Pregnancy/Placental pathology

Question 1

Describe fetal and maternal placenta

Answer 1

Fetal: cord enters, arborizes and dives into placental parenchyma

Maternal has nodular condylemoas; make sure NONE left behind in uterus

Question 2

Understand fetal gas exchange

Answer 2

Veins take blood away, arteries towards

braching continues till single cell barrier or capillary for gas exchange

Mom pumps blood to intervillinous space and gas exchange occurs here

Question 3

What makes up umbilical cord?

Answer 3

Two arteries, one vein, surrounded by Whartons jelly

Question 4

Cord abnormalities; four types

Answer 4

Marginal insertion–into edge of disk

Velamentous insterion–into membranes

Knots

psuedoknots

Question 5

cord inserted into edge of disk

Answer 5

marginal insertion

Question 6

Cord inseted into membranes

Answer 6

Velamentous insertion

Question 7

Neutrophils present in wall of vessels; Neutrophils from BABY and seen in association with infection from mom that baby is defending against

Answer 7

Funisitis: cord inflammation

Question 8

What are the 3 membrane layers in placenta?

Answer 8

Amnion

Chorion laeve

Decidua capsularis

Question 9

You see the picture of a placenta, what happened to baby?

Answer 9

Meconium staining located in the chorion level

Question 10

What is going on in this placenta? Where is inflammation coming from?

Answer 10

Chrioamnionitis: LOTS of neutrophils that are maternal coming from mom’s decidua; mom is sick and working from deciduca–> chorion–> amnion

Tx is delivery

Question 11

What do we see in this image?

Answer 11

Disk with amnion to the right

have chorionic plate and chorion frondosum (chorionic villi)

fetal vessesls to the left

Question 12

What do we see in this image?

Answer 12

Trophoblast

Question 13

Notice all these bumps on placneta and you attending says its squamous metaplasia, what was the likely cause?

Answer 13

Result of oligohydramnios; low fluid, less protection

Question 14

All the whorls are vessels in the fetus, whats wrong with this?

Answer 14

Fetal vasculopathy, should all be open, now we have low blood flow with tiny lumen

Question 15

You notice some lymphocytes in the maternal decidua, is this normal?

Answer 15

yes, she has larger decidual cells with some lymphocytes

Question 16

What happens in placental abruption

Answer 16

Maternal surface gets blood clot the arteries from mom in that area aren’t feeding blood to fetus

Question 17

Implantaiton into the myometrium

Answer 17

accreta

Question 18

Implantation over the cervix

Answer 18

Previa

Question 19

Implantation deeper into the myometrium

Answer 19

Increta

Question 20

Implantation through the uterine wall

Answer 20

Percreta

Question 21

What do we see on histology of villous parenchyma

Answer 21

see chorionic villi, fetal stem vessles and villous capillaries with fetal blood and intervillous space with maternal blood

Question 22

What is a concern with distal villous HYPOplasia?

Answer 22

many end up being avascular leading to low intrauterine growth, baby not getting enough blood supply

Question 23

What are all these white spots on placenta?

Answer 23

Parenchymal infarct: dead spots on placenta with no gas exchange you can see on histology the area to right with white space where there was infarct

Question 24

Two sources of placental infection

Answer 24

ascending from GI/GU tract

Hematogenous: via maternal blood to placenta (evidence in villi)

Question 25

What is the fetal response to placental infection?

Answer 25

leukocytes form fetal blood vessels go into cord and chorionic plate

Question 26

Maternal repsosne to placental infection

Answer 26

leukocytes from decidual vessels into membranes and from intervillous space into villi

Question 27

Implantation of a fertilized ovum anywhere other than the uterine cavity (1% of all pregnancies)

Answer 27

Ectopic: 90% are tubal risk: anything obstructing tubes like PID, ligation

Question 28

Can we detect ectopic pregnancy early?

Answer 28

nope, normal rise in hCG and menstartion stops --\> eventually embryo dies from inadequate attachment or placental invasion causes rupture with massive hemorrhage and shock

Question 29

• Hydatidiform mole (complete and partial) * Invasive mole * Choriocarcinoma

Answer 29

**Gestational Trophoblastic Disease **

Question 30

Arises from two sperm fertilizing an empty or normal egg. Chorionic villi are swollen, edematous, and grape-like Produce b-hCG

Answer 30

Molar pregnancy

Question 31

Complete mole karyotype: villous edema: trophoblast proliferation: atypia:

Answer 31

46 XX or 46 XY (2 sperm, anucelate egg) diffuse villous edema atypia is common

Question 32

What is teh difference btwn hCG in complete and parital mole

Answer 32

Really high hCG in complete vs partial

Question 33

Which has more potential for developing choriocarcinoma: complete or partial mole

Answer 33

2% for complete mole and rare in partial

Question 34

There is p57 staining present, what type of pregnancy?

Answer 34

Partial mole = +p57

Question 35

Partial mole: Karotype: Villous edema: Trophoblast proliferation: atypia

Answer 35

69 XXY patchy villous edema focal or absent trophoblast poliferation no atypea fetus present

Question 36

Invasive moles (10%) see in\_\_\_\_\_ mole with invasive behavior with\_\_\_ metastatic potential

Answer 36

Complete No met potential!

Question 37

Very **aggressive**, **malignant** neoplasm Half occur in the _setting of complete mole_, others after SAB or normal pregnancy **Highly chemosensitive**

Answer 37

Choriocarcinoma (2-3%)

Question 38

Hypertension, edema, and proteinuria in the third trimester of pregnancy

Answer 38

Pre-eclampsia / eclampsia

Question 39

Describe eclampsia

Answer 39

w/seizures = eclampsia • Can be accompanied by DIC and multisystem organ failure • Treated symptomatically, but need to deliver baby

Question 40

Pathophysiology of preeclampisa

Answer 40

• Inadequate maternal blood flow to the placenta due to incomplete remodeling of the spiral arteries

Question 41

two examples of Primary placental tumors

Answer 41

* Hydatidiform moles * Choriocarcinoma

Question 42

Metestatic disease from mom to baby is rare but seen in what malignancies?

Answer 42

breast and melanoma