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Life Cycle > LC Exam 2: Placenta > Flashcards

LC Exam 2: Placenta Flashcards

1
Q

3rd trimester anatomy

A

Fetal side: smooth, amnion fused to chorion
Separated by chorionic villi
Maternal side: basal plate
Cross sections reveal many more capillaries, less fibrous cores

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2
Q

3rd trimester anatomy

A

Fetal side: smooth, amnion fused to chorion
Separated by chorionic villi (capillaries, exchange)
Maternal side: basal plate
Cross sections reveal many more capillaries, less fibrous cores

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3
Q

Functions of the placenta

A

Support growth and development
Transport (nutrients, O2, CO2)
Respiration (2 arteries, 1 vein)
Endocrine
Hepatic (glycogen/FA storage, metabolism, waste)
Immune (transport maternal IgG, IgM can’t cross)
Skin: temperature regulation, barrier

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4
Q

Steroid production by maternal-fetal-placental unit

A

Progesterone production suppresses contractions
E2 production requires MFP
Placenta lacks P450c17, 16a-hydroxylase
Fetus lacks P450 aromatase, 3ßhyrdroxsteroid DH

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5
Q

Amniotic fluid secretion

A

Necessary for pulmonary and MSK fxn

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6
Q

Oligohydramnios

A

Rupture of membranes
GU congenital abnormalities
Nephrotoxic drugs (ACEI, NSAID)
Poor placental perfusion (maternal cardio dz)

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7
Q

Trophoblast invasion

A

Initially: syncytiotrophoblasts
Interstital: cytotrophoblasts (all endo and 1/3 myo)
Endovascular: cytotrophoblasts into spiral arteries, change pressure profile

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8
Q

hCG functions

A

Marker of pregnancy (peak around 10)
Decline due to increased release of progesterone
Regulates trophoblast differentiation to syncytio/cyto

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9
Q

hCG functions

A

Marker of pregnancy (peak around 10)
Responsible for morning sickness
Decline due to increased release of progesterone
Regulates trophoblast differentiation to syncytio/cyto
Elevated in pregnancies with trisomy 21

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10
Q

human Placental Lactogen

A

Produced by sCTB
Shifts maternal system towards fatty acid metabolism
Leaves carbs available for fetus
Creates insulin resistance (gestational diabetes)

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11
Q

Placental Growth Hormone

A

Similar to pituitary GH

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12
Q

Clinical implications of IgG transport

A

Rh attack of fetus
IgG to flu (maternal flu vaccine)
IgG to Tdap
Maternal autoimmune disease

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13
Q

Polyhydramnios

A 
Neural tube defects, esophageal atresia
Gestational diabetes (esp. uncontrolled)
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14
Q

ßhCG producing syndromes

A

Pregnancy
Ectopic
Trophoblastic dz (very high levels, >100,000 at 6wks)

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15
Q

Discriminatory zone

A

Correlate US findings with hCG levels
5-6 weeks = 1,500
7 weeks = 4,000

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16
Q

Ectopic pregnancy risk factors

A 
Most common: PID
Endometriosis
Surgical adhesions (tubes or appendectomy)
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17
Q

Gestational Trophoblastic Disease

A

Benign or malignant
Form from cells that would have become placenta
High ßhCG

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18
Q

Molar pregnancy

A

Mom DNA -> embryonic
Dad DNA -> placental
Too much Dad -> molar pregnancies
Complete mole: diandric diploid: 46XX or XY
1 sperm + empty egg = XX, 2 sperm = XX or XY
Partial mole: diandric triplpoid: 69XXY
2 sperm + 1 egg

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19
Q

Complete mole on ultrasound and characteristics

A

Snowstorm appearance
Cystic space with NO fetal parts, grape like vesicles
No mom DNA = no fetus, lots of dad = placental
Hydropic villi
Diffuse, circumferential proliferation around hydropic villli
Increased risk of recurrent/invasive GTD
Increased risk of choriocarcinoma
Tx: curettage
Therefore intense follow up: monitoring ßhCG levels, must be on contraception (MTX if detected)

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20
Q

Partial mole on ultrasound and characteristics

A 
Fetal tissue present
Some villi hydropic, some normal/fibrotic
Villious inclusions
Focal proliferation around villi
Minimal risk for choriocarcinoma
21
Q

Gestational choriocarcinoma

A

Derived from placental tissue
Preceded by complete mole>partial mole>nml preg
Widely metastatic (usually lung), invade blood vessels
Biphasic (synctio/cyto) with hem/nec
NO chorionic vili
Responds well to chemo (high rate)

22
Q

Placental Site Trophoblast Tumor

A

Neo prolif of extravillous trophoblast (not synctio/cyto)

Sheets/chords of trophoblasts b/t muscle fibers

23
Q

Umbilical cord insertions

A 
Eccentric (normal, on fetal side)
Marginal insertion (on edge, fully covered)
Velamentous (on edge, exposed for some length -> at risk for intermittent hypoxia)
24
Q

Cord size/weight

A 
>75cm = long
Higher risk for knots, nuchal cord, etc
<30cm = short
Associated with decreased fetal movement/neuro problems
<10th%ile in weight = fetal problems
Too heavy = material diabetes
25
Q

Cord infections

A 
Candida (yellow spots, with hyphae)
Necrotising funisitis (barber shop pole)
26
Q

Membrane insertion

A 
Normal = margin of disc
Circumvallete insertion - less room to move
Fetus papyraceus (disappearing twin)
27
Q

Listeria infection

A

Acute, abcess formation in placental parenchyma

28
Q

Categories of placental injury

A

Inflammatory (actue chorioamnionitis, chronic villitis, deciduitis)
Fetal vascular supply (maldevelopment, obstruction, rupture)
Maternal vascular supply (maldevelopment, obstruction, rupture)

29
Q

Acute chorioamnionitis

A

25% live births, 75% premies
Infection in chorion, PMNs in fetal membranes (G.B.S)
Ascending infection - related to PROM

30
Q

Chronic villitis

A 
ToRCHeS (transplacental, hematogenous)
Toxoplasma
Rubella
CMV
HSV/HIV
Syphilis
31
Q

Villitis of unknown etiology

A

Partial autoimmune attack by maternal lymphs
High recurrence risk
2/3 IUFD

32
Q

Fetal vascular supply problems

A 
Meconium (never normal <36 GA, toxic to smooth muscle)
Intervillious thrombi (laminated appearance, KB test)
33
Q

Kleihauer-Betke test

A

Quantification of fetal RBC in maternal circulation

Bad if >20% of fetoplacental volume

34
Q

Maternal vascular supply problems

A

Placental infarct
Collapse of villi
<10% - no effect
15-20% has effects on fetus

35
Q

Placenta accreta

A

Implant of placenta in myometrium
Heavy bleeding
Prior C-section is predisposing factor
Often = hysterectomy

36
Q

Placenta increta vs. percreta

A

INVADE myometrium

PENETRATE serosa

37
Q

Placenta previa

A

Cover os
3rd trimester bleeding
Indication for C-section

38
Q

Preeclampsia: def and risk factors and tx

A

Hypertension, proteinuria, edema >20 GA
Risk factors: FHx, pre-existing dz, previous pre-e preg
No trophoblastic remodeling of vessles (higher pressure, thick walled)
Tx: Deliver

39
Q

Preeclampsia: fetal sequale

A

Still birth risk
IUGR + premature birth
Hypoxia, neuro injury
CAD/CVA risk as adults

40
Q

Preeclampsia: maternal sequale

A

Abruption, DIC, stroke
Chronic HTN
Organ failure: liver, kidney, pulm edema

41
Q

Abruptio placenta

A

Separation of placenta from decidua prior to delivery
Still birth
3rd bleeding, fetal insufficiency

42
Q

Spontaneous abortion

A

Miscarrage before 20 weeks

1st: chr abnmlaties
2nd: structural, placental, infection
3rd: placental

43
Q

IUGR: symmetric vs asymmetric

A

Sym: genetic
Asym: macrocephaly, oligohydramnios (poor kidney development)

44
Q

Monosomy X

A

Turner’s syndrome

Often 1st SAB

45
Q

Trisomy 21

A 
SGA
Round/flat face with palpebral fissures
Transverse palmar crease
Heart (ASD), GI abnmlities
Pancreatic, bone marrow fibrosis (ALL risk)
46
Q

Trisomy 13

A 
Pateau
SGA
Polydactly, facial defects
Cutis aplasia
Heart/brain defects
Pancreato-splenic fusion
47
Q

Trisomy 18

A 
Edwards
SGA
Rocker bottom feet
Renal fusion
Omphalocele
48
Q

Triplody

A 
69 XXX or XXY
Diandric (mole)
Digynic (non-molar)
Incompatable with life
Severe IUGR
Syndactly
49
Q

Fetal hydrops

A

Immune: Rh reactions (20%)

Non-immune: infectous (80%)

Life Cycle (21 decks)

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