Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

DMST 315 OBGYN 3 > Placental Pathology > Flashcards

Placental Pathology Flashcards

(211 cards)

Start Studying
1
Q

By 12 weeks of gestation, two distinct components of the placenta are recognizable, what are they?

A
  1. Fetal portion
  2. Maternal portion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is another name for the fetal portion?

A

Chorion frondosum AKA chorionic plate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is another name for the maternal portion?

A

Decidua basalia AKA basal plate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the two portions of the placenta held together by?

A

Anchoring stem villi at the Cytotrophoblastic shell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Projections of the decidua basalis is called what? What does it do?

A
  1. Placental septa
  2. Divides the placenta into compartments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a cotyledon?

A

Compartment of the placental septa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

There are about ____ cotyledons in a placenta?

A

20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Basic texture of the placenta changes how during gestation?

A

Does not change with gestational age except for the deposition of calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Placental calcifications are present in >50% of placentas after how many weeks?

A

33 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Calcium deposits are found primarily in what area?

A

Basal plate or septa, but may be seen in the subchorionic and previllous spaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Amount of calcification is increased in patients with what three things?

A
  1. IUGR
  2. Hypertension
  3. Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How many grades of the placenta are there?

A

4: Grade 0-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a grade 0 placenta?

A

Homogenous, chorionic plate is straight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does a grade 1 placenta look like?

A
  1. Scattered echogenic areas
  2. Subtle undulations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does a grade 2 placenta look like? 2

A
  1. Indentations
  2. Linear echogenic areas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does a grade 3 placenta look like? 3

A
  1. Indentations to basal layer
  2. Cystic areas
  3. Shadowing calcifications (after 36-38 weeks)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do we document the placenta? What do we need to ensure during this process? 4

A
  1. Document the placental position in SAG and TRX.
  2. Measure from placental edge to the internal OS of the cervix
  3. Document the placental cord insertion in SAG and TRX
  4. Ensure there is only one placental mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What do we need to assess during placental documentation?

A

Texture and thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

During placental documentation we need to measure the placenta how?

A

From the placental edge to the internal OS of the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The placenta should be a minimum of ________ away from the internal OS of the cervix?

A

2cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

The cord insertion for the placenta should be how far from the placental edge in both planes?

A

> 2cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the shape of the placenta?

A

Flat and circular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How heavy is the placenta?

A

500-600 grams

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How thick is the placenta?

A

1.5 - 4cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
The placenta grows how much a week in thickness?
1mm
26
When measuring the placenta, we do not include what in the measurement?
The myometrium or retroplacental complex
27
What is considered placentalmegaly?
>4cm
28
What is the etiology of placentomegaly? 6
1. Maternal diabetes 2. Maternal anemia 3. Hydrops 4. Intrauterine infection 5. Partial mole 6. Chromosomal abnormalities
29
Thickness of the placenta usually depends on what?
Gestational age
30
What is considered a thin placenta?
<1.5 cm
31
Why do we normally have thin placenta?
Placenta insufficiency
32
What is the etiology of thin placenta? 2
1. Vascular deficiency or infarction 2. Pre-eclampsia
33
What are some pre-eclampsia signs that results in thin placentas? 3
1. Hypertension 2. Proteinuria 3. Edema
34
Thin placenta may cause what?
IUGR
35
Intraplacental lesions have what type of clinical significance?
None
36
What are two examples of intraplacental lesions?
1. Maternal lakes (Subchorionic fibrin deposition) 2. Placental lakes (Perivillous fibrin deposition)
37
What are maternal lakes?
Sonolucent area adjacent to chorionic plate
38
What does maternal lakes result in?
Pooling and stasis of maternal blood
39
Often what type of flow is demonstrated in maternal lakes?
Rouleaux flow
40
What does placental lakes look like? What might be visualized with them?
Well defined intraplacental hypoechoic lesions in which rouleaux flow is sometimes visible.
41
What is placental lakes caused by?
Turbulence and stasis of maternal blood in intervillous space within secondary fibrin deposition
42
Placental lakes can be abnormal if seen in 1st trimester, why?
Due to association with placenta accreta spectrum and placental insufficiency
43
What are two examples of intraplacental lesions? (besides plcanetal and maternal lakes)
1. Intervillous and subchorionic thrombus 2. Septal cysts
44
What are intervillous and subchorionic thrombus caused by?
Fetal bleeding into intervillous space
45
What does intervillous and subchorionic thrombus contain? How do they appear?
Fibrin and appear as intraplacental hypoechic lesions
46
Where are intervillous and subchorionic thrombosis located?
Perivillous and subchorionic spaces
47
Intervillous sand subchorionic thrombus are thought to be how significant? What are they associated with?
Insignificant as well but are associated with RH isoimmunization cases
48
Septal cysts are located where?
Top of septa.
49
Septal cysts are thought to be a result from what?
Obstructed venous drainage
50
How does septal cysts appear?
Hypoechoic intraplacental lesions
51
What are placental infarcts?
Microscopic triangular shaped lesions on maternal side of placenta
52
What are placental infarcts due to? What does it lead to?
Obstruction of maternal blood flow leading to necrosis
53
In terms of placental infarcts, over 10% involvement of the placenta is considered what three things?
1. Extensive and associated with IUGR 2. Fetal hypoxia 3. Fetal demise
54
Are placental infarcts generally seen on U/S?
No
55
Most placenta look how in the 1st and early second trimester?
Low
56
What can make the placenta look low?
Distended bladders
57
How does placenta previa appear? What are two other names for placenta previa?
1. Low lying 2. Marginal or partial placental previa 3. Complete placenta previa
58
What is the clinical history for placenta previa? (S/S)
Painless vaginal bleeding
59
What is a low lying placenta?
When the placenta is <2cm from the internal OS but not overlying it
60
What is a partial placenta previa?
Placenta touches the internal OS
61
What is a complete placental previa?
Placenta completely covers the internal OS
62
What do we need to do if the bladder is over distended when viewing the placenta previa?
Empty some bladder
63
When would we empty the bladder when look for placenta previa? 2
1. If cervix looks longer than 4 cm 2. Over distended
64
Why do we need to empty the bladder when we assess for placenta previa?
To asses for uterine contraction in cervix area
65
At the 18-20 week scan, if the placenta is <2cm from the internal os after a post void bladder assessment, what must be done? How long will they need to do this?
1. The patient will return at 24-28 weeks for follow up 2. Until the placenta migrates away from the internal OS by >2cm. Most do migrate but a few will continue to be low lying
66
What do we need to use with EV for placenta previa?
Use condom or non latex probe cover
67
What does EV for placenta previa require from sonographers?
Experience
68
What is required from the patient for a EV for placenta previa? 2
1. No bleeding for 24 hours 2. Empty bladder
69
What is the process of EV for placenta previa? 2
1. Insert slowly under direct visualization 2. Use little to no pressure against cervix
70
Where does the umbilical cord attachment to placenta insert?
At or near the center of placenta
71
What is a battledore?
Marginal cord insertion
72
Where is the cord of a battledore in terms of the placental edge?
<2cm
73
What can a battledore progress to?
Velamentous
74
What is a velamentou insertion?
Cord inserting into the chorionic membranes and then vessels track to placenta
75
With velamentous insertion, vessels are not protected by placenta or Wharton jelly, therefore more susceptible to what?
Rupture
76
Battledores and velamentous CI are associated with what? (Conditions) 4
1. IUGR 2. FHR abnormalities 3. Placental abruption 4. Preterm labour
77
What are some variations in shape for battledore s and velamentous CI? 3
1. Succenturiate 2. Extrachorial 3. Membranacea
78
What are two different branches of extrachorial?
1. Circummarginate 2. Circumvallate
79
What is a succenturiate? 2
1. Accessory lobe 2. Separate piece of placenta connected to main placenta via vessels within membrane
80
Succenturiate are at a higher risk of what two things?
1. Increased risk of retained products 2. Increased risk of vasa previa
81
What are vasa previa in relation to succenturiate?
Vessels connecting placenta to succenturiate lobe going across cervix
82
What is a vasa previa?
Unprotected fetal vessels travelling in the membranes across the lower uterine segment of cervix
83
In terms of vasa previa, vessels may do what?
Rupture in labour or with rupture of membranes, carrying a high risk of fetal death
84
If Vasa previa is identified penatally, what is planned? What does this do for survival rate?
C-section is planned for 34-36 weeks and outcome is >97% survival rate
85
What are some risk factors for vasa previa? 3
1. Velamentous or marginal CI into placenta 2. Resolving placenta previa 3. Succenturiate lobes of placenta
86
What does a screening look like for vasa previa? 3
87
What do we look for with vasa previa during evaluation of the lower uterine segment and cervix?
Bubbles and lines when evaluating the lower uterine segment and cervix
88
Extrachorial placenta occurs when?
The chorionic plate does not extend to the edge of placenta. Chorionic membrane extends over placenta
89
What are two types of Extrachorial placenta?
1. Circummarginate 2. Circumvallate
90
What does Circummarginate looks like?
A flat ring at attachment to chorionic plate
91
What does a Circumvallate look like? 2
1. Fold in the membrane at site of attachment 2. Placenta and fetal membranes fold back towards the chronic surface
92
What are complications of Circumvallates? 3
1. Increased risk of placental abruption 2. Placental insufficiency (fetal IUGR) 3. PRL hemorrhage at delivery
93
In both Circummarginate and Circumvallate placentas the chorionic plate does not do what?
Extend to the edge of the placenta
94
What is a synechiae?
Area of scarring in endometrium
95
Compared to the rest of the uterus, what does the synechiae not do?
Stretch
96
Synechiae leaves the appearance of what?
A membrane that just ends
97
With a synechiae, we can see what in terms of fetal parts?
Fetal parts on both sides of membrane but fetus is not attached to it as it would in an amniotic band syndrome
98
What are the potential complications of Circumvallate placenta? 5
1. Placental rupture 2. Placental insufficiency 3. Hemorrhage 4. IUGR 5. Preterm labour
99
What is the biggest concern for succenturiate lobes?
Vasa previa
100
What is synechiae associated with?
Asherman’s syndrome
101
What is a placenta membranacea?
Entire uterine surface is covered with placenta
102
How does placenta membranacea form?
Due to failure of smooth chorion to compress and become the chorionic membrane in embryology
103
How common is placenta membranacea?
Very rare
104
What are some complications of placenta membranacea? 5
1. Placenta previa 2. IUGR 3. Fetal demise 4. Postpartum hemorrhage 5. Retained tissue post delivery
105
What might placental hemorrhage occur with in terms of placental abruption? 2
1. Marginal 2. Retroplacenta
106
What are three different formation of placental abruption?
1. External bleeding, no hematoma 2. Retroplacental hematoma without external bleeding 3. Subchorionic hematoma with or without bleeding
107
Placenta abruption may be caused by what? 6
1. Abdominal trauma 2. Short umbilical cord 3. PIH (pregnancy induced hypertension) 4. Maternal vascular disease 5. Maternal smoking and/or drug usage 6. Fibroids
108
What are symptoms of placental abruptions? 3
1. Preterm labor contractions 2. Bleeding 3. **PAIN**
109
What is the sonographic apeparence of placenta abruptions? 2
1. Sonolucent or complex mass beneath chorionic membrane 2. Placental thickening, often >5.5cm
110
What are three examples of tumors in the placenta?
1. Teratoma 2. Chorioangioma 3. Metastatic tumors
111
What is a teratoma in a placenta?
A rare germ cell tumor
112
What is a chorioangioma?
Vascular tumor, usually single
113
What does a chorioangioma look like? 2
1. Well defined solid/complex mass 2. If large, may cause hydrops and heart failure
114
How might metastatic tumors arrive in the placenta?
Metastatic tumours may spread to the placenta from mother or fetus, though rare
115
What does PAS stand for?
Placenta Accreta Spectrum
116
What is PAS?
When the placenta does not attach properly to the basalis but rather invades into and beyond the maternal basalis layer
117
What are three types of PAS?
1. Accreta 2. Increta 3. Precreta
118
What happens with PAS Accreta?
Attaches to myometrim
119
What does PAS Increta look like?
Invades into myometrium
120
What does a PAS Precreta look like?
Invades through the myometrium to perimetrium and even beyond
121
What are some risks of placenta Increta a or Precreta risks? 2
1. Increased risk of having acreta after C section or other uterine surgery 2. Increased risk of bleeding postpartum, because the placenta has invaded into the uterine wall it is difficult to remove at delivery
122
Placenta Increta or Precreta may result in what at delivery?
Hysterectomy at delivery
123
What are some common risks of accreta? 2
1. Placenta previa (anterior placenta) 2. Prior c-section
124
What can accreta be associated with? 7
1. Advanced maternal age 2. Increased parity 3. Uterine abnormalities 4. Smoking 5. Myomectomy 6. Previous uterine surgery 7. Previous D and C
125
In terms of placenta Increta or Precreta, what is great question to ask if a patient is Graviida 2 or more?
have you had a C-section delivery
126
What are some sonographic appearance or signs with accreta? 5
1. Anterior placenta 2. Presence of numerous lacunae 3. Look for a “clear zone” between placenta wall in the retroplacental area 4. Thin or imperceptible myometrium 5. Bladder line loss
127
In terms of accreta, what are some things we need to look for with anterior placenta? 2
1. Low lying or anterior previa 2. Previous c-section deliveries
128
In terms of accreta, when we look for a “Clear zone” between placenta and uterine wall in the retroplacental area, what area some things we might see? 2 (abnormal and normal)
1. Abnormal if this clear zone cannot be demonstrated 2. Normal placental clear zone, applying pressure to the clear zone will disappear
129
In terms of accreta, what constitute bladder line loss? 3
1. Not as sharp or clear 2. Lumpy or bumpy 3. Bulges into the bladder
130
What is diagnosis like for accreta on u/s? What can be seen?
1. Difficult on U/S 2. Only Anterior placenta
131
What should we look for in terms of a diagnosis of accreta? What can help us look? 3
1. Absent or severely thinned myometrium 2. Extension to adjacent organs 3. Use colour doppler
132
What can be used to diagnose accreta in the case of ambiguous ultrasound findings?
MRI
133
What does the umbilical cord develop from?
Connecting stock and yolk sac
134
What is the vessel information in the umbilical cord?
2 arteries and 1 vein
135
What is the umbilical cord vessels surrounded by?
Whartons jelly
136
What is umbilical cords covered with?
Amnions
137
How long is Umbilical Cord?
50-100cm long
138
What is cord cysts remnants of?
Allantoic remnant
139
How significant is cord cysts?
Transient and insignificant
140
Multiple cord cysts can be associated with what? 3
1. T18 2. T13 3. Increased risk of miscarriage
141
What are two types of cord knots?
True or false knots
142
False chord knots are due to what?
Cord kink or redundancy
143
How Common are true knots?
Rare (<1% of pregnancy)
144
Most true knots are what? (what happens to them)
Lost
145
What are risk factors of Cord knots? 3 (what causes it)
1. Long cord 2. Polyhydraminos 3. Excessive fetal movements
146
What is a highly specific sign for true or false cord knots?
Hanging noose sign
147
What modality can be used for further characterization of cord knots?
3D/4D
148
What is a umbilical vein varix?
Intra-abdominal focal enlargement of the umbilical vein
149
What might happen in umbilical vein varix?
Stasis may occur here and blood may clot
150
What is umbilical vein varix associated with?
A higher incidence of adverse outcomes
151
Label
152
Label
153
Label the image
154
What does this image represent?
The placental appearance on u/s
155
What does this image represent?
Grade 3 placenta
156
What does these images represent?
SAG placenta and TRX placenta
157
What does this image represent?
Placenta measurements: The placental edge to the internal OS of the cervix
158
What does these images represent?
Placental documentation of the cord insertion
159
What does this image represent?
Size and shape of the placenta in trans
160
What does this image represent? (think size)
Placentomegaly
161
What does this image represent?
1. Maternal lakes 2. Placental Lakes
162
What does this image represent?
Placental Lakes
163
What does this image represent?
Maternal lake
164
What does this image represent?
Placental position with a distended bladder and the low lying placental bladder
165
What does these images represent?
Placental Previa A. Low lying <2cm from internal os B. Marginal Previa C. Partial Previa D. Complete previa
166
What does this image represent?
Low lying placenta - when the placenta is <2cm from the interlay OS but not overlying it
167
What does this image represent?
Partial placental previa
168
What does this image represent?
Complete placenta previa
169
Label
170
What does this image represent?
Low lying placenta
171
What does this image represent?
Normal Transabdominal cervix at 18 weeks LMP
172
What does this image represent?
Normal Endovaginal cervix at 18 weeks
173
What does these images represent?
1. Cord insertion into placenta 2. Inserts at or near center of placenta
174
What does these two images represent?
1. Marginal CI (Battledore) 2. Velamentous CI
175
What does these images represent?
Marginal CI and Velamentous CI
176
What does this image represent?
Succenturiate
177
What does these images represent?
Succenturiate placenta
178
What does these images represent?
1. “Bubbles and Line” when evaluating the lower uterine segment and cervix for vasa previa 2. Bubbles on the top row and lines on the second row
179
What does this image represent?
Vasa previa arterial waveform, which matches fetal heart rate
180
What does these images represent?
Vasa previa vs funic presentation
181
182
What does these images represent?
1. Normal 2. Circummarginate 3. Circumvallate
183
What does these images represent?
A. Circummarginate B. Circumvallate
184
What does these images represent?
Circumvallate
185
What does this image represent?
Circumvallate
186
What does this image represent?
Circumvallate
187
What does this image represent?
Synechiae
188
What does this image represent?
Synechiae
189
What does this image represent?
Synechiae
190
What does this image represent?
Synechiae
191
What does this image represent?
Placenta membranacea
192
What does these images represent?
Placenta abruption A. External bleeding, no hematoma B. Retroplacental hematoma without external bleeding C. Subchorionic hematoma with or without bleeding
193
What does this image represent?
Sonographic appearence of abruptions
194
What does this image represent?
Amniotic hematoma
195
What does this image represent?
Chorioangioma
196
Label
1. Normal creta 2. Accreta 3. Increta 4. Percreta
197
Label
198
What does this image represent?
Clear zone
199
What does this image represent?
Clear zone disappears with probe pressure 1. Clear zone is hypoechoic 2. Slight pressure the clear zone disappears. Normal placental bed
200
What does this image represent?
Loss of clear zone due to invasive placenta
201
What does this image represent?
202
Label
203
What does this image represent?
Umbilical cord
204
What does this image represent?
2UA = 3 vessel cord
205
What does this image represent?
Cord cyst
206
What does this image represent?
Cord knots
207
What does this image represent?
Umbilical vein varix
208
What does this image represent?
Umbilical cord varix
209
What is this?
Hanging noose sign for a cord knot
210
What is a fecalith?
A 30 year old male whose sub type is Brian - Cheats on bench - Probably is a caffeine addiction - is a weaker sub type of the chuong variation
211

DMST 315 OBGYN 3 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions