Pregnancy & Placental Pathology Flashcards Preview

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Flashcards in Pregnancy & Placental Pathology Deck (34):
1

Fetal side of the placenta 

2

Maternal side of the placenta 

3

Umbilical vein brings blood (in/out) the placenta.

Umbilical arteries bring blood (in/out) the placenta.

Umbilical vein brings blood OUT of the placenta. 

Umbilical arteries bring blood IN the placenta.

4

What is the histological composition of the Umbilical Cord?

2 arteries, 1 vein

Wharton's jelly (gelatinous polysaccharide)

5

What are some examples of cord abnormalities? (4)

  • Marginal insertion (edge of disk)
  • Velamentous insertion (into membranes)
  • Knots 
  • Pseudoknots 

6

Cord entanglement 

7

Funisitis (cord inflammation)

Blood & neutrophils

Ascending infections of amniotic fluid 

8

What are the different types of placental membranes? (3)

  • Amnion
  • Chorion laeve
  • Decidua capsularis 

9

What type of staining is this?

Meconium staining 

Yellow-brown pigment laden MΦ

10

Chorioamnionitis 

Maternal neutrophils

From decidua to surface 

11

What is the composition of the placental disk? (3)

  • Amnion
  • Chorionic plate & chorion frondosum
    • Chorion frondosum = chorionic villi
  • Fetal vessels 

12

What is the composition of the trophoblast?

  • Syncytiotrophoblast 
  • Cytotrophoblast
  • Intermediate trophoblast 

13

Oligohydramnios

14

What does fetal vasculopathy look like on histology?

Hypertrophic vessels

Thrombosed vessels

Not a lot of oxygen exchange 

15

What does the maternal decidua look like on histology?

Decidua basalis 

Large decidual cells

Smattering of lymphocytes (triggers labor)

Not pathologic 

16

Placental Abruption

Maternal surface

Arteries of mother's uterine wall

Impeded blood flow --> clot 

17

What are the 4 types of implantation abnormalities?

  • Previa - over cervix
  • Accreta - into the myometrium
  • Increta - deeper into the myometrium
  • Percreta - through the uterine wall 

18

What does the villous parenchyma look like on histology?

  • Chorionic villi
  • Fetal stem vessels & villous capillaries
    • Fetal blood
  • Intervillous space (maternal blood)

19

What does distal villous hypoplasia look like on histology?

  • Terminal villi don't have capillaires (avascular)
  • Leads to intrauterine growth restriction, placental insufficiency 

20

  • Parenchymal Infarctions
  • Death of villi due to lack of oxygen
  • Ischemic necrosis 
  • No remodeling (just death)
  • Small & peripheral infarction less clinically significant than one that is large & central 

21

Infarction

22

What are the two types of placental infection?

  • Ascending
    • From GI/GU tract
    • Bacterial
  • Hematogenous 
    • Via maternal blood, into placenta
    • Viral (infection visible in villi)

23

Placental Infection

Fetal response

Maternal response

  • Fetal response
    • Leukocytes from fetal blood vessels into cord & chorionic plate 
  • Maternal response 
    • Leukocytes from decidual vessels into membranes & from intervillous space into villi 

24

Ectopic Pregnancy 

Definition 

  • Implantation of fertilized ovum anywhere other than the uterine cavity (1% of all pregnancies)
    • 90% tubal
    • Ovaries
    • Peritoneal surfaces of the abdomen 

25

Ectopic Pregnancy

Risk Factors

  • Anything that obstructs the tubes
  • Chronic inflammation (salpingitis, PID)
  • Tubal ligation 

26

Ectopic Pregnancy

Early stages

Eventually 

  • Early stages of pregnancy unremarkable
    • ß-hCG increases normally
    • Menstruation stops
  • Eventually
    • Embryo may die due to inadequate attachment
    • Placental invasion causes rupture w/ massive hemorrhage & shock 

27

What are the 3 types of Gestational Trophoblastic Disease?

  • Hydatiform mole (complete & partial)
  • Invasive mole
  • Choriocarcinoma

28

Molar Pregnancy

Definition

  • Arises from 2 sperm fertilizing an empty (complete mole) or normal (partial mole) egg
  • Chorionic villi swollen, edematous, grape-like
  • Produces ß-hCG

29

Complete Mole vs. Partial Mole 

  • Karyotype
  • Villous edema
  • Trophoblast proliferation
  • Atypia
  • Serum hCG
  • Behavior
  • p57 staining 
  • Fetus 

30

Invasive Moles

Definition

  • 10% of gestational trophoblastic disease
  • Complete mole w/ invasive behavior
  • No metastatic potential 

31

Choriocarcinoma 

Definition 

  • 2-3% of gestational trophoblastic diseae
  • Very aggressive, malignant neoplasm
  • 50% occur in the setting of complete mole, others after SAB or normal pregnancy 
  • Highly chemosensitive 

32

Pre-eclampsia/eclampsia

Definition

  • HTN + edema + proteinuria in 3rd trimester
  • 5-10% of all pregnancies 
  • More common in older women 
  • w/ seizures = eclampsia
    • Can be accompanied by DIC & multisystem organ failure 
    • Treated symptomatically, but need to deliver baby 

33

Pre-eclampsia/eclampsia

Histology 

  • Inadequate maternal blood flow to the placenta due to incomplete remodeling of the spiral arteries 
  • Instead of muscular layer, trophoblast lining
  • Trophoblasts don't contract 
  • Wide open blood flow

34

What are 3 types of placental malignancy?

  • Primary placental tumors
    • Hydatidiform moles
    • Choriocarcinoma 
  • Metastatic disease from mother
    • Melanoma 
    • Breast
    • Others (rarely)
    • *intervilli space*
  • Fetal tumors 
    • Neuroblastoma 
    • *villus capillaries*