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Ob/Gyne 2 > Module 16 : Placenta Pathology > Flashcards

Module 16 : Placenta Pathology Flashcards

1
Q

what are the grades of the placenta

A
  • 0, I, II, III
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2
Q

what is a grade 0 placenta

A
  • homogeneous
  • chorionic plate is straight
  • < 18 weeks
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3
Q

what is a grade I placenta

A
  • scattered echogenic areas
  • subtle undulations
  • 18-22 weeks
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4
Q

what is a grade II placenta

A
  • indentations
  • linear echogenic area
  • 22-36 weeks
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5
Q

what is a grade III placenta

A
  • indentations to basal layer
  • cystic areas
  • shadowing calcs
  • > 36 weeks
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6
Q

what measurement is considered placentomegaly

A
  • > 4cm thick
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7
Q

what was the aetiology of placentomegaly

A
  • maternal diabetes
  • maternal anemia
  • hydrops
  • placental hemorrhage
  • intrauterine infection
  • partial mole
  • chromosomal abnormalities
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8
Q

what does the thickness of the placenta depend on

A
  • gestational age
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9
Q

what does a thin placenta usually result in

A
  • placental insufficiency

- may cause IUGR

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10
Q

what are the 2 etiologys of thin placenta

A
  • vascular deficiencies or infarct

- pre eclampsia - toxaemia of late pregnancy

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11
Q

do intraplacental lesions have any clinical significance

A
  • no
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12
Q

what is a maternal lake

A
  • subchorionic fibrin deposition

- right along placental edge on baby side

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13
Q

what is a placental lake

A
  • perivilus fibrin deposit

- on maternal side

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14
Q

what are the 4 intraplacental lesions

A
  • maternal lake
  • placental lake
  • intervillous thrombosis
  • septal cysts
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15
Q

what are the characteristics of placental infarcts

A
  • microscopic triangular shaped lesions on maternal side of placenta
  • due to obstruction of maternal blood flow
  • > 10% extensive
  • not seen with ultrasound
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16
Q

where do most placenta look like they are in the 1st and early second trimester

A
  • low
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17
Q

what other factor can make the placenta look like

A
  • bladder distended
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18
Q

what are the characteristics of placental previa

A
  • low lying

- marginal or partial or complete

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19
Q

what is the clinical history of placenta previa

A
  • painless vaginal bleeding
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20
Q

what are the characteristics of low lying placenta

A
  • < 2cm from internal os but not overlaying it
21
Q

what is partial placenta previa

A
  • placenta touches the internal os
22
Q

what is complete placenta previa

A
  • placenta completely covers the internal os
23
Q

what are some factors to take into account when assessing for placenta previa

A
  • empty bladder some if fully distended
  • if cervix looks longer than 4cm empty bladder
  • assess for uterine contraction cervix area
24
Q

is the placenta is < 2cm away from internal os at 18 weeks scan what is done

A
  • if still same after post void
  • patient returns in a few weeks
  • EV of the cervix with color doppler is performed at 24-28 weeks (look for vaso previa)
  • patient will continue to return every 2 weeks until placenta moves away
25
Q

protocol for EV with placenta previa

A
  • use condom or on latex probe cover
  • experience
  • no bleeding for 24 hours
  • insert under visualization
  • no or ver little pressure against cervix
26
Q

what are the 3 types of placental shape

A
  • succenturiate
  • extrachorial
  • membranacea
27
Q

characteristics of succentruriate placenta -

A
  • accessory lobe
  • separate piece of placenta connected to main placenta via vessels within membrane
  • increased risk of retained products
  • could have vasoprevia
28
Q

characteristics of extrachorial placenta

A
  • chorionic plate does not extend to edge of placenta
  • chorionic membrane extends over placenta
  • circummarginate
  • circumvallate
  • may cause antepartum hemorrhage
29
Q

what is a circummarginate placenta

A
  • a flat ring at attachment to chorionic plate
30
Q

what is a circumvallate placenta

A
  • fold in membrane at site of attachment
31
Q

what is a synechie (amniotic sheet) placenta

A
  • are of scarring in endo does not stretch like rest of uterus
  • leave appearance of membrane that just ends
  • can see fetal parts on both side of membrane but fetus not attached to it
32
Q

characteristics of placenta membranacea

A
  • entire uterine surface is covered with placenta

- failure of smooth chorion to compress and become chorionic membrane in embryology

33
Q

what are the 2 variations in cord insertion

A
  • battledore

- velamentous insertion

34
Q

what is a battledore cord insertion

A
  • marginal cord insertion

- cord < 2cm from placental edge

35
Q

what is a velamentous insertion

A
  • cord inserting into the chorionic membrane and then vessels track to placenta
36
Q

what is vasa previa

A
  • fetal vessels across internal os
37
Q

what are the 2 common locations of placental hemorrhage

A
  • marginal

- retroplacental

38
Q

what’re the 3 different formations of placental abruption

A
  • external bleeding no hematoma
  • retroplacental hematoma whiteout external bleeding
  • subchorionic hematoma with or without bleeding
39
Q

what may cause a placental abruption

A
  • trauma
  • short umbilical cord
  • PIH
  • maternal vascular disease
  • maternal smoking and or drug usage
  • fibroids
40
Q

what are the symptoms of placental abruptions

A
  • preterm labor contractions
  • bleeding
  • pain
  • fetal distress
41
Q

what is the sonographic appearance of placental abruption

A
  • sonolucent or complex mass beneath placenta or beneath chorionic membrane
42
Q

what are the 2 tumors of the placenta

A
  • teratoma = rare germ cell tumor
  • chorioangioma = vascular well defined complex mass
  • mets
43
Q

what is is placenta Creta and what are the 3 types

A
  • when the placenta does not attach properly to basalts but rather invades beyond the basalis
  • accreta
  • increta
  • percreta
44
Q

what is accreta

A
  • attaches to myometrium
45
Q

what is increta

A
  • invades myometrium
46
Q

what is percreta

A
  • invades through perimetrium and even beyond
47
Q

what are some characteristics of placenta accreta

A
  • increase risk of bleeding post part
  • increase risk after c section because of scar
  • may result in hysterectomy
  • extremely dangerous for mother
48
Q

what is the diagnosis of acreta

A
  • very difficult on ultrasound
  • only anterior placentas
  • absent or severely thinned myometrium
  • extension to adjacent organs
  • color doppler
49
Q

what are the common risks with placenta accreta

A
  • placenta previa

- prior c section

Ob/Gyne 2 (19 decks)

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