Pregnancy & Placental Pathology - Jarzembowski Flashcards Preview

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Flashcards in Pregnancy & Placental Pathology - Jarzembowski Deck (20):
1

Describe the appearance of the fetal and maternal faces of the placenta.

Fetal: Smooth, with a vessel network that coalesces to form the umbilical cord.

Maternal: Rough and bumpy, divided into cotyledons.

2

What fills the intervillous spaces?

What part of the chorion corresponds to the decidua basalis?

Intervillous spaces are filled with maternal blood

The decidua basalis corresponds with the chorion frondosum

3

What are the contents of the umbilical cord?

Two arteries, one vein, and a lot of Wharton's jelly (mucopolysaccharide matrix)

4

Name 3-4 abnormalities that pertain to the umbilical cord.

Marginal insertion (cord should insert into center of disc)
Velamentous insertion
Knots (and pseudoknots)

5

Distinguish between funisitis and chorioamnionitis.

Funisitis is inflammation of the CT of the cord by fetal neutrophils.

Chorioamnionitis is inflammation of the amnion and chorion by maternal neutrophils, indicating ascending infection (especially in prolonged labor)

6

What decidual region corresponds to the chorion laeve?

The chorion laeve (smooth chorion) is met by decidua capsularis.

7

When is meconium released?

How does it appear on histology?

During fetal stress (eg delivery)

Yellow-brown pigment laden macrophages.

8

What are some gross hallmarks of oligohydramnios on the placenta?

Depletion of fluid means more physical damage to the placenta; white spots appear correlating to squamous metaplasia (normally columnar)

9

Are the fetal vessels normally highly patent or narrow?

Highly patent; hypertrophy of the vessels indicates pathology.

10

A placental section reveals abundant lymphocytes. Is this normal or abnormal?

Normal; lymphocytes in the decidua may play a role in triggering labor.

11

How does placental abruption appear?

Abundant hemorrhage and clotting along the decidua basalis. The clotting process further facilitates detachment.

12

What is the primary consequence of previas accreta/increta/percreta?

Implantation into the myometrium (without intervening endometrium) is hard to detach; hemorrhaging is common and may hysterectomy may be needed.

13

What can be found in the villous parenchyma of the placenta?

Chorionic villi (fetal origin)
Fetal stem vessels
Intervillous space (filled with maternal blood)

14

How does a parenchymal infarction appear histologically? How significant is it?

Coagulative necrosis without remodeling (placenta is short-lived, so why bother). If small and peripheral, infarctions are not very concerning.

15

Name two routes by which the placenta may be infected.

Ascending (from GI/GU tract) or hematogenous.

16

Ectopic pregnancies occur in __% of all pregnancies. They are usually located in _____. The main risk factor is ____. It is noticed when _____.

1% of pregnancies, usually tubal, risk factor being tubal obstruction (scarring, etc). Noticed when there is tissue rupture with massive hemorrhage and shock.

17

How does a molar pregnancy appear grossly?

Chorionic villi that are swollen, edematous and grape-like (these may be passed vaginally). Fetal tissue may or not be present.

18

Are complete or partial moles described by the following criteria?

1. Risk of choriocarcinoma
2. Focal regions of trophoblast proliferation
3. Diffuse villous edema
4. Snow-storm pattern
5. Positive p57 staining

1. Complete mole
2. Partial mole
3. Complete mole
4. Complete mole (see #3)
5. Partial mole (only expressed from maternal genome)

19

What are the three signs of pre-eclampsia?
How common is it?
What, roughly, causes it?

Hypertension, edema, proteinuria (third-trimester!)
5-10% of all pregnancies, more with age
Malunion of the maternal and fetal arteries in the placenta.

20

Name two maternal cancers that may metastasize to the placenta.

Where may a fetal neuroblastoma be found?

Name another fetal cancer.

Melanoma and breast

Found in stem and branch arteries.

Leukemia.

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