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Pathology > Placenta > Flashcards

Placenta Flashcards

1
Q

what is the gross appearance of normal mature placenta?

A

single, round to ovoid, disk-shaped organ w/o an accessory lobe

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2
Q

what are the main components of placenta?

A

umbilical cord
membranes (amnion & chorion)
villous parenchyma
maternal decidual tissues

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3
Q

what are the 2 placenta surfaces and its gross appearance?

A
  • fetal surface = bluish gray, shiny, and translucent w/ no opacity or usual discoloration
  • maternal surface = dark red, divided into cotyledons w/ no missing cotyledons
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4
Q

how many blood vessels are in the umbilical cord?

A

2 arteries
1 vein

w/o true knot, hemorrhage or thrombosis

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5
Q

what is the gross appearance of amnion & chorion membranes?

A

gray, shiny and translucent

absence of inflammation in the membranes or green meconium staining

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6
Q

what part of the placenta makes up the bulk of the whole structure?

A

villous parenchyma

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7
Q

what are the 2 types of trophoblast cells?

A

Synctiotrophoblast cells = outer layer
Cytotrophoblast cells = inner layer

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8
Q

what is the histo appearance of villi of the placenta during the 1st trim?

A

relatively large w/ few stromal BVs

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9
Q

whta is the histo appearance of villi of the placenta during the midtrimester?

A

villi becomes smaller and cytotrophoblasts become less evident

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10
Q

what is the histo appearnce of villi during term?

A

placental villi becomes smaller with abundant stromal capillaries
Trophoblast lining appears flat
Synctiotrophoblast = prominent synctial knots

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11
Q

What are the diff lesions of the villous parenchyma?

A

Hydropic placenta
Placental infarcts

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12
Q

Wht are the characteristicsof hydropic placenta?

A

Extreme pallor due to fetal anemia
Villous edema
Immature chorionic villi
Large and thick placentas with coarse cotyledons and villous structures

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13
Q

What is the gross & histo morphology of hydropic placenta?

A

GROSS
- enlarged & pale placenta due to edema & anemia
- placental weight is greater than expected

HISTO
- chorionic villi shows diffuse enlargement w/ villous stromal edema
- INC # of Hofbauer cells, nucleated RBCs

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14
Q

What are placental macrophages?

A

Hofbauer cells

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15
Q

What do placental infarcts represent?

A

Area of villous coagulative necrosis

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16
Q

What are affected of placental infarcts?

A
  1. Ischemia in the placental parenchyma
  2. Intrauterine growth retardation
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17
Q

Where are placental infarcts located, color in the early andlate stage?

A

Location: maternal placental surface, square shaped
Color:
- Early, recent/acute infarcts: dark red hemorrhagic or dark brown due to deposit

  • Late, old infarcts: pale & anemic due to deposits of scar & fibrou tissue
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18
Q

What is the histo appearance of placental infarcts?

A

Ghost outlines of dead, necrotic chorionic villi (coagulative necrosis)

Early infarcts: villous congesion & collapse w/ loss of intervillous space

Late infarcts: fibrin deposition in intervillous space

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19
Q

What are the most common sites of placental implantation?

A

Uterine fundus
Anterior wall & posterior wall

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20
Q

Where are the diff abnormal implantation?

A

Ectopic pregnancy
Placenta previa
Placecnta accreta

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21
Q

What are the 2 hormones responsible for implantation of the endometrium?

A

Estrogen & Progesterone

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22
Q

Where are the normal sites of placental attachment?

A
  • placenta is attached to uterine corpus superolateraly
  • Decidua basalis between placenta proper & uterine endometrium
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23
Q

What causes placenta accreta?

A

Scarring, infection or instrumentation —> placenta attached to the myometrium w/o intervening decidualized endometrium —> deficient decidualization @ implantation site

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24
Q

What is the effect of placenta accreta during labor>

A

Inability of placenta to normally be spontaneously be separated during 3rd phase of normal delivery

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25
Q

What are the 3 types of placenta accreta?

A
  1. Placenta Accreta vera = most common
    • villi implants on myometrial surface w/o intervening decidua
  2. Placenta Increta
    - penetration of villou tissue into parts of the myometrium or villi extend into the myometrium
  3. Placenta percreta
    • villi penetrate the entire myometrial thickness and through the uterine serosa
26
Q

Where is the location of placenta accreta?

A

Uterus
Lower uterine segment
Cervix

27
Q

What are complications from placenta accreta & tx?

A

Life threatining postpartum hemorrhage
Uterine atony
Massive peripartum hemorrhage

Tx: removal of uterus

28
Q

What are the gross appearance of placenta increta & placenta percreta

A

Placenta Increta
- demo directly infiltrating the myometrium w/o intervening decidual plate

Placenta percreta
- placenta invaded the full thickness of the lower myometrial wall, penetrating the seros

29
Q

What is the microscopic appeearance of placenta accreta?

A

Chorionic interdifitate directly with the uterine myometrium w/o an intervening decidual plate

30
Q

Where is placenta implanted in Placenta previa?

A

Lower uterine segment, partially/completely occluding the internal os

31
Q

What is the presentation of Placenta previa?

A

Painless vaginal bleeding in the 2nd to 3rd trimester of pregnancy

32
Q

What are risk factors of devling placenta previa?

A

Multiparity
Myoma
Cesarean section - main
Advanced maternal age - main

33
Q

What are causes of placenta previa?

A
  • surgery,trauma/scar
34
Q

Wht are complications of placenta previa?

A

Fetal malpresentation
Premature rupture of the membranes

35
Q

When do you grade placentas?

A

When placental implantation is low in the uterus

36
Q

What re the gradings & locations of placenta?

A

Grrade I (Lateral placenta) = placenta implanted on LUS
Grade II (Marginal placenta) = edge of plaenta reaches internal Os
GradeIII (partial placenta previa) = low lying placenta partially covers the internal os
Grade IV (complete placenta previa) = low lying placenta COMPLETELY covers the internal os; CS

37
Q

What is the early sepration or premature separation of the placenta?

A

Abruptio placenta

38
Q

What are risk factors of Abruptio placenta?

A

Smoking
Cocaine use
Maternal age >35yo
HTN
Placental abruption in a prior pregnancy

39
Q

What are conditions that could be associated with abruptio placenta?

A

Multiple gestation pregnnacies
Polyhydrdamnios
Preeclampsia
Sudden uterine decompression
Short umbilical cord
Traums to abdomen

40
Q

What causes abruptio placenta?

A

Compromise of the vascular structure resulting in tearing of vascular networks

41
Q

What is a severe form of concealed abruptio placenta?

A

Couvelaire uterus (uterine placental apoplexy)

42
Q

What are the manifesations of preeclampasia & eclampsia?

A

HTN, edema, and proteinuria

43
Q

What is the HELLP syndrome that forms complications of preeclampsia & eclampsia?

A

Micorangiopathic Hemolytic Anemia
Elevated Liver enzymes
Low platelet

44
Q

What are aberrations of preeclampsia & eclampsia?

A
  1. Abnromal placental vasculature
    2, Endonthelkial dysfunction & imabalce of angiogenic and antiangiogenic factors
  2. Endothelial dysf and imabalnce of angiogenic and antiangiogenic factors
  3. Coagulation abnormalities
45
Q

What enzyme is INC in preeclampsia?

A

Endoglin

SFitL (soluble FMS-like tyrosine kinase

46
Q

What are the common sites of coagulation abnormaltiies in preecmplasmia?

A

Liver
Kidneys
Brain
Pitutiary glnad

47
Q

What is the histo apperance of plaenta in toxemia of pregnancy?

A
  • Acute atherosis of uterine vessels
  • clear foam cells in intmia portion of arteries
  • fibrinoid necrosis of the vessel wall & subendothelial macrophages
48
Q

What is benign lobular of blood vessels in the placenta?

A

Chorangioma aka Hemangioma of the placenta

49
Q

What is the microscopic appearnce of chorangioma?

A

Proliferation of small/medium sized vessels aside from the synctiotohphoblasts layer acros sits surface

50
Q

What are the possible routes of placental infections?

A

Ascending infection via birth canal
Hematogenous/transplacental

51
Q

What is itnervillositis, Perivillositis, & Villitis?

A

Villitis = inflammation within the placental chorionic villi; inflammation of the placental parenchyma

Perivillositis = inflammation surrounding the chorionic villi & reflect maternal septicemia

Intervillositis = inflammation involves the intervillous space, ascending infections

52
Q

what are causes of placental intervillositis, villitis, & perivillositis?

A

E. coli, L. monocytogenes, Campylobacter, & Chlamydia spp.
CMV
Rubella or Toxoplasmosis (unuasual)

53
Q

what is seen in CMV caused placental intervillositis villitis?

A

intravenous plasma cells & hemosiderin

54
Q

what are diff abnormal placental shapes & lobes?

A

mature bilobate placenta
accessory lobe or succenturiate lobe
circummarginate & circumvallate placentas

55
Q

what is a diffuse thin placenta without free membranes?

A

placenta membranacea

56
Q

what are clin significance of Bilobate placenta?

A

multiparity
adv maternal age
infertility
presence of placena previa
excessive placental adhesions
first trimester bleeding

57
Q

what abnormal placental shape has bilobate placenta resulting from uterine sulcal implantation?

A

mature bilobate placenta

58
Q

what abnormal placental shape is formed if some of the capsular villus tissue fails to atrophy during devt?

A

accessory lobe or succenturiate lobe

59
Q

accessory lobe/succemnnturiate lobes can often come what?

A

ifnarcted or fibrinous

60
Q

what are clin signficance of accessory/succenturiate lobe?

A
  1. trauma to the vessel can produce fatal hemorrhage
  2. thromotic and thrombo-embolic events
  3. retained palcenta after the delivery
  4. greater assoc of accessory lobe w/ placenta previa
  5. INC tendency for placental infarction
61
Q

what are features of normal umbilical cord?

A
  • pearly white color
  • inserted in a central or paracentral position
  • whartons jelly
62
Q

what are the BVs in whartons jelly?

A

2 arteries = carry deoxygenated blood from baby to the placenta
1 vein = carries the oxygenated blood from placenta to baby

Pathology (8 decks)

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