Placental Pathology

Question 1

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

Answer 1

outer syncytial layer

Question 2

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

Answer 2

inner mononuclear cytotrophoblast layer

Question 3

Spontaneous abortion or miscarriage occurs due to ____

Answer 3

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

Question 4

Substance around fetal vessels

Answer 4

Wharton’s jelly

Question 5

3 membranous layers of placenta

Answer 5

amnion, chorion, decidua

Question 6

___ membrane is continuous with fetal skin

Answer 6

amnion –> fetal derived

Question 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

Answer 7

vasculosyncytial membrane

Question 8

Blastocyst implantation has three phases:

Answer 8

apposition, stable adhesion and invasion

Question 9

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

Answer 9

decidualized endometrial stroma

Question 10

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

Answer 10

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

Question 11

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

Answer 11

12 weeks via uterine spiral arteries

Question 12

How does dissolution of vascular mural smooth muscle facilitate implantation?

Answer 12

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

Question 13

Umbilical arteries arise from ______

Answer 13

internal iliac arteries

Question 14

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

Answer 14

maternal surface

Question 15

maternal surface of placental disc is covered by ____

Answer 15

decidua basalis

Question 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.

Answer 16

vasculosyncytial // villous trophoblast

Question 17

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

Answer 17

T

Question 18

Chorionicity in monozygous twins depends on:

Answer 18

timing of the division of the zygote.

Question 19

Division within the first 72 hours after fertilization results in:

Answer 19

two separate embryos with their own chorion and amnion.

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

The presence of a monochorionic placenta indicates:

Answer 22

monozygous twinning

Question 23

The presence of two chorions indicates:

Answer 23

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

Question 24

___ is the only reliable method for confirming zygosity

Answer 24

molecular genetic testing

Question 25

Chorionicity of conjoined twins by definition is :

Answer 25

monochorionic monoamnionic

Question 26

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

Answer 26

T

Question 27

2 pathways for placental infection

Answer 27

ascending from birth canal and hematogenous

Question 28

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

Answer 28

hematogenous

Question 29

Ascending placental infection are often caused by ___ pathogens

Answer 29

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

Question 30

Ascending placental infection results in inflammation of :

Answer 30

membranes (chorioamnionitis) and cord (funisitis)

Question 31

____ is a frequent cause of preterm labor and delivery

Answer 31

ascending placental infection

Question 32

Hematogenous placental infection are often caused by ___ pathogens

Answer 32

viral, toxoplasma, syphilis, and maternal bacterial sepsis

Question 33

Hematogenous placental infection results in inflammation of :

Answer 33

chorionic villitis

Question 34

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

Answer 34

Hematogenous placental infection

Question 35

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

Answer 35

T

Question 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.

Answer 36

T

Question 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.

Answer 37

neurologic impairment

Question 38

funisitis

Answer 38

fetal neutrophils infiltrate the umbilical vessels and wharton's jelly

Question 39

villitis

Answer 39

maternal inflammatory cells infiltrate villi via intervillous space

Question 40

T/F fetal inflammatory response has worse outcomes/sequelae

Answer 40

T

Question 41

_______ is associated with acute neutrophilic inflammation with microabscess formation

Answer 41

Listeria

Question 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.

Answer 42

agglutination

Question 43

Prolonged inflammation of the villi can lead to:

Answer 43

loss of the fetal capillaries and scarring of the stroma

Question 44

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

Answer 44

CMV

Question 45

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

Answer 45

villitis of unknown etiology (VUE)

Question 46

2 possible effects of vascular lesions of placenta

Answer 46

disrupt blood flow between uterus/placenta and placenta/fetus

Question 47

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

Answer 47

T

Question 48

retroplacental hemorrhage signs

Answer 48

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

Question 49

____ is most common associated condition with retroplacental hemorrhage

Answer 49

hypertension

Question 50

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

Answer 50

underlying villous parenchyma

Question 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.

Answer 51

maternal blood

Question 52

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

Answer 52

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.

Question 53

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

Answer 53

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

Question 54

Preeclampsia is sometimes referred to as ____

Answer 54

toxemia of pregnancy

Question 55

HELLP syndrome

Answer 55

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

Question 56

Preeclampsia is more common in ___ women

Answer 56

primiparous --> pregnant for the first time

Question 57

_______ occurs in approximately half of cases affected by preeclampsia

Answer 57

Atherosis of spiral arteries

Question 58

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

Answer 58

Congenital fetal

Question 59

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

Answer 59

Maternal malignancies

Question 60

2 types of gestational trophoblastic disease

Answer 60

hydatidiform mole, gestational trophoblastic tumors

Question 61

tumor like masses in otherwise normal placentas

Answer 61

vascular lesion, leiomyoma, hepatic/adrenal adenoma

Question 62

T/F chorangioma are benign

Answer 62

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

Question 63

2 mechanisms for complete molar pregnancy

Answer 63

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

Question 64

features of complete molar pregnancy

Answer 64

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

Question 65

Partial molar pregnancy mechanism

Answer 65

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

Question 66

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

Answer 66

complete = higher, partial = lower

Question 67

Trophoblastic hyperplasia results in what clinical marker?

Answer 67

high hcg

Question 68

4 kinds of trophoblast derived tumors

Answer 68

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

Question 69

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

Answer 69

F --> at age extremes

Question 70

T/F choriocarcinoma is not chemoresponsive

Answer 70

F --> highly chemoresponsive