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Flashcards in Placental Pathology Deck (70):
1

The ____ layer of the trophectoderm remodels the endometrium to form the intervillous space.

outer syncytial layer

2

The ____ layer of the trophectoderm propagates to form villous structures.

inner mononuclear cytotrophoblast layer

3

Spontaneous abortion or miscarriage occurs due to ____

usually chromosomal anomalies or genetic mutation but also diabetes, endocrine abnormality, physical defect

4

Substance around fetal vessels

Wharton's jelly

5

3 membranous layers of placenta

amnion, chorion, decidua

6

___ membrane is continuous with fetal skin

amnion --> fetal derived

7

the functional unit of the placenta is the _____________ of the chorionic villi which serves as the interface for nutrient and gas exchange between the fetal and maternal circulations

vasculosyncytial membrane

8

Blastocyst implantation has three phases:

apposition, stable adhesion and invasion

9

he trophectoderm penetrates through the uterine epithelium and deep into the ________________such that the entire gestational sac is implanted within the endometrium.

decidualized endometrial stroma

10

T/F The early intervillous space formed from the lacunae in the trophoblast shell is initially bloodless

T --> Direct connections are made but remain blocked by trophoblast plugs within the arterie

11

full perfusion of the intervillous space occurs around ___ weeks gestation via ___

12 weeks via uterine spiral arteries

12

How does dissolution of vascular mural smooth muscle facilitate implantation?

dissolution of the vascular mural smooth muscle which reduces vasomotor reactivity and resistance.

13

Umbilical arteries arise from ______

internal iliac arteries

14

This layer of the placenta is an admixture of extravillous trophoblast and decidua containing the terminal portions of the maternal arteries and veins.

maternal surface

15

maternal surface of placental disc is covered by ____

decidua basalis

16

the ___ membrane separates the fetal blood from the maternal blood; the “membrane” is composed of apposed portions of the fetal capillary and ______ that are highly attenuated with cytoplasmic organelles and nuclei pushed to the side.

vasculosyncytial // villous trophoblast

17

T/F a dizygous gestation will always have two chorions and amnions.

T

18

Chorionicity in monozygous twins depends on:

timing of the division of the zygote.

19

Division within the first 72 hours after fertilization results in:

two separate embryos with their own chorion and amnion.

20

Division between 4-8 days, after development of the chorion ,results in:

a single chorionic disc but two amnionic sacs (monochorionic diamnionic )

21

Division after 8 days ,following development of the chorion and amnion , results in:

a single chorionic disc and single amnionic sac (monochorionic monoamnionic)

22

The presence of a monochorionic placenta indicates:

monozygous twinning

23

The presence of two chorions indicates:

nothing --> could be fused or not but either way is dizygous

24

___ is the only reliable method for confirming zygosity

molecular genetic testing

25

Chorionicity of conjoined twins by definition is :

monochorionic monoamnionic

26

T/F Gestations with increasing numbers of fetuses can have any combination of disc and membrane arrangements

T

27

2 pathways for placental infection

ascending from birth canal and hematogenous

28

____ route of infection is also referred to as “transplacental” indicating that there is infection of the placental disc

hematogenous

29

Ascending placental infection are often caused by ___ pathogens

bacterial (B strep, ecoli, fusobacterium), mycoplasma and rarely candida

30

Ascending placental infection results in inflammation of :

membranes (chorioamnionitis) and cord (funisitis)

31

____ is a frequent cause of preterm labor and delivery

ascending placental infection

32

Hematogenous placental infection are often caused by ___ pathogens

viral, toxoplasma, syphilis, and maternal bacterial sepsis

33

Hematogenous placental infection results in inflammation of :

chorionic villitis

34

____ is a frequent cause of fetal infection, growth restriction, and intrauterine fetal demise.

Hematogenous placental infection

35

T/F There is poor correlation of histological inflammation and clinical symptoms of chorioamnionitis in the mother

T

36

T/F . The stage and grade of chorioamnionitis are not reliably predictive of any particular clinical outcomes and are not necessarily reported as such.

T

37

In contrast to the maternal inflammatory response, severe fetal inflammation is predictive of _________ at term, has been associated with cerebral palsy, early onset fetal sepsis and clinical signs/symptoms in the mother.

neurologic impairment

38

funisitis

fetal neutrophils infiltrate the umbilical vessels and wharton's jelly

39

villitis

maternal inflammatory cells infiltrate villi via intervillous space

40

T/F fetal inflammatory response has worse outcomes/sequelae

T

41

_______ is associated with acute neutrophilic inflammation with microabscess formation

Listeria

42

Viral infections such as Cytomegalovirus can have increased numbers of plasma cells mixed with lymphocytes and histiocytes. The inflammation causes injury and loss of the surface trophoblast and subsequent _____ of the villi.

agglutination

43

Prolonged inflammation of the villi can lead to:

loss of the fetal capillaries and scarring of the stroma

44

____ infection causes cellular enlargement and large, eosinophilic glassy nuclear inclusions as well as smalller basophilic cytoplasmic inclusions

CMV

45

The majority of cases of “villitis” have no associated infectious pathogen and are designated:

villitis of unknown etiology (VUE)

46

2 possible effects of vascular lesions of placenta

disrupt blood flow between uterus/placenta and placenta/fetus

47

T/F Umbilical cord knots can be asymptomatic or result in obstruction to flow of the fetal circulation

T

48

retroplacental hemorrhage signs

maternal pain, bleeding, uterine enlargement due to premature placental separation

49

____ is most common associated condition with retroplacental hemorrhage

hypertension

50

compression of the ____ in plcaneta can result in severe acute hypoxia and fetal death.

underlying villous parenchyma

51

The trophoblast on the surface of the villi are supported by ______ in the intervillous space as opposed to the central portion of the villous or the stroma which is supported by the fetal villous vessels.

maternal blood

52

Interruptions of maternal blood flow, result in ischemic injury of the _____.

trophoblast --> In the acute phase of an infarct the fetal vessels may appear preserved. However, if the loss of surface trophoblast is severe enough the villous suffer further injury with eventual loss of the internal structure as well, resulting in avascular (non-functional) villi.

53

____ is a clinical syndrome of maternal hypertension, proteinuria, and edma associated with high morbidity and mortality of mother and fetus.

Preeclampsia --> superficial implantation of placenta and incomplete remodeling of uterine spiral arteries

54

Preeclampsia is sometimes referred to as ____

toxemia of pregnancy

55

HELLP syndrome

hemolysis, elevated liver enzymes and low platelets --> associated with preeclampsia

56

Preeclampsia is more common in ___ women

primiparous --> pregnant for the first time

57

_______ occurs in approximately half of cases affected by preeclampsia

Atherosis of spiral arteries

58

_________ tumors identified in the placenta include neuroblastoma, hepatoblastoma, sacrococcygeal teratoma, and leukemia.

Congenital fetal

59

________identified in the placenta include melanoma, leukemia/lymphoma, breast carcinoma, and lung carcinoma.

Maternal malignancies

60

2 types of gestational trophoblastic disease

hydatidiform mole, gestational trophoblastic tumors

61

tumor like masses in otherwise normal placentas

vascular lesion, leiomyoma, hepatic/adrenal adenoma

62

T/F chorangioma are benign

T --> proliferation of small vessels and surrounding stroma; the trophoblast on the overlying surface can be hyperplastic .

63

2 mechanisms for complete molar pregnancy

gestational sac is only composed of paternal DNA --> 1. 1 sperm fertilizes empty ovum with duplication of xsome, 2. 2 sperm fertalize empty ovum

64

features of complete molar pregnancy

lack fetal parts, and characterized by trophoblast hyperplasia and stromal edema

65

Partial molar pregnancy mechanism

2 sperm fertilize normal ovum = triploid --> fetal parts with variable hyperplasia and stroma

66

Which molar pregnancy type has higher risk of trophoblastic tumor and which has lower?

complete = higher, partial = lower

67

Trophoblastic hyperplasia results in what clinical marker?

high hcg

68

4 kinds of trophoblast derived tumors

invasive mole, choriocarcinoma, placental site trophoblastic tumor, epithelial trophoblastic tumor

69

T/F choriocarcinoma risk is hgihest in middle maternal age 20-40

F --> at age extremes

70

T/F choriocarcinoma is not chemoresponsive

F --> highly chemoresponsive