Placenta Pathology

Question 1

Endometrium of the pregnant uterus

Answer 1

Decidua

Question 2

Innermost lining of the membranous sac enclosing the embryo

Answer 2

Amnion

Question 3

Outermost lining of the membranous sac enclosing the embryo

Answer 3

Chorion

Question 4

Placental structure where nutrient and gas exchange occurs; core is composed of loose mesenchyme, fetal blood vessels and vill

Answer 4

Chorionic Villus

Question 5

Part of the VILLOUS trophoblast; the INNER single layer of the trophobast on the surface of the villus

Answer 5

Cytotrophoblast

Question 6

Part of the VILLOUS trophoblast; the OUTER layer of syncytium; make hCG to maintain the Corpus Luteum

Answer 6

Syncytiotrophoblast

Question 7

Extra lobe of placental tissue; membranous (velamentous) vessels connect each lobe; risk of fetal bleeding and may result in retained placental tissue after birth

Answer 7

Accessory or Succenturiate Lobe

Question 8

Condition in which the placenta crosses the internal os of the uterus; at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue

Answer 8

Placenta Previa

Question 9

Common Umbilical Cord abnormalities (3 total)

Answer 9

Common Umbilical Cord abnormalities (3 total)

Question 10

(True/False) umbilical knots are when there is a varicosity with no clinical consequence

Answer 10

False

Question 11

(True/False) umbilical knots are when there is a cord compression

Answer 11

True

Question 12

An inflammation of the amnion and chorion due to a bacterial infection; typically results from bacteria ascending from the vagina into the uterus (usually Strep. agalactiae or E. coli; MOST often associated with prolonged labor; result in maternal fever, uterine tenderness, tachycardia and purulent/foul amniotic fluid; associated with Premature Labor or Rupture of Membranes (PROM)

Answer 12

Chorioamnionitis

Question 13

Bacteria involved with Chorioamnionitis (3 total)

Answer 13

Strep. agalactiae
E. coli
Anaerobes

Question 14

Signs/Symptoms of Chorioamnionitis

Answer 14

Maternal fever
Fetal/Maternal tachycardia
Foul smelling fluid
Uterine tenderness

Question 15

Neutrophils in the umbilical cord; seen in Chorioamnionitis

Answer 15

Funisitis

Question 16

Inflammation of the placenta’s chorionic villi surface; usually due to HEMATOGENOUS infection (TORCH infections) or immune-mediated; will see LYMPHOCYTES (not neutrophils); associated with Intrauterine Growth Restriction (IUGR)

Answer 16

Villitis

Question 17

Infections associated with Villitis

Answer 17

TORCHES infections (Toxo, Rubella, CMV, Herpes, Syphilis)

Question 18

(Chorioamnionitis/Villitis) is associated with premature labor or rupture of membranes (PROM)

Answer 18

Chorioamnionitis

Question 19

(Chorioamnionitis/Villitis) is associated with Intrauterine Growth Restriction (IUGR)

Answer 19

Chronic Villitis

Question 20

What is important to ascertain in a case of Chorioamnionitis?

Answer 20

Source of inflammation; if fetal (neutrophils in cord), greater risk of neurologic effects and may be marker for infection elsewhere in fetus

Question 21

How can you tell between Maternal vs. Fetal immune response in Chorioamnionitis

Answer 21

Maternal: neutrophils in Amnion/Chorion
Fetal: neutrophils in Cord

Question 22

Yellow discoloration of the Fetal membrane means what?

Answer 22

Infection

Question 23

Green discoloration of the Fetal membrane means what?

Answer 23

Meconium

Question 24

Brown discoloration of the Fetal membrane means what?

Answer 24

Hemosiderin (remote hemorrhage)

Question 25

Bile-stained intestinal contents of the fetus; can stain placenta and baby green if discharge before birth; usually after 32 weeks gestation; slight risk of aspiration

Answer 25

Meconium

Question 26

Risk factors for Abruptio Placenta

Answer 26

``` Abd TRAUMA Smoking Cocaine Multiple gestations Premature Rupture of Membranes (PROM) HTN Oligohydramnios Chorioamnionitis ```

Question 27

Premature of separation of the placenta from the decidua before delivery; has pain, uterine bleeding, contractions and DIC; can result in fetal hypoxia, maternal blood loss and fetal death

Answer 27

Abruptio Placenta

Question 28

Hematoma along the maternal surface of the placenta (between the basal plate and uterine wall); seen in correlation with Abruptio Placenta; can compress villous tissue and result in INFARCTION of the placenta

Answer 28

Retroplacental Hematoma

Question 29

Necrosis of Chorionic Villi secondary to decreased or interrupted maternal blood supply; can be due to Maternal HTN, Thrombophilia, Abruption or smoking

Answer 29

Placental Infarct

Question 30

Abnormal implantation of the placenta to the uterine wall; due to lack of maternal Decidua at implantation site; further subdivided based on depth of invasion; usually due to uterine scars; results in retained placenta and post-partum hemorrhage

Answer 30

Placenta Accreta

Question 31

Placenta (accreta/increta/percreta) is when chorionic villi are implanted ON the myometrium WITHOUT intervening Decidua

Answer 31

Placenta accreta "ACcreta ADheres"

Question 32

Placenta (accreta/increta/percreta) is when the chorionic villi INVADE the myometrium

Answer 32

Placenta increta "INcreta INvades"

Question 33

Placenta (accreta/increta/percreta) is when the chorionic villi perforate the ENTIRE uterine wall

Answer 33

Placenta percreta "PERcreta PERforates"

Question 34

What problems can arise from Multiple Gestations

Answer 34

Prematurity Cord problems (entanglements) Maternal HTN Twin-Twin transufion syndrome