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OBSTETRIC PATHOLOGY > ABNORMALITY OF PLACENTA > Flashcards

ABNORMALITY OF PLACENTA Flashcards

1
Q

Placenta size and thickness

A

15-20 diameter
< 4 cm thickness
Discoid shape

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2
Q

Short umblicalcord cause

A

Traction during labor
And delivery
Tearing of cord
Abruption
Inversion of uterus

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3
Q

Long umbilical cord

A

Prolapse
nuckalcord
Tie in true knots

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4
Q

Fibrin deposit in placenta

A

In the floor of placenta
Increase mechanical stability
More flow =î fibrin deposit
Regulation of intervillous circulation

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5
Q

Us of fibrin deposit

A

Subchorionic
Hypeechoic areas under the chorionic plate of the placenta

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6
Q

Differential diagnosis of fibrin deposition

A

Venous lake slow flow with real time sono
Subchorionic hematoma

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7
Q

Placenta size

A

Placentoemegaly
Small placenta

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8
Q

Small placenta

A

Iugr
Intrauterine infection
Aneuploidy

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9
Q

Placenta previa

A

Implantation of placenta over internal cervical os
Normally in body or fundus

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10
Q

Î risk of placenta previa

A

History of cesarean

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11
Q

Types of previa

A

Complete previa
Partial
Marginal
Low-lying

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12
Q

Factors associated with previa

A

Maternal age
Smoking
Cocaine abuse
Prior placental previa
Multiparity
Cs
Uterine surgery

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13
Q

Clinically placenta previa

A

Painless
Originated vaginal bleeding in third trimester
20% with uteri focal myomertrial contraction
Abnormal lie with placenta previa

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14
Q

Vasa previa

A

Large feral vessels run in feral membranes across cervical os

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15
Q

Vasa previa complication

A

Life threatening hemorrhage
Vessels at risk of rupture

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16
Q

Most common cause of vasa previa

A

Relameníous insertion of umblical cord into placental membrane
Which cross over the cervix

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17
Q

Vasa previa can result in

A

Exsanguination of fetus

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18
Q

Placental invasion

A

Abnormal penetration of placental tissue beyond endometrial lining of uterus

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19
Q

Variants of placenta invasion

A

Placenta accrete
Increta
Percreta

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20
Q

Complication of placental invasion

A

High maternal mortality with placenta
Increta
percreta

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21
Q

Placental invasion results from

A

Underdeveloped decidualized of endometrium
Association of placenta previa cause thin dearly formed deciduas of the lower uterine segment little resistance to deeper invasion by the thropheblast

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22
Q

Succenturiate placenta

A

One or move accessory lobes connected of to body placenta by placental vessels

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23
Q

Bilobed placenta

A

The two lobes of the placenta are separated by a thin bridge of placental tissue that covers the internal os
Card inserts into the bridge of tissue

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24
Q

Circumvallate/ circummarginata placenta

A

Attachment of placental membrane to feral surface of placemat rather than to underlying villous placental margin
The feral surface( chorionic plate)
Is smaller than the basal cause rolling and shoulderingthe placental margins

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25
Q

Circumvallate placenta is diagnosed when

A

Placental margin folded
Thickend
Elevated with fibrin and hemorrhage underlying

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26
Q

Circumvallate placenta associated with

A

PROM
Preterm laboR
IUGR
Placental abruption

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27
Q

Placental hemorrhage

A

Bleeding from placenta from any cause

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28
Q

More commonly seen than placental abruption

A

Placental hemorrhage

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29
Q

Locations of placental hemorrhage

A

Retroplacental
Subchorionic
Sub amniotic
Intraplacental sites

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30
Q

Placental hemorrhage echogenicity

A

Depends on age of hemorrhage
Acute bleeding similar echogenicity placenta
Echogenic
Subacute and chronic bleed more hypoechoic

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31
Q

Placental abruption

A

Separation of normally implanted placenta prior
To term delivery
Premature placental detachment
Bleeding in residua basalis occurs with separation

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32
Q

Types of placental abruption

A

Retroplacental
Marginal

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33
Q

Highpressure breed abruption

A

Retroplacental abruption
Rupture E of spiral arteries

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34
Q

Retroplacenian abruption associated with

A

HTN
Vascular disease

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35
Q

May have no vaginal bleeding

A

If blood remains Retroplacental
Hematoma is btw placenta and uterus

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36
Q

US in retroplacental abruption

A

Thickening of placenta
Older hematoma hypoechoic compared to placenta
Separation of placenta from uterine wall

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37
Q

Visual sonographic club in Retroplacental abruption

A

Thickening of placenta
Separation of placenta from uterine wall

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38
Q

Marginal abruption

A

Hemorrhage from tears of marginal veins

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39
Q

Most common type of abruption

A

Marginal abruption

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40
Q

Law pressure bleed

A

Marginal abruption
Tears of marginal veins
Arise from age of placenta
With little placental detachment

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41
Q

Intervillous thrombosis

A

Presense of thrombus within intervillous spaces
Intraplacental hemorrhage by villus capillaries

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42
Q

US of intervillous thrombosis

A

Sono lucena areas within the texture of the placenta

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43
Q

Placenta infarcts

A

Focal discrete lesion caused by ischemic necrosis
Usually small/ no Clinical significance

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44
Q

Maybe unable todistinguish placenta infarcts with

A

Intraplacental hemorrhage
Hypoechoic in acute stage

45
Q

Placenta infarcts stages:

A

Acute. Hypoechoic
Subacute
Chronic
Calcification over time

46
Q

Placental tumors

A

Gestational trophoblastic disease
Chorioangioma

47
Q

Gestational trophoblastic disease

A

Originate in placenta
Benign or malignant

48
Q

Gestational trophoblastic disease types:

A

Complete or partial male
Choriocarcinoma
Invasive mole

49
Q

Complete mole karyotype

A

Diploid karyotype
No fetal tissue

50
Q

Gestational trophoblastic disease clinical symptoms

A

Nasca and vonmiting î hCG
Vaginal bleeding
Uterine size larger than dates

51
Q

Partial or incomplete maoles karyotype

A

A triploid karyotype
Feral tissue is often present

52
Q

US of a hydatiform mole

A

Multiple tiny vesicles throughout of the uterine cavity
Thickend placenta with cystic changes is seen

53
Q

Chorioangioma

A

Benign vascular tumor of placenta

54
Q

Most common rumor of placenta

A

Chorioangioma
Usualy small

55
Q

Benign proliferation of fetal vessels that arise beneath chorionic plate

A

Chorioangioma

56
Q

Large Chorioangioma tumors,act as

A

Act as arteriovenous malformations
Shunting blood from fetus

57
Q

Feral complication in large Chorioangioma

A

Polyhydramnious
Hydros
Anemia
Cardiomegaly
IUGR
Demise

58
Q

Clinical symptoms in large Chorioangioma

A

Î AFT in maternal serum on in AF

59
Q

Chorioangioma in US:

A

Hypeechoicmass
Compared with the normal placenta
Vascularity with cover Doppler

60
Q

Di/Di cariotype

A

Dizygotic, 97%
Or in mono zigotic when division ocurres in first 4 days

61
Q

Risk involved in monochorionic

A

Placental vascular anastomosis

62
Q

Risk involved in monoamniotic

A

Entanglement of umbilical cord

63
Q

Placental location options

A

Anterior
Posterior
R or L Lateral
Fundal

64
Q

Normal location of placenta for pregnancy greater than 16 weeks

A

Placemat age is 2cm or more from the internal os

65
Q

Low-lying placenta

A

Placental edge less than 2 Cm from internal os but not covering internal os
Follow up at 32 weeks of gestation

66
Q

Placenta previa location

A

Placental edge covers the internal os
Follow up at 32 weeks

67
Q

At 32 weeks placental fallow up if

A

The placental edge is less than 2cm from the internal osv(low - lying) or covering the cervical (placenta previa)
Follow up TV Sono at 36 weeks of gestation

68
Q

What happened if vasa previa not diagnosed prior to birth

A

The fetal death rate high as 60%

69
Q

Prominent vessel overlying the cervix how to differentiate eather feral or Mam

A

On color doppler
And spectral tracing arterial flow and heart rate if high it is fetal vessel

70
Q

The important thing in patient with an anterior placenta that is low lying or previa
Is knowing

A

Has the patient had a C section before
Once find at risk patient
Look for robust color flow
Cystic change in the placenta
Marked thin Ning
Of the anterior myometrium

71
Q

Average thickness of a normal placenta

A

2-4 cm

72
Q

Accurate measurement of placenta

A

In the middle portion of the placenta near the umbilical cord insertion in cases of central or near central cord insertion
Perpendicular to the uterine wall
From sub placental veins the to amniotic fluid
Excluding the myometrium

73
Q

Circumvallate placenta.

A

(a) Longitudinal gray-scale US image at 21 weeks gestation shows the raised edge of the placenta (P) as a linear band of tissue or shelf-like structure (arrow) that may mimic a uterine synechia.
(b) Photograph of a gross specimen from another patient shows the doubled-back fold in the membranes at their attachment (black arrows) near the margins of the placental fetal surface.

74
Q

Circumvallate

A

Circumvallate
placenta. Cine US clip through the placenta shows a thick shelflike linear band on both sides of the placenta, which is due to a circumvallate placenta.

75
Q

Accurate measurements placenta

A

Accurate measurements should be done in the midportion of the placenta near the umbilical cord insertion in cases of central or near-central cord insertion, and must be measured perpendicular to the uterine wall from the subplacental veins to the amniotic fluid, while excluding the mvomerritor

76
Q

Placental Cord Insertion

A

(a) Longitudinal color Doppler image at 20 weeks gestation shows placental cord insertion (CI) near the margin of the placenta (P) within 2 cm of the placental edge (arrow).

77
Q

Vasa Previa

A

At gray-scale US, vasa previa appears as linear echolucent structures crossing
Color Doppler US is the imaging modality of choice and shows vascular structures overlying the internal cervical os with a fixed position during maternal repositioning
Spectral waveforms obtained with Doppler US demonstrate fetal-type flow (with a fetal heart rate) within these vessels

78
Q

Placental Cysts

A

Chorionic plate cyst.
Longitudinal color Doppler image at 23 weeks gestation shows a well-defined anechoic avascular structure (arrow) along the fetal surface of the placenta (P), which represents a chorionic plate cyst.

79
Q

Placental Abruption and Associated Hematomas

A

Subchorionic (preplacental) marginal abruption
hemorrhage. Oblique gray-scale
US image at 32 weeks gestation shows a large heterogeneous crescentic hemorrhage (arrows)
between the surface of the placenta (P) and the membranes, highly consistent with subacute hemorrhage.

80
Q

Intraplacental hematoma

A

Longitudinal gray-scale US image at 27 weeks gestation shows a thick heterogeneous placenta (arrows), which is due to a combination of placental tissue and a large isoechoic acute hematoma.

81
Q

Difference between intraplacenta Hemmorage and lacunae

A

(b) Placental lacunae. Longitudinal gray-scale
US image of another patient at 29 weeks gestation shows multiple hypochoic areas (arrowheads) representing placenta lacunae.
These had slow blood flow (not shown).
Hemmorage is isoechoic or hyperechic in placenta

82
Q

Placenta increta

A

(c) Increased vascularity. Longitudinal color Doppler image of placenta increta in another patient at 23 weeks gestation shows increased intraplacental and retroplacental vascularity (arrows).
Loss of bladder-uterine serosal interface.
Sagittal gray-scale US (d) and color Doppler (e) images of another patient at 28 weeks gestation show bulging (arrows in
d) of the placenta (P) and bladder, with increased chaotic vascularity along the interface (arrowheads in e).

83
Q

Placenta percrita

A

Placenta percreta. Sagittal cine
US clip through the lower uterine segment demonstrates features of placenta percreta,
including multiple lacunae,
irregular vessels at the interface with the bladder,
Rubdame
and bulging and extension anteriorly through the lower uterine segment into the bladder wall.

84
Q

Gestational Trophoblastic Disease
Complete molar pregnancy

A

(a) Longitudinal gray-scale US image shows expansion of the endometrial cavity by a multicystic mass (arrows)
(snowstorm appearance). No fetal parts can be identified
Kario type 46 diploid

85
Q

Complete mole with normal fetus in twin

A

Twin pregnancy with a normal fetus and a complete mole, proven at pathologic examination, at 12 weeks gestation in a patient with a history of in vitro fertilization.
Longitudinal gray-scale US image shows a normal fetus (F) and normal placenta (P) in one gestational sac and an abnormally thick placenta (TP) with multiple cysts (arrows) in the other gestational sac; the latter represents a complete molar pregnancy. No normal fetal parts are seen in this gestational sac.

86
Q

Placental Nontrophoblastic Tumors

A

Chorioangioma at 32 weeks gestation. (a) Longitudinal color
Doppler image shows a well-circumscribed hypochoic mass (black arrows) arising from the fetal surface of the placenta (P)
adjacent to the cord insertion
(CI). It demonstrates internal vascularity and a large feeding vessel (white arrow).

87
Q

Sonographic Findings.
• On ultrasound examination, this fibrin deposition from hematoma and lacunae venous lake

A

Sonographic Findings.
• On ultrasound examination, this fibrin deposition (subchorionic) appears as hypochoic areas beneath the chorionic plate of the placenta.
• Differential diagnosis of fibrin deposition includes a venous lake or a subchorionic hematoma.
• A venous lake will have slow flow that can be appreciated with real-time sonography. It may be difficult to distinguish fibrin deposits from a hematoma on ultrasound.

88
Q

Placentomegaly

A

• Maternal diabetes
• Maternal anemia
• a-Thalassemia
• Rh sensitivity
• Fetomaternal hemorrhage
• Chronic intrauterine infections
• Twin-twin transfusion syndrome
• Congenital neoplasms
• Fetal malformations

88
Q

Placentomegaly

A

• Maternal diabetes
• Maternal anemia
• a-Thalassemia
• Rh sensitivity
• Fetomaternal hemorrhage
• Chronic intrauterine infections
• Twin-twin transfusion syndrome
• Congenital neoplasms
• Fetal malformations

89
Q

Placenta Previa

A
  • Implantation of placenta over internal cervical os
    • Normally Implants in body or fundus of uterus
    • In one of 200 pregnancies placenta implants over or near to
    Internal os of cervix.
    • Risk increases with history of cesarean delivery,
90
Q

Types of placenta previa.

A

Complete
Partial
Marginal
Low lying

91
Q

• Complications of placenta previa

A

• Complications of placenta previa
• Preterm delivery
• Maternal hemorrhage
• Increased risk of placental invasion
• Increased risk of postpartum hemorrhage
• IUGR

92
Q

Vasa Previa

A

• Vasa previa potentially life-threatening fetal complication
• Occurs when large fetal vessels run in fetal membranes across cervical os
• Vessels at risk of rupture and life-threatening hemorrhage

93
Q

• Most common causes of vasa previa:

A

• Succenturiate lobe present, and connecting vessels traverse the cervix

• Velamentous insertion of umbilical cord into placental membranes, which cross over the cervix

94
Q

Placental Invasion

A

Transvaginal image of placenta and maternal urinary bladder.
Arrows are showing hypochoic vascular lacunae. Curved arrow is pointing at loss of the subplacental hypochoic zone.

95
Q

Retroplacental Abruption

A
  • Results from rupture of spiral arteries and is “high-pressure” bleed
    • Is associated with HT and vascular disease
    • Hematoma is between placenta and uter.
    • If blood remains retroplacental, patient may have no vaginal bleeding.
96
Q

Marginal Abruption

A

• Subchorionic hemorrhage accumulates at site of the separation from placenta.
• May continue to bleed after initial hemorrhage when blood tracks behind the membranes and through cervix
• This is old blood; frequently brownish in color
• Carefully scan along edge of placenta to identify a marginal abruption.

97
Q

heterogeneous Placentomegaly causes

A

Molar pregnancy, triploidy, placental hemmorrhage

98
Q

Homogeneous Placentomegaly

A

Gestational diabetes, anemia, hydrops, infection, aneuploidy

99
Q

Intervillous Thrombus

A

echogenic cystic lesions, appear and grow in 3rd trimester

100
Q

Placental infarcts

A

triangular white hyperechoic areas due to thrombis of spiral arteries

101
Q

Most common cause of retained products

A

Succenturiate Lobe

102
Q

Partial Placental Previa

A

Over internal os from one side

103
Q

Destructive/ progressive lesions (2)

A

intervillous thrombus and infarcts

104
Q

Infarct of >10% of placenta

A

IUGR, Fetal hypoxia, fetal Demise

105
Q

Coiling of the umbilical cord is generally: a

A

. toward the left

106
Q

Wharton’s jelly

A

Mucoid connective tissue that surrounds the vessels within the umbilical cord

107
Q

Chorioangioma

A

The hypochoic mass compared with the normal.
placenta parenchyma is a chorioangioma (arrow). Vascularity is
demonstrated with color Doppler

108
Q

The diameter of the umbilical cord has been measured to be between ___________________ and
___________________ cm; variations in cord diameter are usually attributed to diffuse accumulation of Wharton’s jelly.

A

2.6
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OBSTETRIC PATHOLOGY (7 decks)

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