This term describes the gross appearance of chorionic villi
How does maternal blood enter the intervillous space?
via the spiral arteries of the uterus
How does deoxygenated fetal blood enter the placenta?
via 2 umbilical arteries
Radial branching of the umbilical arteries form _______
What should you start thinking if you clamp the cord and there is only one umbilical artery?
other anomalies i.e. RENAL and HEART
What should you start thinking if you clamp the cord and there is only one umbilical vein?
Are there any ramifications to a cotyledon staying in the uterus after delivery?
yes they may lead to clotting and or hemorrhage
How are first trimester chorionic villi different than third trimester chorionic villi (microscopically)
first trimester ones are edematous in the center with trophoblastic proliferation on the margins? A third trimester villus will have thinner trophoblast and the center will contain more vessels!
What do syncytial knots tell you about the state of a 2nd trimester placenta? 1st trimester placenta?
These are normal in 2nd trimester as it is starting to mature but if in 1st trimester it is not good
Why would you see intervillous fibrin deposition in a 3rd trimester slice of placenta?
because blood fills the intervillous spaces thus, this is a normal finding
If you are looking at a slice of placenta and note an inflammatory infiltrate what is the likely Dx?
This is the correct term for inflammation of Wharton's Jelly?
Define spontaneous abortion
pregnancy loss before 20 weeks of gestation
What is the most likely fetal cause of spontaenous abortion (general)
What is a major maternal factor for spontaneous pregnancy loss?
UNCONTROLLED DIABETES, but there are many others
If you suspect a systemic disorder affecting maternal vasculature as the cause for a spontaneous abortion, what Ab should you test for?
anti-phospholipid antibodies, APA is assoc with SLE
This is the most common site of ectopic pregnancy
fallopian tubes (90%)
What is the most important predisposing factor to ectopic pregnancy?
Pelvic inflammatory Dz (C. trachomatis > N. gonorrhea)
What is the most common cause of a hematosalpinx?
If a woman is having problems late in pregnancy why are you no longer thinking of ectopic pregnancy (tubal)?
She would have had complications much earlier on from that, so a disorder late in pregnancy is not going to be in the fallopian tubes
What is a major problem that ascending chorioamnionitis may cause?
PROM and delivery
A calculation of fetal hyperactivity is directly proportional to the number of these
twists in the umbilical cord
A retroplacental hemorrhage is aka _________ _____________
What are the 3 types of twin placentas? Given that what combination is not possible?
diamnionicdichorionic, diamnionicmonochorionic, monoamnionicmonochorionic-------not possible to have 2 chorions and 1 amnion, which makes sense, really.
What is implied by a monochorionic placenta in twins?
What is implied by dichorionic placentation?
identical or fraternal twinning
What is a possible complication (for the twins) of monochorionic placentation?
twin-twin transfusion syndrome, this is when one twin steals more of the blood supply and grows bigger than the other twin, this may even kill the other twin
What is fetus papyrus?
a result of twin-twin transfusion syndrome where the dead twin regresses into the placenta
If the placenta is delivered and contains some of the uterine wall, what did disorder of placentation probably occurred?
placenta accreta because it invaded the myometrium
if the first thing to come out in deliver is the placenta, what disorder of placentation probably occurred?
In placenta previa, the blastocyst implants over the __________
This disorder of placentation is a surgical emergency
Differentiate among the following: placenta accreta, placenta increta, placenta percreta
accreta goes into superficial myometrium, increta is deep into it and PERcreta is all the way out through the myometrium into the PERimetrium
These are the 2 pathways by which infection of fetus or extraembryonic membranes may occur
ascending or hematogenous/transplacental
What is the most common pathway of infection, what type of organism?
ascending via birth canal; bacterial
Describe what you would see on an amniocentesis sample if there was a bacterial chorioamnionitis?
it would be cloudy, just like a CSF sample from bacterial meningitis
Describe how you would differentiate whether an infection of the chorionic villi was from a typical bacterial infection via the ascending route or a TORCH infection from the hematogenous route.
Ascending infections are usually bacterial which cause acute inflammation so you would see congestion, edema and PMN's. TORCH infections are hematogenous and elicit a chronic response so you would expect lymphocytes
The triad of pre-eclampsia
edema, HTN, proteinuria
Pre-ecclampsia is from widespread dysfunction of ________
Who is pre-ecclampsia the most common in?
What should the father think if he has 3 kids and the mom is always pre-ecclamptic?
she's got some 'splainin to do
How is ecclampsia different from pre-ecclampsia?
They have seizures now
Why are there areas of coagulative necrosis of the placenta in pre-ecclampsia?
because placental infarcts ( = coagulative necrosis) are common
Given that there is an increase for risk of retroplacental hematomas in pre-ecclampsia one can deduce that there is likely an increased risk for this
Pre-ecclampsia may show this type of necrosis in decidual vessels
Pre-ecclamptics may have deposition of this in their kidneys
Hydatidiforms are associated with these 2 persistent trophoblastic diseases
invasive mole, choriocarcinoma
What is the bimodal age distribution for risk of hydatidiform moles?
at the tails of reproductive life i.e. teens and near-menopause
Differentiate the karyotypes of complete moles and partial moles
A complete mole will have 46 XX, a partial mole is TRIPLOID and is 69 XXY
T/F: complete moles are maternally derived
false, the karyotype arises from fertilization of an EMPTY OVUM with either a haploid sperm that duplicates (90%) or 2 sperm (dispermy, 10%)
What are the 3 possibilities for how a partial mole is formed?
2 sperm fertilize an ovum (NOT an empty ovum), a diploid ovum fertilized by 1 sperm, a diploid sperm fertilizes an ovum
T/F: a partial mole has an increased risk of choriocarcinoma
T/F: a mole that has a coast of Norway appearance on H/E has an increased risk of choriocarcinoma
True, coast of Norway describes the appearance of a complete mole which is associated with increased risk of choriocarcinoma
T/F: a partial mole has an increased risk of persistent molar disease
true but not choriocarcinoma
Which type of mole can be described as having a grape-like appearance?
a complete mole, much more so than a partial mole
THROWBACK: if a young girl came in with vaginal bleeding and you saw grape-like lesions in her vagina what would you diagnose her with?
Botryoides type rhabdomyosarcoma; botryo = "bunch of grapes"
What term describes a mole that penetrates or even perforates the uterine wall?
What are the malignant cells in a choriocarcinoma?
T/F: a woman who has never been pregnant can develop choriocarcinoma
Where do choriocarcinomas "love" to metastasize? Prognosis?
LUNGS (and brain) good prognosis with chemo
Do choriocarcinomas produce chorionic villi?
What kind of trophoblastic tumor produces chorionic villi?
Placental site trophoblastic tumor
Are placental site trophoblastic tumors benign or malignant?