR ME AQUINO

Group 1:
A 39-year old G5P4 (4004) at 18 weeks AOG was stranded in her house in Bicol
because of the flooding wrought about by the typhoon. For about 3 days, she had
barely any food to eat. She was eventually rescued and brought to the hospital.
On assessment, the patient lost 5 pounds because of forced starvation, but baby
fortunately was very active with good cardiac activity.

1. What pregnancy hormones play an important role in conditions like this?

2. Which placental hormones are predominant in each trimester? Discuss the
trend for each hormone.
3. Which is the most important hormone in the first trimester? Explain.
4. Which is the most important hormone in the third trimester, particularly in
the initiation of labor?

Group 2:
A 33-year old G7P5 (5015) at 5 weeks AOG was anxious because she was told
that her HCG level was higher than expected and it might be due to twin
pregnancy among others. Her last pregnancy was an ectopic pregnancy for which
she underwent salpingectomy.

1. Describe the normal trend of serum beta-hCG in a normal pregnancy.

2. How will you explain the higher HCG in our case?
3. What are the other possible conditions that may cause this elevated serum
beta hCG?
4. What are the possible causes of lower hCG plasma levels?
CASES FOR PLACENTAL HORMONES AND FETAL MEMBRANES
LECTURE FOR JANUARY 14, 2019 – DR ME AQUINO

Group 3:
A millennial techie couple excitedly went to the clinic with a positive pregnancy
test. This is their first pregnancy. They have surfed the net about early pregnancy
and they have several questions. You try your best to answer these.

1. Is a positive urine pregnancy test enough to confirm a woman is

pregnant? Is there any other confirmatory test?
2. What are the changes that happens from fertilization to day 10?
3. When can they do an ultrasound and already see an embryo?
4. When is the placenta formed and placental circulation established?

Group 4:
A 40-year old hypertensive G6P5 (5005) at 32 weeks AOG woke up with vaginal
bleeding. She reported minimal fetal movement the day prior to consult. At the
ER, no fetal heart beat was appreciated. Patient eventually went into
spontaneous labor and delivered a stillbirth. Placenta was sent for histopathology.

1. What are the possible reasons why placenta was submitted for
histopathologic examination?
2. Give other conditions, both maternal and fetal, which necessitate
placental histopathologic examination.
3. Arrange in proper order the fetal membranes/placental layers, from fetal
to maternal side. Label appropriately in a diagram.
4. What are some of the abnormalities of the umbilical cord and fetal
membranes?