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OBGYN Pathology > Placenta > Flashcards

Placenta Flashcards

1
Q

What is it called when the placenta completely or partially covers the internal os?

A

Placenta previa

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2
Q

Classifications of Previa

A

Complete
Partial
Marginal

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3
Q

What is considered a low lying placenta?

A

Less than 2 cm from internal os after 32 weeks

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4
Q

Risk factors for previa

A 
Multigravida/multiparous 
Prior c-section
Hx of therapeutic abortion
Advanced maternal age
Closely spaced pregnancies
Abnormal fetal position 
Maternal anemia
Hx of uterine leiomyomatas or infections
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5
Q

Which approach is most accurate for diagnosing placenta previa?

A

Endovaginal

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6
Q

How would you measure to check for previa or low lying placenta?

A

From lowest edge of placenta to center of internal cervical os

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7
Q

What do you call an abnormal placental attachment to the myometrium that doesn’t separate after delivery?

A

Placenta accreta

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8
Q

Classifications of placental attachment

A

Accreta
Increta
Percreta

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9
Q

Which is the least invasive form of placental attachment?

A

Accreta

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10
Q

When the villa penetrate the ___________ but not the myometrium it is considered accreta.

A

Decidua

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11
Q

Increta is:

A

When the villi penetrate/invade myometrium but not serosa

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12
Q

What is percreta?

A

Villi penetrate through myometrium and serosa and may attach to adjacent organs

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13
Q

Risk factors for placenta accreta

A

Previa
Prior c section
Prior uterine surgery
Advanced maternal age.

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14
Q

When the placenta does not separate from the uterus during delivery it results in:

A

Massive hemorrhage

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15
Q

Undiagnosed increta and percreta are associated with:

A

High maternal mortality.

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16
Q

Sonographic evaluation of placenta accreta

A

Absent, thin, or irregular myometrial interface.

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17
Q

What may Color Doppler demonstrate with placenta accreta?

A

Increased periplacental vascularity

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18
Q

What is a succenturiate placenta?

A

Accessory lobe(s) connected to main placenta by blood vessels

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19
Q

Succenturiate placenta can cause a higher incidence of:

A

Eccentric cord insertion, which increases risk of vasa previa
And of placental infarction

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20
Q

Sonographic findings of succenturiate placenta

A

Two separate areas of placental tissue without obvious connection

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21
Q

What use does color Doppler have when assessing a succenturiate placenta?

A

Helps identify connecting vessels between lobes

Can identify vasa previa in LUS and cervical os

22
Q

What is a circumvallate placenta?

A

Has a raised or rolled edge that may involve all or part of placental circumference
An abnormal attachment of placental membranes to fetal placental surface

23
Q

What is a circummarginate placenta?

A

Abnormal attachment of placental membranes into fetal placental surface with a flat or smooth membrane transition

24
Q

What occurs with circumvallate/circummarginate placentas?

A

Basal plate area is larger than fetal surface

25
Q

What risks are there with complete circumvallation?

A 
Bleeding
Low birth weight/IUGR
Premature rupture of membranes 
Premature labor
Placental abruption
Fetal anomalies
26
Q

What will you see Sonographically with a circumvallate placenta?

A

An elevated and thickened placental edge

27
Q

Types of abnormal cord insertions

A

Battledore

Velamentous

28
Q

What else is a battledore placenta called?

A

Marginal cord

29
Q

What is a battledore placenta?

A

Eccentric cord attachment at placental margin
Gives placenta a paddle appearance
Associated with IUGR

30
Q

What is a velamentous cord insertion?

A

Cord not inserted into placental disk, inserted into free membranes
Cord not protected by Wharton’s jelly and is easily damaged

31
Q

What risks are associated with velamentous cord insertion?

A 
Vasa previa
IUGR
Prematurity
Fetal anomalies
Retained placenta 
Fetal bleeding
32
Q

What is a chorioangioma?

A

The most common benign tumor of placenta that arises from chorionic tissue

33
Q

Most chorioangiomas are small and don’t cause problems. When they get larger than ________ they can cause fetal and maternal complications

A

5 cm

34
Q

What complications are associated with large chorioangiomas?

A 
Polyhydramnios
Hydrops
Fetal cardiomegaly
IUGR
Preterm labor
Preeclampsia
Elevated maternal serum alpha-fetoprotein
35
Q

Describe a chorioangioma sonographically.

A 
Well circumscribed
Round
Hypoechoic-mixed echogenic
Solid 
Usually near cord insertion site
Just below chorionic plate 
Moderate vascularity
36
Q

What are some cystic lesions seen with placentas?

A

Placental lakes
Perivillous fibrin deposits
Hemangioma
Teratoma

37
Q

What is an intervillous thrombus?

A

Coagulated blood in intervillous space

38
Q

When would an intervillous thrombus be significant?

A

If found in first trimester
If large
If numerous

39
Q

What is a perivillous fibrin deposit?

A

Triangular or rectangular hypoechoic areas under fetal surface of placenta.
No clinical significance

40
Q

What is placental abruption?

A

Premature separation of placenta from endometrial surface

Disrupts placental and maternal circulation

41
Q

Placental abruption is one of the leading causes of :

A

Perinatal mortality

42
Q

Types of abruption

A

Retroplacental and marginal

43
Q

What occurs with retroplacental abruption?

A

Spiral arteries rupture and cause retroplacental hemorrhage

44
Q

Is retroplacental abruption a high pressure or low pressure bleed?

A

High pressure

45
Q

What is the most risky form of abruption?

A

Retroplacental

46
Q

Sonographic sensitivity for retroplacental abruption?

A

50%

47
Q

Marginal abruption is the:

A

Most common form of abruption

48
Q

What occurs with marginal abruption?

A

Edge of placenta separates from the uterus

49
Q

Is marginal abruption a high pressure bleed or a low pressure bleed?

A

Low pressure from rupture/tear of marginal veins

50
Q

What is marginal abruption AKA?

A

Subchorionic hematoma

OBGYN Pathology (10 decks)

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