Gestational Disorders

3.1 - Hydatidiform Mole & Choriocarcinoma

1) Villous-shaped TROPHY case:

the TROPHOBLAST forms the chorionic villi (part of placenta that derives from the embryo)
(transfers oxygen and nutrients between mother and fetus) (composed of two layers
[SYNCYTIOtrophoblast & CYTOtrophoblast])

2) SYNCHRONIZED swimming trophies on outer shelf:

the SYNCYTIOtrophoblast is the outer layer of villi (comes into direct contact with maternal
blood) (composed of large cells with many nuclei) (secretes β-hCG and human placental
lactogen [HPL])

3) CYTO-CYCLING trophies on inner shelves:

the CYTOtrophoblast is the inner layer of villi (composed of many mononuclear cells)

4) Prominent stressed β-hCG babysitter:

β-human chorionic gonadotropin (β-hCG) is EXTREMELY elevated in many gestational
trophoblastic diseases (because β-hCG is secreted by trophoblast [specifically
SYNCYTIOtrophoblast])

5) Stuffed mole:
Hydatidiform MOLE (alternatively “Molar Pregnancy” because they are a type of abnormal
pregnancy) (most common gestational trophoblastic disease) (can be Complete or Partial)

6) Young mom & older mom:

extremes of maternal age ( <15 or >35) increase the risk of molar pregnancy

7) Repeated mole:
history of molar pregnancy increases the risk of another molar pregnancy)

8) Overturned baby carriage:

history of miscarriage increases the risk of molar pregnancy

9) Shirt COMPLETELY stuffed with mole:

COMPLETE hydatidiform mole (causes EXTREMELY high β-hCG levels)

10) Carrying ONLY a mole:

a COMPLETE mole is COMPLETELY composed of molar components (NO fetal parts)

11) Round mirror:

EMPTY ovum

12) Nerf ball with "X" fin:

NORMAL sperm (haploid 23X)

13) "X" nerf ball duplicated in empty mirror:

most COMPLETE moles are 46XX (EMPTY ovum is fertilized by one 23X sperm → sperm
DUPLICATES within egg → 46XX zygote)

14) Uterus vase completely filled with marbles:

in a COMPLETE mole, all chorionic villi are COMPLETELY ABNORMAL (large, disordered,
and edematous “hydropic”]) (“bunch of grapes”)
15) Uterus vase dripping red:
COMPLETE moles present with vaginal bleeding in early pregnancy

16) Oversized pregnant belly:

COMPLETE moles present with enormous uterus (ENLARGED out of proportion to gestational
age

17) Bullhorn:
ultrasound

18) Detecting feather storm:

on ultrasound, COMPLETE moles display a “snowstorm” pattern (diffuse echogenic material in
uterus)

19) Green face:

COMPLETE moles can present with hyperemesis gravidarum (severe nausea & vomiting) (due
to EXTREMELY high β-hCG levels)

20) Large bowtie:

COMPLETE moles can present with HYPERthyroidism (due to EXTREMELY high β-hCG
levels [hCG shares common alpha subunit with TSH → stimulates TSH receptors in thyroid])

21) Bilateral cystic flowers:

COMPLETE moles can present with bilateral theca-lutein cysts (multilocular ovarian cysts) (due
to EXTREMELY high β-hCG levels)

22) Young child with steaming hair CLAMP:

COMPLETE moles can present with early onset preeclampsia (at <20 weeks gestational age)
(due to abnormal placentation)

23) Crab painting near complete mole:

hydatidiform moles can undergo malignant transformation into choriocarcinoma (or other
gestational trophoblastic neoplasm) (greater risk in COMPLETE > PARTIAL) (suspect if β-hCG
levels don’t decrease after pregnancy termination)
24) Shirt PARTIALLY stuffed with mole:
PARTIAL hydatidiform mole (causes SLIGHTLY high β-hCG levels

25) Labeled laundry basket:

PARTIAL moles are 69 XXX, XXY, or XYY (TRIPLOID and contain at least one X
chromosome)

26) Two "X" nerf balls entering FULL basket:

PARTIAL moles are TRIPLOID (NORMAL ovum is fertilized by TWO normal sperm →
triploid zygote)

27) Uterus vase with baby doll & marbles:

a PARTIAL mole contains fetal PARTS (in addition to abnormal villi)

28) Normal pregnant belly:

PARTIAL moles present with uterine size that is NORMAL or slightly small for gestational age

29) Uterus vase dripping red:

COMPLETE moles present with vaginal bleeding in early pregnancy

30) "57" on term paper:

PARTIAL moles are POSITIVE for p57 (protein expressed by a MATERNAL allele) (in
contrast, COMPLETE poles are NOT positive because of absence of maternal DNA)

31) CHOIR music box:

CHORIOCARCINOMA (most common gestational trophoblastic neoplasm) (malignant tumor
arising from trophoblast) (occurs after pregnancy)

32) Crabs scattered outside uterus box:

CHORIOCARCINOMAS are usually metastatic at time of diagnosis

33) β-hCG babysitter with kid, empty carriage, baby doll keychain, stuffed mole:
CHORIOCARCINOMAS can occur after ANY pregnancy type (normal, preterm, terminated,
ectopic, or molar) (but most common after COMPLETE mole)
34) Disordered TROPHIES without marbles:
on histology, CHORIOCARCINOMA displays abnormal proliferation of CYTOtrophoblast &
SYNCYTIOtrophoblast cells (but NO chorionic villi)

35) Dripping blood from uterus box:

CHORIOCARCINOMAS can present with vaginal bleeding

36) β-hCG babysitter:

CHORIOCARCINOMAS present with rapidly rising β-hCG levels

37) Crab pin on shirt:

CHORIOCARCINOMAS commonly metastasize to the lungs (often prior to time of diagnosis)

38) Bleeding from crab pin:

CHORIOCARCINOMAS can present with hemoptysis (due to lung metastasis)

39) Methotrexate chopsticks:

CHORIOCARCINOMA is treated with methotrexate (highly effective)
3.2 - Gestational Disorders

1) Baby keychain outside uterus purse:

ECTOPIC PREGNANCY (embryo implants outside uterus)

2) Two straps connecting uterus purse to ovarian buttons:

ECTOPIC pregnancy usually implants in the FALLOPIAN tubes (may also occur in ovaries or
abdominal cavity)

3) Key chain at widened mid-strap:

the AMPULLA of the fallopian tube is the most common site of ECTOPIC pregnancy (same
location as fertilization)
4) Knot in curtains:
tubal ligation increases the risk of ECTOPIC pregnancy

5) "DESk":
exposure to diethylstilbestrol (DES) (as a fetus) increases the risk of ECTOPIC pregnancy (due
to abnormal fallopian tube anatomy)

6) Fallopian chandelier with fiery candles:

pelvic inflammatory disease (PID) increases the risk of ECTOPIC pregnancy (due to fallopian
tube injury)

7) Soil spilling out of uterus planter:

ENDOMETRIOSIS increases the risk of ECTOPIC pregnancy (due to fallopian tube injury)

8) Poking belly with name tag:

ECTOPIC pregnancy presents with acute lower abdominal pain

9) Bleeding uterus pot:

ECTOPIC pregnancy presents with vaginal bleeding

10) Deciduous plants in uterus pot:

in ECTOPIC pregnancy, a sample of uterine lining displays DECIDUALIZED endometrium
(thickened endometrium, normally occurs in pregnancy)

11) Torn curtain:

untreated ECTOPIC pregnancy can lead to fallopian tube rupture

12) Passed out from bloody stomach:

untreated ECTOPIC pregnancy can lead to life-threatening intra-abdominal hemorrhage (due to
ruptured fallopian tube)

13) Meat sticks:

ECTOPIC pregnancy can be treated with methotrexate

14) Baby holding HPL formula:

the SYNCYTIOtrophoblast (originates from fetal tissue) secretes human placental lactogen
(HPL)
15) Pregnant woman with HPL & candy jar:
GESTATIONAL DIABETES (new onset diabetes during pregnancy, resolves after delivery)
(caused by increased HPL)

16) Resistance from welcome "INSIDE" mat:

HPL increases INSULIN RESISTANCE in mother

17) Pregnant woman with raised candy jar:

GESTATIONAL DIABETES presents with hyperglycemia (HPL → insulin resistance →
hyperglycemia IF pancreas is unable to compensate by increasing insulin secretion)

18) Drinking sugary party punch:

pregnant women are screened for GESTATIONAL DIABETES with an oral glucose tolerance
test (drink glucose solution → measure serum glucose levels at specified times)

19) Smiling mother:

GESTATIONAL DIABETES resolves once baby is delivered (delivery of placenta → HPL
levels decrease to pre-pregnancy levels)

20) Dia-sweeties candy:

GESTATIONAL DIABETES is associated with a higher risk of developing DM2 later in life

21) Pink plate implanted over trash opening:

PLACENTA PREVIA (implantation of placenta over cervical OS [opening of cervix] (causes
painLESS vaginal bleeding DURING pregnancy)

22) Spilling red food:

PLACENTA PREVIA presents with vaginal bleeding during pregnancy (placenta implanted over
cervical os → disruption of placental attachment as cervix changes size and shape in late
pregnancy → bleeding)

23) Happy face:

in PLACENTA PREVIA, vaginal bleeding is PAINLESS
24) Shirt cut by surgical knife:
previous Cesarean delivery increases the risk of PLACENTA PREVIA

25) Twins:
multiple gestation increases the risk of PLACENTA PREVIA

26) ABRUPTLY dropping pink plate:

PLACENTAL ABRUPTION (premature detachment of placenta from uterine wall) (causes
PAINFUL vaginal bleeding DURING pregnancy)

27) Grimacing:
in PLACENTAL ABRUPTION, vaginal bleeding is PAINFUL

28) Concealed plate:

PLACENTA ABRUPTION sometimes presents WITHOUT vaginal bleeding (“CONCEALED
abruption”) (bleeding DOES occur, but blood is trapped between fetal membranes and uterine
wall)

29) Cast:
physical trauma during pregnancy increases the risk of PLACENTAL ABRUPTION

30) Steaming angry:

hypertension increases the risk of PLACENTAL ABRUPTION

31) Hot "Coca":

cocaine use increases the risk of PLACENTAL ABRUPTION

32) Cigarette:
smoking increases the risk of PLACENTAL ABRUPTION

33) Shaking belly:

PLACENTAL ABRUPTION presents with painful prolonged uterine contractions
34) Red food clump on back of plate:
PLACENTAL ABRUPTION may display a RETROPLACENTAL HEMATOMA (clot behind
placenta) on ultrasound

35) Mother with baby and floppy uterus bag:

UTERINE ATONY (uterus fails to contract after delivery) (most common cause of postpartum
hemorrhage [PPH])

36) Floppy uterus spilling red clothes:

in UTERINE ATONY, uterus fails to contract after placenta detaches from uterine wall →
decreased mechanical compression of exposed uterine vessels → hemorrhage

37) Falling 8 ball:

COAGULOPATHIES can cause PPH hemorrhage (von Willebrand disease, factor VIII
deficiency)

38) Torn pants:

LACERATIONS can cause PPH

39) Pink plate adhered to smooth muscle tile:

PLACENTA ACCRETA (a type of morbidly adherent placenta) (placenta attaches directly to
uterine muscle [myometrium] rather than to endometrium [decidua]) (causes PPH)

40) Plate WITHIN smooth muscle tile:

PLACENTA INcreta (a type of morbidly adherent placenta) (placenta invades INto
myometrium) (causes PPH)

41) Plate PAST smooth muscle tile:

PLACENTA PERcreta (a type of morbidly adherent placenta) (placenta invades PAST
myometrium → into serosa of uterine wall or surrounding organs) (causes PPH)

42) Bleeding pink plate:

a morbidly adherent placenta (ACCRETA, INcreta, PERcreta) causes severe PPH when delivery
of placenta is attempted (because of direct attachment to myometrium)

43) DICe:
severe hemorrhage DURING pregnancy or AFTER delivery (PPH) can lead to disseminated
intravascular coagulation (DIC)

44) Steaming red pipes:

HTN during pregnancy may be due to PRE-EXISTING hypertension (onset before pregnancy or
BEFORE 20 wks gestation) or HYPERTENSIVE DISORDERS OF PREGNANCY (onset > 20
wks) (gestational HTN, preeclampsia, eclampsia, HELLP syndrome)

45) Class of "20":

Gestational HTN (ISOLATED high BP with onset AFTER 20 wks gestation) (treated with
hydralazine, alpha-methyldopa, labetalol)

46) Steaming hair CLAMP:

PREECLAMPSIA (new onset HTN after 20 wks gestation PLUS proteinuria OR signs of end-
organ dysfunction)

47) Proteinaceous hair:

PREECLAMPSIA frequently presents with proteinuria (systemic endothelial dysfunction →
injury to renal capillary endothelium → increased permeability of glomerulus

48) Clutching head:

PREECLAMPSIA can present with headache (sign of end-organ dysfunction)

49) Blurry reflection:

PREECLAMPSIA can present with vision changes (sign of end-organ dysfunction)

50) Plug attached abnormally to placental outlet:

PREECLAMPSIA is caused by abnormal development of blood vessels to the placenta
(“abnormal placentation”)

51) Fiery burned placental outlet:

in PREECLAMPSIA, abnormal blood flow to placenta leads to placental hypoxia, inflammation,
and infarction → release of anti-angiogenic and inflammatory factors into circulation →
systemic endothelial dysfunction

52) Sleeve constricted by red cord:

in PREECLAMPSIA, HTN is caused by systemic VASOCONSTRICTION (systemic
endothelial dysfunction → decreased production of vasodilators [prostaglandin E2, prostacyclin]
AND increased production of vasoconstrictors [thromboxane A2])

53) Poofy pants:

PREECLAMPSIA can present with peripheral edema (systemic endothelial dysfunction →
increased capillary permeability) (also may be secondary to severe proteinuria)

54) Large liver bag:

PREECLAMPSIA leads to liver swelling (--> stretching of liver capsule → RUQ pain)

55) Large liver bag:

PREECLAMPSIA leads to liver swelling (--> stretching of liver capsule → RUQ pain)

56) Raised candy jar:

pre-existing diabetes increases the risk of PREECLAMPSIA (due to vascular insufficiency)

57) Worn kidney purse:

chronic kidney disease increases the risk of PREECLAMPSIA (due to vascular insufficiency)

58) Twins:
multiple gestation increases the risk of PREECLAMPSIA (due to increased placental size
without corresponding increase in blood flow)

59) Grey hair:

older age is a risk factor for PREECLAMPSIA

60) Holding up "1" finger:

first pregnancy is a risk factor for PREECLAMPSIA

61) Shaking from hair CLAMP complication:

ECLAMPSIA (generalized tonic-clonic seizures caused by severe PREeclampsia)

62) "HELLP":
HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets)
63) Broken white plates:
HELLP presents with low platelets

64) Falling red plate & schistocyte squashed tomatoes:

HELLP presents with microangiopathic hemolytic anemia (displays schistocytes on peripheral
smear)

65) ALT & AST tins falling from liver purse:

HELLP presents with elevated transaminases (ALT & AST) (due to hepatic inflammation)

66) MAGazine:
magnesium sulfate is administered to patients with PREECLAMPSIA in order to prevent
seizures (ECLAMPSIA)
3.3 - Polyhydramnios & Oligohydramnios

1) Wet pregnant belly:

POLYhydramnios (excessive amniotic fluid) (due to decreased swallowing of amniotic fluid by
fetus OR increased fetal urination

2) LARGE uterus box:

POLYhydramnios causes uterus to be LARGER than expected for gestational age

3) Falling baby bottle full of unswallowed milk:

POLYhydramnios can be caused by decreased swallowing of amniotic fluid (due to GI
obstruction OR defect in swallowing center in the brain)

4) Tied-off duodenal diaper bag:

DUODENAL ATRESIA can cause POLYhydramnios (GI obstruction → decreased swallowing
of amniotic fluid

5) Esophageal tube attached to tracheal slide:

TRACHEOESOPHAGEAL FISTULA can cause POLYhydramnios (GI obstruction →
decreased swallowing of amniotic fluid)

6) Severed doll head:

ANENCEPHALY (a neural tube defect) can cause POLYhydramnios (defect of swallowing
center in the brain → decreased swallowing of amniotic fluid)

7) Spilling large volume yellow juice:

POLYhydramnios can be caused by increased fetal urination (due to fetal high-output state OR
maternal hyperglycemia)

8) Red confetti exploding from heart popper:

POLYhydramnios can be caused by high fetal cardiac output

9) Pale porcelain doll:

fetal ANEMIA can cause POLYhydramnios (insufficient RBCs → increased cardiac output →
increased blood volume flowing through fetal kidneys → increased urination)

10) Throwing up candy:

MATERNAL DIABETES can cause POLYhydramnios (excessive maternal glucose crosses
placenta → fetal hyperglycemia → fetal polyuria)

11) Wrapped without intervening fluid layer:

OLIGOhydramnios (insufficient amniotic fluid volume)

12) SMALL uterus purse:

OLIGOhydramnios causes uterus to be SMALLER than expected gestational age

13) Minimal yellow juice leaking from spilled cup:

OLIGOhydramnios is caused by decreased fetal urination (due to decreased production by
kidneys OR lower urinary tract obstruction)

14) Two popped kidney balloons:

BILATERAL RENAL AGENESIS can cause OLIGOhydramnios (due to insufficient urine
production)

15) Kidney composed of cystic balloons:

Autosomal Recessive POLYCYSTIC KIDNEY DISEASE can cause OLIGOhydramnios (due to
insufficient urine production)
16) Exposing ACE card:
exposure to ACE inhibitors or ARBs in utero can cause OLIGOhydramnios (because of
decreased angiotensin II)

17) Floppy red angiotensin suspenders:

exposure to ACE inhibitors or ARBs leads to DECREASED ANGIOTENSIN II → abnormal
fetal kidney growth and development → insufficient urine production → OLIGOhydramnios

18) Ribbons obstructing urethral streamer:

POSTERIOR URETHRAL VALVES can cause OLIGOhydramnios (obstruction at the proximal
urethra [near bladder outlet] → decreased urination) (occurs only in males)

19) Tightly wrapped Potter bear:

OLIGOhydramnios prevents the normal development, movement, and cushioning of the fetus →
leads to Potter sequence

20) Twisted feet:

Potter sequence presents with clubbed feet (due to insufficient cushioning of fetus)

21) Tiny lung lapels:

Potter sequence leads to pulmonary hypoplasia (due to insufficient amniotic fluid to swallow)