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Placenta Flashcards

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1
Q

what is the gross appearance of normal mature placenta?

A

single, round to ovoid, disk-shaped organ w/o an accessory lobe

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2
Q

what are the main components of placenta?

A

umbilical cord
membranes (amnion & chorion)
villous parenchyma
maternal decidual tissues

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3
Q

what are the 2 placenta surfaces and its gross appearance?

A
  • fetal surface = bluish gray, shiny, and translucent w/ no opacity or usual discoloration
  • maternal surface = dark red, divided into cotyledons w/ no missing cotyledons
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4
Q

how many blood vessels are in the umbilical cord?

A

2 arteries
1 vein

w/o true knot, hemorrhage or thrombosis

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5
Q

what is the gross appearance of amnion & chorion membranes?

A

gray, shiny and translucent

absence of inflammation in the membranes or green meconium staining

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6
Q

what part of the placenta makes up the bulk of the whole structure?

A

villous parenchyma

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7
Q

what are the 2 types of trophoblast cells?

A

Synctiotrophoblast cells = outer layer
Cytotrophoblast cells = inner layer

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8
Q

what is the histo appearance of villi of the placenta during the 1st trim?

A

relatively large w/ few stromal BVs

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9
Q

whta is the histo appearance of villi of the placenta during the midtrimester?

A

villi becomes smaller and cytotrophoblasts become less evident

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10
Q

what is the histo appearnce of villi during term?

A

placental villi becomes smaller with abundant stromal capillaries
Trophoblast lining appears flat
Synctiotrophoblast = prominent synctial knots

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11
Q

What are the diff lesions of the villous parenchyma?

A

Hydropic placenta
Placental infarcts

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12
Q

Wht are the characteristicsof hydropic placenta?

A

Extreme pallor due to fetal anemia
Villous edema
Immature chorionic villi
Large and thick placentas with coarse cotyledons and villous structures

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13
Q

What is the gross & histo morphology of hydropic placenta?

A

GROSS
- enlarged & pale placenta due to edema & anemia
- placental weight is greater than expected

HISTO
- chorionic villi shows diffuse enlargement w/ villous stromal edema
- INC # of Hofbauer cells, nucleated RBCs

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14
Q

What are placental macrophages?

A

Hofbauer cells

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15
Q

What do placental infarcts represent?

A

Area of villous coagulative necrosis

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16
Q

What are affected of placental infarcts?

A
  1. Ischemia in the placental parenchyma
  2. Intrauterine growth retardation
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17
Q

Where are placental infarcts located, color in the early andlate stage?

A

Location: maternal placental surface, square shaped
Color:
- Early, recent/acute infarcts: dark red hemorrhagic or dark brown due to deposit

  • Late, old infarcts: pale & anemic due to deposits of scar & fibrou tissue
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18
Q

What is the histo appearance of placental infarcts?

A

Ghost outlines of dead, necrotic chorionic villi (coagulative necrosis)

Early infarcts: villous congesion & collapse w/ loss of intervillous space

Late infarcts: fibrin deposition in intervillous space

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19
Q

What are the most common sites of placental implantation?

A

Uterine fundus
Anterior wall & posterior wall

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20
Q

Where are the diff abnormal implantation?

A

Ectopic pregnancy
Placenta previa
Placecnta accreta

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21
Q

What are the 2 hormones responsible for implantation of the endometrium?

A

Estrogen & Progesterone

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22
Q

Where are the normal sites of placental attachment?

A
  • placenta is attached to uterine corpus superolateraly
  • Decidua basalis between placenta proper & uterine endometrium
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23
Q

What causes placenta accreta?

A

Scarring, infection or instrumentation —> placenta attached to the myometrium w/o intervening decidualized endometrium —> deficient decidualization @ implantation site

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24
Q

What is the effect of placenta accreta during labor>

A

Inability of placenta to normally be spontaneously be separated during 3rd phase of normal delivery

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25
What are the 3 types of placenta accreta?
1. Placenta Accreta vera = most common - villi implants on myometrial surface w/o intervening decidua 2. Placenta Increta - penetration of villou tissue into parts of the myometrium or villi extend into the myometrium 3. Placenta percreta - villi penetrate the entire myometrial thickness and through the uterine serosa
26
Where is the location of placenta accreta?
Uterus Lower uterine segment Cervix
27
What are complications from placenta accreta & tx?
Life threatining postpartum hemorrhage Uterine atony Massive peripartum hemorrhage Tx: removal of uterus
28
What are the gross appearance of placenta increta & placenta percreta
Placenta Increta - demo directly infiltrating the myometrium w/o intervening decidual plate Placenta percreta - placenta invaded the full thickness of the lower myometrial wall, penetrating the seros
29
What is the microscopic appeearance of placenta accreta?
Chorionic interdifitate directly with the uterine myometrium w/o an intervening decidual plate
30
Where is placenta implanted in Placenta previa?
Lower uterine segment, partially/completely occluding the internal os
31
What is the presentation of Placenta previa?
Painless vaginal bleeding in the 2nd to 3rd trimester of pregnancy
32
What are risk factors of devling placenta previa?
Multiparity Myoma Cesarean section - main Advanced maternal age - main
33
What are causes of placenta previa?
- surgery,trauma/scar
34
Wht are complications of placenta previa?
Fetal malpresentation Premature rupture of the membranes
35
When do you grade placentas?
When placental implantation is low in the uterus
36
What re the gradings & locations of placenta?
Grrade I (Lateral placenta) = placenta implanted on LUS Grade II (Marginal placenta) = edge of plaenta reaches internal Os GradeIII (partial placenta previa) = low lying placenta partially covers the internal os Grade IV (complete placenta previa) = low lying placenta COMPLETELY covers the internal os; CS
37
What is the early sepration or premature separation of the placenta?
Abruptio placenta
38
What are risk factors of Abruptio placenta?
Smoking Cocaine use Maternal age >35yo HTN Placental abruption in a prior pregnancy
39
What are conditions that could be associated with abruptio placenta?
Multiple gestation pregnnacies Polyhydrdamnios Preeclampsia Sudden uterine decompression Short umbilical cord Traums to abdomen
40
What causes abruptio placenta?
Compromise of the vascular structure resulting in tearing of vascular networks
41
What is a severe form of concealed abruptio placenta?
Couvelaire uterus (uterine placental apoplexy)
42
What are the manifesations of preeclampasia & eclampsia?
HTN, edema, and proteinuria
43
What is the HELLP syndrome that forms complications of preeclampsia & eclampsia?
Micorangiopathic Hemolytic Anemia Elevated Liver enzymes Low platelet
44
What are aberrations of preeclampsia & eclampsia?
1. Abnromal placental vasculature 2, Endonthelkial dysfunction & imabalce of angiogenic and antiangiogenic factors 3. Endothelial dysf and imabalnce of angiogenic and antiangiogenic factors 4. Coagulation abnormalities
45
What enzyme is INC in preeclampsia?
Endoglin SFitL (soluble FMS-like tyrosine kinase
46
What are the common sites of coagulation abnormaltiies in preecmplasmia?
Liver Kidneys Brain Pitutiary glnad
47
What is the histo apperance of plaenta in toxemia of pregnancy?
- Acute atherosis of uterine vessels - clear foam cells in intmia portion of arteries - fibrinoid necrosis of the vessel wall & subendothelial macrophages
48
What is benign lobular of blood vessels in the placenta?
Chorangioma aka Hemangioma of the placenta
49
What is the microscopic appearnce of chorangioma?
Proliferation of small/medium sized vessels aside from the synctiotohphoblasts layer acros sits surface
50
What are the possible routes of placental infections?
Ascending infection via birth canal Hematogenous/transplacental
51
What is itnervillositis, Perivillositis, & Villitis?
Villitis = inflammation within the placental chorionic villi; inflammation of the placental parenchyma Perivillositis = inflammation surrounding the chorionic villi & reflect maternal septicemia Intervillositis = inflammation involves the intervillous space, ascending infections
52
what are causes of placental intervillositis, villitis, & perivillositis?
E. coli, L. monocytogenes, Campylobacter, & Chlamydia spp. CMV Rubella or Toxoplasmosis (unuasual)
53
what is seen in CMV caused placental intervillositis villitis?
intravenous plasma cells & hemosiderin
54
what are diff abnormal placental shapes & lobes?
mature bilobate placenta accessory lobe or succenturiate lobe circummarginate & circumvallate placentas
55
what is a diffuse thin placenta without free membranes?
placenta membranacea
56
what are clin significance of Bilobate placenta?
multiparity adv maternal age infertility presence of placena previa excessive placental adhesions first trimester bleeding
57
what abnormal placental shape has bilobate placenta resulting from uterine sulcal implantation?
mature bilobate placenta
58
what abnormal placental shape is formed if some of the capsular villus tissue fails to atrophy during devt?
accessory lobe or succenturiate lobe
59
accessory lobe/succemnnturiate lobes can often come what?
ifnarcted or fibrinous
60
what are clin signficance of accessory/succenturiate lobe?
1. trauma to the vessel can produce fatal hemorrhage 2. thromotic and thrombo-embolic events 3. retained palcenta after the delivery 4. greater assoc of accessory lobe w/ placenta previa 5. INC tendency for placental infarction
61
what are features of normal umbilical cord?
- pearly white color - inserted in a central or paracentral position - whartons jelly
62
what are the BVs in whartons jelly?
2 arteries = carry deoxygenated blood from baby to the placenta 1 vein = carries the oxygenated blood from placenta to baby

Pathology (8 decks)

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